Clinical experiences with autologous osteochondral mosaicplasty in an athletic population: a 17-year prospective multicenter study.
BACKGROUND
Several methods are used to treat focal chondral and osteochondral defects on the weightbearing surfaces of synovial joints. Autologous osteochondral grafting is 1 option used to replace hyaline cartilage in the defect.


OBJECTIVE
Mosaicplasty is effective in returning elite athletes to participation in sports.


METHODS
Case series; Level of evidence, 4.


METHODS
In 3 institutes, 354 of 383 patients were followed from 2 to 17 years (average, 9.6 years). The results of mosaicplasty were prospectively evaluated at 6 weeks, 3 months, 6 months, and yearly with patient-reported outcomes measures and radiographs.


RESULTS
Slight or moderate degenerative changes (Fairbank grade I or II) were detected preoperatively in 27% of the cases and in 36% of the cases at follow-up. Fairbank grade III changes were observed in 5 cases. An average radiographic deterioration of 0.32 on the Fairbank scale was detected (preoperative, 0.34; postoperative, 0.66). Good to excellent results were found in 91% of femoral mosaicplasties, 86% of tibial, and 74% of patellofemoral; 92% of talar mosaicplasties had similar results (Hannover ankle scoring system). Patellofemoral pain related to graft harvest was observed in 5% of cases. Second-look arthroscopies revealed good, congruent, gliding surfaces of the transplants and acceptable fibrocartilage coverage of donor sites in 16 patients and degenerative changes of the transplants in 5 cases. Histological evaluation revealed good graft incorporation in all 11 cases. Two infections and 3 deep venous thromboses occurred.


CONCLUSIONS
Despite a higher rate of preoperative osteoarthritic changes in the athletic patients, clinical outcomes of mosaicplasty in this group demonstrated a success rate similar to that of less athletic patients. Higher motivation resulted in better subjective evaluation. Slight deterioration in results occurred during the 9.6-year follow-up; thus, autologous osteochondral mosaicplasty may be a useful alternative for the treatment of 1.0- to 4.0-cm(2) focal chondral and osteochondral lesions in competitive athletes.
Hangody
László
L
Uzsoki Hospital, Department of Orthopaedics, Mexikói strasse 62, Budapest, Hungary. hangody@t-online.hu
Dobos
Jozsef
J
Baló
Eszter
E
Pánics
Gergely
G
Hangody
Laszlo Rudolf
LR
Berkes
Istvan
I
D000293:Adolescent; D000328:Adult; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007592:Joint Diseases / Q000601:surgery*; D007718:Knee Injuries / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D010007:Osteochondritis / Q000601:surgery*; D011446:Prospective Studies; D014182:Transplantation, Autologous / Q000379:methods; D055815:Young Adult