Focal Chondral Injuries

Focal chondral defects (FCD) of the knee are common sources of pain and dysfunction in young patients with high activity demands. Both the understanding of the cause of FCDs and the surgical management of these defects has exponentially grown. This is reflected in the number of surgical procedures performed for FCD, which now approximates 200,000 annually. This fact is also apparent in the wide variety of surgical approaches to FCD that now exist, from simple arthroscopic debridement to complex restorative procedures such as osteochondral allograft transplantation. Given the prevalence of FCD and increased attention on treating these lesions, a comprehensive understanding of management from diagnosis to rehabilitation is imperative for the treating surgeon. This chapter presents current concepts in the treatment of FCD, provides an algorithmic approach to selecting interventions to address FCD, and subsequently describes each commonly used surgical technique in the management of these chondral defects, with corresponding clinical outcomes.