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

• Published in: SA Orthopaedic Journal Vol. 21; no. 2; pp. 106 - 110
• Main Authors: Le Roux, Johan, Von Bormann, Richard, Braun, Sepp, Imhoff, Andreas B, Held, Michael
• Format: Journal Article
• Language: English
• Published: Johannesburg Medpharm Publications 01.05.2022
• Subjects: Arthritis; Cartilage; Clinical outcomes; Health Care Sciences & Services; Knee; Mega-OATS; Orthopedics; Osteoarthritis; osteochondral autograft; osteochondral lesion knee; resource restraint; resource restraint; osteochondral lesion knee; osteochondral autograft; Mega-OATS
• ISSN: 2309-8309; 1681-150X; 1681-150X; 2309-8309
• DOI: 10.17159/2309-8309/2022/v21n2a7

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 distal 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.