Mosaicplasty Using Grafts From the Upper Tibiofibular Joint

Mosaicplasty Using Grafts From the Upper Tibiofibular Joint

João Espregueira-Mendes, Renato Andrade, Alberto Monteiro, Hélder Pereira, Manuel Vieira da Silva, J. Miguel Oliveira, Rui L. Reis


Autologous mosaicplasty has been widely used for the treatment of focal, full-thickness, articular cartilage lesions of the knee and ankle joints. Commonly, the autografts are harvested from non–weight-bearing areas of the knee joint, leading to associated donor-site morbidity and representing a considerable disadvantage. This technical note presents a mosaicplasty procedure for harvesting autologous osteochondral plugs from the upper tibiofibular joint to repair articular cartilage defects. With this technique, it is possible to achieve low or no risk of donor-site morbidity, being therefore a safe and favorable option to treat large cartilage defects. Because of its minimal size-related restrictions, it enables harvesting larger plugs (filling an area up to 5 cm2) without any additional iatrogenic complications. Hence, mosaicplasty using the upper tibiofibular joint autografts can overcome many of the reported complications associated with osteochondral autograft harvesting. Thus, the upper tibiofibular joint articular surface should be considered as a safe and reliable autograft source for harvesting osteochondral plugs.

Treating osteochondral cartilage defects still remains a challenge within the daily orthopaedic practice. Autologous osteochondral mosaicplasty is a one-step surgical technique that involves transplanting hyaline articular cartilage and subchondral bone from the minimal weight-bearing areas of the knee. This technique aims to restore focal, full-thickness articular cartilage defects and thus achieve a congruous hyaline surface.1 Scientific literature reports good long-term results in 72% of patients, with an overall failure rate of 28% and a reoperation rate of 19%.2

Mosaicplasty is known to yield several advantages. It is a one-step procedure, it can be applied to larger defects, providing both hyaline cartilage and subchondral bone, and has the capability to adapt according the defect geometry.1, 3 Moreover, it provides a durable cartilage repair, it is less expensive than autologous chondrocyte implantation/matrix-induced autologous chondrocyte implantation, and provides immediate restoration of cartilage surface by treating the entire osteochondral unit.4 Nevertheless, osteochondral graft harvesting is usually associated with donor site morbidity.5 To overcome this concern, a limited number of studies used autologous osteochondral grafts from the upper tibiofibular joint for the treatment of knee articular cartilage lesions.3, 6, 7, 8Therefore, this technical report aims to comprehensively describe the mosaicplasty technique using autologous osteochondral grafts from the upper tibiofibular joint.