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The knee is a complex joint that works like a well-oiled hinge because of cartilage, which creates a nearly friction-free surface on which the bones slide. However, a severe knee injury or a degenerative condition such as osteoarthritis can weaken, tear, or soften knee cartilage. A relatively new procedure, known as Mosaicplasty, replaces the weak or torn cartilage with healthy cartilage from the femur.
Doctors use Mosaicplasty most commonly to treat Osteochondritis Dissecans (OCD), a condition in which cartilage and bone partially or completely tear away from where they belong. The condition creates loose bodies, which must be removed from the knee area. Additionally, since cartilage is diminished as a result of OCD, friction increases in the knee joint, which creates a great amount of pain. During the procedure, healthy cartilage from the femur is inserted as cylinders around the knee, appearing like a mosaic upon completion (hence the name). By moving cartilage from non weight-bearing to weight-bearing areas, Mosaicplasty can restore the shock-absorption and fluidity of the knee joint.
A cartilage transfer procedure uses healthy cartilage from a normal area of the knee, and moves it to a damaged area of the knee.
The two types of cartilage transfer procedures are called:
Mosaicplasty
A mosaicplasty moves round 'plugs' of cartilage and underlying bone to damaged areas. The plugs are each a few millimeters in diameter, and when multiple plugs are moved into a damaged area the result is a mosaic appearance--the multiple small plugs of cartilage look like mosaic tiles.
OATS
OATS stands for 'osteochondral autograft transfer system,' and the technique is very similar to mosaicplasty. In the OATS procedure the plugs are usually larger, and therefore only one or two plugs are needed to fill the area of cartilage damage. Because of this it does not take on the mosaic appearance, but the principle is the same.
Where do the cartilage plugs come from?
The cartilage plugs are taken from areas of the knee that are non-weight-bearing areas. The hope is that the body will not miss this cartilage and it can be used where it is needed. Over time the holes left from where the plugs are taken will fill with bone and scar tissue.
How is a cartilage transfer procedure performed?
The cartilage transfer procedure usually begins with an arthroscopic inspection of the knee. If there is an area of cartilage damage that is suitable to cartilage transfer, then the arthroscope is removed and an incision is made.
The first step is to prepare the area of damaged cartilage. A coring tool is used to make a perfectly round hole in the bone in the area of damage. This hole is sized to fit the plug.
The next step is to 'harvest' the plug of normal cartilage. The plug is taken with the underlying bone to fit into the hole that was prepared in the area of damage. The plug is just slightly larger than the hole so it will fit snugly into position.
The final step is to implant the harvested plugs into the hole that was created in the damaged area. Over time, the hope is that the implanted bone and cartilage will incorporate into its new environment.
Mosaic autografts (mosaicplasty) more recently, several surgeons have suggested using not an osteochondral autograft in a single block, but a collection of small osteochondral cylinders inserted side by side, thus making it possible to maintain the radius of curvature of the articular surface, or congruence. The advantage of this technique is the integration of the spongy element of the graft, which fuses with the spongy bed at the recipient site, and the integration of the transplanted cartilage with the adjacent hyaline cartilage by means of the fibrocartilage which forms between the various grafts, growing upward from the prepared subchondral bed. This technique, known as mosaic grafting (mosaicplasty)
During the procedure
The patient is anesthetized and the doctor performs arthroscopy to assess the condition of the knee and to remove any loose bodies. Cartilage is then taken from non weight-bearing areas of the femur. The cylindrical plugs or “grafts,” each about 4.5 millimeters wide and 15 to 20 millimeters deep, are then implanted arthroscopically in the prepared area of the leg to form a new layer of cartilage, comprised of the intact original cartilage and the transplanted grafts.
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