Factors affecting the outcome of osteochondral autografting (mosaicplasty) in articular cartilage defects of the knee joint: retrospective analysis of 152 cases (original) (raw)
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Knee, 2010
We evaluated short-and medium-term results of the treatment of articular cartilage defects of the knee with autogenous cylindrical osteochondral grafts (mosaicplasty) in 69 patients (median age 33 years) with symptomatic articular cartilage defects. Data of Lysholm score and visual analogue scale (VAS) of pain (0 = no pain; 100 = worst possible pain) were collected before the surgery, at 12 months postoperatively and 5 to 9 (median 7) years after the surgery. At the last follow-up the patients were also asked to state their degree of satisfaction with the outcome on a VAS (0 = not at all satisfied; 100 = completely satisfied), and to answer if they would have undergone the surgery again if necessary (yes or no). The mean Lysholm score and VAS of pain improved from 48 and 62, respectively, at the time of surgery to 81 and 24, respectively, at the 12-months follow-up (p b 0.001 for both comparisons). From 12 months postoperatively, the Lysholm score and VAS of pain deteriorated to 68 and 32, respectively at the 5-to 9-year follow-up (p b 0.001 and p = 0.018, respectively). The mean degree of satisfaction with the outcome was 70 (SD 28), and 61 patients (88%) stated that they would have undergone the surgery again. In conclusion, the mosaicplasty leads to improvement of symptoms and function at short-and medium-term follow-up. A deterioration of the results is observed from 12 months postoperatively to 5-9 years postoperatively.
Medium-term outcome of mosaicplasty for grade III-IV cartilage defects of the knee
Journal of orthopaedic surgery (Hong Kong), 2013
To evaluate the medium-term outcome of mosaicplasty for full-thickness cartilage defects of the knee joint in 17 patients. Records of 12 men and 5 women aged 16 to 57 (mean, 35) years who underwent mosaicplasty for grade III/IV osteochondral defects in the lateral (n=14) or medial (n=3) femoral condyle were reviewed. 12 of the patients had undergone knee surgeries. The mean size of the defects was 3.4 (range, 1-4) cm(2). Three patients had defects of >2 cm(2). All operations were performed by a single surgeon using mini-arthrotomy. The lateral edge of the trochlea was the donor site. Graft integration and the presence of any abnormality at the articular surface were assessed using magnetic resonance imaging (MRI). In addition, patients were evaluated using the International Knee Documentation Committee (IKDC) rating scale, the SF-36 health questionnaire, visual analogue scale (VAS) score for pain. Two of the 17 patients developed necrosis and cystic degeneration of the grafts and...
The American Journal of Sports Medicine, 2017
Background:Few comparative randomized long-term studies on microfracture versus mosaicplasty have been published, and only 2 studies reported a follow-up of 10 years.Hypothesis/Purpose:The purpose was to compare the clinical outcome of microfracture versus mosaicplasty/osteochondral autograft transfer in symptomatic cartilage lesions. The null hypothesis was that the outcome was not statistically different at any point of time.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:Forty patients with articular cartilage defects were randomized to undergo cartilage repair by either microfracture (n = 20) or mosaicplasty (n = 20). Inclusion criteria were as follows: age 18 to 50 years at the time of surgery, 1 or 2 symptomatic focal full-thickness articular chondral defects on the femoral condyles or trochlea, and size 2 to 6 cm2. The main outcome variable was the Lysholm knee score recorded before the surgery and at 12 months, median 5 years, median 10 years, and mini...
Arthroscopic mosaicplasty: long-term outcome and joint degeneration progression
The Knee, 2015
This study aims to document the long-term results in a group of patients treated with arthroscopic mosaicplasty for knee cartilage lesions, both in terms of clinical outcome and joint degeneration progression, evaluated by radiographs. 26 patients (19 men and 7 women, mean age 29 years, mean BMI 23) treated arthroscopically with mosaicplasty for cartilage defects of the femoral condyles (mean/median/mode size 1.9 standard deviation, SD 0.6 cm(2)) were prospectively evaluated at 12 years follow-up. The clinical outcome was analyzed with IKDC and Tegner scores. Range of motion, transpatellar and suprapatellar circumferences were also measured. Radiographs with weight-bearing antero-posterior and Rosenberg projections were used for radiological evaluation in 18 patients, applying both Kellgren-Lawrence score and a direct joint line measurement to assess osteoarthritis. A significant improvement in all clinical scores was obtained from the basal evaluation to the 12-year follow-up (IKDC...
Journal of Orthopaedics, 2019
Background: The purpose was to investigate survival of cartilage repair in the knee joint by osteochondral autograft transfer stratified by location of the lesion; patellofemoral joint (N = 26) versus the medial or lateral femoral condyles (N = 58). Methods: For survival analyses, "failure" was defined as the event of a patient reporting a poor Lysholm score (below 65 points) or undergoing a knee replacement procedure. Results: The survival distribution was not significantly different between the patellofemoral joint and the tibiofemoral joint groups. Conclusions: The current study suggest that similar long-term outcome can be expected after OAT procedures for the patellofemoral or tibiofemoral joint.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2005
To prospectively evaluate the mosaicplasty technique for treatment of femoral condyle cartilage lesions (Outerbridge grade IV) less than 2.5 cm 2 in homogeneous group of young active patients. Type of Study: Case series. Methods: Thirty-seven patients (10 female, 27 male; mean age, 29.5 years) with full-thickness knee chondral lesions were treated by the arthroscopic mosaicplasty technique. All patients practiced sports. There were 12 ACL reconstructions, 11 medial meniscectomies, and 8 lateral meniscectomies associated; 10 meniscectomies, 9 ACL reconstructions, and 5 cartilage reparative operations had been previously performed. All patients were evaluated at a 2-year follow-up. The International Cartilage Repair Society (ICRS) form, return to sports, computed tomography, or magnetic resonance imaging were used for clinical evaluation. In some cases, second-look arthroscopy was performed. Results: The ICRS showed 78.3% good and excellent results; 27 patients returned to sports at the same level and 5 at a lower level, but 5 were not able to resume sports. Results in the lateral condyles were significantly better than those in medial condyles, and younger patients had a better clinical outcome than did older patients. Cases with associated surgery had better clinical results; previous surgery did not significantly influence the clinical outcome. Conclusions: The results of this technique at medium-term follow-up are encouraging with 78.3% clinically satisfactory results. Better results can be obtained in young patients with associated surgery, with localized grade 4 lesions of the lateral condyles. This arthroscopic 1-step surgery appears to be a valid solution for the treatment of grade III-IV cartilage defects not more than 2.5 cm 2 .
The Bone & Joint Journal, 2012
Autologous chondrocyte implantation (ACI) and mosaicplasty are methods of treating symptomatic articular cartilage defects in the knee. This study represents the first long-term randomised comparison of the two techniques in 100 patients at a minimum follow-up of ten years. The mean age of the patients at the time of surgery was 31.3 years (16 to 49); the mean duration of symptoms pre-operatively was 7.2 years (9 months to 20 years). The lesions were large with the mean size for the ACI group being 440.9 mm2 (100 to 1050) and the mosaicplasty group being 399.6 mm2 (100 to 2000). Patients had a mean of 1.5 previous operations (0 to 4) to the articular cartilage defect. Patients were assessed using the modified Cincinnati knee score and the Stanmore-Bentley Functional Rating system. The number of patients whose repair had failed at ten years was ten of 58 (17%) in the ACI group and 23 of 42 (55%) in the mosaicplasty group (p < 0.001). The functional outcome of those patients with a...
Mosaicplasty for the Treatment of Articular Defects of the Knee and Ankle
Clinical Orthopaedics and Related Research, 2001
Efficacious treatment of full-thickness cartilage defects of the weightbearing surfaces is a multifaceted challenge for the orthopaedic surgeon. Autologous osteochondral transplantation represents one solution: to bring about a hyaline or hyalinelike repair of the defected area. The current authors discuss the experimental background and their 8 years of clinical experience with the autologous osteochondral mosaicplasty. Several series of animal studies and subsequent clinical practice have confirmed the survival of the transplanted hyaline cartilage. Hyaline cartilage and fibrocartilage fill the donor sites located on the nonweightbearing surfaces and surfaces that bear less weight. Clinical scores, imaging techniques, control arthroscopies, histologic examination of biopsy samples, and cartilage stiffness measurements were used to evaluate the clinical outcomes and quality of the transplanted cartilage. According to these investigations, femoral condylar implantations have shown good to excellent results in 92%, tibial resurfacing in 88%, patellar and/or trochlear mosaicplasties in 81%, and talar procedures in 94% of patients. The Bandi score showed long-term donor site disturbances in 3% of patients. Fifty-eight of the 68 control arthroscopies had good gliding surfaces, histologically-proven survival of the transplanted hyaline cartilage, and fibrocartilage covering of the donor sites. In the entire series, there were four deep infections and 34 painful hemarthroses after surgery. A multicentric, comparative, prospective evaluation of 413 arthroscopic resurfacing procedures (mosaicplasty, Pridie drilling, abrasion arthroplasty, and microfracture cases in homogenized subgroups) showed that mosaicplasty gave a more favorable clinical outcome in the long-term followup, than the other three techniques. Intermediate-term evaluation of the femoral condylar implantations (3-6-years followup) and talar mosaicplasties (3-7-years followup) confirmed the durability of the early results. From these encouraging results from an increasingly large series and similar results from other centers, it seems that autologous osteochondral mosaicplasty may be a viable alternative treatment of localized fullthickness cartilage damage of the weightbearing surfaces of the knee and other weightbearing synovial joints.
The Knee, 2017
Background: The purpose of this study was to evaluate the outcome after cartilage repair surgery in focal defects of the knee by microfracture versus mosaicplasty. Methods: A cohort of 102 patients undergoing microfracture (n = 52) or mosaicplasty (n = 50) of a single articular cartilage defect in the medial femoral condyle of ≤50 mm 2 was evaluated by Lysholm score before surgery, at six months, 12 months, five years, 10 years, and 15-18 years after surgery. Results: Median age of patients at the time of surgery was 36 years (range 16-58) and median follow-up time was 16 years (range 14-18). Defects were treated with a median size of three square centimetres (range one to five). A significant increase was seen in the Lysholm score from mean 48 (SD 16) at baseline to 66 (SD 23; P b 0.001) at the 15-18 year follow-up. The Lysholm score was higher in the mosaicplasty group at six months, 12 months, five years and 10 years (P b 0.05 for all comparisons). These differences were clinically significant at all points (N10 points). However, at the final follow-up, the difference (eight points) did not reach statistical significance. Conclusions: In the short-term, medium-term and long-term (10 years), mosaicplasty in a single cartilage defect size one to five square centimetres of the femoral condyle resulted in clinically relevant better outcome than microfracture. However, at 15-18 years after the surgery such a difference could not be found. In the six month to 10-15 year (after surgery) perspective, the mosaicplasty procedure offered a better outcome in this type of lesion.
The Journal of Bone and Joint Surgery, 2003
utologous chondrocyte implantation (ACI) and mosaicplasty are both claimed to be successful for the repair of defects of the articular cartilage of the knee but there has been no comparative study of the two methods. A total of 100 patients with a mean age of 31.3 years (16 to 49) and with a symptomatic lesion of the articular cartilage in the knee which was suitable for cartilage repair was randomised to undergo either ACI or mosaicplasty; 58 patients had ACI and 42 mosaicplasty. Most lesions were post-traumatic and the mean size of the defect was 4.66 cm 2 . The mean duration of symptoms was 7.2 years and the mean number of previous operations, excluding arthroscopy, was 1.5. The mean follow-up was 19 months (12 to 26).