Chondral Lesions

Abstract

Articular cartilage damage is a common cause of disability in the knee. Damage to the articular cartilage can span from isolated chondral defects to diffuse cartilage loss and osteoarthritis. Establishing a correct diagnosis and correctly characterizing the lesion are critical in determining a treatment plan. Operative treatment is considered if nonoperative treatment measures fail. Operative treatment techniques include debridement, marrow-stimulating techniques, cartilage restoration procedures (such as ACI), and cartilage replacement (osteochondral autograft or allograft). The type of cartilage procedure chosen depends on many factors including the size of the lesion, condition of the underlying bone, location of the lesion, prior procedures performed, and demands of the patient. Advanced imaging with magnetic resonance imaging (MRI) should be done to evaluate the articular cartilage and subchondral bone and to assess for concomitant meniscus and ligamentous injuries or deficiencies. However, the accuracy of MRI in predicting the size of the lesion has been questioned and has been found to underestimate the size of the lesion. Diagnostic arthroscopy and staged procedures can be very useful and should be considered. This chapter utilizes a case-based format to demonstrate the correlation between MRI and arthroscopy for articular cartilage lesions of the knee. Diagnosis and management of each patient is discussed for each of the seven cases.