Mega-OATS of the knee without specialised instrumentation: a low-cost option for large cartilage defects in a resource-restrained environment

Authors

Keywords:

Mega-OATS, osteochondral lesion knee, osteochondral autograft, resource restraint

Abstract

Background: A 26-year-old patient presented to a specialised knee clinic in a public hospital with ongoing pain after having sustained a soccer injury six years prior. A large osteochondral defect of the dista medial femoral condyle was diagnosed. Due to resource limitations, fresh allograft or a large osteochondral autograft transplantation system (Mega-OATS) workbench was unavailable.

Case report: A Mega-OATS cartilage transplantation was done, using the patient’s posteromedial femoral condyle as donor tissue, and transplanted to the defect in the distal femoral condyle, a technique that has been well documented and followed up. At six weeks postoperatively, an MRI showed early incorporation of the graft tissue. Clinical outcomes were excellent at one year follow-up with the EQ-5D 5L score 11111, the Knee Injury and Osteoarthritis Outcome Score (KOOS-PS) 100%, and the Lysholm score also 100%. Radiographs at one year confirmed an unchanged graft position and showed no signs of osteoarthritis.

Discussion: Large osteochondral lesions in the knee (> 4 cm2) are challenging to treat, and the most commonly used modalities are fresh osteochondral allograft (OCA) or autologous chondrocyte implantation (ACI). Mega-OATS of the knee has previously been described but is not commonly used due to the requirement of a specialised and expensive workbench, and fear of morbidity at the donor site.

Conclusion: Mega-OATS of the knee is possible without a specialised workbench or tools and had good clinical outcomes at two-year follow-up of the patient.

Level of evidence: Level 5

Author Biographies

Johan le Roux, University of Cape Town

Department of Surgery, Division of Orthopaedic Surgery, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa

Richard von Bormann, Netcare Christiaan Barnard Hospital

Netcare Christiaan Barnard Hospital, Cape Town, South Africa

Sepp Braun, Orthopedic Sports Medicine and Injury Prevention

Gelenkpunkt UMIT, Research Unit for Orthopedic Sports Medicine and Injury Prevention, Innsbruck, Austria

Andreas B Imhoff, Technical University of Munich

Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany

Michael Held, University of Cape Town

Department of Surgery, Division of Orthopaedic Surgery, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa

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Published

2022-05-19

Issue

Section

Knee

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