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Managing Chondral Lesions: A Literature Review and Evidence-Based Clinical Guidelines

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Abstract

Background

Articular cartilage lesions are becoming increasingly common. Optimum diagnosis and management of chondral defects cause a lot of dilemma. A number of surgical methods have been reported in the literature for treating focal cartilage defects. There is a lack of consensus on the most effective management strategy, with newer surgical and cell-based treatments being advocated regularly.

Study Design and Methods

A clinical review is constructed by appraising the published literature about clinical evaluation and diagnostic modalities for articular cartilage defects and subsequent surgical procedures, management strategies employed for such lesions. Prominent available databases (PUBMED, EMBASE, Cochrane) were also searched for trials comparing functional outcomes following cartilage procedures. Synthesis of a practical management guideline is then attempted based on the evidence assessed.

Results

Systematic examination and optimal use of diagnostic imaging are an important facet of cartilage defect management. Patient and lesion factors greatly influence the outcome of cartilage procedures and must be considered while planning management. Smaller lesions < 2 cm2 respond well to all treatment modalities. Autologous osteochondral transplants (OATs) are effective in high activity individuals with intermediate lesions. For larger lesions > 4 cm2, newer generation autologous chondrocyte implantation (ACI) has shown promising and durable results. Stem cells with scaffolds may provide an alternate option. Orthobiologics are a useful adjunct to the surgical procedures, but need further evaluation.

Conclusions

Most treatment modalities have their role in appropriate cases and management needs to be individualized for patients. The search for the perfect cartilage restoration procedure continues.

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Acknowledgements

The authors would like to acknowledge the help of Dr. Suvinay Saxena and Dr. Pawan Garg both from the Department of Diagnostic and Interventional Radiology, AIIMS Jodhpur for their valuable help with imaging figures in the article.

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Authors and Affiliations

  1. Department of Orthopedics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342001, India

    Sumit Banerjee

  2. Ortho-One Orthopedic Speciality Centre, Coimbatore, Tamil Nadu, 641005, India

    K. Santosh Sahanand

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Correspondence to Sumit Banerjee.

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Banerjee, S., Sahanand, K.S. Managing Chondral Lesions: A Literature Review and Evidence-Based Clinical Guidelines. JOIO 55, 252–262 (2021). https://doi.org/10.1007/s43465-021-00355-z

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