POSSIBILITIES OF MOSAIC CHONDROPLASTY OF CARTILAGE DEFECTS OF THE ARTICULAR SURFACES OF THE KNEE JOINT IN OSTEOARTHRITIS
Objective - to analyze the mid-term and long-term results of treatment of patients with full-layer destructive-dystrophic osteochondral defects of the articular surfaces of the knee joint after using various methods of mosaic chondroplasty. Materials and methods. The results of surgical treatment were evaluated and their comparative analysis was carried out in 87 patients with gonarthrosis with osteochondral defects of the articular surface of the knee joint. The patients were divided into three groups. The first group (n = 29) received classical mosaic autochondroplas- ty according to L. Hangody. The second group (n = 31) received the developed technique of autochondroplasty (RF Patent No. 2239377), when cancellous bone autografts from the iliac wing were used for replacement of a defect. The third group (n = 27) received the new technique of chondroplasty (RF Patent No. 2484784), i.e. myoplasty of the metaphyseal region of the affected condyle was performed with non-free muscle graft from m.gracilis, along with the classic method by L. Hangody. Treatment outcomes were assessed using the Oxford knee score (OKS), WOMAC index, and Leken's algofunctional index. Magnetic resonance imaging (MRI) and radiography of the knee joint were performed in all patients. The results were evaluated before the operation and after the treatment at the terms of 3, 12 and 36 months. Results. An analysis of the results of treatment revealed their significant difference in patients of the second and third groups compared with the first group. More pronounced clinical and functional recovery of the knee joint, X-ray and MRI symptoms of reparation of the articular surface, and a slower rate of progression of destructive-dystrophic joint damage in the long-term follow-up were noted in patients of the second and third groups. At the same time, the fact of sufficiently similar results of treatment in patients of these groups was recorded already 12 months after the surgical intervention. Conclusion. A comparative analysis of the results of surgical organ-preserving treatment of patients with destructive-dystrophic osteochondral defects of the articular surface of the knee joint showed that the most effective methods were demonstrated by mosaic autoplasty, based not on postulating the priority of simple mechanical filling of the defect area with bone and cartilage grafts, but based on a modern understanding of the role of bone tissue both in the pathogenesis of osteoarthritis and in the processes of reparative regeneration.