Chondral Lesions of the Knee: An Evidence-Based Approach

Management of chondral lesions of the knee is challenging and requires assessment of several factors including the size and location of the lesion, limb alignment and rotation, and the physical and mental health of the individual patient.There are a multitude of options to address chondral pathologies of the knee that allow individualized treatment for the specific needs and demands of the patient.Osteochondral autograft transfer remains a durable and predictable graft option in smaller lesions (<2 cm²) in the young and active patient population.Both mid-term and long-term results for large chondral lesions (≥3 cm²) of the knee have demonstrated favorable results with the use of osteochondral allograft or matrix-associated chondrocyte implantation.Treatment options for small lesions (<2 cm²) include osteochondral autograft transfer and marrow stimulation and/or microfracture with biologic adjunct, while larger lesions (≥2 cm²) are typically treated with osteochondral allograft transplantation, particulated juvenile articular cartilage, or matrix-associated chondrocyte implantation.Emerging technologies, such as allograft scaffolds and cryopreserved allograft, are being explored for different graft sources to address complex knee chondral pathology; however, further study is needed.