AOSSM/AANA Specialty Day 2020-Handout 2 - Surface Cartilage Treatments Are the Way to Go

Handout 2 - Surface Cartilage Treatments Are the Way to Go

Pdf Summary

Dr. Craig H. Bennett’s 2020 presentation on knee cartilage injuries advocates for surface cartilage treatments, especially for moderate to large, mainly contained Grade 3 and Grade 4A lesions. Key factors in treatment decisions include lesion size, depth, location, and patient variables like age and activity level. For small lesions, multiple treatment options exist; for larger defects, autologous surface cell therapies or fresh osteochondral allografts (OCAs) are preferred, with surface grafts favored over OCAs particularly for complex or patellofemoral lesions.<br /><br />Surface grafts offer technical ease, better conformity to underlying bone, and fewer biological risks like immune reactions or disease transmission compared to fresh OCAs. OCAs carry risks of infection, immune response, graft failure, and practical challenges such as availability and surgical complexity.<br /><br />Autologous chondrocyte implantation (ACI) has evolved through four generations, improving durability, handling, and outcomes. Long-term data show ACI success rates up to 82%-92% for lesions under 4.5 cm² and younger patients. Randomized controlled trials demonstrate Matrix-Induced ACI (MACI) outperforms microfracture procedures with sustained benefits at five years. Accelerated rehabilitation protocols following MACI show comparable safety and functional outcomes.<br /><br />Patellofemoral lesions benefit particularly from surface grafting due to anatomical considerations, with both ACI and OCA showing good mid-term results but with higher failure rates seen in fresh OCAs. Surface allograft options like cryopreserved grafts and micronized BioCartilage provide convenient, less costly alternatives with encouraging early outcomes.<br /><br />In case of surface graft failure, fresh OCAs remain a salvage option, and if fresh OCAs fail, further strategies are considered. Overall, maintaining healthy bone and restoring cartilage anatomically using surface cell-based treatments is the preferred approach, reserving fresh OCAs primarily for revisions. This approach is supported by extensive literature and aims to optimize durability, minimize biological risks, and improve patient functional recovery in knee cartilage repair.

Keywords

knee cartilage injuries

surface cartilage treatments

Grade 3 and Grade 4A lesions

autologous surface cell therapies

osteochondral allografts (OCAs)

autologous chondrocyte implantation (ACI)

Matrix-Induced ACI (MACI)

patellofemoral lesions

cryopreserved grafts

cartilage repair rehabilitation