Osteochondral Autograft Transfer

  • Yen Hsun Chen
  • Yonah Heller
  • James Mullen
  • Nicholas A. Sgaglione


Osteochondral autograft transfer (OAT) is indicated for treatment of symptomatic osteochondral defects in the size range of 1–4 cm2. OAT consists of transferring osteochondral autografts from areas with intact articular cartilage subject to less mechanical loads to more mechanically loaded areas with focal, symptomatic osteochondral defects. A major advantage of this technique is the reconstitution of the native osteochondral architecture comprised of a hyaline cartilage surface with underlying subchondral bone. Limitations include donor site morbidity that limits treatment of larger-sized defects. Successful clinical outcomes have been reported with significant improvements in pain and function scores. In this chapter, the current state of the art of the OAT technique will be reviewed.


Osteochondral autograft transfer OAT Mosaicplasty Osteochondral defect Articular cartilage Hyaline cartilage Cartilage repair Osteochondral autograft plug 



Autologous chondrocyte implantation


Continuous passive motion


3D delayed gadolinium-enhanced MRI of cartilage


Fast spin-echo


Gradient refocused acquisition in the steady-state and iterative decomposition of water and fat with echo asymmetry and least-squares estimation


Hospital for Special Surgery


International Cartilage Repair Society


International Knee Documentation Committee


Knee Injury and Osteoarthritis Outcome Score


Magnetic resonance observation of cartilage repair tissue


Magnetic resonance imaging


Osteochondral autograft transfer


Osteochondritis dissecans


Isotropic three-dimensional steady-state free procession


Venous thromboembolism


  1. 1.
    Mithoefer K, McAdams T, Williams RJ, Kreuz PC, Mandelbaum BR. Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: an evidence-based systematic analysis. Am J Sports Med. 2009;37(10):2053–63.CrossRefPubMedGoogle Scholar
  2. 2.
    Campanacci M, Cervellati C, Donati U. Autogenous patella as replacement for a resected femoral or tibial condyle. A report on 19 cases. J Bone Joint Surg Br. 1985;67(4):557–63.CrossRefPubMedGoogle Scholar
  3. 3.
    Yamashita F, Sakakida K, Suzu F, Takai S. The transplantation of an autogenic osteochondral fragment for osteochondritis dissecans of the knee. Clin Orthop Relat Res. 1985;201:43–50.Google Scholar
  4. 4.
    Outerbridge HK, Outerbridge RE, Smith DE. Osteochondral defects in the knee. A treatment using lateral patella autografts. Clin Orthop Relat Res. 2000;377:145–51.CrossRefGoogle Scholar
  5. 5.
    Agneskirchner JD, Brucker P, Burkart A, Imhoff AB. Large osteochondral defects of the femoral condyle: press-fit transplantation of the posterior femoral condyle (MEGA-OATS). Knee Surg Sports Traumatol Arthrosc. 2002;10(3):160–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Richter DL, Schenck RC Jr, Wascher DC, Treme G. Knee articular cartilage repair and restoration techniques: a review of the literature. Sports Health. 2016;8(2):153–60.CrossRefPubMedGoogle Scholar
  7. 7.
    Guettler JH, Demetropoulos CK, Yang KH, Jurist KA. Osteochondral defects in the human knee: influence of defect size on cartilage rim stress and load redistribution to surrounding cartilage. Am J Sports Med. 2004;32(6):1451–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Bartz RL, Kamaric E, Noble PC, Lintner D, Bocell J. Topographic matching of selected donor and recipient sites for osteochondral autografting of the articular surface of the femoral condyles. Am J Sports Med. 2001;29(2):207–12.CrossRefPubMedGoogle Scholar
  9. 9.
    Ahmad CS, Cohen ZA, Levine WN, Ateshian GA, Mow VC. Biomechanical and topographic considerations for autologous osteochondral grafting in the knee. Am J Sports Med. 2001;29(2):201–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Nishizawa Y, Matsumoto T, Araki D, Nagamune K, Matsushita T, Kurosaka M, et al. Matching articular surfaces of selected donor and recipient sites for cylindrical osteochondral grafts of the femur: quantitative evaluation using a 3-dimensional laser scanner. Am J Sports Med. 2014;42(3):658–64.CrossRefPubMedGoogle Scholar
  11. 11.
    Thaunat M, Couchon S, Lunn J, Charrois O, Fallet L, Beaufils P. Cartilage thickness matching of selected donor and recipient sites for osteochondral autografting of the medial femoral condyle. Knee Surg Sports Traumatol Arthrosc. 2007;15(4):381–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Terukina M, Fujioka H, Yoshiya S, Kurosaka M, Makino T, Matsui N, et al. Analysis of the thickness and curvature of articular cartilage of the femoral condyle. Arthroscopy. 2003;19(9):969–73.CrossRefPubMedGoogle Scholar
  13. 13.
    Burks RT, Greis PE, Arnoczky SP, Scher C. The use of a single osteochondral autograft plug in the treatment of a large osteochondral lesion in the femoral condyle: an experimental study in sheep. Am J Sports Med. 2006;34(2):247–55.CrossRefPubMedGoogle Scholar
  14. 14.
    Hangody L, Rathonyi GK, Duska Z, Vasarhelyi G, Fules P, Modis L. Autologous osteochondral mosaicplasty. Surgical technique. J Bone Joint Surg Am. 2004;86-A(Suppl 1):65–72.CrossRefGoogle Scholar
  15. 15.
    Pearce SG, Hurtig MB, Clarnette R, Kalra M, Cowan B, Miniaci A. An investigation of 2 techniques for optimizing joint surface congruency using multiple cylindrical osteochondral autografts. Arthroscopy. 2001;17(1):50–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Koh JL, Wirsing K, Lautenschlager E, Zhang LO. The effect of graft height mismatch on contact pressure following osteochondral grafting: a biomechanical study. Am J Sports Med. 2004;32(2):317–20.CrossRefPubMedGoogle Scholar
  17. 17.
    Nakagawa Y, Suzuki T, Kuroki H, Kobayashi M, Okamoto Y, Nakamura T. The effect of surface incongruity of grafted plugs in osteochondral grafting: a report of five cases. Knee Surg Sports Traumatol Arthrosc. 2007;15(5):591–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Evans PJ, Miniaci A, Hurtig MB. Manual punch versus power harvesting of osteochondral grafts. Arthroscopy. 2004;20(3):306–10.CrossRefPubMedGoogle Scholar
  19. 19.
    Duchow J, Hess T, Kohn D. Primary stability of press-fit-implanted osteochondral grafts. Influence of graft size, repeated insertion, and harvesting technique. Am J Sports Med. 2000;28(1):24–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Huntley JS, Bush PG, McBirnie JM, Simpson AH, Hall AC. Chondrocyte death associated with human femoral osteochondral harvest as performed for mosaicplasty. J Bone Joint Surg Am. 2005;87(2):351–60.CrossRefPubMedGoogle Scholar
  21. 21.
    Diduch DR, Chhabra A, Blessey P, Miller MD. Osteochondral autograft plug transfer: achieving perpendicularity. J Knee Surg. 2003;16(1):17–20.PubMedGoogle Scholar
  22. 22.
    Feczko P, Hangody L, Varga J, Bartha L, Dioszegi Z, Bodo G, et al. Experimental results of donor site filling for autologous osteochondral mosaicplasty. Arthroscopy. 2003;19(7):755–61.CrossRefPubMedGoogle Scholar
  23. 23.
    Schub DL, Frisch NC, Bachmann KR, Winalski C, Saluan PM. Mapping of cartilage depth in the knee and elbow for use in osteochondral autograft procedures. Am J Sports Med. 2013;41(4):903–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Baltzer AW, Arnold JP. Bone-cartilage transplantation from the ipsilateral knee for chondral lesions of the talus. Arthroscopy. 2005;21(2):159–66.CrossRefPubMedGoogle Scholar
  25. 25.
    Makino T, Fujioka H, Terukina M, Yoshiya S, Matsui N, Kurosaka M. The effect of graft sizing on osteochondral transplantation. Arthroscopy. 2004;20(8):837–40.CrossRefPubMedGoogle Scholar
  26. 26.
    Kock NB, Hannink G, van Kampen A, Verdonschot N, van Susante JL, Buma P. Evaluation of subsidence, chondrocyte survival and graft incorporation following autologous osteochondral transplantation. Knee Surg Sports Traumatol Arthrosc. 2011;19(11):1962–70.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Ueblacker P, Burkart A, Imhoff AB. Retrograde cartilage transplantation on the proximal and distal tibia. Arthroscopy. 2004;20(1):73–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Borazjani BH, Chen AC, Bae WC, Patil S, Sah RL, Firestein GS, et al. Effect of impact on chondrocyte viability during insertion of human osteochondral grafts. J Bone Joint Surg Am. 2006;88(9):1934–43.PubMedGoogle Scholar
  29. 29.
    Kosiur JR, Collins RA. Weight-bearing compared with non-weight-bearing following osteochondral autograft transfer for small defects in weight-bearing areas in the femoral articular cartilage of the knee. J Bone Joint Surg Am. 2014;96(16):e136.CrossRefPubMedGoogle Scholar
  30. 30.
    Fazalare JA, Griesser MJ, Siston RA, Flanigan DC. The use of continuous passive motion following knee cartilage defect surgery: a systematic review. Orthopedics. 2010;33(12):878.PubMedGoogle Scholar
  31. 31.
    Bentley G, Biant LC, Carrington RW, Akmal M, Goldberg A, Williams AM, et al. A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. J Bone Joint Surg Br. 2003;85(2):223–30.CrossRefPubMedGoogle Scholar
  32. 32.
    Ma HL, Hung SC, Wang ST, Chang MC, Chen TH. Osteochondral autografts transfer for post-traumatic osteochondral defect of the knee-2 to 5 years follow-up. Injury. 2004;35(12):1286–92.CrossRefPubMedGoogle Scholar
  33. 33.
    Lane JG, Massie JB, Ball ST, Amiel ME, Chen AC, Bae WC, et al. Follow-up of osteochondral plug transfers in a goat model: a 6-month study. Am J Sports Med. 2004;32(6):1440–50.CrossRefPubMedGoogle Scholar
  34. 34.
    Gaweda K, Walawski J, Weglowski R, Drelich M, Mazurkiewicz T. Early results of one-stage knee extensor realignment and autologous osteochondral grafting. Int Orthop. 2006;30(1):39–42.CrossRefPubMedGoogle Scholar
  35. 35.
    Solheim E, Hegna J, Oyen J, Harlem T, Strand T. Results at 10 to 14 years after osteochondral autografting (mosaicplasty) in articular cartilage defects in the knee. Knee. 2013;20(4):287–90.CrossRefPubMedGoogle Scholar
  36. 36.
    Gudas R, Kalesinskas RJ, Kimtys V, Stankevicius E, Toliusis V, Bernotavicius G, et al. A prospective randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint in young athletes. Arthroscopy. 2005;21(9):1066–75.CrossRefPubMedGoogle Scholar
  37. 37.
    Horas U, Pelinkovic D, Herr G, Aigner T, Schnettler R. Autologous chondrocyte implantation and osteochondral cylinder transplantation in cartilage repair of the knee joint. A prospective, comparative trial. J Bone Joint Surg Am. 2003;85-A(2):185–92.CrossRefPubMedGoogle Scholar
  38. 38.
    Gudas R, Gudaite A, Pocius A, Gudiene A, Cekanauskas E, Monastyreckiene E, et al. Ten-year follow-up of a prospective, randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint of athletes. Am J Sports Med. 2012;40(11):2499–508.CrossRefPubMedGoogle Scholar
  39. 39.
    Reddy S, Pedowitz DI, Parekh SG, Sennett BJ, Okereke E. The morbidity associated with osteochondral harvest from asymptomatic knees for the treatment of osteochondral lesions of the talus. Am J Sports Med. 2007;35(1):80–5.CrossRefPubMedGoogle Scholar
  40. 40.
    Ansah P, Vogt S, Ueblacker P, Martinek V, Woertler K, Imhoff AB. Osteochondral transplantation to treat osteochondral lesions in the elbow. J Bone Joint Surg Am. 2007;89(10):2188–94.PubMedGoogle Scholar
  41. 41.
    Paul J, Sagstetter A, Kriner M, Imhoff AB, Spang J, Hinterwimmer S. Donor-site morbidity after osteochondral autologous transplantation for lesions of the talus. J Bone Joint Surg Am. 2009;91(7):1683–8.CrossRefPubMedGoogle Scholar
  42. 42.
    Tetta C, Busacca M, Moio A, Rinaldi R, Delcogliano M, Kon E, et al. Knee osteochondral autologous transplantation: long-term MR findings and clinical correlations. Eur J Radiol. 2010;76(1):117–23.CrossRefPubMedGoogle Scholar
  43. 43.
    Zak L, Krusche-Mandl I, Aldrian S, Trattnig S, Marlovits S. Clinical and MRI evaluation of medium- to long-term results after autologous osteochondral transplantation (OCT) in the knee joint. Knee Surg Sports Traumatol Arthrosc. 2014;22(6):1288–97.CrossRefPubMedGoogle Scholar
  44. 44.
    Bert JM. Abandoning microfracture of the knee: has the time come? Arthroscopy. 2015;31(3):501–5.CrossRefPubMedGoogle Scholar
  45. 45.
    Kock N, van Susante J, Wymenga A, Buma P. Histological evaluation of a mosaicplasty of the femoral condyle-retrieval specimens obtained after total knee arthroplasty–a case report. Acta Orthop Scand. 2004;75(4):505–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Yen Hsun Chen
    • 1
  • Yonah Heller
    • 1
  • James Mullen
    • 1
  • Nicholas A. Sgaglione
    • 1
    • 2
  1. 1.Department of Orthopedic SurgeryLong Island Jewish Medical Center/Northwell HealthNew Hyde ParkUSA
  2. 2.Department of Orthopedic SurgeryNorthwell Health SystemGreat NeckUSA

Personalised recommendations