Case Manager's Corner

Mechanism of Injury:

Can be traumatic following a direct impact to the knee or result from a twisting injury. Can also result from developmental problems such as osteochondritis dissecans.

Subjective Symptoms:

Typically, patients complain of localized pain, mechanical symptoms such as catching or locking, and activity-related swelling.

Objective Signs:

Tenderness over the involved area, effusions and crepitus or catching may be present during range of motion. Plain radiographs and MRI may not always detect articular cartilage injury.

Natural History:

Not all focal articular cartilage defects become symptomatic. However, once these lesions produce symptoms, they may progress and lead to degenerative changes in the opposing joint surfaces.

Nonsurgical:

Palliative care including NSAIDs and physical therapy.

Surgical:

Depends upon several factors, including defect size, location and depth. Options are grouped by ability to repair the articular surface.

1) Palliative: Arthroscopy, debridement and lavage
2) Reparative: Microfracture or drilling
3) Restorative: Autologous chondrocyte implantation (Carticel), osteochondral grafting

Nonsurgical:

Varies based upon extent of symptoms and disease.

Surgical:

1) Palliative:   6-8 weeks
2) Reparative:   4 to 6 months
3) Restorative:
    Osteochondral autograft:   3-4 months
    Osteochondral allograft:   4-6 months
    Carticel™   8-12 months