Articular Cartilage Injury

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Articular Cartilage Injury

• The Knee Blowout

Jon D. Koman, MD
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Tire Analogy

• Tread of a tire articular cartilage

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Degenerative
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Traumatic
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Focal Cartilage Defects

• Traumatic
• Concomitant ligament injury -- ex ACL
• Osteochondritis Dissecans lesion
• Localized cartilage lesion due to unexplainable
  localized poor blood supply.
• Most commonly seen on lateral part of medial
  femoral condyle.

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Cartilage Lesion Classification
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Bad to the Bone
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Diagnosis

• History/Physical
• X-rays
• MRI
• Diagnostic arthroscopy

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History/Physical

• Intermittent, vague, poorly localized pain.
• Locking or catching if loose body present.
• May have associated secondary degenerative
  changes if bony incongruity present.

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X-rays
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MRI
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Treatment Options

• Bone marrow stimulation (lt5 mm).-- scar
  cartilage, not real weight bearing type of
  articular cartilage.
• Autologous Chondrocyte Implantation (gt 2x2 cm
  lesions)--requires open arthrotomy and at least
  two surgeries but theoretically same type of
  weight bearing articular cartilage.
• Osteochondral Autograft Transplant Surgery
  (O.A.T.S.)( lt2 x2 cm lesions ?) -- limited number
  of donor plugs but covers lesion with same type
  of weight bearing articular coverage.

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Bone Marrow Stimulation
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Autologous Chondrocyte Implantation
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O.A.T.S.
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O.A.T.S.
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O.A.T.S.
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Rehabilitation Phases

• Protective (4 wks) NWB x 2 wks then 20-30lbs
  weight bearing. PROM exercises.
• Transition (5th and 6th wks) 25 weight
  bearing, mini squats and aqua jogging.
• Maturation (7-12 wks) Full WB, full squats,
  walking swimming and stairmaster.
• Functional (gt12 wks) Full activity.

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Back to Work Issues

• No sooner than 3 mos.
• ? Permanent work restrictions depending on size
  of lesion and concomitant injuries.
• Will more than likely have lifting restrictions
  depending on size of lesion and concomitant
  injuries.

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Case Study

• 25 year old male sustained a fall/twist on right
  knee.
• PE 2 effusion, ROM 0-130 deg, 2 Lachman,
  pivot shift and anterior drawer .
• Xrays wnl
• MRI ACL tear, medial/lateral meniscus tears,
  full thickness cartilage defect of medial femoral
  condyle.

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MRI
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Arthroscopic Findings

• ACL tear
• MFC defect measuring 8mm x 16 mm.
• Med/lat meniscus tears

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Arthroscopic Treatment

• Partial Med/lat menisectomies
• O.A.T.S. of MFC
• ACL reconstruction

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Conclusions

• O.A.T.S. procedure provides quick and near
  complete coverage of most focal full thickness
  cartilage lesions.
• Covers cartilage lesion with same type of weight
  bearing articular cartilage
• Can be done at same surgery as other planned
  procedures.
• Can be done arthroscopically providing faster
  rehabilitation and sooner return to work.