Revision Cartilage Treatment
Due to its multifaceted nature and high rates for revision procedures, failed cartilage repair represents a challenging problem in patients. Prior to performing a revision procedure, it is essential to identify the non-modifiable and modifiable risk factors that accelerate the degradation of primary cartilage repair tissue. Comorbidities can include a patient’s activity status, malalignment, or instability. Since MRI findings may underestimate the true size of a cartilage lesion, data should also be collected from past operative reports and staging arthroscopies. This should be combined with a comprehensive physical exam to assess ligamentous integrity and proper limb alignment in order to optimize the intra-articular environment. When performing osteochondral allograft transplantation for large osteochondral defects, there are a number of important technical strategies and repair options to choose from in order to optimize graft incorporation. For patients who have failed a prior MST and show cystic or osteophytic changes on MRI, it is likely wise to favor OCA. However, in their absence the surgeon may proceed with either OCA or ACI.
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