Effect of graft positioning on dissipated energy in knee osteochondral autologous transplantation—A biomechanical study

Abstract

Focal cartilage defects can be treated by osteochondral autologous transplantation (OAT). High congruence of the graft with the surrounding cartilage structure is essential for a good clinical outcome, but can not always be achieved. We recently established a method to measure dissipated energy (DE) as a friction parameter in knee joints. We now investigated how autograft harvesting and implant positioning affect the DE during knee motion. Six sheep knee joints were cyclically motioned under 400 N axial load. During the cyclic motion, the flexion angle and the respective torque were recorded and the DE was calculated. Several experimental conditions were tested: first, the DE was measured after approach had been performed (“native”). Subsequently, a cylinder was removed from the medial femur condyles and a donor cylinder was inserted from an unloaded site in four different transplant positions: even, 1 mm deeper, 1 mm higher, and flush without cartilage (defect). No significant changes in friction were observed between the native knee and an even or deep OAT positioning. We, however, found a small but significant increase in DE between the “native” and “1 mm high” formations (ΔDE compared with native = 14 mJ/cycle; P =.004 after data normalization) and a large increase in defect situation (ΔDE compared with native = 119 mJ/cycle; P =.001). Considering the long-term therapeutic aim that is pursued when performing OAT, elevated graft positioning should clearly be avoided. From a biomechanical point of view, donor site morbidity after cylinder harvest can be neglected.