Outcomes of Autogenous Osteochondral Mosaicplasty in the treatment of very large cartilage defects of the femoral condyles in young patients

Abstract

Cartilage defects in femoral condyles of knee joint are a menace in young patients and cause severe pain and inability to climb stairs and carry out routine activities. This type of injury occurs commonly in sports activities. Knee articular cartilage defects > 4 cm2 are considered large defects. Treatment of articular cartilage lesions in the knee remains a challenge for the practising orthopaedic surgeon. A wide range of options are currently practised, ranging from conservative measures to various types of surgeries and recently, use of growth factors and emerging gene therapy techniques. The end result of these methods is usually a fibrous repair tissue (fibro cartilage), which lacks the biomechanical characteristics of hyaline cartilage that are necessary to withstand the compressive forces distributed across the knee. The fibro cartilage generally deteriorates over time, resulting in a return of the original symptoms and occasionally reported progression to osteoarthritis. Autologous Chondrocyte Implantation (ACI) is at present considered to be the gold standard treatment for large cartilage defects (size >4 cm2) in the femoral condyles. The purpose of this study was to find out if the single staged, cheaper and easily accessible option of Autogenous osteochondral cylinder transfer or Mosaicplasty gives equivalent functional outcomes as compared to ACI in the treatment of large cartilage defects of the femoral condyles in the young patients.