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Autologous osteochondral mosaicplasty in osteochondritis dissecans of the patella in adolescents

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Abstract

Purpose

Osteochondritis dissecans of the patella (OCDP) is rare in adolescents. The objective of this study was to evaluate functional results of OCDP management in adolescents with mosaicplasty and to analyze proper integration of osteochondral grafts via MRI.

Methods

This is a retrospective series of eight cases of OCDP treated by mosaicplasty. Mean age at the surgery was 15 years (range 12–17). Clinical features were represented by retropatellar pain, hydarthrosis, locking and crepitus. All patients benefited from knee radiographs as well as pre-operative MRI. Six OCDP were evaluated International Cartilage Repair Society (ICRS) grade III and two were ICRS grade IV. Mean surface of the lesion was 97.5 mm2. The pre- and post-operative assessments were conducted with scores obtained on the IKDC subjective knee evaluation form, Lysholm knee score, and Tegner activity scale. These assessments were completed by post-operative MRI. The magnetic resonance observation of cartilage repair tissue (MOCART) score was calculated from the latest MRI examination conducted after surgery.

Results

Mean follow-up was 28.6 months. At the latest follow-up, the mean IKDC score was 86.5, Lysholm score was 89, and Tegner activity scale score was 6.2 (pre-operative scores were respectively 49.9, 53.8, and 4.5). Radiographs and MRI showed a complete integration of grafts at the latest follow-up with a satisfactory reconstruction of the joint surface. Mean MOCART score was 75/100.

Conclusions

Autologous osteochondral mosaicplasty to manage OCDP in adolescents appears to be a reliable technique on the short term to restore patellar joint surface and obtain satisfactory functional results.

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References

  1. Desai SS, Patel MR, Michelli LJ et al (1987) Osteochondritis dissecans of the patella. J Bone Joint Surg (Br) 69:320–325

    Article  CAS  Google Scholar 

  2. Bruns J, Luessenhop S, Lehmann L (1999) Etiological aspects in osteochondritis dissecans patellae. Knee Surg Sports Traumatol Arthrosc 7:356–359

    Article  CAS  PubMed  Google Scholar 

  3. Mubarak SJ, Carroll NC (1981) Juvenile osteochondritis dissecans of the knee: etiology. Clin Orthop Relat Res 157:200–211

    Google Scholar 

  4. Clanton O, DeLee JC (1982) Osteochondritis dissecans. History, pathophysiology and current treatment concepts. Clin Orthop Relat Res 167:50–64

    Google Scholar 

  5. Cahill BR (1995) Osteochondritis dissecans of the knee: treatment of juvenile and adult forms. J Am Acad Orthop Surg 3:237–247

    Article  CAS  PubMed  Google Scholar 

  6. Nelitz M, Williams RS, Lippacher S et al (2014) Analysis of failure and clinical outcome after unsuccessful medial patellofemoral ligament reconstruction in young patients. Int Orthop 38:2265–2272

    Article  PubMed  Google Scholar 

  7. Visonà E, Chouteau J, Aldegheri R et al (2010) Patella osteochondritis dissequans end stage: the osteochondral mosaicplasty option. Orthop Traumatol Surg Res 96:543–548

    Article  PubMed  Google Scholar 

  8. Stougaard J (1974) Osteochondritis dissecans of the patella. Acta Orthop Scand 45:111–118

    Article  CAS  PubMed  Google Scholar 

  9. Edwards DH, Bentley G (1977) Osteochondritis dissecans patellae. J Bone Joint Surg (Br) 59:58–63

    CAS  Google Scholar 

  10. Peters TA, McLean ID (2000) Osteochondritis dissecans of the patellofemoral joint. Am J Sports Med 28:63–67

    CAS  PubMed  Google Scholar 

  11. Marandola MS, Prietto CA (1993) Arthroscopic Herbert screw fixation of patellar osteochondritis dissecans. Arthroscopy 9:214–216

    Article  CAS  PubMed  Google Scholar 

  12. Matava MJ, Brown CD (1997) Osteochondritis dissecans of the patella: arthroscopic fixation with bioabsorbable pins. Arthroscopy 13:124–128

    Article  CAS  PubMed  Google Scholar 

  13. Sekiya JK, Fontbote CA, Harner CD (2003) Arthroscopically assisted retrograde fixation of patellar osteochondritis dissecans using fluoroscopic guidance: a case report and technical note. Arthroscopy 19:E1–E7

    PubMed  Google Scholar 

  14. Gobbi A, Kon E, Berruto M et al (2006) Patellofemoral full-thickness chondral defects treated with hyalograft-C a clinical, arthroscopic, and histologic review. Am J Sports Med 34:1763–1773

    Article  PubMed  Google Scholar 

  15. Hangody L, Kish G, Kárpáti Z et al (1997) Arthroscopic autogenous osteochondral mosaicplasty for the treatment of femoral condylar articular defects. A preliminary report. Knee Surg Sports Traumatol Arthrosc 5:262–267

    Article  CAS  PubMed  Google Scholar 

  16. Hangody L, Sükösd L, Szabó Z (1999) Repair of cartilage defects. Technical aspects. Rev Chir Orthop Reparatrice Appar Mot 85:846–857

    CAS  PubMed  Google Scholar 

  17. Choi YS, Cohen NA, Potter HG et al (2007) Magnetic resonance imaging in the evaluation of osteochondritis dissecans of the patella. Skelet Radiol 36:929–935

    Article  Google Scholar 

  18. Nho SJ, Foo LF, Green DM et al (2008) Magnetic resonance imaging and clinical evaluation of patellar resurfacing with press-fit osteochondral autograft plugs. Am J Sports Med 36:1101–1109

    Article  PubMed  Google Scholar 

  19. Brittberg M, Winalski CS (2003) Evaluation of cartilage injuries and repair. J Bone Joint Surg Am 85:58–69

    Article  PubMed  Google Scholar 

  20. Schmitt LC, Paterno MV, Huang S (2010) Validity and internal consistency of the international knee documentation committee subjective knee evaluation form in children and adolescents. Am J Sports Med 38:2443–2447

    Article  PubMed  Google Scholar 

  21. Hambly K (2011) The use of the Tegner activity scale for articular cartilage repair of the knee: a systematic review. Knee Surg Sports Traumatol Arthrosc 19:604–614

    Article  PubMed  Google Scholar 

  22. Trattnig S, Millington SA, Szomolanyi P et al (2007) MR imaging of osteochondral grafts and autologous chondrocyte implantation. Eur Radiol 17:103–118

    Article  CAS  PubMed  Google Scholar 

  23. Koller U, Apprich S, Domayer S et al (2014) Magnetic resonance mapping of the rim of articular cartilage defects of the patella. Int Orthop 38:67–72

    Article  PubMed  Google Scholar 

  24. Kramer DE, Yen YM, Simoni MK et al (2015) Surgical management of osteochondritis dissecans lesions of the patella and trochlea in the pediatric and adolescent population. Am J Sports Med 43:654–662

    Article  PubMed  Google Scholar 

  25. Schwarz C, Blazina ME, Sisto DJ et al (1988) The results of operative treatment of osteochondritis dissecans of the patella. Am J Sports Med 16:522–529

    Article  CAS  PubMed  Google Scholar 

  26. Larsen MW, Pietrzak WS, DeLee JC (2005) Fixation of osteochondritis dissecans lesions using poly(l-lactic acid)/poly(glycolic acid) copolymer bioabsorbable screws. Am J Sports Med 33:68–76

    Article  PubMed  Google Scholar 

  27. Friederichs MG, Greis PE, Burks RT (2001) Pitfalls associated with fixation of osteochondritis dissecans fragments using bioabsorbable screws. Arthroscopy 17:542–545

    Article  CAS  PubMed  Google Scholar 

  28. Scioscia TN, Giffin JR, Allen CR et al (2001) Potential complication of bioabsorbable screw fixation for osteochondritis dissecans of the knee. Arthroscopy 17:E7

    Article  CAS  PubMed  Google Scholar 

  29. Teo BJX, Buhary K, Tai BC et al (2013) Cell-based therapy improves function in adolescents and young adults with patellar osteochondritis dissecans. Clin Orthop Relat Res 471:1152–1158

    Article  PubMed  Google Scholar 

  30. Macmull S, Jaiswal PK, Bentley G et al (2012) The role of autologous chondrocyte implantation in the treatment of symptomatic chondromalacia patellae. Int Orthop 36:1371–1377

    Article  PubMed  PubMed Central  Google Scholar 

  31. Robert H (2011) Chondral repair of the knee joint using mosaicplasty. Orthop Traumatol Surg Res 97:418–429

    Article  CAS  PubMed  Google Scholar 

  32. Huang FS, Simonian PT, Norman AG et al (2004) Effects of small incongruities in a sheep model of osteochondral autografting. Am J Sports Med 32:1842–1848

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Orthopaedic Pediatric Surgery Department, University Hospital of Montpellier, Montpellier, France

    Lamine Chadli, Jérôme Cottalorda, Marion Delpont, Philippe Mazeau & Djamel Louahem

  2. Service d’Orthopédie Infantile, Hôpital Lapeyronie, 371 avenue du Doyen Gaston Giraud, 34295, Montpellier, Cedex 5, France

    Jérôme Cottalorda

  3. Pediatric Radiology Department, University Hospital of Montpellier, Montpellier, France

    Yann Thouvenin

Authors
  1. Lamine Chadli
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  2. Jérôme Cottalorda
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  3. Marion Delpont
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  4. Philippe Mazeau
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  5. Yann Thouvenin
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  6. Djamel Louahem
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Correspondence to Jérôme Cottalorda.

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Chadli, L., Cottalorda, J., Delpont, M. et al. Autologous osteochondral mosaicplasty in osteochondritis dissecans of the patella in adolescents. International Orthopaedics (SICOT) 41, 197–202 (2017). https://doi.org/10.1007/s00264-016-3198-z

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  • DOI: https://doi.org/10.1007/s00264-016-3198-z

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