Keeling John J, Gwinn David E, McGuigan Francis X
Department of Orthopaedics and Rehabilitation, National Naval Medical Center, 8901 Wisconsin Ave, Bethesda, MD 20889, USA.
Knee. 2009 Dec;16(6):458-62. doi: 10.1016/j.knee.2009.02.010. Epub 2009 Apr 9.
Osteochondral autograft transfer is a technique for treatment of traumatic and degenerative cartilage lesions. A graft in which the cartilage cap is oriented perpendicular to the long axis of the graft is ideal because it can both restore the cartilage tidemark and minimize articular step-off at the recipient site. This study determines if osteochondral harvest technique (arthroscopic versus mini-open) or donor site location affects suitable graft harvest. One hundred and twenty eight osteochondral grafts were harvested in 16 cadaver knees utilizing a 7 mm OATS chisel from four donor sites: lateral supracondylar ridge, lateral femoral condyle, lateral intercondylar notch and medial femoral condyle. Mini-open and arthroscopic harvesting techniques were equally employed. Radiographic methods were used to analyze graft perpendicularity. Statistical analysis comparing graft suitability based on technique and donor site location was performed. There were no statistically significant differences (p>0.05) in graft suitability regardless of the technique used or donor site location. 69% of arthroscopic and 56% of mini-open graft harvest were considered suitable, possessing a cartilage cap and graft axis angle that would create less than 1 mm of articular incongruity. Incongruity results when the angle between the subchondral bone plug long axis and cartilage interface is greater than 74 degrees . There is no difference in the quality of osteochondral grafts harvested from the knee regardless of technique or donor site used. Osteochondral graft diameter should be kept at or less than 7 mm because of the high percentage of unacceptable grafts with increasing chisel sizes.
自体骨软骨移植是一种治疗创伤性和退行性软骨损伤的技术。软骨帽与移植体纵轴垂直的移植体是理想的，因为它既能恢复软骨潮标，又能使受体部位的关节台阶最小化。本研究确定骨软骨获取技术（关节镜下与小切口）或供体部位是否会影响合适移植体的获取。使用7毫米骨软骨移植系统（OATS）凿子从四个供体部位（外侧髁上嵴、外侧股骨髁、外侧髁间切迹和内侧股骨髁）在16具尸体膝关节中获取了128个骨软骨移植体。小切口和关节镜获取技术的使用频率相同。采用放射学方法分析移植体的垂直度。对基于技术和供体部位的移植体适宜性进行了统计分析。无论使用何种技术或供体部位，移植体适宜性均无统计学显著差异（p>0.05）。69%的关节镜下获取的移植体和56%的小切口获取的移植体被认为是合适的，其软骨帽和移植体轴角造成的关节不匹配小于1毫米。当软骨下骨栓纵轴与软骨界面之间的角度大于74度时会出现不匹配。无论采用何种技术或供体部位，从膝关节获取的骨软骨移植体质量均无差异。由于随着凿子尺寸增大，不可接受移植体的比例较高，骨软骨移植体直径应保持在7毫米或更小。
