Osteochondral Allograft Transplant for Combined Medial and Lateral Patellar Cartilage Lesions: The Osteochondral Wide Lesion (OWL) Technique

Abstract

Symptomatic articular cartilage injuries are often seen in young active patients and athletes. Magnetic resonance imaging screening examinations have frequently identified such lesions in athletic patients. Patellofemoral chondral defects were previously identified as the most common knee cartilage lesion in high-level athletes. Chondral defects measuring 2 cm² or greater and complex cartilage defects involving bone loss are ideally replaced with fresh osteochondral allograft. We describe a technique indicated for patients with symptomatic and recurrent anterior knee pain associated with osteochondral patellar defects including the lateral and medial patellar facets. Patients who have undergone previous interventions, including membrane techniques, microfracture, or autologous chondral transplantation, without clinical benefit are also eligible to undergo osteochondral allograft transplantation for combined medial and lateral patellar cartilage lesions, that is, the osteochondral wide lesion (OWL) technique.

Fig 1

(A) Maximum knee flexion at time of surgery of the right knee, with the patient in the supine position. (ROM, range of motion.) (B-E) Femoral allograft prepared for use in osteochondral wide lesion technique.

Fig 2

(A) Magnetic resonance imaging (MRI, axial view) showing osteochondral tear in patellar articular surface. (B, C) Arthroscopic views of chondral tear and bone exposed at osteochondral tear. LAS, left anterior superior; PLS, posterior left superior; RPI, right posterior inferior

Fig 3

(A) After longitudinal arthrotomy has been performed, we use a K-wire as a joystick to facilitate eversion of the articular surface of the patella. (B) The lateral facet of the patella shows a large osteochondral tear, and the medial facet shows a chondral tear. (C) We use a probe to measure the size of the tear.

Fig 4

(A-C) With a guidewire inserted in the center of the tear, we use a 20-mm drill to create the recipient area in the medial and lateral facets.

Fig 5

Anteroposterior view (A) and lateral view (B) of 2 osteochondral plugs of 20 mm in diameter.

Fig 6

(A) Two osteochondral plugs placed in situ. (B, C) Postoperative magnetic resonance imaging (axial view) at 5 months of follow-up.

Fig 7

The final aspect of the osteochondral wide lesion (OWL) technique is very similar to the face of an owl.