ICL 107 State of the Art Approach to Chondral Injury-Farr Handout

Farr Handout

Pdf Summary

This document by Dr. Jack Farr from the OrthoIndy Cartilage Restoration Center addresses the management of co-morbidities in patients undergoing cartilage restoration procedures. Effective treatment requires comprehensive evaluation and management of associated conditions, both mental and physical, to optimize outcomes.<br /><br />Mental health factors include patient attitude (positive vs. negative), realistic vs. unrealistic expectations, untreated vs. treated depression, and fatigue from multiple surgeries. Physically, whole body conditioning and specific limb factors such as core strength, balance, flexibility, knee muscle atrophy, and body mass index (BMI) are critical considerations because these affect stress tolerance on restorative tissues.<br /><br />Alignment abnormalities are extensively reviewed:<br />- Tibiofemoral varus alignment results in 65% medial compartment loading, typically warranting low-threshold osteotomy (correcting to neutral or slight lateral) to offload the medial compartment without overloading the lateral side.<br />- Tibiofemoral valgus involves 35% lateral compartment load with a higher osteotomy threshold; correction aims to neutralize loading.<br />- Patellofemoral alignment issues, including femoral anteversion, tibial torsion, lateral patellar tilt, and chronic subluxation or dislocation, require targeted surgical techniques such as derotation osteotomies, soft tissue balancing, tuberosity anteromedialization (AMZ), and adjustments in patellar height (alta/infera).<br /><br />Stability problems include ACL injuries, often requiring revision, and patellofemoral instability with medial patellofemoral ligament (MPFL) pathology or iatrogenic medial instability after lateral release.<br /><br />Meniscal pathology requires careful decision-making between repair versus excision, and absence of meniscus necessitates observation, unloading strategies, or transplantation. Bone issues such as bone marrow lesions, insufficiency fractures, avascular necrosis, and osteoporosis must be stabilized, treated, or medically managed, potentially with bone grafting or osteochondral allograft (OCA).<br /><br />In conclusion, Dr. Farr emphasizes thorough documentation and treatment of all co-morbidities during informed consent and treatment planning, aiming to combine management approaches with cartilage restoration procedures to minimize surgeries and enhance patient outcomes.

Keywords

cartilage restoration

co-morbidities management

mental health factors

physical conditioning

alignment abnormalities

osteotomy

patellofemoral instability

meniscal pathology

bone marrow lesions

informed consent