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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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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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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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MACI recovery and return to sportMACI recovery takes twelve to eighteen months before high-impact sport. Most patients return to some sport, but only one-third reach their pre-injury level — a gap significantly driven by kinesiophobia, which clinical teams can screen and address through sports psychology support.MACI recovery takes twelve to eighteen months before high-impact sport. Most patients return to some sport, but only one-third reach their pre-injury level — a gap significantly driven by kinesiophobia, which clinical teams can screen and address through sports psychology support.
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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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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.
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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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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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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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Choosing ACI, MACI or single‑stage cell surgeryACI and MACI are two-stage repairs for localised full-thickness cartilage defects, while single-stage techniques place cells or cell-rich material into the defect in one operation. MACI has the strongest long-term follow-up, but single-stage methods still rest mainly on smaller, less comparable series.ACI and MACI are two-stage repairs for localised full-thickness cartilage defects, while single-stage techniques place cells or cell-rich material into the defect in one operation. MACI has the strongest long-term follow-up, but single-stage methods still rest mainly on smaller, less comparable series.
