AANA/ISAKOS Knee and Shoulder Arthroscopy Course-Online Didactics (April 2024)-Isolation Cartilage Defects_ How Do You Pick Your Cartilage Procedure

Isolation Cartilage Defects_ How Do You Pick Your Cartilage Procedure – An Algorithm for Success in 2022

Video Transcription

Video Summary

Dr. Paul Caldwell discusses cartilage defects in the knee, highlighting that two-thirds of knee arthroscopies reveal focal chondral defects, often undetected on MRI due to size underestimation. Treatment trends favor restorative techniques like osteochondral allografts and autologous chondrocyte implantation (ACI) over traditional chondroplasty and microfracture. Staging arthroscopy helps accurately assess lesions and patient suitability. Small lesions often respond to procedures like chondroplasty or microfracture, though microfracture's long-term outcomes are limited. Larger lesions benefit from osteochondral allograft transplantation—fresh grafts restore hyaline cartilage and subchondral bone in a single surgery—and MACI, involving cultured chondrocytes on collagen membranes. Osteochondral allografts are suited for significant bone loss and revisions; MACI is preferred for surface and patellofemoral defects but requires two surgeries and prolonged rehab. Both methods show good long-term results, with return-to-sport rates around 75-90%. Careful patient evaluation, lesion size, location, and patient lifestyle guide individualized treatment decisions.

Keywords

knee cartilage defects

focal chondral defects

arthroscopy

osteochondral allografts

autologous chondrocyte implantation

microfracture treatment