Autologous osteochondral transplantation for the treatment of knee lesions: results and limitations at two years' follow-up.

Focal chondral and osteochondral knee lesions are a common condition, particularly hard to treat, and often involve young active patients with high expectations in terms of symptomatic relief and return to sports. Autologous osteochondral transplantation allows the defect area to be restored with hyaline cartilage. The aim of this study is to analyse whether it represents a safe and effective treatment option for small-medium-sized knee chondral and osteochondral lesions in a young and active population.Thirty-one patients (18 men, 13 women; mean age 32 ± ten; mean BMI 24 ± 3) affected by focal knee chondral and osteochondral lesions were enrolled and treated with autologous osteochondral transplantation. They were prospectively followed-up for 24 months with the IKDC-subjective, IKDC-objective, and Tegner scores. Adverse events and failures were also reported, as well as the Bandi score to detect symptoms from the donor area.A significant increase was reported in all the clinical scores adopted. In particular, the IKDC-subjective score increased from a basal value of 40.3 ± 16.2 to 62.6 ± 18.0 at the 12 months' evaluation, with a further significant increase up to 71.6 ± 20.5 at the final 24 months' follow-up (p < 0.0005). A positive trend was also found by analysing the IKDC-objective score. The Tegner score revealed a significant improvement from a basal value of 2.2 ± 1.8 to 3.7 ± 1.5 at the final evaluation (p = 0.003), although it was not possible to regain the same pre-injury sports activity level of 5.0 ± 2.2. Two failures were reported. The Bandi score revealed patients complaining of mild and moderate symptoms, not correlated to the lesion size. The presence of symptoms ascribable to the donor area was significantly correlated with a lower clinical outcome.Autologous osteochondral transplantation proved to be, at short-term evaluation, a suitable option to treat small-medium sized chondral and osteochondral lesions. However, clinical improvement is slow and a significant percentage of patients develop symptoms attributable to the donor area, thus reducing the overall benefit of this procedure.