Approach to cartilage injury in the anterior cruciate ligament-deficient knee

The treatment of articular cartilage lesions remains one of the great challenges facing orthopedic surgeons today. The technique of chondrocyte transplantation has opened the door for the application of biologic solutions to difficult problems. These techniques will prove the keystone of further advances into biologic joint repair and replacement. Enthusiasm, however, must be tempered by the numerous gaps in cartilage science and the overwhelming need for further long-term data to demonstrate the efficacy of these techniques in thwarting the presumed eventual progression of these lesions toward osteoarthritis. The status of the articular cartilage is of paramount importance in ACL decision-making. Every effort must be made to protect the existing hyaline articular cartilage during ACL reconstruction. Though current cartilage repair techniques are in their infancy, they remain stepping-stones to future developments. It is hoped that we will one day be able to regenerate normal hyaline cartilage without great morbidity. At present, the ACL surgeon must accept techniques that diminish symptoms and do not burn bridges to future advances. The orthopedic surgeon must increase his knowledge of the basic science of articular cartilage in order to best choose from the various cartilage treatments that evolve.