title: The Long-Term Clinical Outcomes Following Autogenous Bone Grafting for Large-Volume Defects of the Knee: 12- to 21-Year Follow-Up.
abstract: OBJECTIVE
  We report the long-term clinical outcomes of patients who underwent autogenous bone grafting of large-volume osteochondral defects of the knee due to osteochondritis dessicans (OCD) and osteonecrosis (ON). This is the companion report to one previous published on the biological response. We hypothesized that these grafts would integrate with host bone and the articular surface would form fibrocartilage providing an enduring clinical benefit.
  
  
  METHODS
  Three groups (patients/knees) were studied: OCD without a fragment (n = 12/13), OCD with a partial fragment (n = 14/16), and ON (n = 25/26). Twenty-five of 52 patients were available for clinical follow-up between 12 and 21 years. Electronic medical records provided comparison clinical information. In addition, there were plain film radiographs, MRIs, plus repeat arthroscopy and biopsy on 14 patients.
  
  
  RESULTS
  Autogenous bone grafts integrated with the host bone. MRI showed soft tissue covering all the grafts at long-term follow-up. Biopsy showed initial surface fibrocartilage that subsequently converted to fibrocartilage and hyaline cartilage at 20 years. OCD patients had better clinical outcomes than ON patients. No OCD patients were asymptomatic at anytime following surgery. Half of the ON patients came to total knee replacement within 10 years.
  
  
  CONCLUSIONS
  Autogenous bone grafting provides an alternative biological matrix to fill large-volume defects in the knee as a singular solution integrating with host bone and providing an enduring articular cartilage surface. The procedure is best suited for those with OCD. The treatment for large-volume articular defects by this method remains salvage in nature and palliative in outcome.
authors.affiliation: Scripps Health, Okemos, MI, USA.
authors.forename: Lanny Leo
authors.initials: LL
authors.lastname: Johnson
authors.affiliation: Michigan State University, Grand Rapids, MI, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Delano
authors.affiliation: VA Boston Healthcare/Brigham and Women's Hospital, Boston, MA, USA ; Harvard University, Boston, MA, USA.
authors.forename: Myron
authors.initials: M
authors.lastname: Spector
authors.affiliation: Michigan State University, Grand Rapids, MI, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Pittsley
authors.affiliation: Michigan State University, Grand Rapids, MI, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Gottschalk
keywords: arthroscopy; cartilage repair; knee; matrices