Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original ArticleFixation of Unstable Osteochondritis Dissecans Lesions of the Knee Using Arthroscopic Autogenous Osteochondral Grafting (Mosaicplasty)
Section snippets
Methods
Between March 1997 and December 2001, 20 consecutive patients who had been referred to our institution with symptomatic unstable OCD lesions were treated by arthroscopic autogenous osteochondral graft fixation (mosaicplasty). The lesions were all initially diagnosed on MRI scan and confirmed subsequently at the time of arthroscopy. Exclusion criteria included a loose fragment, previous mosaicplasty, a history of patellofemoral pathology, and previous infection. All data were collected
Results
Sixteen of the lesions were ICRS OCD type II, 3 were ICRS OCD type III, and 1 was ICRS OCD type IV. The right knee was affected in 9 of the cases and the left in 11. The lesion was positioned on the lateral aspect of the medial femoral condyle in 19 patients and on the lateral femoral condyle in 1. The average length of follow-up was 3.4 years (range, 2 to 6).
The average age of the patients at the time of surgery was 14.3 years (range, 12 to 27 years) with the physes open in 11 of the cases.
Discussion
The principles of surgical treatment for unstable OCD lesions in the knee are multiple. They should ideally include stable fixation, promotion of a blood supply to the base of the OCD fragment, and bone grafting at the base to promote healing with the articular cartilage over the OCD fragment being left as intact as possible.
A variety of techniques have previously been described and include fixation using simple pins, various types of compression screw devices, corticocancellous bone pegs, and
Conclusions
From the results of this study, we found autogenous osteochondral grafting to be a good technique for the treatment of unstable OCD lesions that have failed adequate nonoperative management. It is a reliable and minimally invasive method that provides a stable biologic fixation using autogenous bone graft and has few complications.
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Cited by (86)
Noninferiority meta-analysis of autologous vs allogeneic osteochondral transplantation for the treatment of osteochondral defects of the knee confounded by defect size differences
2023, Journal of Cartilage and Joint PreservationInternal Fixation of Unstable OCD Lesions with Metal Compression Screws: Techniques and Outcomes
2023, Operative Techniques in Sports MedicineAutologous osteochondral transplantation for focal femoral condyle defects: Comparison of mosaicplasty by arthrotomy vs. arthroscopy
2022, Orthopaedics and Traumatology: Surgery and ResearchCitation Excerpt :Autologous osteochondral transplantation (OAT) by mosaicplasty is a surgical technique used to treat cartilage defects of the knee. Many studies have demonstrated good outcomes in this indication [1–27]. The first arthroscopic mosaicplasty was performed in 1993 by Matsusue et al. [28].
Autologous osteochondral transplantation for focal femoral condyle defects: Comparison of mosaicplasty by arthrotomy vs. arthroscopy
2022, Revue de Chirurgie Orthopedique et TraumatologiqueUnestable knee osteochondritis dissecans: arthroscopic fixation with bio-absorbable device
2021, Revista Espanola de Cirugia Ortopedica y TraumatologiaOCD Injuries in the Paediatric and Adult Population
2020, Evidence-Based Management of Complex Knee Injuries: Restoring the Anatomy to Achieve Best Outcomes
The authors report no conflict of interest.