Autologous osteochondral transplantation for focal femoral condyle defects: Comparison of mosaicplasty by arthrotomy vs. arthroscopy - 23/10/21

Doi : 10.1016/j.otsr.2021.103102

Maxence Bordes ^a, Elliot Sappey-Marinier ^a,^⁎ , Cécile Batailler ^a, Sébastien Lustig ^a,^b, Elvire Servien ^a,^c
^a Orthopaedics surgery and sports medicine department, FIFA Medical Centre of Excellence, Croix-Rousse hospital, Lyon university hospital, 69004 Lyon, France
^b IFSTTAR, LBMC UMR_T9406, Lyon university, Claude Bernard Lyon 1 university, 69622 Lyon, France
^c LIBM – EA 7424, interuniversity laboratory of biology of mobility, Claude Bernard Lyon 1 university, Lyon, France

^⁎Corresponding author.

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Abstract

Background

While many studies have reported the outcomes of open mosaicplasty, data on arthroscopic mosaicplasty are scarce. Only two cadaver studies have compared arthrotomy and arthroscopy. Moreover, the patello-femoral joint, which is the main donor site, has never been assessed using a specific functional score. The objective of this in vivo study was to compare arthrotomy and arthroscopy for mosaicplasty using both a global functional knee score and a specific score of the patello-femoral joint.

Hypothesis

The arthroscopic technique results in better functional patello-femoral outcomes.

Material and methods

We retrospectively compared two groups of 17 patients who underwent mosaicplasty for focal condylar cartilage defects, at our department between 2009 and 2019. Functional outcomes were assessed using the Kujala score and the Lysholm score, at least 1 year after surgery. The return to sports was assessed using the Tegner score.

Results

Mean follow-up was 67.4±15.9 months in the arthrotomy group and 45.2±35.1 months in the arthroscopy group (p<0.01). Cartilage defect size was similar in the two groups (arthrotomy: 1.21±0.91cm²; arthroscopy: 0.92±1.23cm²; p=0.052). The mean Kujala score was 85±21.3 in the arthrotomy group and 91.9±13.7 in the arthroscopy group (p=0.064). The mean Lysholm score was 83.9±19.8 with arthrotomy and 89.5±14.9 with arthroscopy (p=0.1). The Kujala score was greater than 95 in 4 (26%) arthrotomy patients and 13 (81%) arthroscopy patients (p=0.003). The Lysholm score was higher than 95 in 4 (26%) arthrotomy patients and 12 (75%) arthroscopy patients (p=0.012). No patient underwent surgical revision for autograft failure.

Discussion

This is the first clinical study comparing arthrotomy and arthroscopy for mosaicplasty. Clinical outcomes were good with both techniques. The proportion of patients with excellent Lysholm and Kujala functional scores was significantly higher in the arthroscopy group than in the arthrotomy group. This result may be ascribable to decreased donor-site morbidity obtained with arthroscopy.