AUTOARTHROPLASTY OF KNEE CARTILAGE DEFECTS BY OSTEOPERIOSTEAL GRAFTS

Five fresh osteochondral fractures of the knee, which could not be fix ed because of extensive fragmentation, were treated by excision of the fragments and reconstruction of the joint surface defect by an autoge nous osteoperiosteal graft. The procedure was also used for joint surf ace reconstruction in sclerotic osteochondritis of the femoral condyle (nine knees) and grave patellofemoral chondromalacia (three knees). P laster cast immobilization for 3 weeks was used in the two early cases . In all other cases, we employed a passive motion apparatus for 2 day s postoperatively, followed by active mobilization in a knee brace wit h extension-flexion 30 to 90 degrees (femoral condyle reconstruction) or 0 to 45 degrees (patellar reconstruction). Gradual free movements w ere started 3 weeks postoperatively, The results after 1.5 to 6.5 year s were satisfactory in all but one case. One arthroscopic removal of t he loose graft was performed, as were two arthroscopic graft margin sh avings, Three other reoperations were unrelated to the osteoperiosteal reconstruction. It appears that periosteal reconstruction should be c onsidered in local osteochondral lesions, where excision of the injure d cartilage is mandatory. The results were best in fresh trauma cases and younger people.