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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-06-2014 | Knee

Autologous osteochondral mosaicplasty or TruFit™ plugs for cartilage repair

Authors: Paul Hindle, Jane L. Hendry, John F. Keating, Leela C. Biant

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 6/2014

Abstract

Purpose

Autologous osteochondral mosaicplasty and TruFit™ Bone graft substitute plugs are methods used to repair symptomatic articular cartilage defects in the adult knee. There have been no comparative studies of the two techniques.

Methods

This retrospective study assessed functional outcome of patients using the EQ-5D, Knee Injury and Osteoarthritis Outcome Score (KOOS) and Modified Cincinnati scores at follow-up of 1–5 years.

Results

There were 66 patients in the study (35 TruFit and 31 Mosaicplasty): 44 males and 22 females with a mean age of 37.3 years (SD 12.6). The mean BMI was 26.8. Thirty-six articular cartilage lesions were due to trauma, twenty-six due to osteochondritis dissecans and three due to non-specific degenerative change or unknown. There was no difference between the two groups age (n.s.), sex (n.s.), BMI (n.s.), defect location (n.s.) or aetiology (n.s.). The median follow-up was 22 months for the TruFit cohort and 30 months for the mosaicplasty group. There was no significant difference in the requirement for re-operation (n.s). Patients undergoing autologous mosaicplasty had a higher rate of returning to sport (p = 0.006), lower EQ-5D pain scores (p = 0.048) and higher KOOS activities of daily living (p = 0.029) scores. Sub-group analysis showed no difference related to the number of cases the surgeon performed. Patients requiring re-operation had lower outcome scores regardless of their initial procedure.

Conclusion

This study demonstrated significantly better outcomes using two validated outcome scores (KOOS, EQ-5D), and an ability to return to sport in those undergoing autologous mosaicplasty compared to those receiving TruFit plugs.

Level of evidence

IV.

Alford JW (2005) Cartilage restoration, part 1: basic science, historical perspective, patient evaluation, and treatment options. Am J Sports Med 33(2):295–306PubMedCrossRef

Barber FA, Dockery WD (2011) A computed tomography scan assessment of synthetic multiphase polymer scaffolds used for osteochondral defect repair. Arthroscopy 27(1):60–64PubMedCrossRef

Bedi A, Foo LF, Williams RJ, Potter HG (2010) The maturation of synthetic scaffolds for osteochondral donor sites of the knee: an MRI and T2-mapping analysis. Cartilage 1(1):20–28CrossRef

Bentley G, Biant LC, Carrington RWJ, Akmal M, Goldberg A, Williams AM et al (2003) A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. J Bone Joint Surg 85(2):223–230CrossRef

Bentley G, Biant LC, Vijayan S, Macmull S, Skinner JA, Carrington RWJ (2012) Minimum ten-year results of a prospective randomised study of autologous chondrocyte implantation versus mosaicplasty for symptomatic articular cartilage lesions of the knee. J Bone Joint Surg 94(4):504–509CrossRef

Carmont MR, Carey-Smith R, Saithna A, Dhillon M, Thompson P, Spalding T (2009) Delayed incorporation of a TruFit plug: perseverance is recommended. Arthroscopy 25(7):810–814PubMedCrossRef

Crawford DC, Safran MR (2006) Osteochondritis dissecans of the knee. J Am Acad Orthop Surg 14(2):90–100PubMed

Dhollander AAM, Liekens K, Almqvist KF, Verdonk R, Lambrecht S, Elewaut D et al (2012) A pilot study of the use of an osteochondral scaffold plug for cartilage repair in the knee and how to deal with early clinical failures. Arthroscopy 28(2):225–233PubMedCrossRef

EuroQol–a new facility for the measurement of health-related quality of life. The EuroQol Group (1990) EuroQol—a new facility for the measurement of health-related quality of life. The EuroQol Group. Health policy (Amsterdam) 16(3):199–208

10.

Gomoll AH, Madry H, Knutsen G, Dijk N, Seil R, Brittberg M, Kon E (2010) The subchondral bone in articular cartilage repair: current problems in the surgical management. Knee Surg Sports Traumatol Arthrosc 18(4):434–447PubMedCentralPubMedCrossRef

11.

Hangody L, Füles P (2003) 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 85-A (Suppl 2):25–32

12.

Harris JD, Siston RA, Pan X, Flanigan DC (2010) Autologous chondrocyte implantation: a systematic review. J Bone Joint Surg Am 92(12):2220–2233PubMedCrossRef

13.

Kerker JT, Leo AJ, Sgaglione NA (2008) Cartilage repair: synthetics and scaffolds: basic science, surgical techniques, and clinical outcomes. Sports Med Arthrosc 16(4):208–216PubMedCrossRef

14.

Kock N, van Susante J, Wymenga A, Buma P (2004) Histological evaluation of a mosaicplasty of the femoral condyle-retrieval specimens obtained after total knee arthroplasty–a case report. Acta Orthop 75(4):505–508CrossRef

15.

Mankin HJ (1982) The response of articular cartilage to mechanical injury. J Bone Joint Surg Am 64(3):460–466PubMed

16.

Melton JT, Wilson AJ, Chapman-Sheath P, Cossey AJ (2010) TruFit CB bone plug: chondral repair, scaffold design, surgical technique and early experiences. Expert Rev Med Devices 7(3):333–341PubMedCrossRef

17.

Miniaci A, Jambor C, Petrigliano FA (2007) Cartilage repair strategies. In: Williams III RJ (ed) Humana, Totowa, pp 105–114

18.

Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee injury and osteoarthritis outcome score (KOOS)–development of a self-administered outcome measure. J Orthop Sports Phys Ther 28(2):88–96PubMedCrossRef

19.

Smith RC, Spalding T, Masri BA (2009) TruFit polymer scaffolds for the management of cartilage defects of the knee. Tech Knee Surg 8(2):136CrossRef

20.

Spalding T, Carey-Smith R, Carmont M, Dunn K (2009) TruFit plugs for articular cartilage repair in the knee: 2 year experience, results and MRI appearances (SS-59). Arthroscopy 25(6):e32–e33CrossRef

21.

Yang Y, Zhao Y, Tang G, Li H, Yuan X, Fan Y (2008) In vitro degradation of porous poly(l-lactide-co-glycolide)/β-tricalcium phosphate (PLGA/β-TCP) scaffolds under dynamic and static conditions. Polym Degrad Stab 93(10):1838–1845CrossRef

Title: Autologous osteochondral mosaicplasty or TruFit™ plugs for cartilage repair
Authors: Paul Hindle
Jane L. Hendry
John F. Keating
Leela C. Biant
Publication date: 01-06-2014
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 6/2014
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-013-2493-0

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Springer Medicine

Autologous osteochondral mosaicplasty or TruFit™ plugs for cartilage repair

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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