Functional Outcomes of Nuts-in-Jelly Mosaicplasty

Abstract

Introduction: Interspace defects after osteochondral autograft transfer (OATS) are filled only with fibrocartilage. Attempts have been made to address these issues in OATS with procedures like mega OATS and Hexagonal Osteochondral Graft System. We have described the functional outcomes of a hybrid technique combining a regeneration and a restoration modality to address the interspace defect in OATS.

Methods: Consecutive cases of full-thickness focal chondral defects of the knee were treated using the nuts-in-jelly mosaicplasty technique. Patients with less than 1 cm lesions, ligament insufficiency, and alignment abnormalities were excluded. Bone marrow aspirate concentrate (BMAC) with fibrin glue has been used to fill the defect remaining after the osteochondral cylinders are transferred, resulting in a configuration like nuts dispersed in a jelly.

Results: We had a total of 12 cases-4 cases of osteochondritis dessicans (OCD) and 8 cases of traumatic chondral defects. The mean age of the patients was 32 years (range 19 - 44 years). 4 were female patients. The available cartilage was fixed in all the OCD cases. The remaining defect was filled with one or two osteochondral cylinders and the BMAC-fibrin glue or only with BMAC-fibrin glue. In traumatic defect cases, the space remaining after the OATS cylinder transfer was filled with BMAC-fibrin glue. The mean follow-up period was 3 years (range 2 - 5 years). All cases had good to excellent Tegner-Lysholm scores with a mean score of 92 (range 85 - 96).

Conclusion: Nuts in jelly mosaicplasty may address the issue of fibrous cartilage formation after OATS in the interspace. Further prospective comparative studies are necessary to validate the findings of this study.

Keywords: BMAC; Cartilage; Interspace management; Mosaicplasty; Nuts-in-jelly technique.