Saúde Atlúântica Sports Center-FC Porto Stadium, Minho University and Porto University, Porto, Portugal.
Knee Surg Sports Traumatol Arthrosc. 2012 Jun;20(6):1136-42. doi: 10.1007/s00167-012-1910-0. Epub 2012 Jan 28.
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.
膝关节负重区的大软骨损伤的治疗仍然存在争议，是一个具有挑战性的课题。自体马赛克软骨成形术已被证明是一种有效的治疗方法，但最常使用的自体移植物的供区发病率仍然是一个令人关注的问题。本研究旨在评估自体骨-软骨移植物取自胫骨腓骨关节上部用于重建膝关节症状性软骨下骨病变的临床结果和安全性。
1998 年至 2006 年间，采用马赛克软骨成形术技术对 31 例（22 名男性和 9 名女性）膝关节 4 级软骨损伤患者进行了手术，使用取自胫骨腓骨关节上部的自体骨-软骨移植物。临床评估包括视觉模拟评分（VAS）疼痛和 Lysholm 评分。所有患者均在术前和术后通过 MRI 进行评估，以评估关节吻合度，分为良好、中等（1 毫米以内的不吻合）和差（任何帧中记录的不吻合度大于 1 毫米）。供区区状况根据特定的方案进行评估，考虑到胫骨腓骨关节不稳定、疼痛、神经并发症、外侧副韧带功能不全或踝关节不适。
手术时的平均年龄为 30.1 岁（标准差 12.2）。就病变部位而言，22 例位于内侧股骨髁负重区，7 例位于外侧股骨髁，1 例位于滑车，1 例位于髌骨。平均随访时间为 110.1 个月（标准差 23.2）。平均病变面积为 3.3cm2（标准差 1.7），使用的移植物数量不同，平均为 2.5（标准差 1.3）。VAS 评分从 47.1（标准差 10.1）降至 20.0（标准差 11.5）；p = 0.00。同样，Lysholm 评分从 45.7（标准差 4.5）增加到 85.3（标准差 7.0）；p = 0.00。评估了患者的满意度水平，28 例患者表示满意/非常满意，并会再次接受手术，而 3 例患者表示对手术不满意，不会再次接受手术。这 3 例患者的临床评分较低，并伴有与原发病相关但与供区无关的不适主诉。MRI 评分在 18-24 个月时与术前相比显著改善（p = 0.004）。未发现与供区相关的与活动相关的放射学或临床并发症。
本研究证实，采用自体骨-软骨移植物取自胫骨腓骨关节上部的马赛克软骨成形术是治疗膝关节软骨下骨缺损的有效方法。未发现与供区相关的明显并发症。
病例系列，IV 级。
