Surgical Technique and Clinical Outcomes of Retrograde Osteochondral Autograft Transfer for Osteochondral Lesions of the Tibial Plateau.
OBJECTIVE
To present the surgical technique, clinical outcomes, and poor prognostic factors of arthroscopic retrograde osteochondral autograft transfer of the tibial plateau.


METHODS
Twelve patients (6 men, 6 women; mean age, 38.7 years) with tibial plateau osteochondral lesions underwent surgery. The primary diseases were osteonecrosis in 4 cases, cartilage injuries in 6, and postfractures of the tibial plateau in 2. Clinical outcomes were evaluated preoperatively and postoperatively according to the International Knee Documentation Committee score and the Japanese Orthopaedic Association score. The International Cartilage Repair Society score was recorded in 7 cases who underwent second-look arthroscopies postoperatively. Statistical analyses were performed to identify prognostic factors associated with the clinical outcomes.


RESULTS
The mean International Knee Documentation Committee and Japanese Orthopaedic Association scores were both significantly improved from 39.0 (range, 13.0-57.1) to 72.4 (range, 33.3-100) (P = .0022) and from 65.8 (range, 30.0-85.0) to 85.8 (range, 50.0-100) (P = .0022 < .05), respectively. In 2 cases, secondary operations were performed because of knee pain (1 varus osteotomy of the femur and 1 total knee replacement). The mean International Cartilage Repair Society scores were significantly worse in the 2 cases who required a secondary operation (3.5; abnormal) than in the 5 cases who did not (10.6; nearly normal). The secondary operation rate was significantly higher in cases with lesion size ≥400 mm2than in those <400 mm2(Fisher's exact test; P = .046).


CONCLUSIONS
Most clinical scores improved significantly postoperatively. The results indicate that arthroscopic retrograde osteochondral autograft transfer is an effective procedure to achieve sufficient cartilage congruity for osteochondral lesions of the tibial plateau <400 mm2in size.


METHODS
Level IV, therapeutic case series.
Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Fukakusa, Fushimi-ku, Kyoto, Japan. Electronic address: hyabumot@kyotolan.hosp.go.jp.
Hiromitsu
H
Yabumoto
Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Fukakusa, Fushimi-ku, Kyoto, Japan.
Yasuaki
Y
Nakagawa
Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Fukakusa, Fushimi-ku, Kyoto, Japan.
Shogo
S
Mukai
Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Fukakusa, Fushimi-ku, Kyoto, Japan.
Takahiko
T
Saji
Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Fukakusa, Fushimi-ku, Kyoto, Japan.
Takashi
T
Nakamura
D000293:Adolescent; D000328:Adult; D000368:Aged; D001182:Arthroscopy / Q000379:methods; D016025:Bone Transplantation; D002356:Cartilage / Q000637:transplantation*; D002648:Child; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D024162:Second-Look Surgery / Q000379:methods; D013977:Tibia / Q000601:surgery*; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult