Technical aspects of osteochondral autograft transplantation

Osteochondral autograft transplantation is a well-established technique in the treatment of chondral and osteochondral defects. Cylindrical osteochondral plugs are harvested from areas of the articular surface with a lesser weight-bearing role and transferred to areas of osteochondral damage. Using a press-fit technique, the plugs are inserted to replace damaged or missing articular cartilage and to supply the chondral lesion with islands of viable and immediately functional hyaline cartilage. The presence of focal unipolar cartilage defects in the knee measuring 1 to 4 cm2 is a current indication for osteochondral autograft transplantation. Excellent success also has been achieved with the use of this technique for fixation of lesions in patients with osteochondritis dissecans. Osteochondral autograft transplantation is a technically demanding but relatively inexpensive procedure that requires a single operation. Published results are favorable compared with those of other treatment techniques. However, optimal results depend on the location of the lesion, careful adherence to patient selection criteria, and the use of proper surgical techniques. Basic science research enables the continued refinement of surgical techniques and directs future advances in treatment augmentation.