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Complex knee reconstruction: articular cartilage treatment options

      Physicians have known for over 250 years that articular cartilage damage is a “troublesome thing and once destroyed, it is not repaired.”
      • Hunter W.
      On the structure and diseases of articulating cartilage.
      Although chondral lesions that penetrate to or through the subchondral bone may fill with fibrocartilage, the biomechanical and biochemical features remain inferior to hyaline cartilage.
      • Mandelbaum B.R.
      • Browne J.E.
      • Fu F.
      • Micheli L.
      • et al.
      Articular cartilage lesions of the knee.
      ,
      • Mankin H.J.
      The response of articular cartilage to mechanical injury.
      ,
      • Furukawa T.
      • Eyre D.R.
      • Koide S.
      • Glimcher M.J.
      Biochemical studies on repair cartilage resurfacing experimental defects in the rabbit knee.
      Unlike the recognized poor prognosis of the meniscectomized knee, the natural history of chondral lesions remains far more speculative. At this juncture, treatment recommendations are for those lesions believed to be contributing to a patient’s symptoms and are not generally directed toward asymptomatic lesions. Clinical experience has taught us that after these lesions become symptomatic (a cause of pain, swelling, mechanical symptoms), they tend to persist or inexorably progress over an indeterminate time course.
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