Four Case Reports of Mosaicplasty for Knee Joint.

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  • 膝関節軟骨損傷にモザイクプラスティを施行した４例

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Repairing a defect or injury of articular cartilage is a significant challenge. Osteochondral graft, periosteal transplantation, drilling, and chondrocyte transplantation have been attempted clinically for articular surface defects. We evaluated repairs of articular cartilage by mosaicplasty.<BR>Four knees of 4 patients (2 men and 2 women) that underwent mosaicplasty were evaluated in this series. Mean patient age at surgery was 41 years. All knees underwent follow-up MRI, 2 knees underwent follow-up arthroscopy and needle biopsy after informed consent was obtained. The mean period from surgery to final follow-up was 21 months. The mean period from surgery to follow-up arthroscopy was 11 months.<BR>Four cases of mosaicplasty presented satisfactory regeneration of the articular cartilage as seem by MRI or arthroscopic examination. Two knees, after receiving mosaicplasty, demonstrated regeneration of hyaline cartilage even around the gaps in mosaicplasty, by needle biopsy. However, the structure of hyaline cartilage around the gaps in mosaicplasty differed from that of normal hyaline cartilage.<BR>Several reports described a good clinical outcome of mosaicplasty. However, only Hangody reported good hyaline cartilage regeneration at the recipient site and fibrous cartilage at the donor site. Our results demonstrated regeneration of the hyaline cartilage in the gap area of mosaicplasty, but the structure of hyaline cartilage differed from normal. There is a risk of renewed degeneration due to the poor structure of hyaline cartilage. Mosaicplasty is a sure method of repairing hyaline cartilage where there is a small defect in the articular surface. However, one report pointed out the risk of articular degeneration at the donor site after mosaicplasty. One of our cases demonstrated bony defect at the donor site 21 months after mosaicplasty. Adequate observation of both the donor site and recipient site is needed after mosaicplasty.

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