The Large Focal Isolated Chondral Lesion.

Focal chondral defects (FCDs) of the knee can be a debilitating condition that can clinically translate into pain and dysfunction in young patients with high activity demands. Both the understanding of the etiology of FCDs and the surgical management of these chondral defects has exponentially grown in recent years. This is reflected by the number of surgical procedures performed for FCDs, which is now approximately 200,000 annually. This fact is also apparent in the wide variety of available surgical approaches to FCDs. Although simple arthroscopic debridement or microfracture are usually the first line of treatment for smaller lesions, chondral lesions that involve a larger area or depth require restorative procedures such as osteochondral allograft transplantation or other cell-based techniques. Given the prevalence of FCDs and the increased attention on treating these lesions, a comprehensive understanding of management from diagnosis to rehabilitation is imperative for the treating surgeon. This narrative review aims to describe current concepts in the treatment of large FCDs through providing an algorithmic approach to selecting interventions to address these lesions as well as the reported outcomes in the literature.

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J.C. is a board or committee member of the American Orthopaedic Society for Sports Medicine (AOSSM), Arthroscopy Association of North America (AANA), and the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine (ISAKOS); and is a paid consultant for Arthrex, Inc, CONMED Linvatec, Ossur, and Smith & Nephew. A.B.Y. receives research support from Arthrex, Inc, Organogenesis, and Vericel; is an unpaid consultant for Patient IQ, Smith & Nephew, and Sparta Biomedical; is a paid consultant for CONMED Linvatec, JRF Ortho, and Olympus; and receives stock or stock options from Patient IQ. J.F. receives research support from Active Implants, Arthrex, Inc, Episurf, Fidia, JRF Ortho, Moximed, Novartis, Organogenesis, Samumed, Inc, Vericel, and ZimmerBiomet; is a paid consultant for Aesculap/B.Braun, Cartiheal, Cook Biotech, Exactech, Moximed, Inc, Organogenesis, Regentis, Samumed, Inc, and ZKR orthopedics; is on the editorial or governing board of the American Journal of Orthopedics, and Cartialge; is a paid presenter or speaker for Arthrex, Inc, Moximed, Inc, Organogenesis, and Vericel; receives IP royalties from Arthrex, Inc, Biopoly, LLC, and Organogenesis; receives stock or stock options from MedShape, Inc, and Ortho Regenerative Tech; and receives publishing royalties, financial or material support from Springer, and Thieme Medical Publishers, Inc.