The Large Focal Isolated Chondral Lesion

Abstract

Focal chondral defects (FCDs) of the knee can be a debilitating condition that can clinically translate into pain and dysfunction in young patients with high activity demands. Both the understanding of the etiology of FCDs and the surgical management of these chondral defects has exponentially grown in recent years. This is reflected by the number of surgical procedures performed for FCDs, which is now approximately 200,000 annually. This fact is also apparent in the wide variety of available surgical approaches to FCDs. Although simple arthroscopic debridement or microfracture are usually the first line of treatment for smaller lesions, chondral lesions that involve a larger area or depth require restorative procedures such as osteochondral allograft transplantation or other cell-based techniques. Given the prevalence of FCDs and the increased attention on treating these lesions, a comprehensive understanding of management from diagnosis to rehabilitation is imperative for the treating surgeon. This narrative review aims to describe current concepts in the treatment of large FCDs through providing an algorithmic approach to selecting interventions to address these lesions as well as the reported outcomes in the literature.

Management of Articular Cartilage Defects in the Knee: An Evidence-Based Algorithm

“…Significant improvements in function and pain following ACI are evident at short-term (85% return to recreational activities, 66% return to sport at 2 years) and long-term follow-up (stable clinical improvements with a 10% failure rate at 11 years) 39,40 . However, patient expectations must be managed as ACI requires 2 surgeries and 6 weeks non–weight-bearing postoperatively 2 .…”

“…Chondral defects of the knee affect over 900,000 people in the United States, resulting in over 200,000 surgical treatments annually 1 . Articular cartilage lesions are seen in over 60% of patients undergoing knee arthroscopy and are most commonly found on the lateral aspect of the medial femoral condyle 1,2 . Over 50% of these patients have large focal lesions (≥2 cm 2 ) and are twice as likely to undergo knee arthroplasty compared with patients with small defects (<2 cm 2 ) 2,3 .…”

Outcomes of Plug Osteochondral Allograft Transplantation With or Without Concomitant Osteotomy for Cartilage Defects in the Knee: Minimum 2-year Follow-up

“…9,10 In general, focal lesions that are .2 cm 2 are currently treated with osteochondral allografts (OCAs) and matrix-induced autologous chondrocyte implantation. [8][9][10] The use of OCA for large, full-thickness osteochondral defects of the knee has been established as a reliable single-stage treatment option with reproducible clinical outcomes such as a five-year graft survivorship of .80%. [10][11][12][13][14] OCAs provide viable hyaline cartilage and subchondral bone, without donor-site morbidity, the need for tissue matching, or immunosuppressive therapy.…”

“…3-6 Biological, joint-preserving alternatives range from bone marrow stimulation techniques with microfracture and autologous matrix-induced chondrogenesis, to transplantation with osteochondral grafts or matrix-induced autologous chondrocyte implantation. 7-9 Multiple patient-specific and defect-specific factors contribute to treatment choice, and no single technique has been demonstrated to be unequivocally superior in improving pain and functional outcomes. 9,10 In general, focal lesions that are >2 cm 2 are currently treated with osteochondral allografts (OCAs) and matrix-induced autologous chondrocyte implantation.…”

“…9,10 In general, focal lesions that are >2 cm 2 are currently treated with osteochondral allografts (OCAs) and matrix-induced autologous chondrocyte implantation. 8-10…”