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J Knee Surg 2020; 33(12): 1187-1200
DOI: 10.1055/s-0040-1721053
Special Focus Section

Management of Large Focal Chondral and Osteochondral Defects in the Knee

Jacob G. Calcei 
1   Department of Orthopaedic Surgery, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio
,
Taylor Ray
2   Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, California
,
Seth L. Sherman
2   Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, California
,
Jack Farr
3   Knee Preservation and Cartilage Restoration Center, OrthoIndy, Indianapolis, Indiana
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Abstract

Large, focal articular cartilage defects of the knee (> 4 cm2) can be a source of significant morbidity and often require surgical intervention. Patient- and lesion-specific factors must be identified when evaluating a patient with an articular cartilage defect. In the management of large cartilage defects, the two classically utilized cartilage restoration procedures are osteochondral allograft (OCA) transplantation and cell therapy, or autologous chondrocyte implantation (ACI). Alternative techniques that are available or currently in clinical trials include a hyaluronan-based scaffold plus bone marrow aspirate concentrate, a third-generation autologous chondrocyte implant, and an aragonite-based scaffold. In this review, we will focus on OCA and ACI as the mainstay in management of large chondral and osteochondral defects of the knee. We will discuss the techniques and associated clinical outcomes for each, while including a brief mention of alternative treatments. Overall, cartilage restoration techniques have yielded favorable clinical outcomes and can be successfully employed to treat these challenging large focal lesions.

Keywords

large chondral defects - cartilage injury - autologous chondrocyte implantation - osteochondral allograft transplant


Publication History

Received: 28 May 2020

Accepted: 17 October 2020

Article published online:
01 December 2020

© 2020. Thieme. All rights reserved.

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

 

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