A 2020 narrative review by Krych et al. synthesizing assessment and surgical decision-making for focal knee cartilage injuries. It organizes treatment options by defect size, location, and concurrent pathology. The paper addresses when to use each technique and why microfracture has fallen out of favor.
Every cartilage case starts with the same two questions: how big is the defect, and what concurrent pathology needs to be fixed? Below 2 cm², use chondroplasty or OAT. Do not default to microfracture — bone overgrowth occurs in over 60% of patients, and function deteriorates after 2 years.
Above 2 cm², choose OCA (for osteochondral lesions with bone involvement, revision cases, or when immediate functional loading matters) or MACI (for contained defects where a form-fitting cell-based graft is preferred). PJAC is a one-stage alternative for large patellar lesions, but long-term knee data are absent.
Before any cartilage procedure, correct malalignment ≥5°, reconstruct unstable ligaments, and address meniscal pathology. Skipping this step is the most reliable way to fail a technically well-executed repair.
A 2020 narrative review by Krych et al. synthesizing assessment and surgical decision-making for focal knee cartilage injuries. It organizes treatment options by defect size, location, and concurrent pathology. The paper addresses when to use each technique and why microfracture has fallen out of favor.
Every cartilage case starts with the same two questions: how big is the defect, and what concurrent pathology needs to be fixed? Below 2 cm², use chondroplasty or OAT. Do not default to microfracture — bone overgrowth occurs in over 60% of patients, and function deteriorates after 2 years.
Above 2 cm², choose OCA (for osteochondral lesions with bone involvement, revision cases, or when immediate functional loading matters) or MACI (for contained defects where a form-fitting cell-based graft is preferred). PJAC is a one-stage alternative for large patellar lesions, but long-term knee data are absent.
Before any cartilage procedure, correct malalignment ≥5°, reconstruct unstable ligaments, and address meniscal pathology. Skipping this step is the most reliable way to fail a technically well-executed repair.