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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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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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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.
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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.
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Do you need a knee or ankle cartilage specialistPersistent knee or ankle pain, swelling or loss of function despite simple self-care usually warrants orthopaedic assessment; a cartilage or joint-preservation specialist is most useful when MRI shows a focal defect in a relatively healthy joint, while diffuse wear-and-tear or advanced arthritis usually suits a general orthopaedic or sports surgeon.Persistent knee or ankle pain, swelling or loss of function despite simple self-care usually warrants orthopaedic assessment; a cartilage or joint-preservation specialist is most useful when MRI shows a focal defect in a relatively healthy joint, while diffuse wear-and-tear or advanced arthritis usually suits a general orthopaedic or sports surgeon.
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Choosing joint preserving surgery before knee replacementOne-compartment knee wear does not automatically mean replacement is next: bracing, osteotomy and focal cartilage repair can reduce pain and delay arthroplasty when alignment and damage remain localised. Microfracture is now usually limited to very small defects, while AMIC, MACI, OATS and OCA are chosen by lesion size, depth and…One-compartment knee wear does not automatically mean replacement is next: bracing, osteotomy and focal cartilage repair can reduce pain and delay arthroplasty when alignment and damage remain localised. Microfracture is now usually limited to very small defects, while AMIC, MACI, OATS and OCA are chosen by lesion size, depth and joint health.
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Choosing cartilage repair pathways for knee and ankleSmall focal cartilage defects in the knee and ankle are treated differently from diffuse arthritis: first with physiotherapy and symptom control, then with repair procedures such as microfracture for lesions under about 1.0 cm², scaffold augmentation for larger defects, and OATS or osteochondral allograft for bigger or cystic lesions.Small focal cartilage defects in the knee and ankle are treated differently from diffuse arthritis: first with physiotherapy and symptom control, then with repair procedures such as microfracture for lesions under about 1.0 cm², scaffold augmentation for larger defects, and OATS or osteochondral allograft for bigger or cystic lesions.
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High tibial osteotomy recovery and joint preservationHigh tibial osteotomy shifts load away from a damaged knee compartment and is best suited to younger, active patients with correctable medial osteoarthritis. Recovery takes months, full weight bearing depends on fixation and healing, and long-term success is strongest when arthritis remains localised.High tibial osteotomy shifts load away from a damaged knee compartment and is best suited to younger, active patients with correctable medial osteoarthritis. Recovery takes months, full weight bearing depends on fixation and healing, and long-term success is strongest when arthritis remains localised.
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Can chondroplasty or an unloader brace helpChondroplasty trims and smooths damaged knee cartilage to ease catching and irritation, but it does not regrow cartilage; outcomes are best in isolated grade 2 to 3 lesions, not grade 4 disease. An unloader brace can reduce one-compartment load and pain when varus or valgus malalignment is driving symptoms, but…Chondroplasty trims and smooths damaged knee cartilage to ease catching and irritation, but it does not regrow cartilage; outcomes are best in isolated grade 2 to 3 lesions, not grade 4 disease. An unloader brace can reduce one-compartment load and pain when varus or valgus malalignment is driving symptoms, but it cannot correct alignment.
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Which knee cartilage repair fits your situationKnee cartilage repair choice is driven by defect size, bone involvement and whether treatment is single-stage or staged. OATS or mosaicplasty uses the patient's own osteochondral plugs for small focal defects of roughly 1 to 4 cm², while OCA uses donor tissue when the defect is larger, post-traumatic or involves…Knee cartilage repair choice is driven by defect size, bone involvement and whether treatment is single-stage or staged. OATS or mosaicplasty uses the patient's own osteochondral plugs for small focal defects of roughly 1 to 4 cm², while OCA uses donor tissue when the defect is larger, post-traumatic or involves significant bone loss. AMIC is a single-stage marrow stimulation with a collagen membrane; MACI takes two stages but has 15- to 17-year follow-up data, while head-to-head AMIC-vs-MACI ev...
