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“Nuts In Jelly” Mosaicplasty for Medium to Large Chondral Defects of Knee – Functional Outcomes Up to 5 Years Follow Up

“Nuts In Jelly” Mosaicplasty for Medium to Large Chondral Defects of Knee – Functional Outcomes Up to 5 Years Follow Up

Girinivasan Chellamuthu, MBBS, MS Ortho, FIOT, FASM, INDIA Santosh Sahanand Kulasekaran, MBBS,MS(ortho), INDIA David V. Rajan, MS(Orth), MNAMS(Orth), FRCS(G), INDIA

Ortho One Orthopaedic Specialty Centre, Coimbatore, Tamil Nadu, INDIA

2023 Congress   ePoster Presentation   2023 Congress   rating (1)


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Summary: “Nuts in Jelly” mosaicplasty is effective in medium to large chondral defects of knee


In the medium to large chondral lesions particularly in smaller Indian knees, mosaicplasty is difficult and incomplete because of the limited donor area, requiring advanced staged procedures like autologous chondrocyte implantation and allograft transplantation. In such scenarios, we have developed and used the technique of “Nuts in Jelly” mosaicplasty.


It is a single-center study. Consecutive patients of age less than 50 years with chondral defect size of more than 2 cm2 were operated on with “Nuts in Jelly” mosaicplasty and followed up. The surgical technique essentially involves filling the defect using cylindrical autografts dispersed in a mixture of fibrin glue with Bone Marrow Aspirate Concentrate just like the nuts dispersed in jelly. The functional outcomes during follow-up were measured with Tegner Lysholm score and MRI at two years of follow-up.


13 cases were followed up for a minimum of 2 years (5 to 2 years). The average age is 34 years (23 to 46 years). There were 10 males and 3 females. Repeat MRI showed complete healing of lesions at 2 years in all cases. The Tegner Lysholm score was good in 4 patients and excellent in 9 patients.


Our technique has yielded good to excellent outcomes in midterm follow-up. It is a cost-effective single-stage procedure for the treatment of the medium to large chondral defects of the knee. Further prospective comparison studies are needed to validate the superiority of this technique over chondrocyte implantation techniques

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