Osteochondral Grafting using the Mosaicplasty Technique

Treatment of cartilage and osteochondral defects has always posed difficult problems for orthopaedic surgeons (Fig. 1). Conventional methods, Pridie’s perforations, microfractures or subchondral abrasion (abrasion arthroplasty) lead to imperfect results in around 50 % of cases (Fig. 2). These techniques lead to the formation of fibrocartilaginous scar tissue whose biomechanical properties are significantly inferior to those of hyaline cartilage, and which does not prevent the onset or progression of a degenerative arthropathy. In order to overcome the drawbacks inherent in traditional methods, alternative methods have been developed: osteochondral or chondrocyte allografts and autografts. Good results for osteochondral allografts have been published. However, owing to the risk of transmission of viral diseases and uncertainties surrounding maintenance of the properties of the transplanted tissue, many authors have switched to using autografts. Various types of autograft are available: Grafts using autologous chondrocytes involve two surgical procedures: one to remove a disc of hyaline cartilage, the other to implant the chondrocytes after they have been cultivated. This involves cumbersome and expensive biotechnology. Implantation of the cultivated chondrocytes involves an open procedure, with harvesting of a graft of Figure 1: The problem: cartilage fracture with detached cartilage. Figure 2: Conventional treatment: excision of detached cartilage, subchondral abrasion, Pridie's perforations. CURRENT METHODS OF REPAIRING CARTILAGE DEFECT