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Mosaicplasty
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Mosaicplasty

Untreated joint (articular) cartilage defects can eventually lead to degeneration of the joint and disability, in terms of joint function. Several cartilage repair techniques exist for the treatment of cartilage defects.

Among these, mosaicplasty was introduced into clinical practice in 1992, and it is based on the mosaic-like transplantation of several small, cylindrical plugs of bone and cartilage, known as ‘osteochondral grafts’, to provide an even resurfaced area.

Intended audience

This article is intended for anyone suffering from damage to their articular cartilage and their families who would like to find out about mosaicplasty, as well as anyone interested in cartilage problems.

What is Mosaicplasty?

Mosaicplasty is a technique in which cartilage (‘chondral’) lesions and bone and cartilage (‘osteochondral’) lesions are repaired by harvesting and transplanting cylindrical plugs of bone and cartilage. In the knee, these plugs are taken from less weight-bearing areas, termed ‘donor sites’, and inserted into drilled tunnels in the defective section of the cartilage.

The transplanted hyaline cartilage is capable of surviving and produces a more durable surface than the fibrous repair tissue that would have formed if the defective cartilage had been left to heal on its own.

Repair of the donor site occurs via natural healing processes. The tunnels become filled with cancellous bone and the surface is covered with fibrocartilage built by marrow-derived cells.

Implanting the grafts in a mosaic-like fashion allows the effective management of small and medium-sized localised, or ‘focal’, defects. Clinical experience shows that the majority of focal defects belong to this category. Mosaicplasty ensures good results in most cases, and the findings of experimental arthroscopies and laboratory assessments confirm what have been seen clinically in patients underoging the procedure.

The development of the mosaicplasty technique began at the beginning of 1990s, and the first clinical application was in February 1992. During the subsequent years, clinical data have been reported by various authors, confirming the results seen in animal models. Since 1995, the procedure has been used with similar success in several institutions all over the world.

Small-sized, single focal lesions of the femoral condyles are the main indication for mosaicplasty procedures; however, defects on the tibial, patellar and trochlear surfaces can be also treated by osteochondral grafting. Besides osteochondral defects of the knee, a frequent indication for mosaicplasty is lesions of the talus.

The availability of donor sites and certain technical considerations limit the optimal size of defect that can be successfully covered to 1–4 cm2. Due to a decreased capacity for repair, 50 years of age is the recommended upper age limit for mosaicplasty.

Mosaicplasty is not recommended if osteoarthritis or rheumatoid arthritis is present, or lesions caused by infection or tumours. This is because the survival of the transplanted hyaline cartilage on the recipient site is hindered by these conditions.

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Mosaicplasty

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