JBJS - 2026-07-06 - Journal Article
Osteochondral Autograft Transfer for Focal Osteochondral Defects of the Knee: Indications, Technique, Outcomes, and Future Directions.
Strony JT, Ina JG, Apostolakos JM, Calcei JG, Karns MR, Ode GE, Salata MJ, Voos JE, Rodeo SA, Williams Rd RJ
Topics
Key Takeaway
OAT achieves return-to-sport rates >85% within 6 months for focal femoral condyle lesions 1–4 cm², with outcomes declining significantly once defect size exceeds 3 cm².
Summary Depth
Choose how much analysis to show on this article page.
Summary
This review synthesizes indications, technique, outcomes, and emerging directions for OAT in focal full-thickness articular cartilage defects of the knee. Optimal candidates are young, active patients with unipolar lesions 1–4 cm²; OAT demonstrates superiority over microfracture and comparable or superior results to cellular resurfacing in appropriately selected patients. Outcomes are negatively influenced by lesion size >3 cm², older age, lower activity demand, malalignment, instability, and meniscal deficiency.
Key Limitation
As a narrative review without meta-analytic pooling, the >85% return-to-sport figure and the 3 cm² outcome threshold are not derived from a defined patient cohort or statistical synthesis, limiting the precision of these benchmarks.
Original Abstract
➢ Osteochondral autograft transfer (OAT) restores hyaline cartilage and subchondral bone in a single stage, offering a durable joint-preserving option for focal full-thickness articular cartilage defects in young, active patients.➢ Optimal candidates have unipolar femoral condyle, patellofemoral, or tibial plateau lesions measuring 1 to 4 cm2; outcomes become less predictable once the defect size exceeds 3 cm2. Outcomes are further influenced by age, activity level, sex, alignment, instability, and meniscal deficiency, with older, lower-demand patients and those with larger lesions demonstrating comparatively inferior results.➢ Technical success requires meticulous recipient-site preparation, perpendicular graft harvest, and flush implantation; both arthroscopic and open approaches achieve reliable results.➢ OAT demonstrates high return-to-sport rates (often >85% within 6 months), significant functional improvements, and superiority over microfracture. Outcomes may be comparable or superior to cellular resurfacing or allograft techniques in appropriately selected patients.➢ Emerging biologic adjuncts, recess-filling strategies, and donor-site substitutes may enhance graft integration and reduce morbidity, although long-term clinical benefits remain unproven.