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|Título:||Osteochondral transplantation using autografts from the upper tibio-ﬁbular joint for the treatment of knee cartilage lesions|
|Autor(es):||Mendes, João Espregueira|
Silva, Manuel Vieira da
Oliveira, Joaquim M.
Reis, R. L.
Upper tibio-ﬁbular joint
|Editora:||Springer Berlin Heidelberg|
|Revista:||Knee Surg Sports Traumatol Arthrosc|
|Resumo(s):||Purpose Treatment of large cartilage lesions of the knee in weight-bearing areas is still a controversy and challenging topic. Autologous osteochondral mosaicplasty has proven to be a valid option for treatment but donor site morbidity with most frequently used autografts remains a source of concern. This study aims to assess clinical results and safety proﬁle of autologous osteochondral graft from the upper tibio-ﬁbular joint applied to reconstruct symptomatic osteochondral lesions of the knee. Methods Thirty-one patients (22 men and 9 women) with grade 4 cartilage lesions in the knee were operated by mosaicplasty technique using autologous osteochondral graft from the upper tibio-ﬁbular joint, between 1998 and 2006. Clinical assessment included visual analog scale (VAS) for pain and Lysholm score. All patients were evaluated by MRI pre- and post-operatively regarding joint congruency as good, fair (inferior to 1 mm incongruence), and poor (incongruence higher than 1 mm registered in any frame). Donor zone status was evaluated according to speciﬁc protocol considering upper tibio-ﬁbular joint instability, pain, neurological complications, lateral collateral ligament insufﬁciency, or ankle complaints. Results Mean age at surgery was 30.1 years (SD 12.2). In respect to lesion sites, 22 were located in weight-bearing area of medial femoral condyle, 7 in lateral femoral condyle, 1 in trochlea, and 1 in patella. Mean follow-up was 110.1 months (SD 23.2). Mean area of lesion was 3.3 cm 2 (SD 1.7), and a variable number of cylinders were used, mean 2.5 (SD 1.3). Mean VAS score improved from 47.1 (SD 10.1) to 20.0 (SD 11.5); p = 0.00. Similarly, mean Lysholm score increased from 45.7 (SD 4.5) to 85.3 (SD 7.0); p = 0.00. The level of patient satisfaction was evaluated, and 28 patients declared to be satisﬁed/very satisﬁed and would do surgery again, while 3 declared as unsatisﬁed with the procedure and would not submit to surgery again. These three patients had lower clinical scores and kept complaints related to the original problem but unrelated to donor zone. MRI score signiﬁcantly improved at 18–24 months comparing with pre-operative (p = 0.004). No radiographic or clinical complications related to donor zone with implication in activity were registered. Conclusions This work corroborates that mosaicplasty technique using autologous osteochondral graft from the upper tibio-ﬁbular joint is effective to treat osteochondral defects in the knee joint. No relevant complications related to donor zone were registered.|
|Aparece nas coleções:||3B’s - Artigos em revistas/Papers in scientific journals|