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. 2022 Jul-Sep;13(3):19476035221102571.
doi: 10.1177/19476035221102571.

Sandwich Technique for Large Osteochondral Lesions of the Knee

C Holwein  1   2 , P M Jungmann  3 , J Suchowierski  2 , A S Gersing  4   5 , K Wörtler  4 , P U Brucker  6   7 , P Angele  8   9 , A B Imhoff  2 , S Vogt  10
Affiliations

Sandwich Technique for Large Osteochondral Lesions of the Knee

C Holwein et al. Cartilage. 2022 Jul-Sep.

Abstract

Objective: To evaluate whether a sandwich technique procedure for large osteochondral lesions (OCL) of the medial femur condyle reduces clinical symptoms and improves activity level as well as to assess repair tissue integration on MRI over 2 years.

Design: Twenty-one patients (median age: 29 years, 18-44 years) who received matrix-associated autologous chondrocyte transplantation (MACT) combined with cancellous bone grafting at the medial femur condyle in a 1-step procedure were prospectively included. Patients were evaluated before surgery (baseline) as well as 3, 6, 12, and 24 months postoperatively, including clinical evaluation, Lysholm score, Tegner Activity Rating Scale, and MRI with Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score and a modified Whole-Organ Magnetic Resonance Imaging Score (WORMS).

Results: Seventeen patients were available for the 24-month (final) follow-up (4 dropouts). Lysholm significantly improved from 48 preoperatively stepwise to 95 at final follow-up (P < 0.05). Tegner improvement from 2.5 at baseline to 4.0 at final follow-up was not significant (P = 1.0). MOCART score improved significantly and stepwise from 65 at 3 months to 90 at 24 months (P < 0.05). Total WORMS improved from 14.5 at surgery to 7.0 after 24 months (P < 0.05). Body mass index and defect size at surgery correlated with total WORMS at final follow-up (P < 0.05) but did not correlate with clinical scores or defect filling.

Conclusion: MACT combined with cancellous bone grafting at the medial femoral condyle reduces symptoms continuously over 2 years. A 1-step procedure may reduce perioperative morbidity. However, despite improvements, patients' activity levels remain low, even 2 years after surgery.

Keywords: MACT; autologous chondrocyte; bone grafting; cartilage transplantation; grafts; joint involved; knee.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Image 1.
Image 1.
Surgical technique: arthrotomy for exploration of OCL (A), defect debridement (B), defect filling with impacted cancellous bone (C), covering with chondrocyte matrix (D).
Figure 1.
Figure 1.
Flexion deficit.
Figure 2.
Figure 2.
Extension deficit.
Figure 3.
Figure 3.
Swelling.
Figure 4.
Figure 4.
Effusion.
Figure 5.
Figure 5.
Lysholm score over the course of time. OP = time at surgery.
Figure 6.
Figure 6.
Tegner activity rating scale over the course of time. OP = time at surgery.
Image 2.
Image 2.
Magnetic resonance imaging of ID 18 with final magnetic resonance observation of cartilage repair tissue of 65.
Image 3.
Image 3.
Magnetic resonance imaging of ID 9 with final magnetic resonance observation of cartilage repair tissue of 95.
Figure 7.
Figure 7.
Significant differences of MOCART during follow-up. MOCART = Magnetic Resonance Observation of Cartilage Repair Tissue.
Figure 8.
Figure 8.
Significant differences of WORMS during follow-up. WORMS = Whole-Organ Magnetic Resonance Imaging Score.
Figure 9.
Figure 9.
Lysholm, MOCART, and total WORMS over the course of time. MOCART = Magnetic Resonance Observation of Cartilage Repair Tissue; WORMS = Whole-Organ Magnetic Resonance Imaging Score; OP = time at surgery.
See this image and copyright information in PMC

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