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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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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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Who qualifies for MACI knee surgery?Patients aged 18–55 with deep focal cartilage damage (Grade III-IV, >2 cm²) qualify for MACI if their knees are structurally sound—stable ligaments, correct alignment, no generalised osteoarthritis—and conservative treatment has failed. The procedure is two-stage, with extended rehabilitation required.Patients aged 18–55 with deep focal cartilage damage (Grade III-IV, >2 cm²) qualify for MACI if their knees are structurally sound—stable ligaments, correct alignment, no generalised osteoarthritis—and conservative treatment has failed. The procedure is two-stage, with extended rehabilitation required.
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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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Osteochondral Allograft for Post-Traumatic Knee DefectsOsteochondral allograft restores both the cartilage surface and the bone beneath in a single operation for post-traumatic knee injuries — a combination other procedures cannot deliver.Osteochondral allograft restores both the cartilage surface and the bone beneath in a single operation for post-traumatic knee injuries — a combination other procedures cannot deliver.
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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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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.
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OATS versus mosaicplasty for knee cartilage repairOATS and mosaicplasty are the same surgical technique applied at different scales: OATS transfers a single cartilage plug for knee defects under 2 cm², mosaicplasty tiles smaller grafts across 2–4 cm² lesions.OATS and mosaicplasty are the same surgical technique applied at different scales: OATS transfers a single cartilage plug for knee defects under 2 cm², mosaicplasty tiles smaller grafts across 2–4 cm² lesions.
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AMIC vs microfracture for knee cartilage repairBoth AMIC and microfracture improve pain and function in the first two years; beyond that point, microfracture outcomes progressively deteriorate whilst AMIC maintains stable gains through a decade of follow-up.Both AMIC and microfracture improve pain and function in the first two years; beyond that point, microfracture outcomes progressively deteriorate whilst AMIC maintains stable gains through a decade of follow-up.
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ACI vs MACI for knee cartilage repairMACI seeds harvested chondrocytes onto a collagen membrane secured with fibrin glue; first-generation ACI injects them as a liquid suspension under a sutured periosteal patch. This engineering difference has driven MACI's adoption: complication rates of approximately 10% versus 29%, with superior pain reduction and activity levels.MACI seeds harvested chondrocytes onto a collagen membrane secured with fibrin glue; first-generation ACI injects them as a liquid suspension under a sutured periosteal patch. This engineering difference has driven MACI's adoption: complication rates of approximately 10% versus 29%, with superior pain reduction and activity levels.
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Allograft or Autograft for Large Knee Cartilage DefectsDefect size is the primary determinant in knee cartilage repair: below 4 cm², autograft transfer from low-load zones is standard; above that threshold, cadaveric allograft removes the biological supply ceiling.Defect size is the primary determinant in knee cartilage repair: below 4 cm², autograft transfer from low-load zones is standard; above that threshold, cadaveric allograft removes the biological supply ceiling.
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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.
