How to Manage Cartilage Injuries?

Area of Science:

• Orthopedic Surgery
• Regenerative Medicine
• Sports Medicine

Background:

• Knee cartilage injuries, while common, vary significantly in severity.
• Traumatic injuries, especially with ligament or meniscal tears, increase cartilage damage incidence.
• Restoration options range from conservative management to complex reconstructive surgeries.

Purpose of the Study:

• To outline current surgical strategies for treating chondral and osteochondral knee injuries.
• To correlate specific lesion characteristics (size, depth, location) with optimal treatment modalities.
• To emphasize the importance of addressing concomitant knee pathologies for successful cartilage restoration.

Main Methods:

• Review of established and emerging surgical techniques for cartilage repair.
• Categorization of treatments based on lesion size: <2 cm² (marrow stimulation, osteochondral autograft) and >2 cm² (osteochondral allograft, resurfacing).
• Consideration of biologic adjuncts like bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP).

Main Results:

• Microfracture is suitable for small cartilage defects (<2 cm²) but less durable for larger lesions.
• Osteochondral autograft transplantation is effective for smaller lesions with subchondral involvement.
• Osteochondral allograft transplantation and matrix autologous chondrocyte implantation (MACI) are preferred for larger lesions (>2 cm²).

Conclusions:

• Treatment selection for knee cartilage restoration is highly individualized based on lesion characteristics.
• Advanced techniques like MACI offer good long-term outcomes for chondral defects.
• Addressing underlying biomechanical issues and instability is crucial for successful cartilage repair and knee function.