Cartilage Conundrums in 2023: Cases From the Experts (2023 Annual Meeting)-Cartilage Conundrums in 2023

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Video Summary

The discussion centers on osteochondral lesions (OCD) of the lateral trochlea in a 22-year-old skeletally mature patient, highlighting the challenges in treatment. Such lesions often present with bone marrow edema, sclerosis, and instability, making conservative management less favorable. Surgeons note the lesion’s poor prognosis, especially in the lateral trochlea, often requiring surgical intervention including debridement, fixation, cartilage restoration (MACE, ACI, OCA), and possible tibial tubercle osteotomy for alignment correction. The decision to repair or remove unstable fragments depends on intraoperative assessment of fragment stability. CT arthrograms can aid preoperative planning. The group emphasizes that OCD in the trochlea may need multiple staged surgeries and warn patients accordingly. Treatment varies with patient age, lesion size, and symptoms; young patients with open growth plates may heal better. Overall, precise alignment and stabilization are crucial to optimize cartilage restoration outcomes, and fragmented lateral trochlear lesions remain difficult to manage successfully.

Asset Caption

Andreas Gomoll, M.D. | Rachel Frank, M.D.

Keywords

osteochondral lesions

lateral trochlea

cartilage restoration

surgical intervention

tibial tubercle osteotomy