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Review
. 2016 Mar-Apr;8(2):153-60.
doi: 10.1177/1941738115611350. Epub 2015 Oct 12.

Knee Articular Cartilage Repair and Restoration Techniques: A Review of the Literature

Dustin L Richter  1 , Robert C Schenck Jr  2 , Daniel C Wascher  2 , Gehron Treme  2
Affiliations
Review

Knee Articular Cartilage Repair and Restoration Techniques: A Review of the Literature

Dustin L Richter et al. Sports Health. 2016 Mar-Apr.

Abstract

Context: Isolated chondral and osteochondral defects of the knee are a difficult clinical challenge, particularly in younger patients for whom alternatives such as partial or total knee arthroplasty are rarely advised. Numerous surgical techniques have been developed to address focal cartilage defects. Cartilage treatment strategies are characterized as palliation (eg, chondroplasty and debridement), repair (eg, drilling and microfracture [MF]), or restoration (eg, autologous chondrocyte implantation [ACI], osteochondral autograft [OAT], and osteochondral allograft [OCA]).

Evidence acquisition: PubMed was searched for treatment articles using the keywords knee, articular cartilage, and osteochondral defect, with a focus on articles published in the past 5 years.

Study design: Clinical review.

Level of evidence: Level 4.

Results: In general, smaller lesions (<2 cm(2)) are best treated with MF or OAT. Furthermore, OAT shows trends toward greater longevity and durability as well as improved outcomes in high-demand patients. Intermediate-size lesions (2-4 cm(2)) have shown fairly equivalent treatment results using either OAT or ACI options. For larger lesions (>4 cm(2)), ACI or OCA have shown the best results, with OCA being an option for large osteochondritis dissecans lesions and posttraumatic defects.

Conclusion: These techniques may improve patient outcomes, though no single technique can reproduce normal hyaline cartilage.

Keywords: articular cartilage; autologous chondrocyte implantation; cartilage restoration; knee; microfracture; mosaicplasty; osteochondral autograft transfer; osteochondral defect.

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Conflict of interest statement

The authors report no potential conflicts of interest in the development and publication of this article.

Figures

Figure 1.
Figure 1.
(a) Coronal magnetic resonance image (MRI) demonstrating a medial femoral condyle osteochondral defect. (b) Sagittal MRI of osteochondral defect involving the weightbearing portion of the medial femoral condyle.
Figure 2.
Figure 2.
(a) Arthroscopic view after microfracture treatment of the medial femoral condyle in patient from Figure 1. (b, c) Follow-up coronal and sagittal magnetic resonance images 1 year after microfracture showing filling of osteochondral defect. (d) Second-look arthroscopy 1 year after microfracture demonstrating filling of previous defect with reparative tissue.
Figure 3.
Figure 3.
(a) Arthroscopic view of cylindrical sizer used to characterize defect and pattern for osteochondral autograft plug transfer. (b) First of 2 plugs sunk flush with the surrounding articular cartilage. (c) Two plugs have been transferred to fill the osteochondral defect.
Figure 4.
Figure 4.
(a) Arthoscopic view of autologous chondrocyte implantation (ACI) with sutured patch. (b) Second-look arthoscopy 1 year after ACI demonstrating filling of defect with reparative tissue.
Figure 5.
Figure 5.
Anteroposterior radiograph of a lateral unicompartmental osteochondral allograft.
See this image and copyright information in PMC

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