Staging and comorbidities

Abstract

Articular cartilage lesions of the distal femur and patella are common. To provide an accurate diagnosis of a clinically symptomatic cartilage lesion and subsequent appropriate planning for potential treatment options, a proper staging is required. This includes clinical exam, radiographic imaging as well as arthroscopy. Once the staging is completed, other comorbidities may need to be addressed that may require additional surgical procedures. These can either be planned as staged procedures or concomitantly with a cartilage repair procedure. This article will discuss this staging and evaluation process in depth to serve as a guideline to the orthopaedic surgeon engaged in the treatment of cartilage defects in patients with early posttraumatic osteoarthritis (OA).

Figure 1

ICRS grading scheme for cartilage defects.

Figure 2

This is a Grade 4b lesion in a medial femoral condyle after direct trauma. This patient was involved in an MVA 3 months prior to this image and had a penetrating trauma to the knee.

Figure 3

Lesion 3A is an isolated Grade 3b defect in an otherwise pristine appearing knee joint. This patient went on to receive a microfracture and did well. Figure 3B is a similar size Grade 3b lesion (indicated with the circle) surrounded by areas of Grade 2 lesions. This patient failed an initial microfracture and went on to receive an autologous chondrocytes implantation involving the majority of her condyle (2.2×4.8cm). Even though this is obvious on the video of this lesion it is difficult to document this significant difference in character of this lesion in pictures.