There have been different procedures described for the treatment of cartilage defects. When the defect is full thickness, the chances of “self-repair” are small. Historically, micro-fracture surgery has been utilized for smaller defects. However, this promotes healing through the formation of fibrocartilage, which is not ideal in the setting of repetitive weight-bearing and compressive forces, which can be detrimental to the joint over time and linked to worse patient outcomes.
Other procedures utilizing autologous cells have been described. Autologous chondrocyte implantation, a procedure involving placement of cultured chondrocytes into the defect and sutured into place, has been described downfall being the technically demanding nature of the procedure; however, it can be a good option for larger lesions. Osteochondral autograft transplantation can consist of a single plug or multiple plugs used to fill a larger defect.
The use of multiple plugs to fill a defect is termed mosaicplasty. The single plug technique requires the donor surface architecture to be similar to the recipient site for the procedure to be successful. With mosaicplasty, the donor site architecture can be less congruent since multiple donor plugs are placed into the defect. The spaces between the multiple plugs will fill with fibrocartilage. In the past, articular cartilage lesions have been treated by subchondral bone abrasions or drilling at the site of focal damage. For osteochondral lesions, bulk autografts and allografts have been used. But these are reserved for massive lesions, which are larger than 10 cm2.
Autogenous or allogenic osteochondral plugs have become popular due to the following reasons:
They can be performed in a single procedure.
They offer a chance at true hyaline cartilage resurfacing.
No outside laboratory assistance required.
It can be performed with reusable equipment.
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