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.
- 8.Bentley G, Biant LC, Vijayan S, Macmull S, Skinner JA, Carrington RWJ. Minimum ten-year results of a prospective randomised study of autologous chondrocyte implantation versus mosaicplasty for symptomatic articular cartilage lesions of the knee. J Bone Joint Surg Br. 2012;94:504–9.CrossRefGoogle Scholar
- 9.Gudas R, Gudaitė A, Pocius A, Gudienė A, Čekanauskas E, Monastyreckiene E, Basevičius A. Ten-year follow-up of a prospective, randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint of athletes. Am J Sports Med. 2012;40:2499–508.CrossRefGoogle Scholar
- 11.Zaslav K, Cole B, Brewster R, DeBerardino T, Farr J, Fowler P, Nissen C. A prospective study of autologous chondrocyte implantation in patients with failed prior treatment for articular cartilage defect of the knee: results of the Study of the Treatment of Articular Repair (STAR) clinical trial. Am J Sports Med. 2008;37:42–55.CrossRefGoogle Scholar
- 13.Minas T, Ogura T, Headrick J, Bryant T. Autologous chondrocyte implantation “Sandwich” technique compared with autologous bone grafting for deep osteochondral lesions in the knee. Am J Sports Med. 2017;16:036354651773800.Google Scholar