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This Article Full Text Full Text (PDF) All Versions of this Article: 36/6/1101    most recent 0363546508314417v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Request Reprints Google Scholar Articles by Nho, S. J. Articles by Williams, R. J. PubMed PubMed Citation Articles by Nho, S. J. Articles by Williams, R. J., III Related Collections Chondral/cartilage Shoulder Arthroscopy

Magnetic Resonance Imaging and Clinical Evaluation of Patellar Resurfacing With Press-Fit Osteochondral Autograft Plugs

Shane J. Nho, MD, MS^,*, Li Foong Foo, MD, David M. Green, MD, Michael K. Shindle, MD, Russell F. Warren, MD, Thomas L. Wickiewicz, MD, Hollis G. Potter, MD and Riley J. Williams, III, MD

From the Institute for Cartilage Repair, The Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York, and the MRI Division, Department of Radiology and Imaging, The Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York

^* Address correspondence to Shane J. Nho, MD, MS, The Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 (e-mail: nhos{at}hss.edu).

Background: Autologous osteochondral transplantation (AOT) has been successfully used in the femoral condyle and trochlea and is an attractive treatment option for full-thickness patellar cartilage lesions.

Hypothesis: Patients treated with AOT for the repair of symptomatic, isolated patellar cartilage lesions will demonstrate improvement in functional outcomes and postoperative magnetic resonance imaging appearance.

Study Design: Case series; Level of evidence, 4.

Methods: Between 2002 and 2006, patients with focal patellar cartilage lesions treated with AOT were prospectively followed. The mean age at the time of surgery was 30 years. Clinical assessment was performed with the International Knee Documentation Committee (IKDC), activities of daily living of the Knee Outcome Survey (ADL), and Short Form-36 (SF-36) at baseline and most recent follow-up. Magnetic resonance imaging was used to evaluate the cartilage repair morphologic characteristics in 14 cases.

Results: Twenty-two patients met the study criteria with a mean follow-up of 28.7 months (range, 17.7–57.8 months). The mean patellar lesion size was 165.6 ± 127.8 mm², and the mean size of the donor plug was 9.7 ± 1.1 mm in diameter with 1.8 ± 1.4 plugs/defect. The mean preoperative IKDC score was 47.2 ± 14.0 and improved to 74.4 ± 12.3 (P = .028). The mean preoperative ADL score was 60.1 ± 16.9 and increased to 84.7 ± 8.3 (P = .022). The mean SF-36 also demonstrated an improvement, from 64.0 ± 14.8 at baseline to 79.4 ± 15.4 (P = .059). Nine patients underwent concomitant distal realignment and demonstrated improvement between preoperative and postoperative outcomes scores, but these differences were not statistically significant. Magnetic resonance imaging appearance demonstrated that all plugs demonstrated good (67%–100%) cartilage fill, 64% with fissures < 2 mm at the articular cartilage interface, 71% with complete trabecular incorporation, and 71% with flush plug appearance.

Conclusion: Patellar AOT is an effective treatment for focal patellar chondral lesions, with significant improvement in clinical follow-up. This study suggests that patients with patellar malalignment may represent a subset of patients who have a poor prognostic outlook compared with patients with normal alignment.

Key Words: patella • focal chondral defect • cartilage injury • osteochondral autograft • mosaicplasty