AANA Fellowship Education - Cartilage Restoration: Indications and Expectations-Cartilage Restoration: Indications and Expectations

Video Transcription

Video Summary

The webinar titled "Cartilage Restoration: Indications and Expectations," part of the Fellowship Education Series, featured expert faculty discussing current approaches to cartilage repair, including diagnostic arthroscopy, autologous chondrocyte implantation (ACI/MACI), and fresh osteochondral allografts.<br /><br />Dr. Adam began by emphasizing the role of diagnostic arthroscopy and mechanical debridement, noting that while evidence is still limited, debridement remains the most common initial treatment for cartilage defects, often providing symptomatic relief and potentially delaying or avoiding more invasive procedures. He presented cases illustrating patient selection, including a challenging patellar delamination and a young patient with complex instability and cartilage loss, highlighting that arthroscopy helps determine appropriate surgical planning.<br /><br />Andreas discussed the evolution from first-generation ACI to MACI, noting MACI's advantages such as collagen scaffolding, applicability across different knee compartments, and improved surgical techniques including arthroscopic delivery and glue fixation. Indications for MACI include full-thickness, focal defects over 2 cm², especially in complex geometries or multiple lesions, with caution on bipolar tibiofemoral lesions considered more arthritic.<br /><br />Christian focused on fresh osteochondral allografts, underscoring their value for deep osteochondral defects involving bone loss (e.g., AVN, OCD, post-traumatic cases), multi-procedural surgeries, and salvage situations following failed cartilage repair. Technical considerations such as graft sizing, orientation, and storage time impact outcomes. He warned against unproven processed allografts and cautioned that bipolar and patellofemoral allografts remain challenging and generally reserved for experts.<br /><br />Case discussions included athletes and young active patients where timing, lesion size, location, and previous treatments influenced choices among debridement, OATS, MACI, or allograft transplantation. The panel emphasized that cartilage restoration should not be used in arthritic joints and that personalized strategies are critical. Emerging topics such as radiofrequency debridement were viewed skeptically due to limited biological benefit. Overall, the session stressed a multimodal, evidence-informed approach tailored to patient needs to optimize cartilage repair outcomes.

Asset Caption

Dr. Brian J. Cole | Dr. Adam B. Yanke | Dr. Christian Lattermann | Dr. Andreas H. Gomoll

Keywords

cartilage restoration

diagnostic arthroscopy

mechanical debridement

autologous chondrocyte implantation (ACI)

matrix-induced autologous chondrocyte implantation (MACI)

fresh osteochondral allografts

cartilage repair techniques

patellar delamination

osteochondral defects

salvage cartilage surgery

evidence-based cartilage treatment