[Surgical treatment of knee joint osteoarthritis in the middle-aged patient]

Several treatment options for the osteoarthritis of the knee in middle-aged patients to preserve the joint are available. Arthroscopic debridement is still a valuable treatment when detailed indications are considered. Microfracture procedure showed good and excellent results primarily at a follow-up of 2 years. Cartilage defects up to 4 cm2 should be treated by the mosaic-type osteochondral autologous transplantation. Autologous chondrocyte implantation (ACI) should be discussed when larger defects are presented in the younger patient. Existing osteoarthritis, ACI is not recommended. Up till now, there was no significant difference in outcomes comparing ACI and mosaicplasty or microfracture. Basic for successful surgical cartilage repair is a stable joint with a normal limb. An eventual additional osteotomy of the knee should be considered based on a standing, three-joint radiograph in every patient.