Arthroscopic-assisted retrograde mosaicplasty for an osteochondral defect of the femoral head without performing surgical hip dislocation

Kocadal, Onur; Akman, Budak; Güven, Melih; Şaylı, Uğur

doi:10.1051/sicotj/2017030

Cited by 10 publications

(10 citation statements)

References 12 publications

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“…Finally, 16 studies were found to be eligible for inclusion in our review (Figure 1). Fifty-one (51) femoral head mosaicplasty procedures were published in 16 papers [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38], which included short-, mid-, and long-term (one case) studies ranging from one case to 27 cases (Table 1). The etiology of the osteochondral femoral head defect included 21 trauma, 13 femoroacetabular impingement (FAI), four osteochondritis dissecans (OCD), one chondroblastoma, eight sequelae of Legg-Calve-Perthes disease, and four epiphyseal dysplasia.…”

Section: Resultsmentioning

confidence: 99%

“…It was suggested that non-weight-bearing for six weeks be followed by gradually increasing weight-bearing as tolerated. The mean follow-up was 29.2 (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39) months. The Postel Merle d'Aubigné score improved from the preoperative period to the latest follow-up, from 10.5 (8-13) points to 15.5 (12)(13)(14)(15)(16)(17) points, and the Harris Hip Score increased from 52.8 (35-74) points to 79.5 (65-93) points, respectively [25].…”

Section: Discussionmentioning

confidence: 99%

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Mosaicplasty of the Femoral Head: A Systematic Review and Meta-Analysis of the Current Literature

Athanasiou¹,

Argyropoulou²,

Antzoulas³

et al. 2022

Cureus

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Osteochondral lesions of the femoral head are rare. For the treatment of these lesions, various jointpreserving procedures, particularly in young, active patients, have been developed. Mosaicplasty is a wellestablished surgical procedure for the knee. However, there is little evidence that this method can also be used to treat osteochondral lesions in the hip. The indication for cartilage procedures continues to evolve for the knee, and a similar strategy may be adopted for the hip joint. Due to limited evidence and a lack of experience, mosaicplasty treatment of these lesions remains challenging, especially in young patients. This study shows that open and arthroscopic management using the knee and femoral head as donor sites yielded good to excellent short-to mid-term outcomes. For osteochondral lesions of the femoral head, mosaicplasty may be a new alternative treatment option, although this needs to be proven with longer follow-ups and in a larger sample of patients.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mosaicplasty of the Femoral Head: A Systematic Review and Meta-Analysis of the Current Literature

Athanasiou¹,

Argyropoulou²,

Antzoulas³

et al. 2022

Cureus

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“…4,[22][23][24][25] Lately, due to patients reluctance to undergo a major surgery, there has been a trend towards developing arthroscopic alternatives, including transtrochanteric drilling and even arthroscopic retrograde osteochondral autologous transplantation. 11,26,27 In this scenario, we intended to report the outcomes of an arthroscopically assisted, percutaneous retrograde drilling of the femoral head.…”

Section: Discussionmentioning

confidence: 99%

“…With satisfactory outcomes, the historic treatment method described for this pathology has been open surgery, including both surgical hip dislocation and mini-invasive anterior approach 4,22–25. Lately, due to patients reluctance to undergo a major surgery, there has been a trend towards developing arthroscopic alternatives, including transtrochanteric drilling and even arthroscopic retrograde osteochondral autologous transplantation 11,26,27. In this scenario, we intended to report the outcomes of an arthroscopically assisted, percutaneous retrograde drilling of the femoral head.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic-assisted Retrograde Drilling for the Treatment of Osteochondral Lesions of the Femoral Head: Surgical Technique and Outcome of a Case Series

Slullitel

Nally

García-Mansilla

et al. 2020

Techniques in Orthopaedics

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When femoral head chondropaties are located medially or parafoveal, they pose a challenge to arthroscopically reach the affected area through commonly used portals. Though surgical hip dislocation remains as the gold standard for treatment of such lesions, many patients reject surgery for its potential complications and postoperative demanding rehabilitation protocol. We aimed to describe the surgical technique for microfracturing osteochondral lesions of the femoral head with a 3.2-mm drill in an arthroscopically assisted manner and to describe the outcome of this procedure. We describe 9 transtrochanteric drillings throughout an otherwise uneventful arthroscopic treatment of femoroacetabular impingement pathology. All of them had a parafoveal osteochondral lesion unapproachable with curved awls through routinely used portals. After debriding the cartilage flap with a chondrotome, the surgical technique consisted of a minimally invasive 3.2-mm drilling through the femoral lateral cortex fluoroscopically guided. Mean follow-up was 55.8 months (range, 43 to 113 mo). Outcome was evaluated with the modified Harris Hip Score (mHHS) and healing was assessed through magnetic resonance imaging findings. Overall, all patients showed better results when comparing preoperative and postoperative mHHS (43.8 vs. 79.5; P = 0.0008). No complications were reported due to the surgical technique. Complete healing of the osteochondral lesion was confirmed in 7 of 9 cases, and partially in one. One patient with Tönnis 2 preoperative changes required conversion to total hip arthroplasty at 80-month followup. Retrograde drilling was a valid option for treating small-sized medially located osteochondral lesions of the femoral head which are difficult to treat through standard arthroscopic portals.

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“…Osteochondral defects may result from trauma, femoro‐acetabular impingement, osteochondritis dissecans, avascular necrosis, or sequalae of Legg–Calvé–Perthes disease [3, 11, 14, 17, 22, 30]. In young patients, different surgical strategies have been proposed to repair chondral lesions and restore articular surfaces, including microfracture, autologous chondrocyte implantation, and osteochondral autograft or allograft transplantation [10, 12, 14, 23, 24, 26, 30].…”

Section: Introductionmentioning

confidence: 99%

Promising outcomes of hip mosaicplasty by minimally invasive anterior approach using osteochondral autografts from the ipsilateral femoral head

Viamont-Guerra

Bonin²,

May

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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Purpose Recent studies demonstrated promising results of mosaicplasty for femoral head osteochondral lesions using posterior and lateral approaches. This study aimed to evaluate outcomes of mosaicplasty using ipsilateral femoral head autografts by minimally invasive anterior approach. The hypothesis was that this surgical technique would grant satisfactory clinical outcomes with considerable improvement of clinical scores. Methods A consecutive series of 27 mosaicplasties, to treat osteochondral lesions of the femoral head measuring 1.6 ± 0.7 cm 2 (range 0.8-4.0) in patients aged 28.7 ± 7.4 years (range 19-44), was evaluated using the mHHS and WOMAC scores at minimum follow-up of 12 months. All patients were operated by minimally invasive anterior (Hueter) approach and osteochondral plugs were harvested from the non-weight-bearing portion of the femoral head. Adjuvant osteoplasty was necessary for some patients at the acetabulum (n = 3), femur (n = 14) or both (n = 2). Results Three patients were excluded due to concomitant periacetabular osteotomies or shelf procedures, one patient could not be reached, and another was revised to THA. This left 22 patients for clinical assessment at 39.4 ± 23.2 months (12.0-90.2). Their mHHS improved from 56.3 ± 12.6 to 88.4 ± 9.9, and WOMAC improved from 45.1 ± 16.9 to 80.6 ± 13.0. Two patients (8.4%) underwent arthroscopy at 13 and 30 months to remove painful residual cam-type deformities. Regression analyses revealed that net improvement in WOMAC decreased with lesion size (p = 0.002) and increased with follow-up (p = 0.004). Conclusions Hip mosaicplasty using autografts from the ipsilateral femoral head, performed by minimally invasive anterior approach, granted satisfactory outcomes and functional improvements. Caution is, however, advised for lesions > 2 cm 2 (diameter > 16 mm) which may be a threshold limit for this procedure. Level of evidence Level IV, Case series.

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Arthroscopic-assisted retrograde mosaicplasty for an osteochondral defect of the femoral head without performing surgical hip dislocation

Cited by 10 publications

References 12 publications

Mosaicplasty of the Femoral Head: A Systematic Review and Meta-Analysis of the Current Literature

Mosaicplasty of the Femoral Head: A Systematic Review and Meta-Analysis of the Current Literature

Arthroscopic-assisted Retrograde Drilling for the Treatment of Osteochondral Lesions of the Femoral Head: Surgical Technique and Outcome of a Case Series

Promising outcomes of hip mosaicplasty by minimally invasive anterior approach using osteochondral autografts from the ipsilateral femoral head

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