Bulletin of the Hospital for Joint Diseases
Volume 63, Numbers 1 & 2
2005
37
Osteochondral Multiple Autograft Transfer (OMAT)
for the Treatment of Cartilage Defects in the Knee
Joint
O. Sahap Atik, M.D., M. Murad Uslu, M.D., and Fatih Eksioglu, M.D.
Abstract
The ideal articular cartilage repair tissue should be
durable and well-integrated. We have been performing
osteochondral multiple autograft transfers (OMAT)
since 1996 with the experience we had using carbon
fiber implants. We call this technique OMAT instead of
mosaicplasty because we use uniform osteochondral
autografts.
Osteochondral multiple autograft transfer (OMAT) was
performed either by arthrotomy or arthroscopy on 12 patients (6 male and 6 female) for the treatment of cartilage
defects in the knee joint. The patients ranged in age from 20
to 63 years (mean: 38 years). All had weightbearing-related
pain or decrease in the range of motion. None had instability
or malalignment. The average follow-up time was 4 years
(range: 2 to 8 years).
Clinical results were satisfactory. All of the paients were
improved initially by the procedure and 85% are still pain
free. The mean Lysholm knee rating score was 56 points
preoperatively and 86 points postoperatively. Second-look
arthroscopy (five patients) demonstrated a normal shiny
appearance and color of the grafted area. We observed
slight joint effusion postoperatively that disappeared in two
months. There was no donor site morbidity.
OMAT is a promising surgical technique for the treatment
of articular cartilage defects. Long-term follow-up with more
patients and histological and biomechanical evaluation
of chondral interfaces are the subjects of our continuing
study.
O. Sahap Atik, M.D., is a professor in orthopaedic surgery, and
President of Turkish Joint Diseases Foundation, Ankara, Turkey.
M. Murad Uslu, M.D., and Fatih Eksiolu, M.D., are both associate professors in orthopaedic surgery, Medical School, Kirikkale
University, Turkey.
Correspondence: O. Sahap Atik, M.D., Bugday Sokak 6/27, Kavaklidere 06700, Ankara, Turkey.
n a recent study, 31,516 knee arthroscopies revealed
that chondral lesions were present in 63%, with an
average of 2.7 hyaline cartilage lesions per knee.1
The treatment of cartilage defects in the knee joint is
controversial. Most of the commonly used techniques
yield a repair tissue with unidentical histological and
biomechanical properties as the original. The ideal
articular cartilage repair tissue should be durable and
well-integrated. It should also provide a clinical improvement and eliminate or significantly postpone the need
for arthroplasty.
Arthroscopic lavage, arthroscopic debridement,
spongialization, arthroscopic abrasion arthroplasty, subchondral drilling, microfracture, and carbon-fiber matrix
applications promote the development of fibrocartilage.2
Applications of osteochondral autografts, fresh osteochondral allograft, periosteal arthroplasty, perichondrial
arthroplasty, and chondrocyte transplantation with or
without biodegradeable materials promote the development of the repair tissue resembling hyaline cartilage.2
Outerbridge and colleagues used osteochondral autografts for the treatment of osteochondritis dissecans.3
Hangody popularized mosaicplasty for larger cartilage
defects in the femoral condyle and patella.4
We have been performing a similar technique since
1996 with the experience we had using carbon fiber
implants (Fig. 1).5-10 We call this technique as osteochondral multiple autograft transfer (OMAT) instead
of mosaicplasty because we use uniform osteochondral
autografts.
Materials and Methods
Osteochondral multiple autograft transfer (OMAT) was
performed either by arthrotomy or arthroscopy on 12
patients (6 male and 6 female) for the treatment of cartilage defects in the knee joint. They ranged in age from
38
Bulletin of the Hospital for Joint Diseases Volume 63, Numbers 1 & 2
2005
Figure 1 Carbon fiber implants for the treatment of osteochondral
defect in femoral condyle (second-look arthroscopies in short- and
long-term follow-up).
Figure 2 The instruments used for the OMAT, an osteochondral
autograft, and the knees that had OMAT with arthrotomy.
Figure 3 Arthroscopic OMAT.
Figure 4 Preoperative and postoperative appearance in secondlook arthroscopy of donor site.
20 to 63 years (mean: 38 years). All had weightbearingrelated pain or decrease in the range of motion. None
had instability or malalignment.
During diagnostic arthroscopy, full-thickness craterlike chondral defects larger than 10 mm in diameter
(Outerbridge IV 11) located on the weightbearing area
of the femoral condyle (9 patients) or lateral femoral
condyle (one patient) or on the patella (two patients with
osteoarthritis, in conjunction with total knee arthroplasty)
were considered for OMAT (Figs. 2, 3, and 6). Up to
five osteochondral cylinders, 3.5 mm in diameter and 10
mm long, were used during these procedures (Fig. 2).
The grafts are taken by using the instruments that were
originally made for the removal of broken screws (Fig.
2). Donor site was either the lower weightbearing area
of the patellofemoral joint when arthrotomy was used or
the intercondylar notch area when arthroscopic surgery
was used (Fig. 4). When arthrotomy was used, the donor
site was the area of minimal weightbearing, and when
arthroscopic surgery was used, the donor site was the
Bulletin of the Hospital for Joint Diseases
Volume 63, Numbers 1 & 2
2005
39
Figure 5 Second-look arthroscopies in short- and long-term follow-up of femoral condyles that had OMAT.
intercondylar notch area (Fig. 4).
Full weightbearing was permitted in all patients in the
sixth postoperative week, but two patients with patellar
repair were permitted immediate weightbearing.
The average follow-up time was 4 years (range: 2 to
8 years).
Second-look arthroscopy (five patients) demonstrated
a normal shiny appearance and color of the grafted area
(Figs. 5 and 7).
We observed slight joint effusion postoperatively that
disappeared within two months. There was no donor site
morbidity.
Results
Discussion
Clinical results were satisfactory. All of the paients were
improved initially by the procedure, and 85% of them are
still pain free. The mean Lysholm knee rating score was
56 points preoperatively and 86 points postoperatively.
When we performed arthroscopic procedures including
lavage, debridement, abrasion arthroplasty, subchondral
drilling, or microfracture, these techniques provided
temporary pain relief in short-term followup.7 However,
most of long-term follow-up studies do not demonstrate
adequate pain relief, probably due to fibrocartilaginous
repair tissue that lacks the durability and the mechanical
properties of articular hyaline cartilage.2
We also used artificial matrix, carbon fiber scaffolds
to enhance ingrowth of repair fibrocartilage and to support the fibrocartilage.5, 6 We observed that carbon is well
tolerated by human tissues, and most of patients in our
series have experienced satisfactory results without adverse effects. However, poor results have been reported in
another study12; there was seeding of carbon debris within
synovium producing a histiocytic giant cell reaction, but
without any evidence of progressive synovitis.
Outerbridge first used osteochondral autografts for
the treatment of osteochondritis dissecans in the femur.3
But Hangody popularized mosaicplasty that provided
surgical treatment for larger cartilage defects.4 The histological analysis of transplanted cartilage demonstrates
Figure 6 OMAT in patella during total knee replacement.
Figure 7 Second-look arthroscopies of patellae that
had OMAT. The patella shown on the right had an
irregular surface.
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Bulletin of the Hospital for Joint Diseases Volume 63, Numbers 1 & 2
that the specimens were composed of 70% to 80% hyaline
cartilage. The biopsy at 4.5 years demonstrated normal
appearing chondrocytes, high glycosaminoglycan (GAG)
content, normal orientation of chondrocytes and matrix
elements, and matrix integration between the hyaline
and the fibrocartilage. The grafts are obtained from the
lower-weigtbearing periphery of the patellofemoral joint
or intercondylar notch area. The donor sites healed in a
manner similar to the sites when subchondral drilling is
used (Fig. 4).
Good or excellent (91%) results have been reported
at the 3-year followup.4 The success rate was 85% for
patellar cartilage defects. We obtained similar results in
our patients with a success rate of 85% at an average of
4-years followup. Osteochondral autografts may cause
donor site morbidity, but it seems to be well compensated in our patients and in other studies.13 This issue is
related to the size of the defect. For larger defects other
techniques should be considered.
OMAT is a promising surgical technique for the treatment of articular cartilage defects. Long-term follow-up
with more patients, and histological and biomechanical
evaluation of chondral interfaces are the subjects of our
continuing study.
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