Repair of Osteochondral Lesions - Engineered Bone: Tissue Engineering Intelligence Unit - page 167

Figure 1. Current cartilage repair techniques for the treatment of a confined cartilage defect include per-
foration of the subchondral bone (A, microfracturing), injection of autologous chondrocytes under a
periosteal flap (B, autologous chondrocyte implantation) or transfer of osteochondral cylinders from a
minor weight bearing area of the joint (C, mosaicplasty). Extensive, unconfined joint defects may be treated
by transfer of fresh osteochondral allografts (D).
properties, and in most instances the durability of articular cartilage. 13 Thus, despite evidence
that microfracturing stimulates the formation of fibrocartilaginous repair tissue, the clinical
value of this approach remains uncertain and the indications for its use are not objectively
identified.
Autografts and Allografts
Autologous Periosteal Transfer
The technique consists in harvesting autologous periosteal tissue from the medial proxi-
mal tibia and suturing it into the defect, thereby introducing a new cell population along with
an organic matrix (Fig. 1B). 14 Animal experiments and clinical experience have shown that
periosteal grafts placed in articular cartilage defects can produce new cartilaginous tissue.
However, increasing patient age adversely affected the results 13 and some groups reported not
totally satisfactory outcomes. 15 The lack of consensus on the optimal orientation of the peri-
osteum (e.g., with the cambium layer facing the bone 14 or the joint 16 ) is an indication of
uncertain clinical performance.
Autologous Osteochondral Transfer
The technique, also called mosaicplasty, consists in harvesting osteochondral cylinders from
a joint area of minor load and press-fitting them into predrilled holes at the defect site 17 (Fig.
1C). Based on clinical improvement and, in some cases, graft integration, it was concluded that
small symptomatic osteochondral or cystic lesions are appropriate indications for this