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Knee Cartilage Repair and PreservationArticular cartilage lacks blood vessels, so when damaged it forms fibrocartilage—a mechanically inferior scar tissue that typically deteriorates within two to three years. This biological constraint shapes every treatment option, from temporary symptom relief to procedures attempting true cartilage regeneration.Articular cartilage lacks blood vessels, so when damaged it forms fibrocartilage—a mechanically inferior scar tissue that typically deteriorates within two to three years. This biological constraint shapes every treatment option, from temporary symptom relief to procedures attempting true cartilage regeneration.
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When Shoulder Pain Points to a Rotator Cuff TearRotator cuff tears on imaging in asymptomatic adults are not diagnoses; tear size predicts symptoms poorly, so clinical management turns on functional loss and pain, not scan findings.Rotator cuff tears on imaging in asymptomatic adults are not diagnoses; tear size predicts symptoms poorly, so clinical management turns on functional loss and pain, not scan findings.
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When cartilage repair is the right choiceCartilage repair is suited to younger, active patients with isolated damage in otherwise healthy joints where conservative care has not worked. It is mechanistically impossible when underlying bone is worn smooth, degeneration spans multiple compartments, or malalignment and instability persist uncorrected.Cartilage repair is suited to younger, active patients with isolated damage in otherwise healthy joints where conservative care has not worked. It is mechanistically impossible when underlying bone is worn smooth, degeneration spans multiple compartments, or malalignment and instability persist uncorrected.
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When physiotherapy isn't enough for hip osteoarthritisHip osteoarthritis referral requires simultaneous criteria: Oxford Hip Score below 20, X-ray confirmation of moderate or severe OA, BMI optimisation, and inadequate response to conservative management—not automatic progression based on symptoms or time alone.Hip osteoarthritis referral requires simultaneous criteria: Oxford Hip Score below 20, X-ray confirmation of moderate or severe OA, BMI optimisation, and inadequate response to conservative management—not automatic progression based on symptoms or time alone.
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Knee cartilage repair versus stem cell therapyEstablished cartilage repair using autologous chondrocytes shows 10–17 year durability for focal knee defects; mesenchymal stem cell therapies have not been tested in large-scale trials against them.Established cartilage repair using autologous chondrocytes shows 10–17 year durability for focal knee defects; mesenchymal stem cell therapies have not been tested in large-scale trials against them.
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Ten-Year Success Rates for OATS MosaicplastyTen-year success rates for OATS mosaicplasty span 72–89% in young, active patients; failure rates drop to 12.5–14% in optimal candidates (under 40, lesion under 3 cm²) but rise to 38–40% in older patients with larger defects.Ten-year success rates for OATS mosaicplasty span 72–89% in young, active patients; failure rates drop to 12.5–14% in optimal candidates (under 40, lesion under 3 cm²) but rise to 38–40% in older patients with larger defects.
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Cartilage specialist or general orthopaedic surgeon for a knee defectKnee cartilage repair without correcting underlying malalignment results in reoperation in 47.4% of cases, versus 17.3% when alignment is corrected simultaneously — a surgical integration that general orthopaedic surgeons often omit from initial assessment and planning.Knee cartilage repair without correcting underlying malalignment results in reoperation in 47.4% of cases, versus 17.3% when alignment is corrected simultaneously — a surgical integration that general orthopaedic surgeons often omit from initial assessment and planning.
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Choosing between ACI and MACI for cartilage repairMACI cartilage grafts show 90% fill at two years but decline to 49% by ten years; 73% become fibrocartilage rather than the hyaline cartilage needed for durability.MACI cartilage grafts show 90% fill at two years but decline to 49% by ten years; 73% become fibrocartilage rather than the hyaline cartilage needed for durability.
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OATS versus osteochondral allograft for large knee defectsDefect size determines which procedure: OATS, harvesting cartilage plugs from the patient's own knee, suits lesions up to 4 cm²; osteochondral allograft, using donor tissue, handles larger defects without an equivalent size limit.Defect size determines which procedure: OATS, harvesting cartilage plugs from the patient's own knee, suits lesions up to 4 cm²; osteochondral allograft, using donor tissue, handles larger defects without an equivalent size limit.
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OATS or MACI for mid-size knee cartilage defectsWithin the 2–4 cm² range, cartilage defects are large enough that a single plug fails to cover them, yet small enough that two repair techniques remain viable: osteochondral autograft restores cartilage and bone in one operation but creates coverage gaps, whilst matrix-induced autologous chondrocyte implantation requires two operations with laboratory…Within the 2–4 cm² range, cartilage defects are large enough that a single plug fails to cover them, yet small enough that two repair techniques remain viable: osteochondral autograft restores cartilage and bone in one operation but creates coverage gaps, whilst matrix-induced autologous chondrocyte implantation requires two operations with laboratory culture but accommodates irregular shapes without gaps.
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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.
