AANA Lab Course 913 - Advanced Knee Course-Evidence-based Treatment of Smaller Condylar Lesions (_2 cm) Faculty Lecture

Evidence-based Treatment of Smaller Condylar Lesions (_2 cm) Faculty Lecture_ Jeffrey A. Macalena, MD

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This presentation from the University of Minnesota, led by Dr. Jeffrey Macalena, focuses on evidence-based treatment of small condylar cartilage lesions (≤2 cm²). The key message is that many small lesions can be managed non-surgically, especially if discovered incidentally, with no strong evidence supporting prophylactic or preventative cartilage surgery.<br /><br />Nonoperative management includes observation or benign neglect, activity modification, NSAIDs, BMI optimization, physical therapy, and injection therapies such as corticosteroids or viscosupplementation, although the biological activity of these injections remains uncertain. Surgery is generally reserved for symptomatic lesions or failure of conservative care.<br /><br />Microfracture (Mfx), which creates fibrocartilage repair tissue by venting marrow, is viewed critically due to concerns over durability and inferior fibrocartilage quality. It may be considered very rarely, only in ideal cases: small lesions (~2 cm²), low BMI (~30), intact surrounding cartilage, and neutral limb alignment. The procedure involves cleaning lesion edges and removing unstable flaps without coalescence, followed by close postoperative monitoring.<br /><br />In contrast, osteochondral autograft transplantation (OAT) is supported by better clinical outcomes and improved return-to-sport (RTS) rates in both short- and long-term follow-up, as reported in major journals (AJSM 2018, JBJS 2012). OAT is also considered cost-effective and provides durable repair with hyaline cartilage plugs.<br /><br />In summary, small cartilage lesions often do not require immediate surgery unless symptomatic. When surgery is indicated, osteochondral autograft transplantation is preferred over microfracture due to superior outcomes and lasting benefit. Overall, cartilage surgery remains cost-effective in appropriate cases, but current data do not support prophylactic interventions for asymptomatic lesions.

Keywords

small condylar cartilage lesions

nonoperative management

microfracture (Mfx)

osteochondral autograft transplantation (OAT)

evidence-based treatment

conservative care

cartilage surgery outcomes

return-to-sport rates

cost-effectiveness of cartilage surgery

symptomatic vs asymptomatic lesions