title: Autologous osteochondral transplantation for treating patellar chondral injuries: evaluation, treatment, and outcomes of a two-year follow-up study.
abstract: BACKGROUND
  The patella is the largest human sesamoid bone and often sustains chondral injury. There is no consensus on how to treat a full-thickness, symptomatic articular cartilage injury of the patella. We analyzed the clinical and functional outcomes of patients with symptomatic full-thickness patellar chondral lesions treated with autologous osteochondral transplantation and evaluated osteochondral autograft bone-plug integration through magnetic resonance imaging.
  
  
  METHODS
  In this prospective study, thirty-three patients with a symptomatic full-thickness patellar chondral injury surgically treated with autologous osteochondral transplantation were evaluated before and after surgical treatment with a minimum two-year follow-up using the Lysholm, Kujala, and Fulkerson questionnaires and the Short Form-36 health survey score. Magnetic resonance images were made at six and twelve months postoperatively and studies were performed to analyze the osteochondral autograft bone-plug integration.
  
  
  RESULTS
  All thirty-three patients showed a significant improvement in functional scores two years after surgery. The average Lysholm scores were 57.27 points preoperatively and 80.76 points at two years postoperatively, the average Kujala scores were 54.76 points preoperatively and 75.18 points at two years postoperatively, and the Fulkerson average scores were 54.24 points preoperatively and 80.42 points at two years postoperatively. The Short Form-36 life quality score improved significantly. Two years after surgery, all magnetic resonance images showed full bone-plug integration into the patella.
  
  
  CONCLUSIONS
  Autologous osteochondral transplantation is a successful technique to surgically treat symptomatic full-thickness patellar articular cartilage injuries smaller than 2.5 cm in diameter. Patients had a significant improvement in clinical scores. Bone-plug integration and surface alignment were demonstrated in all patients two years after surgery.
  
  
  METHODS
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Universidade Federal de São Paulo, Rua Borges Lagoa 783, 5° andar, São Paulo, Brazil 03840-032. E-mail address for D.C. Astur: mcastur@yahoo.com.
authors.forename: Diego Costa
authors.initials: DC
authors.lastname: Astur
authors.affiliation: Universidade Federal de São Paulo, Rua Borges Lagoa 783, 5° andar, São Paulo, Brazil 03840-032. E-mail address for D.C. Astur: mcastur@yahoo.com.
authors.forename: Gustavo Gonçalves
authors.initials: GG
authors.lastname: Arliani
authors.affiliation: Universidade Federal de São Paulo, Rua Borges Lagoa 783, 5° andar, São Paulo, Brazil 03840-032. E-mail address for D.C. Astur: mcastur@yahoo.com.
authors.forename: Mario
authors.initials: M
authors.lastname: Binz
authors.affiliation: Universidade Federal de São Paulo, Rua Borges Lagoa 783, 5° andar, São Paulo, Brazil 03840-032. E-mail address for D.C. Astur: mcastur@yahoo.com.
authors.forename: Nelson
authors.initials: N
authors.lastname: Astur
authors.affiliation: Universidade Federal de São Paulo, Rua Borges Lagoa 783, 5° andar, São Paulo, Brazil 03840-032. E-mail address for D.C. Astur: mcastur@yahoo.com.
authors.forename: Camila Cohen
authors.initials: CC
authors.lastname: Kaleka
authors.affiliation: Universidade Federal de São Paulo, Rua Borges Lagoa 783, 5° andar, São Paulo, Brazil 03840-032. E-mail address for D.C. Astur: mcastur@yahoo.com.
authors.forename: Joicemar Tarouco
authors.initials: JT
authors.lastname: Amaro
authors.affiliation: Universidade Federal de São Paulo, Rua Borges Lagoa 783, 5° andar, São Paulo, Brazil 03840-032. E-mail address for D.C. Astur: mcastur@yahoo.com.
authors.forename: Alberto
authors.initials: A
authors.lastname: Pochini
authors.affiliation: Universidade Federal de São Paulo, Rua Borges Lagoa 783, 5° andar, São Paulo, Brazil 03840-032. E-mail address for D.C. Astur: mcastur@yahoo.com.
authors.forename: Moises
authors.initials: M
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D000328:Adult; D064592:Autografts; D016025:Bone Transplantation / Q000379:methods / Q000534:rehabilitation; D002356:Cartilage / Q000637:transplantation*; D002358:Cartilage, Articular / Q000293:injuries*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010329:Patella / Q000293:injuries* / Q000601:surgery; D011182:Postoperative Care / Q000534:rehabilitation; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D020127:Recovery of Function; D016896:Treatment Outcome; D055815:Young Adult