Abstract
BackgroundMosaicplasty has been associated with good short- to long-term results. Nevertheless, the osteochondral harvesting is restricted to the donor-site area available and it may lead to significant donor-site morbidity.PurposeProvide an overview of donor-site morbidity associated with harvesting of osteochondral plugs from the knee joint in mosaicplasty procedure.MethodsComprehensive search using Pubmed, Cochrane Library, SPORTDiscus and CINAHL databases was carried out through 10th October of 2016. As inclusion criteria, all English-language studies that assessed the knee donor-site morbidity after mosaicplasty were accepted. The outcomes were the description and rate of knee donor-site morbidity, sample’s and cartilage defect’s characterization and mosaicplasty-related features. Correlation between mosaicplasty features and rate of morbidity was performed. The methodological and reporting quality were assessed according to Coleman’s methodology score.ResultsTwenty-one studies were included, comprising a total of 1726 patients, with 1473 and 268 knee and ankle cartilage defects were included. The defect size ranged from 0.85 cm2 to 4.9 cm2 and most commonly 3 or less plugs (averaging 2.9 to 9.4 mm) were used. Donor-site for osteochondral harvesting included margins of the femoral trochlea (condyles), intercondylar notch, patellofemoral joint and upper tibio-fibular joint. Mean donor-site morbidity was 5.9 % and 19.6 % for knee and ankle mosaicplasty procedures, respectively. Concerning knee-to-knee mosaicplasty procedures, the most common donor-site morbidity complaints were patellofemoral disturbances (22 %) and crepitation (31 %), and in knee-to-ankle procedures there was a clear tendency for pain or instability during daily living or sports activities (44 %), followed by patellofemoral disturbances, knee stiffness and persistent pain (13 % each). There was no significant correlation between rate of donor-site morbidity and size of the defect, number and size of the plugs (p > 0.05).ConclusionsOsteochondral harvesting in mosaicplasty often results in considerable donor-site morbidity. The donor-site morbidity for knee-to-ankle (16.9 %) was greater than knee-to-knee (5.9 %) mosaicplasty procedures, without any significant correlation between rate of donor-site morbidity and size of the defect, number and size of the plugs. Lack or imcomplete of donor-site morbidity reporting within the mosaicplasty studies is a concern that should be addressed in future studies.Level of evidenceLevel IV, systematic review of Level I-IV studies.
Highlights
Mosaicplasty has been associated with good short- to long-term results
Osteochondral harvesting in mosaicplasty often results in considerable donor-site morbidity
Lack or imcomplete of donor-site morbidity reporting within the mosaicplasty studies is a concern that should be addressed in future studies
Summary
Mosaicplasty has been associated with good short- to long-term results. the osteochondral harvesting is restricted to the donor-site area available and it may lead to significant donor-site morbidity.Purpose: Provide an overview of donor-site morbidity associated with harvesting of osteochondral plugs from the knee joint in mosaicplasty procedure. László Hangody (Hangody et al 1997; Hangody & Karpati 1993) in 1992, created the mosaicplasty resurfacing concept, involving the transfer of multiple small-sized, cylindrical osteochondral grafts This procedure aimed to overcome the limitations and difficulties in repairing focal, full-thickness cartilage lesions of weight-bearing areas of the femoral condyles, patella, and talus. Long-term results have shown promising outcomes (Gomoll et al 2012; Lynch et al 2015; Hangody et al 2010) This technique has been indicated majorly for small-to-medium size focal articular cartilage or osteochondral defects of the weighbearing areas of the femoral condyles, patellofemoral joint and talus (Bartha et al 2006; Hangody & Füles 2003). The derived osteochondral plugs may be suitable for filling deep (>8-10 mm) and/or large osteochondral defects in cases that sandwich strategy (combined autologous chondrocyte implantation and subchondral bone restoration procedure) is not possible (Peterson 2003)
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