Autologous Costal Cartilage Grafting for Large Osteochondral Lesion of Femoral Head improves hip function and QoL

Chang-Qing Zhang et al performed a 1-year single-arm study and 2 additional years of follow-up of patients with a large (defined as >3 cm2) Osteochondral Lesion of the Femoral Head (OLFH) treated with insertion of autologous costal cartilage graft (ACCG) to restore femoral head congruity after lesion debridement. Investigation was performed at Shanghai Sixth People’s Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China. The study has been published in “THE JOURNAL OF BONE AND JOINT SURGERY.”

Twenty patients <=40 years old who had substantial hip pain and/or dysfunction after nonoperative treatment were enrolled at a single center. The primary outcome was the change in Harris hip score (HHS) from baseline to 12 months postoperatively. Secondary outcomes included the EuroQol visual analogue scale (EQ VAS), hip joint space width, subchondral integrity on computed tomography scanning, repair tissue status evaluated with the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score, and evaluation of cartilage biochemistry by delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) and T2 mapping.

Key findings of the study were:

• All 20 enrolled patients (31.02 ± 7.19 years old, 8 female and 12 male) completed the initial study and the 2 years of additional follow-up.

• The HHS improved from 61.89 ± 6.47 at baseline to 89.23 ± 2.62 at 12 months and 94.79 ± 2.72 at 36 months.

• The EQ VAS increased by 17.00 ± 8.77 at 12 months and by 21.70 ± 7.99 at 36 months (p < 0.001 for both).

• Complete integration of the ACCG with the bone was observed by 12 months in all 20 patients.

• The median MOCART score was 85 (interquartile range [IQR], 75 to 95) at 12 months and 75 (IQR, 65 to 85) at the last follow-up (range, 24 to 38 months).

• The ACCG demonstrated magnetic resonance properties very similar to hyaline cartilage; the median ratio between the relaxation times of the ACCG and recipient cartilage was 0.95 (IQR, 0.90 to 0.99) at 12 months and 0.97 (IQR, 0.92 to 1.00) at the last follow-up.

The authors concluded that – “ACCG is a feasible method for improving hip function and quality of life for at least 3 years in young patients who were unsatisfied with nonoperative treatment of an OLFH. Promising long-term outcomes may be possible because of the good integration between the recipient femoral head and the implanted ACCG.”

Level of Evidence: Therapeutic Level IV.

Further reading:

Autologous Costal Cartilage Grafting for a Large Osteochondral Lesion of the Femoral Head A 1-Year Single-Arm Study with 2 Additional Years of Follow-up

Chang-Qing Zhang, Da-Jiang Du et al

J Bone Joint Surg Am. 2022;104:2108-16

http://dx.doi.org/10.2106/JBJS.22.00542