Osteochondral allograft and autograft transplantation

Osteochondral Autograft Transfer System surgery (OATS) was first reviewed by the HTCC in 2011.

  • In 2018, a review of OATS medical literature was performed to determine if evidence published since the 2011 review was likely to change the original decision.

Status: Decision completed

Policy context

Injury or damage to cartilage can be resistant to healing due to low vascularization, and in joints, may lead to pain and loss of function. The resulting irritation and inflammation of the joint may also be associated with further degeneration and osteoarthritis. Treatments for injured cartilage include arthroscopic removal of damaged cartilage, stimulation of the underlying bone to encourage cartilage growth, injection of chondrocytes to encourage repair, and/or grafts of cartilage from other parts of the joint or from preserved cadaver tissue. Advanced joint degeneration is treated with other approaches, such as the injection of cushioning material (hyaluronic acid), bone shaping to reduce wear and joint replacement.

Injuries suitable for repair using OATS/mosaicplasty often occur in young, athletic individuals. Treatment that allows a continued healthy lifestyle and avoids long term joint damage and eventual more invasive procedures is of great benefit. Though definite causes for osteoarthritis have not been identified, there are indications that minor joint damage followed by years of continuous wear may be the major cause. Significant questions remain about the safety, efficacy, and effectiveness, and cost effectiveness of OATS/mosaicplasty cartilage surgery.

Primary criteria ranking

  • Safety = Medium
  • Efficacy = High
  • Cost = Low

Update literature search (2018)

Assessment (2011)

Assessment timeline

  • Draft report published: September 14, 2011
  • Public comment period: September 14 to September 30, 2011
  • Final report published: October 18, 2011
  • HTCC public meeting: November 18, 2011


Osteochondral Autograft Transfer System surgery is a graft procedure that uses one or more "plugs" of healthy cartilage to fill in damaged areas. It can be done as an open or arthroscopic procedure, and is sometimes combined with other joint operations such as arthroscopic debridement or ACL repair. The grafted cartilage is harvested from another area within the joint, and the harvest site as well as the repair site need to heal properly, so a period of physical therapy is required after the operation.

Osteochondral Allograft Transplant Surgery is a graft procedure similar to Osteochondral Autograft Transfer System, but using graft material from preserved cadaver cartilage. There is some indication that allograft cartilage does not integrate as well, and transplantation involves some risk of infection. However, adequate healthy cartilage tissue is not always available within the joint under repair. Mosaicplasty is a more generic term that covers either Osteochondral autograft or allograft, open or arthroscopic.