Purpose: We report the results of a prospective consecutive series of 25 patient with non-degenerative chondral lesions treated by mosaicplasty osteochondral grafts.

Material and method: The main group was composed of 22 knees, including 16 with osteochonritis dissecans, five with cartilage damage concomitant with chronic anterior laxity, and one with necrosis of the medial condyle. The other lesions involved the talus. Mean patient age was 28 years. Mean follow-up was 13 months (range 1 – 39 months). Among the knee group, 15 patients underwent standard mosaicplasty. The lesion measured 1.96 cm2 on the average. For the other cases, associated procedures included: valgus tibial osteotomy (n=4), anterior ligamentoplasty (n=3). There were few complications except one case of infection. Clinical assessment was based on the new ICRS chart (with an updated IKDC subjective score sheet). The subjective IKDC score was 48.7% preoperatively.

Results: Mean coverage of the lesion was 68.5%. Solitary mosaicplasty provided good results. The subjective IKDC score was 67.5% and 77% of the patients experienced little or no pain in their knee. Two-thirds of the patients scored their performance at 8 or more on the 10 point scale. The objective IKDC score gave 11/15 A and 4/15 B. There was one complication related to the donor site causing femoropatellar impingement after harvesting substantial graft material. Recovery was more difficult for patients with associated procedures and results were less satisfactory. All patients underwent an MRI at six months that showed in general a good morphological aspect.

Discussion: The technique used is particularly important due to a number of pitfalls and difficulties requiring much surgical skill. While we have found that most associated procedures such as grafting the anterior cruciate ligament are warranted, the appropriateness of an associated osteotomy would be highly debatable. Lesions measuring more than 3 cm2 correspond to the limit of this technique.

Conclusion: Mosaicplasty is a reliable method for cartilage repair. Long-term assessment will allow better indications and identification of any iatrogenic factors in order to determine the appropriate place for this technique among the other methods used for cartilage repair.

Purpose: The purpose of this work was to analyse functional results in patients with objective patellar instability who underwent surgery between 1988 and 1999.

Material and methods: One hundred eighty knees, 140 patients, were included in this series. Minimum follow-up was two years, and the mean follow-up was five years (range 24 – 152 months). The IKDC 99 subjective knee chart was used for postoperative assessment. This chart has ten items for sports activities and functional status of the knee for everyday activities. Eighty-three percent of the patients (118 patients) responded to the questionnaire.

Results: Clinical assessment was available for 98 patients (63%) and phone interview data for 29 (20%). Subjectively, 111 (94.87%) patients were very satisfied, five (4.27%) were satisfied, and one was dissatisfied. We assessed results by pain level (37.6% mild or weather-related pain), residual oedema, sensation of blockage (15.8%), instability, daily activities (68% with difficulty in the kneeling position), sports activity and level.

Discussion: Certain authors (Insall) question the pertinence of operating objective patellar instability because of the risk of secondary femoropatellar degeneration. For us, surgical treatment is indicated when there has been at least one dislocation associated with morphological anomalies. We have not observed any cases of femoroatellar degeneration among our patients who were operated on more than ten years ago. The patients’ own subjective assessment shows that surgical treatment with medialisation and/or lowering of the tibial tuberosity has been effective with a very excellent rate of satisfaction. The quality of the results is directly related to correct treatment of the lesions (for patients without recurrent dislocation) and systematic analysis of the different factors contributing to patellar instability (trochlear dyplasia, patellar height, quadriceps dyplasia, length of the patellar tendon). Our rate of revision appears to be low but was directly related to the young age of this population and is close to or above the revision rates observed in series with follow-ups greater than two years.

Conclusion: Surgery for objective patellar instability gives good mid- and long-term results. The subjective IKDC score allows precise self-evaluation. We have not been able to find any correlation between subjective results and objective results.