In part 1 of this 2-part Current Concepts article, the authors reviewed the basic science of normal articular and meniscal cartilage and its response to injury. They reviewed the historical perspectives and basic science behind these various methods and presented a rationale for patient evaluation, treatment selection, and timing. In part 2, the authors review the specific indications for the treatment of chondral injuries and describe the techniques and outcomes of the various treatment options, including palliative, reparative, and restorative procedures. In addition, they will examine specific complex clinical scenarios emphasizing treatment options of comorbid conditions including ligament instability, meniscal deficiency, and malalignment. A limited review of the application of these techniques in joints other than the knee will also be presented. A conceptual algorithm is developed to assist in clinical decision making.
Aglietti P, Ciardullo A, Giron F, Ponteggia F. Results of arthroscopic excision of the fragment of osteochondritis dissecans of the knee. Arthroscopy.2001;17:741-746.
2.
Aichroth P. Osteochondritis dissecans of the knee: a clinical survey. J Bone Joint Surg Br.1971;53:440-447.
3.
Anderson A. Antegrade drilling for osteochondritis dissecans. Arthroscopy.1997;13:319-324.
4.
Angermann P, Jensen P. Osteochondritis dissecans of the talus: long-term results of surgical treatment. Foot Ankle.1989;10:161-163.
5.
Baker CL, Andrews JR, Ryan JB. Arthroscopic treatment of transchondral talar dome fractures. Arthroscopy.1986;2:82-87.
6.
Bartz RL, Kamaric E, Noble PC, Lintner D, Bocell J. Topographic matching of selected donor and recipient sites for osteochondral autografting of the articular surface of the femoral condyles. Am J Sports Med.2001;29:207-212.
7.
Bauer M, Jonsson K, Linden B. Osteochondritis dissecans of the ankle: a 20-year follow-up study. J Bone Joint Surg Br.1987;69:93-96.
8.
Bentley G, Biant LC, Carrington RW, et al.A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. J Bone Joint Surg Br.2003;85:223-230.
9.
Berlet GC, Mascia A, Miniaci A. Treatment of unstable osteochondritis dissecans lesions of the knee using autogenous osteochondral grafts (mosaicplasty). Arthroscopy.1999;15:312-316.
10.
Bert JM, Maschka K. The arthroscopic treatment of unicompartmental gonarthrosis: a five-year follow-up of abrasion arthroplasty plus arthroscopic debridement and arthroscopic debridement alone. Arthroscopy.1989;5:25-32.
11.
Blevins FT, Steadman JR, Rodrigo JJ, Silliman J. Treatment of articular cartilage defects in athletes: an analysis of functional outcome and lesion appearance. Orthopedics.1998;21:761-768.
12.
Bobic V. Arthroscopic osteochondral autograft transplantation in anterior cruciate ligament reconstruction: a preliminary clinical study. Knee Surg Sports Traumatol Arthrosc.1996;3:262-264.
13.
Bradley JP, Petrie RS. Osteochondritis dissecans of the humeral capitellum: diagnosis and treatment. Clin Sports Med.2001;20:565-590.
14.
Brittberg M, Nilsson A, Lindahl A, Ohlsson C, Peterson L. Rabbit articular cartilage defects treated with autologous cultured chondrocytes. Clin Orthop.1996;326:270-283.
15.
Brittberg M, Peterson L, Sjogren-Jansson E, Tallheden T, Lindahl A. Articular cartilage engineering with autologous chondrocyte transplantation: a review of recent developments. J Bone Joint Surg Am.2003;85(suppl 3):109-115.
Byrd JW, Jones KS. Arthroscopic surgery for isolated capitellar osteochondritis dissecans in adolescent baseball players: minimum three-year follow-up. Am J Sports Med.2002;30:474-478.
19.
Cain EL, Clancy WG. Treatment algorithm for osteochondral injuries of the knee. Clin Sports Med.2001;20:321-342.
20.
Chu CR, Convery FR, Akeson WH, Meyers M, Amiel D. Articular cartilage transplantation: clinical results in the knee. Clin Orthop.1999;360:159-168.
21.
Cole BJ, Carter TR, Rodeo SA. Allograft meniscal transplantation: background, techniques, and results. Instr Course Lect.2003;52:383-396.
22.
Cole BJ, Fox J, Nho S, et al.Prospective evaluation of autologous chondrocyte implantation. Paper presented at: Annual Meeting of the American Academy of Orthopaedic Surgeons; February 2003; New Orleans, La.
23.
Cugat R, Garcia M, Cusco X, et al.Osteochondritis dissecans: a historical review and its treatment with cannulated screws. Arthroscopy.1993;9:675-684.
24.
D’Amato M, Cole BJ. Autologous chondrocyte implantation. Orthop Tech.2001;11:115-131.
25.
Duchow J, Hess T, Kohn D. Primary stability of press-fit-implanted osteochondral grafts: influence of graft size, repeated insertion, and harvesting technique. Am J Sports Med.2000;28:24-27.
26.
Erggelet C, Sittinger M, Lahm A. The arthroscopic implantation of autologous chondrocytes for the treatment of full-thickness cartilage defects of the knee joint. Arthroscopy.2003;19:108-110.
27.
Fowler JL, Wicks MH. Osteochondritis dissecans of the lunate. J Hand Surg Am.1990;15:571-572.
Frisbie DD, Trotter GW, Steadman JR. Arthroscopic subchondral bone plate microfracture technique augments healing of large chondral defects in the radial carpal bone and medial femoral condyle of horses. Vet Surg.1999;28:242-255.
30.
Fulkerson JP. Anteromedialization of the tibial tuberosity for patellofemoral malalignment. Clin Orthop.1983;177:176-178.
31.
Garretson RB III, Katolik LI, Verma N, Beck BR, Cole BJ. Contact pressure at osteochondral donor sites in the patellofemoral joint. Am J Sports Med.2004;32:967-974.
32.
Garrett JC. Osteochondral allografts for reconstruction of articular defects of the knee. Instr Course Lect.1998;47:17-522.
33.
Ghazavi MT, Pritzker KP, Davis AM, Gross AE. Fresh osteochondral allografts for post-traumatic osteochondral defects of the knee. J Bone Joint Surg Br.1997;79:1008-1013.
34.
Giannini S, Buda R, Grigolo B, Vannini F. Autologous chondrocyte transplantation in osteochondral lesions of the ankle joint. Foot Ankle Int.2001;22:513-517.
35.
Gill T. The role of the microfracture technique in the treatment of full-thickness chondral injuries. Oper Tech Sports Med.2000;8:138-140.
36.
Gill T, Macgillivray J. The technique of microfracture for the treatment of articular cartilage defects in the knee. Oper Tech Orthop.2001;2:105-107.
37.
Gillogly SD, Voight M, Blackburn T. Treatment of articular cartilage defects of the knee with autologous chondrocyte implantation. J Orthop Sports Phys Ther.1998;28:241-251.
38.
Gobbi A, Nunag P, Malinowski K. Treatment of full thickness chondral lesions of the knee with microfracture in a group of athletes. Knee Surg Sports Traumatol Arthrosc. In press.
39.
Grande D, Breidbart A, Mason J, Paulino C, Laser J, Schwartz R. Cartilage tissue engineering: current limitations and solutions. Clin Orthop.1999;367(suppl):S176-S185.
40.
Grande D, Halberstadt C, Naughton G, Schwartz R. Evaluation of matrix scaffolds for tissue engineering of articular cartilage grafts. J Biomed Mater Res.1997;34:211-220.
Gross AE. Repair of cartilage defects in the knee. J Knee Surg.2002;15:167-169.
43.
Gugenheim JJ Jr, Brinker MR. Bone realignment with use of temporary external fixation for distal femoral valgus and varus deformities. J Bone Joint Surg Am.2003;85:1229-1237.
44.
Hangody L, Feczko P, Bartha L, Bado G, Kish G. Mosaicplasty for the treatment of articular defects of the knee and ankle. Clin Orthop.2001;391(suppl):S328-S336.
45.
Hangody L, Füles P. Autologous osteochondral mosaicplasty for the treatment of full-thickness defects of weight-bearing joints: ten years of experimental and clinical experience. J Bone Joint Surg Am.2003;85(suppl 2):25-32.
46.
Hangody L, Kish G, Karpati Z, et al.Osteochondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral articular defects. Oper Tech Orthop.1997;7:312-322.
47.
Hangody L, Kish G, Modis L, et al.Mosaicplasty for the treatment of osteochondritis dissecans of the talus: two to seven year results in 36 patients. Foot Ankle Int.2001;22:552-558.
48.
Harada M, Ogino T, Takahara M, Ishigaki D, Kashiwa H, Kanauchi Y. Fragment fixation with a bone graft and dynamic staples for osteochondritis dissecans of the humeral capitellum. J Shoulder Elbow Surg.2002;11:368-372.
49.
Horas U, Pelinkovic D, Herr G, Aigner T, Schnettler R. Autologous chondrocyte implantation and osteochondral cylinder transplantation in cartilage repair of the knee joint: a prospective, comparative trial. J Bone Joint Surg Am.2003;85:185-192.
50.
Hunziker EB, Quinn TM. Surgical removal of articular cartilage leads to loss of chondrocytes from cartilage bordering the wound edge. J Bone Joint Surg Am.2003;85(suppl 2):85-92.
51.
Johansen O, Lindahl A, Peterson L, et al.Hip osteochondritis treated by debridement, suture of a periosteal flap and chondrocyte implantation: a case report. In: Hunziker E, Mainil-Varlet P, eds. Updates in Cartilage Repair: A Multimedia Production on Cartilage Repair [6 CDROMs]. Philadelphia, Pa: Lippincott Williams and Wilkins; 2000.
52.
Johnson DL, Swenson TM, Livesay GA, Aizawa H, Fu FH, Harner CD. Insertion-site anatomy of the human menisci: gross, arthroscopic, and topographical anatomy as a basis for meniscal transplantation. Arthroscopy.1995;11:386-394.
53.
Jurgenson I, Bachmann G, Haas H, et al.Effect of arthroscopic therapy on osteochondritis dissecans of the knee and ankle. Arthroskopie.1998;11:193-199.
54.
Kivisto R, Pasanen L, Leppilahti J. Arthroscopic repair of osteochondritis dissecans of the femoral condyles with metal staple fixation: a report of 28 cases. Knee Surg Sports Traumatol Arthrosc.2002;10:305-309.
55.
Knutsen G, Engebretsen L, Ludvigsen TC, et al.Autologous chondrocyte implantation compared with microfracture in the knee: a randomized trial. J Bone Joint Surg Am.2004;86:455-464.
56.
Koulalis D, Schultz W. Massive intraosseous ganglion of the talus: reconstruction of the articular surface of the ankle joint. Arthroscopy.2000;16:E14.
57.
Koulalis D, Schultz W, Heyden M. Autologous chondrocyte transplantation for osteochondritis dissecans of the talus. Clin Orthop.2002;395:186-192.
58.
Krijnen MR, Lim L, Willems WJ. Arthroscopic treatment of osteochondritis dissecans of the capitellum: report of 5 female athletes. Arthroscopy.2003;19:210-214.
59.
Lee CR, Grodzinsky AJ, Hsu HP, Spector M. Effects of a cultured autologous chondrocyte-seeded type II collagen scaffold on the healing of a chondral defect in a canine model. J Orthop Res.2003;21:272-281.
60.
Lobenhoffer P, Agneskirchner JD. Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc.2003;11:132-138.
61.
Mandelbaum BR, Gerhardt MB, Peterson L. Autologous chondrocyte implantation of the talus. Arthroscopy.2003;19(suppl 1):129-137.
62.
McDermott AG, Langer F, Pritzker KP, Gross AE. Fresh small-fragment osteochondral allografts: long-term follow-up on the first 100 cases. Clin Orthop.1985;197:96-102.
63.
Micheli LJ, Browne JE, Erggelet C, et al.Autologous chondrocyte implantation of the knee: multicenter experience and minimum 3-year follow-up. Clin J Sport Med.2001;11:223-228.
64.
Minas T. Autologous chondrocyte implantation for focal chondral defects of the knee. Clin Orthop.2001;391(suppl):S349-S361.
65.
Minas T, Chiu R. Autologous chondrocyte implantation. Am J Knee Surg.2000;13:41-50.
66.
Minas T, Peterson L. Advanced techniques in autologous chondrocyte transplantation. Clin Sports Med.1999;18:13-44.
67.
Mitsunaga M, Adishian DA, Bianco AJ Jr. Osteochondritis dissecans of the capitellum. J Trauma.1982;22:53-55.
68.
Navarro R, Cohen M, Filho MC. The arthroscopic treatment of osteochondritis dissecans of the knee with autologous bone sticks. Arthroscopy.2002;18:840-844.
69.
Newman AP. Articular cartilage repair. Am J Sports Med.1998;26:309-324.
70.
Nilsson A, Lindahl A, Peterson L, et al.Autologous chondrocyte transplantation of the human wrist. In: Hunziker E, Mainil-Varlet P, eds. Updates in Cartilage Repair: A Multimedia Production on Cartilage Repair [6 CD-ROMs]. Philadelphia, Pa: Lippincott Williams and Wilkins; 2000.
Pearce SG, Hurtig MB, Clarnette R, Kalra M, Cowan B, Miniaci A. An investigation of 2 techniques for optimizing joint surface congruency using multiple cylindrical osteochondral autografts. Arthroscopy.2001;17:50-55.
73.
Peterson L, Brittberg M, Kiviranta I, Akerlund EL, Lindahl A. Autologous chondrocyte transplantation: biomechanics and long-term durability. Am J Sports Med.2002;30:2-12.
74.
Peterson L, Menche D, Grande D, et al.Chondrocyte transplantation: an experimental model in the rabbit. Trans Orthop Res Soc.1984;9:218.
75.
Peterson L, Minas T, Brittberg M, Nilsson A, Sjogren-Jansson E, Lindahl A. Two- to 9-year outcome after autologous chondrocyte transplantation of the knee. Clin Orthop.2000;374:212-234.
76.
Pill SG, Ganley TJ, Flynn JM, Gregg JR. Osteochondritis dissecans of the capitellum: arthroscopic-assisted treatment of large, full-thickness defects in young patients. Arthroscopy.2003;19:222-225.
77.
Rodeo SA. Meniscal allografts: where do we stand?Am J Sports Med.2001;29:246-261.
78.
Romeo AA, Cole BJ, Mazzocca AD, Fox JA, Freeman KB, Joy E. Autologous chondrocyte repair of an articular defect in the humeral head. Arthroscopy.2002;18:925-929.
79.
Schenk RC, Goodnight JM. Current concepts review: osteochondritis dissecans. J Bone Joint Surg Am.1996;78:439-456.
80.
Schwarz C, Blazina ME, Sisto DJ, Hirsh LC. The results of operative treatment of osteochondritis dissecans of the patella. Am J Sports Med.1988;16:522-528.
81.
Sekiya LC, Fontbote CA, Harner CD. Arthroscopically assisted retrograde fixation of patellar osteochondritis dissecans using fluoroscopic guidance: a case report and technical note. Arthroscopy.2003;19:E1-E7.
82.
Sellers R, Zhang R, Glasson SS, et al.Repair of articular cartilage defects one year after treatment with recombinant human bone morphogenetic protein-2 (rhBMP-2). J Bone Joint Surg Am.2000;82:151-160.
83.
Sgaglione NA, Miniaci A, Gillogly SD, Carter TR. Update on advanced surgical techniques in the treatment of traumatic focal articular cartilage lesions in the knee. Arthroscopy.2002;18(suppl 1):9-32.
84.
Shelton WR, Dukes AD. Meniscus replacement with bone anchors: a surgical technique. Arthroscopy.1994;10:324-327.
85.
Shwarz C, Blazina ME, Sisto DJ, Hirsch LC. The results of operative treatment of osteochondritis dissecans of the patella. Am J Sports Med.1988;16:522-529.
86.
Simonian PT, Sussmann PS, Wickiewicz T, Paletta GA, Warren RF. Contact pressures at osteochondral donor sites in the knee. Am J Sports Med.1998;26:491-494.
87.
Slough J, Noto A, Schmidt T. Tibial cortical bone peg fixation in OCD of the knee. Clin Orthop.1991;267:122-127.
88.
Steadman JR, Briggs KK, Rodrigo JJ, Kocher MS, Gill TJ, Rodkey WG. Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy.2003;19:477-484.
89.
Steadman JR, Rodkey WG, Rodrigo JJ. Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop.2001;391(suppl):S362-S369.
90.
Steadman JR, Rodkey WG, Singelton SB, et al.Microfracture technique for full thickness chondral defects: technique and clinical results. Oper Tech Orthop.1997;7:300-307.
91.
Szomor ZL, Martin TE, Bonar F, Murrell GA. The protective effects of meniscal transplantation on cartilage: an experimental study in sheep. J Bone Joint Surg Am.2000;82:80-88.
92.
Thomson N. Osteochondritis dissecans and osteochondral fragments managed by Herbert compression screw fixation. Clin Orthop.1987;224:71-78.
93.
Verhagen RA, Struijs PA, Bossuyt PM, van Dijk CN. Systematic review of treatment strategies for osteochondral defects of the talar dome. Foot Ankle Clin.2003;8:233-242, viii-ix.
94.
Weiler A, Hoffmann RF, Stahelin AC, Helling HJ, Sudkamp NP. Biodegradable implants in sports medicine: the biological base. Arthroscopy.2000;16:305-321.
95.
Wilcox TR, Goble EM, Doucette SA. Goble technique of meniscus transplantation. Am J Knee Surg.1996;9:37-42.
96.
Wouters DB, van Horn JR, Bos RR. The use of biodegradables in the treatment of osteochondritis dissecans of the knee: fiction or future?Acta Orthop Belg.2003;69:175-181.
97.
Zuniga JJR, Sagastibelza J, Lopez Blasco JJ, Martinez Grande M. Arthroscopic use of the Herbert screw in osteochondritis dissecans of the knee. Arthroscopy.1993;9:668-670.
