27416 Osteochondral autograft(s), knee, open (eg, mosaicplasty) (includes harvesting of autograft[s])

Name of the Procedure:

Osteochondral autograft(s), knee, open (e.g., mosaicplasty)

Summary

Osteochondral autograft transplantation, commonly known as mosaicplasty, is a surgical procedure used to repair damaged cartilage in the knee by transplanting healthy cartilage from a non-weight-bearing area of the patient’s own knee.

Purpose

This procedure addresses cartilage damage or defects in the knee, which can cause pain, swelling, and limited movement. The goal is to restore the normal function of the knee, reduce pain, and improve mobility by replacing damaged cartilage with healthy cartilage.

Indications

• Chronic knee pain due to cartilage defects
• Persistent swelling and limited knee movement
• Cartilage damage from trauma or degenerative conditions
• Patients who have not responded to conservative treatments like physical therapy or medications

Preparation

• Fasting for at least 8 hours before the procedure
• Discontinuing certain medications as advised by the surgeon
• Undergoing pre-operative imaging studies like MRI or X-Rays to assess the cartilage damage
• Blood tests and medical clearance may be required to ensure the patient is fit for surgery

Procedure Description

1. The patient is positioned and administered general or regional anesthesia.
2. The surgeon makes an incision over the knee to access the damaged cartilage.
3. Healthy cartilage tissue is harvested from a non-weight-bearing area of the knee using specialized tools.
4. The donor cartilage is transplanted into the prepared defect area, fitting like a mosaic, to ensure smooth surface and stability.
5. The incision is closed with sutures or staples, and a sterile dressing is applied.

Duration

The procedure typically takes about 1 to 2 hours, depending on the extent of the cartilage damage.

Setting

Osteochondral autograft transplantation is performed in a hospital operating room or a surgical center.

Personnel

• Orthopedic surgeon
• Surgical nurses
• Anesthesiologist

Risks and Complications

• Infection at the surgical site
• Blood clots
• Bleeding
• Swelling and stiffness
• Donor site pain or problems
• Failure of the graft to properly integrate or heal

Benefits

• Restoration of knee function
• Reduction in pain and swelling
• Improved mobility and quality of life
• Long-term durability of the repair

Recovery

• Use of crutches or a knee brace post-surgery to protect the knee
• Physical therapy starting a few days after the procedure to restore strength and flexibility
• Avoidance of high-impact activities for several months
• Full recovery may take 4 to 6 months, with regular follow-up appointments

Alternatives

• Arthroscopic microfracture surgery
• Autologous chondrocyte implantation (ACI)
• Osteochondral allograft transplantation
• Conservative management with physical therapy and medications

Each alternative has its pros and cons, which should be discussed with the healthcare provider.

Patient Experience

During the procedure, the patient will be under anesthesia and not feel any discomfort. Post-operatively, there may be pain and swelling, which can be managed with pain medications and ice packs. Physical therapy and limited weight-bearing are crucial for a successful recovery. The patient may feel some discomfort during rehabilitation, but this usually improves over time.