Abstract
Objective
The purpose of this retrospective study was to evaluate the results and prognostic factors affecting the outcome of osteochondral autografting (mosaicplasty) in articular cartilage defects of the knee joint.
Materials and methods
One hundred fifty-two patients who underwent mosaicplasty for femoral condylar cartilage defects (modified Outerbridge classification: Grade III and IV) of the knee joint between 1998 and 2007 in our institution were included. There were 126 male and 26 female patients with a mean age of 24.8 ± 4.6 years. The average size of the lesion was 2.7 ± 0.7 cm2. Of these patients, 33 had concomitant meniscal and/or cruciate ligament injuries which were treated simultaneously. All patients were followed up with a mean of 18.2 ± 4.2 months (range 12–24 months) using Lysholm knee score. We analyzed the relationship between the outcome variable (Lysholm knee score at the final follow-up) and the predictor variables (age, gender, lesion size, lesion grade, localization, accompanying intra-articular injuries and duration of follow-up).
Results
The mean preoperative Lysholm knee score was 55.2 ± 3.6 points and increased to 88.2 ± 2.5 points at the final follow-up. There was a significant increase in Lysholm score during follow-up period (p = 0.0001). The results were excellent in 2 cases (1.3 %), good in 144 cases (94.7 %) and fair in 6 cases (3.9 %). No patients had infection, systemic complication and revision surgery. Backward regression analysis showed that age, lesion size, localization and associated intraarticular injuries are the only predictors of the final Lysholm knee score in best fit model (R 2 = 0.442, p = 0.0001). The linear regression equation was (Lysholm score at final follow-up) = 93.4 − [0.2 (age of patient) + 0.8 (lesion size) + 0.9 (localization) + 2.8 (presence of associated intraarticular injuries)].
Conclusions
Mosaicplasty is an effective technique for the treatment of articular cartilage defects of the knee joint which restores the joint function in a short period of follow-up. Furthermore, age, lesion size, localization, and concomitant surgical interventions are major factors affecting the final outcome. The final knee score deteriorates as the age of the patient and size of the lesion increases. Furthermore, concomitant surgical interventions and lesions located on the medial femoral condyle have a negative effect on the final knee score.
Similar content being viewed by others
References
Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG (1997) Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy 13(4):456–460
Widuchowski W, Widuchowski J, Trzaska T (2007) Articular cartilage defects: study of 25,124 knee arthroscopies. Knee. 14(3):177–182
Buckwalter JA (2002) Articular cartilage injuries. Clin Orthop Relat Res 402:21–37
Magnussen RA, Dunn WR, Carey JL, Spindler KP (2008) Treatment of focal articular cartilage defects in the knee: a systematic review. Clin Orthop Relat Res 466:952–962
Bedi A, Feeley BT, Williams RJ 3rd (2010) Management of articular cartilage defects of the knee. Bone Jt Surg Am 92:994–1009
Hangody L, Ráthonyi GK, Duska Z, Vásárhelyi G, Füles P, Módis L (2004) Autologous osteochondral mosaicplasty. Surgical technique. J Bone Jt Surg Am 86-A(Suppl 1):65–72
Hangody L, Kish G, Karpati Z, Szerb I, Udvarhelyi I (1997) Arthroscopic autogenous osteochondral mosaicplasty for the treatment of femoral condylar articular defects. A preliminary report. Knee Surg Sports Traumatol Arthrosc 5:262–267
Haklar U, Tüzüner T, Kocaoğlu B, Güven O (2008) Mosaicplasty technique in the treatment of osteochondral lesions of the knee. Acta Orthop Traumatol Turc. 42(5):344–349
Oztürk A, Ozdemir MR, Ozkan Y (2006) Osteochondral autografting (mosaicplasty) in grade IV cartilage defects in the knee joint: 2- to 7-year results. Int Orthop 30(3):200–204
Barber FA, Chow JC (2006) Arthroscopic chondral osseous autograft transplantation (COR procedure) for femoral defects. Arthroscopy 22(1):10–16
Solheim E, Hegna J, Oyen J, Austgulen OK, Harlem T, Strand T (2010) Osteochondral autografting (mosaicplasty) in articular cartilage defects in the knee: results at 5 to 9 years. Knee 17(1):84–87
Marcacci M, Kon E, Zaffagnini S, Iacono F, Neri MP, Vascellari A, Visani A, Russo A (2005) Multiple osteochondral arthroscopic grafting (mosaicplasty) for cartilage defects of the knee: prospective study results at 2-year follow-up. Arthroscopy 21(4):462–470
Chow JC, Hantes ME, Houle JB, Zalavras CG (2004) Arthroscopic autogenous osteochondral transplantation for treating knee cartilage defects: a 2- to 5-year follow-up study. Arthroscopy 20(7):681–690
Ollat D, Lebel B, Thaunat M, Jones D, Mainard L, Dubrana F, Versier G (2011) Mosaic osteochondral transplantations in the knee joint, midterm results of the SFA multicenter study; French Arthroscopy Society. Orthop Traumatol Surg Res 97(8 Suppl):S160–S166
Hangody L, Fules P (2003) Autologous osteochondral mosaicplasty for the treatment of full-thickness defects of weight-bearing joints: ten years of experimental and clinical experience. J Bone Jt Surg [Am] 85(Suppl 2):25–32
Bartha L, Vajda A, Duska Z, Rahmeh H, Hangody L (2006) Autologous osteochondral mosaicplasty grafting. J Orthop Sports Phys Ther 36(10):739–750
Szerb I, Hangody L, Duska Z, Kaposi NP (2005) Mosaicplasty: long-term follow-up. Bull Hosp Jt Dis 63(1–2):54–62
Hangody L, Vásárhelyi G, Hangody LR, Sükösd Z, Tibay G, Bartha L, Bodó G (2008) Autologous osteochondral grafting—technique and long-term results. Injury 39(Suppl 1):S32–S39
Hangody L, Dobos J, Baló E, Pánics G, Hangody LR, Berkes I (2010) Clinical experiences with autologous osteochondral mosaicplasty in an athletic population: a 17-year prospective multicenter study. Am J Sports Med 38(6):1125–1133
Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49
Atik OS, Uslu MM, Ekioglu F (2005) Osteochondral multiple autograft transfer (OMAT) for the treatment of cartilage defects in the knee joint. Bull Hosp Jt Dis 63(1–2):37–40
Jakob RP, Franz T, Gautier E, Mainil-Varlet P (2002) Autologous osteochondral grafting in the knee: indication, results, and reflections. Clin Orthop Relat Res 401:170–184
Bentley G, Biant LC, Vijayan S, Macmull S, Skinner JA, Carrington RW (2012) Minimum ten-year results of a prospective randomised study of autologous chondrocyte implantation versus mosaicplasty for symptomatic articular cartilage lesions of the knee. J Bone Jt Surg Br 94(4):504–509
Makris EA, Hadidi P, Athanasiou KA (2011) The knee meniscus: structure-function, pathophysiology, current repair techniques, and prospects for regeneration. Biomaterials 32(30):7411–7431
Andersson-Molina H, Karlsson H, Rockborn P (2002) Arthroscopic partial and total meniscectomy: a long-term follow-up study with matched controls. Arthroscopy 18(2):183–189
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Emre, T.Y., Ege, T., Kose, O. et al. Factors affecting the outcome of osteochondral autografting (mosaicplasty) in articular cartilage defects of the knee joint: retrospective analysis of 152 cases. Arch Orthop Trauma Surg 133, 531–536 (2013). https://doi.org/10.1007/s00402-013-1680-2
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-013-1680-2