Knee donor-site morbidity after mosaicplasty - a systematic review.
BACKGROUND
Mosaicplasty has been associated with good short- to long-term results. Nevertheless, the osteochondral harvesting is restricted to the donor-site area available and it may lead to significant donor-site morbidity.


OBJECTIVE
Provide an overview of donor-site morbidity associated with harvesting of osteochondral plugs from the knee joint in mosaicplasty procedure.


METHODS
Comprehensive search using Pubmed, Cochrane Library, SPORTDiscus and CINAHL databases was carried out through 10thOctober of 2016. As inclusion criteria, all English-language studies that assessed the knee donor-site morbidity after mosaicplasty were accepted. The outcomes were the description and rate of knee donor-site morbidity, sample's and cartilage defect's characterization and mosaicplasty-related features. Correlation between mosaicplasty features and rate of morbidity was performed. The methodological and reporting quality were assessed according to Coleman's methodology score.


RESULTS
Twenty-one studies were included, comprising a total of 1726 patients, with 1473 and 268 knee and ankle cartilage defects were included. The defect size ranged from 0.85 cm2to 4.9 cm2and most commonly 3 or less plugs (averaging 2.9 to 9.4 mm) were used. Donor-site for osteochondral harvesting included margins of the femoral trochlea (condyles), intercondylar notch, patellofemoral joint and upper tibio-fibular joint. Mean donor-site morbidity was 5.9 % and 19.6 % for knee and ankle mosaicplasty procedures, respectively. Concerning knee-to-knee mosaicplasty procedures, the most common donor-site morbidity complaints were patellofemoral disturbances (22 %) and crepitation (31 %), and in knee-to-ankle procedures there was a clear tendency for pain or instability during daily living or sports activities (44 %), followed by patellofemoral disturbances, knee stiffness and persistent pain (13 % each). There was no significant correlation between rate of donor-site morbidity and size of the defect, number and size of the plugs (p > 0.05).


CONCLUSIONS
Osteochondral harvesting in mosaicplasty often results in considerable donor-site morbidity. The donor-site morbidity for knee-to-ankle (16.9 %) was greater than knee-to-knee (5.9 %) mosaicplasty procedures, without any significant correlation between rate of donor-site morbidity and size of the defect, number and size of the plugs. Lack or imcomplete of donor-site morbidity reporting within the mosaicplasty studies is a concern that should be addressed in future studies.


METHODS
Level IV, systematic review of Level I-IV studies.
Faculty of Sports, University of Porto, Porto, Portugal.|Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.|Dom Henrique Research Centre, Porto, Portugal.
Renato
R
Andrade
Orthopaedic and Trauma Department, Campus Biomedico University of Rome, Rome, Italy.
Sebastiano
S
Vasta
Faculty of Sports, University of Porto, Porto, Portugal.|Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.|Dom Henrique Research Centre, Porto, Portugal.|Faculty of Health Sciences, University of Fernando Pessoa, Porto, Portugal.
Rogério
R
Pereira
Dom Henrique Research Centre, Porto, Portugal.|Orthopaedic Department, Centro Hospitalar Póvoa de Varzim, Vila do Conde, Portugal.|3B's Research Group-Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal.|ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.|Ripoll y De Prado Sports Clinic FIFA Medical Centre of Excellence, Murcia-Madrid, Spain.
Hélder
H
Pereira
Orthopaedic and Trauma Department, Campus Biomedico University of Rome, Rome, Italy.
Rocco
R
Papalia
Department of Orthopaedic Surgery, Acibadem University, Istanbul, Turkey.
Mustafa
M
Karahan
Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.|3B's Research Group-Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal.|ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.
J Miguel
JM
Oliveira
3B's Research Group-Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal.|ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.
Rui L
RL
Reis
Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal. espregueira@dhresearchcentre.com.|Dom Henrique Research Centre, Porto, Portugal. espregueira@dhresearchcentre.com.|3B's Research Group-Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017, Guimarães, Portugal. espregueira@dhresearchcentre.com.|ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal. espregueira@dhresearchcentre.com.|Orthopaedics Department of Minho University, Minho, Portugal. espregueira@dhresearchcentre.com.
João
J
Espregueira-Mendes
Articular cartilage lesions; Donor-site morbidity; Knee; Mosaicplasty; Osteochondral