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


METHODS
IV.
Stone Research Foundation, San Francisco, CA, USA. kstonemd@stoneclinic.com.|The Stone Clinic, San Francisco, CA, USA. kstonemd@stoneclinic.com.
Kevin R
KR
Stone
Stone Research Foundation, San Francisco, CA, USA.
Jonathan R
JR
Pelsis
Stone Research Foundation, San Francisco, CA, USA.|Tulane University School of Medicine, New Orleans, LA, USA.
Kellen
K
Na
Stone Research Foundation, San Francisco, CA, USA.|The Stone Clinic, San Francisco, CA, USA.
Ann W
AW
Walgenbach
Stone Research Foundation, San Francisco, CA, USA.
Thomas J
TJ
Turek
D000293:Adolescent; D000328:Adult; D000368:Aged; D001182:Arthroscopy; D002356:Cartilage / Q000637:transplantation; D002358:Cartilage, Articular / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057072:Intra-Articular Fractures / Q000473:pathology; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery; D059408:Pain Management; D010147:Pain Measurement; D011184:Postoperative Period; D014182:Transplantation, Autologous; D019737:Transplants; D016896:Treatment Outcome; D055815:Young Adult
Arthroscopy; Articular cartilage; Articular cartilage repair; Autologous cartilage transplantation; Biologic knee repair; Cartilage reconstruction; Histology; Knee; Long-term clinical outcome; Orthobiologics; Osteoarthritis; Osteochondral grafting; Paste graft; Survival analysis; Treatment gap
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