AANA Lab Course 913 - Advanced Knee Course-Articular Cartilage_ Decision Making in 2019

Articular Cartilage_ Decision Making in 2019_ An Evidenced-Based Approach

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The AANA Advanced Knee Course in November 2019 focused on decision-making for articular cartilage injuries in the knee, providing evidence-based approaches and case discussions moderated by Drs. Kevin Bonner and Seth Sherman with expert panelists.<br /><br />Several clinical vignettes highlighted real-world challenges: a 29-year-old male with medial knee pain post workplace injury underwent marrow stimulation and later arthroscopic osteochondral allograft, resulting in 80% improvement but not full recovery. Data from a large insurance database showed microfracture (MFX) vastly outnumbers advanced restorative procedures like osteochondral autograft transfer (OAT) and autologous chondrocyte implantation (ACI), despite mixed literature outcomes. Systematic reviews indicate no significant long-term differences between some treatments, though mosaicplasty shows better outcomes than microfracture for moderate defect sizes.<br /><br />Meniscal allograft transplantation was discussed, with studies showing variable return-to-sport rates around 74-77%, though reoperation rates can be significant. Cases involving adolescents and young adults illustrated management of osteochondritis dissecans (OCD) and traumatic cartilage injuries, demonstrating options from fragment refixation to osteochondral repair and highlighting good short-term outcomes with fixation of large cartilage fragments.<br /><br />Complex cases, such as a 24-year-old pre-med student with maltracking and lateral patellofemoral pain, and a 35-year-old attorney with loose bodies pre-wedding, emphasized individualized approaches including osteochondral allografting, tibial tubercle osteotomy, and chondroplasty.<br /><br />Long-term studies show that excision of OCD fragments can lead to high osteoarthritis rates compared to fragment preservation or grafting. Return-to-sport meta-analyses indicate higher success rates for OAT, OCA, and ACI versus microfracture, though donor site morbidity remains a consideration.<br /><br />Additional presentations covered management of osteonecrosis of the trochlea, criteria for return-to-play in young athletes post-cartilage restoration, and treatment of degenerative isolated cartilage defects in former athletes using fresh osteochondral allografts.<br /><br />Overall, the course highlighted the complexity of cartilage injury management, the importance of tailored treatment plans considering patient factors, graft choices, and evidence from long-term outcomes to optimize functional recovery and delay osteoarthritis progression.

Keywords

AANA Advanced Knee Course

articular cartilage injuries

microfracture (MFX)

osteochondral allograft

meniscal allograft transplantation

osteochondritis dissecans (OCD)

osteochondral autograft transfer (OAT)

autologous chondrocyte implantation (ACI)

return-to-sport outcomes

cartilage restoration techniques