Decision-making and approach to articular cartilage surgery

Most clinicians treating focal articular cartilage lesions in the knee will be faced with the challenge of deciding which lesions should be treated and which procedure should be selected. Furthermore, questions may arise as to when surgery should be performed and if asymptomatic lesions should be operated on. Multiple surgical techniques have been reported and continue to be refined as evolving technologies, equipment, and approaches expand. The unpredictable nature and variable presentation of articular cartilage pathology results in numerous clinical scenarios. An individualized approach to each case requires sound judgment to appropriately counsel patients about the type and timing of treatment. Indications are reviewed including current surgical options that may defined as first line versus second line or advanced techniques. The various surgical options are discussed and outlined to highlight their advantages and disadvantages. A clinical practice guideline algorithm is described.