
Abstract
Perichondrial transplantation was performed in 29 patients suffering
from a deep chondral lesion with different etiologies. Only those patients with
a cartilage lesion in the knee joint were included. Patients were initially and
postoperatively examined using the Lysholm- and HSS-Score. In most of the
patients (20/29) trauma and the recurrence of osteochondrosis dissecans (6/29)
were the cause of the cartilage lesion. Most often the medial femoral condyle
(19/29) and, secondly, the lateral femoral condyle (5/29) were involved. In six
patients additional therapeutic measures (ACL-plasty,
n = 2; high tibial osteotomy because of varus
mal-alignment, n = 4) had to be adopted. Follow-up
examination was possible in 26/29 patients after a minimum postoperative period
of 12 months. All patients exhibited a distinct and significant increase in
both the Lysholm and the HSS-score. A follow-up after a minimum of 24 months
was possible in 13/29 patients. Even these patients exhibited a distinct and
significant improvement. Multiple follow-up examinations in 9/29 patients
demonstrated maintenance of the first postoperative results obtained after one
postoperative year for a maximum of 49 months in most of the patients. Only in
one female patient, implantation of a semi-constrained total knee replacement
was necessary because of osteoarthrosis resulting from crystal arthropathy
(chondrocalcinosis). It was possible to obtain biopsies from three patients at
the time osteosynthetic material was removed. In all cases hyaline-like
cartilage was histologically observed. In the treatment of selected patients
suffering from a circumscript cartilaginous lesion resulting from trauma or the
recurrence of osteochondritis dissecans with a concomitant cartilage lesion but
without major signs of osteoarthritis, perichondrial grafting can achieve
acceptable clinical results, after a short follow-up period. In order to
achieve satisfying results a good selection of patients and additional
treatment of other articular disorders, such as ACL-instability or axial
mal-alignment, is necessary. Further studies have to be undertaken to evaluate
the durability of these results over a longer period of time to see if
osteoarthrosis can be avoided.
Key words
Articular cartilage lesion - perichondrium - autologous - transplantation - osteoarthrosis
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Prof. Dr. J. Bruns, M.D.
Dept. of Orthopaedic Surgery · University of Hamburg
Martinistraße 52 · 20246 Hamburg · Germany
·
Telefon: +49 40 42803 3670
Fax: +49 40 42803 5018
eMail: j.bruns@uke.uni-hamburg.de