Mosaicplasty for symptomatic articular cartilage defects of the knee

To inform the committee, NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 9 sources, which was discussed by the committee. The evidence included 1 network meta-analysis, 3 systematic reviews, 1 randomised control trial, 3 case series and 1 non-randomised comparative study, and is presented in table 2 of the interventional procedures overview. Other relevant literature is in additional relevant papers in the overview.

The specialist advisers and the committee considered the key efficacy outcomes to be: restoration of functional hyaline cartilage in weight-bearing areas, improved mobility, return to usual activities, less pain including in the long term, and a reduction in subsequent joint degeneration and need for revision surgery.

The specialist advisers and the committee considered the key safety outcomes to be: infection, thrombosis, donor-site morbidity (including acceleration of wear at the donor site), procedure failure and joint stiffness.

Patient commentary was sought but none was received.

The committee noted that earlier mobilisation may lead to better outcomes.

Most of the evidence was from patients aged between 16 years and 30 years.

Outcomes are better and donor-site morbidity is less when the procedure is used to treat smaller defects.