Treatment Options for Focal Cartilage Lesions of the Knee.

Abstract

Background: Focal lesions of knee cartilage are a common reason for consulting an orthopedic surgeon. They may be painful and impair knee joint function. Cartilage lesions can progress to osteoarthritis of the knee.

Methods: This narrative review is based on pertinent publications of the last 25 years that were retrieved by a selective search in PubMed.

Results: Nonsteroidal anti-inflammatory drugs, physiotherapy, weight loss, and intra-articular injections are the available options for conservative treatment. The choice of surgical technique is primarily based on the area over which the lesion extends. Surgical treatment options include bone marrow stimulation with or without a matrix, osteochondral transplantation, autologous cartilage cell transplantation, and the minced cartilage technique. Among all these, autologous chondrocyte transplantation has yielded the best results, and its superiority has been demonstrated in randomized controlled trials. Autologous chondrocytes are cultured in a collagen matrix in vitro and sutured onto the edges of the cartilage lesion. The minced cartilage technique is relatively new, and the evidence, thus far, is limited.

Conclusion: The current standard of treatment for knee cartilage lesions with an area of ca. 2 cm2 or more is matrix-associated autologous chondrocyte transplantation. Smaller lesions can be treated with osteochondral transplantation or bone marrow stimulation, possibly combined with a matrix for medium-sized lesions. The minced cartilage technique has high potential and has yielded promising initial results; its wider implementation will need a larger evidence base.