Comparative Evaluation of Autologous Chondrocyte Implantation and Mosaicplasty

Dozin, Béatrice; Malpeli, Mara; Cancedda, Ranieri; Bruzzi, Paolo; Calcagno, S.; Molfetta, Luigi; Priano, F.; Kon, Elizaveta; Marcacci, Maurilio

doi:10.1097/01.jsm.0000171882.66432.80

Cited by 189 publications

(162 citation statements)

References 44 publications

(41 reference statements)

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“…There are several references in the literature reporting not significantly different results with microfractures, mosaicplasty, and autologous condrocyte implantation [7,15,16,18,38]. Mosaicplasty presents the advantage of transferring hyaline cartilage into the defect with favorable integration of the cancellous bone component of the ''plug'' [12,21].…”

Section: Discussionmentioning

confidence: 99%

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

Espregueira-Mendes

Pereira

Sevivas

et al. 2012

Knee Surg Sports Traumatol Arthrosc

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Purpose 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. Methods 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. Results 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 cm 2 (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. Conclusions 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. Level of evidence Case series, Level IV.

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Section: Discussionmentioning

confidence: 99%

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

Espregueira-Mendes

Pereira

Sevivas

et al. 2012

Knee Surg Sports Traumatol Arthrosc

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“…Traditional methods of repair of osteochondral defects include debridement, marrow stimulation, osteochondral grafting and autologous chondrocyte implantation (ACI) [4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Bioengineering of Articular Cartilage: Past, Present and Future

Felimban

Moulton

et al. 2013

Regen. Med.

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The treatment of cartilage defects poses a clinical challenge owing to the lack of intrinsic regenerative capacity of cartilage. The use of tissue engineering techniques to bioengineer articular cartilage is promising and may hold the key to the successful regeneration of cartilage tissue. Natural and synthetic biomaterials have been used to recreate the microarchitecture of articular cartilage through multilayered biomimetic scaffolds. Acellular scaffolds preserve the microarchitecture of articular cartilage through a process of decellularization of biological tissue. Although promising, this technique often results in poor biomechanical strength of the graft. However, biomechanical strength could be improved if biomaterials could be incorporated back into the decellularized tissue to overcome this limitation.

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“…Randomized studies with a control group have been performed. Horas et al (Horas et al, 2003) and Dozin et al (Dozin et al, 2005) concluded that the clinical outcome of mosaicplasty was equivalent to autologous chondrocyte implantation, with a high rate of hyaline cartilage. However, after early-stage promising results, Solheim et al (Solheim et al, 2010) showed that there is a gradual reduction of efficacy after 10 to 14 years of follow-up; 40% of the 73 cases had poor outcome, and good outcome was often seen in younger patients with defect size <3 cm 2 .…”

Section: Complicationsmentioning

confidence: 99%

Autologous osteochondral transplantation for treatment of cartilage defects in osteoarthritic knee: preliminary results

Bui

Nguyen

et al. 2016

Biomed Res Ther

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Introduction: Osteoarthritis is a contributing factor for pain and loss of function of the knee. Osteoarthritis results in many damages to the knee; one of the most common damages that is difficult to recover is cartilage injury. This study aims to apply autologous osteochondral transplantation (OAT) under knee arthroscopy for the treatment of knee cartilage defects. Methods: This was a prospective, descriptive and non-controlled study. Patients were diagnosed as having osteoarthritis, as confirmed by 1cm 2 -3cm 2 cartilage defects. Arthroscopic OAT was performed on each patient. Treatment efficacy and safety were evaluated based on Lysholm, Oxford Knee Scores (OKS) and pain scales (VAS) after 3, 6, 12 and 18 months. Results: From 3/2014 -8/2016, 61 cases (54 women and 7 men) participated in the study. The average age was 55 ± 8 years old. Most cases had cartilage defects in the medial condyle. Results showed that Lysholm, OKS scores and VAS scales improved after 12 months of treatment. Of the cases, 33 of 61 were followed out to 18 months; these patients showed improvement in knee function and pain scores. There was 1 case with incomplete matching between the plug and receiving site and 1 case with a broken plug. At the final stage of monitoring, there were no patients who experienced complications, such as broken instruments or fracture of condyle, nor who experienced early postoperative complications, such as infection and bleeding. Conclusion: Autologous osteochondral transplantation via arthroscopy is a safe and promising method for the treatment of knee cartilage defects in patients with average osteoarthritis.

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Comparative Evaluation of Autologous Chondrocyte Implantation and Mosaicplasty

Cited by 189 publications

References 44 publications

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

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

Bioengineering of Articular Cartilage: Past, Present and Future

Autologous osteochondral transplantation for treatment of cartilage defects in osteoarthritic knee: preliminary results

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