Age-related surgical management of chondral and osteochondral lesions

Abstract

Introduction: Cartilage lesions and osteoarthritis are very prevalent and imply a significant clinical and economic burden. Objectives: To review treatments for cartilage lesions in a time life sequence and its particularities. Methods: We performed a broad PUBMED database review with a sensitive systematized strategy without restriction to article date or type. Results: This review brings us to the aspects of chondral and osteochondral lesions throughout the different age groups of patients. Focusing mainly on surgical treatment, we present here the most widely used techniques. To facilitate discussion, patients have been divided into 3 groups: children and adolescents with open physes, adults until the fifth decade, and adult patients over the fifth decade. For open physes patients, their capacity for healing is of important consideration in both conservative and operative management. In those with closed physes, most patients are treated surgically. While marrow stimulation is the most common cartilage treatment procedure, there is a growing use of other techniques such as osteochondral autograft transplantation and osteochondral allograft transplantation. Patients over 50 years old commonly present with more severe chondral lesions, which influences the treatment decision-making process. Conclusion: When attempting to optimize cartilage restoration in these 3 groups, it is important to weigh the physiologic age, the extent of the cartilage lesion, and the stage of the degenerative and osteoarthritic processes.

Keywords

• Adults
• Autologous chondrocyte implantation
• Children
• Microfracture
• Osteochondral lesion
• Osteochondral transplantation