The effect of graft sizing on osteochondral transplantation.

PURPOSE: The goal of this study was to analyze the effect of graft sizing on the histologic property of articular cartilage in autologous osteochondral transplantation. TYPE OF STUDY: Histologic analysis using an animal model. METHODS: Eighteen skeletally mature female Japanese white rabbits were used in this study and divided into 2 groups based on the surgical procedure. Group I: A cylindrical fragment (7 mm in diameter and 5 mm in depth) was harvested at the femoral condyle using the Osteochondral Autograft Transfer System (Arthrex, Naples, FL), then precisely returned to the defect from which the fragment was originally harvested. This surgical model supposes that the articular surface geometry of the osteochondral graft exactly matches that of the cartilage lesion; however, the osteochondral graft is not the same size as the defect in this model because of the surrounding gap that corresponds to the blade thickness of the chisel used to take the graft. Group II: A 1-mm larger osteochondral fragment (8 mm in diameter and 5 mm in depth) taken from the contralateral femoral condyle was transplanted to the osteochondral defect made as in group I, achieving a tight fit. Specimens were stained with Safranin-O fast green and analyzed microscopically at 4, 12, and 24 weeks after surgery. RESULTS: In group I, histologic examination revealed an increase in cartilage thickness and cell density during the implantation period. Round and polygonal hypertrophic clusters of chondrocytes with cytoplasmic vacuoles were observed. By contrast, in group II, the thickness of the articular cartilage was almost the same as that of the normal adjacent cartilage with no significant change observed. CONCLUSIONS: It is suggested that sizing of the implanted osteochondral fragment plays an important role in preserving the histologic properties of cartilage. CLINICAL RELEVANCE: This study suggests that osteochondral graft stability may influence the histologic properties of the repaired cartilage. It is preferable to implant the slightly oversized graft into the cartilage lesion in autologous osteochondral transplantation to preserve the histologic properties of cartilage.

Analysis of the thickness and curvature of articular cartilage of the femoral condyle.

PURPOSE: To develop an optimal autologous osteochondral transplantation technique, we analyzed the thickness and curvature of the femoral condyle. TYPE OF STUDY: Basic research for surgical technique, anatomic study. METHODS: Eight cadaveric femoral condyles were sectioned sagittally into 8 slices. Photographs of each slice were digitized, and the thickness and curvature of the overlaying cartilage were analyzed using a National Institutes of Health image program. RESULTS: The average thickness of the cartilage was 1.69 mm. The minimum and maximum values were measured at 0.22 mm and 3.65 mm, respectively, with the thinnest part seen in the sulcus terminalis (the groove for meniscus). The average curvature of the cartilage was 4.4 m(-1). The minimum and maximum values were measured at -20.0 m(-1) and 27.2 m(-1), respectively. CONCLUSIONS: When the chondral lesion is assumed at the weight bearing area of the medial or lateral femoral condyle, the anterior portion of the sulcus terminalis (the groove for meniscus) in the middle section of the lateral condyle is considered to be the optimal donor site.

The effect of the small and unstable autologous osteochondral graft on repairing the full-thickness large articular cartilage defect in a rabbit model.

We have investigated the effect of the insufficient autologous osteochondral graft on healing of the large articular cartilage defect using a rabbit model. An osteochondral defect, 7 mm in diameter, was made on the patellar groove of the femoral condyle and repaired with two surgical procedures: Group I, the osteochondral fragment as half as the defect was grafted. The graft was unstable and the size of the graft was smaller than the defect. This is a model of the insufficient autologous osteochondral graft to the large articular cartilage defect; Group II, the defect was left empty. At 2, 4, 12, and 24 weeks after the surgery, the specimens were analyzed macroscopically and histologically. To evaluate the microscopic morphology, a histologic grading scale composed of 5 categories was used. In Group I, although the graft sank a little, a grafted cartilage survived and the reparative fibrous tissue filled the defect covering implanted cartilage. In contrast, in Group II, the defect was only partially covered by fibrocartilaginous tissue with a faintly staining matrix. Throughout the entire observed periods, the scores of the repaired cartilage in Group I are significantly higher than those in Group II. Even the half size of osteochondral graft has an effect to reduce the size of the cartilage defect such as the spacer and leads to better healing compared to the cartilage defect untreated. In case that it is hard to transplant an optimal osteochondral graft because of large cartilage lesion, even the small and unstable osteochondral plug should be transplanted.