TABLE 2.

Treatment Principles for Chondral and Osteochondral Defect Repair in the Knee Joint Among Children and Adolescents

With the exception of fresh traumatic flakes, conservative therapy should be first-line treatment of symptomatic defects to the joint surface.

Standard cartilage repair techniques are recommended to surgically treat symptomatic International Cartilage Repair Society grade 3 or 4 lesions.

Standard cartilage repair techniques are microfracture, osteochondral cylinder transplantation, and autologous chondrocyte implantation.

The technical application should be evaluated by cartilage defect diameter, subchondral bone deficiency, and defect localization.

The joint surface defect size has to be considered with relation to overall knee joint dimensions; the treatment modality has to be adapted accordingly.

Marrow stimulation procedures as well as osteochondral cylinder transplantation are not recommended for the patellar undersurface.

Retainment of osteochondral flakes via refixation/reattachment should be the desired goal in fresh traumatic lesions.

Osteochondritis dissecans defects are operatively treated by retrograde drilling, fragment reattachment plus subchondral bone repair, or standard cartilage repair techniques when preservation is impossible.

Any concomitant or coexisting abnormality has to be treated simultaneously with the desired/executed joint surface repair.