Understanding the TREATMENT

What Are Osteochondral Grafts?

Osteochondral grafts are small “plugs” of healthy cartilage and bone. If you have a deep cartilage lesion with underlying (or subchondral) bone damage, your surgeon may recommend an OATS® (or osteochondral autograft/allograft transplant) procedure.

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There are several types of osteochondral grafts, all of which aim to replace the damaged cartilage and bone. Your surgeon will choose the best option for your specific needs.

Three Options, One Goal

Choose the Right Technique for Your Defect

Donor Cartilage

Allograft OATS Technique

An allograft is a cleansed and decellularized piece of tissue and/or bone from a deceased donor. Your doctor will measure your cartilage lesion and match it to a healthy donor graft, considering additional factors including your age, activity level, health, and specific injury. The goal is to allow the osteochondral allograft to incorporate into the surrounding tissue.

OFTEN USED FOR

Large cartilage lesions with underlying bone damage

GRAFT SOURCE

Donor

DETAILS

Donor grafts can be sized from 10 mm (about the size of a shirt button) to 35 mm (about the diameter of a gumball).

KEY BENEFITS

Excellent patient-reported outcomes and a high return-to-sport rate⁶
Graft viability of 75-80%, meaning the grafts incorporate well⁶‍
Avoids using for multiple surgical sites needed for autografts
No risk of morbidity (eg, pain, scarring, or infection), which is a potential risk of using a graft from your own body

THINGS TO KNOW

It is important to note that an allograft may not be the right choice for patients with sensitivities to some antibiotics and cleansing agents.⁷

Your Own Cartilage

Autograft OATS Technique

Another well-established option is the autograft OATS procedure. Your surgeon will collect a healthy cartilage "plug" from a non–weight-bearing cartilage surface in your knee to replace the damaged cartilage. Over time, cartilage from the autograft is meant to grow into and replace the damaged area.¹

OFTEN USED FOR

Smaller lesions with underlying bone damage

GRAFT SOURCE

A non–weight-bearing surface of your own knee

DETAILS

Harvested grafts are usually 6-12 mm in diameter (ranging from about the size of a pencil eraser up to the size of a blueberry)

KEY BENEFITS

Good long-term outcomes at 10 and 15 years^2,3‍
Potential for a faster recovery and higher rate of return to preinjury athletics⁴
High chance of graft incorporation and no risk of disease transmission⁵

THINGS TO KNOW

It is important to note that autograft procedures do have a chance of graft-site morbidity, or symptoms at the location your surgeon harvested the bone plug.

Donor Cartilage

BioUni® Technique

BioUni instrumentation is designed for cartilage defects that aren't round—the elongated, oblong lesions that are difficult to treat with circular grafts. A single, custom-shaped graft replaces the damaged area instead of using multiple overlapping plugs.

OFTEN USED FOR

Larger, oblong/oval cartilage lesions in the area of the knee called the femoral condyle

GRAFT SOURCE

Donor

DETAILS

If you have a large, uniquely shaped defect, your doctor may create a custom-sized oval plug using a BioUni kit, which allows them to use just one allograft instead of multiple grafts to replace your damaged cartilage with healthy tissue.

KEY BENEFITS

Restores the knee's articular surface (the cartilage in the joint that protects bones from directly touching)
Only needs one graft rather than multiple to fill the defect

THINGS TO KNOW

Another common way to treat these irregular defects is called the “snowman” technique, which is when surgeons use multiple circular grafts.

Compare Treatment Benefits

BENEFIT TYPE

Autograft OATS Technique

Allograft OATS Technique

BioUni Technique

Tissue source

Your Own Cartilage

Donor Cartilage

Treats large defects?

Custom-fit graft

Used in

Knee, Ankle

Knee

the TREATMENT

How Do the OATS Procedures Work?

Joint Inspection

Your surgeon will inspect the knee joint to confirm the size and location of your lesion and to determine if you need any other treatments.

Graft Sizing

Your surgeon will use a special sizer to identify the exact size and location of the graft they will use to replace your damaged cartilage and bone.

Recipient Site Preparation

Your surgeon will clean out the damaged area on your knee, called the recipient site, to prepare it for graft placement.

Graft Preparation

Your surgeon will collect your graft, either from your own knee in an autograft OATS procedure or a donor knee in an allograft OATS procedure. They will then use a surgical tool to shave the graft to the correct size and depth to ensure proper fit into your knee.

Graft Placement

Your surgeon will place the graft into the recipient site, then gently press or tap it in until it is secure. They may add a biologic putty to help the graft fit perfectly.

Can My Cartilage Defect Be Treated Without Surgery?

If your symptoms aren't affecting your daily life, your surgeon may suggest trying non-surgical options first. But if your symptoms are getting worse, surgery is usually recommended. Non-surgical options may include physical therapy, anti-inflammatory medication, or a knee brace to reduce pressure on the joint.

Frequently Asked Questions

Does this treat arthritic conditions?

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OATS procedures are meant for cartilage defects located in a specific area, such as those caused by trauma and some medical conditions. It serves to help replace and restore the cartilage in the location of a defect. These procedures are not used for arthritis due to the widespread damage to the cartilage.

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There are several options available if you have osteoarthritis impacting large areas of the cartilage in your knee, including partial or total knee replacement (called arthroplasty) and/or correction of the alignment of your knee (called an osteotomy).⁸

Do these treatments prevent joint replacement?

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Fixing damaged cartilage early is can help prevent further injury, painful arthritis, and the need for a total joint replacement later in life.

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While these surgeries are made to repair your cartilage and protect your joint, they are not a 100% guarantee that you will never need a joint replacement in the future. Everyone’s body heals differently, so it is important to talk with your doctor about your specific goals and long-term treatment plan.

Where do allografts come from? 

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Cartilage and bone allografts like the ones used in OATS procedures come from people who chose to be organ and tissue donors after their deaths. Organizations called tissue banks decide what tissue can be safely used for surgeries by testing it for infectious diseases and cleaning it to remove any cellular components. Finally, the right size and shape of graft is chosen to fit your specific defect.

Can these procedures be revised if they don’t work? 

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Like all surgeries, there are risks involved, including possible complications or failure of the graft. Your surgeon will discuss the risks involved with your surgery. There are many factors that could cause the graft to not work optimally. If this does happen, your surgeon will discuss your options and may explore other knee preservation techniques.

Need more information?

Download our patient guide for common questions you may want to ask your doctor.

View Patient Guide

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Explore Other Options

Arthrex offers options for all types and sizes of cartilage defects.

Cartiform® Implant

Osteochondral allograft (donor tissue) used to replace damaged bone and cartilage in smaller, shallower cartilage defects.

Learn More

AutoCart™ Technique

Single-stage, no-incision cartilage repair with biologics to encourage healing.

Learn More

IntraOsseous BioPlasty® (IOBP®) Technique

Biologics used to help heal the subchondral bone below the cartilage surface.

Learn More