Synthetic Scaffold Mosaicplasty
Synthetic Scaffold (Plug) mosaicplasty is a good option for patients seeking treatment for a symptomatic articular cartilage lesion. Dr. Williams has been performing this type of surgery since 2006.
In this procedure, a man-made synthetic scaffold is inserted into an articular cartilage defect as a way to facilitate the creation of new cartilage repair tissue. These scaffold are made of materials that are typically found in both articular cartilage and bone. Calcium sulfate, poly-D,L-lactide-co-glycolide, and surfactant are some of the many compounds that make up these implants. These plugs are bone void fillers that eventually dissolve, leaving the patient’s own tissue in its place. These scaffolds have both a bony and cartilage component (biphasic), and are mechanically strong. And unlike other procedures like microfracture of the OATS procedure, the strong mechanical properties of these plugs allows for early weight bearing and a speedy rehabilitation process following these scaffold-based procedures.
During a synthetic scaffold mosaicplasty, multiple implants are used to fill a cartilage defect. These “off-the-shelf” plugs are usually soaked in the patient’s own concentrated bone marrow blood (taken at the time of surgery). Bone marrow blood contains a high concentration of stem cells; these cells are the basis for healing injured tissue all over the body. Soaking the scaffolds in the patient’s marrow blood facilitates the delivery of these stem cells in the area of cartilage repair. This hastens the cartilage repair process. Small drill holes are made in the bone where the cartilage defect exists. The soaked plugs are then inserted into these holes to fill the defect. The plugs are close-packed to lend stability to the overall repair. The plugs are then contoured to match the surrounding normal articular cartilage, making the repaired area smooth.
Synthetic Scaffold Mosaicplasty Procedure
Synthetic scaffold mosaicplasty is a minimally invasive procedure. Small incisions are made to access the joint for surgery. The arthroscope allows the surgeon to visually examine the joint and guide the instruments to the precise area for treatment. The mosaicplasty procedure is performed under regional (epidural or spinal) anesthesia. Typical surgical time is about 30-45 minutes, and is done on an outpatient basis. Patients are discharged home with crutches and a small knee brace.
After surgery, patients remain on crutches for about 7 days, and are then cleared to begin full weight bearing. Physical therapy typically starts about 10 days following surgery, and lasts for about 2-3 months. Therapy can be done near the patient’s home or work. Dr. Williams recommends at least 2 formal PT visits per week, and home exercises for a successful return to function. Dr. Williams has performed well over 400 of these types of procedures. He has observed a 90%+ good clinical results for all patients treated (HSS Cartilage Registry Data 2012).