Orthopaedics and Traumatology Department, Memorial Private Hospital, Istanbul, Turkey.
Arch Orthop Trauma Surg. 2013 Apr;133(4):531-6. doi: 10.1007/s00402-013-1680-2. Epub 2013 Jan 18.
The purpose of this retrospective study was to evaluate the results and prognostic factors affecting the outcome of osteochondral autografting (mosaicplasty) in articular cartilage defects of the knee joint.
One hundred fifty-two patients who underwent mosaicplasty for femoral condylar cartilage defects (modified Outerbridge classification: Grade III and IV) of the knee joint between 1998 and 2007 in our institution were included. There were 126 male and 26 female patients with a mean age of 24.8 ± 4.6 years. The average size of the lesion was 2.7 ± 0.7 cm(2). Of these patients, 33 had concomitant meniscal and/or cruciate ligament injuries which were treated simultaneously. All patients were followed up with a mean of 18.2 ± 4.2 months (range 12-24 months) using Lysholm knee score. We analyzed the relationship between the outcome variable (Lysholm knee score at the final follow-up) and the predictor variables (age, gender, lesion size, lesion grade, localization, accompanying intra-articular injuries and duration of follow-up).
The mean preoperative Lysholm knee score was 55.2 ± 3.6 points and increased to 88.2 ± 2.5 points at the final follow-up. There was a significant increase in Lysholm score during follow-up period (p = 0.0001). The results were excellent in 2 cases (1.3 %), good in 144 cases (94.7 %) and fair in 6 cases (3.9 %). No patients had infection, systemic complication and revision surgery. Backward regression analysis showed that age, lesion size, localization and associated intraarticular injuries are the only predictors of the final Lysholm knee score in best fit model (R (2) = 0.442, p = 0.0001). The linear regression equation was (Lysholm score at final follow-up) = 93.4 - [0.2 (age of patient) + 0.8 (lesion size) + 0.9 (localization) + 2.8 (presence of associated intraarticular injuries)].
Mosaicplasty is an effective technique for the treatment of articular cartilage defects of the knee joint which restores the joint function in a short period of follow-up. Furthermore, age, lesion size, localization, and concomitant surgical interventions are major factors affecting the final outcome. The final knee score deteriorates as the age of the patient and size of the lesion increases. Furthermore, concomitant surgical interventions and lesions located on the medial femoral condyle have a negative effect on the final knee score.
本回顾性研究旨在评估影响膝关节软骨缺损骨软骨自体移植（马赛克plasty）疗效的结果和预后因素。
本研究纳入了 1998 年至 2007 年期间在我院行膝关节股骨髁软骨缺损（改良 Outerbridge 分级：III 级和 IV 级）马赛克plasty 的 152 例患者。其中男 126 例，女 26 例，平均年龄 24.8±4.6 岁。平均病灶大小为 2.7±0.7cm2。其中 33 例患者合并半月板和/或交叉韧带损伤，同时进行了治疗。所有患者均采用 Lysholm 膝关节评分进行平均 18.2±4.2 个月（12-24 个月）的随访。我们分析了结局变量（最终随访时的 Lysholm 膝关节评分）与预测变量（年龄、性别、病灶大小、病灶分级、定位、伴随的关节内损伤和随访时间）之间的关系。
术前平均 Lysholm 膝关节评分为 55.2±3.6 分，最终随访时增加至 88.2±2.5 分。随访期间 Lysholm 评分有显著升高（p=0.0001）。结果为优 2 例（1.3%），良 144 例（94.7%），可 6 例（3.9%）。无感染、全身并发症和翻修手术。向后回归分析显示，年龄、病灶大小、定位和伴随的关节内损伤是最佳拟合模型中最终 Lysholm 膝关节评分的唯一预测因素（R2=0.442，p=0.0001）。线性回归方程为（最终随访时的 Lysholm 评分）=93.4-[0.2（患者年龄）+0.8（病灶大小）+0.9（定位）+2.8（伴随的关节内损伤）]。
马赛克plasty 是治疗膝关节软骨缺损的有效技术，可在短期内恢复关节功能。此外，年龄、病灶大小、定位和伴随的手术干预是影响最终疗效的主要因素。患者年龄和病灶增大，最终膝关节评分恶化。此外，伴随的手术干预和内侧股骨髁上的病灶对最终膝关节评分有负面影响。
