The Utility of Biologics, Osteotomy, and Cartilage Restoration in the Knee

Abstract

The management of complex cartilage and meniscal pathology in young, athletic patients is extremely challenging. Joint preservation surgery is most difficult in patients with concomitant knee pathologies, including cartilage defects, meniscal deficiency, malalignment, and/or ligamentous insufficiency. Clinical decision making for these patients is further complicated by articular cartilage lesions, which often are incidental findings; therefore, treatment decisions must be based on the confirmed contribution of articular cartilage lesions to symptomatology. Surgical management of any of the aforementioned knee pathologies that is performed in isolation typically results in acceptable patient outcomes; however, concomitant procedures for the management of concomitant knee pathologies often are essential to the success of any single procedure. The use of biologic therapy as an alternative to or to augment more conventional surgical management has increased in popularity in the past decade, and indications for biologic therapy continue to evolve. Orthopaedic surgeons should understand knee joint preservation techniques, including biologic and reconstructive approaches in young, high-demand patients.

Clinical Outcomes of Multifocal Osteochondral Allograft Transplantation of the Knee: An Analysis of Overlapping Grafts and Multifocal Lesions

“…Many patients in each group underwent concomitant procedures that may have affected patient outcomes. However, as others have previously reported, 12,21,31 it is not uncommon for patients with large chondral or osteochondral lesions to have additional abnormalities such as malalignment, maltracking of the patella, ligamentous instability, and/or meniscal tears or deficiency, which is thus challenging to control for. Further, postoperative imaging including radiography and magnetic resonance imaging was not performed on all patients and was not able to be included in the analysis.…”

Arthroscopic Technique for Treating Patella and Femoral Condyle Lesions With DeNovo Natural Tissue Allograft

“…Treatment of talar lesions using arthroscopic techniques have also been described with comparable results to open methods 11, 12. Size of the lesion is important for preoperative planning with less reliable results in lesions >3 cm 2, 13…”

“…Full-thickness lesions rarely heal and can accelerate osteoarthritis 1 . Numerous options for treating chondral lesions have been proposed depending on location and severity 2 . Methods include arthroscopic debridement, marrow-stimulating techniques, autograft and allograft osteochondral transplantation, as well as cell-based therapies.…”

Survivorship of Patellofemoral Osteochondral Allograft Transplantation

“…There are several limitations to this study. First, as authors have previously described, [24][25][26] it is not uncommon to have concomitant pathology such as meniscal injury or deficiency, ligamentous instability, or malalignment, which is addressed surgically at the time of OCA and is thus difficult to control for. This study is no exception, with 20 (40%) of patients undergoing a concomitant procedure at the time of OCA, which may confound the ability to attribute knee joint preservation and symptom modification or lack thereof directly to the OCA procedure.…”