Deciding How Best to Treat Cartilage Defects

Abstract

The decision-making regarding and treatment of cartilage abnormalities requires a systematic approach. This article reviews the concepts and principles that guide the management of this complex problem. The precise incidence, demographics, and progression of cartilage lesions have not been clearly delineated. Pursuing a patient-centered approach that considers the available nonsurgical and surgical options remains the cornerstone of patient care. The importance of determining concomitant knee pathologies, the proper interpretation and implications of imaging findings, and an accurate determination of the intra-articular and subchondral findings represent the primary elements of the decision analysis. Treatment options vary depending on patient goals, the disposition of the lesion, and a variety of other factors. The authors recommend proper patient education and consideration of how nonsurgical treatment or less invasive options such as arthroscopic debridement might be effective. If these strategies should fail, appropriate matching of a surgical procedure to the patient's pathology, goals, and expectations is warranted. Surgical options include debridement, marrow stimulation techniques, surface allograft treatments, autologous chondrocyte implantation, and osteochondral grafting (autograft and allograft) in addition to some emerging technologies. This article focuses on the decision-making process. [Orthopedics. 2016; 39(6):343-350.].

Outcomes of Osteochondral Allograft Transplantation With and Without Concomitant Meniscus Allograft Transplantation: A Comparative Matched Group Analysis

“…5,9,16,26,39 Joint preservation procedures for articular cartilage lesions include microfracture, autologous chondrocyte implantation, surface allograft transplantation, osteochondral autograft transplantation, surface allograft procedures, and osteochondral allograft transplantation (OCA). 14,30,34,36 Similarly, for appropriately indicated patients with symptomatic meniscus deficiency, meniscus allograft transplantation (MAT) is often recommended. 10,35,41,42 Patients indicated for joint preservation procedures such as OCA and/or MAT are particularly challenging, as they often present after having undergone at least 1 prior surgical procedure, they have high preinjury activity levels, and they often have high postoperative expectations.…”

Nonsurgical Management of Cartilage Defects of the Knee: Who, When, Why, and How?

“…Nonsurgical management options for cartilage defects should involve an individualized approach to treatment that considers patient-specific goals and relevant barriers to adoption that are pivotal to achieving optimal outcomes. 11 The majority of those with cartilage defects present with pain as their primary symptom, typically complaints of pain exacerbated by weight-bearing and improved with rest. Common secondary symptoms include morning stiffness (less than 30 minutes of duration), bony tenderness, and decreased range of motion.…”

Chondral lesions in the hip: a review of relevant anatomy, imaging and treatment modalities

“…The pros and cons of each of these treatment modalities are summarized in Table III. Oliver-Welsh et al [40] created a general treatment algorithm for articular cartilage defects that first takes into consideration criteria for surgery such as pain, dysfunction, concomitant pathologies, as well as the lesion size and patient activity. The algorithm then suggests second line therapies, and is summarized in Table IV.…”