Arthroscopy, knee, surgical; osteochondral autograft(s) (eg, mosaicplasty) (includes harvesting of the autograft[s])
CPT4 code
Name of the Procedure:
Arthroscopy, knee, surgical; osteochondral autograft(s) (eg, mosaicplasty)
Common Name(s): Knee Arthroscopy with Osteochondral Autograft, Knee Mosaicplasty
Summary
Knee arthroscopy with osteochondral autograft, also known as knee mosaicplasty, is a minimally invasive surgical procedure to repair damaged cartilage in the knee. It involves using a small camera (arthroscope) to visualize the knee joint and transplanting bone-cartilage plugs from non-weight-bearing areas of the patient's knee to the damaged area.
Purpose
This procedure addresses cartilage defects in the knee, often caused by injury or osteoarthritis. The goal is to relieve pain, restore joint function, and improve the patient's mobility by promoting cartilage repair and regeneration.
Indications
- Persistent knee pain and swelling
- Cartilage damage confirmed by MRI or other imaging
- Failure of conservative treatments like physical therapy and medication
- Patients with localized cartilage lesions
Preparation
- Fasting for at least 8 hours prior to surgery
- Adjusting or stopping certain medications as advised by the surgeon
- Preoperative imaging studies (MRI, X-rays)
- Physical examination and medical history review
Procedure Description
- Administer Anesthesia: General or regional anesthesia is given.
- Arthroscope Insertion: A small camera is inserted through a tiny incision to visualize the joint.
- Cartilage Assessment: The surgeon assesses the damaged cartilage area.
- Harvesting Autograft: Healthy bone-cartilage plugs are harvested from non-weight-bearing areas of the knee.
- Implantation: These plugs are transplanted into the damaged cartilage site, forming a mosaic pattern to cover the defect.
- Closure: The incisions are closed with sutures or staples.
Tools/Equipment: Arthroscope, cannulas, shavers, bone-cartilage harvesting tools.
Duration
The procedure typically takes between 1 to 2 hours.
Setting
The procedure is usually performed in a hospital or outpatient surgical center.
Personnel
- Orthopedic Surgeon
- Anesthesiologist
- Surgical Nurses
- Surgical Technicians
Risks and Complications
- Infection
- Bleeding
- Blood clots
- Damage to surrounding tissues
- Incomplete cartilage healing
- Pain and stiffness in the knee
Benefits
- Reduced knee pain
- Improved joint function and mobility
- Faster recovery compared to open surgery
- Long-term durability of the cartilage repair
Recovery
- Initial rest and limited weight-bearing with crutches
- Physical therapy to regain motion and strength
- Avoid high-impact activities for several months
- Follow-up appointments with the surgeon to monitor progress
- Complete recovery in 4 to 6 months
Alternatives
- Microfracture surgery
- Osteochondral allograft transplantation
- Autologous chondrocyte implantation
- Total or partial knee replacement
Pros and Cons: Each alternative has its own benefits and risks which should be discussed with a healthcare provider. For example, microfracture is less invasive but may not be as durable, while knee replacement is more invasive but may offer a permanent solution.
Patient Experience
During the procedure, the patient will be under anesthesia, so they will not feel pain. Post-surgery, the patient may experience mild to moderate pain and discomfort, which is managed with medications. Swelling and stiffness are common but will gradually improve with physical therapy and rehabilitation.