A Prospective Clinical and Radiological Assessment of Osteochondral Autograft Transfer for International Cartilage Repair Society Grade IV Osteochondral Lesions of the Knee.

Abstract

Introduction: Focal International Cartilage Repair Society (ICRS) Grade IV osteochondral lesions of the knee lead to pain, mechanical symptoms, and functional limitations in young active individuals. Osteochondral autograft transfer (OATS) repairs both hyaline cartilage and subchondral bone. This study assessed the clinical and radiological results of OATS in isolated Grade IV knee lesions.

Materials and methods: This prospective cohort study involved 38 patients aged 15-40 years with isolated ICRS Grade IV osteochondral defects spanning 2.0-4.0 cm2. Out of these, 35 patients completed an 18-month follow-up. We evaluated functional outcomes using the Lysholm knee score, International Knee Documentation Committee (IKDC) subjective score, and Tegner activity scale before surgery and at 6, 12, and 18 months postoperatively. In addition, serial magnetic resonance imaging (MRI) scans were performed to monitor graft integration, surface alignment, structural issues, and degenerative changes.

Results: The average age was 25.8 ± 5.6 years, with 76.3% being male. After 18 months, patients showed significant improvements: Lysholm scores increased from 50.29 ± 10.90 to 93.03 ± 4.11, IKDC scores from 48.29 ± 9.45 to 91.24 ± 4.55, and Tegner scores from 2.40 ± 0.60 to 8.71 ± 0.75. These improvements were statistically significant (P < 0.001). MRI results indicated graft healing in all patients, with 91.4% showing congruent articular surfaces and 8.6% exhibiting cystic degeneration or delamination. No graft failures or donor-site complications were observed.

Conclusion: OATS achieved significant, lasting functional gains with consistent graft integration in carefully selected young patients suffering from moderate-sized isolated ICRS grade IV knee lesions, endorsing its effectiveness as a joint-preserving treatment option.