OATS versus mosaicplasty for knee cartilage repairOATS and mosaicplasty are the same surgical technique applied at different scales: OATS transfers a single cartilage plug for knee defects under 2 cm², mosaicplasty tiles smaller grafts across 2–4 cm² lesions.OATS and mosaicplasty are the same surgical technique applied at different scales: OATS transfers a single cartilage plug for knee defects under 2 cm², mosaicplasty tiles smaller grafts across 2–4 cm² lesions.
OCA or MACI for large knee cartilage defectsWhen subchondral bone is damaged alongside large knee cartilage defects, OCA — a single-stage transplant of donor bone and cartilage — is the preferred choice; MACI, which implants cultured cells, cannot restore bone stock once lost.When subchondral bone is damaged alongside large knee cartilage defects, OCA — a single-stage transplant of donor bone and cartilage — is the preferred choice; MACI, which implants cultured cells, cannot restore bone stock once lost.
Osteochondral Allograft for Post-Traumatic Knee DefectsWhen post-traumatic knee injury damages both cartilage and underlying bone, osteochondral allograft transplants provide a single-stage solution that other repair methods cannot match. Roughly 75–82% of patients return to sport; grafts show 87% survival at five years, declining to 68% at twenty.When post-traumatic knee injury damages both cartilage and underlying bone, osteochondral allograft transplants provide a single-stage solution that other repair methods cannot match. Roughly 75–82% of patients return to sport; grafts show 87% survival at five years, declining to 68% at twenty.
MACI versus microfracture for knee cartilage repairMACI outperforms microfracture for knee cartilage defects of 3 cm² or larger, according to the SUMMIT randomised trial, which found significantly greater improvements in pain and function at two years that persisted through five years.MACI outperforms microfracture for knee cartilage defects of 3 cm² or larger, according to the SUMMIT randomised trial, which found significantly greater improvements in pain and function at two years that persisted through five years.
AMIC vs microfracture for knee cartilage repairBoth AMIC and microfracture improve pain and function in the first two years; beyond that point, microfracture outcomes progressively deteriorate whilst AMIC maintains stable gains through a decade of follow-up.Both AMIC and microfracture improve pain and function in the first two years; beyond that point, microfracture outcomes progressively deteriorate whilst AMIC maintains stable gains through a decade of follow-up.
ACI knee cartilage repair in the UKACI harvests a patient's own cartilage cells, cultures them to roughly 20 times their original number, then implants them in a second operation; NHS funding applies only to patients with defects over 2 cm², no prior cartilage repair, minimal arthritis, and access to a specialist centre.ACI harvests a patient's own cartilage cells, cultures them to roughly 20 times their original number, then implants them in a second operation; NHS funding applies only to patients with defects over 2 cm², no prior cartilage repair, minimal arthritis, and access to a specialist centre.
Is OATS knee surgery worth itCartilage damage beyond a certain point cannot self-repair. OATS transplants healthy cartilage plugs to replace it, with 85–93% achieving clinical success and improvements sustained at ten and twenty years, though 10–15% experience persistent donor-site pain.Cartilage damage beyond a certain point cannot self-repair. OATS transplants healthy cartilage plugs to replace it, with 85–93% achieving clinical success and improvements sustained at ten and twenty years, though 10–15% experience persistent donor-site pain.
ACI vs MACI for knee cartilage repairMACI seeds harvested chondrocytes onto a collagen membrane secured with fibrin glue; first-generation ACI injects them as a liquid suspension under a sutured periosteal patch. This engineering difference has driven MACI's adoption: complication rates of approximately 10% versus 29%, with superior pain reduction and activity levels.MACI seeds harvested chondrocytes onto a collagen membrane secured with fibrin glue; first-generation ACI injects them as a liquid suspension under a sutured periosteal patch. This engineering difference has driven MACI's adoption: complication rates of approximately 10% versus 29%, with superior pain reduction and activity levels.
Allograft or Autograft for Large Knee Cartilage DefectsDefect size is the primary determinant in knee cartilage repair: below 4 cm², autograft transfer from low-load zones is standard; above that threshold, cadaveric allograft removes the biological supply ceiling.Defect size is the primary determinant in knee cartilage repair: below 4 cm², autograft transfer from low-load zones is standard; above that threshold, cadaveric allograft removes the biological supply ceiling.
Single-stage or two-stage cartilage repairCartilage repair decisions hinge on defect size: lesions below roughly 1.5–2 cm² suit single-stage surgery, those of 2–4 cm² permit either approach, and larger defects typically require tissue replacement rather than repair.Cartilage repair decisions hinge on defect size: lesions below roughly 1.5–2 cm² suit single-stage surgery, those of 2–4 cm² permit either approach, and larger defects typically require tissue replacement rather than repair.
MACI vs Microfracture for Knee Cartilage RepairFor focal knee cartilage defects above 3 cm², MACI outperformed microfracture across all clinical measures: pain scores improved to 82.5 versus 70.9 at two years, with durability sustained at five-year follow-up.For focal knee cartilage defects above 3 cm², MACI outperformed microfracture across all clinical measures: pain scores improved to 82.5 versus 70.9 at two years, with durability sustained at five-year follow-up.
Cartilage repair or knee replacementThe choice between cartilage repair and knee replacement hinges on whether damage is focal or diffuse. Isolated defects in otherwise healthy joints can be repaired; widespread bone-on-bone osteoarthritis affecting multiple compartments requires replacement instead.The choice between cartilage repair and knee replacement hinges on whether damage is focal or diffuse. Isolated defects in otherwise healthy joints can be repaired; widespread bone-on-bone osteoarthritis affecting multiple compartments requires replacement instead.