Cartilage resurfacing - Filling defects

Chondral defects with no significant bone involvement can be managed arthroscopically using surface treatments such as debridement and drilling, abrasion arthroplasty, and microfracture. Chondral defects can also be managed arthroscopically using osteochondral autografts (mosaicplasty) or by cartilage cell transplant or periosteal grafts, both of which are performed in open surgery. The arthroscopic surface treatments are best reserved for small defects, but cell transplantation and mosaicplasty have been used for defects up to 3 cm in diameter. Periosteal grafting can be used for large defects affecting an entire condyle, but clinical experience with this procedure is limited and it is still considered investigational. Larger osteochondral defects (uncontained defects greater than 3 cm in diameter and greater than I cm in depth) are managed using osteochondral allografts. Realignment osteotomy should be considered in conjunction with any of these techniques in the presence of a coexisting deformity.