AANA Middle East Arthroscopy Master Course (International)-Cartilage Lesions

Cartilage Lesions

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This document presents a case-based approach to decision-making in treating cartilage lesions in the knee, authored by Dr. Joseph C. Tauro and Dr. Brian J. Cole, orthopedic surgery experts.<br /><br />Three cases illustrate different cartilage defects and their management:<br /><br />Case 1 involves a 20-year-old college point guard with a focal chondral defect in the right knee. Preoperative imaging (radiographs and MRI) identified the lesion, confirmed intraoperatively. The treatment plan combined microfracture surgery with bone marrow aspirate concentrate (BMAC) to stimulate cartilage repair.<br /><br />Case 2 describes a 35-year-old female experiencing patellar cartilage defects, characterized by anterior knee pain, swelling, and a prior diagnosis of a 7x7 mm full-thickness lesion on the medial patellar facet. Despite previous medial patellofemoral ligament reconstruction (MPFLR) and treatments with hyaluronic acid and platelet-rich plasma, pain recurred. Clinical evaluation showed neutral alignment and stable ligaments. Imaging and arthroscopy guided a treatment plan including patellar osteochondral allograft (OCA) and tibial tubercle osteotomy (TTO). Detailed osteotomy and allograft procedures were outlined.<br /><br />Case 3 features a 34-year-old female with multiple cartilage defects in the right knee, including the medial femoral condyle (MFC), trochlea, and lateral femoral condyle (LFC). History included previous microfracture and chondroplasty. Examination revealed mild effusion and tenderness over the MFC. Imaging and arthroscopy demonstrated multiple lesions. Surgical grafts were prepared for the trochlea, MFC, and LFC sites.<br /><br />The document also raises consideration of meniscal involvement when addressing cartilage lesions.<br /><br />A cartilage treatment algorithm summarizing decision-making steps is provided, integrating diagnostic findings, lesion characteristics, and previous treatments to guide surgical approaches including microfracture, osteochondral allograft transplantation, and osteotomies.<br /><br />In summary, effective management of cartilage lesions relies on thorough clinical and imaging assessment, tailored treatments such as microfracture with biologics or osteochondral grafting, and correction of biomechanical factors via osteotomy when indicated.

Keywords

cartilage lesions

knee surgery

microfracture

bone marrow aspirate concentrate

osteochondral allograft

tibial tubercle osteotomy

patellar defects

chondroplasty

meniscal involvement

cartilage treatment algorithm