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Cartilage Restoration, Part 2

Techniques, Outcomes, and Future Directions

J. Winslow Alford, MD^* and Brian J. Cole, MD, MBA^,

From ^* Shoulder and Sports Medicine Division, West Bay Orthopedics, Warwick, Rhode Island, and the Department of Orthopedics & Anatomy and Cell Biology, Rush Cartilage Restoration Center, Rush University, Chicago, Illinois

Address correspondence to Brian J. Cole, MD, MBA, 1725 West Harrison Street, Suite 1063, Chicago, IL 60612 (e-mail: bcole{at}rushortho.com).

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.

Key Words: cartilage restoration • techniques • outcomes • microfracture • autologous chondrocyte implantation • allograft • osteochondral autograft transfer • mosaicplasty • comorbidities

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