UĞUR HAKLAR, Tolga TÜZÜNER, Barış KOCAOĞLU, Osman GÜVEN

Diz eklemi osteokondral lezyonlarının tedavisinde mozaikplasti tekniği

Amaç: Tam kat kıkırdak lezyonu nedeniyle mozaikplasti uygulanan hastaların erken dönem sonuçları değerlendirildi. Çalışma planı: Çalışmaya, lateral (n=6) ve medial (n=18) femur kondillerinin yük taşıyan bölgelerinde bulunan tam kat kıkırdak lezyonu nedeniyle mozaikplasti uygulanan 24 hasta (8 kadın, 16 erkek; ort. yaş 39; dağılım 17-52) alındı. Cerrahi yaklaşım olarak açık teknik tercih edildi. Hastaların aynı taraf femur kondili sulkus terminalis seviyesinden alınan otogreftler mozaikplasti tekniği ile defektli bölgelere implante edildi. Ortalama defekt çapı 13.5 mm (dağılım 8-27 mm), hasta başına uygulanan greft sayısı 1.5 (dağılım 1-4) idi. Hastalar son takiplerinde klinik olarak Lysholm ve ICRS (International Cartilage Repair Society) skorlama sistemleri ile değerlendirildi. Radyolojik değerlendirmede Kellgren-Lawrence ölçütleri kullanıldı. Verici saha değerlendirmesi Bandi skorlama sistemi ile yapıldı. Ortalama takip süresi 30.5 ay (dağılım 13-47 ay) idi. Sonuçlar: Ameliyat öncesi ortalaması 46 (dağılım 28-64) olan Lysholm skoru, ameliyat sonrasında 86’ya (dağılım 76-100) yükseldi. ICRS skorlama sistemine göre, 16 hasta (%66.7) derece I, altı hasta (%25) derece II, iki hasta (%8.3) derece III bulundu. Beş hastada (%20.8) gözlenen verici saha ile ilgili şikayetler altı ay içinde günlük aktiviteleri kısıtlamayacak düzeye geriledi. Tüm hastaların normal aktivite düzeylerine döndüğü görüldü. Ameliyat sonrası manyetik rezonans değerlendirmesinde greftlerde gevşeme ya da çökme bulgusuna rastlanmadı. Kellgren- Lawrence ölçütlerine göre 20 hastada (%83.3) osteoartrit bulgusuna rastlanmadı. Dört hastada (%16.7) osteoartrit başlangıç bulguları görüldü. Çıkarımlar: Mozaikplasti, minimal invaziv teknikle uygulanabilmesi, tek seanslı oluşu, düşük komplikasyon oranı ve düşük maliyeti nedeniyle, tam kat kıkırdak lezyonlarında güvenilir bir tedavi yöntemidir.

Anahtar Kelimeler:

Doku ve organ hazırlama, Kıkırdak hastalıkları, Diz eklemi, Geriyedönük çalışma, Hastalık ciddiyet indeksi, Tedavi sonucu, Osteoartrit, diz, Kıkırdak, eklem, Zaman faktörleri, Nakil, otolog, Fonksiyon iyileşmesi

Mosaicplasty technique in the treatment of osteochondral lesions of the knee

Objectives: We evaluated early results of patients undergoing mosaicplasty for full-thickness cartilage lesions of the knee. Methods: The study included 24 patients (8 females, 16 males; mean age 39 years; range 17 to 52 years) with full-thickness cartilage lesions on the weight-bearing surface of the lateral (n=6) and medial (n=8) femoral condyles. Mosaicplasty was performed with open surgery. All grafts were harvested from the ipsilateral femoral condyle at the level of the sulcus terminalis and transplanted with the mosaicplasty technique to the defect area. The mean defect diameter was 13.5 mm (range 8 to 27 mm), and the mean number of grafts used was 1.5 (range 1 to 4). Final clinical assessments were made using the Lysholm and ICRS (International Cartilage Repair Society) scoring systems. Radiological evaluations were made according to the Kellgren-Lawrence criteria. Donor-site morbidity was evaluated according to the Bandi scoring system. The mean follow-up was 30.5 months (range 13 to 47 months). Results: The mean pre- and postoperative Lysholm knee scores were 46 (range 28 to 64) and 86 (range 76 to 100), respectively. ICRS scores were grade I in 16 patients (66.7%), grade II in six patients (25%), and grade III in two patients (8.3%). Five patients (20.8%) had slight donorsite disturbance which regressed within six months to a level that did not restrict daily physical activities. All the patients returned to preinjury activity levels. Postoperative magnetic resonance imaging showed no signs of graft loosening or collapse. According to the Kellgren-Lawrence criteria, 20 patients (83.3%) were free from any signs of osteoarthritis, whereas four patients (16.7%) exhibited early osteoarthritic changes. Conclusion: Mosaicplasty is a reliable procedure in the treatment of full-thickness chondral lesions because it is minimally invasive, can be performed at a single session, and has a low complication rate and low cost.

Keywords:

Tissue and Organ Harvesting, Cartilage Diseases, Knee Joint, Retrospective Studies, Severity of Illness Index, Treatment Outcome, Osteoarthritis, Knee, Cartilage, Articular, Time Factors, Transplantation, Autologous, Recovery of Function,

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