Hunter 1743Hunter 1743

“ “ ... once violated ... articular ... once violated ... articular cartilage defects a troublecartilage defects a trouble

something ... they don’t heal !!!something ... they don’t heal !!!””

Chondral lesion on the Chondral lesion on the patellofemoral joint ispatellofemoral joint is

the main problem the main problem

in the sports traumatologyin the sports traumatology

BASIC PROBLEMS OF THE BASIC PROBLEMS OF THE ““osteochondral osteochondral autologous autologous

transplantationtransplantation”in the patellofemoral ”in the patellofemoral jointjoint

Donor sites should be relatively nonweight-bearing Donor sites should be relatively nonweight-bearing

surfaces which are limited in the knee jointsurfaces which are limited in the knee joint

Harvesting too big plugs, struggle the risk of Harvesting too big plugs, struggle the risk of

incongruency at the recipient siteincongruency at the recipient site

Increased patellofemoral pressure/patellar tilt-Increased patellofemoral pressure/patellar tilt-

subluxationsubluxation

SOLUTIONSOLUTION

Harvesting multiple smaller size plugsHarvesting multiple smaller size plugs

Implantation in Mosaicform to recipient siteImplantation in Mosaicform to recipient site

Lateral release, Fulkerson anteromedialization Lateral release, Fulkerson anteromedialization osteotomyosteotomy

AIMAIMReconstruction of the Reconstruction of the

joint surfacejoint surface

INDICATIONSINDICATIONS

1 – 3cm1 – 3cm22 IDEALIDEAL

Lesion Lesion typetype

Localized / Complete Localized / Complete

SizeSize

LocalizationLocalization Central faset Central faset

DONOR AREADONOR AREA

Both sites of the Both sites of the femoral trochlear femoral trochlear bordersborders

TECHNIQUETECHNIQUE

>5 mm from >5 mm from periphearyperipheary

DONOR AREADONOR AREA

>6mm gap >6mm gap between greftsbetween grefts

DONOR AREADONOR AREA Do not harvest any plug from tibiafemoral siteDo not harvest any plug from tibiafemoral site

Control each harvested plug for:Control each harvested plug for:

•Integrity •Fracture •Obliquity•Depth

DONOR AREADONOR AREA

RECIPIENT AREARECIPIENT AREA

Filling the defects as much as Filling the defects as much as with Hyaline cartilage can with Hyaline cartilage can reduce Fibrocartilage formationreduce Fibrocartilage formation

OATSOATS

PATELLAR DRILLING PATELLAR DRILLING

SUBCHONDRAL BONE İS TOO HARD TO SUBCHONDRAL BONE İS TOO HARD TO PREPARE WİTH OATS RECIPIENT PREPARE WİTH OATS RECIPIENT

INSTRUMENTSINSTRUMENTS

TRICKTRICKSSTake care the joint Take care the joint congruensy while congruensy while transfering plugstransfering plugs

Joint surface reconstruction is a challengeJoint surface reconstruction is a challenge

OAT + Fulkerson osteotomyOAT + Fulkerson osteotomy

CASE-1CASE-1

CASE-1CASE-1

CASE-2

CASE-2

CASE-2

CASE-3

CASE-3

CASE-4CASE-4

CASE-5CASE-5BB

CASE-6CASE-6

CASE-7CASE-7

CASE-7CASE-7

CONCLUSIONCONCLUSION

Donor site morbidity is a problemDonor site morbidity is a problem. Borders of the PF joint . Borders of the PF joint are accepted as relatively nonweight-bearing surfaces but are accepted as relatively nonweight-bearing surfaces but we don’t have any idea for long termwe don’t have any idea for long term

Short term results of OAT are promising,Short term results of OAT are promising,BUTBUT we don’t know whether these transplanted hyaline we don’t know whether these transplanted hyaline cartilage grafts prevent arthrosis for long term or not ???cartilage grafts prevent arthrosis for long term or not ???