Knee donor-site morbidity after mosaicplasty - a systematic review

Abstract

Background: Mosaicplasty has been associated with good short- to long-term results. Nevertheless, the osteochondral harvesting is restricted to the donor-site area available and it may lead to significant donor-site morbidity.

Purpose: Provide an overview of donor-site morbidity associated with harvesting of osteochondral plugs from the knee joint in mosaicplasty procedure.

Methods: Comprehensive search using Pubmed, Cochrane Library, SPORTDiscus and CINAHL databases was carried out through 10^th October of 2016. As inclusion criteria, all English-language studies that assessed the knee donor-site morbidity after mosaicplasty were accepted. The outcomes were the description and rate of knee donor-site morbidity, sample's and cartilage defect's characterization and mosaicplasty-related features. Correlation between mosaicplasty features and rate of morbidity was performed. The methodological and reporting quality were assessed according to Coleman's methodology score.

Results: Twenty-one studies were included, comprising a total of 1726 patients, with 1473 and 268 knee and ankle cartilage defects were included. The defect size ranged from 0.85 cm² to 4.9 cm² and most commonly 3 or less plugs (averaging 2.9 to 9.4 mm) were used. Donor-site for osteochondral harvesting included margins of the femoral trochlea (condyles), intercondylar notch, patellofemoral joint and upper tibio-fibular joint. Mean donor-site morbidity was 5.9 % and 19.6 % for knee and ankle mosaicplasty procedures, respectively. Concerning knee-to-knee mosaicplasty procedures, the most common donor-site morbidity complaints were patellofemoral disturbances (22 %) and crepitation (31 %), and in knee-to-ankle procedures there was a clear tendency for pain or instability during daily living or sports activities (44 %), followed by patellofemoral disturbances, knee stiffness and persistent pain (13 % each). There was no significant correlation between rate of donor-site morbidity and size of the defect, number and size of the plugs (p > 0.05).

Conclusions: Osteochondral harvesting in mosaicplasty often results in considerable donor-site morbidity. The donor-site morbidity for knee-to-ankle (16.9 %) was greater than knee-to-knee (5.9 %) mosaicplasty procedures, without any significant correlation between rate of donor-site morbidity and size of the defect, number and size of the plugs. Lack or imcomplete of donor-site morbidity reporting within the mosaicplasty studies is a concern that should be addressed in future studies.

Level of evidence: Level IV, systematic review of Level I-IV studies.

Keywords: Articular cartilage lesions; Donor-site morbidity; Knee; Mosaicplasty; Osteochondral.

Fig. 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart for the database search

Fig. 2

Knee donor-site morbidity figures from knee-to-knee mosaicplasty procedure

Fig. 3

Knee donor-site morbidity figures from knee-to-ankle mosaicplasty procedure

Fig. 4

Correlation between the donor-site morbidity rate (%) from mosaicplasty harvesting and mean defect size (mm), mean number of plugs (n) and mean size of plugs (mm). a) Knee-to-knee mosaicplasty donor-site morbidity rate (%) vs mean defect size (mm), (r = 0.228, p = 0.588); b) Knee-to-knee mosaicplasty donor-site morbidity rate (%) vs mean number of plugs (mm), (r = -0.109, p = 0.781); c) Knee-to-knee mosaicplasty donor-site morbidity rate (%) vs mean size of plugs (mm), (r = 0.275, p = 0.509); d) Knee-to-ankle mosaicplasty donor-site morbidity rate (%) vs mean defect size (mm), (r = 0.216, p = 0.548); e) Knee-to-ankle mosaicplasty donor-site morbidity rate (%) vs mean number of plugs (mm), (r = 0.563, p = 0.114); f) Knee-to-ankle mosaicplasty donor-site morbidity rate (%) vs mean size of plugs (mm), (r = 0.486, p = 0.329)