MOSAICPLASTY

DEPARTMENT OF ORTHOPAEDICS
KMC MANGALORE

MODERATOR : PROF R. M. SHENOY

CO-MODERATOR : DR. VIVEK MAHAJAN
PRESENTER : DR. HIMANSHU GAUR

INTRODUCTION
Damaged Articular cartilage Limited potential for
healing
Focal chondral & osteochondral defects of loading
surfaces Early degenerative changes
Traditional Resurfacing techniques
Debridement
Subchondral penetration
Micro fracture

Recently introduced Resurfacing

techniques
Periosteal and Perichondral grafts
Autologous Osteochondral mixture
Autologous Chondrocyte transplantation
Osteochondral Allografts
Autologous Osteochondral transplantation

PRINCIPLE OF MOSAICPLASTY
Obtaining multiple small sized cylindrical
osteochondral grafts from minimal wt bearing
surfaces & transplanting them to cartilage defect
sites on wt bearing surfaces
Developed by Laszlo Hangody in Hungary in the
1990s.

INDICATIONS
Small or medium sized focal chondral and

Osteochondral defects of the wt bearing articular

surfaces of the knee
Defects of other diarthrodial surfaces of
Talus, Humeral capitulum
Ideal diameter of the defect 1 to 4 cm2
Age of less than 50 years

ADVANTAGE
More tissue can be transplanted
Preserving the integrity of the donor site
Mosaic like implanting fashion Progressive

contouring of new surfaces.

Donor sites- Peripheral parts of both Femoral

condyles at the level of the Patellofemoral joint
GA or regional anaesthesia with Tourniquet control
is recommended for an open procedure.

ARTHROSCOPIC MOSAICPLASTY
The patient is positioned
supine with the knee free
to flex to 120 with
contralateral limb placed
in a stirrup.
Initial route is
parapatellar, medial or
lateral

Cartilage defect identified, its

edges are debrided to healthy
hyaline cartilage
The base of lesion is curetted
down to viable subchondral
bone
A drill guide is used to
determine the number of
grafts that are needed

The donor site is reached by

extending the knee
A properly sized Tubular Chisel is
introduced perpendicular to the donor
site
Driven to a depth corresponding to
that of recipient site
15mm depth Cartilage defects
25mm depthOsteochondral defects

Tapping Toggling with No

RotationChisel is removed
Graft is delivered from harvester
Push out the graft from the
Osseous end to avoid damaging
the Hyaline cartilage cap
Recipient site is reached by flexing
the knee

Insertion of the grafts is done through the universal

guide,this guide tapped into Osseous base of
defect.
Drill bitRecipient tunnel

A Dilator Conical shaped Recipient tunnelEasy

insertion of the transplanted graft

PlungerInsertion of grafts
Graft surface should match to
the surrounding articular
surface
Grafts implanted
Perpendicular Fashion
Procedure is repeated and all
of the grafts are inserted

When all of the

holes are filled, the
knee is put through a
range of motion with
varus or valgus
stress to seat the
grafts fully and to
ensure their press fit
stability

Mosaicplasty outside of the knee requires

arthroscopic graft harvest from the knee
and open access to the affected bone
Open Mosaicplasty
The principles of the procedure are
similar to open procedure.

Open Mosaicplasty

Macroscopic and histological

evaluations
Consistent survival of the transplanted hyaline
cartilage.
Formation of a composite cartilage layers from
transplanted hyaline cartilage and ingrowth of
fibrocartilage from osseos base of defect
Deep matrix integration of the transplanted cartilage
with the surrounding tissue at recipient site
Filling of donor sites to the surface with cancellous
bone capped with fibrocartilage by 8week

Post operative complications

Deep infections
Painful hemarthroses

Post operative treatment

Autologous osteochondral mosaicplasty permits an
immediate full range of motion.
Non weight bearing for 2 week
Partial weight bearing for 2 to 4 week

Advantages of Mosaicplasty
Defect can be filled immediately with mature hyaline
articular cartilage
Maintain the radius of curvature of articular surface
or congruence
Integration of spongy element of the graft which
fuses with spongy bed at recipient site
Integration of transplanted cartilage with adjacent
hyaline cartilage by means of fibrocartilage

Disadvantages of Mosaicplasty
Mosaicplasty is restricted to defects of less than 4cm 2
Donor site morbidiy
Inherent problem of restricted donor area
Difficulty in achieving satisfactory congruent surface
for large defect
Harvesting grafts for a cartilage defect in another
joint requires the opening of an otherwise healthy
knee joint.
Early weight bearing can cause grafts to sink

Contraindications
Infection
Tumor
Generalised or Rheumatic arthritis
Osteoarthritis
Lack of appropriate donar area
Age of greater than 50 years
Defect larger than 8cm2

Autologous osteochondral mosaicplasty is an

innovative & promoising treatment for focal
chondral & osteochondral articular cartilage
defects that are b/w 1 &4 cm2 in size. In these
defects,Mosaicplasty demonstrates a 90%
good to excellent results.

References
Autologous Osteochondral Mosaicplasty for the treatment
of full thickness defects of weight bearing joints,Laszlo
Hangody and Peter Fules, JBJS; 2003,Vol 85-A,pages 25
to 32
Autologous Osteochondral Mosaicplasty -Surgical
Technique,Laszlo Hangody,JBJS;2004, Vol 85-A,pages 65
to 72
A clinical review of cartilage repair
techniques,G.D.Smith,G.knutsen,J.B.Richardson,
JBJS;April 2005,Vol 87-B,pages 445 to 449
Current Concepts Review The Healing and Regeneration
of Articular Cartilage, JBJS;DEC 1998,Vol 80-A,pages
1795 to 1804

Current Concepts Review The Healing and

Regeneration of Articular Cartilage, JBJS;DEC
1998,Vol 80-A,pages 1795 to 1804
Chondrocyte death associated with human
Femoral Osteochondral harvest as performed
for Mosaicplasty. JBJS;Feb 2005,Vol 87-A,pages
351 to 360
A Prospective randomised comparison of
autologous chondrocyte implantation versus
Mosaicplasty for osteochondral defects in knee.
JBJS;March 2003,Vol 85-B,pages 223 to 230

Campbells Operative Orthopedics, Vol III,

11th Edition, Chapter 43, Knee Injuries.
Robert H. Miller and Frederick M.AZAR,
Pg.2553-2563
Campbells Operative Orthopedics, Vol III,
11th Edition, Chapter 42, Ankle Injuries.
David R. Richardson, Pg.2377-2389

References
Autologous Osteochondral Mosaicplasty for the treatment
of full thickness defects of weight bearing joints,Laszlo
Hangody and Peter Fules, JBJS; 2003,Vol 85-A, pages
25 to 32
Autologous Osteochondral Mosaicplasty -Surgical
Technique,Laszlo Hangody,JBJS;2004, Vol 85-A, pages
65 to 72
A clinical review of cartilage repair
techniques,G.D.Smith,G.knutsen,J.B.Richardson,
JBJS;April 2005,Vol 87-B,pages 445 to 449
Current Concepts Review The Healing and
Regeneration of Articular Cartilage, JBJS; DEC 1998,
Vol 80-A,pages 1795 to 1804

Chondrocyte death associated with human Femoral

Osteochondral harvest as performed for Mosaicplasty.
JBJS;Feb 2005,Vol 87-A,pages 351 to 360
A Prospective randomised comparison of autologous
chondrocyte implantation versus Mosaicplasty for
osteochondral defects in knee. JBJS;March 2003,
Vol 85-B,pages 223 to 230
Campbells Operative Orthopedics, Vol III, 11th Edition,
Chapter 43, Knee Injuries. Robert H. Miller and Frederick
M.AZAR, Pg.2553-2563
Campbells Operative Orthopedics, Vol III, 11th Edition,
Chapter 42, Ankle Injuries. David R. Richardson,
Pg.2377-2389