Surgical Approach to Articular Cartilage Repair

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.