Mosaicplasty: trade name for 1 method of performing osteochondral transplant of multiple small osteochondral plugs
Definitions
Variety of surgical techniques to repair or replace damaged or missing articular cartilage surfaces in knee
All techniques begin with removal of abnormal articular cartilage
Bone marrow stimulation techniques
Appropriate for smaller lesions
Puncture of subchondral bone releases pluripotential stem cells that form fibrocartilaginous scar
Resulting scar does not have biomechanical properties of normal cartilage
Long-term results not as good as with transplant and autologous chondrocyte implantation (ACI) techniques
Types of procedures; may be used in combination
Microfracture ("pick" procedure)
Multiple small holes are created in subchondral bone with awl to promote bleeding → fibrocartilaginous scar
Most commonly performed marrow stimulation procedure
Integrity of repair may degrade at 18-36 weeks
Newer procedures add scaffold or polymer to site to augment process
e.g., autologous matrix-induced chondrogenesis: porcine collagen matrix added to surgical site with fibrin glue
Considered 1st-line procedure for treatment of cartilage defects
Good clinical outcomes for smaller lesions (< 2-4 cm in size, in younger patients)
Abrasion arthroplasty
Underlying subchondral bone is roughened using arthroscopic burr to promote bleeding and subsequent scar formation in chondral defect
Less commonly used due to risk of thermal necrosis and injury to underlying bone
Subchondral drilling
Drill used to trephine subchondral bone and promote bleeding → fibrocartilaginous scar
Less commonly used due to risk of thermal necrosis and injury to underlying bone
Biodegradable pin/screw fixation
Biodegradable pins used to stabilize lesion
In situ unstable osteochondral lesions
Cartilage flap tears
Pins resorb in 6-24 months
Variably threaded metallic screws still used by some surgeons
Osteochondral transplantation
Osteochondral autograft transfer system (OATS), autologous osteochondral transplant (AOT), and mosaicplasty often used interchangeably in literature and clinical practice: osteochondral autograft will be used to refer to all procedures here
Appropriate for lesions 1-4 cm²
Osteochondral plugs inserted into lesion
Osteochondral autograft
Harvested from non-weight-bearing surface, usually lateral trochlea > margin of intercondylar notch
Relies on presence of usable donor cartilage
Possibility of donor site morbidity
Several fragments may be placed to fill 1 large defect (mosaicplasty)
Spaces between plugs eventually fill in with fibrocartilaginous grout
Osteochondral allograft
Cadaveric graft material
Used for larger lesions
Allows for rectangular or round grafts
Original concern for immune response and disease transmission not substantiated in practice
ACI
Appropriate for lesions 2-12 cm²
Patient's own cartilage harvested from non-weight-bearing surface
Cells grown in culture for 3-5 weeks to produce chondrocytes
Periosteal or synthetic cover/membrane sewn or glued over defect
Cultured chondrocytes injected under cover of periosteal sleeve
Resulting cartilage hyaline-like, thought to have biomechanical properties similar to native cartilage
Commonly complicated by hypertrophy of periosteum
Increased long-term durability
Matrix-associated chondrocyte implantation (MACI)
3D biologic scaffold optimized for culture of seeded autologous chondrocytes implanted in defect by miniarthrotomy
Trimmed to fit defect and glued in place
Stem cell transplantation
Intraarticular injection of stem cells from various sources
Results are variable
Controversial
Leukocyte-rich, platelet-rich plasma
Potential conservative treatment for knee osteoarthritis
IMAGING
General Features
CT Findings
MR Findings
Imaging Recommendations
PATHOLOGY
Microscopic Features
CLINICAL ISSUES
Natural History & Prognosis
DIAGNOSTIC CHECKLIST
Consider
Reporting Tips
Selected References
Kenmochi M: Clinical outcomes following injections of leukocyte-rich platelet-rich plasma in osteoarthritis patients. J Orthop. 18:143-9, 2020
Tradati D et al: AMIC-autologous matrix-induced chondrogenesis technique in patellar cartilage defects treatment: a retrospective study with a mid-term follow-up. J Clin Med. 9(4):1184, 2020
Zamborsky R et al: Surgical techniques for knee cartilage repair: an updated large-scale systematic review and network meta-analysis of randomized controlled trials. Arthroscopy. 36(3):845-58, 2020
Hede K et al: Combined bone marrow aspirate and platelet-rich plasma for cartilage repair: two-year clinical results. Cartilage. Epub, 2019
Liu YW et al: MR imaging of cartilage repair surgery of the knee. Clin Imaging. 58:129-39, 2019
Hayashi D et al: Understanding magnetic resonance imaging of knee cartilage repair: a focus on clinical relevance. Cartilage. 9(3):223-36, 2018
Oei EHG et al: Cartilage imaging: techniques and developments. Semin Musculoskelet Radiol. 22(2):245-60, 2018
Redondo ML et al: Preservation of knee articular cartilage. Sports Med Arthrosc Rev. 26(4):e23-30, 2018
Campbell AB et al: Return to sport after articular cartilage repair in athletes' knees: a systematic review. Arthroscopy. 32(4):651-68.e1, 2016
Oussedik S et al: Treatment of articular cartilage lesions of the knee by microfracture or autologous chondrocyte implantation: a systematic review. Arthroscopy. 31(4):732-44, 2015
Forney MC et al: Magnetic resonance imaging of cartilage repair procedures. Magn Reson Imaging Clin N Am. 22(4):671-701, 2014
Trattnig S et al: MR imaging of postoperative talar dome lesions. Semin Musculoskelet Radiol. 16(3):177-84, 2012
Hughes RJ et al: Clinical and MRI considerations in sports-related knee joint cartilage injury and cartilage repair. Semin Musculoskelet Radiol. 15(1):69-88, 2011
Harris JD et al: Treatment of chondral defects in the athlete's knee. Arthroscopy. 26(6):841-52, 2010
Van Assche D et al: Autologous chondrocyte implantation versus microfracture for knee cartilage injury: a prospective randomized trial, with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc. 18(4):486-95, 2010
Welsch GH et al: T2 and T2* mapping in patients after matrix-associated autologous chondrocyte transplantation: initial results on clinical use with 3.0-Tesla MRI. Eur Radiol. 20(6):1515-23, 2010
Gold GE et al: Recent advances in MRI of articular cartilage. AJR Am J Roentgenol. 193(3):628-38, 2009
Kon E et al: Matrix-assisted autologous chondrocyte transplantation for the repair of cartilage defects of the knee: systematic clinical data review and study quality analysis. Am J Sports Med. 37 Suppl 1:156S-66S, 2009
Nehrer S et al: Treatment of full-thickness chondral defects with hyalograft C in the knee: a prospective clinical case series with 2 to 7 years' follow-up. Am J Sports Med. Suppl 1:81S-7S, 2009
Potter HG et al: New techniques in articular cartilage imaging. Clin Sports Med. 28(1):77-94, 2009
Trattnig S et al: MR imaging of cartilage and its repair in the knee--a review. Eur Radiol. 19(7):1582-94, 2009
Van Assche D et al: Physical activity levels after characterized chondrocyte implantation versus microfracture in the knee and the relationship to objective functional outcome with 2-year follow-up. Am J Sports Med. 37 Suppl 1:42S-9S, 2009
Choi YS et al: MR imaging of cartilage repair in the knee and ankle. Radiographics. 28(4):1043-59, 2008
Domayer SE et al: MRI monitoring of cartilage repair in the knee: a review. Semin Musculoskelet Radiol. 12(4):302-17, 2008
McNickle AG et al: Overview of existing cartilage repair technology. Sports Med Arthrosc. 16(4):196-201, 2008
Potter HG et al: Magnetic resonance imaging of cartilage repair. Sports Med Arthrosc. 16(4):236-45, 2008
Welsch GH et al: Cartilage T2 assessment at 3-T MR imaging: in vivo differentiation of normal hyaline cartilage from reparative tissue after two cartilage repair procedures--initial experience. Radiology. 247(1):154-61, 2008
Williams Iii RJ et al: Cartilage repair procedures: clinical approach and decision making. Instr Course Lect. 57:553-61, 2008
Tins BJ et al: Autologous chondrocyte implantation in knee joint: MR imaging and histologic features at 1-year follow-up. Radiology. 234(2):501-8, 2005
Recht M et al: MR imaging of cartilage repair procedures. Skeletal Radiol. 32(4):185-200, 2003
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KEY FACTS
Terminology
Imaging
Pathology
TERMINOLOGY
Synonyms
Mosaicplasty: trade name for 1 method of performing osteochondral transplant of multiple small osteochondral plugs
Definitions
Variety of surgical techniques to repair or replace damaged or missing articular cartilage surfaces in knee
All techniques begin with removal of abnormal articular cartilage
Bone marrow stimulation techniques
Appropriate for smaller lesions
Puncture of subchondral bone releases pluripotential stem cells that form fibrocartilaginous scar
Resulting scar does not have biomechanical properties of normal cartilage
Long-term results not as good as with transplant and autologous chondrocyte implantation (ACI) techniques
Types of procedures; may be used in combination
Microfracture ("pick" procedure)
Multiple small holes are created in subchondral bone with awl to promote bleeding → fibrocartilaginous scar
Most commonly performed marrow stimulation procedure
Integrity of repair may degrade at 18-36 weeks
Newer procedures add scaffold or polymer to site to augment process
e.g., autologous matrix-induced chondrogenesis: porcine collagen matrix added to surgical site with fibrin glue
Considered 1st-line procedure for treatment of cartilage defects
Good clinical outcomes for smaller lesions (< 2-4 cm in size, in younger patients)
Abrasion arthroplasty
Underlying subchondral bone is roughened using arthroscopic burr to promote bleeding and subsequent scar formation in chondral defect
Less commonly used due to risk of thermal necrosis and injury to underlying bone
Subchondral drilling
Drill used to trephine subchondral bone and promote bleeding → fibrocartilaginous scar
Less commonly used due to risk of thermal necrosis and injury to underlying bone
Biodegradable pin/screw fixation
Biodegradable pins used to stabilize lesion
In situ unstable osteochondral lesions
Cartilage flap tears
Pins resorb in 6-24 months
Variably threaded metallic screws still used by some surgeons
Osteochondral transplantation
Osteochondral autograft transfer system (OATS), autologous osteochondral transplant (AOT), and mosaicplasty often used interchangeably in literature and clinical practice: osteochondral autograft will be used to refer to all procedures here
Appropriate for lesions 1-4 cm²
Osteochondral plugs inserted into lesion
Osteochondral autograft
Harvested from non-weight-bearing surface, usually lateral trochlea > margin of intercondylar notch
Relies on presence of usable donor cartilage
Possibility of donor site morbidity
Several fragments may be placed to fill 1 large defect (mosaicplasty)
Spaces between plugs eventually fill in with fibrocartilaginous grout
Osteochondral allograft
Cadaveric graft material
Used for larger lesions
Allows for rectangular or round grafts
Original concern for immune response and disease transmission not substantiated in practice
ACI
Appropriate for lesions 2-12 cm²
Patient's own cartilage harvested from non-weight-bearing surface
Cells grown in culture for 3-5 weeks to produce chondrocytes
Periosteal or synthetic cover/membrane sewn or glued over defect
Cultured chondrocytes injected under cover of periosteal sleeve
Resulting cartilage hyaline-like, thought to have biomechanical properties similar to native cartilage
Commonly complicated by hypertrophy of periosteum
Increased long-term durability
Matrix-associated chondrocyte implantation (MACI)
3D biologic scaffold optimized for culture of seeded autologous chondrocytes implanted in defect by miniarthrotomy
Trimmed to fit defect and glued in place
Stem cell transplantation
Intraarticular injection of stem cells from various sources
Results are variable
Controversial
Leukocyte-rich, platelet-rich plasma
Potential conservative treatment for knee osteoarthritis
IMAGING
General Features
CT Findings
MR Findings
Imaging Recommendations
PATHOLOGY
Microscopic Features
CLINICAL ISSUES
Natural History & Prognosis
DIAGNOSTIC CHECKLIST
Consider
Reporting Tips
Selected References
Kenmochi M: Clinical outcomes following injections of leukocyte-rich platelet-rich plasma in osteoarthritis patients. J Orthop. 18:143-9, 2020
Tradati D et al: AMIC-autologous matrix-induced chondrogenesis technique in patellar cartilage defects treatment: a retrospective study with a mid-term follow-up. J Clin Med. 9(4):1184, 2020
Zamborsky R et al: Surgical techniques for knee cartilage repair: an updated large-scale systematic review and network meta-analysis of randomized controlled trials. Arthroscopy. 36(3):845-58, 2020
Hede K et al: Combined bone marrow aspirate and platelet-rich plasma for cartilage repair: two-year clinical results. Cartilage. Epub, 2019
Liu YW et al: MR imaging of cartilage repair surgery of the knee. Clin Imaging. 58:129-39, 2019
Hayashi D et al: Understanding magnetic resonance imaging of knee cartilage repair: a focus on clinical relevance. Cartilage. 9(3):223-36, 2018
Oei EHG et al: Cartilage imaging: techniques and developments. Semin Musculoskelet Radiol. 22(2):245-60, 2018
Redondo ML et al: Preservation of knee articular cartilage. Sports Med Arthrosc Rev. 26(4):e23-30, 2018
Campbell AB et al: Return to sport after articular cartilage repair in athletes' knees: a systematic review. Arthroscopy. 32(4):651-68.e1, 2016
Oussedik S et al: Treatment of articular cartilage lesions of the knee by microfracture or autologous chondrocyte implantation: a systematic review. Arthroscopy. 31(4):732-44, 2015
Forney MC et al: Magnetic resonance imaging of cartilage repair procedures. Magn Reson Imaging Clin N Am. 22(4):671-701, 2014
Trattnig S et al: MR imaging of postoperative talar dome lesions. Semin Musculoskelet Radiol. 16(3):177-84, 2012
Hughes RJ et al: Clinical and MRI considerations in sports-related knee joint cartilage injury and cartilage repair. Semin Musculoskelet Radiol. 15(1):69-88, 2011
Harris JD et al: Treatment of chondral defects in the athlete's knee. Arthroscopy. 26(6):841-52, 2010
Van Assche D et al: Autologous chondrocyte implantation versus microfracture for knee cartilage injury: a prospective randomized trial, with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc. 18(4):486-95, 2010
Welsch GH et al: T2 and T2* mapping in patients after matrix-associated autologous chondrocyte transplantation: initial results on clinical use with 3.0-Tesla MRI. Eur Radiol. 20(6):1515-23, 2010
Gold GE et al: Recent advances in MRI of articular cartilage. AJR Am J Roentgenol. 193(3):628-38, 2009
Kon E et al: Matrix-assisted autologous chondrocyte transplantation for the repair of cartilage defects of the knee: systematic clinical data review and study quality analysis. Am J Sports Med. 37 Suppl 1:156S-66S, 2009
Nehrer S et al: Treatment of full-thickness chondral defects with hyalograft C in the knee: a prospective clinical case series with 2 to 7 years' follow-up. Am J Sports Med. Suppl 1:81S-7S, 2009
Potter HG et al: New techniques in articular cartilage imaging. Clin Sports Med. 28(1):77-94, 2009
Trattnig S et al: MR imaging of cartilage and its repair in the knee--a review. Eur Radiol. 19(7):1582-94, 2009
Van Assche D et al: Physical activity levels after characterized chondrocyte implantation versus microfracture in the knee and the relationship to objective functional outcome with 2-year follow-up. Am J Sports Med. 37 Suppl 1:42S-9S, 2009
Choi YS et al: MR imaging of cartilage repair in the knee and ankle. Radiographics. 28(4):1043-59, 2008
Domayer SE et al: MRI monitoring of cartilage repair in the knee: a review. Semin Musculoskelet Radiol. 12(4):302-17, 2008
McNickle AG et al: Overview of existing cartilage repair technology. Sports Med Arthrosc. 16(4):196-201, 2008
Potter HG et al: Magnetic resonance imaging of cartilage repair. Sports Med Arthrosc. 16(4):236-45, 2008
Welsch GH et al: Cartilage T2 assessment at 3-T MR imaging: in vivo differentiation of normal hyaline cartilage from reparative tissue after two cartilage repair procedures--initial experience. Radiology. 247(1):154-61, 2008
Williams Iii RJ et al: Cartilage repair procedures: clinical approach and decision making. Instr Course Lect. 57:553-61, 2008
Tins BJ et al: Autologous chondrocyte implantation in knee joint: MR imaging and histologic features at 1-year follow-up. Radiology. 234(2):501-8, 2005
Recht M et al: MR imaging of cartilage repair procedures. Skeletal Radiol. 32(4):185-200, 2003
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