Karmali Samir, Guerreiro Rui, Costa Daniel Sá da, Fonseca Jorge, Gonçalves Ricardo
Departamento Ortopédico, Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal.
Departamento Ortopédico, Unidade de Ombro e Cotovelo, Hospital Privado de Gaia, Vila Nova de Gaia, Portugal.
Rev Bras Ortop (Sao Paulo). 2019 May;54(3):316-321. doi: 10.1055/s-0039-1691763. Epub 2019 Jun 27.
Focal osteochondral lesions of the knee are found in two thirds of patients undergoing arthroscopy; their treatment, when isolated and especially in young individuals, remains a debating topic. The present study analyzes the results obtained by the application of the mosaicplasty technique on the treatment of isolated knee femoral condyle osteochondral lesions. Retrospective study of patients submitted to mosaicplasty and to subjective analyses with pre- and postsurgery International Knee Documentation Committee (IKDC) scores. A total of 13 cases with an average age of 34 years old, with male patients ( = 4; 31%) with an average age of 23 years old (range: 17-31 years old), and female patients ( = 9; 69%) with an average age of 39 years old (range: 16-56 years old); medial versus lateral femoral ( = 11; 85% versus = 2; 15%); the average size of the lesion was 1.8 cm (range: 0.6-4 cm ); average follow-up time: 5.045 ± 3.47 years (range: 1.15-11.01 years). The average preoperative IKDC score was of 31.63 points (±20.24), the average postoperative IKDC score was of 74.18 points (±20.26). The difference between the post- and preoperative IKDC scores was of 42.55 (±21.05) points, being the minimal score increase of 8.1 points and the maximum score increase of 82.8 points. A statistically significant difference ( < 0.001) was found between the IKDC scores before and after the surgery. A statistically significant relation ( = 0.038) was found between the IKDC score increase (the difference between the postoperative and the preoperative scores) and the dimension of the lesion. Mosaicplasty with osteochondral autograft transfer, when adequately used, can produce excellent results with great durability and functional impact, low morbidity rates and costs. Expansion of the indication criteria shows promising mid-term and long-term results.
在接受关节镜检查的患者中,三分之二会发现膝关节局灶性骨软骨损伤;对于其治疗,尤其是孤立性损伤且患者为年轻人时,仍是一个有争议的话题。本研究分析了应用镶嵌成形术治疗孤立性膝关节股骨髁骨软骨损伤所取得的结果。
对接受镶嵌成形术的患者进行回顾性研究,并采用国际膝关节文献委员会(IKDC)术前和术后评分进行主观分析。
共有13例患者,平均年龄34岁,其中男性患者4例(占31%),平均年龄23岁(范围:17 - 31岁),女性患者9例(占69%),平均年龄39岁(范围:16 - 56岁);股骨内侧与外侧损伤比例为11例(占85%)对2例(占15%);损伤平均大小为1.8平方厘米(范围:0.6 - 4平方厘米);平均随访时间:5.045 ± 3.47年(范围:1.15 - 11.01年)。术前IKDC平均评分为31.63分(±20.24),术后IKDC平均评分为74.18分(±20.26)。术后与术前IKDC评分的差值为42.55(±21.05)分,最小评分增加8.1分,最大评分增加82.8分。手术前后IKDC评分存在统计学显著差异(P < 0.001)。IKDC评分增加量(术后与术前评分的差值)与损伤大小之间存在统计学显著相关性(P = 0.038)。
自体骨软骨移植镶嵌成形术若使用得当,可产生优异的效果,具有良好的耐久性和功能影响,发病率低且成本低。扩大适应证标准显示出中期和长期的良好结果。