Cartilage is the smooth coating on the end of the bones that provides cushioning and support for comfortable and fluid movement of the joints. Cartilage damage may occur as a result of injury or degeneration and can lead to severe pain and arthritis. Damaged cartilage can eventually wear away and leave the bone unprotected. There are several surgical techniques currently used to repair damaged cartilage and restore normal movement of the joints. These techniques involve transplanting healthy cartilage from another part of the joint to stimulate the growth of new cartilage in a damaged area.
Osteochondral autograft transplantation is a cartilage transfer procedure that transfers cartilage from one part of the joint to another. A mosaicplasty is a a form of osteochondral autograft transplantation in which multiple plugs of cartilage and bone are removed and transferred. In this procedure, the healthy cartilage is removed from a portion of bone that does not bear weight. Mosiacplasty can help to relieve the discomfort caused by damaged or worn cartilage, as well protect the joint from further wear and tear. A mosiacplasty is commonly performed on athletes, as it has a quicker recovery time than other treatments and athletes can return to full sports participation after a shorter rehabilitation period.
During a mosaicplasty, several plugs of tissue are removed for transfer. The graft tissue is taken out using a specialized tool that withdraws a plug of cartilage and subchondral bone. These plugs are quite small, typically less than one centimeter in diameter. The number of plugs used will vary by patient, depending on the extent of the damage in the joint. The plugs are then placed in the damaged area of cartilage, leaving a full, smooth cushion of cartilage in the joint to protect the bones. This technique is typically best suited to smaller areas of defective cartilage. Only a limited amount of healthy cartilage can be removed from within the same joint and transferred successfully.
The Mosaicplasty Procedure
The mosaicplasty procedure is performed while the patient is sedated under general anesthesia. It is a minimally invasive procedure that is performed using an arthroscope, enabling the surgeon to make tiny incisions to access the joint. The arthroscope allows the surgeon to visually examine the joint and guide the instruments to the precise area for treatment. The surgeon examines the interior of the joint and removes any debris. The cartilage is withdrawn from non-weight bearing portions of the joint and then grafted into the damaged area. A new layer of cartilage is then created that is a combination of existing cartilage and these transplanted plugs.
Recovery from Mosaicplasty
Most mosaicplasty procedures are performed on an outpatient basis, but in some cases, an overnight stay in the hospital may be required. Following the procedure, individuals may use a continuous passive motion (CPM) machine to keep the joint moving and to alleviate joint stiffness. Patients are typically advised to rest the affected joint for one to two weeks after the surgery. Depending on the joint affected, crutches or other assistive devices may be necessary to avoid putting too much pressure on the joint. A physical therapy program helps to restore mobility and improve strength and flexibility of the affected joint. Exercise and and regular activity can normally resume 2 to 3 months after the mosaicplasty procedure
Risks of Mosaicplasty
Although mosaicplasty is considered a safe procedure for most patients, there are certain risks associated with all surgical procedures. Potential complications may include:
- Donor site pain
- Blood clots
- Weakening of muscles
- Limited range of motion
These risks are considered uncommon, and most patients experience relief of symptoms after this procedure. When a mosaicplasty is performed arthroscopically, the small incisions help to greatly reduce the recovery time, and allow patients to return to work and other activities at a quicker pace than traditional cartilage repair surgeries.