[Techniques for repair of chondral and osteochondral lesions in the knee. Principles of rehabilitation]

Abstract

The objective of the present study is to assess the techniques, indications and management of the three principal repair methods of cartilaginous lesions of the knee. Arthroscopic irrigation and debridement are excluded. The most important articles of the last 20 years have been evaluated favouring those written by the protagonists of the technique and those with the longest follow-up. Each technique, i.e. the microfractures, the osteochondral grafts and the chondrocyte grafts, is explained in detail with its surgical principles, management of specific reeducation and results. Postoperative treatment is not very different during the first weeks; for condyle lesions protection of the graft site is mandatory by strict avoidance of non weight bearing, whereas immediate mobilisation of the knee is possible; for patellar lesions, weight bearing is permitted whereas flexion is limited. Later, the delay concerning resumption of weight bearing, muscular training and sports is specific for each technique. These three techniques are only apply to symptomatic lesions of the condyle at the weight-hearing zone or the femoro-patellar site in young patients. The degenerative knee, even in its beginning, is excluded. Those lesions can be linked to rupture of the anterior cruciate ligament and immediate cartilaginous repair is discussed.