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High tibial osteotomy as a first step in knee preservationHigh tibial osteotomy repositions the tibia to shift weight-bearing from damaged inner knee cartilage to the healthier outer compartment. For younger, active patients, the procedure preserves the natural joint and potentially extends its working life by a decade or more.High tibial osteotomy repositions the tibia to shift weight-bearing from damaged inner knee cartilage to the healthier outer compartment. For younger, active patients, the procedure preserves the natural joint and potentially extends its working life by a decade or more.
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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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How single-stage ACI differs from MACIMACI repairs cartilage defects over two operations, with weeks between them for external cell expansion; STACi compresses the entire process—harvesting, processing, and implantation—into a single surgical session.MACI repairs cartilage defects over two operations, with weeks between them for external cell expansion; STACi compresses the entire process—harvesting, processing, and implantation—into a single surgical session.
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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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OCA or MACI for large knee cartilage defectsWhen subchondral bone is damaged alongside large knee cartilage defects, OCA — a single-stage transplant of donor bone and cartilage — is the preferred choice; MACI, which implants cultured cells, cannot restore bone stock once lost.When subchondral bone is damaged alongside large knee cartilage defects, OCA — a single-stage transplant of donor bone and cartilage — is the preferred choice; MACI, which implants cultured cells, cannot restore bone stock once lost.
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MACI versus microfracture for knee cartilage repairMACI outperforms microfracture for knee cartilage defects of 3 cm² or larger, according to the SUMMIT randomised trial, which found significantly greater improvements in pain and function at two years that persisted through five years.MACI outperforms microfracture for knee cartilage defects of 3 cm² or larger, according to the SUMMIT randomised trial, which found significantly greater improvements in pain and function at two years that persisted through five years.
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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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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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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.
