Tibial plateau defects present a challenging clinical entity, as their location, geometry, and proximity to surrounding structures make them technically challenging to treat. Additionally, the literature on the management of tibial plateau cartilage defects is not well-developed. Techniques such as osteochondral allografts or autografts are technically complicated in these regions and should be approached with caution. Microfracture is a well-established technique that is technically simple and has low rates of complications, and it is well-suited for treating tibial plateau defects. However, concerns about the long-term outcomes of microfracture have been raised, likely secondary to the generation of fibrocartilage. Newer treatments that are available including BioCartilage (Arthrex, Naples, FL) and matrix-associated autologous chondrocyte implantation (MACI) may have promise in this technically demanding area.
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