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ACI for talar cartilage repairOsteochondral lesions of the talus occur in up to 70% of ankle fractures; defects measuring 2cm² or larger typically undergo autologous chondrocyte implantation, which uses cultured cells rather than bone plugs to restore cartilage but requires medial malleolar osteotomy to access the joint.Osteochondral lesions of the talus occur in up to 70% of ankle fractures; defects measuring 2cm² or larger typically undergo autologous chondrocyte implantation, which uses cultured cells rather than bone plugs to restore cartilage but requires medial malleolar osteotomy to access the joint.
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When cartilage repair is the right choiceCartilage repair succeeds for a focal defect in otherwise healthy joint tissue in younger patients, but fails in diffuse arthritis. Lesion size, depth, patient age, and activity level determine the appropriate technique.Cartilage repair succeeds for a focal defect in otherwise healthy joint tissue in younger patients, but fails in diffuse arthritis. Lesion size, depth, patient age, and activity level determine the appropriate technique.
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When OATS mosaicplasty beats other ankle cartilage repairsLesions exceeding 150 mm² require OATS mosaicplasty: marrow stimulation produces fibrocartilage that breaks down within two to three years, whilst transplanted hyaline cartilage lasts decades.Lesions exceeding 150 mm² require OATS mosaicplasty: marrow stimulation produces fibrocartilage that breaks down within two to three years, whilst transplanted hyaline cartilage lasts decades.
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OATS or microfracture for active knee patientsMicrofracture improves early but deteriorates progressively beyond two years because it deposits fibrocartilage, whilst OATS transplants intact cartilage that remains stable long-term.Microfracture improves early but deteriorates progressively beyond two years because it deposits fibrocartilage, whilst OATS transplants intact cartilage that remains stable long-term.
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Osteochondral Allograft for Ankle Cartilage DefectsLesions on the talus larger than 15mm fail with microfracture repair; osteochondral allograft instead restores the cartilage and bone using donor tissue, achieving 85% survivorship at ten years.Lesions on the talus larger than 15mm fail with microfracture repair; osteochondral allograft instead restores the cartilage and bone using donor tissue, achieving 85% survivorship at ten years.
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Allograft vs autograft for large knee cartilage defectsAutograft for knee cartilage defects larger than roughly 2–4 cm² risks replacing one area of cartilage loss with another at the harvest site. Osteochondral allografts from cadaveric donors eliminate this trade-off and achieve 5-year survival of 79–87.8%.Autograft for knee cartilage defects larger than roughly 2–4 cm² risks replacing one area of cartilage loss with another at the harvest site. Osteochondral allografts from cadaveric donors eliminate this trade-off and achieve 5-year survival of 79–87.8%.
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How ACI and MACI differ for cartilage repairMACI pre-seeds cultured chondrocytes onto a collagen membrane fixed with fibrin glue, eliminating the sutures required in earlier ACI variants. The technique enables arthroscopic implantation and supports faster recovery than open surgical approaches.MACI pre-seeds cultured chondrocytes onto a collagen membrane fixed with fibrin glue, eliminating the sutures required in earlier ACI variants. The technique enables arthroscopic implantation and supports faster recovery than open surgical approaches.
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Injectable scaffold vs surgical knee cartilage repairFor focal knee cartilage defects, injectable collagen scaffolds provide a non-surgical treatment by acting as an acellular matrix that guides the patient's own progenitor cells in regenerating cartilage-like tissue, overcoming cartilage's inability to repair itself due to lacking blood supply.For focal knee cartilage defects, injectable collagen scaffolds provide a non-surgical treatment by acting as an acellular matrix that guides the patient's own progenitor cells in regenerating cartilage-like tissue, overcoming cartilage's inability to repair itself due to lacking blood supply.
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When is it too late for cartilage repair?Once cartilage loss becomes generalised and surfaces contact bone, no restoration procedure works; repair is viable only for focal defects.Once cartilage loss becomes generalised and surfaces contact bone, no restoration procedure works; repair is viable only for focal defects.
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AMIC versus MACI for focal cartilage repairAMIC repairs focal cartilage defects in one operation: drilling channels into damaged cartilage releases a blood clot rich in stem cells, which a collagen membrane then stabilises and concentrates to guide tissue repair. A 2025 trial found it equivalent to MACI at two years.AMIC repairs focal cartilage defects in one operation: drilling channels into damaged cartilage releases a blood clot rich in stem cells, which a collagen membrane then stabilises and concentrates to guide tissue repair. A 2025 trial found it equivalent to MACI at two years.
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OATS for focal knee cartilage repair in active patientsSingle-stage transplantation of cartilage plugs from the patient's own knee achieves 8.4-year mean functional survival in younger active patients — nearly double microfracture repair — with 75–93% returning to pre-injury sport within six to nine months.Single-stage transplantation of cartilage plugs from the patient's own knee achieves 8.4-year mean functional survival in younger active patients — nearly double microfracture repair — with 75–93% returning to pre-injury sport within six to nine months.
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Chondroplasty for knee cartilage damageChondroplasty removes loose cartilage fragments that cause catching and grinding, relieving mechanical symptoms, but does not rebuild the cartilage itself; it is palliative, not restorative.Chondroplasty removes loose cartilage fragments that cause catching and grinding, relieving mechanical symptoms, but does not rebuild the cartilage itself; it is palliative, not restorative.
