Article

Medium-term outcome of mosaicplasty for grade III-IV cartilage defects of the knee

Department of Trauma and Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
Journal of orthopaedic surgery (Hong Kong) (Impact Factor: 0.7). 04/2013; 21(1):4-9.
Source: PubMed

ABSTRACT

Purpose:
To evaluate the medium-term outcome of mosaicplasty for full-thickness cartilage defects of the knee joint in 17 patients.

Methods:
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.

Results:
Two of the 17 patients developed necrosis and cystic degeneration of the grafts and underwent conversion to unicompartmental knee arthroplasty within 2 years. They were older than 45 years and had defects of >2 cm(2). Respectively in years 4 and 7, one and 4 patients were lost to follow-up, the mean IKDC score was 75% and 88%, the SF-36 score was 83% and 90%, and the VAS score was ≤3 in 13 of 14 patients at year 4 and in all 11 patients at year 7. At the 7-year follow-up, patient satisfaction with mosaicplasty was excellent in 8 patients, good in 3, and poor in 2 (who underwent unicompartmental knee arthroplasty). At year 4, MRI showed integration of the cartilage repair tissue and incorporation of the osseous portion of the graft into the bone in 13 of the 14 patients. The remaining patient had osteoarthritis at the graft donor site. At year 7, MRI showed good integration of the implant in all 11 available patients, but fissures were seen on the cartilage surface in 3 patients.

Conclusion:
The medium-term outcome of autologous mosaicplasty for symptomatic osteochondral defects in the femoral condyle is good. Longer follow-up is needed to determine the structural and functional integrity of the graft over time.

0 Followers
 · 
9 Reads
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Interest in osteochondral repair has been increasing with the growing number of sports-related injuries, accident traumas, and congenital diseases and disorders. Although therapeutic interventions are entering an advanced stage, current surgical procedures are still in their infancy. Unlike other tissues, the osteochondral zone shows a high level of gradient and interfacial tissue organization between bone and cartilage, and thus has unique characteristics related to the ability to resist mechanical compression and restoration. Among the possible therapies, tissue engineering of osteochondral tissues has shown considerable promise where multiple approaches of utilizing cells, scaffolds, and signaling molecules have been pursued. This review focuses particularly on the importance of scaffold design and its role in the success of osteochondral tissue engineering. Biphasic and gradient composition with proper pore configurations are the basic design consideration for scaffolds. Surface modification is an essential technique to improve the scaffold function associated with cell regulation or delivery of signaling molecules. The use of functional scaffolds with a controllable delivery strategy of multiple signaling molecules is also considered a promising therapeutic approach. In this review, we updated the recent advances in scaffolding approaches for osteochondral tissue engineering.
    Full-text · Article · Jan 2014 · Journal of Tissue Engineering
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Full thickness cartilage defect might occur at different ages, but a focal defect is a major concern in the knee of young athletes. It causes impairment and does not heal by itself. Several techniques were described to treat symptomatic full thickness cartilage defect. Recently, several advances were described on the known techniques of microfracture, osteochondral allograft, cell therapy, and others. This article brings an update of current literature on these well-described techniques for full thickness cartilage defect.
    Full-text · Article · Jul 2014 · Current Reviews in Musculoskeletal Medicine
  • [Show abstract] [Hide abstract]
    ABSTRACT: Degeneration or defect of articular cartilage is a major predicament and if it is left untreated, it may lead to progressive damage and disability affecting every one disregard of their age. Although nonsurgical management of articular cartilage injury has remained largely the same over many years, surgical treatment keeps on evolving. Restorative techniques, mainly the cell-based therapies and autologous or allograft transplants continue to expand, giving surgeons more options for biologic reconstruction of the articular surfaces. Hence the field of articular cartilage tissue engineering which seeks to repair, restore and improve injured or diseased articular cartilage functionality has aroused deep interest and holds great potential for improving articular cartilage therapy. However despite this great evolution, therapeutic uncertainty in the restoration of damaged cartilage using tissue engineering approaches still remains unclear for the surgeon treating patients to make evidence-based decisions. This paper will give a general idea to different level of audiences in understanding the concept of tissue engineering from bench to bed-side regarding recent developments in this exciting field.
    No preview · Article · Feb 2015 · Tissue Engineering and Regenerative Medicine