Treatment of deep hyalin cartilage defects with autologous perichondrial grafts.

Bruns J, Steinhagen J.

Dept. of Orthopaedic Surgery, School of Medicine, University of Hamburg, Germany.

Perichondrial transplantation was performed in 29 patients suffering from a deep chondral lesion with different etiologies. Only those patients with a cartilage lesion in the knee joint were included. Patients were initially and postoperatively examined using the Lysholm- and HSS-Score. In most of the patients (20/29) trauma and the recurrence of osteochondrosis dissecans (6/29) were the cause of the cartilage lesion. Most often the medial femoral condyle (19/29) and, secondly, the lateral femoral condyle (5/29) were involved. In six patients additional therapeutic measures (ACL-plasty, n = 2; high tibial osteotomy because of varus mal-alignment, n = 4) had to be adopted. Follow-up examination was possible in 26/29 patients after a minimum postoperative period of 12 months. All patients exhibited a distinct and significant increase in both the Lysholm and the HSS-score. A follow-up after a minimum of 24 months was possible in 13/29 patients. Even these patients exhibited a distinct and significant improvement. Multiple follow-up examinations in 9/29 patients demonstrated maintenance of the first postoperative results obtained after one postoperative year for a maximum of 49 months in most of the patients. Only in one female patient, implantation of a semi-constrained total knee replacement was necessary because of osteoarthrosis resulting from crystal arthropathy (chondrocalcinosis). It was possible to obtain biopsies from three patients at the time osteosynthetic material was removed. In all cases hyaline-like cartilage was histologically observed. In the treatment of selected patients suffering from a circumscript cartilaginous lesion resulting from trauma or the recurrence of osteochondritis dissecans with a concomitant cartilage lesion but without major signs of osteoarthritis, perichondrial grafting can achieve acceptable clinical results, after a short follow-up period. In order to achieve satisfying results a good selection of patients and additional treatment of other articular disorders, such as ACL-instability or axial mal-alignment, is necessary. Further studies have to be undertaken to evaluate the durability of these results over a longer period of time to see if osteoarthrosis can be avoided.