Treatment algorithm for osteochondral injuries of the knee

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Regenerative Medicine

Background:

• Osteochondral fractures and osteochondritis dissecans (OCD) lesions of the knee lack a universally accepted treatment.
• Recent advancements offer diverse techniques, highlighting the need for a structured approach.

Purpose of the Study:

• To present a treatment algorithm for knee osteochondral lesions based on patient age, skeletal maturity, and lesion characteristics.
• To review current surgical techniques for articular surface reconstruction.

Main Methods:

• Algorithm development based on patient age, skeletal maturity, and subchondral bone integrity.
• Review of surgical options including drilling, fixation, autologous bone grafting, mosaicplasty, osteochondral allograft, and autologous chondrocyte transplantation.
• Comparison of regenerative techniques (fibrocartilage) versus reconstructive techniques (hyaline cartilage).

Main Results:

• Nondisplaced lesions in skeletally immature patients often respond to conservative management.
• Skeletally mature patients may require drilling, fixation, or bone grafting for stable or unstable lesions.
• Reconstructive procedures aim for hyaline cartilage, but long-term efficacy compared to fibrocartilage remains under investigation.

Conclusions:

• A tailored treatment algorithm considering patient factors and lesion type is crucial for managing knee osteochondral lesions.
• Current reconstructive techniques show promise for articular surface restoration, but long-term prevention of degenerative arthritis needs further validation.
• Prospective studies are essential to determine the ultimate effectiveness of various reconstructive procedures.