László Hangody M.D., Ph.D., D.Sc.

Long lasting resurfacement of full thickness cartilage defects of the weight bearing surfaces represents a great challenge for the orthopaedic surgeon. Autologous osteochondral transplantation is one of the alternatives, which tries to promote a hyaline or hyaline like coverage of the defected area. Mosaicplasty as a new technique of osteochondral autograft transfer has been developed in 1991 in Hungary to lessen donor site morbidity of graft harvest, and eliminate congruency and technical problems of osteochondral resurfacement. This paper describes experimental background and 8 years experiences with the clinical application of the autologous osteochondral mosaicplasty. During this period indications of this technique has been extended from the knee to the ankle, hip and certain problems of the upper extremity as well. Repeated animal trials and clinical practice have confirmed consistent survival of transplanted hyaline cartilage and fibrocartilage covering of donor sites located on the non and less weight bearing surfaces of the knee joint. Interfaces between transplanted hyaline cartilage and host tissue have been studied by histological evaluation of biopsy materials harvested during second looks and found deep matrix integration in most of the investigated samples. Mosaicplasty can be performed arthroscopically or as an open procedure. Arthroscopic mosaicplasty is a technique, which can be performed in a one day surgery system. This organization of the surgery requires a very demanding and well organized rehabilitation protocol. In the recent eight years clinical scores, imaging techniques, control arthroscopies, histological evaluations of biopsy materials and cartilage stiffness measurements have been performed to check the clinical outcome and to control the quality of the resurfaced area. Data of these evaluations are introduced in this paper. According to several forms of these evaluations it seems that autologous osteochondral mosaicplasty seems to be as a possible alternative in the treatment of small and medium sized focal chondral and osteochondral defects of the weight bearing surfaces.