Grade IV OCD lesion of medial femoral condyle (22 × 15 × 7.7 mm) — MACI vs OATS/mosaicplasty or other options?
I’m 24 and have a Grade IV osteochondral/OCD lesion of the medial femoral condyle in my right knee.
My MRI shows:
- Osteochondral defect: 22 mm AP × 15 mm transverse
- Defect depth: 7.7 mm
- There is fluid tracking underneath the margins of the defect
- A 15 × 7 mm osteochondral fragment is displaced into the suprapatellar recess
- Small joint effusion
- Menisci and ligaments are otherwise intact
- Alignment is maintained
- The remaining articular cartilage is reported as normal
The displaced fragment cannot be salvaged/fixed, so I’m looking at cartilage/osteochondral restoration options.
Unfortunately, fresh osteochondral allograft is not available to me, so the options currently available to me include MACI and OATS/mosaicplasty.
I would really appreciate input from anyone who has experience with a lesion of this size, particularly orthopedic surgeons, cartilage restoration specialists, or people who have gone through treatment for a similar OCD lesion.
For a 22 × 15 mm (~3.3 cm²) Grade IV lesion with 7.7 mm of depth in the medial femoral condyle:
- Would OATS/mosaicplasty be a reasonable choice for a defect this size and depth?
- Would MACI be preferable?
- Are there other procedures or treatment approaches I should be considering besides MACI and OATS/mosaicplasty?
- How does the 7.7 mm bone involvement/depth affect the choice between these procedures?
- For someone in their early 20s, which option would generally be considered better for long-term durability and preserving the knee?
- If you’ve had a similar-sized lesion, what procedure did you have and how is your knee doing now?
I’m trying to understand all the realistic options available to me before making a decision, since an osteochondral allograft isn’t an option where I am.
I’ve attached the MRI report/images for reference. I’d especially appreciate responses from people with similar-sized medial femoral condyle OCD lesions, rather than smaller cartilage defects.