Is there an option for harvesting autologous osteochondral grafts without damaging weight-bearing areas in the knee joint?

Within the past few years autologous osteochondral transplantation has beco me an established standardized procedure in joint surgery. One significant disadvantage of this technique is the harvesting of the osteochondral graft s from the weightbearing area of the knee joint. The tibiofibular articulat ion is located close to the knee joint that is operated on. This articulati on is covered with cartilage. The purpose of this study was to evaluate whe ther this joint is suitable as a donor site for osteochondral grafts. Ten h uman knee specimens were freed of all soft tissues around the proximal calf . The age of the specimens ranged between 58 and 79 years. Next the tibiofi bular articulation was identified, and both the ligaments and the capsule w ere removed. After opening the joint the tibial- and fibular-sided joint su rfaces were inspected and measured. In all specimens the articular surfaces showed good cartilage coverage. In only a single joint did the cartilage m acroscopically show degeneration. In all other joints the cartilage surface was in surprisingly good condition, especially considering the age of the specimens. The average diameter of the cartilage surface on the tibial side was 1.7 +/- 0.26 x 1.9 +/- 0.22 cm and on the fibular side 1.6 +/- 0.31 x 1.8 +/- 0.32 cm. This results in an area of cartilage for transplantation o f 3.23 cm(2) at the tibia and of 2.88 cm(2) at the fibula. The total area f or cartilage transplantation is 6.11 cm(2). The tibiofibular joint contains cartilage, which may be a reasonable donor site even for the elderly patie nt. Harvesting the graft from this area may avoid iatrogenic damaging of in tra-articular weight-bearing cartilage of the knee joint.