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Treatment of osteochondral defects with a combination of bone grafting and AMIC technique

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Osteochondral defects of the knee may cause functional impairment of young and sportively active patients. Different surgical treatment options have been proposed using either one or two step procedures. The aim of the current study was to evaluate mid-term outcomes of combined bone grafting with autologous matrix-associated chondrogenesis (AMIC) for the treatment of large osteochondral defects.

Materials and methods

15 Patients with osteochondrosis dissecans of the medial femoral condyle grade III or IV according to ICRS classification were treated with a single step surgical procedure combining bone grafting and the AMIC procedure. Mean defect size was 4.98 cm2 (± 3.02) and patients were examined at 6, 12 weeks, 6 and 12 month and at mean final follow-up of 49 months (36–61). Patients were evaluated using VAS, IKDC, KOOS, Lysholm, Tegner activity scores and psychological and physical health assessed using the SF 12. MRI evaluation was performed at final follow-up using the MOCART score.

Results

Pain had significantly decreased at final follow-up (7.2 ± 1.4 vs. 2.4 ± 2.6) compared to preoperative baseline. All functional scores had improved significantly throughout the follow-up period (IKDC from 36.6 ± 20.6 vs. 72.2 ± 18.7; KOOS 50.0 ± 18.9 vs. 81.7 ± 13.9; LYSHOLM 39.3 ± 19.5 vs. 79.8 ± 15.1). SF12 evaluation showed a significant increase in physical component summary (PCS) (31.2 ± 11.1 preoperative vs. 46.3 ± 9.9 at final follow-up), while mental component summary (MCS) remained stable (51.8 ± 8.9 vs. 57.3 ± 3.3). MOCART score revealed a mean overall score of 77 ± 15 at final follow-up. Integration to the adjacent cartilage was complete in 79%, incomplete in 21%. Defect filling was complete in 64%, incomplete in 36%.

Conclusion

Significant improvement of knee function and restoration of homogenous cartilage morphology could be achieved with simultaneous AMIC procedure and bone grafting in 2/3 of all patients with large osteochondral lesions at 4 years postoperatively.

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Authors and Affiliations

  1. Center for Musculoskeletal Surgery, Charité, Universitaetsmedicine Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Arnd Hoburg, Julia Marcella Leitsch, Rex Lehnigk & Carsten Perka

  2. Department of Radiology, Charité, Universitaetsmedicine Berlin, Berlin, Germany

    Gerd Diederichs

  3. Department of Orthopedic Surgery and Traumatology, Hospital Brandenburg, Brandenburg Medical School, Brandenburg/Havel, Germany

    Roland Becker

  4. Sporthopaedicum, Berlin, Germany

    Sven Scheffler

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  1. Arnd Hoburg
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Correspondence to Arnd Hoburg.

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All authors would like to state that they have no conflict of Interest. No outside funding or grants were received that assisted in the study. Thus, this research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Hoburg, A., Leitsch, J.M., Diederichs, G. et al. Treatment of osteochondral defects with a combination of bone grafting and AMIC technique. Arch Orthop Trauma Surg 138, 1117–1126 (2018). https://doi.org/10.1007/s00402-018-2944-7

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  • DOI: https://doi.org/10.1007/s00402-018-2944-7

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