Journal of the Korean Orthopaedic Association (대한정형외과학회지)

Korean Orthopaedic Association (대한정형외과학회)
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Autogenous Osteochondral Grafting for Treating Osteochondral Defect of the Femoral Condyle of the Knee Joint

슬관절의 대퇴골과 골연골 결손에 대한 자가 골연골 이식술

Seo, Seung-Suk;Kim, Chang-Wan;Ha, Dong-Jun;Choi, Jang-Seok;Kim, Ho-Jun;Lee, Chang-Rack
서승석;김창완;하동준;최장석;김호준;이창락

  • Published : 20090600
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Abstract

Purpose: We wanted to evaluate the outcomes of an autologous osteochondral graft (Mosaicplasty) for treating chondral defects of the femoral condyle and We assessed the factors affecting the clinical results. Materials and Methods: This study enrolled 18 patients (19 cases) who underwent an autogenous osteochondral graft to treat a osteochondral defect in the femoral condyle from July 2000 to June 2006. The average age was 26.2 years old (age range: 16-48 years old). Among the patients, 17 cases were men. In 14 cases, the osteochondral defects were localized in the medial femoral condyle and only 5 cases showed a defect in the lateral femoral condyle. The average size of the osteochondral defects was 4.2 $cm^2$ (1-13 $cm^2$). The Lysholm knee scoring scale and the Tegner's activity score were applied for clinical evaluation. Further, we carried out simple X-ray for all the cases and we performed MRI in 5 cases for the radiological evaluation. Tthe factors affecting the clinical results were also analyzed and the complications were evaluated. Results: The average follow-up period was 22 months (range: 6-55 months). Eighten out of 19 cases (94.7%) were able to return to ordinary life. The Lysholm knee scoring scale and the Tegner's activity score indicated much better clinical results for small lesions and for young patients. For the radiological results, all the cases displayed a decrease in the size of radiolucent zones on the follow up X-ray. Among the 5 cases for which an MRI was performed, graft unions were observed in 3 cases, but 2 cases displayed continuous peri-graft edema. Any other complications involving the donor and recipient site were not observed. Conclusion: We conclude that autogenous osteochondral grafting is useful for specific patients depending on the size of the lesion and the patient's age. It is a valuable treatment option for osteochondral defects in the knee joint.

목 적: 슬관절의 대퇴골과 연골 결손에 대한 자가 골연골 이식술의 치료 결과 및 이에 영향을 미치는 요소들을 알아보고자 하였다. 대상 및 방법: 2000년 7월부터 2006년 6월까지 대퇴골과 연골 결손을 자가 골연골 이식술로 치료한 18명, 19슬 관절을 대상으로 하였다. 평균 연령은 26.2세(16-48세)였다. 골연골 결손의 위치는 대퇴골 내과가 14예, 외과가 5예였으며, 결손의 크기는 평균 4.2 $cm^2$ (1-13 $cm^2$)였다. 전 예에서 술 후 추시 관찰을 통하여 Lysholm 점수 및 Tegner 활동 점수를 이용한 임상적 결과, 단순 방사선 사진 소견, 자기공명영상 소견(5예), 합병증 그리고 결과에 영향을 미치는 요소들에 대하여 분석하였다. 결 과: 평균 추시 관찰 기간은 22개월(6-55개월)이었다. 19예 중 18예(94.7%)에서 일상 생활으로의 복귀가 가능 하였다. 병변의 크기가 작은 경우 및 젊은 연령의 환자 군에서 임상적 결과가 우수하였다. 방사선학적 결과상 전 예에서 방사선 투과 영역의 감소가 관찰되었으며, 5예에서 시행한 자기공명영상에서 3예에서는 이식편의 유합이, 2예에서는 지속적인 이식편 주위의 부종이 관찰되었다. 공여부 및 수여부의 다른 합병증들은 관찰되지 않았다. 결 론: 자가 골연골 이식술은 병변의 크기, 환자의 연령 등에 따른 적절한 환자군의 선택이 중요하며, 슬관절의 대퇴골과 연골 결손에 대한 치료 방법으로서 임상적으로 유용한 술식이라 사료된다.

Keywords

References

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