Harvest site
Option 1
- lateral and medial aspect femoral trochlea
Option 2
- intercondylar notch
Option 3
- allograft
- can take larger grafts without donor site risk
Size
Many options
- 4.5 mm most common
- want to minimise donor site pathology
Technique Mosaicplasty Type 3 OCD
Harvest
- insert 4.5 mm chisel
- hammer to appropriate depth / 20 mm
- twist handle to remove
Debride base of OCD and reduce
Drill site of mosaicplasty with 4.5 mm drill
- overdrill 2 - 4 mm
- do not want to leave plug proud
- impossible to sink further or remove
Insert dilator
Insertion device
- place over drill hole
- impact with hammer to seat in cartilage
- insert plug
- use tap to insert plug
- best to countersink 1 - 2 mm
Repeat
Post op
Often most stable in extension
- splint in extension 2 weeks
- gentle increased ROM in brace over next 4 weeks
- strict NWB 6/52
Allow weight bearing at 6/52
- no sports for 6/12
- MRI cartilage sequences at 3 and 6 months to assess cartilage healing
