Functional outcome of osteochondral autograft is equivalent in stable knee and in anterior cruciate ligament reconstruction

Abstract

Introduction: Anterior cruciate ligament (ACL) tears are associated in 10% to 20% of cases with extensive traumatic focal osteochondral damage. Ligament reconstruction may require osteochondral autograft for symptomatic osteochondral lesions. Combined ACL and chondral or osteochondral reconstruction is poorly evaluated in the literature; osteochondral reconstruction in stable knee better documented. The objective of this study was to compare functional results after osteochondral autograft transfer (OAT) for significant symptomatic femoral condyle defect, in stable or stabilised knees (concomitant ACL reconstruction). The hypothesis was that functional results are equivalent in both groups.

Material & method: This was a single-centre retrospective comparative observational study of patients consecutively operated on between 2000 and 2018. Fifty patients met the inclusion criteria and were divided into two groups: Group 1 (OAT+ACL, n=13) and group 2 (OAT on stable knee, n=37). The following criteria were recorded at follow-up: pain (VAS), KOOS, IKDC and Lysholm scores and Hughston radiologic score, and time to return to sport. Mean follow-up was 79.7±60 months in group 1 and 86.4±62 months in group 2.

Results: Ten patients were included for analysis in group 1 and 30 in group 2. Cartilage lesion size was comparable between groups: 1.6±1.20 cm² for group 1 and 2.3±1.3 cm² for group 2 (ns). One complication (infection with favourable course) was observed in group 2. Sport was resumed at 8.7±2.7 vs. 8.4±3.3 months, respectively. Mean subjective scores were respectively 83.3±7.4 and 75.4±14 for Lysholm, 89.7±7.8 and 89.7±19.6 for KOOS, 78±13.7 and 72.2±12.9 for subjective IKDC, 0.5±0.5 and 0.8±0.9 for pain on VAS and 3 and 3 for radiological Hughston radiologic score, with no significant differences between groups.

Conclusion: Symptomatic focal osteochondral lesions treated by osteochondral autograft transfer gives the same outcome on stable or stabilised knee.

Level of evidence: IV; retrospective study.

Keywords: ACL; Arthroscopy; Femoral condyle; Knee; Mosaicplasty; Osteochondral autograft transfer.