Clinical Experiences With Autologous Osteochondral Mosaicplasty in an Athletic Population
| Autor: | László Hangody, Eszter Baló, István Berkes, Gergely Pánics, Jozsef Dobos |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Radiography Population Physical Therapy Sports Therapy and Rehabilitation Knee Injuries Transplantation Autologous Young Adult Osteochondral grafting Humans Medicine Orthopedic Procedures Orthopedics and Sports Medicine Elite athletes Prospective Studies education Osteochondritis Synovial joints education.field_of_study Bone Transplantation business.industry Hyaline cartilage Middle Aged Osteochondral transplantation Surgery medicine.anatomical_structure Multicenter study Female Joint Diseases business Follow-Up Studies |
| Zdroj: | The American Journal of Sports Medicine. 38:1125-1133 |
| ISSN: | 1552-3365 0363-5465 |
| DOI: | 10.1177/0363546509360405 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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