«Efectos de pequeños defectos en un modelo, en oveja, de autotrasplante osteocondra.»
Fred S. Huang, MD*, Peter T. Simonian, MD, Anthony G. Norman and John M. Clark, MD, PhD,
From the * Valley Orthopaedic Associates, Renton, Washington, Simonian Sports Medicine Clinic, Fresno, California, and Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
Exact reconstruction of an osteochondral defect by autogenous transplantation (mosaicplasty) is difficult given the variation in joint surface contour. Clinical and experimental studies do not show the extent to which incongruity can be tolerated in autografting.
Grafted articular cartilage will hypertrophy to correct the incongruity created by recession of the transplanted surface.
Controlled laboratory study.
To test the response of grafts to incongruities, osteochondral autografts were transplanted from the trochlea to the femoral condyle in adult male sheep stifle joints. In groups of 6 animals, graft surfaces were placed flush, countersunk 1 mm or countersunk 2 mm, then histologically analyzed 6 weeks after surgery. Cartilage thickness, condition of the articular surfaces, and preservation of hyaline characteristics were the primary features compared.
Bony union, vascularization, and new bone formation were present in all grafts. Cartilage-to-cartilage healing did not occur. In flush specimens, cartilage changed minimally in thickness and histologic architecture. The specimens countersunk 1 mm demonstrated significant cartilage thickening (54.7% increase, P <.05). Chondrocyte hyperplasia, tidemark advancement, and vascular invasion occurred at the chondroosseous junction, and the surface remained smooth. Cartilage necrosis and fibrous overgrowth were observed in all grafts countersunk 2 mm.
Minimally countersunk autografts possess a capacity for remodeling that can correct initial incongruities while preserving hyaline characteristics. Grafts placed deeper do not restore the contour or composition of the original articular surface.
If preservation of normal hyaline cartilage is the objective, thin grafted articular cartilage can remodel, but the tolerance for incongruity is limited and probably less than that reported for an intra-articular fracture.
The American Journal of Sports Medicine 32:1842-1848 (2004).