Cartilage Injury of the Knee: Current Controversies in 2022 (AANA22)-Cartilage Case Pane: It Doesn’t Have to be Complex to be Controversial

Video Transcription

Video Summary

The panel discusses management of patellofemoral cartilage lesions, emphasizing that tibial tubercle osteotomy (TTO) is not required for every case but used based on abnormal anatomy and lesion characteristics. Anteriorization with TTO unloads the patella effectively. For meniscus root repair, early range of motion is allowed but weight-bearing is limited for six weeks. Managing cartilage defects in patients with high BMI involves encouraging weight loss preoperatively, though surgery can be considered in selected cases. Cartilage repair candidacy depends on lesion focality and OA severity; osteotomy decisions are based on alignment degrees. Small focal defects, particularly in the trochlea, may be managed with biologics, marrow stimulation, or osteochondral plugs, depending on size and patient factors. Subchondral bone edema signals joint failure and requires biomechanical correction rather than direct bone treatment. There is skepticism about routine heat use for cartilage smoothing and marrow stimulation is less common, reserved for select cases. Osteochondral allograft transplantation is favored for significant subchondral bone involvement or high-demand patients. For borderline malalignment (3-4 degrees varus), treatment is individualized based on lesion cause and patient activity. Novel implant techniques like coral plugs rely on mesenchymal cell migration for cartilage regeneration and have shown good outcomes in select trochlear lesions. The overall approach combines anatomy correction, lesion-specific interventions, and patient factors for optimal cartilage repair.

Keywords

patellofemoral cartilage lesions

tibial tubercle osteotomy

meniscus root repair

high BMI cartilage defects

osteochondral allograft transplantation

subchondral bone edema

coral plug implants