Grafting Repairs Damaged Knee Cartilage

In this prospective, longitudinal case series, 145 patients with a full-thickness chondral fracture in the knee (classified as an Outerbridge grade IV lesion) underwent 136 surgical procedures involving an articular cartilage paste graft. The mean age of the patients was 46 years, and 66% were men. Clinical data were recorded in 125 patients from two to 12 years postoperatively. A total of 66 patients underwent second-look arthroscopy, and cartilage biopsies were evaluated to qualify and quantify defect fill by a blinded, independent histopathology reviewer.

The review showed that validated pain, functioning, and activity measures improved significantly after surgery, and 104 (83.2%) of 125 patients were considered a clinical success. Of 18 surgical failures, 10 underwent subsequent joint arthroplasty, and eight reported worse pain after surgery. In the 66 biopsies performed, 63.6% showed strong and consistent evidence of replacement of the articular surface, while 27.3% revealed areas of cartilage indistinguishable from normal. The results were reported in the March 2006 issue of Arthroscopy.

This procedure offers excellent, long-lasting pain relief, restored functioning, and the possibility of tissue regeneration for patients with painful chondral lesions in arthritic knees, wrote Kevin R. Stone, M.D., and colleagues of The Stone Clinic (San Francisco, CA, USA).

Cartilage paste grafting involves formation of an osteocartilaginous paste from the intercondylar notch, which is subsequently injected into the chondral defect. This paste is thought to augment mesenchymal stem cell supply and improve the vascular supply to the damaged area, stimulating normal cartilage growth.



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