Decision making in cartilage repair procedures

The treatment of isolated articular cartilage lesions remains a difficult clinical problem. Cartilage has a poor intrinsic capacity for repair. Untreated lesions persist indefinitely and can predispose affected joints to pain and dysfunction. Fortunately, the treatment options for these lesions continue to evolve and expand. However, a validated approach to the treatment of such lesions remains elusive. Decision making in these circumstances is highly variable between practitioners. We describe an approach to the patient with a symptomatic articular cartilage lesion. Consideration of certain parameters, including lesion size, lesion location, patient demand, body mass index, limb alignment, and treatment history should be considered when selecting a surgical approach. In addition, surgeons should understand the physiology of the cartilage repair method employed and how this relates to the postoperative rehabilitation program. Cartilage repair strategies are classified into the following: enhancement intrinsic repair response, cell-based, scaffold-based, cell plus scaffold-based, and whole tissue transplantation. A treatment algorithm based on lesion size, patient demand, and treatment (primary vs secondary) is presented.