Reverte-Vinaixa Maria Mercedes, Joshi Nayana, Diaz-Ferreiro Eugenio Wenceslao, Teixidor-Serra Jordi, Dominguez-Oronoz Rosa
Department of Trauma and Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
J Orthop Surg (Hong Kong). 2013 Apr;21(1):4-9. doi: 10.1177/230949901302100104.
To evaluate the medium-term outcome of mosaicplasty for full-thickness cartilage defects of the knee joint in 17 patients.
Records of 12 men and 5 women aged 16 to 57 (mean, 35) years who underwent mosaicplasty for grade III/IV osteochondral defects in the lateral (n=14) or medial (n=3) femoral condyle were reviewed. 12 of the patients had undergone knee surgeries. The mean size of the defects was 3.4 (range, 1-4) cm(2). Three patients had defects of >2 cm(2). All operations were performed by a single surgeon using mini-arthrotomy. The lateral edge of the trochlea was the donor site. Graft integration and the presence of any abnormality at the articular surface were assessed using magnetic resonance imaging (MRI). In addition, patients were evaluated using the International Knee Documentation Committee (IKDC) rating scale, the SF-36 health questionnaire, visual analogue scale (VAS) score for pain.
Two of the 17 patients developed necrosis and cystic degeneration of the grafts and underwent conversion to unicompartmental knee arthroplasty within 2 years. They were older than 45 years and had defects of >2 cm(2). Respectively in years 4 and 7, one and 4 patients were lost to follow-up, the mean IKDC score was 75% and 88%, the SF-36 score was 83% and 90%, and the VAS score was ≤3 in 13 of 14 patients at year 4 and in all 11 patients at year 7. At the 7-year follow-up, patient satisfaction with mosaicplasty was excellent in 8 patients, good in 3, and poor in 2 (who underwent unicompartmental knee arthroplasty). At year 4, MRI showed integration of the cartilage repair tissue and incorporation of the osseous portion of the graft into the bone in 13 of the 14 patients. The remaining patient had osteoarthritis at the graft donor site. At year 7, MRI showed good integration of the implant in all 11 available patients, but fissures were seen on the cartilage surface in 3 patients.
The medium-term outcome of autologous mosaicplasty for symptomatic osteochondral defects in the femoral condyle is good. Longer follow-up is needed to determine the structural and functional integrity of the graft over time.
评估17例膝关节全层软骨缺损患者接受镶嵌成形术的中期疗效。
回顾12例男性和5例女性患者的记录，年龄在16至57岁（平均35岁），他们因股骨外侧髁（n = 14）或内侧髁（n = 3）的III/IV级骨软骨缺损接受了镶嵌成形术。其中12例患者曾接受过膝关节手术。缺损的平均大小为3.4（范围1 - 4）cm²。3例患者的缺损面积大于2 cm²。所有手术均由一名外科医生采用微型关节切开术进行。滑车外侧缘为供区。使用磁共振成像（MRI）评估移植物的整合情况以及关节表面是否存在任何异常。此外，使用国际膝关节文献委员会（IKDC）评分量表、SF - 36健康调查问卷、疼痛视觉模拟量表（VAS）对患者进行评估。
17例患者中有2例出现移植物坏死和囊性退变，并在2年内改行单髁膝关节置换术。他们年龄大于45岁且缺损面积大于2 cm²。在第4年和第7年，分别有1例和4例患者失访，平均IKDC评分为75%和88%，SF - 36评分为83%和90%，在第4年14例患者中有13例VAS评分≤3，在第7年所有11例患者的VAS评分均≤3。在7年随访时，8例患者对镶嵌成形术的满意度为优秀，3例为良好，2例（改行单髁膝关节置换术者）为差。在第4年，14例患者中有13例MRI显示软骨修复组织整合且移植物的骨部分融入骨中。其余1例患者在移植物供区出现骨关节炎。在第7年，11例可评估患者的MRI均显示植入物整合良好，但3例患者的软骨表面出现裂隙。
自体镶嵌成形术治疗股骨髁有症状性骨软骨缺损的中期疗效良好。需要更长时间的随访以确定移植物随时间推移的结构和功能完整性。
