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Measuring outcomes following articular cartilage repair should be performed using instruments that have demonstrated content validity as well as adequate psychometric properties including reliability, construct validity and responsiveness in this population of interest. As per the International Cartilage Repair Society (ICRS) recommendation, the primary outcome for articular cartilage surgery should be either the Knee Injury and Osteoarthritis Outcome Score (KOOS) or the International Knee Documentation Committee (IKDC). Secondary outcomes should include an activity scale as well as a measure of generic health-related quality of life (QoL) which can concomitantly allow for an evaluation of the cost-effectiveness of a group of interventions. Such a biopsychosocial approach towards outcome measurement will allow for a comprehensive understanding of how patients experience articular cartilage pathology and how they respond to treatment over time.

This chapter provides a comprehensive approach to evaluating patients with articular cartilage defects, as well as a description of treatment algorithms and surgical techniques. During the initial workup (history, physical exam, imaging), a thorough lower extremity assessment is emphasized such that comorbidities including ligamentous instability, malalignment, and meniscal deficiency can be concomitantly addressed. Patient and defect-specific factors pertinent to surgical decision-making are discussed along with an evidence-based and technical overview of common surgical approaches including microfracture, osteochondral (OC) autograft/allograft, and autologous chondrocyte implantation (ACI). An approach to patients with a failed index cartilage procedure is also described.

The goals of managing patients with symptomatic chondral defects of the knee include optimizing clinical and functional outcomes, generating durable hyaline or hyaline-like cartilage with low procedure-associated morbidity, utilizing cost-effective technology, and ultimately delaying the development of osteoarthritis. The objective of this chapter is to provide an overview of the different types of commercially available bioengineered cartilage grafts including cell-based therapies, microfracture augmentation techniques, and the use of particulated articular cartilage, as well as examples of scaffold and synthetic materials that can be used in isolation.

Articular cartilage serves as a lubricated, wear-resistant, friction-reducing self-maintaining material that is slightly compressible to evenly distribute forces onto the bone. Articular cartilage macromolecular composition and architecture and its biomechanical properties are well adapted to withstand mechanical loads increasingly for a ten-decade lifetime. The three-dimensional orientation of the structural molecules and various levels of compartmentalization, namely, the horizontal zones from the articular surface to the underlying subchondral bone as well as interstitially from the surface of the chondrocytes, enable articular cartilage function by facilitating smooth knee movements by reducing friction and absorbing the impact of loading. Coupled with the biomechanical function of articular cartilage in its entirety, articular cartilage lubrication mechanisms provide almost frictionless surfaces between moving joints and do this throughout life adapting to both age and arthritic disease.