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CC BY-NC-ND-license · Joints 2015; 03(04): 173-178
DOI: 10.11138/jts/2015.3.4.173
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Treatment of unstable osteochondritis dissecans in adults with autogenous osteochondral grafts (Mosaicplasty): long-term results

Mario Ronga
1   Orthopaedics and Traumatology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy
,
Placido Stissi
1   Orthopaedics and Traumatology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy
,
Giuseppe La Barbera
1   Orthopaedics and Traumatology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy
,
Marco Valoroso
1   Orthopaedics and Traumatology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy
,
Gloria Angeretti
2   Radiology Unit, Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
,
Eugenio Genovese
3   Department of Radiology, University of Cagliari, Italy
,
Paolo Cherubino
1   Orthopaedics and Traumatology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy
› Author Affiliations
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Publication History

Publication Date:
15 September 2017 (online)

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Abstract

Purpose: the unstable osteochondritis dissecans (OCD-type II and III according to the ICRs classification) of the knee largher than > 2.5 cm2 in adults are uncommon lesions and there is no consensus on how to treat them. Medium-term studies have reported good re sults 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 cm2 (range, 2.55-5.1 cm2 ). The lesions were treated in situ with a variable number of autogenous osteochondral plugs (Ø 4.5 mm2). 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.

Level of evidence: Level IV, therapeutic case series.

Key Words

osteochondritis dissecans - osteochondral graft - adults - MR arthrography