Clinical experiences with autologous osteochondral mosaicplasty in an athletic population: A 17-year prospective multicenter study

L. Hangody, Jozsef Dobos, Eszter Balo, Gergely Panics, Laszlo Rudolf Hangody, I. Berkes

Research output: Article

192 Citations (Scopus)

Abstract

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. Hypothesis: Mosaicplasty is effective in returning elite athletes to participation in sports. Study Design: 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. Conclusion: 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-cm2 focal chondral and osteochondral lesions in competitive athletes.

Original languageEnglish
Pages (from-to)1125-1133
Number of pages9
JournalAmerican Journal of Sports Medicine
Volume38
Issue number6
DOIs
Publication statusPublished - jún. 2010

Fingerprint

A 17
Multicenter Studies
Sports
Prospective Studies
Transplants
Athletes
Population
Cartilage
Fibrocartilage
Hyaline Cartilage
Arthroscopy
Weight-Bearing
Thigh
Ankle
Venous Thrombosis
Motivation
Joints
Tissue Donors
Pain
Infection

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation
  • Medicine(all)

Cite this

Clinical experiences with autologous osteochondral mosaicplasty in an athletic population : A 17-year prospective multicenter study. / Hangody, L.; Dobos, Jozsef; Balo, Eszter; Panics, Gergely; Rudolf Hangody, Laszlo; Berkes, I.

In: American Journal of Sports Medicine, Vol. 38, No. 6, 06.2010, p. 1125-1133.

Research output: Article

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abstract = "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. Hypothesis: Mosaicplasty is effective in returning elite athletes to participation in sports. Study Design: 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. Conclusion: 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-cm2 focal chondral and osteochondral lesions in competitive athletes.",
keywords = "Autogenous osteochondral graft, Full-thickness chondral defect, Mosaicplasty, Osteochondral transfer",
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AU - Hangody, L.

AU - Dobos, Jozsef

AU - Balo, Eszter

AU - Panics, Gergely

AU - Rudolf Hangody, Laszlo

AU - Berkes, I.

PY - 2010/6

Y1 - 2010/6

N2 - 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. Hypothesis: Mosaicplasty is effective in returning elite athletes to participation in sports. Study Design: 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. Conclusion: 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-cm2 focal chondral and osteochondral lesions in competitive athletes.

AB - 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. Hypothesis: Mosaicplasty is effective in returning elite athletes to participation in sports. Study Design: 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. Conclusion: 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-cm2 focal chondral and osteochondral lesions in competitive athletes.

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KW - Full-thickness chondral defect

KW - Mosaicplasty

KW - Osteochondral transfer

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