Download PDF
J Knee Surg 2020; 33(12): 1180-1186
DOI: 10.1055/s-0040-1716359
Special Focus Section

Small Cartilage Defect Management

Brittney A. Hacken
1   Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
,
Matthew D. LaPrade 
1   Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
,
Michael J. Stuart 
1   Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
,
Daniel B. F. Saris
1   Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
,
Christopher L. Camp
1   Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
,
Aaron J. Krych
1   Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
› Author Affiliations Funding This study was partially funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases for the Musculoskeletal Research Training Program (T32AR56950). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.
› Further Information
    Permissions and Reprints

Abstract

Cartilage defects in the knee are common resulting in significant pain and morbidity over time. These defects can arise in isolation or concurrently with other associated injuries to the knee. The treatment of small (< 2–3 cm2) cartilage deficiencies has changed as our basic science knowledge of tissue healing has improved. Advancements have led to the development of new and more effective treatment modalities. It is important to address any associated knee injuries and limb malalignment. Surgical options are considered when nonoperative treatment fails. The specific procedure depends on individual patient characteristics, lesion size, and location. Debridement/chondroplasty, microfracture, marrow stimulation plus techniques, fixation of unstable osteochondral fragments, osteochondral autograft transfer, and osteochondral allograft transplantation, all have roles in the treatment of small cartilage defects.

Keywords

knee - cartilage defect - malalignment


Publication History

Received: 30 March 2020

Accepted: 21 July 2020

Article published online:
08 September 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Camp CL, Stuart MJ, Krych AJ. Current concepts of articular cartilage restoration techniques in the knee. Sports Health 2014; 6 (03) 265-273
    CrossrefPubMedGoogle Scholar
  • 2 Heir S, Nerhus TK, Røtterud JH. et al. Focal cartilage defects in the knee impair quality of life as much as severe osteoarthritis: a comparison of knee injury and osteoarthritis outcome score in 4 patient categories scheduled for knee surgery. Am J Sports Med 2010; 38 (02) 231-237
    CrossrefPubMedGoogle Scholar
  • 3 Arøen A, Løken S, Heir S. et al. Articular cartilage lesions in 993 consecutive knee arthroscopies. Am J Sports Med 2004; 32 (01) 211-215
    CrossrefPubMedGoogle Scholar
  • 4 Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG. Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy 1997; 13 (04) 456-460
    CrossrefPubMedGoogle Scholar
  • 5 Anderson DE, Rose MB, Wille AJ, Wiedrick J, Crawford DC. Arthroscopic mechanical chondroplasty of the knee is beneficial for treatment of focal cartilage lesions in the absence of concurrent pathology. Orthop J Sports Med 2017; 5 (05) 2325967117707213
    Google Scholar
  • 6 Lim HC, Bae JH, Song SH, Park YE, Kim SJ. Current treatments of isolated articular cartilage lesions of the knee achieve similar outcomes. Clin Orthop Relat Res 2012; 470 (08) 2261-2267
    CrossrefPubMedGoogle Scholar
  • 7 Mankin HJ. The response of articular cartilage to mechanical injury. J Bone Joint Surg Am 1982; 64 (03) 460-466
    CrossrefPubMedGoogle Scholar
  • 8 Patil S, Tapasvi SR. Osteochondral autografts. Curr Rev Musculoskelet Med 2015; 8 (04) 423-428
    CrossrefPubMedGoogle Scholar
  • 9 Rowland R, Colello M, Wyland DJ. Osteochondral autograft transfer procedure: arthroscopic technique and technical pearls. Arthrosc Tech 2019; 8 (07) e713-e719
    CrossrefPubMedGoogle Scholar
  • 10 Krych AJ, Hevesi M, Desai VS, Camp CL, Stuart MJ, Saris DBF. Learning from failure in cartilage repair surgery: an analysis of the mode of failure of primary procedures in consecutive cases at a tertiary referral center. Orthop J Sports Med 2018; 6 (05) 2325967118773041
    Google Scholar
  • 11 Allaire R, Muriuki M, Gilbertson L, Harner CD. Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy. J Bone Joint Surg Am 2008; 90 (09) 1922-1931
    CrossrefPubMedGoogle Scholar
  • 12 McCormick F, Harris JD, Abrams GD. et al. Trends in the surgical treatment of articular cartilage lesions in the United States: an analysis of a large private-payer database over a period of 8 years. Arthroscopy 2014; 30 (02) 222-226
    CrossrefPubMedGoogle Scholar
  • 13 Yanke AB, Konopka ML, Butty DC. et al. Effect of vertical or beveled chondral defect creation on rim deformation and contact. Cartilage 2019; 10 (02) 222-228
    CrossrefPubMedGoogle Scholar
  • 14 Scillia AJ, Aune KT, Andrachuk JS. et al. Return to play after chondroplasty of the knee in National Football League athletes. Am J Sports Med 2015; 43 (03) 663-668
    CrossrefPubMedGoogle Scholar
  • 15 Gudas R, Gudaitė A, Mickevičius T. et al. Comparison of osteochondral autologous transplantation, microfracture, or debridement techniques in articular cartilage lesions associated with anterior cruciate ligament injury: a prospective study with a 3-year follow-up. Arthroscopy 2013; 29 (01) 89-97
    CrossrefPubMedGoogle Scholar
  • 16 Bisson LJ, Kluczynski MA, Wind WM. et al. Patient outcomes after observation versus debridement of unstable chondral lesions during partial meniscectomy: the chondral lesions and meniscus procedures (ChAMP) randomized controlled trial. J Bone Joint Surg Am 2017; 99 (13) 1078-1085
    CrossrefPubMedGoogle Scholar
  • 17 Steadman JR, Rodkey WG, Rodrigo JJ. Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop Relat Res 2001; (391) S362-S369
    CrossrefPubMedGoogle Scholar
  • 18 Steadman JR, Rodkey WG, Briggs KK. Microfracture: its history and experience of the developing surgeon. Cartilage 2010; 1 (02) 78-86
    CrossrefPubMedGoogle Scholar
  • 19 Cerynik DL, Lewullis GE, Joves BC, Palmer MP, Tom JA. Outcomes of microfracture in professional basketball players. Knee Surg Sports Traumatol Arthrosc 2009; 17 (09) 1135-1139
    CrossrefPubMedGoogle Scholar
  • 20 Bert JM. Abandoning microfracture of the knee: has the time come?. Arthroscopy 2015; 31 (03) 501-505
    CrossrefPubMedGoogle Scholar
  • 21 Mithoefer K, McAdams T, Williams RJ, Kreuz PC, Mandelbaum BR. Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: an evidence-based systematic analysis. Am J Sports Med 2009; 37 (10) 2053-2063
    Google Scholar
  • 22 Mithoefer K, Gill TJ, Cole BJ, Williams RJ, Mandelbaum BR. Clinical outcome and return to competition after microfracture in the athlete's knee: An evidence-based systematic review. Cartilage 2010; 1 (02) 113-120
    CrossrefPubMedGoogle Scholar
  • 23 Orth P, Goebel L, Wolfram U. et al. Effect of subchondral drilling on the microarchitecture of subchondral bone: analysis in a large animal model at 6 months. Am J Sports Med 2012; 40 (04) 828-836
    CrossrefPubMedGoogle Scholar
  • 24 Mithoefer K, Venugopal V, Manaqibwala M. Incidence, degree, and clinical effect of subchondral bone overgrowth after microfracture in the knee. Am J Sports Med 2016; 44 (08) 2057-2063
    CrossrefPubMedGoogle Scholar
  • 25 Pestka JM, Bode G, Salzmann G, Südkamp NP, Niemeyer P. Clinical outcome of autologous chondrocyte implantation for failed microfracture treatment of full-thickness cartilage defects of the knee joint. Am J Sports Med 2012; 40 (02) 325-331
    CrossrefPubMedGoogle Scholar
  • 26 Demange MK, Minas T, von Keudell A, Sodha S, Bryant T, Gomoll AH. Intralesional osteophyte regrowth following autologous chondrocyte implantation after previous treatment with marrow stimulation technique. Cartilage 2017; 8 (02) 131-138
    CrossrefPubMedGoogle Scholar
  • 27 Wu IT, Custers RJH, Desai VS. et al. Internal fixation of unstable osteochondritis dissecans: do open growth plates improve healing rate?. Am J Sports Med 2018; 46 (10) 2394-2401
    CrossrefPubMedGoogle Scholar
  • 28 Barrie HJ. Hypertrophy and laminar calcification of cartilage in loose bodies as probable evidence of an ossification abnormality. J Pathol 1980; 132 (02) 161-168
    CrossrefPubMedGoogle Scholar
  • 29 Carey JL, Grimm NL. Treatment algorithm for osteochondritis dissecans of the knee. Clin Sports Med 2014; 33 (02) 375-382
    CrossrefPubMedGoogle Scholar
  • 30 Bauer KL. Osteochondral injuries of the knee in pediatric patients. J Knee Surg 2018; 31: 382-391
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Hurley ET, Davey MS, Jamal MS, Manjunath AK, Alaia MJ, Strauss EJ. EJ S. Return-to-play and rehabilitation protocols following cartilage restoration procedures of the knee: a systematic review. Cartilage 2019; (e-pub ahead of print) DOI: 10.1177/1947603519894733.
    CrossrefPubMedGoogle Scholar
  • 32 Richter DL, Tanksley JA, Miller MD. Osteochondral autograft transplantation: a review of the surgical technique and outcomes. Sports Med Arthrosc Rev 2016; 24 (02) 74-78
    Google Scholar
  • 33 Krych AJ, Harnly HW, Rodeo SA, Williams III RJ. Activity levels are higher after osteochondral autograft transfer mosaicplasty than after microfracture for articular cartilage defects of the knee: a retrospective comparative study. J Bone Joint Surg Am 2012; 94 (11) 971-978
    Google Scholar
  • 34 Hangody L, Dobos J, Baló E, Pánics G, Hangody LR, Berkes I. Clinical experiences with autologous osteochondral mosaicplasty in an athletic population: a 17-year prospective multicenter study. Am J Sports Med 2010; 38 (06) 1125-1133
    CrossrefPubMedGoogle Scholar
  • 35 Hangody L, Vásárhelyi G, Hangody LR. et al. Autologous osteochondral grafting--technique and long-term results. Injury 2008; 39 (Suppl. 01) S32-S39
    CrossrefPubMedGoogle Scholar
  • 36 Filardo G, Kon E, Perdisa F, Balboni F, Marcacci M. Autologous osteochondral transplantation for the treatment of knee lesions: results and limitations at two years' follow-up. Int Orthop 2014; 38 (09) 1905-1912
    CrossrefPubMedGoogle Scholar
  • 37 Dozin B, Malpeli M, Cancedda R. et al. Comparative evaluation of autologous chondrocyte implantation and mosaicplasty: a multicentered randomized clinical trial. Clin J Sport Med 2005; 15 (04) 220-226
    CrossrefPubMedGoogle Scholar
  • 38 Krych AJ, Pareek A, King AH, Johnson NR, Stuart MJ, Williams III RJ. Return to sport after the surgical management of articular cartilage lesions in the knee: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2017; 25 (10) 3186-3196
    CrossrefPubMedGoogle Scholar
  • 39 Werner BC, Cosgrove CT, Gilmore CJ. et al. Accelerated return to sport after osteochondral autograft plug transfer. Orthop J Sports Med 2017; 5 (04) 2325967117702418
    Google Scholar
  • 40 Jackson DW, Lalor PA, Aberman HM, Simon TM. Spontaneous repair of full-thickness defects of articular cartilage in a goat model. A preliminary study. J Bone Joint Surg Am 2001; 83 (01) 53-64
    CrossrefPubMedGoogle Scholar
  • 41 Hangody L, Füles P. Autologous osteochondral mosaicplasty for the treatment of full-thickness defects of weight-bearing joints: ten years of experimental and clinical experience. J Bone Joint Surg Am 2003; 85-A (Suppl. 02) 25-32
    CrossrefPubMedGoogle Scholar
  • 42 Levy YD, Görtz S, Pulido PA, McCauley JC, Bugbee WD. Do fresh osteochondral allografts successfully treat femoral condyle lesions?. Clin Orthop Relat Res 2013; 471 (01) 231-237
    CrossrefPubMedGoogle Scholar
  • 43 Cavendish PA, Everhart JS, Peters NJ, Sommerfeldt MF, Flanigan DC. Osteochondral allograft transplantation for knee cartilage and osteochondral defects: a review of indications, technique, rehabilitation, and outcomes. JBJS Rev 2019; 7 (06) e7
    CrossrefPubMedGoogle Scholar
  • 44 Melugin HP, Ridley TJ, Bernard CD. et al. Prospective Outcomes of Cryopreserved Osteochondral Allograft for Patellofemoral Cartilage Defects at Minimum 2-Year Follow-up. Cartilage 2020; (e-pub ahead of print) DOI: 10.1177/1947603520903420.
    CrossrefPubMedGoogle Scholar
  • 45 Hoffman JK, Geraghty S, Protzman NM. Articular cartilage repair using marrow stimulation augmented with a viable chondral allograft: 9-month postoperative histological evaluation. Case Rep Orthop 2015; 2015: 617365
    PubMedGoogle Scholar
  • 46 Geraghty S, Kuang JQ, Yoo D, LeRoux-Williams M, Vangsness Jr. CT, Danilkovitch A. A novel, cryopreserved, viable osteochondral allograft designed to augment marrow stimulation for articular cartilage repair. J Orthop Surg Res 2015; 10: 66
    CrossrefPubMedGoogle Scholar
  • 47 Cotter EJ, Wang KC, Yanke AB, Chubinskaya S. Bone marrow aspirate concentrate for cartilage defects of the knee: from bench to bedside evidence. Cartilage 2018; 9 (02) 161-170
    CrossrefPubMedGoogle Scholar
  • 48 Bogunovic L, Wetters NG, Jain A, Cole BJ, Yanke AB. In vitro analysis of micronized cartilage stability in the knee: effect of fibrin level, defect size, and defect location. Arthroscopy 2019; 35 (04) 1212-1218
    CrossrefPubMedGoogle Scholar
  • 49 Fortier LA, Chapman HS, Pownder SL. et al. BioCartilage improves cartilage repair compared with microfracture alone in an equine model of full-thickness cartilage loss. Am J Sports Med 2016; 44 (09) 2366-2374
    Google Scholar
  • 50 Abrams GD, Mall NA, Fortier LA, Roller BL, Cole BJ. BioCartilage: background and operative technique. Oper Tech Sports Med 2013; 21 (02) 116-124
    CrossrefPubMedGoogle Scholar
  • 51 Steinwachs M, Cavalcanti N, Mauuva Venkatesh Reddy S, Werner C, Tschopp D, Choudur HN. Arthroscopic and open treatment of cartilage lesions with BST-CARGEL scaffold and microfracture: a cohort study of consecutive patients. Knee 2019; 26 (01) 174-184
    Google Scholar
  • 52 Shive MS, Stanish WD, McCormack R. et al. BST-CarGel treatment maintains cartilage repair superiority over microfracture at 5 years in a multicenter randomized controlled trial. Cartilage 2015; 6 (02) 62-72
    CrossrefPubMedGoogle Scholar