Arthroscopy
Cartilage Procedures (OATS/Mosicplasty)
Articular cartilage is a firm, rubbery material that covers the ends of bones in the knee joint. It reduces friction in the joint and acts as a "shock absorber." When cartilage becomes damaged or deteriorates, it limits the knee's normal movement and can cause significant pain. If damaged cartilage is not treated, it can worsen and eventually require knee replacement surgery.
Who are the candidates for cartilage procedures?
Cartilage repair and regeneration is the treatment for an otherwise healthy knee, but not for knees affected by osteoarthritis, a condition that causes natural cartilage deterioration from ageing.
The treatment is recommended for patients with knee cartilage damage or deterioration caused by:
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Trauma including sports injury
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Osteochondritis dessicans (OCD)
Types of Cartilage Procedures
Cartilage tissue’s ability to repair itself is severely limited because it does not contain blood vessels, and bleeding is necessary for healing. The damaged cartilage can either be regenerated by encouraging new cartilage growth or replaced by cartilage replacement procedures.
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What cartilage procedure is used will depend on the size of the cartilage injury being treated and the surgeon’s expertise and recommendation.
Cartilage Regeneration Procedures
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Knee microfracture, which requires the damaged cartilage to be cleared away completely. The surgeon then uses a sharpened tool called an awl to pierce the bone underneath the damaged cartilage; blood from the microfracture will facilitate new cartilage cell growth.
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Knee abrasion arthroplasty, which requires the damaged cartilage to be completely cleared away. The surgeon then uses a special tool to scrape and roughen the affected bone’s surface.
Cartilage Replacement Procedures:
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Osteochondral autograft transplantation (OATS), uses cartilage from the patient. The surgeon removes a small (<1cm), a round plug of healthy cartilage—and a tiny bit of underlying bone—from a non-weight-bearing area of the knee joint. The surgeon transfers the plug to the area being treated. This OATs procedure can be used to repair one or more relatively small cartilage defects in a knee. When more than one plug is used to treat a single cartilage defect, the procedure is called mosaicplasty. The surgery is usually done arthroscopically.
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Osteochondral allograft transplantation uses cartilage from outside the patient, usually from a cadaver. The surgeon removes a circular plug of healthy cartilage from an outside donor. An allograft is usually used when cartilage defect being treated is too large for an autograft (≥2cm). This surgery usually requires an open incision.