APEX Knee Navigating Pearls and Pitfalls-Dealing with Failed Cartilage Surgery

Video Transcription

Video Summary

Dr. Andreas Gomoll discusses failures in cartilage repair, emphasizing that complications are common and understanding failure mechanisms is crucial for effective revision. Failures can arise from disease progression in other knee compartments rather than the repair itself, or from issues like delamination, poor biological integration, formation of fibrous tissue or bone instead of cartilage, graft collapse, or unexplained pain. Causes of failure may include bad luck, patient factors (e.g., unrealistic expectations, smoking, obesity, age), poor patient selection, suboptimal products, or procedural errors such as wrong procedure choice or poor technique. Revision strategies depend on accurate diagnosis using imaging (MRI, CT arthrogram) and diagnostic arthroscopy. Important considerations include correcting alignment and addressing meniscal or ligament issues. Sometimes staged procedures are preferable. Managing patient expectations is vital, as revision surgeries have lower success rates (~60%) than primaries. Conservative management may be suitable when structural issues cannot be identified. In cases of extensive joint damage, knee replacement might be the best option. Dr. Gomoll stresses learning from failures to improve primary and revision outcomes, careful patient counseling, and individualized treatment planning to optimize cartilage repair success.

Asset Caption

Dr. Andreas Gomoll

Keywords

cartilage repair failure

revision surgery

knee joint complications

diagnostic imaging MRI CT

patient selection factors

surgical technique errors

treatment planning