The Journal of Bone and Joint Surgery (American) 86:65-72 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.
Autologous Osteochondral Mosaicplasty
Surgical Technique
László Hangody, MD, PhD, DSc1,
Gábor K. Ráthonyi, MD1,
Zsófia Duska1,
Gábor Vásárhelyi, MD1,
Péter Füles, MD1 and
László Módis, MD, PhD, DSc1
1 Uzsoki Hospital, Orthopaedic and Trauma Department, Mexikói Street 62,
1145 Budapest, Hungary. E-mail address:
hangody{at}axelero.hu
Investigation performed at Uzsoki Hospital, Orthopaedic and Trauma
Department, Budapest, Hungary
The original scientific article in which the surgical technique was
presented was published in JBJS Vol. 85-A, Suppl. 2, pp. 25-32, 2003
In support of their research or preparation of this manuscript, one or more
of the authors received grants or outside funding from the Hungarian Health
Ministry. In addition, one or more of the authors received payments or other
benefits or a commitment or agreement to provide such benefits from a
commercial entity (royalty payment after mosaicplasty instrumentation, Smith
and Nephew Endoscopy, Inc., Andover, Massachusetts). No commercial entity paid
or directed, or agreed to pay or direct, any benefits to any research fund,
foundation, educational institution, or other charitable or nonprofit
organization with which the authors are affiliated or associated.
The line drawings in this article are the work of Daniel Müller of
Haderer & Müller
(art{at}ilustracao-biomedica.com).
BACKGROUND:
The successful treatment of chondral and osteochondral defects of the
weight-bearing surfaces is a challenge for orthopaedic surgeons. Autologous
osteochondral transplantation is one method that can be used to create hyaline
or hyaline-like repair in the defect area. This paper describes the results
after ten years of clinical experience with autologous osteochondral
mosaicplasty.
METHODS:
Clinical scores, imaging techniques, arthroscopy, histological examination
of biopsy samples, and cartilage stiffness measurements were used to evaluate
the clinical outcomes and quality of the transplanted cartilage in 831
patients undergoing mosaicplasty.
RESULTS:
According to these investigations, good-to-excellent results were achieved
in 92% of the patients treated with femoral condylar implantations, 87% of
those treated with tibial resurfacing, 79% of those treated with patellar
and/or trochlear mosaicplasties, and 94% of those treated with talar
procedures. Long-term donor-site disturbances, assessed with use of the Bandi
score, showed that patients had 3% morbidity after mosaicplasty. Sixty-nine of
eighty-three patients who were followed arthroscopically showed congruent
gliding surfaces, histological evidence of the survival of the transplanted
hyaline cartilage, and fibrocartilage filling of the donor sites.
Complications of the surgery included four deep infections and thirty-six
painful postoperative hemarthroses.
CONCLUSIONS:
On the basis of these promising results and those of other similar studies,
autologous osteochondral mosaicplasty appears to be an alternative for the
treatment of small and medium-sized focal chondral and osteochondral defects
of the weight-bearing surfaces of the knee and other weight-bearing synovial
joints.
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