What is mosaicplasty?

The process known as mosaicplasty is in which lesions of cartilage, or those involving bone and cartilage, are treated by harvesting and transplants of cylindrical plugs of bone and cartilage. In the knee, these plugs are taken from less weight-bearing areas known as 'donor sites' and placed into drilled tunnels within the defective portion of the cartilage.

What is the procedure of mosaicplasty?

The mosaicplasty procedure takes place on the patient who is under general anesthesia. It is a minimally invasive procedure performed through an arthroscope so that the intervention may be made possible with tiny incisions for approaching the joint. It allows the surgeon to watch the joint's interior to manipulate instruments to the exact area where the treatment will be conducted. The surgeon will look at the inside of the joint and clean out the debris. Subsequently, the cartilage removed from non-weight-bearing parts of the joint is implanted into the defective area. A new layer of cartilage hybrid between the existing cartilage and these transplanted plugs is thus created.

What are the benefits of the mosaicplasty procedure?

The benefits of the procedure are:

• The graft is a viable working unit. It is a hyaline cartilage run on the bony base in the shape of an osteochondral graft.
• The graft size can be flexed to the recipient site within definite limits.
• Mosaicplasty is a one-stage procedure that does not use any lab or cell rehabilitation.
• The risk of infection is minimal and the risk of rejection is negligible.

What are the disadvantages of the mosaicplasty procedure?

• This procedure requires careful harvesting and implantation to ensure maximal coverage that approaches or exceeds 80% with good integration and stabilization of the grafts.
• Postoperative pain is a consequence of harvesting multiple grafts.

What are the risks associated with the mosaicplasty procedure?

Although mosaicplasty is a generally safe procedure for most patients, there are risks associated with any surgical procedure. Some of the possible complications include:

• Swelling
• Infection
• Pain at the donor site
• Development of blood clots
• Weakening of the muscles
• Limited range of motion

These are considered relatively uncommon, and most patients notice a resolution of symptoms after receiving this procedure. Arthroscopic mosaicplasty results in a dramatic decrease in recovery time since it enables the utilization of small incisions, whereas many patients who receive traditional cartilage repair surgery tend to return to work and other activities more slowly.

How soon can I return to work, sports, and normal activities?

The final goal of rehabilitation should be to allow patients to resume all daily and sporting activities. It takes about 4–5 months to form a composite hyaline-like surface over the area of transplant, which is competent in tolerating shear forces.

Return to sports activities depends on the defect's depth and extent and the neuromuscular system's state. If the patients still lack strength, power, endurance, balance, and flexibility, sports activity should be postponed.

It should be noted that mosaicplasty is often combined with the treatment of other joint problems, such as ligament reconstruction, osteotomy (corrective bone removal), meniscectomy (removal of the meniscus), or suture/replacement of a torn meniscus. Treatment of accompanying pathologies usually requires a particular modification of the rehabilitation protocol and can alter and extend the duration of the time periods given above.

May surgery be avoided or delayed?

Cartilage repair is not an acute surgery. It can certainly be postponed, and patients have the choice to not have any surgical treatment at all. However, it must be taken into account that these lesions have a very poor capability of regeneration, and left without surgery, the condition will worsen, causing more complaints.

What is recovery after the mosaicplasty procedure?

Most mosaicplasty procedures are outpatient, but some instances require patients to spend some time in the hospital overnight. For a while, post procedure, using a CPM machine will help keep the joint moving and decrease the stiffness in the joint. Patients should be placed at rest for a period of a week or two after the surgery has been performed on the operated joint. This may require the utilization of crutches or other supporting devices to avoid overloading the affected joint. A physical therapy program is designed to help restore mobility and improve the strength and flexibility of the affected joint. Normally, exercise and regular activity may resume 2 to 3 months after the mosaicplasty procedure.

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