Primary articular cartilage procedures in the middle-aged knee

The treatment of articular cartilage damage in the middle-aged knee poses a difficult problem for surgeons. Such damage is common and is often the result of trauma to the knee or repetitive impact as in sports. It is well established that cartilage possesses a poor innate ability to heal. Non-surgical treatments such as anti-inflammatory medications may provide symptomatic relief, but the damage will often progress further to osteoarthritis. Surgical treatment must be aimed at repairing the articular surface with a durable tissue, with mechanical properties similar to native articular cartilage. Although arthroscopic debridement was once believed to be beneficial, recent evidence has suggested that this provides little if any long-term relief. Subchondral abrasion, drilling, and microfracture are used to recruit marrow elements in hopes of stimulating repair. Recently, procedures such as autologous osteochondral transplantation and autologous chondrocyte transplantation have been used to restore the articular surface. When other methods have failed the use of total and unicompartmental knee arthroplasty are viable options, because recent long-term results have shown success even in young, active patients.