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EDUCATION CENTER: Therapies

Mosaicplasty

Overview
The knee is a complex joint that works like a well-oiled hinge because of cartilage, which creates a nearly friction-free surface on which the bones slide. However, a severe knee injury or a degenerative condition such as osteoarthritis can weaken, tear, or soften knee cartilage. A relatively new procedure, known as Mosaicplasty, replaces the weak or torn cartilage with healthy cartilage from the femur. Developed by Dr. Laszlo Hangody, M.D., Ph.D., in 1991, Mosaicplasty has a high success rate among people under 30. Doctors use Mosaicplasty most commonly to treat Osteochondritis Dissecans (OCD), a condition in which cartilage and bone partially or completely tear away from where they belong. The condition creates loose bodies, which must be removed from the knee area. Additionally, since cartilage is diminished as a result of OCD, friction increases in the knee joint, which creates a great amount of pain. During the procedure, healthy cartilage from the femur is inserted as cylinders around the knee, appearing like a mosaic upon completion (hence the name). By moving cartilage from non weight-bearing to weight-bearing areas, Mosaicplasty can restore the shock-absorption and fluidity of the knee joint.

Read Dr. Hangody's Knee Care Hero interview here.

Detailed Description
Specialist
Orthopedic surgeon

Procedure
Before the procedure:
1) The doctor will order diagnostic x-rays, and possibly blood or urine tests to check for possible abnormalities.
2) The doctor will discuss the surgery, including different procedure possibilities, with the patient and gain consent.

During the procedure:
The patient is anesthetized and the doctor performs arthroscopy to assess the condition of the knee and to remove any loose bodies. Cartilage is then taken from non weight-bearing areas of the femur. The cylindrical plugs or “grafts,” each about 4.5 millimeters wide and 15 to 20 millimeters deep, are then implanted arthroscopically in the prepared area of the leg to form a new layer of cartilage, comprised of the intact original cartilage and the transplanted grafts.

Recovery
Hospitalization: outpatient to one night
Post-operative therapy: Several months

  • Expect to be off your feet completely for at least two weeks after surgery, and connected to a CPM (Continuous Passive Motion) machine.
  • While resting in bed, reduce the swelling by elevating your leg and moving frequently by pumping your ankles.
  • Be patient: you will need at least eight to 10 weeks to resume normal activity; it will be months until you can resume playing sports.
  • Use crutches to walk until your doctor says otherwise.
  • Wear comfortable shoes.
  • Stay within your safe range of motion as directed by your doctor.
  • Bathe and shower as usual three days after surgery. (unless your surgeon directs otherwise)
  • Ice the knee.
  • Avoid active sports. Restrictions may last up to 9 to 12 months after surgery.

Complications/Risks
The procedure carries with it a few risks. Among them:

  • Blood clots (very rare)
  • Surgical wound infection
  • Postoperative hematomas (rare)
  • Risk of developing arthritis
  • Weakening of muscles
  • Lack of full range of motion

Medications
Prescription and non-prescription pain relievers.

Follow up with your doctor if:
Pain, swelling, redness, drainage or bleeding increases in the knee. Also if you experience any symptoms suggestive of infection such as general malaise (tiredness) or fever.

Last updated: 26-Oct-01


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