Chondral Injury of the Knee: Current Controversies in 2019 (AANA19)-Get It Right The First Time!-Dr. Aaron John Krych, M.D.

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Video Summary

The speaker emphasizes careful patient evaluation in cartilage surgery, often advising against surgery unless truly indicated. Key steps include thorough imaging—X-rays, long-leg standing films, and MRIs—to distinguish focal lesions (like a single "pothole") from diffuse cartilage damage ("more potholes than road"). Proper diagnosis guides treatment, as diffuse damage generally isn’t suitable for cartilage restoration, whereas focal lesions may benefit from procedures like osteochondral allografts or autograft transfers. Addressing underlying biomechanical issues, such as malalignment, is crucial to success, often requiring additional procedures like osteotomies or ligament reconstructions. Patient expectations must be managed realistically: cartilage surgery improves but doesn’t fully restore the knee, with pain reduction often partial. Age is less critical than knee physiology and patient health. Diagnostic staging arthroscopy before definitive surgery can reveal lesion details not visible on MRI and sometimes has therapeutic value alone. The discussion highlights balancing imaging, clinical judgement, and individualized treatment planning for optimal outcomes.

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Instructional Course Lecture: Chondral Injury of the Knee: Current Controversies in 2019

Keywords

cartilage surgery

patient evaluation

imaging techniques

focal lesions

biomechanical issues