Cartilage Procedures (OATS/Mosicplasty)

Articular cartilage serves as a resilient, rubbery layer that encases the ends of bones within the knee joint, minimizing friction and functioning as a cushion against impacts. However, when this cartilage undergoes damage or deterioration, it restricts the knee’s natural range of motion and often results in considerable discomfort. Failure to address damaged cartilage promptly can lead to worsening symptoms over time, potentially necessitating knee replacement surgery in the future.

Who are the candidates for cartilage procedures?

Cartilage repair and regeneration are effective treatments for maintaining the health of a knee that is otherwise healthy. However, it is not suitable for knees affected by osteoarthritis, a condition characterized by the natural degradation of cartilage due to aging.

This treatment is advisable for patients experiencing knee cartilage damage or deterioration resulting from:

  1. Trauma, including sports injuries.
  2. Osteochondritis dissecans (OCD).

Types of Cartilage Procedures

The capacity of cartilage tissue to heal itself is significantly restricted due to its lack of blood vessels, which are crucial for the healing process. Repairing damaged cartilage typically involves either stimulating new cartilage growth for regeneration or resorting to cartilage replacement procedures.

The choice of procedure depends on the size of the cartilage injury being addressed and the recommendations of the surgeon, who will consider their expertise in making the best decision for treatment.

Cartilage Regeneration Procedures

Knee microfracture involves the complete removal of damaged cartilage, followed by the surgeon utilizing an awl, a sharpened tool, to puncture the bone beneath the damaged area. This puncturing promotes the growth of new cartilage cells with the assistance of blood from the microfracture.

In knee abrasion arthroplasty, the procedure starts with the complete removal of damaged cartilage. Subsequently, the surgeon utilizes a specialized tool to scrape and roughen the surface of the affected bone.

Cartilage Replacement Procedures:

Osteochondral autograft transplantation (OATS) involves taking healthy cartilage from the patient. The surgeon extracts a small, round piece of healthy cartilage, along with a small portion of underlying bone, from a non-weight-bearing area of the knee joint. This piece is then transferred to the damaged area being treated. This procedure is typically employed to repair relatively small cartilage defects in the knee. In cases where multiple plugs are needed to address a single defect, the procedure is known as mosaicplasty. Typically, this surgery is performed arthroscopically.

On the other hand, osteochondral allograft transplantation uses cartilage from a donor outside of the patient, usually obtained from a cadaver. Here, the surgeon removes a circular plug of healthy cartilage from the donor. Allografts are typically utilized when the cartilage defect being addressed is too large for an autograft (2cm or more). This type of surgery typically requires an open incision.