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Donor-Site Morbidity After Osteochondral Autologous Transplantation for Lesions of the Talus
J. Paul, MD1; A. Sagstetter1; M. Kriner, PhD2; A.B. Imhoff, MD1; J. Spang, MD1; S. Hinterwimmer, MD1
1 Abteilung für Sportorthopädie, Klinikum rechts der Isar, TU München, Connollystrasse 32, 80809 München, Germany. E-mail address for J. Paul: jochen.paul@web.de. E-mail address for A. Sagstetter: andreas.sagstetter@mytum.de. E-mail address for A.B. Imhoff: A.Imhoff@lrz.tu-muenchen.de. E-mail address for J. Spang: jspang13@gmail.com. E-mail address for S. Hinterwimmer: Stefan.Hinterwimmer@lrz.tum.de
2 Institut für Medizinische Statistik und Epidemiologie, Klinikum rechts der Isar, Ismaninger Strasse 22, 81675 München, Germany. E-mail address: monika.kriner@tum.de
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at Abteilung für Sportorthopädie, Klinikum rechts der Isar, München, Germany

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Jul 01;91(7):1683-1688. doi: 10.2106/JBJS.H.00429
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Background: Autologous osteochondral transplantation is accepted as one of the major treatment options for cartilage defects of the talus. One disadvantage of this technique is the need to harvest a donor graft from a normal knee. The potentially detrimental effect of graft harvest on knee function remains unclear.

Methods: Two hundred patients who had transplantation of an autologous osteochondral graft obtained from an asymptomatic knee for the treatment of an osteochondral defect of the talus were evaluated. Of the 200 patients, 112 were followed for a minimum of two years (mean duration of follow-up, fifty-five months). The WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) and the Lysholm score were used to assess functional outcome. Variables that were examined included the number of grafts, total size of the harvested cylinders, patient age, body mass index, and overall satisfaction of the patient with the result of the procedure at the knee. A multiple linear regression analysis was utilized to determine the influence of each parameter on the WOMAC and Lysholm scores. In addition, the Lysholm scores for the entire patient group were reviewed to determine how long after the index surgery clinical improvement ceased.

Results: The mean postoperative WOMAC score (and standard deviation) for the 112 patients who had been followed for a minimum of two years was 5.5% ± 0.1%, and the mean postoperative Lysholm score was 89 ± 17 points. The number of grafts, the size of the transplanted cylinders, and patient age did not influence either the Lysholm or the WOMAC score. A higher body mass index and lower general satisfaction ratings did negatively influence the Lysholm and WOMAC scores. Gradual clinical improvement, as measured with the Lysholm score for all 200 study subjects, continued throughout the postoperative period.

Conclusions: Donor-site morbidity of a knee from which a graft has been harvested can potentially lead to functional impairment. In our study, the functional outcome of the knee was not affected by the number of donor grafts, the size of the donor grafts, or the age of the patient. Surgeons performing osteochondral transplantations and harvesting autografts from the knee should be aware of the potentially negative effect of a higher body mass index on clinical outcomes after surgery.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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