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Der autologe Transfer der posterioren Femurkondyle bei ausgedehnten osteochondralen Schäden des Knies

5-Jahres-Ergebnisse der Mega-OATS-Technik

Autologous transfer of the posterior femoral condyle for large osteochondral lesions of the knee

5-year results of the Mega-OATS technique

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Zusammenfassung

Hintergrund

Bei jungen und aktiven Patienten mit großen osteochondralen Defekten in der femoralen Belastungszone wurde ein autologer Transfer der posterioren Femurkondyle durchgeführt. Diese Technik dient als Salvageoperation, um den Patienten wieder eine angemessene Mobilität zu ermöglichen.

Material und Methode

Zwischen 07/1999 und 12/2000 wurden 18 Patienten operiert; 16 Patienten wurden unter Verwendung des Lysholm-Scores nachuntersucht. Es wurden Röntgenaufnahmen und von 8 Patienten zusätzlich Magnetresonanztomographien (MRT) angefertigt. Das Patientenalter zum Zeitpunkt der Operation betrug durchschnittlich 37,4 (15–59) Jahre, das Follow-up 55,2 (46–62) Monate. Der Defekt maß im Durchschnitt 5,4 (3,1–7,1) cm2 und war zu 81% Folge eines Traumas oder einer Osteochondrosis dissecans.

Ergebnisse

Der Lysholm-Score verbesserte sich signifikant (p=0,001) von median 65 auf postoperativ 86 Punkte; 15 Patienten waren wieder in der Lage Sport auszuüben. Bei 12 Patienten zeigte sich eine Abrundung der Osteotomiekante und bei 11 eine knochendichte Auffüllung des Entnahmebereichs. Alle MRT-Aufnahmen zeigten einen vitalen und kongruenten Zylinder.

Schlussfolgerung

Damit ist das Verfahren sehr gut geeignet, um große und tiefgehende fokale osteochondrale Defekte in der femoralen Belastungszone zu decken.

Abstract

Background

Large osteochondral defects of the weight-bearing zones of the femoral condyles in young and active patients were treated by autologous transfer of the posterior femoral condyle. This technique is a salvage procedure and aims at pain-free mobility of patients.

Material and methods

Between July 1999 and December 2000, 18 patients were operated on. Sixteen patients were evaluated using the Lysholm score. X-rays were done, and eight individuals underwent magnetic resonance imaging (MRI) analysis. The average age at the date of surgery was 37.4 (15–59) years, and the mean follow-up time was 55.2 (46–62) months. The mean defect size was 5.4 cm² (3.1–7.1). Trauma or osteochondrosis dissecans was pathogenetic in 81%.

Results

The Lysholm score showed a significant (p=0.001) increase from a preoperative median of 65.0 to a postoperative median of 86.0 points. Fifteen patients returned to sport activities. X-rays showed a rounding of the osteotomy edge in 12 patients and a partial bone-dense remodelling of the posterior femoral condyle in 11 patients. All MRI examinations showed vital and congruent grafts.

Conclusion

Thus, the procedure is recommended for treating large and deep focal osteochondral lesions in the weight-bearing zone of the femoral condyle.

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Authors and Affiliations

  1. Abteilung für Sportorthopädie, KlinikumRechts der Isar, Technische Universität München, Connollystraße 32, 80809, München, Deutschland

    P. Minzlaff & A.B. Imhoff

  2. Department für Orthopädie und Traumatologie, Universitätsklinikum Freiburg, Freiburg, Deutschland

    S. Braun

  3. Institut für Medizinische Statistik und Epidemiologie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland

    B. Haller

  4. Abteilung für Radiologie, Technische Universität München, München, Deutschland

    K. Wörtler

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  1. P. Minzlaff
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  2. S. Braun
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  3. B. Haller
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  4. K. Wörtler
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  5. A.B. Imhoff
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Correspondence to P. Minzlaff.

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Minzlaff, P., Braun, S., Haller, B. et al. Der autologe Transfer der posterioren Femurkondyle bei ausgedehnten osteochondralen Schäden des Knies. Orthopäde 39, 631–636 (2010). https://doi.org/10.1007/s00132-010-1608-2

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