Treatment of osteochondritis dissecans of the knee: One-step procedure with bone grafting and matrix-supported autologous chondrocyte transplantation

Aim: The aim of this study was to establish and assess a one-step reconstruction procedure of deep osteochondral defects of the knee joint with bone grafting and matrix-supported autologous chondrocyte transplantation in osteochondritis dissecans. Method: Between 2004 and 2006 22 patients with osteochondral defects in the weight-bearing zone of the femoral condyles (ICRS CCD III and IV) were reconstructed simultaneously with bone grafting and matrix-supported autologous chondrocyte transplantation (NOVOCART(R) 3D). All patients were analysed prospectively. Results: 17 males and 5 females (age 28.3, range: 17-49 years) were surgically treated with the above-mentioned novel method. Before reconstruction osteochondral defects had an average defect area of 4.8 (2.4-9.0) cm(2) and a depth of between 4 and 15 mm. For reconstruction an average of 2.6 (1-6) monocortical cancellous bone cylinders (diameter 8 mm) was used to fill the osseous defect and to reconstruct the subchondral bone plate with adequate positioning of the monocortical layer of the graft. Then a Matrix-ACT was used to cover the reconstructed subchondral bone plate. The average follow-up was 16 (6-36) months. The average Tegner activity score was 4 (3-7) of 10. The Lysholm-Gillquist score and the Cincinnati Sports Medicine and Orthopedic Center score were significantly improved postoperatively. The IKDC-2000 questionnaire was also significantly increased by 50%. Conclusion: The simultaneous reconstruction of deep osteochondral detects of the knee joint with bone grafting and matrix-supported autologous chondrocyte transplantation in osteochondritis dissecans is a biological, one-step alternative to previously reported methods with encouraging first results.