Burhan KURTULUŞ, Hakan ASLAN, Osman Yağız ATLI, Halis Atıl ATİLLA, Mutlu AKDOĞAN

Evaluation of donor field morbidity after mosaicplasty application in the healthy knee joint

Aim: The aim of this study is to investigate the donor site morbidity that develops in patients who received autologous osteochondral grafts from the ipsilateral healthy knee with the Mosaicplasty technique due to talus chondral lesion, to investigate its relationship with age, gender, body mass index, number of grafts and diameter. Material and Method: 20 patients with talus chondral lesion underwent osteochondral transfer from the same-sided healthy knees using the Mosaicplasty technique. The mean age of the patients at surgery was 36.15, mean follow-up time was 25.99 months, mean body mass index was 26.51. The mean graft diameter was 0.87cm, the mean number of grafts was 1.5. Lysholm and VAS scores were evaluated. Kellgren-Lawrance classification was used for radiological changes. Results: Donor site morbidity was observed in a total of 4 patients. Two patients had mild knee pain, one patient had moderate knee pain. It was observed that the number of grafts taken, age, body mass index negatively affected Lysholm scores in the final follow-ups after the surgery, and VAS scores were lower in females. Conclusion: In this study, no symptoms were observed in 80% of patients who harvested ostechondral grefts from their healthy knees. However, it is necessary to keep in mind the potential morbidity that may develop in the healthy knee joint after osteochondral transfer to the talus cartilage lesions, especially due to the low Lysholm scores detected in patients over 40 years of age, with a body mass index ≥25 and who harvested more than one graft.

Keywords:

Articular cartilage lesions, Donor-site morbidity, Mosaicplasty, Osteochondral, Knee,

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1. De l’ Escalopier N, Barbier O, Mainard D, Mayer J, Ollat D,Versier G. Outcomes of talar dome osteochondral defect repair using osteocartilaginous autografts: 37 cases of Mosaicplasty®. OrthopTraumatol Surg Res 2015;101(1), 97–102.
2. Andrade R, Vasta S, Pereira R, Pereira H, Papalia R, Karahan M et al. Knee donor-site morbidity after mosaicplasty – a systematic review. J Exp Orthop2016;Dec;3(1):31.
3. Ferkel RD, Zanotti RM, Komenda GA, Sgaglione NA, Cheng MS, Applegate GRet al. Arthroscopic Treatment of Chronic Osteochondral Lesions of the Talus. Am J Sports Med2008;36(9), 1750–62.
4. Laffenêtre O. Osteochondral lesions of the talus: Current concept. OrthopTraumatol Surg Res 2010;96(5), 554–66.
5. Hangody L, Vásárhelyi G, Hangody LR, Sükösd Z, Tibay G, Bartha Let al. Autologous osteochondral grafting-Technique and long-term results.Injury 2008;39(1), 32–39.
6. Iwasaki N, Kato H, Kamishima T, Suenaga N, Minami A. Donor Site Evaluation after Autologous Osteochondral Mosaicplasty for Cartilaginous Lesions of the Elbow Joint. Am J Sports Med 2007;35(12), 2096–100.
7. McCoy B,Miniaci A. OsteochondralAutograft Transplantation/Mosaicplasty. J Knee Surg 2012;25(02), 099–108.
8. Nakagawa Y, Mukai S, Setoguchi Y, Goto T, Furukawa T, Nakamura T. Clinical Outcomes of Donor Sites After Osteochondral Graft Harvest from Healthy Knees. Orthop J Sports Med2017;5(10). 9. Bedi A, Feeley BT,Williams RJ. Management of Articular Cartilage Defects of the Knee. J Bone Joint Surg Am 2010;92(4), 994–1009.
10. Shimozono Y, Seow D, Yasui Y, Fields K, Kennedy J G. Knee-to-Talus Donor-Site Morbidity Following Autologous Osteochondral Transplantation. Clin OrthopRelat Res 2019;477(8), 1915–31.
11. Matsuura T, Hashimoto Y, Kinoshita T, Nishino K, Nishida Y, Takigami J et al.Donor Site Evaluation After Osteochondral Autograft Transplantation for Capitellar Osteochondritis Dissecans. Am J Sports Med. 2019 Oct;47(12):2836-43.
12. Paul J, Sagstetter A, Kriner M, Imhoff A, Spang J,Hinterwimmer S. Donor-Site Morbidity After Osteochondral Autologous Transplantation for Lesions of the Talus. J Bone Joint Surg Am 2009;91(7), 1683–88.
13. Nishimura A, Morita A, Fukuda A, Kato K, Sudo A. Functional Recovery of the Donor Knee After Autologous Osteochondral Transplantation for Capitellar Osteochondritis Dissecans. Am J Sports Med 2010;39(4), 838–42.
14. Bexkens R, Ogink PT, Doornberg JN, Kerkhoffs GMMJ, Eygendaal D, Oh LS et al.Donor-site morbidity after osteochondral autologous transplantation for osteochondritis dissecans of the capitellum: a systematic review and meta-analysis. Knee Surg Sports TraumatolArthrosc 2017;25(7), 2237–46.
15. Valderrabano V, Leumann A, Rasch H, Egelhof T, Hintermann B, Pagenstert G. Knee-to-Ankle Mosaicplasty for the Treatment of Osteochondral Lesions of the Ankle Joint. Am J Sports Med 2009;37(1_suppl), 105–111.
16. Woelfle JV, Reichel H, Nelitz M. Indications and limitations of osteochondral autologous transplantation in osteochondritis dissecans of the talus. Knee Surg Sports TraumatolArthrosc2013;21(8), 1925–30.
17. Al-Shaikh RA, Chou LB, Mann JA, Dreeben SM,Prieskorn D. Autologous Osteochondral Grafting for Talar Cartilage Defects. Foot Ankle Int 2002;23(5), 381–89.
18. Reddy S, Pedowitz DI, Parekh SG, Sennett BJ, Okereke E.The Morbidity Associated with Osteochondral Harvest from Asymptomatic Knees for the Treatment of Osteochondral Lesions of the Talus. Am J Sports Med 2007;35(1), 80–85.
19. Kim YS, Park EH, Kim YC, Koh YG, Lee JW.Factors Associated with the Clinical Outcomes of the Osteochondral Autograft Transfer System in Osteochondral Lesions of the Talus. Am J Sports Med 2012;40(12), 2709–19.
20. Guettler JH, Demetropoulos CK, Yang KH, Jurist KA.Dynamic Evaluation of Contact Pressure and the Effects of Graft Harvest with Subsequent Lateral Release at Osteochondral Donor Sites in the Knee. Arthroscopy 2005;21(6), 715–20.