AOSSM/AANA Specialty Day 2020-Handout 1 - Surface Cartilage Treatments Are the Way to Go

Handout 1 - Surface Cartilage Treatments Are the Way to Go

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This presentation by Dr. Craig H. Bennett focuses on treating knee cartilage injuries, specifically emphasizing surface cartilage repair techniques as preferable treatments for moderate to large, primarily contained Grade 3 and 4A lesions.<br /><br />Key considerations for treatment include patient factors (age, activity, alignment), lesion specifics (size, depth, location), and whether it is an initial or revision surgery. Small lesions offer many options, but moderate to large lesions are best addressed with autologous surface cell therapies or fresh osteochondral allografts (OCAs).<br /><br />Surface cartilage grafts have several advantages over osteochondral grafts: they are technically easier with better predictability, conform well to the subchondral surface, can access difficult knee locations (e.g., tibial plateau, posterior lateral femoral condyle), and allow for treatment of multiple lesions. Biologically, surface grafts pose no immune reaction risk and can accommodate autograft bone grafting in cases with subchondral bone disease.<br /><br />While fresh OCAs carry risks such as disease transmission, immune reactions, and incorporation failures, surface autologous chondrocyte implantation (ACI) offers durable, bone-preserving treatment with excellent long-term outcomes, especially in patients under 30 years. Clinical studies show 70-75% good results and high patient satisfaction over 10-20 years. Newer generation ACI techniques (MACI) improve surgical efficiency, handling, and rehabilitation times.<br /><br />Randomized controlled trials demonstrate MACI superiority over microfracture in lesion repair and function at 2-5 years. Patellofemoral lesions are particularly suited to surface grafts due to joint geometry. Accelerated weight-bearing rehabilitation after MACI is safe and effective.<br /><br />Recent developments include cryopreserved allograft cartilage (Cartiform), micronized cartilage matrix (BioCartilage), and minced juvenile cartilage (DeNovo), expanding options with ease of use and improved biological integration.<br /><br />A proposed treatment algorithm favors autologous or juvenile cell-based surface repairs for well-contained defects with intact subchondral bone, reserving fresh OCAs for revisions or subchondral bone damage.<br /><br />In sum, surface cartilage treatments maintain bone health, restore cartilage effectively, and yield durable results, making them the preferred approach for moderate to large knee cartilage lesions, with OCAs as revision salvage.

Keywords

knee cartilage injuries

surface cartilage repair

Grade 3 and 4A lesions

autologous chondrocyte implantation (ACI)

fresh osteochondral allografts (OCAs)

MACI technique

patellofemoral lesions

cryopreserved allograft cartilage (Cartiform)

micronized cartilage matrix (BioCartilage)

minced juvenile cartilage (DeNovo)