Management of Large Focal Chondral and Osteochondral Defects in the Knee.

Journal and index pages often block iframe embedding. This reader keeps the evidence details in Orthonotes and leaves the source page one click away.

Abstract

[Indexed for MEDLINE] Conflict of interest statement: S. L. S. reports personal fees from Joint Restoration Foundation, personal fees from Olympus, personal fees from Smith and Nephew, personal fees from Vericel, personal fees from Arthrex, personal fees from ConMed, personal fees from Flexion Therapeutics, personal fees from Vivorte, outside the submitted work.J. F. reports other from Active Implants, personal fees from Aesculap/B.Braun, from American Journal of Orthopedics, personal fees and other from Arthrex, Inc., personal fees from Biopoly, LLC, personal fees from Cartiheal, other from Cartilage, personal fees from Cook Biotech, Inc., other from Episurf, personal fees from Exactech, other from Fidia Pharma, other from JRF Ortho, personal fees from MedShape, Inc., personal fees and other from Moximed, Inc., other from Novartis, personal fees and other from Organogenesis, personal fees from Ortho Regenerative Tech, Inc., personal fees from Regentis, personal fees and other from Samumed, Inc., personal fees and other from Springer, personal fees and other from Thieme Medical Publishers, Inc., personal fees and other from Vericel, other from ZimmerBiomet, personal fees from ZKR Orthopedics, Inc., outside the submitted work. 5. Indian J Orthop. 2021 Jan 26;55(2):252-262. doi: 10.1007/s43465-021-00355-z. eCollection 2021 Apr. Managing Chondral Lesions: A Literature Review and Evidence-Based Clinical Guidelines. Banerjee S(1), Sahanand KS(2). Author information: (1)Department of Orthopedics, All India Institute of Medical Sciences, Jodhpur, Rajasthan 342001 India. (2)Ortho-One Orthopedic Speciality Centre, Coimbatore, Tamil Nadu 641005 India. BACKGROUND: Articular cartilage lesions are becoming increasingly common. Optimum diagnosis and management of chondral defects cause a lot of dilemma. A number of surgical methods have been reported in the literature for treating focal cartilage defects. There is a lack of consensus on the most effective management strategy, with newer surgical and cell-based treatments being advocated regularly. STUDY DESIGN AND METHODS: A clinical review is constructed by appraising the published literature about clinical evaluation and diagnostic modalities for articular cartilage defects and subsequent surgical procedures, management strategies employed for such lesions. Prominent available databases (PUBMED, EMBASE, Cochrane) were also searched for trials comparing functional outcomes following cartilage procedures. Synthesis of a practical management guideline is then attempted based on the evidence assessed. RESULTS: Systematic examination and optimal use of diagnostic imaging are an important facet of cartilage defect management. Patient and lesion factors greatly influence the outcome of cartilage procedures and must be considered while planning management. Smaller lesions  4 cm2, newer generation autologous chondrocyte implantation (ACI) has shown promising and durable results. Stem cells with scaffolds may provide an alternate option. Orthobiologics are a useful adjunct to the surgical procedures, but need further evaluation. CONCLUSIONS: Most treatment modalities have their role in appropriate cases and management needs to be individualized for patients. The search for the perfect cartilage restoration procedure continues. © Indian Orthopaedics Association 2021. DOI: 10.1007/s43465-021-00355-z PMCID: PMC8046678