title: Treatment of unstable osteochondritis dissecans in adults with autogenous osteochondral grafts (Mosaicplasty): long-term results.
abstract: OBJECTIVE
  the unstable osteochondritis dissecans (OCD-type II and III according to the ICRS classification) of the knee largher than > 2.5 cm(2) in adults are uncommon lesions and there is no consensus on how to treat them. Medium-term studies have reported good results using autogenous osteochondral plugs (mosaicplasty). The aim of this study is to analyze the long-term results of this technique for the treatment of unstable OCD in a selected group of adult patients.
  
  
  METHODS
  four patients with OCD at either one of the femoral condyles were included in this prospective study. The average age was 21.2 years (range, 18-24 years). The OCD lesions were classified as type II in three patients and type III in one patient and the average size was 3.8 cm(2) (range, 2.55-5.1 cm(2)). The lesions were treated in situ with a variable number of autogenous osteochondral plugs (Ø 4.5 mm(2)). The Modified Cincinnati, Lysholm II and Tegner scores were used for clinical and functional evaluation. Magnetic resonance arthrography (MRA) was performed before surgery and at 2, 5 and 10 years after surgery. A modified MOCART score was used to evaluate MRA findings.
  
  
  RESULTS
  the average follow-up duration was ten years and 6 months (range, 10-11 years). No complications occurred. At the final follow-up, all scores (clinical, functional and MOCART) improved. In all but one of the patients MRA showed complete osteochondral repair.
  
  
  CONCLUSIONS
  the fixation of large and unstable OCD lesions with mosaicplasty may be a good option for treating type II or III OCD lesions in adults. The advantages of this technique include stable fixation, promotion of blood supply to the base of the OCD fragment, and grafting of autologous cancellous bone that stimulates healing with preservation of the articular surface.
  
  
  METHODS
  Level IV, therapeutic case series.
authors.affiliation: Orthopaedics and Traumatology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Ronga
authors.affiliation: Orthopaedics and Traumatology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy.
authors.forename: Placido
authors.initials: P
authors.lastname: Stissi
authors.affiliation: Orthopaedics and Traumatology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: LA Barbera
authors.affiliation: Orthopaedics and Traumatology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Valoroso
authors.affiliation: Radiology Unit, Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy.
authors.forename: Gloria
authors.initials: G
authors.lastname: Angeretti
authors.affiliation: Department of Radiology, University of Cagliari, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Genovese
authors.affiliation: Orthopaedics and Traumatology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Cherubino
keywords: MR arthrography; adults; osteochondral graft; osteochondritis dissecans