Treatment Options for Full Thickness Cartilage Defects

Introduction to Treatment Options

The American Academy of Orthopaedic Surgeons recommends that the treatment of full thickness cartilage defects should be based on lesion size, location, and patient factors, with microfracture recommended for smaller defects (<2 cm²) and osteochondral allograft transplantation for medium-sized defects (2-6 cm²) 1, 2

For femoral head lesions <2 cm², the American Academy of Orthopaedic Surgeons recommends microfracture as the first-line treatment 1, 3
For femoral head lesions 2-6 cm², the American Academy of Orthopaedic Surgeons recommends osteochondral allograft transplantation as the first-line treatment 1, 4
For acetabular lesions <2 cm², microfracture is recommended 1, 4
For lesions not identified preoperatively, microfracture is recommended 1

Microfracture creates small holes in subchondral bone to release marrow cells and growth factors that form fibrocartilage to fill the defect, with a 93% fill rate with good-quality cartilage macroscopically at second-look arthroscopy 3, 5, 6
Mosaicplasty uses autologous osteochondral cylindrical grafts to fill chondral defects, with indications for patient age <45 years, no signs of osteoarthritis, and focal full-thickness lesion <3 cm² 7
Osteochondral allograft transplantation uses cadaveric donor tissue to replace damaged cartilage and bone, with indications for patient age ≤50 years, no evidence of osteoarthritis, and defect >2.5 cm² or substantial subchondral bone loss 4, 7

Patients should meet the following criteria for joint-preserving management: age ranging from skeletal maturity to 50 years, minimal or no sign of osteoarthritis, no inflammatory arthritis, one or more full-thickness defects, but no bipolar lesions, and ability to perform rigorous postoperative physical therapy regimen 1, 2

The American College of Rheumatology/Arthritis Foundation does not currently recommend stem cell therapy due to heterogeneity and lack of standardization 8
Limited evidence is available for most treatment modalities, with most studies being small case series or case reports with no long-term data or control groups 1, 2