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

Video Transcription

Video Summary

Dr. Craig Bennett discusses knee cartilage injuries and treatment options, emphasizing surface cartilage repair techniques for moderate to large, contained grade 3 and 4A lesions. He highlights the importance of factors such as lesion size, location, patient age, and bone health in treatment decisions. For lesions larger than 2 cm², advanced autologous chondrocyte implantation (ACI) offers technical, biological, and clinical advantages over fresh osteochondral allografts (OCAs), including easier procedures, better conformity to bone contours, no immune reactions, and preservation of healthy bone. Long-term studies show ACI success rates around 82%, outperforming OCAs in durability and return to high-level sports. Third- and fourth-generation ACI techniques have improved surgical consistency, decreased complications like periosteal hypertrophy, and allow earlier weight bearing. While OCAs remain valuable especially in revision cases or situations with poor bone quality, they present challenges such as immune response and technical demands. Surface allograft options, including cryopreserved cartilage and micronized cartilage matrices, provide cost-effective, less invasive alternatives with promising early outcomes. Dr. Bennett underscores that maintaining normal anatomy via cell-based surface cartilage restoration aligns with orthopedic principles, offering young patients better long-term outcomes. He concludes that for most moderate to large lesions, especially in cost-sensitive environments, surface cartilage procedures—autograft or allograft—are optimal, reserving fresh OCAs mainly for revisions.

Keywords

knee cartilage injuries

surface cartilage repair

autologous chondrocyte implantation (ACI)

osteochondral allografts (OCA)

lesion size and location

third and fourth generation ACI

immune response in cartilage treatment

cost-effective cartilage restoration