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Int J Sports Med 2003; 24(5): 382-388
DOI: 10.1055/s-2003-40703
Orthopedics & Biomechanics
© Georg Thieme Verlag Stuttgart · New York

Treatment of Deep Hyalin Cartilage Defects With Autologous Perichondrial Grafts

J.  Bruns1 , J.  Steinhagen1
  • 1Dept. of Orthopaedic Surgery, School of Medicine, University of Hamburg, Germany
Further Information

Publication History

Accepted after revision: January 15, 2003

Publication Date:
17 July 2003 (online)

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Abstract

Perichondrial transplantation was performed in 29 patients suffering from a deep chondral lesion with different etiologies. Only those patients with a cartilage lesion in the knee joint were included. Patients were initially and postoperatively examined using the Lysholm- and HSS-Score. In most of the patients (20/29) trauma and the recurrence of osteochondrosis dissecans (6/29) were the cause of the cartilage lesion. Most often the medial femoral condyle (19/29) and, secondly, the lateral femoral condyle (5/29) were involved. In six patients additional therapeutic measures (ACL-plasty, n = 2; high tibial osteotomy because of varus mal-alignment, n = 4) had to be adopted. Follow-up examination was possible in 26/29 patients after a minimum postoperative period of 12 months. All patients exhibited a distinct and significant increase in both the Lysholm and the HSS-score. A follow-up after a minimum of 24 months was possible in 13/29 patients. Even these patients exhibited a distinct and significant improvement. Multiple follow-up examinations in 9/29 patients demonstrated maintenance of the first postoperative results obtained after one postoperative year for a maximum of 49 months in most of the patients. Only in one female patient, implantation of a semi-constrained total knee replacement was necessary because of osteoarthrosis resulting from crystal arthropathy (chondrocalcinosis). It was possible to obtain biopsies from three patients at the time osteosynthetic material was removed. In all cases hyaline-like cartilage was histologically observed. In the treatment of selected patients suffering from a circumscript cartilaginous lesion resulting from trauma or the recurrence of osteochondritis dissecans with a concomitant cartilage lesion but without major signs of osteoarthritis, perichondrial grafting can achieve acceptable clinical results, after a short follow-up period. In order to achieve satisfying results a good selection of patients and additional treatment of other articular disorders, such as ACL-instability or axial mal-alignment, is necessary. Further studies have to be undertaken to evaluate the durability of these results over a longer period of time to see if osteoarthrosis can be avoided.

Key words

Articular cartilage lesion - perichondrium - autologous - transplantation - osteoarthrosis

References

  • 1 Alfredson H, Thorsen K, Lorentzon R. Treatment of tear of the anterior cruciate ligament combined with localised deep cartilage defects in the knee with ligament reconstruction and autologous periosteum transplantation.  Knee Surg Sports Traumatol Arthrosc. 1999;  7 69-74
    CrossrefPubMedGoogle Scholar
  • 2 Alfredson H, Lorentzon R. Superior results with continuous passive motion after periosteal transplantation.  Knee Surg Sports Traumatol Arthrosc. 1999;  7 232-238
    CrossrefPubMedGoogle Scholar
  • 3 Amiel D, Coutts R D, Abel M, Stewart W, Harwood F, Akeson W H. Rib perichondrial grafts for the repair of full-thickness articular-cartilage defects.  J Bone Joint Surg. 1985;  67 911-920
    PubMedGoogle Scholar
  • 4 Amiel D, Coutts R D, Harwood F L, Ishizue K K, Kleiner J B. The chondrogenesis of rib perichondrial grafts for repair of full thickness articular cartilage defects in a rabbit model: a one year postoperative assessment.  Connect Tiss Res. 1988;  18 27-39
    PubMedGoogle Scholar
  • 5 Bobic V, Noble J. Annotation articular cartilage - to repair or not to repair.  J Bone Joint Surg. 2000;  82 165-166
    CrossrefPubMedGoogle Scholar
  • 6 Bouwmeester S JM, Beckers J MH, Kuijer R, v. d. Linden A J, Bulstra S K. Long-term results of rib perichondrial grafts for repair of cartilage defects in the human knee.  Int Orthop. 1997;  21 313-317
    CrossrefPubMedGoogle Scholar
  • 7 Bouwmeester P, Kuijer R, Terwindt-Rouwenhorst E, v. d. Linden T, Bulstra S. Histological and biochemical evaluation of perichondrial transplants in human articular cartilage defects.  J Orthop Res. 1999;  17 843-849
    CrossrefPubMedGoogle Scholar
  • 8 Bouwmeester P, Kuijer R, Homminga G N, Bulstra S K, Geesink R GT. A retrospective analysis of two prospective cartilage repair studies: perichondrial grafting versus subchondral drilling 10 years post-surgery.  J Orthop Res. 2002;  20 267-273
    CrossrefPubMedGoogle Scholar
  • 9 Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaaksson O, Peterson L. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation.  N Engl J Med. 1994;  331 889-895
    CrossrefPubMedGoogle Scholar
  • 10 Bruns J, Kersten P, Lierse W, Silbermann M. Autologous rib perichondrial grafts in experimentally induced osteochondral lesions in the sheep-knee joint: morphological results.  Virchows Arch A Pathol Anat. 1992;  421 1-8
    PubMedGoogle Scholar
  • 11 Bruns J, Kersten P, Lierse W, Weiss A, Silbermann M. The in vitro influence of different culture conditions on the potential of sheep rib perichondrium to form hyaline-like cartilage.  Virchows Arch . 1994;  424 169-175
    PubMedGoogle Scholar
  • 12 Bruns J, Kersten P, Silbermann M, Lierse W. The cartilage flow-phenomen and its evidence in perichondrial grafting.  Arch Orthop Trauma Surg. 1997;  116 66-73
    PubMedGoogle Scholar
  • 13 Bulstra S K, Homminga G N, Buurman W A, Terwindt-Rouwenhorst E, v. d. Linden A J. The potential of adult human perichondrium to form hyalin cartilage in vitro.  J Orthop Res. 1990;  8 328-335
    CrossrefPubMedGoogle Scholar
  • 14 Carranza-Bencano A, Perez-Tinao M, Ballesteros-Vazquez P, Armas-Padron J R, Hevia-Alonso A, Martos Crespo F. Comparative study of the reconstruction of articular cartilage defects with free costal perichondrial grafts and free tibial periosteal grafts: an experimental study on rabbits.  Calcif Tissue Int. 1999;  65 402-407
    CrossrefPubMedGoogle Scholar
  • 15 Dounchis J S, Coutts R D, Amiel D. Cartilage repair with autogenic perichondrium cell/polylactic acid grafts: a two-year study in rabbits.  J Orthop Res. 2000;  18 512-513
    CrossrefPubMedGoogle Scholar
  • 16 Dounchis J S, Bae W C, Chen A C, Sah R L, Coutts R D, Amiel D. Cartilage repair with autogenic perichondrium cell and polylactic acid grafts.  Clin Orthop. 2000;  377 248-264
    PubMedGoogle Scholar
  • 17 Coutts R D, Woo S LY, Amiel D, von Schroeder H P, Kwan M K. Rib perichondrial autografts in full-thickness articular cartilage defects in rabbits.  Clin Orthop. 1992;  275 263-273
    PubMedGoogle Scholar
  • 18 Hangody L, Kish G, Karpati Z, Szerb I, Udarhelyi I. Arthroscopic autogenous osteochondral mosaicplasty for the treatment of femoral condylar articular defects.  Knee Surg Sports Traumatol Arthroscopy. 1996;  5 262-267
    PubMedGoogle Scholar
  • 19 Hangody L, Sükösd L, Szabó Z S. La réparation cartilagineuse. Cartilage defects repair.  Rev chir orthop. 1999;  85 846-857
    PubMedGoogle Scholar
  • 20 Homminga G N, v. d. Linden T J, Terwindt-Rouwenhorst E W. Repair of articular defects by perichondrial grafts.  Acta Orthop Scand. 1989;  60 326-329
    PubMedGoogle Scholar
  • 21 Homminga G N, Bulstra S K, Bouwmeester P SM, v. d. Linden A J. Perichondrial grafting for cartilage lesions of the knee.  J Bone Joint Surg. 1990;  72-B 1003-1007
    PubMedGoogle Scholar
  • 22 Homminga G N, Buma P, Koot H WJ, Kraan P M, Berg W B. Chondrocyte behavior in fibrin glue in vitro.  Acta Orthop Scand. 1993;  64 441-445
    PubMedGoogle Scholar
  • 23 Imhoff A, Minotti O, Schreiber A. 15 Jahresresultate nach konservativer und operativer Behandlung der Osteochondrosis dissecans am Knie.  Arthroskopie. 1992;  5 10-18
    PubMedGoogle Scholar
  • 24 Korkala O, Kuokkanen H. Autoarthroplasty of knee cartilage defects by osteoperiosteal grafts.  Arch Orthop Trauma Surg. 1995;  114 253-256
    PubMedGoogle Scholar
  • 25 Lindahl A, Brittberg M, Peterson L. Health economics benefits following autologous chondrocyte transplantation for patients with focal chondral lesions of the knee.  Knee Surg Sports Trauamtol Arthrosc. 2001;  9 358-363
    CrossrefPubMedGoogle Scholar
  • 26 Lorentzon R, Alfredson H, Hildingson C. Treatment of deep cartilage defects of the patella with periosteal transplantation.  Knee Surg Sports Traumatol Arthrosc. 1998;  6 202-208
    CrossrefPubMedGoogle Scholar
  • 27 Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale.  Am J Sports Med. 1982;  10 150-155
    CrossrefPubMedGoogle Scholar
  • 28 Messner K, Maletius W. The long-term prognosis for severe damage of weight-bearing cartilage in the knee.  Acta Orthop Scand. 1996;  67 165-168
    PubMedGoogle Scholar
  • 29 Niedermann B, Boe S, Lauritzen J, Rubak J M. Glued periosteal grafts in the knee.  Acta Orthop Scand. 1985;  56 457-460
    PubMedGoogle Scholar
  • 30 O’Driscoll S W, Recklies A D, Poole A R. Chondrogenesis in periosteal explants.  J Bone Joint Surg. 1994;  76 1042-1051
    PubMedGoogle Scholar
  • 31 O'Driscoll S W. The healing and regeneration of articular cartilage.  J Bone Joint Surg. 1998;  80 1795-1812
    PubMedGoogle Scholar
  • 32 Pastacaldi P, Engkvist O. Perichondrial wrist arthroplasty in rheumatoid patients.  The Hand. 1979;  11 184-190
    PubMedGoogle Scholar
  • 33 Ranawat C S, Insall J, Shine J. Duo-condylar knee arthroplasty: hospital for special surgery design.  Clin Orthop. 1976;  120 76-82
    PubMedGoogle Scholar
  • 34 Ritsilä V, Santavirta S, Alhopura S, Poussa M, Jaroma H, Rubak J M, Eskola A, Hoikka V, Snellmann O, Österman K. Periosteal and perichondral grafting in reconstructive surgery.  Clin Orthop. 1994;  302 259-265
    PubMedGoogle Scholar
  • 35 Serradge H, Kutz J A, Kleinert H E, Lister G D, Wolff T W, Atasoy E. Perichondrial resurfacing arthroplasty in the hand.  J Hand Surg. 1984;  9 880-886
    PubMedGoogle Scholar
  • 36 Tapper E M, Hoover N W. Late results after meniscectomy.  J Bone Joint Surg. 1969;  51 517-526
    PubMedGoogle Scholar
  • 37 Tizzoni G. Sulla istologica normale e patologica delle cartilagini ialine.  Arch Sci Med. 1978;  2 27-102
    PubMedGoogle Scholar
  • 38 Upton J, Sohn S A, Glowacki J. Neocartilage derived from transplanted perichondrium: What is it?.  Plast Reconstr Surg. 1981;  68 166-174
    PubMedGoogle Scholar
  • 39 Woo S LY, Kwan M, Lee T Q, Field F P, Kleiner J B, Coutts R D. Perichondrial autograft for the articular cartilage. Shear modulus of neocartilage studied in rabbits.  Acta Orthop Scand. 1987;  58 510-515
    PubMedGoogle Scholar

Prof. Dr. J. Bruns, M.D.

Dept. of Orthopaedic Surgery · University of Hamburg

Martinistraße 52 · 20246 Hamburg · Germany ·

Phone: +49 40 42803 3670

Fax: +49 40 42803 5018

Email: j.bruns@uke.uni-hamburg.de

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