Treatment of Knee Osteochondral Defects with Mosaicoplasty Technique


Mohsen Fawzy Omar, Mohammed a Gheith*

Citation: “Treatment of Knee Osteochondral Defects with Mosaicoplasty Technique”. American Research Journal of Orthopedics and Traumatology; V2, I1; pp: 1-9

Copyright This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Abstract:

Background: Due to the avascular nature of the articular cartilage and the limited stem cell population the lesions of articular cartilage have limited ability to repair. Another factor is the constant and repeated loads on the articular cartilage of the knee that create unsound mechanical environment for healing. 

Objective: To evaluate the results of osteochondral autograft technique in treatment of chondral and osteochondral defects.

Material and Methods: From May 2013 to November 2016 sixteen patients with chondral or osteochondral defects of one of the femoral condyles were treated using the osteochondral grafts technique. Open technique was used in (10 patients) and arthroscopic technique in (6 cases). For patient evaluation we used two scores: the chondral defect scoring system, and Lysholm score.

Results: according to the Chondral defect scoring system, significant improvement of the subjective score of the pain, swelling, locking and full weight bearing. The mean total (CGSS - objective & subjective) was improved from 47.6 (SD±15.3) preoperatively to a postoperative mean of 83 (SD±11.2). The Lysholm score shown significant improvement for the Limp, locking sensation, using cane, giving way, swelling, climbing stairs and also for squatting.

Conclusion: Mosaicoplasty as one-step procedure, has low morbidity, independent of laboratory use. Based upon the results of this study, osteochondral autograft is a good solution for treatment of full thickness cartilage damage.

Keywords: Mosaicplasty, Autograft, Osteochondral defect, Knee.

This prospective study was conducted on sixteen patients in Zagazig University in Sharqia between 2013 and 2016.


Description:

INTRODUCTION

The articular cartilage is an avascular, hypo cellular, lymphatic tissue. Thelow-friction, highly durable and wear-resistant surface of articular cartilage is due to the dense collagen and proteoglycan matrix. The function of the smooth articular surface is to give pain-free gliding surface and shock absorption of the joints during skeletal motion. Degeneration of this articular cartilage surface can lead to joint arthritis due to its minimal reparative potential [1]. The mechanism of injury in patients with chondral or osteochondral injuries is typically an axial loadingcombined with either twisting, or shearing-type injury or it may be an impaction injury due to significant blunt trauma. The clinical presentations of the patients usually are pain increasing with weight bearing, recurrent effusion,locking and catching [2].Imaging of the knee includes plain x-ray weight-bearing (AP) anteroposterior view in full extension for both knees, lateral view, and an axial patellofemoral joint view. Magnetic resonance imaging (MRI) is helpful in detecting the extent of articular cartilage lesions [3]. The main goals of surgical treatment of symptomatic chondral defects are relieving symptoms, improvement of joint congruence, and prevention of further deterioration.The technique of Osteochondral autograft transfer (OAT) involves the transfer of plugs of healthy cartilage combined with its subchondral bone from decreased load bearing areato the full-thickness lesion in another important weight bearing area of the knee. This procedure can be done arthroscopically or open through an arthrotomy as a single-stage procedure. The most important disadvantages of this technique are the donor-site morbidity and the shortage of the available graft for harvesting [4].

Patients and Methods 

Through the period from May 2013 to November 2016 sixteen patients with chondral or osteochondral defects of one of the femoral condyles were treated using the osteochondral grafts technique. Open technique was used in (10 patients) and arthroscopic technique in (6 cases). The patients with severe osteoarthritic or sever lower limb deformity were excluded from the study. Autologous osteochondral grafts from the same knee were used in all patients. The mean age of the patients was 26.1 years (SD ±7.6) ranged from 18 and 37 years, with the body weight ranged from 65 -98 Kg (mean of 77.6 Kg - SD±10.2 ) and the height of the patients ranged from 164 to 190 cm with a mean of 172.4 cm ( SD ±9.8).There were12 males (75%) and 4females (25 %). The right knee was injured in12 patients (75 %) and the left knee in 4 patients (25 ℅). Ten patients have the defects in the dominant knee (62.5 %) and 6 patients in the non- dominant knee (37.5 %). The defect was in the medial femoral condyle (M.F.C.) in 14 patients (87.5℅) and in the lateral femoral condyle (L.F.C.) in 2 patients (12.5℅). The man complaint was knee pain in all of the cases, while catching was found in 8 patients (50 %), effusion in 10 patients (62.5%).The plain radiography of AP and lateral standing views, and axial patellofemoral view added to M.R.I. were used in all cases (Fig. 1). For patient evaluation we used two scores: the chondral defect scoring system(Table 1) [5], andLysholm score(Table 2) [6].