Treatment of large osteochondral defects in the knee with partial condylar transfer (SS-45)

This is a long-term follow-up study of about 53 patients over 5 to 15 years. Treatment of large and deep osteochondral lesions is very demanding. We use large autogenous osteochondral grafts from the most posterior partsof the lateral and medial femoral condyles as a partial condylar transfer (PCT). If necessary additional smaller grafts of the trochlea patellae can be used. Harvesting is done by a diamond cutting device. Between 1986 and 1996 we operated 53 patients with large osteochondral defects of the femoral condyles. Postoperative ingrowth control was done by MRI in all cases after 6 and 12 weeks. Only 1 case developed a wide necrosis of the transplants and had to be revised. This complication was due to technical error. Two cases showed small subchondral cysts of no clinical evidence. Clinical evaluation of the long-term follow-up was done by the Standard Cartilage Evaluation Form of the ICRS. More than 90% of the patients showed a significant improvement compared to the preoperative data. There was no morbidity of the posterior harvest side whereas the harvest side in the anterior parts cases problems in a few cases. The Kellgren and Lawrence Score was used for X-ray evaluation. There was only a mild degenerative progression in most of the cases. Patients with varus or valgus deformity showed more progression than those patients without malalignment. Advantage of our method is the possibility of immediate full weight bearing, little harvest morbidity and excellent long-term results.