Mosaicplasty

Harvest site

 

Option 1

- lateral and medial aspect femoral trochlea

 

Option 2

- intercondylar notch

 

Mosaicplasty Harvest Site

 

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

 

Mosaicplasty equipment

 

Lateral Femoral OCDLateral Femoral OCD Superior Displacement

 

Harvest

- insert 4.5 mm chisel

- hammer to appropriate depth / 20 mm

- twist handle to remove

 

Mosaicplasty Harvest ChiselMosaic Harvest Site 2Mosaicplasty Harvest Site 2

 

Mosaicplasty PlugsMosaicplasty Plugs 2

 

Mosaicplasty Harvest Site MRI

 

Debride base of OCD and reduce

 

Femoral OCD Base DebridementFemoral OCD ReductionFemoral OCD Reduction 2

 

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

 

Mosaicplasty 4.5 mm drilMosaicplasty 4.5 mm drill 2

 

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

 

Mosaicplasty Plug ImpactionMosaicplasty Cartilage Cap ProudMosaicplasty Impaction

 

Mosaicplasty Plug in situ

 

Repeat

 

Mosaciplasty second plugMosaicplasty Plugs in OCD

 

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

 

Knee OCD Mosaicplasty PreKnee OCD Mosaicplasty 9 months post

 

Mosaicplasty Healed OCD LateralMosaicplasty Healed MRI AP