Purpose
Osteochondral injuries have proven difficult to treat. Several treatments are available, but no gold standard treatment exists. Our group presented the short-term data on Autologous Dual-Tissue Transplantation (ADTT) in 2015. ADTT is a one-step, combined autologous bone and articular cartilage chips transplantation. The aim of this study was to investigate the long-term results using MRI, CT and subjective and functional clinical outcome scores.
Methods
Eight patients (age 32 ± 7.5 years) suffering from osteochondritis dissecans in the knee were included. The lesion was debrided, and the osteochondral defect was filled with autologous bone, to a level at the base of the adjacent cartilage. Cartilage from the intercondylar notch was chipped using a scalpel and embedded in fibrin glue in the defect. Radiologic evaluation was performed using MRI and CT preoperatively, at one and at 7.5 years, and patient reported outcome scores were used to assess subjective and functional clinical outcome preoperatively and at one, two, five and 7.5 years (IKDC, KOOS and Tegner activity score).
Results
The preoperative IKDC score increased from 35.9 to 68.1, 73.0, 75.3 and 72.9 after one, two, five and 7.5 years (p<0.01). The Tegner score improved from 2.5 to 4.7, 4.8, 4.8 and 4.6 at one, two, five and 7.5 years (p<0.001). All KOOS subscores improved at one year and the improvements persisted at two, five and 7.5 years (p<0.01).
Cartilage tissue repair evaluated using MOCART score improved from 22.5 to 53.1 at one year (p<0.01), with a slight deterioration to 44.3 after 7.5 years (not statistically significant). CT imaging demonstrated good subchondral bone healing at one year, with an average bone defect filling of 80%. At 7.5 years CT showed an improvement in all patients with an average bone filling of 90% and a more even surface than at one year.
Conclusion
ADTT resulted in good subchondral bone restoration and cartilage repair. Significant improvements in patient reported outcome was found at one year postoperative and the improvements persisted at two, five and 7.5 years. This study suggests ADTT as a promising, low-cost, treatment for osteochondral injuries.