Treatment of unstable osteochondritis dissecans in adults with autogenous osteochondral grafts (Mosaicplasty): long-term results

Abstract

Purpose: the unstable osteochondritis dissecans (oCD-type ii and iii according to the iCRs classification) of the knee largher than > 2.5 cm 2 in adults are uncommon lesions and there is no consensus on how to treat them. Medium-term studies have reported good re sults using autogenous osteochondral plugs (mosaicplasty). the aim of this study is to analyze the long-term results of this technique for the treatment of unstable oCD in a selected group of adult patients. Methods: four patients with oCD at either one of the femoral condyles were included in this prospective study. the average age was 21.2 years (range, 18-24 years). the oCD lesions were classified as type ii in three patients and type iii in one patient and the average size was 3.8 cm 2 (range, 2.55-5.1 cm 2 ). the lesions were treated in situ with a variable number of autogenous osteochondral plugs (Ø 4.5 mm 2 ). the Modified Cincinnati, Lysholm ii and tegner scores were used for clinical and functional evaluation. Magnetic resonance arthrography (MRA) was performed before surgery and at 2, 5 and 10 years after surgery. A modified MoCARt score was used to evaluate MRA findings.Results: the average follow-up duration was ten years and 6 months (range, 10-11 years). no complications occurred. At the final follow-up, all scores (clinical, functional and MoCARt) improved. in all but one of the patients MRA showed complete osteochondral repair. Conclusions: the fixation of large and unstable oCD lesions with mosaicplasty may be a good option for treating type ii or iii oCD lesions in adults. the advantages of this technique include stable fixation, promotion of blood supply to the base of the oCD fragment, and grafting of autologous cancellous bone that stimulates healing with preservation of the articular surface. Level of evidence: Level iV, therapeutic case series.

Matrix-assisted chondrocyte transplantation with bone grafting for knee osteochondritis dissecans: stable results at 12 years

“…Among these, arthroscopic matrix‐assisted autologous chondrocyte transplantation (MACT) with an associated bone grafting procedure has been introduced aiming at overcoming the drawbacks of first‐generation ACI [11, 26, 27, 36]. In fact, MACT can be implanted with an arthroscopic approach and was shown to reduce graft hypertrophy [35], with scaffolds providing support for cell adhesion and proliferation, maintaining chondrocyte phenotype and matrix production, and avoiding the dedifferentiation into fibroblasts typical of 2D culture [18, 29]. This technique showed promising results at mid‐term follow‐up [17], but no long‐term data are available, yet.…”

Mosaicplasty of the Femoral Head: A Systematic Review and Meta-Analysis of the Current Literature

“…Studies have shown that the long-term clinical outcome after mosaicplasty varies greatly depending on age, gender, and the size of the lesion [31,47,51,54,[57][58][59][60][61][62][63].…”

Fresh Osteochondral Allograft Transplantation in Osteochondritis Dissecans in the Knee Joint

“…In fact, while Smolders et al [54] described satisfactory results treating OCD lesions ranging from 0.5 to 3.2 cm 2 , and other studies reported that OAT provides good-to-excellent results when applied to smaller articular cartilage between 1 and 4 cm 2 [58], lesions > 6 cm 2 are associated with a poor prognosis, even when multiple graft plugs are used [53]. Furthermore, few studies with small cohorts have looked specifically at the use of OAT for the treatment of OCD [32,54,[59][60][61].…”