Long-term Results of Matrix-assisted Autologous Chondrocyte Transplantation Combined With Autologous Bone Grafting for the Treatment of Juvenile Osteochondritis Dissecans

Background: Osteochondritis dissecans is a pathology affecting young patients that involves the entire osteochondral unit. In the case of unfixable fragments, regenerative cartilage treatments are a viable solution, but little is known about the use of these procedures for the treatment of juvenile osteochondritis dissecans (JOCD). The aim of this study was to evaluate the long-term results offered by matrix-assisted autologous chondrocyte transplantation combined with autologous bone grafting for the treatment of JOCD. Methods: Nineteen patients have been enrolled. The mean age at the time of treatment was 16.8 +/- 1.5 years, with a mean body mass index of 22.9 +/- 2.7. The average size of the defects was 2.8 +/- 1.2cm(2). All patients were evaluated prospectively before surgery and at 12, 24, 60, and at a final follow-up of 120 months with International Knee Documentation Committee scores, EuroQol-Visual Analogue Scale, and the Tegner Score. Results: A statistically significant improvement in all clinical scores was observed from baseline evaluation to 120 months of final follow-up. In particular, the International Knee Documentation Committee subjective score improved from the preoperative evaluation of 38.7 +/- 17.3 to 74.0 +/- 21.8 at 12 months (P < 0.0005), with scores remaining stable for up to 120 months (83.8 +/- 20.7), with all follow-ups showing a statistically significant improvement compared with the basal value (P < 0.0005). Three patients failed at 12 months, for a failure rate of 16% at 10 years of follow-up. Lesions > 3.5cm(2) obtained worse subjective results. In addition, lesion size and female sex were significantly associated with failures. Conclusions: The matrix-assisted autologous chondrocyte transplantation technique with autologous bone grafting is a valid treatment option for JOCD in case of unfixable fragments. The clinical improvement obtained is significant and stable, with good results maintained for up to 10 years of follow-up and an overall low failure rate. Lesion size and sex could influence the clinical outcome and should be considered in the treatment choice. Level of Evidence:Level IV-case series.