HSS Journal

, Volume 6, Issue 2, pp 228–234 | Cite as

Traumatic Osteochondral Injury of the Femoral Head Treated by Mosaicplasty: A Report of Two Cases

  • Denis Nam
  • Michael K. Shindle
  • Robert L. Buly
  • Bryan T. Kelly
  • Dean G. Lorich
Case Report


The increased risk of symptomatic progression towards osteoarthritis after chondral damage has led to the development of multiple treatment options for cartilage repair. These procedures have evolved from arthroscopic lavage and debridement, to marrow stimulation techniques, and more recently, to osteochondral autograft and allograft transplants, and autogenous chondrocyte implantation. The success of mosaicplasty procedures in the knee has led to its application to other surfaces, including the talus, tibial plateau, patella, and humeral capitellum. In this report, we present two cases of a chondral defect to the femoral head after a traumatic hip dislocation, treated with an osteochondral autograft (OATS) from the ipsilateral knee, and the inferior femoral head, respectively, combined with a surgical dislocation of the hip. At greater than 1 year and greater than 5 years of follow-up, MRI studies have demonstrated good autograft incorporation with maintenance of articular surface conformity, and both patients clinically continue to have no pain and full active range of motion of their respective hips. In our opinion, treatment of osteochondral defects in the femoral head surface using a surgical dislocation combined with an OATS procedure is a promising approach, as full exposure of the femoral head can be obtained while preserving its vasculature, thus enabling adequate restoration of the articular cartilage surface.


hip dislocation osteochondral autograft transplant femoral head osteochondral defect osteochondral injury mosaicplasty 


  1. 1.
    Alford JW, Cole BJ. Cartilage restoration, part 2: Techniques, outcomes, and future directions. Am J Sports Med. 2005;33:443–460.CrossRefPubMedGoogle Scholar
  2. 2.
    Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med. 1994;331:889–895.CrossRefPubMedGoogle Scholar
  3. 3.
    Steadman JR, Rodkey WG, Briggs KK. Microfracture to treat full-thickness chondral defects: Surgical technique, rehabilitation, and outcomes. J Knee Surg. 2002;15:170–176.PubMedGoogle Scholar
  4. 4.
    Alford JW, Cole BJ. Cartilage restoration, part 1: Basic science, historical perspective, patient evaluation, and treatment options. Am J Sports Med. 2005;33:295–306.CrossRefPubMedGoogle Scholar
  5. 5.
    Buckwalter JA, Mow VC, Ratcliffe A. Restoration of injured or degenerated articular cartilage. J Am Acad Orthop Surg. 1994;2:192–201.PubMedGoogle Scholar
  6. 6.
    Frisbie DD, Trotter GW, Powers BE, Rodkey WG, Steadman JR, Howard RD, Park RD, McIlwraith CW. Arthroscopic subchondral bone plate microfracture technique augments healing of large chondral defects in the radial carpal bone and medial femoral condyle of horses. Vet Surg. 1999;28:242–255.CrossRefPubMedGoogle Scholar
  7. 7.
    Nehrer S, Spector M, Minas T. Histologic analysis of tissue after failed cartilage repair procedures. Clin Orthop Relat Res. 1999;(365):149–162.CrossRefPubMedGoogle Scholar
  8. 8.
    Steadman JR, Briggs KK, Rodrigo JJ, Kocher MS, Gill TJ, Rodkey WG. Outcomes of microfracture for traumatic chondral defects of the knee: Average 11-year follow-up. Arthroscopy. 2003;19:477–484.CrossRefPubMedGoogle Scholar
  9. 9.
    Hangody L, Vasarhelyi G, Hangody LR, Sukosd Z, Tibay G, Bartha L, Bodo G. Autologous osteochondral grafting--technique and long-term results. Injury. 2008;39 Suppl 1:S32–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Kish G, Modis L, Hangody L. Osteochondral mosaicplasty for the treatment of focal chondral and osteochondral lesions of the knee and talus in the athlete. rationale, indications, techniques, and results. Clin Sports Med. 1999;18:45–66, vi.CrossRefPubMedGoogle Scholar
  11. 11.
    Hangody L, Fules P. Autologous osteochondral mosaicplasty for the treatment of full-thickness defects of weight-bearing joints: Ten years of experimental and clinical experience. J Bone Joint Surg Am. 2003;85-A Suppl 2:25–32.PubMedGoogle Scholar
  12. 12.
    Ganz R, Gill TJ, Gautier E, Ganz K, Krugel N, Berlemann U. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br. 2001;83:1119–1124.CrossRefPubMedGoogle Scholar
  13. 13.
    Letournel E. Fractures of the acetabulum: A study of a series of 75 cases -- les fractures du cotyle, etude d’une serie de 75 cas. J de chirurgie 82:47–87, 1961. (translated and substantially abridged). J Orthop Trauma. 2006;20:S15-9.PubMedGoogle Scholar
  14. 14.
    Gardner MJ, Suk M, Pearle A, Buly RL, Helfet DL, Lorich DG. Surgical dislocation of the hip for fractures of the femoral head. J Orthop Trauma. 2005;19:334–342.PubMedGoogle Scholar
  15. 15.
    Kish G, Hangody L. A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. J Bone Joint Surg Br. 2004;86:619; author reply 619–20.PubMedGoogle Scholar
  16. 16.
    Horas U, Pelinkovic D, Herr G, Aigner T, Schnettler R. Autologous chondrocyte implantation and osteochondral cylinder transplantation in cartilage repair of the knee joint. A prospective, comparative trial. J Bone Joint Surg Am. 2003;85-A:185–192.PubMedGoogle Scholar
  17. 17.
    Delcogliano A, Caporaso A, Menghi A, Rinonapoli G, Chiossi S. Results of autologous osteochondral grafts in chondral lesions of the knee. Minerva Chir. 2002;57:273–281.PubMedGoogle Scholar
  18. 18.
    Ansah P, Vogt S, Ueblacker P, Martinek V, Woertler K, Imhoff AB. Osteochondral transplantation to treat osteochondral lesions in the elbow. J Bone Joint Surg Am. 2007;89:2188–2194.CrossRefPubMedGoogle Scholar
  19. 19.
    Tsujii M, Hasegawa M, Hirata H, Uchida A. Subchondral insufficiency fracture of the second metatatarsal head in an elderly woman treated with autologous osteochondral transplantation. Arch Orthop Trauma Surg. 2008;128:689–693.CrossRefPubMedGoogle Scholar
  20. 20.
    Wahegaonkar AL, Doi K, Hattori Y, Addosooki A. Technique of osteochondral autograft transplantation mosaicplasty for capitellar osteochondritis dissecans. J Hand Surg Am. 2007;32:1454–1461.CrossRefPubMedGoogle Scholar
  21. 21.
    Hart R, Janecek M, Visna P, Bucek P, Kocis J. Mosaicplasty for the treatment of femoral head defect after incorrect resorbable screw insertion. Arthroscopy. 2003;19:E1–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Gautier E, Ganz K, Krugel N, Gill T, Ganz R. Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Joint Surg Br. 2000;82:679–683.CrossRefPubMedGoogle Scholar
  23. 23.
    Cain EL, Clancy WG. Treatment algorithm for osteochondral injuries of the knee. Clin Sports Med. 2001;20:321–342.CrossRefPubMedGoogle Scholar
  24. 24.
    Hunziker EB, Quinn TM. Surgical removal of articular cartilage leads to loss of chondrocytes from cartilage bordering the wound edge. J Bone Joint Surg Am. 2003;85-A Suppl 2:85–92.PubMedGoogle Scholar

Copyright information

© Hospital for Special Surgery 2010

Authors and Affiliations

  • Denis Nam
    • 1
    • 2
  • Michael K. Shindle
    • 1
    • 2
  • Robert L. Buly
    • 1
    • 2
  • Bryan T. Kelly
    • 1
    • 2
  • Dean G. Lorich
    • 1
    • 2
  1. 1.Department of Orthopaedics SurgeryHospital for Special SurgeryNew YorkUSA
  2. 2.Weill Medical College of Cornell UniversityNew YorkUSA

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