Mosaicplasty
Cartilage is the smooth coating on the end of the bones that provides cushioning and support for comfortable and fluid movement of the joints. Cartilage damage may occur as a result of injury or degeneration and can lead to severe pain and arthritis. Damaged cartilage can eventually wear away and leave the bone unprotected. There are several surgical techniques currently used to repair damaged cartilage and restore normal movement of the joints. These techniques involve transplanting healthy cartilage from another part of the joint to stimulate the growth of new cartilage in a damaged area.
Osteochondral autograft transplantation is a cartilage transfer procedure that transfers cartilage from one part of the joint to another. A mosaicplasty is a a form of osteochondral autograft transplantation in which multiple plugs of cartilage and bone are removed and transferred. In this procedure, the healthy cartilage is removed from a portion of bone that does not bear weight. Mosiacplasty can help to relieve the discomfort caused by damaged or worn cartilage, as well protect the joint from further wear and tear. A mosiacplasty is commonly performed on athletes, as it has a quicker recovery time than other treatments and athletes can return to full sports participation after a shorter rehabilitation period.
During a mosaicplasty, several plugs of tissue are removed for transfer. The graft tissue is taken out using a specialized tool that withdraws a plug of cartilage and subchondral bone. These plugs are quite small, typically less than one centimeter in diameter. The number of plugs used will vary by patient, depending on the extent of the damage in the joint. The plugs are then placed in the damaged area of cartilage, leaving a full, smooth cushion of cartilage in the joint to protect the bones. This technique is typically best suited to smaller areas of defective cartilage. Only a limited amount of healthy cartilage can be removed from within the same joint and transferred successfully.
The Mosaicplasty Procedure
The mosaicplasty procedure is performed while the patient is sedated under general anesthesia. It is a minimally invasive procedure that is performed using an arthroscope, enabling the surgeon to make tiny incisions to access the joint. The arthroscope allows the surgeon to visually examine the joint and guide the instruments to the precise area for treatment. The surgeon examines the interior of the joint and removes any debris. The cartilage is withdrawn from non-weight bearing portions of the joint and then grafted into the damaged area. A new layer of cartilage is then created that is a combination of existing cartilage and these transplanted plugs.
Recovery from Mosaicplasty
Most mosaicplasty procedures are performed on an outpatient basis, but in some cases, an overnight stay in the hospital may be required. Following the procedure, individuals may use a continuous passive motion (CPM) machine to keep the joint moving and to alleviate joint stiffness. Patients are typically advised to rest the affected joint for one to two weeks after the surgery. Depending on the joint affected, crutches or other assistive devices may be necessary to avoid putting too much pressure on the joint. A physical therapy program helps to restore mobility and improve strength and flexibility of the affected joint. Exercise and and regular activity can normally resume 2 to 3 months after the mosaicplasty procedure
Risks of Mosaicplasty
Although mosaicplasty is considered a safe procedure for most patients, there are certain risks associated with all surgical procedures. Potential complications may include:
- Swelling
- Infection
- Donor site pain
- Blood clots
- Weakening of muscles
- Limited range of motion
These risks are considered uncommon, and most patients experience relief of symptoms after this procedure. When a mosaicplasty is performed arthroscopically, the small incisions help to greatly reduce the recovery time, and allow patients to return to work and other activities at a quicker pace than traditional cartilage repair surgeries.
Osteoarthritis
Arthritis is a condition that causes pain, stiffness and swelling in the joints. Osteoarthritis is the most common form of arthritis. It develops as the cartilage protecting the bones of a joint wears down over time. Over the years, as stress is put on the joints, cartilage wears thin and sometimes even erodes completely, resulting in stiffness and pain. It occurs more frequently in older individuals, however it sometimes develops in athletes from overuse of a joint or after an injury. It commonly affects the fingers, knees, lower back and hips and is often treated with medication and certain forms of exercise and physical therapy. In severe cases, joint replacement surgery may be suggested. Osteoarthritis tends to get worse over time.
Symptoms of Osteoarthritis
The symptoms of osteoarthritis often develop slowly and progress over time. Common symptoms of osteoarthritis affect the joints and may include:
- Pain
- Stiffness
- Swelling
- Tenderness
- Loss of flexibility
- Grating sensation or clicking sounds when joints are used
Sometimes bone spurs, which are also painful and interfere with movement, develop from the friction created by the bones rubbing together from osteoarthritis.
Diagnosis of Osteoarthritis
In order to diagnose osteoarthritis, a thorough physical examination is performed to evaluate pain level, muscle weakness, range of motion, and any possible involvement of other joints. A complete medical history that assesses family history and past injuries is taken. If the physical examination indicates osteoarthritis, other diagnostic tests may be performed, including:
- X-rays
- MRI scan
- Blood tests to screen for other diseases
- Analysis of fluid that lubricates the joint
Treatment of Osteoarthritis
Osteoarthritis is commonly treated with a combination of methods. Medication may be used to treat pain and may include:
- Anti-inflammatory drugs
- Acetaminophen
- Prescription pain relievers
- Corticosteroid injections
Physical therapy may be a successful form of treatment for some patients. Avoiding certain physical activities that place stress on the joints may also be helpful. Severe cases of osteoarthritis may require surgery to smooth irregular tissue surfaces, or to reposition or replace joints through arthroscopy.
