Large osteochondral defects of the femoral condyle: press-fit transplantation of the posterior femoral condyle (MEGA-OATS)

Abstract

Background and aims: Large osteochondral defects in the weight-bearing zone of the knee remain a challenging therapeutic problem. Surgical options include drilling, microfracturing, and transplantation of osteochondral plugs but are often insufficient for the treatment of large defects of the femoral condyle.

Patients and methods: Large osteochondral defects of the femoral condyle (mean defect size 7.2 cm(2) range 3-20) were treated by transplantation of the autologous posterior femoral condyle. Between 1984 and 2000, 29 patients were operated on: in 22 the medial, in 6 the lateral femoral condyle, and in one the trochlear groove was grafted. Thirteen patients underwent simultaneous high tibial valgus osteotomy. In the first series (1984-1999) the graft was temporarily fixed with a screw ( n=12), but from 1999 we used a newly developed press-fit technique ( n=17) avoiding screw fixation of the graft. The operative technique comprising graft harvest, defect preparation, transplantation, and fixation is described. Patients were clinically evaluated using the Lysholm score, and magnetic resonance imaging with intravenous contrast was performed 6 and 12 weeks after surgery (mean follow-up 17.7 months (range 3-46).

Results: Pain and swelling were reduced in 26 patients. Three patients of the first series reported persistent problems and were subjectively not satisfied. The mean Lysholm score rose from preoperatively 52 to 77 points after 3 months, 74 after 6, 88 after 12, and 95 after 18. Magnetic resonance imaging showed good graft viability in all cases. We saw one arthrofibrosis after 6 months but noted no problems related to the loss of the missing posterior condyle.

Conclusion: Large osteochondral defects of the femoral condyle can be treated by transplantation of the autologous posterior femoral condyle. The use of only one osteochondral piece renders better approximation of the femoral cartilage curvature and thus joint congruence than in mosaic plasty. However, whether loss of the posterior condyle has a long-term negative impact on the knee joint remains to be elucidated.