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Good results seen at 17 years follow-up of more than 1,000 mosaicplasty cases
A 10 year follow-up of athletes treated with the procedure showed that 83% returned to sports.
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MIAMI— Long-term follow-up has shown mosaicplasty to be a successful option for treating full-thickness defects in the knee and other weight-bearing joints.
Since its first clinical application in 1992, several researchers have reported on different surgical techniques and anatomic applications for autologous osteochondral mosaicplasty.
“There were a lot of clinical evaluations of the mosaicplasty technique and many of them published a similar outcome — about a 90% success rate,” László Hangody, MD, PhD, said during his presentation at the 8th World Congress of the International Cartilage Repair Society.
Subgroup analysis
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Image: Brockenbrough G, Orthopedics Today |
In their follow-up of 1,178 mosaicplasties performed in different joints between 1992 and 2007, Hangody and colleagues from the Uzsoki Hospital in Budapest found good to excellent results with a low complication rate. A subset analysis of 849 femoral condylar cases with 10.3 years follow-up revealed a modified Hospital for Special Surgery (HSS) score of 92 points and a modified Cincinnati Knee Score (CKS) of 89 points. An 8.9 year follow-up of 36 tibial condylar cases showed an HSS score of 87 and a CKS score of 85. In addition, an analysis of 171 patellar and trochlear cases with 9.3 years follow-up showed an HSS score of 79, a CKS score of 72 and a Bandi score of 76%.
“The talar results were the best subgroup,” Hangody, who was one of the first investigators to report on the technique, said. “We saw more than 90% good or excellent results.”
Donor site morbidity
Overall, the investigators found four deep septic complications and seven deep venous thromboses. Using the Bandi score, they found a long-term donor site morbidity of 3%.
“However, we observed excessive bleeding from the empty donor sites in a limited number of patients,” Hangody said.
The finding lead investigators to test different biodegradable materials to fill donor sites. Early research using a biodegradable polymeric drug delivery system (Polyactive, OctoPlus) has shown implant fragmentation, degradation and new bone formation at 9 months. However, Hangody noted that the material leads to a fibrocartilaginous surface repair.
Athletes
Hangody and his colleagues have also found good results using mosaicplasty to treat high-level athletes. “At 10-years follow-up, 64% of our patients returned to the same level of sports activity,” Hangody said. “Nineteen percent returned to a lower level of sports activity and only 17% were finished in their sports career.”
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Images: Hangody L |
He noted that the procedure is indicated for patients with symptomatic focal chondral or osteochondral defects measuring between 1 cm2 and 4 cm2.
“For small lesions, mosaicplasty is still an excellent surgery,” Hangody said. “If the defect is bigger and there are degenerative changes with it, use the microfracture procedure. In cases of big superficial but focal lesions, the best procedure could be the first or second generation chondrocyte transplantation. If the defect is not only big but also deep, you have to try transplantation with fresh osteochondral allografts.”
For more information:Reference:
- Laszlo Hangody, MD, PhD, can be reached at Uzsoki Hospital, H-1145 Budapest, Mexikoi ut 64, Hungary; 36-1 251-4455; e-mail: hangody@t-online.hu. He receives royalties from Smith & Nephew.
- Hangody L, Hangody LR, Módis L. Mosaicplasty— Experimental background and 17 years clinical experiences with autologous osteochondral mosaicplasty. #5.3. Presented at the 8th World Congress of the International Cartilage Repair Society. May 23-26, 2009. Miami.