Autologous Osteochondral Mosaicplasty Research Articles

Systematic evaluation of the incidence of the knee donor area after autobone cartilage mosaic xentoplasty

To provide an overview of the incidence of knee donor -site morbidity after autologous osteochondral mosaicplasty. A comprehensive search was conducted in PubMed, EMbase, Wanfang Medical Network, and CNKI databases from January 2010 to April 20, 2021. Relevant literature was selected based on predefined inclusion and exclusion criteria, and data were evaluated and extracted. The correlation between the number and size of transplanted osteochondral columns and donor-site morbidity was analyzed. A total of 13 literatures were included, comprising a total of 661 patients. Statistical analysis revealed an incidence of knee donor-site morbidity at 8.6% (57/661), with knee pain being the most common complaint, accounting for 4.2%(28/661). There was no significant correlation between the number of osteochondral columns and postoperative donor-site incidence (P=0.424, N=10), nor between the diameter size of osteochondral columns and postoperative donor-site incidence(P=0.699, N=7). Autologous osteochondral mosaicplasty is associated with a considerable incidence of knee donor-site morbidity, with knee pain being the most frequent complaint. There is no apparent correlation between donor-site incidence and the number and size of transplanted osteochondral columns. Donors should be informed about the potential risks.

Autologous Osteochondral Mosaicplasty for Centrally and Laterally Located, Advanced Capitellar Osteochondritis Dissecans in Teenage Athletes: Clinical Outcomes, Radiography, and Magnetic Resonance Imaging Findings

Background: Autologous osteochondral mosaicplasty (ie, mosaicplasty) results in satisfactory clinical outcomes and reliable return to play for patients with large or unstable lesions due to osteochondritis dissecans (OCD) of the humeral capitellum. However, the association between the healing of the reconstructed cartilage and clinical outcomes remains unclear. Purpose: To evaluate the efficacy of mosaicplasty in teenage athletes through use of clinical scores and imaging. The secondary purpose was to compare the clinical outcomes with images of centrally and laterally located lesions. Study Design: Case series; Level of evidence, 4. Methods: This study analyzed 22 elbows (all male patients; mean age, 13.5 ± 1.2 years) with capitellar OCD managed with mosaicplasty. Patients were divided into 2 groups according to the location of the lesions: central (10 patients) and lateral (12 patients). Evaluation was performed through use of the clinical rating system of Timmerman and Andrews, plain radiographs, and magnetic resonance imaging (MRI; the cartilage repair monitoring system of Roberts). The mean follow-up period was 27.5 months (range, 24-48 months). Results: Lateral lesions were significantly larger than central lesions (147.1 ± 51.9 mm2 vs 95.5 ± 27.4 mm2, P = .01). No other significant differences were found between central and lateral lesions. Timmerman and Andrews scores for both central and lateral lesions improved significantly from 125.0 ± 30.1 points and 138.3 ± 34.5 points preoperatively to 193.5 ± 11.3 points and 186.7 ± 18.1 points, respectively, at final follow-up (P < .0001, P < .0001). Radiography identified complete graft incorporation in all cases and the absence of severe osteoarthritic changes or displaced osteochondral fragments. In the lateral group, the radial head ratio at final follow-up (1.83 ± 0.23) was significantly larger than the preoperative findings (1.75 ± 0.14, P = .049). The quality of joint surface reconstruction was found to be acceptable for central and lateral lesions on MRI evaluation. Conclusion: Mosaicplasty resulted in satisfactory clinical outcomes and smooth cartilage surface integrity in teenage athletes with OCD on their return to competition-level sports activities irrespective of lesion location.

Autologous osteochondral mosaicplasty in osteochondritis dissecans of the patella in adolescents.

Osteochondritis dissecans of the patella (OCDP) is rare in adolescents. The objective of this study was to evaluate functional results of OCDP management in adolescents with mosaicplasty and to analyze proper integration of osteochondral grafts via MRI. This is a retrospective series of eight cases of OCDP treated by mosaicplasty. Mean age at the surgery was 15years (range 12-17). Clinical features were represented by retropatellar pain, hydarthrosis, locking and crepitus. All patients benefited from knee radiographs as well as pre-operative MRI. Six OCDP were evaluated International Cartilage Repair Society (ICRS) grade III and two were ICRS grade IV. Mean surface of the lesion was 97.5mm2. The pre- and post-operative assessments were conducted with scores obtained on the IKDC subjective knee evaluation form, Lysholm knee score, and Tegner activity scale. These assessments were completed by post-operative MRI. The magnetic resonance observation of cartilage repair tissue (MOCART) score was calculated from the latest MRI examination conducted after surgery. Mean follow-up was 28.6months. At the latest follow-up, the mean IKDC score was 86.5, Lysholm score was 89, and Tegner activity scale score was 6.2 (pre-operative scores were respectively 49.9, 53.8, and 4.5). Radiographs and MRI showed a complete integration of grafts at the latest follow-up with a satisfactory reconstruction of the joint surface. Mean MOCART score was 75/100. Autologous osteochondral mosaicplasty to manage OCDP in adolescents appears to be a reliable technique on the short term to restore patellar joint surface and obtain satisfactory functional results.

Utilizing tissue-engineered cartilage or BMNC-PLGA composites to fill empty spaces during autologous osteochondral mosaicplasty in porcine knees

The potential empty spaces between cylindrical plugs remaining after autologous osteochondral mosaicplasty rely on fibrous repair, which may constrain the quality and integrity of the repair. Thus, the empty spaces should be repaired, and how to fill the empty spaces is still a problem. In the present study, a standardized full-thickness defect (diameter, 6 mm) was created in the weight-bearing area of each medial femoral condyle in both knees of 18 miniature pigs. The 36 knees were randomly assigned to four groups with nine in each group. The defects were initially repaired by autologous osteochondral mosaicplasty. Simultaneously, any empty spaces between the multiple plugs were filled with cell-free poly(lactide-co-glycolide) (PLGA) scaffolds (the scaffold group), tissue-engineered cartilage (the TE group) or bone marrow mononuclear cell (BMNC)-PLGA composites (the composite group). The empty spaces were left untreated as control (the control group). Six months after surgery, the repair results were assessed via macroscopic observation, histological evaluation, magnetic resonance imaging, biomechanical assessment and glycosaminoglycan content. The results demonstrated that mosaicplasty combined with the treatment of the empty spaces could improve cartilage regeneration. The filling of empty spaces by tissue-engineered cartilage produced the best result in all the four groups. Meanwhile, utilizing BMNC-PLGA composites achieved a similar repair result. Considering the cost-effective, time-saving and convenient performance, the BMNC-PLGA composite could be an alternative option to fill the empty spaces combined with mosaicplasty. Copyright © 2014 John Wiley & Sons, Ltd.

Autologous osteochondral mosaicplasty or TruFit™ plugs for cartilage repair

Autologous osteochondral mosaicplasty and TruFit Bone graft substitute plugs are methods used to repair symptomatic articular cartilage defects in the adult knee. There have been no comparative studies of the two techniques. This retrospective study assessed functional outcome of patients using the EQ-5D, Knee Injury and Osteoarthritis Outcome Score (KOOS) and Modified Cincinnati scores at follow-up of 1-5 years. There were 66 patients in the study (35 TruFit and 31 Mosaicplasty): 44 males and 22 females with a mean age of 37.3 years (SD 12.6). The mean BMI was 26.8. Thirty-six articular cartilage lesions were due to trauma, twenty-six due to osteochondritis dissecans and three due to non-specific degenerative change or unknown. There was no difference between the two groups age (n.s.), sex (n.s.), BMI (n.s.), defect location (n.s.) or aetiology (n.s.). The median follow-up was 22 months for the TruFit cohort and 30 months for the mosaicplasty group. There was no significant difference in the requirement for re-operation (n.s). Patients undergoing autologous mosaicplasty had a higher rate of returning to sport (p = 0.006), lower EQ-5D pain scores (p = 0.048) and higher KOOS activities of daily living (p = 0.029) scores. Sub-group analysis showed no difference related to the number of cases the surgeon performed. Patients requiring re-operation had lower outcome scores regardless of their initial procedure. This study demonstrated significantly better outcomes using two validated outcome scores (KOOS, EQ-5D), and an ability to return to sport in those undergoing autologous mosaicplasty compared to those receiving TruFit plugs. IV.

Osteochondral transplantation using autografts from the upper tibio-fibular joint for the treatment of knee cartilage lesions

Treatment of large cartilage lesions of the knee in weight-bearing areas is still a controversy and challenging topic. Autologous osteochondral mosaicplasty has proven to be a valid option for treatment but donor site morbidity with most frequently used autografts remains a source of concern. This study aims to assess clinical results and safety profile of autologous osteochondral graft from the upper tibio-fibular joint applied to reconstruct symptomatic osteochondral lesions of the knee. Thirty-one patients (22 men and 9 women) with grade 4 cartilage lesions in the knee were operated by mosaicplasty technique using autologous osteochondral graft from the upper tibio-fibular joint, between 1998 and 2006. Clinical assessment included visual analog scale (VAS) for pain and Lysholm score. All patients were evaluated by MRI pre- and post-operatively regarding joint congruency as good, fair (inferior to 1 mm incongruence), and poor (incongruence higher than 1 mm registered in any frame). Donor zone status was evaluated according to specific protocol considering upper tibio-fibular joint instability, pain, neurological complications, lateral collateral ligament insufficiency, or ankle complaints. Mean age at surgery was 30.1 years (SD 12.2). In respect to lesion sites, 22 were located in weight-bearing area of medial femoral condyle, 7 in lateral femoral condyle, 1 in trochlea, and 1 in patella. Mean follow-up was 110.1 months (SD 23.2). Mean area of lesion was 3.3 cm2 (SD 1.7), and a variable number of cylinders were used, mean 2.5 (SD 1.3). Mean VAS score improved from 47.1 (SD 10.1) to 20.0 (SD 11.5); p = 0.00. Similarly, mean Lysholm score increased from 45.7 (SD 4.5) to 85.3 (SD 7.0); p = 0.00. The level of patient satisfaction was evaluated, and 28 patients declared to be satisfied/very satisfied and would do surgery again, while 3 declared as unsatisfied with the procedure and would not submit to surgery again. These three patients had lower clinical scores and kept complaints related to the original problem but unrelated to donor zone. MRI score significantly improved at 18-24 months comparing with pre-operative (p = 0.004). No radiographic or clinical complications related to donor zone with implication in activity were registered. This work corroborates that mosaicplasty technique using autologous osteochondral graft from the upper tibio-fibular joint is effective to treat osteochondral defects in the knee joint. No relevant complications related to donor zone were registered. Case series, Level IV.

Osteochondral Autograft and Mosaicplasty in the Football (Soccer) Athlete.

Objective:To evaluate the clinical outcomes of mosaicplasty in the treatment of focal chondral and osteochondral defects of joints among elite football players.Methods:Case series; Level of evidence, 4. The results of mosaicplasty were prospectively evaluated with 1-year intervals with patient-reported outcome measures, radiographs, and sports participation.Results:Sixty-one patients who received mosaicplasty in the knee joint were followed from 2 to 17 years (average, 9.6 years). The International Cartilage Repair Society (ICRS) score showed 89% good and excellent results. Sixty-seven percent of all players returned to the same level of sport, with 89% of the elite players and 62% of the competitive players. The average time to return to competitions was 4.5 months (range, 3.5-6.1 months). Players who had better clinical outcomes were significantly younger and had smaller lesions. The results of the medial and lateral condyles were significantly better than those in the patella or trochlea. Concomitant adjuvant procedures improved clinical outcomes. Despite a higher rate of preoperative osteoarthritic changes, clinical outcomes demonstrated a success rate similar to that of less athletic patients.Conclusion:Autologous osteochondral mosaicplasty in competitive football players is a good alternative procedure to repair cartilage damage.

Mosaic osteochondral transplantations in the knee joint, midterm results of the SFA multicenter study

There are several possible options to treat focal articular cartilage defects of the knee. The aim of this study was to evaluate the results and prognostic factors cartilage defects of the knee treated by autologous osteochondral mosaicplasty after more than five years of follow-up. One hundred forty-two cases were included in this retrospective multicenter study. Etiologies included osteochondral fractures (n=79), and osteochondritis dissecans (n=61). Mean age of patients was 31. There was a majority of men (76%). Mean BMI was 25 (range: 21-41). Fifty-three percent of the knees had a history of surgery. Mean delay between the accident and surgery was 2.5 years. Mean area of the defect was 2.29 cm(2) (range: 0.3-12.25 cm(2)). The depth of the defect was 3 or 4 on the ICRS score in 97% of cases. An additional surgical procedure was associated with mosaicplasty in 14% of the cases. The follow-up evaluation was based on the Hughston score, the ICRS score, the IKDC subjective score, and the IKDC radiological score. Evaluation of control MRI was based on a modified MOCART score. The mean follow-up was 96 ± 28 months. There were complications in 19 patients. Patients were able to begin athletic activities again after a mean 35 weeks. Most patients (81.8%) were satisfied or very satisfied. There was a significant improvement (p<0.001) in the ICRS, IKDC function and Hughston scores at follow-up. The factors for a good prognosis were: male gender, medial femoral condyle defects, osteochondritis dissecans, deep, small defects, and the shortest possible delay to surgery. Obesity, smoking, work-related accidents, the level of sports practiced, the percentage of coverage of the defect, the number of plugs, and associated lesions did not have a statistically significant effect on the functional results in the final follow-up. Autologous osteochondral mosaicplasty seems to be a reliable technique in the short and intermediate term. It has the advantage of being less expensive than reconstructive techniques, is a one-step surgical procedure and results in immediate restoration of cartilage surface. Nevertheless, this is a difficult technique, which may result in complications and requires articular harvesting. This technique is limited by the size of the defect to be treated. The primary indication is deep, small defects on the medial femoral condyle.

Autologous Osteochondral Mosaicplasty for Osteochondritis Dissecans of the Elbow in Teenage Athletes

Although autologous osteochondral mosaicplasty is widely used as a procedure for osteochondritis dissecans lesions, the effectiveness of this procedure in elbow lesions remains unclear. Our aim was to clarify the surgical efficacy of mosaicplasty for teenage athletes with advanced lesions of capitellar osteochondritis dissecans. From 2001 to 2006, nineteen teenage male patients who were competitive athletes and had advanced lesions of capitellar osteochondritis dissecans underwent mosaicplasties. The mean age of the patients was 14.2 years. The surgical technique involved obtaining small-sized cylindrical osteochondral grafts with a mean diameter of 3.5 mm from the lateral periphery of the femoral condyle at the level of the patellofemoral joint and transplanting the grafts (mean, 3.3 grafts) to prepared osteochondral defects. The patients were evaluated clinically and radiographically at a mean of forty-five months after surgery. Eighteen patients were free from elbow pain, and one had mild pain occasionally. The mean total arc of elbow motion and standard deviation increased significantly from 112° ± 17° preoperatively to 128° ± 12° postoperatively (p < 0.005). The mean clinical score described by Timmerman and Andrews (with a maximum of 200 points) improved significantly from 131 ± 23 points preoperatively to 191 ± 15 points postoperatively (p < 0.0001). All patients except one had an excellent or good clinical result. All donor knees were graded as excellent on the basis of the Lysholm knee scoring system. All patients except two returned to a competitive level of the sport they had previously played. Neither loose-body formation nor secondary osteoarthritic changes were found in any patient. The current midterm results indicate that mosaicplasty can provide satisfactory clinical outcomes for teenage athletes with advanced capitellar osteochondritis dissecans lesions.

Clinical Experiences With Autologous Osteochondral Mosaicplasty in an Athletic Population

Background: Several methods are used to treat focal chondral and osteochondral defects on the weightbearing surfaces of synovial joints. Autologous osteochondral grafting is 1 option used to replace hyaline cartilage in the defect. Hypothesis: Mosaicplasty is effective in returning elite athletes to participation in sports. Study Design: Case series; Level of evidence, 4. Methods: In 3 institutes, 354 of 383 patients were followed from 2 to 17 years (average, 9.6 years). The results of mosaicplasty were prospectively evaluated at 6 weeks, 3 months, 6 months, and yearly with patient-reported outcomes measures and radiographs. Results: Slight or moderate degenerative changes (Fairbank grade I or II) were detected preoperatively in 27% of the cases and in 36% of the cases at follow-up. Fairbank grade III changes were observed in 5 cases. An average radiographic deterioration of 0.32 on the Fairbank scale was detected (preoperative, 0.34; postoperative, 0.66). Good to excellent results were found in 91% of femoral mosaicplasties, 86% of tibial, and 74% of patellofemoral; 92% of talar mosaicplasties had similar results (Hannover ankle scoring system). Patellofemoral pain related to graft harvest was observed in 5% of cases. Second-look arthroscopies revealed good, congruent, gliding surfaces of the transplants and acceptable fibrocartilage coverage of donor sites in 16 patients and degenerative changes of the transplants in 5 cases. Histological evaluation revealed good graft incorporation in all 11 cases. Two infections and 3 deep venous thromboses occurred. Conclusion: Despite a higher rate of preoperative osteoarthritic changes in the athletic patients, clinical outcomes of mosaicplasty in this group demonstrated a success rate similar to that of less athletic patients. Higher motivation resulted in better subjective evaluation. Slight deterioration in results occurred during the 9.6-year follow-up; thus, autologous osteochondral mosaicplasty may be a useful alternative for the treatment of 1.0- to 4.0-cm2 focal chondral and osteochondral lesions in competitive athletes.

Osteochondral transfer using a transmalleolar approach for arthroscopic management of talus posteromedial lesions

Characterizing osteochondral lesions of the talus has enabled the strategies of surgical management to be better specified. The main technical problem is one of access for arthroscopy instruments to posteromedial lesions. A range of techniques and approaches has been described in ankle arthroscopy in general, and a transmalleolar approach provides reliable and efficient access in these cases. It is frequently used for transchondral drilling, but also enables satisfactory implant positioning in autologous osteochondral mosaicplasty procedures. We report our technique and results on five cases with a minimum 1.2 years' follow-up.

Autologous Osteochondral Mosaicplasty for Osteochondritis Dissecans of the Elbow in Teenage Athletes

Although autologous osteochondral mosaicplasty is widely used as a procedure for osteochondritis dissecans lesions, the effectiveness of this procedure in elbow lesions remains unclear. Our aim was to clarify the surgical efficacy of mosaicplasty for teenage athletes with advanced lesions of capitellar osteochondritis dissecans. From 2001 to 2006, nineteen teenage male patients who were competitive athletes and had advanced lesions of capitellar osteochondritis dissecans underwent mosaicplasties. The mean age of the patients was 14.2 years. The surgical technique involved obtaining small-sized cylindrical osteochondral grafts with a mean diameter of 3.5 mm from the lateral periphery of the femoral condyle at the level of the patellofemoral joint and transplanting the grafts (mean, 3.3 grafts) to prepared osteochondral defects. The patients were evaluated clinically and radiographically at a mean of forty-five months after surgery. Eighteen patients were free from elbow pain, and one had mild pain occasionally. The mean total arc of elbow motion and standard deviation increased significantly from 112 degrees +/- 17 degrees preoperatively to 128 degrees +/- 12 degrees postoperatively (p < 0.005). The mean clinical score described by Timmerman and Andrews (with a maximum of 200 points) improved significantly from 131 +/- 23 points preoperatively to 191 +/- 15 points postoperatively (p < 0.0001). All patients except one had an excellent or good clinical result. All donor knees were graded as excellent on the basis of the Lysholm knee scoring system. All patients except two returned to a competitive level of the sport they had previously played. Neither loose-body formation nor secondary osteoarthritic changes were found in any patient. The current midterm results indicate that mosaicplasty can provide satisfactory clinical outcomes for teenage athletes with advanced capitellar osteochondritis dissecans lesions.

Réparation du cartilage articulaire par ingénierie tissulaire

The treatment of full thickness articular defects remains a challenging problem for the orthopaedic surgeon. Beside bone marrow stimulation techniques (microfractures) and autologous osteochondral mosaicplasty, a variety of procedures have been proposed to promote the healing of articular lesions by cultured competent cells. Tissue engineering is an emerging field, whose goal is to repair or replace tissues and organs by delivering the appropriate cells, biomaterials and signaling factors to diseased or damaged areas. In this article, we review the preclinical and clinical literature reported on the fabrication of implantable cartilage structures from chondrocytes and mesenchymal stem cells and discuss potential areas of development in the field of cartilage repair. Before routine use of engineered cartilage grafts in the clinic, the safety and efficacy of these therapies need to be validated in prospective human clinical trials.

Autologous Chondrocyte Implantation in the Hip: Case Report and Technique

The treatment of symptomatic, full-thickness articular lesions in the hip in young patients provides a challenge to orthopedic surgeons. The advent of hip arthroscopy has improved the diagnostic as well as some therapeutic capabilities surrounding certain hip pathologies. With the advancements in diagnostic ability, more symptomatic chondral defects are being recognized in the hips of young patients. The optimal surgical treatment for these patients has not been clearly defined, and there is little in the literature about biological repair for hip chondral defects. The current options include open and arthroscopic debridements and microfracture, redirectional osteotomies, autologous and allogenic osteochondral grafting, biological resurfacing with periosteum or autologous chondrocyte implantation, and prosthetic resurfacing arthroplasties. This article presents a clinical case and describes the surgical technique of autologous chondrocyte implantation for a large femoral head chondral defect (10 cm 2 ) in a young patient who had progression of disease after prior autologous osteochondral mosaicplasty.

Intraoperative Acoustic Evaluation of Living Human Cartilage of the Elbow and Knee during Mosaicplasty for Osteochondritis Dissecans of the Elbow

Background Autologous osteochondral mosaicplasty for osteochondritis dissecans of the capitellum is being used increasingly In adolescent patients. Little research has been published on the material properties of living human cartilage of the elbow and knee. Hypothesis The cartilage of the osteochondritis dissecans lesion is detected as degenerated by ultrasound. The material properties of the cartilage of the intact part of the elbow are not different from those of the intact knee except in thickness. Study Design Descriptive laboratory study. Methods The authors studied 10 young male athletes with osteochondritis dissecans of the capitellum who underwent mosaicplasty. An acoustic probe was used for measurement, and the wavelet transform method was used. Three parameters were used: signal intensity (Index of cartilage stiffness), signal duration (index of roughness), and signal interval (index of thickness). Results The cartilage of the osteochondritis dissecans lesion had lower signal intensity than did the intact part of the capitellum. The cartilage of the radial head opposite the capitellum had significantly lower signal intensity and higher signal duration than did other sites. The signal intensity of the radial head was significantly higher in early-stage patients than in late-stage Patients, although the macroscopic view was almost all intact. The signal intensity of the plug was decreased significantly after 9rafting. Conclusion The osteochondritis dissecans lesion had lower signal intensity than did the intact part of the capitellum. Although the macroscopic view looked intact, the radial head cartilage was degenerated as measured acoustically. Clinical Relevance Not only the cartilage of the capitellum but the cartilage of the radial head are acoustically degenerated in osteochondritis dissecans patients. Plugs might be damaged in the transplanting procedure, and further follow-up is necessary.

Autologous osteochondral grafting—Technique and long-term results

Efficacious treatment of chondral and osteochondral defects of weightbearing articular surfaces is a daily challenge in musculoskeletal care. Autogenous osteochondral transplantation represents a possible solution for creating hyaline or hyaline-like repair in the affected area that has a noninflammatory pathoorigin. This paper discusses the experimental background and over 15 years of clinical experience with autologous osteochondral mosaicplasty. Several series of animal studies and subsequent clinical practice of over 1,000 mosaicplasty patients were assessed to confirm the survival of transplanted hyaline cartilage and fibrocartilage filling of donor sites located on relatively less weightbearing surfaces, as well as donor-site disturbances and morbidity. Histological evaluations of dog and horse implantations as well as several series of clinical evaluations in the human material are summarized in this paper. Clinical scores, different types of imaging techniques, second-look arthroscopies, histological examination of biopsy samples, and cartilage stiffness measurements were used to evaluate the clinical outcomes and quality of the transplanted cartilage. Analysis of clinical scores has shown good to excellent results in 92% of patients with femoral condylar implantations, 87% of tibial resurfacements, 74% of patellar and/or trochlear mosaicplasties and 93% of talar procedures. Longterm donor-site complaints measured by the Bandi score were minor and present only in 3% of patients. 81 out of the 98 control arthroscopies represented congruent and good gliding surfaces and histologically proven survival of the transplanted hyaline cartilage as well as fibrocartilage covering of the donor sites. Complications in the entire patient group were four deep infections and four deep venous thromboses. In nearly 8% of the cases excessive intraarticular bleeding was observed in the early postoperative period, as a minor complication of the procedure. Multicentric, comparative, prospective evaluation of 413 arthroscopic resurfacing procedures (mosaicplasty, Pridie drilling, abrasion arthroplasty and microfracture cases in homogenised subgroups) demonstrated that mosaicplasty resulted in favourable clinical outcome in the long-term follow-up compared to other three techniques. Durability of the early results was confirmed in long-term evaluations both of the femoral condylar implantations and talar mosaicplasties. According to our encouraging results in this increasingly large series, supported by similar findings from other centres, it seems that autologous osteochondral mosaicplasty may be an alternative for small and medium-sized focal chondral and osteochondral defects of weightbearing surfaces of the knee and other weightbearing synovial joints.

Donor Site Evaluation after Autologous Osteochondral Mosaicplasty for Cartilaginous Lesions of the Elbow Joint

Background One significant disadvantage of autologous osteochondral mosaicplasty (mosaicplasty) is the harvesting of osteochondral grafts from the normal articular area of the knee joint. However, the effect of harvesting grafts on knee function remains unclear. Purpose To clarify the functional effects on the donor knee of harvesting osteochondral grafts and to perform magnetic resonance imaging evaluation of donor site repair after mosaicplasty for capitellar osteochondritis dissecans in young athletes. Study Design Case series; Level of evidence, 4. Methods Eleven male competitive athletes with advanced lesions of capitellar osteochondritis dissecans underwent mosaicplasties. The surgical technique involves obtaining small-sized cylindrical osteochondral grafts from the lateral periphery of the femoral condyle at the level of the patellofemoral joint and transplanting them to osteochondral defects in the capitellum. Assessment at a mean follow-up of 26 months included local findings of the donor knees, a Lysholm knee scoring scale, International Knee Documentation Committee standard evaluation form, and magnetic resonance imaging evaluation. Results All patients returned to a competitive level of their previous sports without any donor site disturbances. Based on the Lysholm knee score and International Knee Documentation Committee evaluation form, all knees were graded as excellent and normal, respectively. The magnetic resonance imaging showed 50% to 100% defect fill in 6 of 9 patients and normal or nearly normal signals in 4 patients at the donor sites. Conclusion No adverse effects of osteochondral graft harvest on donor knee function were found after mosaicplasty for capitellar osteochondritis dissecans in young athletes. However, magnetic resonance imaging indicates that the donor site is resurfaced with fibrous tissue.

Autologous Osteochondral Mosaicplasty Grafting

Successful management of chondral and osteochondral defects of the weight-bearing joint surfaces has always been a challenge for orthopedic surgeons and rehabilitation specialists. Autologous osteochondral mosaic transplantation technique is one of the recently evolved methods to create hyaline or hyaline-like repair tissue in the pathologic area. Clinical evaluation, various imaging techniques, arthroscopy (second look), histological examination of biopsy samples, and measurements of cartilage mechanical properties are used to evaluate the merits of outcomes and quality of the transplanted cartilage. According to our investigations, good to excellent results were achieved in more than 92% of patients treated with femoral condylar implantations, 87% of those treated with tibial resurfacing, 79% of those treated with patellar and/or trochlear mosaicplasties, and 94% of those treated with talar procedures. Long-term donor-site discrepancies, assessed with use of the Bandi Score, showed that patients had 3% morbidity after mosaicplasty. Sixty-nine of 89 patients who were followed up with a second-look arthroscopy showed congruent gliding surfaces, histological evidence of the survival of the transplanted hyaline cartilage, and fibrocartilage filling of the donor sites. In a series of 831 consecutive patients, very few complications have been observed. These included 4 deep infections and 36 painful postoperative intra-articular bleedings. On the basis of these results and those of other similar studies, autologous osteochondral mosaicplasty appears to be a promising alternative for the treatment of small- and medium-sized focal chondral and osteochondral defects of the weight-bearing surfaces of the knee and other weight-bearing synovial joints.

Autologous Osteochondral Mosaicplasty for Capitellar Osteochondritis Dissecans in Teenaged Patients

Background Autologous osteochondral mosaicplasty is a new technique to provide hyaline repair for articular defects. Although recent studies have reported the successful treatment of articular defects in the knee and ankle joints with this surgical procedure, little attention has been given to the surgical efficacy of mosaicplasty in the treatment of osteochondritis dissecans of the humeral capitellum. Purpose To clarify the clinical outcomes of mosaicplasty for teenaged patients with advanced lesions of capitellar osteochondritis dissecans. Study Design Case series; Level of evidence, 4. Methods Eight teenaged patients with advanced lesions of capitellar osteochondritis dissecans underwent mosaicplasties. All patients were baseball players who were affected on the right side, which was also their throwing side. The surgical technique involves obtaining small-sized cylindrical osteochondral grafts from the lateral periphery of the femoral condyles and transplanting them to prepared osteochondral defects. At a mean follow-up of 24 months, all patients were evaluated clinically and radiographically. Results Seven of the 8 patients were free from elbow pain, and the remaining patient had mild pain occasionally. The mean clinical score described by Timmerman and Andrews (a maximum of 200 points) significantly improved from 140 points to 183 points postoperatively. All patients except one had excellent or good clinical results. Radiographically, the graft incorporation and a normal contour of the subchondral cortex were found in all patients. Magnetic resonance imaging showed that the preoperative heterogeneity of the lesion had disappeared and the signal intensity returned to normal. Six of the 8 patients, including all 3 pitchers, returned to competitive-level baseball. Conclusion Mosaicplasty for advanced lesions of capitellar osteochondritis dissecans in teenaged baseball players can provide satisfactory clinical and radiographic results.

Experimental results of donor site filling for autologous osteochondral mosaicplasty

Purpose: Autologous osteochondral mosaicplasty has become a treatment option for focal chondral and osteochondral defects in recent years. Excessive postoperative bleeding from the donor site was reported as a possible complication of the procedure. The purpose of this study was to investigate different biodegradable materials for donor site filling, which could prevent excessive postoperative bleeding from these sites but would allow reasonable blood clot formation on the articular surfaces of donor tunnels. Type of Study: Basic science evaluation. Methods: In an experimental model, “donor site plugs” made from hydroxylapatite, carbon fiber, polyglyconate-B, compressed collagen, and 2 versions of polycaprolactones were used to fill the bony tunnels created by harvesting. These materials were tested in 100 knees of 50 German Shepherd dogs to determine the quality of the repair tissue formation on the surfaces of the harvesting holes filled by these materials. Arthroscopies of the dogs were performed at several intervals, from 4 weeks to 26 weeks, and macroscopic studies were performed on euthanized animals between 8 weeks and 30 weeks to evaluate donor site filling and coverage. Empty donor tunnels served as controls for the evaluation of the different filling materials. Results: All tested materials effectively decreased postoperative bleeding. Hydroxylapatite, carbon rods, polyglyconate-B, and melted polycaprolactone materials showed a good integration to the surrounding cancellous bone, but these fillings showed only a limited repair tissue formation, even at 30 weeks postoperatively. Second-look arthroscopy and histologic evaluation of necropsies showed the best fibrocartilage coverage after filling by compressed collagen. Technical details of the filling also had certain importance in the quality of the repair tissue formation. Conclusions: According to histologic results, compressed collagen appears to be a good material to fill donor tunnels of osteochondral graft harvest. This material is substituted gradually by bone formation and its articular surface can serve as an appropriate scaffold for fibrocartilage coverage created by the natural intrinsic repair process.