Description
In this presentation, Andy Metcalfe discusses the complexities surrounding failed articular cartilage repair, emphasizing that failure can manifest as both structural and symptomatic issues. He highlights the importance of thorough patient evaluations, including understanding individual symptoms and the time elapsed since their treatment, to prevent misdiagnosis and inappropriate interventions.
Metcalfe advises caution regarding non-operative treatments and encourages clinicians to engage patients, learning about their background and compliance with rehabilitation programs. He details the significance of biomechanics for successful cartilage repair, pointing out that malalignment, ligament instability, and meniscal loss are leading causes of failure.
He explores various treatment options, from microfracture techniques—which he argues have questionable durability—to more advanced procedures like autologous chondrocyte implantation (ACI) and osteochondral allografts. Metcalfe shares insights from Coventry's experience with these methods, suggesting that while ACI combined with bone grafting shows promise, the practicality and accessibility of these solutions remain challenging.
Ultimately, he stresses that dealing with complex cartilage lesions involves addressing biomechanical and systemic factors as they relate to the integrity of both cartilage and subchondral bone. Metcalfe concludes by advocating for osteochondral allograft as a go-to intervention for managing multi-operated cases, while also recognizing upcoming options like multilayer scaffolds and mini-metal implants.