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Autologous Osteochondral Transplantation for Treating Patellar Chondral Injuries: Evaluation, Treatment, and Outcomes of a Two-Year Follow-up Study

Astur, Diego Costa MD1; Arliani, Gustavo Gonçalves MD1; Binz, Mario MD1; Astur, Nelson MD1; Kaleka, Camila Cohen MD1; Amaro, Joicemar Tarouco MD1; Pochini, Alberto MD1; Cohen, Moises MD, PhD1

Journal of Bone & Joint Surgery - American Volume: 21 May 2014 - Volume 96 - Issue 10 - p 816–823
doi: 10.2106/JBJS.M.00312
Scientific Articles
Supplementary Content
Disclosures

Background: The patella is the largest human sesamoid bone and often sustains chondral injury. There is no consensus on how to treat a full-thickness, symptomatic articular cartilage injury of the patella. We analyzed the clinical and functional outcomes of patients with symptomatic full-thickness patellar chondral lesions treated with autologous osteochondral transplantation and evaluated osteochondral autograft bone-plug integration through magnetic resonance imaging.

Methods: In this prospective study, thirty-three patients with a symptomatic full-thickness patellar chondral injury surgically treated with autologous osteochondral transplantation were evaluated before and after surgical treatment with a minimum two-year follow-up using the Lysholm, Kujala, and Fulkerson questionnaires and the Short Form-36 health survey score. Magnetic resonance images were made at six and twelve months postoperatively and studies were performed to analyze the osteochondral autograft bone-plug integration.

Results: All thirty-three patients showed a significant improvement in functional scores two years after surgery. The average Lysholm scores were 57.27 points preoperatively and 80.76 points at two years postoperatively, the average Kujala scores were 54.76 points preoperatively and 75.18 points at two years postoperatively, and the Fulkerson average scores were 54.24 points preoperatively and 80.42 points at two years postoperatively. The Short Form-36 life quality score improved significantly. Two years after surgery, all magnetic resonance images showed full bone-plug integration into the patella.

Conclusions: Autologous osteochondral transplantation is a successful technique to surgically treat symptomatic full-thickness patellar articular cartilage injuries smaller than 2.5 cm in diameter. Patients had a significant improvement in clinical scores. Bone-plug integration and surface alignment were demonstrated in all patients two years after surgery.

Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

1Universidade Federal de São Paulo, Rua Borges Lagoa 783, 5° andar, São Paulo, Brazil 03840-032. E-mail address for D.C. Astur: mcastur@yahoo.com

Investigation performed at the Universidade Federal de São Paulo, São Paulo, Brazil

Copyright 2014 by The Journal of Bone and Joint Surgery, Incorporated
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