The treatment of focal chondral lesions of the knee]

Focal osteochondral lesions of the knee are a common cause of pain and other knee symptoms, and are mostly caused by traumatic injuries. The spontaneous repair ability of the articular cartilage tissue is very limited. Thus, focal chondral lesions result in early degenerative changes and post-traumatic osteoarthritis. The surgical treatment of focal osteochondral lesions can be divided into three major groups: cartilage debridement techniques, marrow stimulating techniques and transplantation techniques. Lesion debridement causes limited and temporary symptoms relief. While marrow stimulating techniques are considered simple, cheap and easy to perform, some of the transplantation techniques are complicated and consist of highly demanding surgery and new technologies of tissue engineering. Many published studies attempted to evaluate the efficacy of the treatment methods and to compare between them. There is no obvious or definite advantage of any one technique. There are relative advantages of some techniques according to the lesion size and patient's factors. Yet, among the current available treatment options none was found to produce hyaline cartilage consistently. In order to improve the current treatment and to find new treatment techniques, significant advances were achieved in the research of stem cells, scaffolds and growth factors in the last years. Further advances and more comparative and long term studies, particularly those that evaluate the efficacy of the new treatment techniques are needed.