Autologous Osteochondral Mosaicplasty
Autologous osteochondral transplantation represents one solution: to bring about a hyaline or hyaline-like repair of the defected area. This paper discusses the experimental background and 10 years of clinical experience with autologous osteochondral mosaicplasty. Several series of dog and horse studies and subsequent clinical practice have confirmed the survival of the transplanted hyaline cartilage. Fibrocartilage fills the donor sites located on the less–weight-bearing surfaces. Clinical scores, imaging techniques, control arthroscopies, histologic examination of biopsy samples, and cartilage stiffness measurements were used to evaluate the clinical outcomes and quality of the transplanted cartilage. According to these investigations, 92% of femoral condylar implantations have shown good to excellent results, as have 88% of tibial resurfacements, 81% of patellar and/or trochlear mosaicplasties, and 94% of talar procedures. The Bandi score showed long-term donor site disturbances in 3% of patients. Sixty-nine of the 81 control arthroscopies represented good gliding surfaces, histologically proven survival of the transplanted hyaline cartilage, and fibrocartilage coverage of the donor sites. In the entire series, there were four deep infections and 38 painful hemarthroses after surgery. Multicentric, comparative, prospective evaluation of 413 arthroscopic resurfacing procedures (mosaicplasty, Pridie drilling, abrasion arthroplasty, and microfracture cases in homogenized subgroups) demonstrated that mosaicplasty yielded favorable clinical outcome in long-term follow-up compared to the other three techniques. Intermediate-term evaluation of the femoral condylar implantations (3–6 y follow-up) and talar mosaicplasty procedures (3–7 y follow-up) confirmed the durability of the early results. From these encouraging results from an increasingly large series and similar results from other centers, it seems that autologous osteochondral mosaicplasty may be a viable alternative treatment of localized full-thickness cartilage damage of the weight-bearing surfaces of the knee and other weight-bearing synovial joints.