Overview
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.
Autogenous osteochondral transfer for Osteochondritis dissecans was described initially by Yamashita (CORR 1985). Mosaicplasty or Osteochondral autograft transfer(OATS) involves transfer of small bone plugs covered with normal hyaline articular cartilage that are removed from a relatively nonweightbearing surface and transferred in a single stage to the chondral defect.
Advantages
- Defects can be filled immediately with mature, hyaline articular cartilage.
- The technique is also useful in osteochondral defects where there is bone loss.
- Good success rate in getting hyaline type cartilage.
Disadvantages
- Donor site morbidity is a concern and hence there is a limit to defect size treatable with this method. Hangody and Fuies recommend that the area to be treated is limited to between 1 and 4 cm 2
- The thickness of the donor cartilage may differ from that of the area to be treated and reconstitution of the important subchondral layer may not occur. In addition, lateral integration rarely occurs (Horas) raising the concern that synovial fluid may penetrate through the subchondral layer and cause cyst formation.
- Perpendicular access to the cartilage surface by cylinder cutters is required for this technique and this makes treatment of defects of the tibial plateau difficult.
- Mosaicplasty is not recommended on the patella (Bentley, Cole). Contact pressures of the patellofemoral joint make this a particularly challenging region with respect to osteochondral plug size, articular surface contour, and implantation technique (Garretson)
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.
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