Elmokhtar Abdallah, Rafrafi Abderazzak, Znagui Talel, Saadi Saber, Khezami Mounira, Hamdi Mounir, Nouisri Lotfi
Service d'Orthopédie à Hôpital Militaire Principal de Tunis, Tunis, Tunisie.
Pan Afr Med J. 2019 Apr 18;32:191. doi: 10.11604/pamj.2019.32.191.17308. eCollection 2019.
Several surgical procedures, including mosaic arthroplasty, can be used to treat patients with cartilage loss in the femoral condyles. This study aims to assess mid-term clinical and radiological results as well as the main prognostics elements. We conducted a retrospective epidemiological study over a period of 15 years. During the study period we collected data from 35 workable medical records of patients with osteochondritis dissecans of the femoral condyles treated by mosaic arthroplasty, with an average follow-up of 24 months. The level of complaints as well as preoperative knee function were evaluated and compared with the healthy knee according to the International Cartilage Repair Society (ICRS) score, the International Knee Documentation Committee (IKDC) score and visual analogue scale (VAS). It was less than 60% in 27 patients. During the follow-up period, the results were analyzed according to Hughston's functional and radiological criteria. After an average follow-up of 24 months, algoneurodystrophy was reported in 5 cases with a single case of haemarthrosis. A net ICRS score improvement was observed with a mean increasing from 54% to 74% on the follow-up visit. Most of patients were satisfied or very satisfied (82.9%). The elements of good prognosis recognized in our study included: a mean time between symptom onset and surgery of less of 18 months, having deep lesions with a diameter less than 02 cm and having lesions in the internal condyle. The treatment of cartilage loss is necessarily based on the correction of its direct and indirect causes namely the morphotype, the laxity and meniscus capital. No consensus in the decision-making was reached and no one could confirm the superiority of a technique in relation to the other but we can say that cartilage defect which sizes from 2 to 4 cm² may be the best indication for mosaic arthroplasty.
包括镶嵌式关节成形术在内的多种外科手术可用于治疗股骨髁软骨损伤患者。本研究旨在评估中期临床和放射学结果以及主要预后因素。我们进行了一项为期15年的回顾性流行病学研究。在研究期间，我们收集了35例接受镶嵌式关节成形术治疗的股骨髁剥脱性骨软骨炎患者的可行医疗记录数据，平均随访24个月。根据国际软骨修复协会（ICRS）评分、国际膝关节文献委员会（IKDC）评分和视觉模拟量表（VAS）评估患者的主诉水平以及术前膝关节功能，并与健康膝关节进行比较。27例患者的评分低于60%。在随访期间，根据休斯顿功能和放射学标准对结果进行分析。平均随访24个月后，报告有5例发生痛性神经营养不良，1例发生关节积血。观察到ICRS评分净改善，随访时平均从54%提高到74%。大多数患者满意或非常满意（82.9%）。我们研究中公认的良好预后因素包括：症状出现至手术的平均时间少于18个月、有直径小于2cm的深部病变以及病变位于内侧髁。软骨损伤的治疗必须基于对其直接和间接原因的纠正，即形态类型、松弛度和半月板。在决策方面未达成共识，也没有人能够证实一种技术相对于另一种技术的优越性，但我们可以说，面积为2至4cm²的软骨缺损可能是镶嵌式关节成形术的最佳适应证。
