Autologous Osteochondral Transplantation to Treat Patellar Chondral Injuries

Introduction Autologous osteochondral transplantation for the treatment of patellar chondral injuries is a single-stage procedure through a single surgical approach that allows replacement of the chondral injury with an osteochondral plug that has the same cartilaginous hyaline characteristics as the site had before the injury. Step 1 Preoperative Planning Make radiographs (anteroposterior, lateral, and Merchant patellofemoral views), computed tomography scans, and magnetic resonance imaging (MRI) of the knee for an anatomic study and to determine cartilage lesion details. Step 2 Perform Knee Arthroscopy and Lesion Identification Classify and locate the cartilage lesion on the basis of the intraoperative arthroscopic knee evaluation. Step 3 Use a Parapatellar Approach Perform a parapatellar incision and patellar eversion as they are necessary to access cartilage lesions. Step 4 Harvest the Osteochondral Plug at the Donation Site Harvest an appropriate osteochondral graft, which is essential for a successful procedure. Perpendicular graft harvesting is crucial for a perfect cartilage surface match. Step 5 Characterize and Prepare the Lesion At this point, prepare the receptor area with a power drill. Step 6 Insert the Osteochondral Plug into the Receptor Site Insert the graft with press-fit fixation. Step 7 Postoperative Care Instruct all patients to follow a rehabilitation protocol. Results Our clinical experience with this procedure has corresponded to the scores and MRI-based findings in our original study, in which we prospectively evaluated thirty-three knees in patients who underwent autologous osteochondral transplantation for a symptomatic full-thickness cartilaginous injury on the patellar articular surface.IndicationsContraindicationsPitfalls & Challenges.