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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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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.
