eMedicine Specialties > Orthopedic Surgery > Knee

Osteochondral Grafting of Articular Cartilage Injuries: Multimedia

Author: Andrew Turtel, MD, Clinical Adjunct Professor, Department of Orthopedic Surgery, Beth Israel Medical Center
Contributor Information and Disclosures

Updated: May 15, 2009

Multimedia

Lesions of the femoral condyle up to 8.5 cm2 have...
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Media file 1: Lesions of the femoral condyle up to 8.5 cm2 have been filled by up to 19 cylindrical osteochondral plugs measuring 4.5-6.5 mm in diameter. However, 4 cm2 appears to be the upper limit for lesions in which reasonable results can be expected.
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Lesions of the femoral condyle up to 8.5 cm2 have...

Lesions of the femoral condyle up to 8.5 cm2 have been filled by up to 19 cylindrical osteochondral plugs measuring 4.5-6.5 mm in diameter. However, 4 cm2 appears to be the upper limit for lesions in which reasonable results can be expected.

Strong data support the ability of cancellous bon...
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Media file 2: Strong data support the ability of cancellous bone plugs to heal, whether the recipient holes have been drilled, trephined, or cored.
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Strong data support the ability of cancellous bon...

Strong data support the ability of cancellous bone plugs to heal, whether the recipient holes have been drilled, trephined, or cored.

Biopsy studies have shown the ability of transpla...
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Media file 3: Biopsy studies have shown the ability of transplanted cartilage to survive if placed in a mechanically advantageous position.
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Biopsy studies have shown the ability of transpla...

Biopsy studies have shown the ability of transplanted cartilage to survive if placed in a mechanically advantageous position.

The relative inability to resurface the entire de...
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Media file 4: The relative inability to resurface the entire defect area is a persisting concern.
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The relative inability to resurface the entire de...

The relative inability to resurface the entire defect area is a persisting concern.

Hangody has shown that at 8 weeks postoperatively...
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Media file 5: Hangody has shown that at 8 weeks postoperatively, the areas between the cartilage interfaces seal with fibrocartilage that is generated from the abraded subchondral area.
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Hangody has shown that at 8 weeks postoperatively...

Hangody has shown that at 8 weeks postoperatively, the areas between the cartilage interfaces seal with fibrocartilage that is generated from the abraded subchondral area.

The lesion is measured in an attempt to estimate ...
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Media file 6: The lesion is measured in an attempt to estimate the number and sizes of grafts that will appropriately fill the lesion. An instrument with a known size (generally supplied in the instrumentation) allows for accurate measurement of the lesion.
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The lesion is measured in an attempt to estimate ...

The lesion is measured in an attempt to estimate the number and sizes of grafts that will appropriately fill the lesion. An instrument with a known size (generally supplied in the instrumentation) allows for accurate measurement of the lesion.

Once the size of the grafts and the number of eac...
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Media file 7: Once the size of the grafts and the number of each size graft are determined, harvesting begins. Typically, harvest sites include the superior trochlear ridge and the intercondylar notch area.
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Once the size of the grafts and the number of eac...

Once the size of the grafts and the number of each size graft are determined, harvesting begins. Typically, harvest sites include the superior trochlear ridge and the intercondylar notch area.

Best-fit scenario. Each circle has a surface area...
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Media file 8: Best-fit scenario. Each circle has a surface area of pr2. The total surface area of the 4 circles = 4pr2 = 4p(0.25 cm)2 = 0.785 cm2. The total coverage of the square surface is therefore 0.785 cm2/1 cm = 78.5%.
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Best-fit scenario. Each circle has a surface area...

Best-fit scenario. Each circle has a surface area of pr2. The total surface area of the 4 circles = 4pr2 = 4p(0.25 cm)2 = 0.785 cm2. The total coverage of the square surface is therefore 0.785 cm2/1 cm = 78.5%.

After identification of the lesion, all cartilage...
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Media file 9: After identification of the lesion, all cartilage is removed down to the subchondral bone. The edges of the lesion are taken back to areas of well-attached hyaline cartilage. Abrasion of exposed subchondral bone.
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After identification of the lesion, all cartilage...

After identification of the lesion, all cartilage is removed down to the subchondral bone. The edges of the lesion are taken back to areas of well-attached hyaline cartilage. Abrasion of exposed subchondral bone.

Verification of lesion size using known sizers in...
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Media file 10: Verification of lesion size using known sizers in order to determine size and number of grafts needed.
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Verification of lesion size using known sizers in...

Verification of lesion size using known sizers in order to determine size and number of grafts needed.

Graft harvest. Perpendicular access is critical.
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Media file 11: Graft harvest. Perpendicular access is critical.
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Graft harvest. Perpendicular access is critical.

Graft harvest. Perpendicular access is critical.

Graft insertion.
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Media file 12: Graft insertion.
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Graft insertion.

Graft insertion.

Intraoperative arthroscopic mosaicplasty. Healed ...
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Media file 13: Intraoperative arthroscopic mosaicplasty. Healed mosaicplasty viewed arthroscopically 4 years after implantation.
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Intraoperative arthroscopic mosaicplasty. Healed ...

Intraoperative arthroscopic mosaicplasty. Healed mosaicplasty viewed arthroscopically 4 years after implantation.

More on Osteochondral Grafting of Articular Cartilage Injuries

Overview: Osteochondral Grafting of Articular Cartilage Injuries
Workup: Osteochondral Grafting of Articular Cartilage Injuries
Treatment: Osteochondral Grafting of Articular Cartilage Injuries
Follow-up: Osteochondral Grafting of Articular Cartilage Injuries
Multimedia: Osteochondral Grafting of Articular Cartilage Injuries
References
Further Reading
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References

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Keywords

articular cartilage injury, osteochondral grafts, OATS, osteoarticular transfer surgery, osteochondral pathology, partial-thickness cartilage injuries, full-thickness cartilage injuries, knee injuries, degenerative arthrosis, knee joint arthrosis, articular disorders of the patellofemoral joint, trochlear replacement systems, articular cartilage lesions, osteochondral lesions, hyaline cartilage defects

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Contributor Information and Disclosures

Author

Andrew Turtel, MD, Clinical Adjunct Professor, Department of Orthopedic Surgery, Beth Israel Medical Center
Andrew Turtel, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Albert W Pearsall IV, MD, Associate Professor, Department of Orthopedic Surgery, University of South Alabama; Director, Section of Sports Medicine and Shoulder Service, Department of Orthopedic Surgery, University of South Alabama Medical Center
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Thomas M DeBerardino, MD, Director, John A Feagin, Jr, Sports Medicine Fellowship at West Point, Associate Professor of Orthopedic Surgery, Uniformed Services University of the Health Sciences and Keller Army Community Hospital
Thomas M DeBerardino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, and American Orthopaedic Society for Sports Medicine
Disclosure: Arthrex, Inc. Grant/research funds Other; Arthrex, Inc. Honoraria Speaking and teaching; Genzyme Biosurgery. Inc. Grant/research funds Other; Musculoskeletal Transplant Foundation Grant/research funds Other; Histogenics Grant/research funds None; Arthrex, Inc. Consulting fee Speaking and teaching

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Carlos J Lavernia, MD, FAAOS, Adjunct Clinical Professor, Department of Orthopedic Surgery, University of Miami School of Medicine; Medical Director, Orthopedic Institute at Mercy Hospital
Carlos J Lavernia, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Hip and Knee Surgeons, Arthritis Foundation, Biomedical Engineering Society, Florida Orthopaedic Society, and Orthopaedic Research Society
Disclosure: Zimmer Stock Implant Designer

 
 
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