Osteochondral Problems of the Knee

Transcription

1 Arthroscopy: The Journal of Arthroscopic & Related Surgery Online October 1999, Supplement 1 Volume 15 Number 7 << Back to topic list Abstracts Previous article in Issue Next article in Issue Drug links from Mosby's DrugConsult Genetic information from OMIM These are the abstracts of the papers presented at the Second Biennial Meeting of The International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine, Washington, DC, May 29- June 3, Antegrade Drilling for Osteochondritis Dissecans of the Medial Condyle of the Knee: Report of 25 Knees. Philippe Beaufifs Stephane Louisia Mous Katabi Henry Robert Purpose: Anterograde drilling for osteochondritis dissecans (ocd) has been proposed in the early stages of the disease. The purpose of this study was to report our results with a long follow-up and to define the indications. Materials and Methods: 24 patients (25 medial condyles) were reviewed for this multicentric study. The grade of ocd was evaluated according to Bedouelle's radiologic classification. The size of the lesions was evaluated on X rays by multiplying width by length, by height. The lesion of the articular cartilage was defined according to Guhl's classification. The average age of the patients was 16.1 yrs http~//~ww2~us~e~sevierhea~th~c~rn/inst~serve?~chdb&gr~up~ste~ch~ndra~+pr~b~ems+~f+the+knee (1 of 10) [12/13/ :44:06 PM]

2 Arthroscopy: The Journal oi: Arthroscopic & Related Surgery Online (11 to 29). There were 17 JOCD(open physes) and 8 AOCD(closed physes). The average duration of symptoms before surgery was 26 months. The average size of the JOCD was 6048 vs 6490 (mm3) for AOCD. Among JOCD there were 6 grade la, 5 Ib, 6 Ila vs 3 Ib, 4 Ila, 1 lib among AOCD. The articular cartilage was grade 1 for JOCD and grade 2 for 1/17 vs grade 1 for 6/8 and grade 2 for 2/8 among AOCD. Antegrade drilling was performed under arthrotomy (8 25) or arthroscopy (17/25). Post operatively, the patients were begun on early active range of motion and no weight bearing for 2 months. The average follow-up was: 10 yrs (3 to 26). The assessment after surgery was based on clinical examination and X-rays (AP, lateral and tunnel radiographs). We used the clinical criteria of the Hughston rating scale (<<Clinic Hughston>>). Results: JOCD scored excellent with the 'Clinic Hughston', 3/17 good, 1/17 fair and 1/17 poor. 12/17 JOCD had a normal X-rays or a healed lesion, 2/17 were grade la, 1/17 Ib and 2/17 Ila. 3/17 had decreased and 2/17 had increased the size of their lesion. 3 required additional surgery 7/8 AOCD scored good with the 'Hughston clinic', 1/8 poor. 2/8 had a healed lesion on the X-rays 1/8 was grade la, 3/8 Ib, 1/8 Ila and 1/8 III. 5/8 had decreased, 3/8 increased the size of their lesion. 2/8 required additional surgery. Conclusions: The duration of symptoms before surgery suggests that antegrade drilling improves the healing of lesions that didn't heal with conservative treatment. The figures are consistent with the literature and suggest that the healing potential of JOCD is much higher than AOCD for the same grade of lesion. This low morbidity procedure is mainly indicated in case of symptomatic JOCD with normal articular cartilage after failure of conservative treatment. 82. Osteochondral Autograft for Treatment of Osteochondritis Dissecans of the Knee. Carlo FabbricianL M.D. Giuseppe Milano, M.D. Andrea Manunta, M.D. Alfredo S. PannL M.D. Purpose: The aim of this study was to evaluate the results of osteochondral autograft for treatment of osteochondritis dissecans of the knee. Methods: Between 1982 and 1992 we treated surgically 16 patients (12 males and 4 females) affected by osteochondritis dissecans of the knee. Age ranged between 17 and 24 years (average: 19.6 years). Osteochondral lesion was localized on the medial femoral condyle in 14 cases and on the lateral femoral condyle in 2 cases. None patient had a history of trauma or previous osteochondral injury to the affected knee. Clinical diagnosis was confirmed with radiographical and bone scan examination. In all cases an open osteochondral autograft was performed. The size of the lesion varied from 12 mm to 17 mm. Osteochondral fragment appeared partially detached in 6 cases and completely detached in 10 cases. After removing the fragment, the lesion was debrided with a bur and multiple drillings were performed into the defect. A single osteochondral graft, about 1 cm thick, has been harvested from the not weight-bearing area of the lateral femoral condyle (trochlear region) with a Cloward drill. The graft has been positioned into the defect and fixed with fibrin glue. Continuous passive motion of the knee started the day after surgery. Partial weight bearing was allowed after 3 weeks and complete weight bearing after 8 weeks. Long-term follow-up ranged between 7 and 15 years (average: 10.5 years). Osteochondral + Problems +of+the + Knee (2 of 10) [12/13/ :44:06 PM]

3 Arthroscopy: The Journal oi: Arthroscopic & Related Surgery Online Clinical results have been evaluated using the Lysholm II score and compared with preoperative values. Radiographical evaluation (antero-posterior, lateral and Merchant's view) and magnetic resonance of the knee at follow-up was performed in all cases, in order to evaluate the healing of the graft and degenerative changes of the patello-femoral joint at the harvest site. Moreover, in 4 cases we performed a second-look arthroscopy at months after surgery. Results: We did not observe any aintraoperative or postoperative complication. At follow-up the activity level was unchanged in 10 patients and decreased in 4 cases respect to that prior injury. Two patients did not return to sports activity. Range of motion evaluation showed a loss of flexion of 10 degrees respect to the contralateral knee in 3 cases. Lysholm II score at follow-up had a mean value of 93.6 compared to 64.8 mean score observed at the preoperative evaluation. Results were excellent in 8 cases, good in 6 cases and fair in 2 cases. Patellar crepitus was observed in 5 cases but neither anterior knee pain or tenderness at the harvest site was observed in any case. Radiographical and MR evaluation showed a good healing of the graft into the defect. We did not observe degenerative changes either at the graft site or the patello-femoral joint. Second-look arthroscopy showed a preservation of the articular cartilage of the graft. Conclusions and Significance: Osteochondral autograft seem to be an efficient technique to treat a massive osteochondral defect of the knee as it permits to fill the area of the defect with a viable tissue which has the same biological and mechanical properties of the native tissue. In our experience, single massive osteochondral autograft was successful in 87.5% of the cases. However, the success of this technique depends on many factors: precise selection of the cases (massive osteochondral defect in weight-bearing area of the femoral condyle), correct harvest technique (thickness of the graft no less than 1 cm) and choice of the harvest site, and good fit of the graft into the defect. 83. Treatment of Full Thickness Chondral Defects of the Knee With Autologous Chondrocyte Implantation. Scott D. Gillogly, M.D. Objective: Large focal full thickness articular defects in the knee have presented a continued challenge to Orthopedists with no traditional treatment method providing consistent acceptable long term clinical results. In contrast to marrow stimulation techniques which populate the defect with pluripotential stem cells, the use of cultured autologous chondrocytes fills the defect with cells of a committed pathway to develop hyaline like cartilage. The purpose of this study is to evaluate the clinical effectiveness of using cultured autologous chondrocytes in treatment of large focal chondral defects of the knee. Methods: Sixty five full thickness articular cartilage defects in fifty one knees were treated with autologous cultured chondrocytes placed under a sutured periosteal patch. The indications for this procedure were the presence of a focal defect(s) of the femur or patella in symptomatic patients with recurrent effusion, joint pain, and giving way without significant osteoarthritis. Adequate or obtainable alignment and stability were also prerequisites. Patients were evaluated pre-operatively and at 6, 12, 24, and 36 months postoperatively using the modified Cincinnati and Knee Society clinical rating systems. Results: The patients ranged in age from 14 to 52 years. The average size of the chondral lesions Osteochondral + Problems +of+the + Knee (3 of 10) [12/13/ :44:06 PM]

4 Arthroscopy: The Journal oi: Arthroscopic & Related Surgery Online was 5.74 cm 2. The sites of the lesions included 32 medial femoral condyle, 14 lateral femoral condyle, 11 femoral trochlea, 7 patella and one tibia. Eight of the femoral condyle defects were osteochondritis dissecans. Thirty seven patients (73%) had undergone 62 prior surgical procedures to include chondroplasty, abrasion arthroplasty, drilling or microfracture techniques without clinical benefit. Twenty six patients underwent concomitant procedures at the time of the implantation for ACL reconstruction (8), anteromedialization of tibial tubercle (16), HTO (3), meniscal transplant (1). In 34 patients with minimum one year follow-up (range 12 to 36 mos)the modified Cincinnati rating system showed that average clinician and patient evaluations of overall knee scores significantly improved from baseline of 3.3 and 3.2 respectively to 6.8 and 6.7 at one year (p<.001) and 8.8 and 8.4 at two years postoperatively (p<.001). There was a statistically significant improvement in clinician evaluation between one and two year follow-up for 15 patients (p<.01). Patient reported pain improved from 3.9 to 7.8 at one year and 9.4 at two year follow-up and swelling improved from 4.25 to 8.1 at one year and 9.7 at two years (all p<.001 ). The sports score which takes into account not only level of sports activity but also frequency and duration of activity significantly improved from a preoperative score of 38 to 65 at one year and 87 at two years (both p<.001). The Knee Society clinical rating system also showed statistically significant improvement from a pre-op score of 67 to 88 at one year (p<.001) and 97 at two years (p<.001). One patient underwent debridement of graft hypertrophy at 6 mos. and 3 patients undergoing concomitant procedures required arthroscopic lysis of adhesions for decreased motion within the first 6 mos. post-operatively. Conclusion and Significance: Overall, 30 of 34 patients (88%) were improved and returned to increased levels of function and sports participation at 12 to 36 mos follow-up. The results of this study support the published efficacy and safety of this procedure in treatment of large focal chondral defects of the femur and patella and osteochondritis dissecans of the femur with autologous chondrocyte implantation. 84. Articular Cartilage Paste Grafting to Arthritic and Traumatic Joint Lesions: Two to Seven Year Follow Up. Kevin R. Stone, M.D. Ann Walgenbach, R. N, N P., M. S. N. Carmen L. Carrouche, R. N, M.S.N. Purpose: This prospective study presents the results of a two to seven year follow up of 39 patients receiving an articular cartilage paste from November 1991 through June Method: The surgical technique included producing a paste of articular cartilage and cancellous bone harvested from the intercondylar notch and transplanted to morselized traumatic and arthritic defects. All patients underwent follow up examinations with the longest follow up of 78 months. Nineteen patients have undergone second look arthroscopy with core biopsy for histologic analysis and collagen typing of the grafted defect. Results: Pain scores improved from a grade of 2.5 pre-op to 1.1 post-op on a scale of 0-3 (3 being the worst pain). The surgical appearance of the lesions has been generally smooth with color varying from grayish translucent to normal white. The histologic appearance of the biopsies is consistent with immature hyaline cartilage without fibrocartilage in 8 of 19 biopsies, a mixed hyaline and fibrocartilage Osteochondral + Problems +of+the + Knee (4 of 1 O) [12/13/ :44:06 PM]

5 Arthroscopy: The Journal of Arthroscopic & Related Surgery Online appearance in 7 biopsies, and predominantly fibrocartilage in 3 biopsies to date. Collagen typing has revealed a variable concentration of type I and type II collagen by qualitative gel electrophoresis examination and by immunohistochemical labelling. Conclusion: The mixture of articular cartilage and cancellous bone appears to provide a supportive matrix for cartilage formation. Pain relief is excellent if careful surgical technique and a defined rehabilitation program is followed. Significance: This surgical technique offers an alternative treatment to damaged articular cartilage in the knee. 85. Intraoperative Complications With O.A.T. Ronald A. Navarro, M.D. Objectives: The objectives are to describe an intraoperative complication that has been encountered during the donor harvest step of one commercially available autograft osteochondral transfer system in detail so other surgeons are aware of it and know how to proceed, in case it occurs. Methods: From January of 1997 to April of 1998, a single surgeon used an osteochondral autograft system for treatment of articular lesions in the knee and ankle. The location of the lesion was medial femoral condyle in 6, lateral femoral condyle in 2 and medial talus in 2. The grafts were harvested from the knee (notch in 9 and lateral trochlea in 1). A single core was used to resurface the lesion in 3 cases, 2 cores were used in 6 and 3 cores were used in 1. The 5/6 mm tube harvester set was used 5 times, the 6/7 mm set 7, the 7/8 mm set 2, the 8/9 mm set 1 and the 9/10 mm set 3 times. Results: The operation proceeded uneventfully in eight cases. In two cases, the 7 mm donor tube harvester malfunctioned while notch harvesting was being performed. Both cases involved African- American males. In one case, the tip of the harvester failed and folded in (seen after salvage) so that no graft was harvested, just compacted. When rotation of the harvester was performed, the tube fractured leaving the imbedded harvester material in the notch region. After arthrotomy, the metal was retrieved. A second donor harvest and placement in the recipient site was performed. In the second case, rotation during harvest led to trephine fracture with loss of the metal into the back of the knee. After arthrotomy, it looked as if a usable core remained. A 9 mm harvester was placed over the core and the 7 mm core was successfully retrieved and placed into the recipient site. All patients have regained full range of motion and all are full weight bearing. Preoperative symptoms have abated in all and all would have the surgery again. Discussion: The manufacturer was contacted regarding these instances of tube harvester fracture. The manufacturing process was assessed and incrementally thicker walls were designed in the harvester to guard against fracture. Dense bone exists in the notch region and, in African-American males, this area may be more dense. We now routinely harvest from the lateral trochlear region in this scenario. At early follow-up this procedure shows promise and no other harvester fractures have occurred since the design change was made. Significance: If this complication is encountered, it is hoped that this description will help prepare the surgeon with an appropriate salvage option. Osteochondral + Problems +of+the + Knee (5 of 10) [12/13/ :44:06 PM]

6 Arthroscopy: The Journal oi: Arthroscopic & Related Surgery Online 86. Harvesting Techniques for Osteochondral Transplantation. Anthony MiniacL M.D., F.R. C S. (C) Peter Evans, M.D. Mark Hurtig, D. V.M. Purpose: The success of resurfacing osteochondral defects by use of osteochondral dowels may depend upon the method of graft harvesting which this study investigates. The purpose of this study was to look at power trephination versus manual punch technique to determine chondrocyte viability of the cartilage plugs. Harvesting of osteochondral grafts by the use of a power trephine as opposed to a manual punch causes significantly greater chondrocyte death and may impact the ultimate function of the resurfaced area. One needs to be very careful in the harvest of osteochondral defects by the use of osteochondral dowels and it appears that the mechanism of plug harvest is important to the survival of chondrocytes. Osteochondral transplantation for resurfacing discrete chondral and osteochondral defects is being utilized clinically with increasing prevalence. The method of graft harvesting may have a significant impact on outcome at both the donor and recipient site. Power versus manual osteochondral harvesting techniques were assessed in an ovinemodel. Method: Power (P) trephine versus manual (M) punch harvesting of 2.7 mm and 4.5 mm dowels were harvested from eight femoral trochlea from four sheep utilizing the Acufex MosaicPlasty system. Grafts were harvested perpendicular to the articular surface to a depth of 10 mm under constant saline irrigation. Power trephine grafts (n=46, 2.7P, n-45, 4.5P) were harvested by a trephine with a serrated cutting surface driven by a standard AO drill. Manual punch grafts (N=41,2.7M, n=33, 4.5M) were harvested by malleting the punch to the required depth, minimizing rocking and only slightly turning the punch upon removal. Five 40 mm thick cartilage sections were cut from each dowel with a vibratome perpendicular to the articular surface. Sections were stained with Syto 13 and ethidium bromide (EthBr) vital stains. The total number of membrane-intact (Syto 13 +) and membrane-damaged (EthBr +) chondrocytes were counted over 3-4 fields per section sampling both central and peripheral aspects of each graft. Data was expressed as the % live cells per field. Results: Chondrocyte viability was significantly greater for manual versus power harvesting of both sizes of grafts (p<0.005). Chondrocyte viability was significantly greater for 4.5P versus 2.7P grafts (p=0.005), but no difference was found between the 2.7M and 4.5M (p-0.357). Discussion: Harvesting of osteochondral grafts by the use of a power trephine as opposed to a manual punch causes significantly greater chondrocyte death and may impact the ultimate function of the resurfaced area. 87. Cartilaginous Defects of the KneemA New Osteochondral Autogenous Graft From the Upper Tibio-Peroneal Joint. Espregueira Mendes, M.D., Ph.D. J. M. Lopes, M.D., Ph.D. Osteochondral + Problems +of+the + Knee (6 of 10) [12/13/ :44:06 PM]

7 Arthroscopy: The Journal of Arthroscopic & Related Surgery Online T. Cabral, M.D., Ph.D. A. Monteiro, M.D. Purpose: In this study we used a new osteochondral autogenous graft from the upper tibio-peroneal joint (GUT) to reconstruct the cartilaginous lesions of the knee surface. Anatomic Study: We dissected 20 knee joint in fresh cadaver models to study the upper tibioperoneal joint. In those we evaluated the shape and measures of the tibial and peroneal cartilage surface. According to the shape we propose the division of the upper tibio-peroneal in two types: Type I (Plane) and Type II (Shaped in L). Patients and Methods: From 1989 to 1998, 13 knees with extensive cartilage lesion of the knee, after the closure of the growth plates, in weight bearing surface, were treated with an autogenous osteocartilaginous graft from the upper tibio-peroneal joint. There were 8 patients with osteochondritis dissecans (IV) and 5 traumatic cartilaginous lesion. They were selected after MRI/CT scan and diagnostic arthroscopy. The mean age was 31 years (17-45), the mean time between the onset of symptoms and operation was 16 months (1 to 44) and in 10 knees (77%) was related to trauma. We studied the type of lesion, location and extention. Most were situated in the weight bearing femoral condyle surface and the mean size was 14mm x 10 mm. Innicialy the graft was collected with an open incision and since 1997 percutaneously. In 9 patients we used an open procedure and in 4 patients the percutaneous technique. We developed instruments to collect symmetric osteocartilaginous cylinders (2 each time with 4mm of diameter) from the lateral side (peroneal) to medial (tibial). Results: The preliminary results were very successfully. We noted an incorporation of the graft after 6 months of surgery and patients did not report pain at the donor zone. This new osteocartilaginous graft causes no morbidity to the donor zone with normal joint mobility. IKDC score showed 9 patients classed A, 3 B and 1 C. Conclusion: GUT appears to be a satisfactory procedure to treat cartilage defects in young patients. Significance: We show the simplicity, no morbidity of the donor zone, good results and the good quality of the osteochondral autogenous graft from the upper tibio-peroneal joint. 88. Stability of Press-Fit Implanted Osteochondral Grafts: Influence of Graft Size, Harvesting Technique and Mode of Insertion. Jochen Duchow, M.D. Thomas Hess, M.D., Ph.D. Dieter Kohn, M.D., Ph.D. Purpose: To evaluate the primary stability of press-fit inserted osteochondral grafts depending on size, harvesting- and insertion technique. Methods: In a biomechanical model using the OsteochondraI-Autograft-Transfer-System (OATS, Arthrex Co.) on pig femora we tested transplant pull-out strength (Group I: donor diameters 8mm and 1 lmm, n=12; Group I1: donor depth 10mm, 15mm and 20mm, n=12; Group II1: repeated pull-out of Osteochondral + Problems +of+the + Knee (7 of 10) [12/13/ :44:06 PM]

8 Arthroscopy: The Journal oi: Arthroscopic & Related Surgery Online graft after reinsertion, n=12; Group IV: harvesting with and without levering, n=8). T-Test for unpaired samples was used for statistical analysis. Results: Pull-out strength of 11 mm diameter grafts was higher than that of 8mm grafts (mean 92N vs. 41 N; p=0.05). With increasing depth of grafts (10mm vs. 20mm) pull-out strength rose significantly (mean 40,3N vs. 121 N; p=0.05). When the graft was pulled out repeatedly after reinsertion, stability decreased significantly (mean 85N vs. 43N vs 32N; p=0.001). As levering is sometimes necessary to detach grafts, we compared pull-out strength according to the modus of graft harvesting. Here, levering of the 8mm donor-tube instead of simple turning significantly reduced pull-out strength (mean 29N vs. 52N; p=0.05). Conclusion: Our data indicate, that primary stability of press-fit implanted osteochondral grafts depends on the size of grafts chosen, and is significantly reduced whenever harvesting conditions are not optimal, especially if levering is necessary for detachment. Significance: Knowledge of factors contributing to the stability of osteochondral grafts will improve operative technique and clinical outcome. 89. Early Experience With Autologous Chondrocyte Implantation: A Preliminary Report. Jason L. Koh, M.D. Robert Buly, M.D. Russell F. Warren, M.D. Steven Haas, M.D. Introduction: Autologous chondrocyte implantation is a new treatment for cartilage defects. We report on the early experience of three surgeons at our institution with autologous chondrocyte implantation in the knee. Materials and Methods: Patients were selected for autologous chondrocyte transplantation based on size and location of chondrocyte defects. All data was prospectively gathered. Cartilage was arthroscopically harvested from minimally weight-bearing areas of the knee. Biopsy tissue was purified and chondrocytes grown in vitro. Autologous chondrocytes were reimplanted via arthrotomy and covered with periosteal flaps. Rehabilitation consisted of non-weightbearing and CPM for 6 weeks, followed by careful advancement of weightbearing. 14 patients underwent harvest and transplantation. Average age was 35.4 years. 10 were male, 4 female. 4 were manual laborers. Pain was severe in 11, moderate in 2, and mild in 1, with rest pain in 11 patients. 13 experienced "swelling" in the knee and 8 had effusions on presentation. All experienced limitation of activities, and only one was able to participate in sports. 13 had previous surgery on the affected knee, primarily arthroscopic debridement or menisectomy. 2 had ACL reconstructions. Five had drilling, picking, or abrasionplasty. One had mosaicplasty. Average size of defect was 19 x 13 mm (range, 8x8 to 37x30). Location of defect was medial femoral condyle in 8, trochlea in 5, and patella in 1. All patients had normal alignment and stable ligamentous exam. No patient had patellar maltracking. Four patients had additional pathology, consisting of chondromalacia of the patella in 2, patellar exostosis in 1, and thinning of the cartilage on the lateral femoral condyle in one. No patient had extensive degenerative disease. All lesions were isolated and well defined. Clinical rating by surgeons averaged 3.1/10 (worst possible score 0). Results: 14 patients were available for an average months follow-up (range, 7 to 22). Pain was Osteochondral + Problems +of+the + Knee (8 of 10) [12/13/ :44:06 PM]

9 Arthroscopy: The Journal of Arthroscopic & Related Surgery Online improved in seven patients. Three experienced improvement of activity by one level. Three patients had worsened activity levels. Seven patients required 10 subsequent reoperations. These operations included arthroscopy in 6, manipulation under anesthesia in 1, partial lateral patellectomy in one, and a high tibial osteotomy in one. Other complications included hematoma requiring aspiration (1). Length of stay was 1-3 days. MRI findings demonstrated extensive fat pad scarring in 8 patients. Five of six patients who underwent arthroscopy demonstrated partial or complete filling of defects with cartilage; one had thickened periosteal tissue in the defect. Four demonstrated separation at the edge of the lesion. Five patients had periosteal thickening or hypertrophy at the margin of the graft that was debrided. Fibrosis or retinacular tightening was found in 6 patients. Overall clinical evaluation rating by surgeons averaged 4.75/10. Eight patients improved by surgeon's evaluation, six decreased. Discussion: Early results of autologous chondrocyte transplantation at our institution are mixed. Certain patients appear to have responded well to treatment and are satisfied with their result. However, a significant number have required further operative treatment. All patients with follow-up MRIs have demonstrated significant fat pad scarring. Several patients have had patello-femoral joint problems requiring arthroscopic or open release. Arthrofibrosis causing limitation of range of motion has also been seen. The Genzyme data collection instrument does not specifically address patellofemoral joint pathology except patellar tracking, and adverse affects may be underreported. We remain cautious about the extensive use of this procedure. 90. Osteoarticular Resurfacing of the Distal Femur Utilizing Cryopreserved AIIograft. Stephen W. Munns, M.D. W. Daniel Bradley, M.D. Purpose: This study retrospectively reviews our results treating full thickness articular cartilage defects cryopreserved osteoarticular allografts inserted press-fit with the Garrett technique and instrumentation. Methods: Eleven knees in ten patients with distal femoral osteochondral lesions were treated with press-fit cryopreserved osteoarticular allografts, 9 medial and 2 lateral femoral condyles. Mean followup was 43.8 months, range 12 to 94 months. Five patients had additional procedures performed at the time of transplant (2 meniscus transplants, 3 high tibial osteotomies). Follow-up included physical examination, radiographs, and completion of a Cincinnati Knee Rating Form. Nine of eleven knees were evaluated post-operatively with a second-look arthroscopy. Results: There were no rejections. All patients reported improvement in symptoms post-operatively. Nine of eleven patients demonstrated either improvement or no change in joint space on radiographs. All grafts completely incorporated. Despite symptomatic improvement in all patients, none returned to pre-injury level of activity. Post-operative arthroscopic evaluation revealed an intact cartilage surface covering all allograft surfaces, but with consistent Noyes 2A changes covering the majority of surfaces. Two patients, both undergoing simultaneous lateral condyle resurfacing and lateral meniscus transplant, showed progressive degenerative changes. Conclusions: This procedure produced symptomatic improvement in all and radiographic Osteochondral + Problems +of+the + Knee (9 of 10) [12/13/ :44:06 PM]

10 Arthroscopy: The Journal of Arthroscopic & Related Surgery Online improvement/stability in nine of eleven patients at intermediate (43.8 month average) follow-up. Significance: This study demonstrates consistent success in improving symptoms/quality of life in patients treated with cryopreserved osteoarticular allografts for osteoarticular defects of the femoral condyles, comparable to other current autogenous techniques. Osteochondral + Problems +of+the + Knee (10 of 10) [12/13/ : 44:06 PM]