Systematic evaluation of the incidence of the knee donor area after autobone cartilage mosaic xentoplasty / 中国骨伤

OBJECTIVE@#To provide an overview of the incidence of knee donor -site morbidity after autologous osteochondral mosaicplasty.@*METHODS@#A comprehensive search was conducted in PubMed, EMbase, Wanfang Medical Network, and CNKI databases from January 2010 to April 20, 2021. Relevant literature was selected based on predefined inclusion and exclusion criteria, and data were evaluated and extracted. The correlation between the number and size of transplanted osteochondral columns and donor-site morbidity was analyzed.@*RESULTS@#A total of 13 literatures were included, comprising a total of 661 patients. Statistical analysis revealed an incidence of knee donor-site morbidity at 8.6% (57/661), with knee pain being the most common complaint, accounting for 4.2%(28/661). There was no significant correlation between the number of osteochondral columns and postoperative donor-site incidence (P=0.424, N=10), nor between the diameter size of osteochondral columns and postoperative donor-site incidence(P=0.699, N=7).@*CONCLUSION@#Autologous osteochondral mosaicplasty is associated with a considerable incidence of knee donor-site morbidity, with knee pain being the most frequent complaint. There is no apparent correlation between donor-site incidence and the number and size of transplanted osteochondral columns. Donors should be informed about the potential risks.

Tratamiento de lesiones osteocondrales de patela con trasplante autólogo: resultados funcionales e imagenológicos / Treatment of patellar osteochondral lesions with autologous grafts: functional and imaging results

Introducción El trasplante osteocondral autólogo es una técnica reproducible y con pocas complicaciones para el manejo de lesiones traumáticas grado III y IV de Outerbridge en patela. Con este estudio se busca evaluar los resultados funcionales e imagenológicos en pacientes manejados con esta técnica. Materiales y métodos Estudio descriptivo tipo serie de casos. Se incluyeron pacientes con lesiones traumáticas grado III y IV de Outerbridge (OB) en patela, menores de 25mm de diámetro, sin otras lesiones agregadas, operados con trasplante osteocondral autólogo entre marzo de 2013 y diciembre de 2016. Se evaluaron la escala visual análoga (EVA) y la escala funcional Kujala prequirúrgicas, y se compararon con los controles a los 3 y 6 meses. Se usó el score MOCART por resonancia magnética nuclear a los 6 meses postquirúrgicos para evaluar el porcentaje de osteointegración del injerto. Resultados El estudio incluyó 13 pacientes, 8 hombres (62%) con una edad promedio de 30 años. La lesión más frecuente fue la tipo IV de OB con un 86.6%. El EVA prequirúrgico promedio fue de 7.8 (±0.83), con controles a los 3 y 6 meses de 3.3 (±1.67) y 2.9 (±2.1) respectivamente, ambos con un valor de p <0.05. La escala funcional Kujala tuvo un promedio prequirúrgico de 33.3 (±10.1), con controles a los 3 y 6 meses de 56.1 (±21.1) y 74 (±17.6) respectivamente, ambos con un valor de p <0.05. El score MOCART promedio a los 6 meses fue de 70.5 (±12.1); 7 pacientes (53.8%) presentaron un valor mayor a 80. Discusión El Trasplante Osteocondral Autólogo en patela es una técnica con buenos resultados en pacientes con lesiones grado III y IV de OB, con mejoría significativa a los 3 y 6 meses del postoperatorio en la escala funcional de Kujala y reducción de la EVA. La tasa de integración del injerto medido por MOCART a los 6 meses fue 53%.

Background Autologous osteochondral grafting is a reproducible technique with few complications for the management of grade III and IV Outerbridge patellar injuries. This study aims to evaluate the functional and imaging results in patients managed with this technique. Methods A Case Series study was performed. The study included patients with grade III and IV Outerbridge (OB) traumatic patellar injuries of less than 25mm in diameter, with no other aggregate lesions, and operated on using autologous osteochondral grafts between March 2013 and December 2016. A pre-surgical assessment was made using a visual analogue scale (VAS) and the Kujala functional scale, and was compared with controls at 3 and 6 months. The MOCART score was used by nuclear magnetic resonance at 6 months post-operatively to evaluate the percentage of osteointegration of the graft. Results The study included 13 patients, 8 men (62%) with a mean age of 30 years. The most frequent lesion was type IV OB, with 86.6%. The mean pre-surgical VAS was 7.8 (± 0.83), with controls at 3 and 6 months of 3.3 (± 1.67) and 2.9 (± 2.1), respectively, both with a value of P<.05. The Kujala functional scale had a pre-surgical mean of 33.3 (± 10.1), with controls at 3 and 6 months of 56.1 (± 21.1) and 74 (± 17.6), respectively, both with a value of P<.05. The mean (magnetic resonance observation of cartilage repair tissue) MOCART score at 6 months was 70.5 (± 12.1), and 7 patients (53.8%) had a value greater than 80. Discussion Autologous osteochondral graft in the patella is a technique that obtained good results in patients with grade III and IV OB lesions. There is a significant improvement 3 and 6 months after surgery in the Kujala functional scale and a reduction of the VAS. The graft integration rate measured by MOCART at 6 months was 53%.

Operative Treatment of Knee Cartilage Injuries: A Review of the Current Literature on Non-Cell-Based and Cell-Based Therapies.

Aims: Cartilage is frequently damaged through injury and disease but shows little or no capacity for repair. Injuries that extend to the subchondral level show some capacity for repair due to the release of bone marrow derived mesenchymal stem cells. Focal articular cartilage defects are challenging clinical problems that may progress to more generalised lesions. We reviewed the literature to analyse the results of available noncell- based and cell-based strategies for the repair of articular cartilage defects in the knee. Study design: Review Article Place and Duration of Study: University College London Institute of Orthopaedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, United Kingdom Methodology: We reviewed the literature to identify studies on the use of non-cellbased and cell-based strategies for the repair of articular cartilage defects in the knee. Results: Repair techniques that do not utilise cell therapy include bone marrow stimulating techniques such as microfracture that is effective in small well-contained lesions and has the advantages of being performed arthroscopically as a single stage and cheaper costs compared to cell-based therapies. It also associated with no donor site morbidity unlike mosaicplasty, and perichondrial or periosteal grafting. The evidence suggests that none of the techniques described above consistently produce durable results. There are encouraging mid-term results with Autologous Matrix Induced Chondrogenesis (AMIC) procedures in small number of patients. Although microfracture is appropriate for smaller cartilage defects, Autologous Chondrocyte Implantation (ACI) and Matrix-carried Autologous Chondrocyte Implantation (MACI), as well as other cell carrier systems, are currently used to treat larger full thickness chondral defects in the knee. Although the results are fairly similar, MACI and procedures using other cell carrier systems are amenable to be performed arthroscopically or through a more limited approach. There are a small number of studies using mesenchymal stem cells with promising early results bur further in vitro and in vivo studies are needed before this treatment becomes more routinely available. Conclusion: Focal articular cartilage defects are challenging clinical problems that progress to more generalised lesions. Only cartilage injuries that extend to the subchondral level show some capacity for repair due to the release of bone marrow derived mesenchymal stem cells. Bone marrow stimulating techniques such as microfracture are effective in small well-contained lesions (<2cm2) and have the advantages of being performed arthroscopically as a single stage and cheaper costs compared to cell-based therapies. Mosaicplasty, and perichondrial or periosteal grafting are associated with donor site morbidity. Longer term studies on AMIC may help define the role for this procedure. The best form of non-cell-based treatment for focal articular cartilage defects in the long term is still unknown. ACI and MACI, as well as other cell carrier systems, are currently used in clinical practice to treat larger full thickness chondral defects in the knee. There are a small number of studies using mesenchymal stem cells and further in vitro and in vivo studies are needed before this treatment is optimised.

Mosaicoplastia revestida com periósseo no tratamento de perda osteocondral do joelho / Mosaicplasty with periosteal gratf for resurfacing local full-thickness chondral defects of the knee

Introdução e Objetivos: Existem várias formas de tratamento das perdas extensas de substância osteocondral (OC), entre elas, a mosaicoplastia recoberta com periósseo (mosaicambium). Neste trabalho pretende-se avaliar os resultados clínicos a médio dos doentes com defeito osteocondral tratados por esse método. Métodos: Vinte joelhos com defeito osteocondral superior a 2cm2 foram operados entre 1999 e 2005, com recurso a duas técnicas cirúrgicas (mosaicoplastia/mosaicambium). Todos os doentes foram avaliados em pré-operatório clinicamente (escalas ICRS,VAS), radiograficamente e com RM. No ano de 2008 todos foram revistos e avaliados seguindo os mesmos critérios. Os casos foram distribuídos em dois grupos consoante o tipo de tratamento.A avaliação estatística recorreu ao programa informático EPI2000. Utilizou-se o teste do qui-quadrado para variáveis categoriais e o teste t de Student para variáveis contínuas. Aceitou-se como erro alfa um valor de 0,05. Tipo de estudo: Estudo clínico, retrospectivo, nível de evidência 4. Resultados: Antes, todos os doentes estavam nos grupos ICRS C e D. Em 2008, 18 doentes estavam nos grupos A e B (12 no grupo A). Comparando os resultados entre grupos (mosaicoplastia/mosaicambium), não houve diferenças significativas entre os grupos. Radiograficamente, não existiam alterações em 55% dos casos. Discussão: Sem diferenças clínicas, por que a opção mosaicambium? A morbilidade nas zonas dadoras não é desprezível. A opção mosaicambium recorreu a menos cilindros OC, reduzindo a morbilidade resultante. Conclusão: A técnica mosaicambium é uma boa opção alternativa para perdas de substância OC com mais de 2 cm2.

Introduction and Objectives: Clinical and functional assessment comparing cases of full-thickness chondral defects (OC) treated with mosaicplasty or mosaicplasty covered with periosteum (mosaicambium). Methods: 20 knees with chondral defect, (10 mosaicplasty/10 mosaicambium) were operated between 1999 and 2005. All patients were clinically assessed preoperatively using the ICRS scale, VAS scale, X-ray and MRI. During 2008, we reviewed patients using the sameprotocol. For statistical purposes, the patients were divided into two groups, according to the surgical technique. Statistical analysis was performed with EPI2000 program, using chi-squared test and Student's t test, with a significance level of 0.05. Results: Preoperatively, all patients were in group C /D (ICRS scale). In 2008, 18 cases were in groups A and B according to the ICRS scale (12 in A). Between groups, there were no statistical differences. The X-ray study revealed nochanges in 55% of cases. Discussion: With no differences, why mosaicambium option? Morbidity on graft donor zones is not negligible. Mosaicambium uses less chondral grafts, reducing the potential for morbidity at graft donor zones. Conclusion: The mosaicambium technique is an excellent alternative forchondral defects greater than 2 cm2.

Second-look Arthroscopy after Surgical Treatment for Osteochondral Lesion of Talus: Comparison of Mosaicplasty with Microfracture / 대한족부족관절학회지

PURPOSE: To evaluate the results of mosaicplasty and microfracture after surgical treatments for symptomatic osteochondral lesion of talus (OLT) by second-look arthroscopy. MATERIALS AND METHODS: 7 cases of mosaicplasty and 7 cases of microfracture were reviewed who undertook second-look arthroscopy at 6 months or one year after undertaking mosaicplasty or microfracture for OLT between December 2004 and October 2005. The mean age at first operation was 43.6 years (Range, 20-59) (Mosaicplasty; 43.9 years, Microfracture; 43.4 years). The mean size of cartilage defect was 15.0 x 7.7 mm in mosaicplasty and 7.1 x 6.6 mm in microfracture. Clinical outcomes were evaluated by Freiburg ankle score. Cartilage healing state was evaluated by Insall's classification for chondromalasia during second-look arthroscopy. RESULTS: By the Freiburg ankle score, 9 ankles (6 in mosaicplasty, 3 in microfracture) had excellent and 5 (1 in mosaicplasty, 4 in microfracture) had good results at the times of second-look arthroscopy. By Insall's classification, consistency of the osteochondral grafts and congruity between grafts and native cartilage (Grade I) were shown in 9 (6 ankles in mosaicplasty, 3 ankles in microfracture), a fissuring (Grade II) in one ankle of mosaicplasty, a fasciculation (Grade III) in one ankle of microfracture, and partial exposure of subchondral bone (Grade IV) in 3 ankles of microfractures. CONCLUSION: Mosaicplasty was more excellent in consistency and hardness of cartilage than microfracture. In some cases of microfracture, cartilage healing was incomplete at 6 months postoperatively, so second-look arthroscopy is necessary to identify. If incomplete cartilage healing was shown, additional procedure such as microfracture or mosaicplasty was needed.

Experimental study of treating osteochondral defects with osteochondral composites constructed in vivo / 中国矫形外科杂志

[Objective]To evaluate the effect of treating the osteochondral defects with implanted cell-scaffold composites,cultured MSCs as seed cells and PLGA as scaffolds,and to acquire desirable seed cells and scaffold materials.[Method]BMSCs were induced to differenciatiated into chondrocytes,co-cultured with PLGA scaffold respectively in vitro,then implanted into osteochondral defects on canine models by using techniques of mosaicplasty,induced BMSC-PLGA scaffold composites in the top of the defect and BMSC-PLGA scaffold composites in the bottom of the defect,osteochondral composites were constructed in vivo,and repair was observed with naked eyes and histology.[Result]At 16 weeks after transplantation the defects of expeirmental group were covered with semi-transparent smooth white tissue and the margins between the repair tissue and the surrounding cartilage were not recognized.Histologically,most of the repair tissue was consisted with chondrocytes,maintained their thickness to the full depth of the original defects.The subchondral bone was well remodeled.The tidemark was observed.The defects of positive control group were covered with repair tissues,and partial were conformed with original cartilage.The repair tissue was partly filled with chondrocytes.However,the defects of negative control group were repaired with soft fibrous tissues without luster,and an obvious boundary between reparative and original cartilage was seen.[Conclusion]MSCs-PLGA scaffold composites,constructed into osteochondral composites by suppressing closely in vivo,are the ideal materials for repairing cartilage defects.

Tissue engineering combined with mosaicplasty to promote healing and integration of the osteochondral defects / 中华创伤骨科杂志

Objective To develop a new method, the bone marrow stromal cells (BMSCs)-mediated tissue engineering technique combined with mosaicplasty, for repair of osteochondral defects and integration of gaps. Methods BMSCs from 12 Chinese goats were cultured and proliferated in vitro. Prior to the BMSCs harvest, osteochondral defects, 5 mm in diameter and 3 mm in depth, were created in the femoral medial condyles of both the goat's hind limbs. When the mosaicplasty (osteochondral autograft transplantation) was performed, the BMSCs, which had been harvested and compounded with hyaluronic acid, were injected into the gaps between the osteochondral autografts in the left hind limb. The right hind limb which only received osteochondral autograft transplantation without BMSCs served as a control. At four, eight and 16 weeks post-operatively, samples of the repaired defects were harvested and assessed by histological evaluation, immunohistochemical analysis and glycosaminoglycan (GAG) quantification. In both groups 16 weeks post-operatively, the GAG quantification was analyzed by one-way ANOVA and least significant difference (LSD) method. Results At all the time points, the cartilage autografts in both groups survived as hyaline cartilage and presented no significant difference from the surrounding native cartilage. In the group filled with BMSCs compound, the gaps were replaced by regenerated hyaline cartilage and disappeared; however, in the control group, the osteochondral autografts were still distinct from the surrounding normal cartilage, though the gaps were replaced by fibrous tissue or fibrous cartilage. Immunohistochemical analysis of typeⅡcollagen showed positive staining in the matrix of transplanted and regenerated cartilage. The Alcian blue method also confirmed a significantly less GAG content in the regenerated tissue in gaps in the control group than in the treatment group and in the normal cartilage. Conclusion Since tissue engineering combined with mosaicplasty can promote gap integration and cartilage healing, the method can be an ideal way for osteochondral defect repair.