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Algorithm-Based Surgical Decision-Making for Focal Knee Cartilage Defects: A Pragmatic Clinical Framework with
Birzhan Suiindik1,2, Yerik Raimagambetov1, Kazybek Baktybergen3
1Department of Orthopaedics National Scientific Center of Traumatology and Orthopaedics named after N.D. Batpenov.
Orthopedic Reviews
|June 12, 2026
Summary
An algorithm-based framework for focal knee cartilage defects shows promising early clinical and radiological outcomes. This reproducible approach aids surgical decisions, demonstrating consistent patient improvement in real-world settings.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Regenerative Medicine
Background:
- Focal knee cartilage defects present a significant clinical challenge.
- Current treatment strategies vary, necessitating standardized decision-making frameworks.
- Reproducible and cost-effective techniques are crucial for routine clinical practice.
Purpose of the Study:
- To evaluate early clinical and radiological outcomes of an algorithm-based surgical decision-making framework for focal knee cartilage defects.
- To assess the feasibility of using reproducible, cost-effective techniques in routine clinical practice.
- To provide a practical framework for surgical treatment selection in knee cartilage injuries.
Main Methods:
- Retrospective case series of five patients with ICRS Grade 3-4 chondral or osteochondral lesions.
- Treatment guided by a structured algorithm considering fragment viability, lesion size, and patient factors.
- Surgical procedures included bone marrow stimulation (BMS), osteochondral autograft transplantation (OAT), and osteochondral fragment refixation.
- Clinical outcomes assessed via Visual Analogue Scale (VAS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) at 1, 3, and 6 months.
- Radiological assessment using MRI-based MOCART 2.0 scoring at 6 months.
Main Results:
- All patients showed progressive clinical improvement with decreased mean VAS scores (6.6 to 1.2 at 6 months).
- KOOS scores improved across all subscales, particularly in activities of daily living.
- MRI revealed variable structural maturation (mean MOCART 2.0 score: 60), with better outcomes in fragment refixation cases.
- Bone marrow stimulation yielded satisfactory short-term outcomes even in complex cases.
Conclusions:
- The algorithm-based approach offers a practical and reproducible framework for surgical treatment selection in focal knee cartilage defects.
- Consistent clinical improvement supports the feasibility and applicability of this decision-making model.
- The framework is particularly relevant for real-world and resource-constrained settings.