Osteoperiosteal Cylindrical Iliac Bone Graft and Minced Cartilage as an Osteochondral Autograft for a Large Osteochondral Lesion

Abstract

Mosaicplasty is a relatively challenging procedure used in the management of focal osteochondral lesions of the joints. Donor-site morbidity is still the main concern after mosaicplasty because it entails the harvesting of an osteochondral autograft from an otherwise healthy region to be impacted later on the weight-bearing damaged site. We describe a possible alternative to conventional mosaicplasty with subchondral bone support harvested from the iliac crest as an osteoperiosteal autograft and covered with a minced cartilage layer.

Fig 1

(A) Osteochondral lesion on the medial femoral condyle of the right knee as viewed from the anterolateral portal. The lesion’s margins are debrided with a curette (arrows) from the anteromedial portal. (B) Healthy cartilage tissue is harvested from the non–weight-bearing area of the lateral condyle (arrow) with a shaver inserted from the anterolateral portal. (C) The harvested tissue is collected with an external graft harvester. (D) The harvested tissue is separated (arrow) for subsequent use.

Fig 2

A bone marrow aspiration needle is inserted on the ipsilateral iliac crest (A, arrow) (left side, patient supine, left cephalad), and 60 mL of bone marrow is aspirated and then concentrated into bone marrow aspirate concentrate (B).

Fig 3

(A) At the same spot of aspiration, a small incision is performed and the iliac crest’s bone (arrow) is exposed (patient supine, left iliac crest, right cephalad). (B, C) By use of an autologous osteochondral graft harvester (arrow), 2 cylindrical osteoperiosteal autografts (arrows) with a length of at least 15 mm are obtained and stored for later use.

Fig 4

On the side table, the harvested healthy chondral tissue (A, arrow), the preoperatively prepared conditioned serum (B), and the bone marrow aspirate concentrate (C) are injected into the Thrombinator system (D, arrow) and are shaken together (arrows) to obtain a homogeneous mixture (E).

Fig 5

(A) The ultimate mixture from the Thrombinator system is further mixed with the double-syringe system (arrow) until a putty solution of minced cartilage is obtained. (B) The previously obtained autologous osteoperiosteal grafts are impacted into the previously drilled medial femoral condyle (arrows) (left flexed knee, medial parapatellar incision, superior cephalad). (C) The minced cartilage obtained from the double-syringe system is spread over the damaged area. (D) The surface is flattened and contoured accordingly (arrows). After a minimum of 5 minutes, the knee is first mobilized and then closed in standard fashion.