Oslo Sports Trauma Research Center

Intoduction

This article presents the first long-term follow-up case report in which autologous chondrocyte transplantation was performed in a distal tibial chondral lesion. The authors found this technique to be a promising treatment option for young patients with massive chondral and osteochondral lesions in the ankle joint.

Full thickness chondral injury to the articular surface is considered a risk factor for more extensive joint damage because articular cartilage has very limited intrinsic healing capacity. To prevent early joint degeneration, various surgical treatments have been performed for cartilage injuries.

Recently, autologous chondrocyte transplantation has been gaining much attention in the orthopedic field. Although there are many reports on autologous chondrocyte transplantation to repair osteochondral defects of the knee, much less is known about the clinical outcome of this method for the treatment of distal tibial chondral and osteochondral lesions.

In this case report, a 13-year-old female sustained an axial twisting load through the right foot in a fall. As a result, she sustained a fracture of the distal fibula and an intraarticular fracture of the tibial plafond. Nine months after primary surgery, X-rays of her right ankle at this time showed joint space narrowing, although bone union was achieved.

The patient had severe pain and reduced function, but she did not consent to arthrodesis. After 24 months a cartilage biopsy specimen was harvested from the outer edge of the superior medial femoral condyle of the ipsilateral knee joint under arthroscopy, and after cultivating chondrocytes for 4 weeks the transplantation was performed. The size of the defect of articular cartilage was appx. 75% of the joint surface of the tibial plafond. An ankle brace was applied immediately after surgery and restricted range-of-motion exercise (from –10° to 10°) was started. Full weight bearing was permitted from 10 weeks after surgery.

Although she experienced pain in her right ankle joint for 18 months, the ankle pain decreased by degrees and she returned to recreational sports at 24 months after autologous chondrocyte transplantation. At 8 years after surgery, she had no pain in her daily activities.

The authors found the clinical outcome of 8-year follow-up to be very encouraging. However, it was emphasized that longer follow-up is necessary in order to fully assess the advantages of this procedure.

First author of this study is Atsuo Nakamae, who was a visiting researcher at Oslo Sports Trauma Research Center 2004-2005. The study was co-authored by Lars Engebretsen (OSTRC) and Lars Peterson (University of Gothenburg).