Skip to main content
SpringerLink
Log in

Articular cartilage paste graft for severe osteochondral lesions of the knee: a 10- to 23-year follow-up study

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study is to evaluate the clinical outcomes of the articular cartilage paste graft procedure at a minimum of 10 years from surgery. It is hypothesized that articular cartilage paste grafting can provide patients with a durable repair of severe full-thickness osteochondral injuries, measured by persistence of procedure-induced benefit and subjective outcome scores at 10 or more years.

Methods

Seventy-four patients undergoing paste grafting at a mean age of 45.3 ± 10.8 years (range 13–69 years) were followed up at a mean of 16.8 ± 2.4 years (range 10.6–23.2 years) post-operatively using validated subjective outcome measures; Kaplan–Meier survival analysis was performed to estimate expected population benefit time.

Results

Kaplan–Meier estimated median benefit time of 19.1 years (mean: 16.6 ± 0.9 years) for all patients undergoing paste grafting. Thirty-one (41.9 %) patients had progressed to arthroplasty at a mean of 9.8 ± 5.6 years (range 0.4–20.6 years). Ninety percent of patients reported that the procedure provided good to excellent pain relief. Median IKDC subjective score increased significantly at most recent follow-up (70.1) compared to preoperative (55.7, p = 0.013). Median WOMAC scores decreased significantly from 26 to 14 (p = 0.001). Median Tegner score increase from 4 to 6 was not found to be significant (ns). VAS pain averaged 23/100 at most recent follow-up.

Conclusions

Patients who underwent the paste grafting reported improved pain, function, and activity levels for an expected mean of 16.6 years, and for those who ultimately progressed to knee replacement, surgical treatment including the paste graft was able to delay arthroplasty until a mean age of 60.2 years, an age at which the procedure is commonly performed. Full-thickness articular cartilage loss can be successfully treated, reducing pain, and improving function, using this single-step, inexpensive arthroscopic procedure.

Level of evidence

IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Australian Orthopaedic Association National Joint Replacement Registry (2010) Hip and knee arthroplasty: annual report 2010. Adelaide

  2. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15:1833–1840

    CAS  PubMed  Google Scholar 

  3. Bhumiratana S, Vunjak-Novakovic G (2012) Concise review: personalized human bone grafts for reconstructing head and face. Stem Cells Transl Med 1:64–69

    Article  CAS  PubMed  Google Scholar 

  4. Briggs KK, Steadman JR, Hay CJ, Hines SL (2009) Lysholm score and Tegner activity level in individuals with normal knees. Am J Sports Med 37:898–901

    Article  PubMed  Google Scholar 

  5. Busija L, Bridgett L, Williams SRM, Osborne RH, Buchbinder R, March L, Fransen M (2010) Osteoarthritis. Best Pract Res Clin Rheumatol 24:757–768

    Article  PubMed  Google Scholar 

  6. Carr AJ, Robertsson O, Graves S, Price AJ, Arden NK, Judge A, Beard DJ (2012) Knee replacement. Lancet (London, England) 379:1331–1340

    Article  Google Scholar 

  7. Coathup MJ, Batta V, Pollock RC, Aston WJ, Cannon SR, Skinner JA, Briggs TWR, Unwin PS, Blunn GW (2013) Long-term survival of cemented distal femoral endoprostheses with a hydroxyapatite-coated collar: a histological study and a radiographic follow-up. J Bone Joint Surg Am 95:1569–1575

    Article  PubMed  Google Scholar 

  8. Crawford DC, Heveran CM, Cannon WD, Foo LF, Potter HG (2009) An autologous cartilage tissue implant NeoCart for treatment of grade III chondral injury to the distal femur: prospective clinical safety trial at 2 years. Am J Sports Med 37:1334–1343

    Article  PubMed  Google Scholar 

  9. Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen M, Bridgett L, Williams S, Guillemin F, Hill CL, Laslett LL, Jones G, Cicuttini F, Osborne R, Vos T, Buchbinder R, Woolf A, March L (2014) The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis 73:1323–1330

    Article  PubMed  Google Scholar 

  10. Denard PJ, Jiwani AZ, Lädermann A, Burkhart SS (2012) Long-term outcome of a consecutive series of subscapularis tendon tears repaired arthroscopically. Arthroscopy 28:1587–1591

    Article  PubMed  Google Scholar 

  11. Farr S, Huyer D, Sadoghi P, Kaipel M, Grill F, Ganger R (2014) Prevalence of osteoarthritis and clinical results after the Elmslie-Trillat procedure: a retrospective long-term follow-up. Int Orthop 38:61–66

    Article  PubMed  Google Scholar 

  12. Frisbie DD, Oxford JT, Southwood L, Trotter GW, Rodkey WG, Steadman JR, Goodnight JL, McIlwraith CW (2003) Early events in cartilage repair after subchondral bone microfracture. Clin Orthop Relat Res 407:215–227

    Article  Google Scholar 

  13. Gillogly SD, Arnold RM (2014) Autologous chondrocyte implantation and anteromedialization for isolated patellar articular cartilage lesions: 5- to 11-year follow-up. Am J Sports Med 42:912–920

    Article  PubMed  Google Scholar 

  14. Gobbi A, Karnatzikos G, Kumar A (2014) Long-term results after microfracture treatment for full-thickness knee chondral lesions in athletes. Knee Surg Sports Traumatol Arthrosc 22:1986–1996

    Article  PubMed  Google Scholar 

  15. Hsu LP, Dias LS, Swaroop VT (2013) Long-term retrospective study of patients with idiopathic clubfoot treated with posterior medial-lateral release. J Bone Joint Surg Am 95:e27

    Article  PubMed  Google Scholar 

  16. Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, Neyret P, Richmond JC, Shelborne KD (2001) Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 29:600–613

    Article  CAS  PubMed  Google Scholar 

  17. Jaroszewski J, Kruczyński J, Piontek T, Trzeciak T, Kaszuba B, Lubiatowski P (2003) Value of autologous transplantation of osteo-chondral paste in reconstruction of experimental cartilage defects. Part II. Microscopic analysis of integration with surrounding cartilage, structural integrity and subchondral bone reconstruction in repair tissue. Chir Narzadow Ruchu Ortop Pol 68:335–340

    PubMed  Google Scholar 

  18. Jaroszewski J, Kruczyński J, Piontek T, Trzeciak T, Lubiatowski P (2003) The value of autologous osteochondral paste for in vitro treatment of damage to articular cartilage. Part I. Macroscopic and microscopic assessment of the regenerated articular surface. Chir Narzadow Ruchu Ortop Pol 68:237–241

    PubMed  Google Scholar 

  19. Jaroszewski J, Kruczynski J, Trzeciak T, Lubiatowski P, Kaszuba B (2004) Value of osteo-chondral paste autologous transplantation in experimental cartilage defects reconstruction. Part III—microscopic analysis of reconstructed cartilage thickness and surface regularity. Chir Narzadow Ruchu Ortop Pol 69:35–39

    PubMed  Google Scholar 

  20. Jaroszewski J, Kruczyński J, Trzeciak T, Piontek T, Kaszuba B (2004) Value of osteo-chondral paste autologous transplantation in experimental cartilage defects reconstruction. Part IV—microscopic analysis of cellularity and of traits of necrosis in the defect-filling tissue. Chir Narzadow Ruchu Ortop Pol 69:115–119

    PubMed  Google Scholar 

  21. Kon E, Gobbi A, Filardo G, Delcogliano M, Zaffagnini S, Marcacci M (2009) Arthroscopic second-generation autologous chondrocyte implantation compared with microfracture for chondral lesions of the knee: prospective nonrandomized study at 5 years. Am J Sports Med 37:33–41

    Article  PubMed  Google Scholar 

  22. Kreuz PC, Erggelet C, Steinwachs MR, Krause SJ, Lahm A, Niemeyer P, Ghanem N, Uhl M, Südkamp N (2006) Is microfracture of chondral defects in the knee associated with different results in patients aged 40 years or younger? Arthroscopy 22:1180–1186

    Article  PubMed  Google Scholar 

  23. Li CS, Karlsson J, Winemaker M, Sancheti P, Bhandari M (2014) Orthopedic surgeons feel that there is a treatment gap in management of early OA: international survey. Knee Surg Sports Traumatol Arthrosc 22:363–378

    Article  PubMed  Google Scholar 

  24. London NJ, Miller LE, Block JE (2011) Clinical and economic consequences of the treatment gap in knee osteoarthritis management. Med Hypotheses 76:887–892

    Article  PubMed  Google Scholar 

  25. Mahadev A, Mahara DP, Chang P, Mitra AK, Tay BK, Sim CS (2001) Autogenous osteochondral morselised grafts for full thickness osteochondral defects in the knee joints of pigs. Singap Med J 42:410–416

    CAS  Google Scholar 

  26. Martinčič D, Radosavljevič D, Drobnič M (2014) Ten-year clinical and radiographic outcomes after autologous chondrocyte implantation of femoral condyles. Knee Surg Sports Traumatol Arthrosc 22:1277–1283

    Article  PubMed  Google Scholar 

  27. Marx RE (2004) Platelet-rich plasma: evidence to support its use. J Oral Maxillofac Surg 62:489–496

    Article  PubMed  Google Scholar 

  28. Mithoefer K, McAdams T, Williams RJ, Kreuz PC, Mandelbaum BR (2009) Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: an evidence-based systematic analysis. Am J Sports Med 37:2053–2063

    Article  PubMed  Google Scholar 

  29. Mithoefer K, Williams RJ 3rd, Warren RF, Potter HG, Spock CR, Jones EC, Wickiewicz TL, Marx RG (2006) Chondral resurfacing of articular cartilage defects in the knee with the microfracture technique. Surgical technique. J Bone Joint Surg Am 88(Suppl 1):294–304

    Article  PubMed  Google Scholar 

  30. Mithoefer K, Williams RJ, Warren RF, Potter HG, Spock CR, Jones EC, Wickiewicz TL, Marx RG (2005) The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospective cohort study. J Bone Joint Surg Am 87:1911–1920

    Article  PubMed  Google Scholar 

  31. National Joint Registry for England and Wales (2010) 7th Annual report

  32. Nho SJ, Foo LF, Green DM, Shindle MK, Warren RF, Wickiewicz TL, Potter HG, Williams RJ (2008) Magnetic resonance imaging and clinical evaluation of patellar resurfacing with press-fit osteochondral autograft plugs. Am J Sports Med 36:1101–1109

    Article  PubMed  Google Scholar 

  33. Outerbridge RE (1961) The etiology of chondromalacia patellae. J Bone Joint Surg Br 43-B:752–757

    CAS  PubMed  Google Scholar 

  34. Pelissier A, Boyer P, Boussetta Y, Bierry G, Van Hille W, Hamon P, Jaeger JH, Massin P (2014) Satisfactory long-term MRI after autologous chondrocyte implantation at the knee. Knee Surg Sports Traumatol Arthrosc 22:2007–2012

    Article  CAS  PubMed  Google Scholar 

  35. R Core Team (2016) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna

    Google Scholar 

  36. Steinwachs MR, Guggi T, Kreuz PC (2008) Marrow stimulation techniques. Injury 39(Suppl 1):S26–S31

    Article  PubMed  Google Scholar 

  37. Stone KR, Pelsis JR, Crues JV, Walgenbach AW, Turek TJ (2014) Osteochondral grafting for failed knee osteochondritis dissecans repairs. Knee 21:1145–1150

    Article  PubMed  Google Scholar 

  38. Stone KR, Walgenbach AW (1997) Surgical technique for articular cartilage transplantation to full thickness cartilage defects in the knee joint. Oper Tech Orthop 7:305–311

    Article  Google Scholar 

  39. Stone KR, Walgenbach AW (2003) Meniscal allografting: the three-tunnel technique. Arthroscopy 19:426–430

    Article  PubMed  Google Scholar 

  40. Stone KR, Walgenbach AW, Freyer A, Turek TJ, Speer DP (2006) Articular cartilage paste grafting to full-thickness articular cartilage knee joint lesions: a 2- to 12-year follow-up. Arthroscopy 22:291–299

    Article  PubMed  Google Scholar 

  41. Swedish Knee Arthroplasty Register (2010) Annual report 2010. Lund

  42. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49

    Google Scholar 

  43. Ulstein S, Arøen A, Røtterud JH, Løken S, Engebretsen L, Heir S, Årøen A, Røtterud JH, Løken S, Engebretsen L, Heir S (2014) Microfracture technique versus osteochondral autologous transplantation mosaicplasty in patients with articular chondral lesions of the knee: a prospective randomized trial with long-term follow-up. Knee Surg Sports Traumatol Arthrosc 22:1207–1215

    Article  PubMed  PubMed Central  Google Scholar 

  44. Woolf AD, Pfleger B (2003) Burden of major musculoskeletal conditions. Bull World Health Organ 81:646–656

    PubMed  PubMed Central  Google Scholar 

  45. Xing L, Jiang Y, Gui J, Lu Y, Gao F, Xu Y, Xu Y (2012) Microfracture combined with osteochondral paste implantation was more effective than microfracture alone for full-thickness cartilage repair. Knee Surg Sport Traumatol Arthrosc 21:1770–1776

    Article  Google Scholar 

  46. Zak L, Krusche-Mandl I, Aldrian S, Trattnig S, Marlovits S (2014) Clinical and MRI evaluation of medium- to long-term results after autologous osteochondral transplantation (OCT) in the knee joint. Knee Surg Sports Traumatol Arthrosc 22:1–10

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Stone Research Foundation, San Francisco, CA, USA

    Kevin R. Stone, Jonathan R. Pelsis, Kellen Na, Ann W. Walgenbach & Thomas J. Turek

  2. The Stone Clinic, San Francisco, CA, USA

    Kevin R. Stone & Ann W. Walgenbach

  3. Tulane University School of Medicine, New Orleans, LA, USA

    Kellen Na

Authors
  1. Kevin R. Stone
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jonathan R. Pelsis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kellen Na
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ann W. Walgenbach
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas J. Turek
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kevin R. Stone.

Ethics declarations

Conflict of interest

All authors declare no conflict of interest.

Funding

There was no financial support used for this study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stone, K.R., Pelsis, J.R., Na, K. et al. Articular cartilage paste graft for severe osteochondral lesions of the knee: a 10- to 23-year follow-up study. Knee Surg Sports Traumatol Arthrosc 25, 3824–3833 (2017). https://doi.org/10.1007/s00167-016-4323-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-016-4323-7

Keywords

Search

Navigation