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Arthroscopic Cartilage Repair / Mosicplasty

Dr. Lingaraju A P - Consultant Orthopaedic & Joint Replacement

Arthroscopic cartilage repair / Mosicplasty / Arthroscopic Osteochondral Autograft Transplantation (OATS)

What is Articular Cartilage?

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 lead to severe knee arthritis which may require total knee replacement.

What are the causes of articular damage?

Articular cartilage can be damaged by injury, osteochondritis desiccants or normal wear and tear.

Arthroscopic Articular Cartilage Repair
What are the symptoms?

The common symptoms are a pain in the knee, stiffness, swelling and difficulty in weight-bearing.

What are the common procedures for cartilage damage?

The most common procedures for cartilage restoration are:

  1. Microfracture
  2. Drilling
  3. Abrasion Arthroplasty
  4. Autologous Chondrocyte Implantation
  5. Osteochondral Autograft Transplantation
  6. Osteochondral Allograft Transplantation
What is Microfracture procedure for articular cartilage damage treatment?

Micro fracture is a technique to stimulate the growth of new articular cartilage by creating a new blood supply. A sharp tool called an awl is used to make multiple holes in the joint surface. The holes are made in the bone beneath the cartilage, called subchondral bone. This action creates a healing response. New blood supply can reach the joint surface, bringing with it new cells that will form the new cartilage.

The best candidates are young patients with single lesions and healthy subchondral bone.

What is drilling procedure for articular cartilage damage treatment?

Drilling, like micro fracture, stimulates the production of healthy cartilage. Multiple holes are made through the injured area in the subchondral bone with a surgical drill or wire. The subchondral bone is penetrated to create a healing response.

What is abrasion arthroplasty procedure for articular cartilage damage treatment?

Abrasion arthroplasty is similar to drilling. Instead of drills or wires, high-speed burrs are used to remove the damaged cartilage and reach the subchondral bone.

What is Autologous Chondrocyte Implantation (ACI) procedure for articular cartilage damage treatment?

ACI is a two-step procedure. New cartilage cells are grown and then implanted in the cartilage defect.

First, healthy cartilage tissue is removed from a non-weight bearing area of the bone. This step is done as an arthroscopic procedure. The tissue which contains healthy cartilage cells, or chondrocytes, is then sent to the laboratory. The cells are cultured and increase in number over a 3- to 5-week period.

An open surgical procedure, or arthrotomy, is then done to implant the newly grown cells. The cartilage defect is prepared. A layer of bone-lining tissue, called periosteum, is sewn over the area. This cover is sealed with fibrin glue. The newly grown cells are then injected into the defect under the periosteal cover.

ACI is most useful for younger patients who have single defects larger than 2 cm in diameter. ACI has the advantage of using the patient’s own cells, so there is no danger of a patient rejecting the tissue. It does have the disadvantage of being a two-stage procedure that requires an open incision. It also takes several weeks to complete

What is Osteochondral Autograft Transplantation (OATS) procedure for articular cartilage damage treatment?

In Osteochondral Autograft transplantation, cartilage is transferred from one part of the joint to another. Healthy cartilage tissue -a graft is taken from an area of the bone that does not carry weight (non-weight bearing). The graft is taken as a cylindrical plug of cartilage and subchondral bone. It is then matched to the surface area of the defect and impacted into place. This leaves a smooth cartilage surface in the joint. 

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