Anterior cruciate reconstruction combined with autologous osteochondral transplantation

The purpose of this prospective study was to evaluate the results of simultaneous anterior cruciate ligament (ACL) reconstruction and osteochondral autograft transplantation performed in patients suffering an anterior instability associated with symptomatic full-thickness cartilage defects. Our clinical report includes the first 21 patients (six women, 15 men) who have been followed up for 32 months or longer. The average patient age was 29 years (range 22-44 years), and mean time from injury to the combined reconstructive surgery was 10 months (range 4-27 months). The cartilage defects had a mean area of 3.5 cm2 (range 2.0-5.0 cm2). All patients were evaluated according to the IKDC, Lysholm and Tegner scoring scales by an independent observer. A visual analogue scale (VAS) reflecting patient pain was evaluated. Assessment using the IKDC knee scoring scale revealed 81% of the patients with a normal or nearly normal knee joint. There was a significant improvement in subjective discomfort, and the KT-1000 arthrometric evaluation showed a reduction of the ventral tibial translation (5.9 to 1.9 mm). All but two patients had returned to full activities without restriction and were asymptomatic. The results of this study suggest that symptomatic full-thickness articular cartilage defects associated with ACL instability can be effectively treated by performing ACL reconstruction and osteochondral autologous grafts in one procedure. However, only the years which follow will show the long-term outcome of the patients.