Mosaicplasty of the Knee: Surgical Techniques, Pearls and Pitfall

Background: Focal articular cartilage lesions are common, evident in nearly one-fifth of routine arthroscopic examinations. In some cases, surgical intervention may be needed, if rehabilitation has failed to establish proper function. However, choosing the best surgical treatment of articular cartilage defects continues to pose a problem for orthopaedic surgeons, as the long-term results of traditional methods have largely been disappointing. Methods: Several new options for treating cartilage defects have evolved over the last 20–30 years, including auto-implantation of small-diameter autogenous cylindrical osteochondral grafts, e.g., mosaicplasty, popularised by professor Hangody in the early 1990s. This review of the surgical technique of mosaicplasty is based on our own experience with the technique for the last 20 years. Technique: The goal of mosaicplasty is to harvest small-diameter cartilage and bone cylinders from low-weight areas to repair articular cartilage defects in the same knee by auto-transplanting the grafts into burr holes and secure them in place by press-fit. In this paper, we aim to walk through the mosaicplasty technique, accompanied with our own surgical images, and share some pearls of wisdom and potential pitfalls. Conclusion: Mosaicplasty is a valid option for treating small- and medium-sized articular cartilage defects of the knee. The present presentation aims to be of help to surgeons not too familiar with the technique.