This 1982 Current Concepts Review by Mankin synthesizes experimental evidence on how articular cartilage responds to three types of mechanical injury. It explains why the avascular nature of cartilage fundamentally limits healing compared with other musculoskeletal tissues. The injury-type framework — superficial laceration, deep penetrating, and blunt impact — remains the organizing taxonomy for cartilage pathology and surgical decision-making.
William Hunter wrote in 1743 that ulcerated cartilage, once destroyed, is not repaired. Mankin's 1982 review gave that observation its mechanistic explanation and clinical framework.
When a patient has an isolated chondral lesion that does not reach bone — found incidentally at arthroscopy. The evidence says: leave it alone or debride it, but do not expect repair. These lesions are stable and rarely progress.
When you make the decision to perform microfracture or subchondral drilling, you are deliberately crossing the tidemark to recruit marrow-derived cells. The resulting fibrocartilage is functional but imperfect, which is why defect size matters: stay below 3 mm for reliable healing, and counsel patients that tissue above 9 mm will not fully fill.
The CPM data reported here, drawn from Salter's concurrent rabbit work, is why we mobilize cartilage repair patients early rather than immobilize them. Motion drives differentiation toward hyaline-like tissue.
This 1982 Current Concepts Review by Mankin synthesizes experimental evidence on how articular cartilage responds to three types of mechanical injury. It explains why the avascular nature of cartilage fundamentally limits healing compared with other musculoskeletal tissues. The injury-type framework — superficial laceration, deep penetrating, and blunt impact — remains the organizing taxonomy for cartilage pathology and surgical decision-making.
William Hunter wrote in 1743 that ulcerated cartilage, once destroyed, is not repaired. Mankin's 1982 review gave that observation its mechanistic explanation and clinical framework.
When a patient has an isolated chondral lesion that does not reach bone — found incidentally at arthroscopy. The evidence says: leave it alone or debride it, but do not expect repair. These lesions are stable and rarely progress.
When you make the decision to perform microfracture or subchondral drilling, you are deliberately crossing the tidemark to recruit marrow-derived cells. The resulting fibrocartilage is functional but imperfect, which is why defect size matters: stay below 3 mm for reliable healing, and counsel patients that tissue above 9 mm will not fully fill.
The CPM data reported here, drawn from Salter's concurrent rabbit work, is why we mobilize cartilage repair patients early rather than immobilize them. Motion drives differentiation toward hyaline-like tissue.