Novel and Alternative Surgical Techniques for Cartilage Disorders of the Knee

Articular cartilage lesions of the knee, ranging from focal defects to tricompartmental osteoarthritis, present significant clinical challenges because of cartilage's limited regenerative capacity. It is important to highlight modern surgical advancements in the treatment of chondral pathology beyond injection therapy, traditional osteotomies, and arthroplasty options. Surface- and cell-based repair techniques, including matrix-induced autologous chondrocyte implantation, offer improved long-term outcomes, with emerging fourth-generation variants facilitating single-stage arthroscopic implantation. Off-the-shelf cartilage repair strategies, such as particulated juvenile cartilage, micronized allografts, and viable cartilage allografts, represent promising alternatives that bypass the need for two-stage procedures. For osteochondral defects, osteochondral autograft transfer and fresh allograft transplantation remain the gold standard, although decellularized and cryopreserved viable allografts are under investigation. Recently approved artificial osteochondral scaffolds, such as Agili-C, offer an FDA-cleared, acellular biphasic implant with promising midterm results. For patients with malalignment-associated osteoarthritis, patient-specific instrumentation in high tibial and distal femoral osteotomies enhances accuracy, particularly in biplanar corrections, and reduces intraoperative variability. Novel load-sharing implants, such as fiber-reinforced rafting nails and the MISHA knee system, provide less invasive alternatives to osteotomy, showing early success in reducing medial compartment load and improving functional outcomes. There is an expanding arsenal of biologically and biomechanically innovative treatments for articular cartilage restoration and osteoarthritis management.