In this article, you will discover everything you need to know about Mosaicplasty, its effectiveness, and advanced alternatives such as Prolotherapy for long-lasting relief from pain and cartilage injuries.
Table of Contents
- What is Mosaicplasty?
- History of Mosaicplasty
- How is Mosaicplasty Performed?
- Benefits of Mosaicplasty
- Disadvantages of Mosaicplasty
- Alternatives to Mosaicplasty
- Prolotherapy
- Frequently Asked Questions (FAQs)
- ProHealth Clinic
- Author Bio
- References
What is Mosaicplasty?
Mosaicplasty, also called Autologous Osteochondral Grafting (OAG), is a surgical technique for transplanting bone and hyaline cartilage into areas affected by knee cartilage damage. Mosaicplasty is used to treat osteochondral defects and full-thickness lesions of the articular cartilage in various joints, including the knee, ankle, and hip. In this procedure, multiple tiny cylindrical osteochondral plugs are harvested and implanted into the damaged site to restore joint function and encourage cartilage regeneration.
This approach allows surgeons to contour the surface of the joint while minimizing donor-site damage. The procedure can be performed arthroscopically, enabling minimally invasive cartilage repair surgery. Mosaicplasty is often performed alongside procedures like microfracture surgery to maximize healing and joint recovery.
Lane et al. demonstrated that hyaline cartilage can remain sustainable for up to 12 weeks post-transfer. However, single-plug techniques often faced limitations such as poor surface fit and donor-site morbidity. Mosaicplasty was developed to address these issues more effectively.
History of Mosaicplasty
Over the decades, orthopedic surgeons have attempted various cartilage repair strategies using large osteochondral grafts from areas like the posterior femoral condyle, medial trochlea, and patella. These methods, however, often disrupted biomechanics and led to inconsistent outcomes.
- 1993: Matsusue et al. published the first case study on a femoral condyle defect.
- 1996: Bobic reported further outcomes using the method.
- 1992–1997: Hangody pioneered and refined the multiple graft “Mosaicplasty” technique.
How is Mosaicplasty Performed?
The Mosaicplasty procedure involves harvesting cylindrical grafts from a low weight-bearing area of the knee and transplanting them into the damaged site, typically on the femoral condyle.
Surgical Steps
- Installation – patient positioning and tool preparation.
- Arthroscopic Evaluation – assessment, curettage, and defect debridement.
- Planning – determination of graft size and number.
- Harvesting – cylindrical grafts are taken from donor areas.
- Implantation – plugs are press-fit into the recipient site.
Preoperative Workup
- Assessment of joint alignment and stability
- Functional instability evaluation
- Imaging (MRI or CT arthrography with cartilage sequences)
After surgery, patients are encouraged to maintain free joint movement, but weight-bearing is delayed for 2–4 weeks. Mosaicplasty is most suitable for patients under 50 with localized cartilage damage (< 3 cm). It is contraindicated in osteoarthritis.
Benefits of Mosaicplasty
- Uses natural hyaline cartilage with bone support for stability.
- Grafts can be adjusted to match defect size.
- Single-stage procedure, no lab processing required.
- Low risk of infection or rejection.
Disadvantages of Mosaicplasty
- Requires precise harvesting and implantation for best results.
- Donor site may develop postoperative pain.
Alternatives to Mosaicplasty
While Mosaicplasty is effective for small cartilage defects, other non-surgical and minimally invasive options are available. One of the most advanced alternatives is Prolotherapy.
Prolotherapy
Prolotherapy has gained recognition as a regenerative medicine technique for treating pain. It involves injecting a natural regenerative solution directly into weakened or injured tissues, stimulating the production of collagen and enhancing the body’s natural healing response.
Research shows that Prolotherapy can reduce pain, decrease inflammation, and encourage long-term cartilage regeneration (Rabago et al., 2016).
Unlike temporary painkillers, Prolotherapy addresses the root cause of pain, offering lasting results and preventing recurrence of symptoms.
Frequently Asked Questions (FAQs)
What is the smallest cartilage defect suitable for Mosaicplasty?
Research suggests defects larger than 10 mm significantly impact joint biomechanics. Most experts recommend Mosaicplasty for defects over 9–10 mm (Convery et al.).
What are the success rates of Mosaicplasty?
Lane et al. reported promising outcomes in animal models, with 95% graft viability and restoration of cartilage-like surfaces at 3 months.
What happens at the donor site after Mosaicplasty?
Most donor sites heal with fibrous tissue, though some surgeons attempt to fill them with osteoperiosteal plugs. Studies show mixed results (Van Susante et al.).
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Author Bio
Having performed over 10,000 procedures, Mr. Oliver Eaton is one of the UK’s leading practitioners in treating pain, with patients travelling from across the UK, Europe, and the Middle East.
With over 12 years of clinical experience, Oliver specializes in helping patients understand the causes of their pain and providing effective treatments to resolve it. He trained in Prolozone Therapy and Prolotherapy in the USA with the American Academy of Ozonotherapy and has additional qualifications from:
- Royal Society of Medicine
- Charing Cross Hospital, London
- Keele University Anatomy & Surgical Training Centre
- Heidelberg University, Germany
He has treated elite-level athletes, including Olympic and Commonwealth medallists.
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References
- Oztürk A, Ozdemir MR, Ozkan Y. Osteochondral autografting (mosaicplasty) in grade IV cartilage defects: 2- to 7-year results. Int Orthop. 2006;30(3):200-204. doi:10.1007/s00264-005-0068-5
- Robert H. Chondral repair of the knee joint using Mosaicplasty. Orthop Traumatol Surg Res. 2011;97(4):418-429. doi:10.1016/j.otsr.2011.04.001
- Lane JG, et al. Osteochondral autograft plug transfer in an animal model. Arthroscopy. 2001;17(8):856-863. doi:10.1016/S0749-8063(01)90010-6
- Van Susante JLC, Wymenga AB, Buma P. Osteoperiosteal bone plug for donor-site defects in mosaicplasty. Arch Orthop Trauma Surg. 2003;123:466–470. doi:10.1007/s00402-003-0577-x
- Curl WW, et al. Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy. 1997;13(4):456-460. doi:10.1016/s0749-8063(97)90124-9
- Rabago D, et al. Prolotherapy for osteoarthritis and chronic pain. Clin Med Insights Arthritis Musculoskelet Disord. 2016;9:19–28. doi:10.4137/CMAMD.S39160