Knee Surgery, Sports Traumatology, Arthroscopy
Favourable long-term functional and radiographical outcome
after osteoautograft transplantation surgery of the knee: a minimum
· Keijo Mäkelä
· Ia Kohonen
· Ari Hiltunen
· Ari Itälä
Received: 27 November 2017 / Accepted: 30 May 2018
© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018
Purpose The aim of this study was to assess the progression of radiological cartilage changes and to document the functional,
long-term results during a follow-up of 10 years after osteoautograft transplantation (OAT) knee surgery.
Methods The study was a retrospective analysis of all patients who underwent OAT at Turku University Hospital from
1999 to 2007. Pre- and postoperative cartilage changes were estimated based on standardised radiographs. The extent of
osteoarthritis (OA) was graded according to the Kellgren–Lawrence scale. Clinical outcomes were evaluated with the Knee
Injury and Osteoarthritis Outcome Score (KOOS) questionnaire.
Results A total of 60 patients (64 knees) with a median age of 30 years (range 14–62) were included. The median follow-up
was 140 months (range 47–205). Of the 64 knees examined, 14 (22%) had a traumatic chondral lesion and 50 (78%) had
osteochondritis dissecans (OCD). Preoperatively, 71% of the patients had Kellgren–Lawrence grades of 0–1; during the
follow-up period, 50% of the patients showed radiographical progression of OA. OA progressed most signiﬁcantly in patients
with normal preoperative Kellgren–Lawrence grades (p = 0.0003). Patients with no progression in joint space narrowing had
statistically signiﬁcantly better overall KOOS (p = 0.02) than patients whose Kellgren–Lawrence grades worsened. Patients
with defect sizes > 3.0 cm
scored statistically signiﬁcantly better in all subscales than patients with smaller defect sizes
(p = 0.02). Patients with OCD had statistically signiﬁcantly better KOOS than patients with chondral defects (p = 0.008).
Conclusions OAT surgery for treating patients with cartilage defects of the knee had good clinical results after a mean follow-
up of 11 years. Radiological analyses revealed a progression of cartilage degeneration in 50% of the operated knees. Patients
with no progression of the degenerative changes scored statistically signiﬁcantly better on the KOOS self-assessment test.
These results indicate that OAT surgery appears to be a reasonable therapeutic option to restore knee function in patients
with cartilage lesions.
Level of evidence IV.
Keywords Osteoautograft transplantation · Knee · Cartilage · Osteoarthritis
Injured articular cartilage has a limited ability to regenerate,
and full-thickness lesions may contribute to the development
of osteoarthritis (OA) [12, 16]. However, the best method
for repairing full-thickness cartilage defects remains a great
debate, and a number of diﬀerent treatment options have
been used to address this injury with variable success rates
. In this context, the osteoautograft transplantation (OAT)
involves the transfer of a healthy osteochondral plug from
minimally weight-bearing portions of the femur to a small-
or medium-sized focal chondral or osteochondral defect in
high weight-bearing regions. Depending on the size of the
* Elina Ekman
Department of Orthopaedic Surgery, Turku University
Hospital, University of Turku, Kiinamyllynkatu 4-8,
20521 Turku, Finland
Medical Imaging Centre of Southwest Finland, Turku
University Hospital, Turku, Finland
Department of Orthopaedics, Terveystalo-Pulssi Hospital,