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Single-stage vs two-stage ACI for cartilage repairTraditional two-stage ACI involves two general anaesthetics separated by a four-to-six-week cell culture period; STACI performs both stages in a single theatre session, requiring one general anaesthetic and eliminating the inter-stage gap.Traditional two-stage ACI involves two general anaesthetics separated by a four-to-six-week cell culture period; STACI performs both stages in a single theatre session, requiring one general anaesthetic and eliminating the inter-stage gap.
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OATS for Osteochondral Lesions of the TalusLesions larger than approximately 150 mm² fail bone marrow stimulation treatment 97% of the time. OATS transplants genuine hyaline cartilage to replace the weakening fibrocartilage scar that microfracture produces in larger defects.Lesions larger than approximately 150 mm² fail bone marrow stimulation treatment 97% of the time. OATS transplants genuine hyaline cartilage to replace the weakening fibrocartilage scar that microfracture produces in larger defects.
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ACI for Ankle Cartilage DefectsMicrofracture produces fibrocartilage that deteriorates within two to three years for ankle cartilage lesions over 15 mm in diameter; autologous chondrocyte implantation regenerates more durable, hyaline-like cartilage that more closely resembles native tissue for larger defects.Microfracture produces fibrocartilage that deteriorates within two to three years for ankle cartilage lesions over 15 mm in diameter; autologous chondrocyte implantation regenerates more durable, hyaline-like cartilage that more closely resembles native tissue for larger defects.
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Who Qualifies for OATS Knee Cartilage RepairOATS and mosaicplasty repair focal knee cartilage defects of 1–4 cm² with hyaline cartilage in a single operation; suitable for physically active patients aged 16–50, both achieve return to sport in 66–91% of cases.OATS and mosaicplasty repair focal knee cartilage defects of 1–4 cm² with hyaline cartilage in a single operation; suitable for physically active patients aged 16–50, both achieve return to sport in 66–91% of cases.
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When knee cartilage repair is worth consideringCartilage lacks a blood supply and cannot self-heal, but surgical or minimally invasive repair can restore focal defects in otherwise healthy joints, potentially delaying knee replacement by years or decades.Cartilage lacks a blood supply and cannot self-heal, but surgical or minimally invasive repair can restore focal defects in otherwise healthy joints, potentially delaying knee replacement by years or decades.
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The cost of leaving a knee cartilage defect untreatedKnee cartilage defects do not heal because cartilage lacks blood supply; defects widen under load with each step, spreading damage to surrounding tissue and progressing towards osteoarthritis if untreated.Knee cartilage defects do not heal because cartilage lacks blood supply; defects widen under load with each step, spreading damage to surrounding tissue and progressing towards osteoarthritis if untreated.
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OCA vs MACI for large knee cartilage defectsMACI (matrix-induced autologous chondrocyte implantation) is a surface repair requiring intact subchondral bone; osteochondral allograft (OCA) replaces both cartilage and bone. When knee cartilage defects breach underlying bone, OCA addresses what MACI cannot.MACI (matrix-induced autologous chondrocyte implantation) is a surface repair requiring intact subchondral bone; osteochondral allograft (OCA) replaces both cartilage and bone. When knee cartilage defects breach underlying bone, OCA addresses what MACI cannot.
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AMIC vs MACI for knee cartilage repairStandalone microfracture for knee cartilage defects has less than 60% survivorship at three years; AMIC adds a collagen membrane to stabilize repair, whilst MACI uses cultured chondrocytes and shows superiority in the SUMMIT trial for lesions over 3 cm².Standalone microfracture for knee cartilage defects has less than 60% survivorship at three years; AMIC adds a collagen membrane to stabilize repair, whilst MACI uses cultured chondrocytes and shows superiority in the SUMMIT trial for lesions over 3 cm².
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How single-stage ACI differs from MACIMACI repairs cartilage defects over two operations, with weeks between them for external cell expansion; STACi compresses the entire process—harvesting, processing, and implantation—into a single surgical session.MACI repairs cartilage defects over two operations, with weeks between them for external cell expansion; STACi compresses the entire process—harvesting, processing, and implantation—into a single surgical session.
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How defect size and age decide OATS or OCADefect size determines whether focal cartilage repair uses autograft (OATS, harvested from the patient's own knee) or donor allograft (OCA): below 2 cm², autograft is viable; above 4 cm², only allograft remains before arthroplasty.Defect size determines whether focal cartilage repair uses autograft (OATS, harvested from the patient's own knee) or donor allograft (OCA): below 2 cm², autograft is viable; above 4 cm², only allograft remains before arthroplasty.
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Who qualifies for MACI knee surgeryMACI grows hyaline-like cartilage from the patient's own cells and maintains superior pain and function scores at five years, unlike microfracture, whose fibrocartilage typically deteriorates within two to three years.MACI grows hyaline-like cartilage from the patient's own cells and maintains superior pain and function scores at five years, unlike microfracture, whose fibrocartilage typically deteriorates within two to three years.
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Who qualifies for OATS knee surgeryOATS transplants hyaline cartilage harvested from a low-load zone of the same knee to repair focal defects. The donor site heals with fibrocartilage, creating potential for catching, locking, or anterior knee pain.OATS transplants hyaline cartilage harvested from a low-load zone of the same knee to repair focal defects. The donor site heals with fibrocartilage, creating potential for catching, locking, or anterior knee pain.
