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

Sgaglione Handout

Pdf Summary

This detailed overview by Dr. Nicholas Sgaglione addresses the diagnosis, clinical profiling, and treatment options for articular cartilage injuries, primarily focusing on the knee. Cartilage damage commonly presents with pain, effusion, mechanical symptoms, and can be associated with ligament injury, patella dislocation, or osteochondritis dissecans. Accurate diagnosis considers injury mechanism, lesion size, patient age, BMI, alignment, and activity level.<br /><br />Treatment strategies vary from palliative debridement to repair and replacement techniques. Microfracture (MFx) promotes cartilage repair by creating marrow stimulation holes but shows better outcomes in younger patients with smaller lesions and proper joint alignment. However, MFx durability can decline over time, with emerging concerns about subchondral bone damage (“bridge burned” phenomenon). Enhancements include deeper, narrower perforations and augmentations with scaffolds, growth factors, PRP, and stem cells, though randomized controlled trials are needed to validate these advances.<br /><br />Osteochondral autograft transfer (AOT) involves precise harvest and implantation of cartilage-bone plugs, demonstrating superior clinical results compared to MFx and debridement in certain cohorts. Fresh osteochondral allografts provide another option, with studies showing good survivorship and graft integration in young and athletic populations. Juvenile partictuated cartilage allografts have shown promising early outcomes due to their higher regenerative potential and chondrocyte density.<br /><br />Cell-based therapies like autologous chondrocyte implantation (ACI) and matrix-associated ACI (MACI) offer durable repair, with long-term data supporting their efficacy. Athletic populations treated with ACI have demonstrated good return-to-play rates, though issues remain with achieving true hyaline cartilage and integration.<br /><br />Addressing mechanical factors such as malalignment and ligament laxity (ACL) is essential for success. The presentation also highlights the unmet need for effective treatments in “tweener” patients (around 30 years old) who are too old for some repair techniques but too young for joint replacement. Biologics including PRP and stem cell therapies show potential benefits but require further rigorous studies.<br /><br />Overall, the management of articular cartilage injuries involves a continuum of treatments tailored to lesion characteristics and patient profiles, with ongoing evolution toward biologic augmentation and improved repair techniques.

Keywords

articular cartilage injuries

knee cartilage damage

microfracture technique

osteochondral autograft transfer

autologous chondrocyte implantation

matrix-associated ACI

patella dislocation

osteochondritis dissecans

biologic augmentation

stem cell therapy