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Autologous Osteochondral Transplantation to Treat Patellar Chondral Injuries
Diego Costa Astur1, Guilherme Conforto Gracitelli1, Gustavo Gonçalves Arliani1
1Orthopaedic and Traumatology Department, Universidade Federal de São Paulo, Rua Borges Lagoa 783, 5° andar, Vila Clementino, São Paulo, Brazil 03840-032. E-mail address for D.C. Astur: mcastur@yahoo.com. E-mail address for G.C. Gracitelli: ggracitelli@gmail.com. E-mail address for G.G. Arliani: ggarliani@hotmail.com. E-mail address for N. Astur: nelsonan@yahoo.com. E-mail address for C.C. Kaleka: camilacohen@kaleka.com.br. E-mail address for A. Pochini: apochini@uol.com.br. E-mail address for M. Cohen: m.cohen@uol.com.br.
Introduction:
Autologous osteochondral transplantation for the treatment of patellar chondral injuries is a single-stage procedure through a single surgical approach that allows replacement of the chondral injury with an osteochondral plug that has the same cartilaginous hyaline characteristics as the site had before the injury.
Step 1 Preoperative Planning:
Make radiographs (anteroposterior, lateral, and Merchant patellofemoral views), computed tomography scans, and magnetic resonance imaging (MRI) of the knee for an anatomic study and to determine cartilage lesion details.
Step 2 Perform Knee Arthroscopy And Lesion Identification:
Classify and locate the cartilage lesion on the basis of the intraoperative arthroscopic knee evaluation.
Step 3 Use A Parapatellar Approach:
Perform a parapatellar incision and patellar eversion as they are necessary to access cartilage lesions.
Step 4 Harvest The Osteochondral Plug At The Donation Site:
Harvest an appropriate osteochondral graft, which is essential for a successful procedure. Perpendicular graft harvesting is crucial for a perfect cartilage surface match.
Step 5 Characterize And Prepare The Lesion:
At this point, prepare the receptor area with a power drill.
Step 6 Insert The Osteochondral Plug Into The Receptor Site:
Insert the graft with press-fit fixation.
Step 7 Postoperative Care:
Instruct all patients to follow a rehabilitation protocol.
Results:
Our clinical experience with this procedure has corresponded to the scores and MRI-based findings in our original study, in which we prospectively evaluated thirty-three knees in patients who underwent autologous osteochondral transplantation for a symptomatic full-thickness cartilaginous injury on the patellar articular surface.IndicationsContraindicationsPitfalls & Challenges.
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