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Chondral injuries of the femoral head and their possible progression to osteoarthritis is well known. Regarding focal lesions in young patients, microfracturing or autologous chondrocyte implantation (ACI) are the most frequent used techniques to address them. Although ACI provides the better tissue quality, it is a two-step procedure and needs a lot of resources. Mincing cartilage is an old technique that has become popular again over the last few years, with good short-term results in threatening cartilage lesion in the knee. It seems intriguing to transfer this technique to the hip because you can harvest good-quality cartilage from the cam lesion, and it is a one-step procedure using autologous thrombin and fibrin. This technical note describes the repair of a parafoveal chondral defect using minced cartilage via surgical dislocation of the hip., Technique Video Video 1 Minced cartilage implantation for a cystic defect on the femoral head. Twenty-seven-year-old patient with a parafoveal chondral lesion, patient history (00:06 min), imaging (00:22), intraoperative findings (00:59), preparing of the cartilage defect (01:10), mincing and harvesting of the cartilage with the GraftNet device (Arthrex, Munich, Germany) (01:30), getting a membrane-like structure of the minced cartilage (01:46), implantation of the minced cartilage into the defect (01:58), sealing of the construct with PRP and autologous thrombin (02:16), and postoperative imaging and care (02:28).

The American journal of sports medicine 50(10), 2853-2859 (2022). doi:10.1177/03635465211029642, Published by Sage, London [u.a.]

Objective Large articular cartilage defects are a challenge to regenerative surgery. Biomaterial scaffolds might provide valuable support for restoration of articulating surface. The performance of a composite biomaterial scaffold was evaluated in a large porcine cartilage defect. Design Cartilage repair capacity of a biomaterial combining recombinant human type III collagen (rhCo) and poly-(l/d)-lactide (PLA) was tested in a porcine model. A full-thickness chondral defect covering the majority of the weightbearing area was inflicted to the medial femoral condyle of the right knee. Spontaneous cartilage repair and nonoperated healthy animals served as controls. The animals were sacrificed after a 4-month follow-up. The repair tissue was evaluated with the International Cartilage Repair Society (ICRS) macroscopic score, ICRS II histological score, and with micro-computed tomography. Additionally, histopathological evaluation of lymph nodes and synovial samples were done for toxicological analyses. Results The lateral half of the cartilage defect in the operated groups showed better filling than the medial half. The mean overall macroscopic score for the rhCo-PLA, spontaneous, and nonoperated groups were 5.96 ± 0.33, 4.63 ± 0.42, and 10.98 ± 0.35, respectively. The overall histological appearance of the specimens was predominantly hyaline cartilage in 3 of 9 samples of the rhCo-PLA group, 2 of 8 of the spontaneous group, and 9 of 9 of the nonoperated group. Conclusions The use of rhCo-PLA scaffold did not differ from spontaneous healing. The repair was affected by the spatial properties within the defect, as the lateral part of the defect showed better repair than the medial part, probably due to different weightbearing conditions.

Objective Cartilage repair strategies have seen improvement in recent years, especially with the use of scaffolds that serve as a template for cartilage formation. However, current fixation strategies are inconsistent with regards to retention, may be technically challenging, or may damage adjacent tissues or the implant itself. Therefore, the goal of this study was to evaluate the retention and repair potential of cartilage scaffolds fixed with an easy-to-implement bioresorbable pin. Design Electrospun hyaluronic acid scaffolds were implanted into trochlear groove defects in 3 juvenile and 3 adult pigs to evaluate short-term retention (2 weeks; pin fixation vs. press-fit and fibrin fixation) and long-term repair (8 months; scaffold vs. microfracture), respectively. Results For the retention study, press-fit and fibrin fixation resulted in short-term scaffold dislodgment ( n = 2 each), whereas pin fixation retained all scaffolds that were implanted ( n = 6). Pin fixation did not cause any damage to the opposing patellar surface, and only minor changes in the subchondral bone were observed. For long-term repair, no differences were observed between microfracture and scaffold groups, in terms of second-look arthroscopy and indentation testing. On closer visualization with micro computed tomography and histology, a high degree of variability was observed between animals with regard to subchondral bone changes and cartilage repair quality, yet each Scaffold repair displayed similar properties to its matched microfracture control. Conclusions In this study, pin fixation did not cause adverse events in either the short- or the long-term relative to controls, indicating that pin fixation successfully retained scaffolds within defects without inhibiting repair.

Objective The aim of this study is to evaluate the effects of intraarticular insulin on the treatment of chondral defects. Design Twenty-four mature New Zealand rabbits were randomly divided into 3 groups as control (Group 1), microfracture (Group 2), and microfracture and insulin (Group 3). Four-millimeter full-thickness cartilage defects were created to the weight-bearing surface on the medial femoral condyles of each rabbit. In the first group, any additional interventions were not performed. Microfracture was performed on defects in groups 2 and 3. Additionally, 10 IU of insulin glargine was administrated into the knee joints of the third group. Three months after surgery, the knee joints were harvested and cartilage quality was assessed according to Wakitani and ICRS (International Cartilage Repair Society) scores histopathologically. Insulin injections were performed into the knees of 2 additional rabbits without creating a cartilage defect to evaluate the potential adverse effects of insulin on healthy cartilage (Group 4). Results The total ICRS and Wakitani scores of the insulin group were found to be significantly lower than the microfracture group but similar to the control group. No negative effects of insulin on healthy cartilage were detected. Intraarticular insulin after surgery has led to a statistically significant decrease in systemic blood sugar levels whereas the decrease observed after administration to intact tissues was not statistically significant. Conclusions Insulin had a negative influence on the quality of cartilage regeneration and had no effect on healthy cartilage. Intraarticular insulin administration does not cause significant systemic effects in intact tissue.

Introduction Collagen scaffolds are a good surgical option for covering large focal osteochondral defects in the knee. In the recent literature there is a wide range of patient profiles and chondral defect treatments (chondral and osteochondral defects, associated procedures, etc.). The aim of the present study was to evaluate clinical and imaging outcomes with collagen scaffolds and to assess any correlation between medium-term clinical outcome and MRI features. The hypothesis was that there is no correlation between clinical outcome and MRI after 2 years postoperatively. Material and methods A single-center retrospective observational study included all patients receiving a MaioRegen® scaffold for large painful focal osteochondral defect of the femoral condyle. There were 17 patients, with a mean age of 28 ± 9 years. Defect locations comprised 12 medial femoral condyles, 4 lateral femoral condyles and 1 lateral tibial plateau. Mean defect area was 4.5 ± 1.4 cm2. All patients were evaluated clinically and on KOOS and objective and subjective IKDC scales, with MRI at last follow-up. Results At a mean follow-up of 46 ± 17 months, mean subjective IKDC was 67.8 ± 23; KOOS scores were: symptoms, 78 ± 22; pain, 78 ± 23; function, 85 ± 20; sports, 66 ± 27; and activities of daily living, 59 ± 25. MRI MOCART score revealed incomplete scaffold healing in 21.4% of cases, with variable signal intensity within regenerated tissue. Functional scores did not correlate with reconstruction aspect on MRI. Discussion/Conclusion 3D collagen scaffolds yield good medium-term clinical outcomes in large osteochondral defects of the knee. There is, however, a discrepancy between MRI features of the recipient site and objective and subjective clinical scores. These scaffolds may be a good option for treating large focal osteochondral defects in knees of young patients, but MRI does not provide satisfactory medium-term assessment.

Background Matrix-induced autologous chondrocyte implantation (mACI) can be performed in a full arthroscopic or mini-open fashion. A systematic review was conducted to investigate whether arthroscopy provides better surgical outcomes compared with the mini-open approach for mACI in the knee at midterm follow-up. Methods This systematic review was conducted following the PRISMA guidelines. The literature search was performed in May 2021. All the prospective studies reporting outcomes after mACI chondral defects of the knee were accessed. Only studies that clearly stated the surgical approach (arthroscopic or mini-open) were included. Only studies reporting a follow-up longer than 12 months were eligible. Studies reporting data from combined surgeries were not eligible, nor were those combining mACI with less committed cells (e.g., mesenchymal stem cells). Results Sixteen studies were included, and 770 patients were retrieved: 421 in the arthroscopy group, 349 in the mini-open. The mean follow-up was 44.3 (12–60) months. No difference between the two groups was found in terms of mean duration of symptoms, age, body mass index (BMI), gender, defect size (P > 0.1). No difference was found in terms of Tegner Score (P = 0.3), Lysholm Score (P = 0.2), and International Knee Documentation Committee (IKDC) Score (P = 0.1). No difference was found in the rate of failures (P = 0.2) and revisions (P = 0.06). Conclusion Arthroscopy and mini-arthrotomy approaches for mACI in knee achieve similar outcomes at midterm follow-up. Level of evidence II, systematic review of prospective studies.

CASE A patient presented with chronic ankle pain and instability. Imaging revealed a talar osteochondral lesion as well as intra-articular loose bodies. Intraoperatively, an unusual, well-demarcated chondral defect was found. A glass fragment was also identified in the joint. The patient subsequently recalled a minor ankle laceration from a shattered glass bottle, suggesting unrecognized foreign body retention as the cause of the cartilage damage. CONCLUSION This is the first reported example of glass migrating into the ankle joint, leading to significant cartilage damage. This case highlights the elusive nature of foreign bodies and the difficulty of diagnosis with standard imaging.

This study aimed to evaluate graft survivorship according to the size and location of chondral defects and its effect on clinical outcomes after meniscal allograft transplantation (MAT). It was hypothesized that large chondral defects would be associated with inferior outcomes. Patients who underwent lateral MAT with fresh-frozen allografts between 2007 and 2016 were retrospectively reviewed. The inclusion criteria were patients with femoral or tibial chondral defects (International Cartilage Repair Society grade 4) who were followed up more than 2 years with 3.0-T magnetic resonance imaging (MRI) scans. Maximal lesion diameter and location were assessed on MRI. The patients were divided into two groups, with chondral defects of

Background/Aims Significant acetabular chondral defects are a common clinical finding during hip arthroscopy, for which the current surgical management approach may be falling short. Autologous matrix-induced chondrogenesis and matrix-assisted autologous chondrocyte transplantation are two novel cell-regenerative therapies that offer a way to repair acetabular chondral defects. Methods A literature search of Cochrane, CINAHL, AMED and Medline (2007–2017) databases revealed seven relevant articles, but only four involved a hip arthroscopic approach. Results All included studies demonstrated some significant improvements in patient-reported outcomes for autologous matrix-induced chondrogenesis and matrix-assisted autologous chondrocyte transplantation. There appears to be a practical advantage in terms of cost and convenience for using one-step autologous matrix-induced chondrogenesis. However, over-reliance on one particular research team and use of small-scale retrospective studies constitutes low-level, non-generalisable evidence. Conclusions The literature does not convincingly support either of these new applications over and above any other currently available treatments. Further research is needed and should involve different centres, longer follow-ups and place a higher emphasis on methodological rigour in order to maximise the trustworthiness of results.

One-step clinical therapies of articular cartilage defects remains a challenge. In this study, a strategy was proposed to utilize type II collagen (Col-II) gels with autologous bone marrow-derived cells (BMDCs) embedded to repair full-thickness chondral defects. Its feasibility and efficacy were further assessed in a minipig model. An 8-mm full-thickness chondral defect was created on the femoral trochlea of two knees in Guizhou minipigs. One knee received Col-II gels with BMDCs implantation versus the untreated one as control. After 1, 3, and 6 months operation, the animals were sacrificed, and the repair outcomes of chondral defects were evaluated using Magnetic Resonance Imaging (MRI), macro- and microscopic observation, and histological analysis. The treatment group showed significantly better repair outcomes of chondral defects than that in the control group at each time point (P < 0.01). Furthermore, the image showed that the repaired tissue in the treatment group was more similar to the surrounding healthy cartilage tissue. Based on the hyaline-like tissue regenerated ability, this one-step strategy provides a promising therapeutic potential for clinical application.

Introduction Chondral defects of the talus are common and their treatment is challenging. Source of data Recent published literatures. Areas of agreement Membrane-induced Autologous Chondrocyte Implantation (mACI) and Autologous Matrix-Induced Chondrogenesis (AMIC) have been proposed as management for chondral defects of the talus. Areas of controversy It is debated whether AMIC provides greater outcomes compared to mACI for chondral regeneration. Several clinical studies showed controversial results, and the best treatment has not yet been clarified. Growing points To investigate whether AMIC provide superior outcomes than mACI at midterm follow-up. Areas timely for developing research AMIC exhibits similar clinical results to mACI. However, AMIC involves one single surgical procedure, no articular cartilage harvest and hence no morbidity from it, no need for chondrocyte expansion in a separate laboratory setting. For these reasons, AMIC may be preferred to mACI.

The introduction of mesenchymal stem cells (MSCs) into orthopedics has opened a variety of new evolving cellular treatments for treatment of chondral injuries. These cells are processed in one-step protocols or by cellular expansion to regenerate cartilage tissue and often combined with existing therapies such as microfracture. MSCs vary in their differentiation capacities, depending on their source, and cell harvest at each source yields varying numbers of cells. Recent literature has indicated MSCs to be safe and show positive results in producing superior cartilage tissue quality as well as better clinical patient outcomes. However, the main issue with MSC treatments is lack of standardization and quality control which has been a recent focus in stem cell medicine. Overall, the evidence in favor of MSC therapies is not definitive, and future research holds the key to determining their role in treatment. This chapter outlines the current characteristics MSCs have in repairing symptomatic cartilage defects.

The treatment of chondral defects using microdrilling often results in a mechanically weak fibrocartilagenous repair, rather than a more robust hyaline cartilage repair. Many different microfracture/microdrilling augmentation techniques have been described, including the use of cellular products to enhance healing. Autologous peripheral blood progenitor cells can be obtained via apheresis after administration of granulocyte colony stimulating factor (G-CSF) and have been used successfully augment microdrilling in clinical patients. The objective of this study was to use apheresis derived mononuclear blood cells to augment microdrilling treatment of a cartilage defect in an ovine model in order to determine the effect on healing. Forty adult female sheep were used in this study and were divided into a control group (microdrilling alone) and a treatment group (microdrilling, hyaluronic acid and apheretic product). Outcome measurements included weight bearing on the operated limb, macroscopic scoring of the joint, histology and immunohistochemistry. In addition, MRI was used to attempt to identify SPION labelled cells from the apheretic product in the operated limbs. The results showed a significant increase in healing as measured by the modified O'Driscoll sore in the treated group. No evidence of homing of SPION labelled cells to the defect was found and no correlation was found between the response to G-CSF administration or concentration of CD34+ve and outcome. A correlation was found between healing and the concentration of white blood cells and peripheral blood mononuclear cell numbers in the apheretic product. This article is protected by copyright. All rights reserved.

Background: BST-CarGel (CarGel) is an injectable chitosan scaffold that is mixed with fresh, autologous blood and injected into the site of microfracture (MF) to physically stabilize clots and enhance cartilage repair. Purpose: To evaluate short-term clinicoradiological outcomes of patients treated arthroscopically for acetabular chondral defects with CarGel in conjunction with MF compared with those treated with MF alone. Study Design: Cohort study; Level of evidence, 3. Methods: All patients who underwent hip arthroscopy and received MF with or without CarGel for acetabular chondral defects between 2014 and 2018 with a minimum 2-year clinicoradiological follow-up were included. Intraoperative details, postoperative complications, and clinical outcome scores, including the international Hip Outcome Tool–33 (iHOT-33), Hip Outcome Score (HOS)–Activities of Daily Living (HOS-ADL), and Hip Outcome Score–Sports Profile, were analyzed. Serial plain radiographs were assessed independently by 2 blinded observers. A survival analysis was performed to identify the number of cases converted to total hip arthroplasty (THA) in both groups, which was correlated with the cartilage defect size at the time of surgery. Results: Eighty patients (54 CarGel and 26 MF) were evaluated, including 56 men (70%) and 48 right hips (60%). Three patients were lost to follow-up. There were no major adverse events in either group. The average defect size was 3.63 and 4.97 cm2 in MF and CarGel, respectively ( P = .002). There was a statistically significant improvement in iHOT-33 (from 43.24 to 60.17 in MF and from 41.13 to 58.39 in CarGel) and HOS-ADL (from 62.25 to 76.75 in MF and from 44.69 to 79.16 in CarGel) scores. There was no difference between the 2 groups in the outcome scores after adjusting for covariates. Survival analysis showed 34.6% of MF cases and 5.9% of CarGel cases were converted to THA ( P = .001). The mean defect size of the failure group was higher in CarGel than in MF (8.83 and 3.72 cm2, respectively). Mean joint space reduction was 1.41 mm in MF and 0.19 mm in CarGel ( P < .001). Conclusion: Two-year clinicoradiological results were promising in these lesions that are difficult to treat. Arthroscopic treatment of chondral acetabular defects with CarGel demonstrated a significant decrease in progressive loss of joint space and conversion to THA compared with MF as an isolated procedure.

The management of symptomatic articular cartilage lesions, especially in the young, fit individual remains an area of considerable controversy. Articular cartilage repair or reconstruction techniques may offer these patients alternatives to arthroplasty. The TruFit™ plug is a synthetic biphasic polymer scaffold that is designed for implantation at the site of a focal chondral defect. The aim of this study is to report the long-term clinical and radiological outcomes of patients treated with the TruFit™ plug for chondral defects within the knee. 11 patients underwent TruFit™ plug implantation. Long-term outcome scores were available for 6 patients at a mean follow up of 121 months (SD 12.0 months, 1 patient unavailable and 4 excluded after arthroplasty surgery). There was no statistically significant improvements in any score although all scores did improve. At a mean radiographic follow up of 70 months (17-113) of 9 patients, the mean MOCART score was 22.2 (SD 15.6). All patients had incomplete or no evidence of plug incorporation and persistent chondral loss. Based on these results, we do not recommend the use of the TruFit™ plug.

Background The purpose of this study was to assess the outcomes of patients who underwent combined hip arthroscopy and periacetabular osteotomy with acetabular focal chondral defects and compare these outcomes with a group of patients without focal chondral defects. Methods A retrospective review looking at patients who underwent hip arthroscopy and/or periacetabular osteotomy was performed. Minimum 2-year follow-up, Tonnis grade 0-1, and a Beck chondromalacia stages 4-5 were included. Twenty-eight hips met inclusion criteria. These patients were then matched 1:1 and compared. Results The average acetabular chondral defect size was 144.3 mm 2 ± standard deviation 116.2. Postoperative, modified Harris Hip Score, Hip Disability and Osteoarthritis Outcome Score, and University of California Los Angeles scores were similar between groups ( P = .382, P = .755, P = .763, respectively). At the last follow-up, Tonnis grade was similar between groups ( P = .552). No association between having a defect and increased risk of failure was noted (hazard ratio 1.35 [95% CI 0.43-4.24], P = .607). Conclusion We found that patients with focal chondral defects did similar to a comparison group of patients without chondral defects.

Over the past decade, arthroscopic microfracture has become increasingly popular to treat full-thickness (Outerbridge grade IV) chondral defects of the hip. This procedure borrows marrow stimulation treatment principles and techniques from knee arthroscopy, with similar mixed clinical outcomes that may be more favorable in the short term (

The aim of this study was to evaluate the functional and radiological outcome of TruFit plugs. We retrospectively reviewed 10 patients who underwent treatment for a symptomatic chondral/osteochondral lesion using one or more Trufit Plugs. Full incorporation of the bony portion of the plug occurred in only 3 and partial incorporation in 7 lesions. The remaining portion of these 7 lesions looked cystic on MRI. The significance of this cystic change is not clear. Though all 10 patients showed some improvement on the IKDC scoring system but the amount of the improvement was small.

Objective To determine biomechanical effects of knee cartilage defect perimeter morphology based on cartilage strain and opposing subchondral bone contact. Design Articular cartilage defects were created in 5 bovine femoral condyles: group 1, 45° inner bevel with 8-mm rim; group 2, vertical with 8-mm rim; and group 3, 45° outer bevel with 8-mm base. Samples were placed into a custom-machined micro–computed tomography tube and subjected to 800 N of axial loading. DICOM data were used to calculate cartilage thickness 4 and 6 mm from the center, distance between tibial cartilage surface and femoral subchondral bone, and contact width between tibial cartilage and subchondral bone. Strain 4 mm from the center and both absolute and change in distance (mm) to subchondral bone were compared between groups 1 and 2 using paired t tests. Strain at 6 mm and distance changed, loaded distance, and contact width (mm) were compared between groups using the Friedman test with post hoc analysis using Wilcoxon signed rank test. Results No significant differences in rim strain were noted between groups 1 and 2 at 4 mm ( P = 0.10) and between groups 1, 2, and 3 at 6 mm ( P = 0.247) from the defect center. The loaded distance was significantly different between groups 1 and 3 ( P = 0.013). No significant change in distance to the subchondral bone was found between groups ( P = 0.156). The difference in subchondral bone contact area approached but did not reach significance ( P = 0.074). Conclusion When debriding focal articular cartilage defects, establishment of an inner bevel decreases tissue deformation and contact with opposing subchondral bone.

Cartilage disorders, including focal cartilage lesions, are among the most common clinical problems in orthopedic practice. Left untreated, large focal lesions may result in progression to osteoarthritis, with tremendous impact on the quality of life of affected individuals. Current management strategies have shown only a modest degree of success, while several upcoming interventions signify better outcomes in the future. Among these, stem cell therapies have been suggested as a promising new era for cartilage disorders. Certain characteristics of the stem cells, such as their potential to differentiate but also to support healing made them a fruitful candidate for lesions in cartilage, a tissue with poor healing capacity. The aim of this editorial is to provide an update on the recent advancements in the field of stem cell therapy for the management of focal cartilage defects. Our goal is to present recent basic science advances and to present the potential of the use of stem cells in novel clinical interventions towards enhancement of the treatment armamentarium for cartilage lesions. Furthermore, we highlight some thoughts for the future of cartilage regeneration and repair and to explore future perspectives for the next steps in the field.

The aim of the study was to assess the 2-year-follow-up of matrix-associated stem cell transplantation (MAST) in chondral defects of the 1st metatarsophalangeal joint (MTPJ). In a prospective consecutive non-controlled clinical follow-up study, 20 patients with 25 chondral defect at the 1st MTPJ that were treated with MAST from October 1st, 2011 to March, 30th, 2013 were analysed. The size and location of the chondral defects range of motion (ROM), and the Visual-Analogue-Scale Foot and Ankle (VAS FA) before treatment and at follow-up were registered. Stem cell-rich blood was harvested from the ipsilateral pelvic bone marrow and centrifuged (10min, 1500 RPM). The supernatant was used to impregnate a collagen I/III matrix (Chondro-Guide). The matrix was fixed into the chondral defect with fibrin glue. The age of the patients was 42 years on average (range, 35-62 years). The VAS FA before surgery was 50.5 (range, 18.3-78.4). The defects were located as follows, dorsal metatarsal head, n=12, plantar metatarsal head, n=5, dorsal & plantar, n=8 (two defects, n=5). The defect size was 0.7cm2 (range, .5-2.5cm2). ROM was 10.3/0/18.8° (dorsal extension/plantar flexion). All patients completed 2-year-follow-up. VAS FA improved to 91.5 (range, 74.2-100; t-test, p

Background: It is unclear whether chondral fragments without bone have the potential to heal after fixation. Controversy exists and opinions differ regarding the optimal treatment of chondral defects after pure chondral fracture. Purpose: To determine clinical and radiographic outcomes after internal fixation of traumatic chondral fragments repaired to bone in the knee. Study Design: Case series; Level of evidence, 4. Methods: A retrospective clinical and radiographic evaluation of 10 male patients with a mean age of 14.6 years (range, 10-25 years) at the time of surgery was performed. Eight of 10 patients were skeletally immature. Patients were selected by operating surgeons per the presence of a large displaced pure chondral fragment on magnetic resonance imaging and confirmed on intraoperative inspection. All patients had a diagnosed traumatic displaced pure chondral fracture of the knee (without bone) and underwent internal fixation with minimum 1-year follow-up. Validated patient-reported and surgeon-measured outcomes were collected pre- and postoperatively. All patients were evaluated at a mean 56 months postoperatively. Results: At surgery, the mean defect size that was primarily repaired with the displaced chondral fragment was 1.9 × 2.0 cm. With minimum 1-year follow-up, there were no clinical failures. All 8 patients who had subsequent magnetic resonance imaging follow-up had radiographic evidence of complete healing of the chondral fragment back to bone. At a mean follow-up of 56 months (range, 13-171 months; median, 36 months), patients had a mean International Knee Documentation Committee score of 94.74 (range, 87.4-100), a mean Marx Activity Scale score of 14.4 (range, 8-16), and a mean Tegner Activity Scale score of 7 (range, 5-9). At final follow-up, all patients except 1 returned to sports. Conclusion: The treatment of large traumatic chondral fragments is controversial. In this select series of 10 young patients who underwent primary repair with internal fixation, there were no failures clinically. Patients demonstrated excellent short-term clinical and radiographic results after fixation of these relatively large chondral fragments in the knee.

Tibiofemoral cartilage defects are often found in concurrence with and may be secondary to malalignment. This case discusses the treatment and evaluation of a 34-year-old female with a history of 2 years of atraumatic medial knee pain with prior partial meniscectomy found to have varus malalignment of 6° and a 2 cm2 chondral defect in the medial femoral condyle with an intact subchondral bone plate. When determining the appropriate treatment for a patient with these or similar symptoms, factors to consider include the following: degree of malalignment, smoking status, BMI, contralateral defects, concomitant meniscal lesions, extent of arthritis, range of motion, and likelihood of postoperative compliance. This discussion uses a review of recent literature to address the process of choosing an appropriate treatment and determining whether or not to correct cartilage abnormalities in conjunction with misalignment correction.

Life 11(3), 244 (2021). doi:10.3390/life11030244 special issue: "Special issue "Focal chondral defects" / special issue editors: Filippo Migliorini, guest editor; Nicola Maffulli, guest editor", Published by MDPI, Basel

Background: Chondral-only fragments of the knee have traditionally been treated with excision, with or without cartilage restoration procedures. This is because of the historical assumption that cartilage has limited ability to heal to cancellous or subchondral bone. There is now a growing body of evidence supporting surgical fixation of these fragments. Hypothesis: We hypothesized that surgical fixation of chondral fragments would result in acceptable rates of healing with improvement in clinical outcome scores. Study Design: Case series; Level of evidence, 4. Methods: Data were collected on 15 surgically fixed chondral-only fragments in 14 patients. We retrospectively collected participant demographic information, lesion characteristics, primary mechanism (osteochondritis dissecans vs traumatic shear injury), fixation methods, reoperation information, second-look arthroscopic information, and clinical outcome scores. The mean clinical follow-up was 3.96 years, with a minimum of 1-year follow-up. All patients underwent follow-up magnetic resonance imaging at a mean of 2 years after the index procedure. Results: The mean age of our cohort was 17.7 years. We found an 80% survival rate for fixation of the fragments at a mean 4-year follow-up. There were statistically significant improvements in postoperative Knee injury and Osteoarthritis Outcome Score and Tegner scores compared with preoperative scores. Follow-up magnetic resonance imaging scans showed complete healing in 10 knees, partial healing in 2 knees, and loss of fixation in 3 knees. Second-look arthroscopic surgery of 3 knees for reasons other than fragment symptoms showed healing of the fragment, while arthroscopic surgery of 3 symptomatic knees showed loss of fixation. Conclusion: Surgical fixation of chondral-only lesions showed an 80% success rate with improvements in the KOOS and Tegner scores.

This article is a critical analysis of a study, “Minimally Manipulated Bone Marrow Concentrate Compared with Microfracture Treatment of Full-Thickness Chondral Defects: A One-Year Study in an Equine Model,” by Chu et al. (J Bone Joint Surg Am. 100(2):138–146, 2018). The investigation compared two interventions in the management of full-thickness chondral defects in an equine model: autologous bone marrow concentrate without concomitant microfracture treatment versus microfracture treatment alone. This review analyzes the methodology and results of their investigation and examines how their findings may influence the continued development of therapeutic options for full-thickness cartilage injuries. The study utilized in vitro analysis, arthroscopic assessment, magnetic resonance imaging (MRI) evaluation, and histological analysis to compare the treatments and their influence on the quality of cartilage repair. Although Chu et al. reported similar results between groups, their findings offer insight into the role of arthroscopy, MRI, and histology in the evaluation of repair quality. We compare their findings to those of similar investigations, highlighting the limited therapeutic options and variable clinical outcomes related to the treatment of full-thickness articular cartilage defects. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11420-018-9647-z) contains supplementary material, which is available to authorized users.

Purpose: To develop a subchondral defect in a rabbit model and assess cartilage repair using a mesenchymal stem cell-seeded scaffold. Materials and Methods: To achieve this goal, a bovine explant model and two pilot rabbit studies were conducted. Initial work using chondral explant tissue harvested from stifle joints of 12-month-old cattle sourced from a local abattoir, followed by a pilot rabbit study demonstrated that a chondral defect was an unsuitable model for the scaffold being studied. Assessment of a novel reproducible technique for subchondral defect creation was conducted using a rabbit model in accordance with University guidelines and ethical approval with 4 test groups, empty 3mm x1mm defect (n=6), empty 3mm x3mm defect (n=6), press-fit scaffold in 3mm x1mm defect (n=6), press-fit cell-seeded scaffold in 3mm x1mm defect (n=6). l. In brief, skeletally mature rabbits, weighing more than 3kg were anesthetized and bilateral defects were created on the medial femoral condyle using an electrical drill with a previously sterilized 2.8mm drill bit covered with a sterile depth stop. The walls of the defect were finished with a dental curette, and the scaffold press-fit into place. Defects was assessed histologically after 28 days implantation. Results: The subchondral defects could be created with the same reproducibility as osteochondral defects and tissue repair was achieved in both cell free and cell-seeded scaffolds. Conclusion: A reproducible subchondral defect was successfully created in a rabbit model to assess cartilage repair using a cell-seeded scaffold. Early cartilage repair was achieved in both cell free and cell-seeded scaffolds, with improved repair seen in the cell free scaffold group

Tibial tubercle osteotomy (TTO) is a procedure that may be used to address a wide array of patellofemoral joint pathology. The most common indications for TTO include (1) patellar instability, including either a lateralized force vector or abnormal patellar alta, and (2) patellar focal cartilage defects or chondromalacia. Customization of the TTO can effectively address the patellofemoral joint pathology by modifying patellar tracking in the trochlear groove and/or altering the contact pressures experienced by the patellofemoral cartilage. TTO may be most successful when performed in conjunction with soft-tissue stabilization and/or biological augmentation of chondral injuries. Specifically, isolated anteromedialization is recommended for focal, distal lateral patellar lesions; combined anteromedialization and cartilage restoration are recommended for medial, central, and/or panpatellar cartilage pathology; medialization with soft-tissue stabilization is recommended for a lateralized tubercle position (elevated tibial tubercle-trochlear groove distance); and distalization with soft-tissue stabilization is recommended for patella alta. Clinical studies have shown good to excellent results at long-term follow-up when a TTO is performed for patellar instability, whereas TTO performed for chondral defects has shown good to excellent outcomes that correlate strongly with the size and location of the chondral defect. With appropriate patient selection, TTO is a valuable tool for the treatment of patellofemoral joint pathology.

UNLABELLED ΒACKGROUND: To present surgical instrumentation used in knee chondrectomy and evaluate its effectiveness - a review of the literature. Surgical removal of joint cartilage, or chondrectomy, has been performed by orthopedists since the 1950s. Initially carried out as an open surgery, it has generally come to be performed arthroscopically. Its aim is to create even and stable cartilaginous edges perpendicular to the joint surface and a suitably prepared bottom of the defect for optimum integration of the cartilaginous regenerate. MATERIAL AND METHODS In order to present surgical instrumentation used in knee chondrectomy, English-language journals from the years 2010-2013 with an Impact Factor (2013) of at least 2.0 were analyzed. Papers concerning effectiveness and precision of knee chondrectomy according to the instrument used were also analyzed. RESULTS According to the articles the most popular instruments used to debride chondral defects are open bone curettes (67% of the surgeries), scalpels (35%) and shavers (21%). Open bone curettes were used most frequently in open surgeries (78%), often along with scalpels (49% of the surgeries). In arthroscopic procedures, the most common instruments were shavers (50% of the surgeries) and open bone curettes (49%). CONCLUSIONS 1. In open chondrectomies, the most frequently used instruments are open bone curettes and scalpels. 2. Of all instrumentation presented in this review, this combination ensures the highest precision, as required by Steadman's criteria, of debriding the edges and bottom of a chondral defect. 3. In arthroscopic procedure, a shaver and an open bone curette is the most frequently used combination. 4. None of the instruments and their combinations used in arthroscopic procedure ensures debridement of the defect in compliance with Steadman's recommendations.

Chondral defects of the knee are frequently encountered during arthroscopy. For symptomatic lesions, several surgical options exist. Determining the best surgical option for a patient can be challenging for the treating surgeon. Autologous chondrocyte implantation (ACI) is an articular cartilage–restoring procedure that is commonly used to treat medium-to-large full-thickness cartilage lesions of the knee. It is a 2-stage procedure requiring cartilage biopsy, 4-6 weeks of in vitro chondrocyte expansion, followed by reimplantation. Short- and long-term outcome studies have been promising regarding patient satisfaction and durability. Realignment procedures, as indicated, have been shown to improve clinical outcome and longevity of the transplanted grafts. As newer generation techniques evolve, complications have been minimized.

Reports of irreducible patellar dislocations are exceedingly sparse throughout the literature. Obvious radiographic or physical exam findings including fracture or inversion of the patella are often present to explain the block to reduction. Not described previously in the literature is the instance of an irreducible patella dislocation in the setting of innocuous appearing injury imaging. We present a case of a healthy thirty-two-year-old female who sustained an irreducible lateral patella dislocation while participating in a dance aerobics class. Closed means of reduction were unsuccessful, necessitating open reduction. Intraoperative findings suggest incarceration of a nondisplaced fracture and a chondral defect as the block to reduction. Following open reduction, the patient has had no further episodes of pain or instability related to the patella at one-year follow-up. Irreducible patellar dislocations are exceedingly rare injuries, where associated osseous or chondral lesions may necessitate open reduction despite innocuous appearing initial imaging. A high index of suspicion to proceed with open reduction may limit repeated attempts at closed reduction and further injury.

Damage to articular cartilage can over time cause degeneration to the tissue surrounding the injury. To address this problem, scaffolds that prevent degeneration and promote neotissue growth are needed. We introduce a new hybrid scaffold that combines a stereolithography-based three-dimensional printed support structure with an injectable and photopolymerizable hydrogel for delivering cells to treat focal chondral defects. In this proof of concept study, we demonstrate the ability to a) infill the support structure with an injectable hydrogel precursor solution, b) incorporate cartilage cells during infilling using a degradable hydrogel that promotes neotissue deposition, and c) minimize damage to the surrounding cartilage when the hybrid scaffold is placed in situ in a focal chondral defect in an osteochondral plug that is cultured under mechanical loading. With the ability to independently control the properties of the structure and the injectable hydrogel, this hybrid scaffold approach holds promise for treating chondral defects.

The use of three-dimensional (3D) printing has seen a vast expansion over recent years, with an increased application for its use in orthopaedics. This report details the use of 3D printing technology to aid in the treatment of a medial femoral condyle osteochondral defect in a 26-year-old female who had previously undergone a failed autograft procedure. A preoperative computed tomography scan of the knee and chondral defect was used to generate a 3D printed, one-to-one scale replica of the distal femur. This replica was then used to size a patient-specific allograft plug for the osteochondral transplantation procedure. The patient recovered well, and 1 year postoperatively the allograft was well incorporated into the medial femoral condyle and healed. This report illustrates the advantages of using a 3D printed model to allow for tactile feedback and improved visualization that will allow for improved understanding of complex surgical procedures. Level of evidence V.

Please provide affiliation for the authors “Jorge Chahla”; “Robert F. LaPrade”; “Mark Cinque”.

The management of chondral defects is a challenging topic of current interest for scientists and surgeons. Chondral defects caused by tumor, trauma, infection, congenital malformations are very common in clinical, which seriously affect the patient’s function and quality of life. Even several centuries after its first observation, this problem has still not found a satisfactory and definitive answer. Cartilage tissue engineering, which involves novel natural scaffolds, has emerged as a promising strategy for cartilage regeneration and repair. In this chapter, we aimed to review the application of the scaffold materials in cartilage tissue engineering, including the conditions needed to meet the ideal stent, the preparation of scaffold materials, preparation methods and so on.

The concept of Dislocation Arthropathy was first described by Samilson and Prieto in 1983 and refers to the articular changes that can be seen in patients with an unstable shoulder. It is a frequent disease that affects more than half of the patients suffering from instability problems. Radiological findings are usually mild and clinical symptoms as well, and they do not differ from those arising from other shoulder arthritis causes.Surgical management is advocated when a well-established conservative protocol fails. This would include arthroscopic debridement and total shoulder replacement as the most reliable options. For isolated unipolar lesions, techniques intended to repair the chondral defect (microfractures, cartilage transplantation, osteochondral allografts or partial resurfacing) have also been proposed.

Focal chondral lesions of the glenohumeral joint, though less common than chondral defects in the knee or ankle, can be a significant source of pain in an active population. For patients in whom nonsurgical management fails, promising results have been reported after arthroscopic microfracture surgery to treat such lesions. However, microfracture leads to growth of fibrocartilage tissue and is biomechanically less durable than native hyaline cartilage. Recently, augmentation of the microfractured defect with micronized allogeneic cartilage and platelet-rich plasma has been described to restore hyaline-like cartilage and potentially protect the subchondral bone from postsurgical fracture biology within the base of the defect. We present a simple arthroscopic technique of implanting dehydrated, micronized allogeneic cartilage scaffold to treat an isolated chondral lesion of the glenoid.

Treatment of osteochondral lesions of the knee with synthetic scaffolds seems to offer a good surgical option preventing donor site morbidity. The TruFit® plug has frequently been shown to not properly incorporate into.To evaluate the relationship between MRI findings and functional scores of patients with osteochondral lesions of the knee treated with TruFit®.Patients were evaluated with MOCART score for magnetic resonance imaging assessment of the repair tissue. KOOS, SF-36 and VAS were used for clinical evaluation. Correlation between size of the treated chondral defect and functional scores was also analyzed.Fifty-seven patients with median follow-up of 44.8 months (range 24-73) were included. KOOS, SF-36 and VAS improved from a mean 58.5, 53.9 and 8.5 points to a mean 87.4, 86.6 and 1.2 at last follow-up (p0.001). Larger lesions showed less improvement in KOOS (p=0.04) and SF-36 (p=0.029). Median Tegner values were restored to preinjury situation (5, range 2-10). Mean MOCART score was 43.2 ± 16.1. Although the cartilage layer had good integration, it showed high heterogeneity and no filling of the subchondral bone layer.TruFit® failed to restore the normal MRI aspect of the subchondral bone and lamina in most cases. The appearance of the chondral layer in MRI was partially re-established. This unfavourable MRI appearance did not adversely influence the patient's outcome in the short time and they restored their previous level of activity. There was an inverse linear relationship between the size of the lesion and the functional scores.Therapeutic case series; level 4.

Chondral injuries of the hip joint are often symptomatic and affect patient activity level. Several procedures are available for addressing chondral injuries, including microfracture. Microfracture is a marrow-stimulating procedure, which creates subchondral perforation in the bone, allowing pluripotent mesenchymal stem cells to migrate from the marrow into the chondral defect and form fibrocartilaginous tissue. In the knee, microfracture has been shown to relieve pain symptoms. In the hip, microfracture has been studied to a lesser extent, but published studies have shown promising clinical outcomes. The depth, joint congruity, and geometry of the hip joint make microfracture technically challenging. The most common technique uses hip-specific microfracture awls, but the trajectory of impaction is not perpendicular to the subchondral plate. Consequently, the parallel direction of impaction creates poorly defined channels. We describe an arthroscopic microfracture technique for the hip using a flexible microfracture drill. The drill and angled guides simplify access to the chondral defect. The microfracture drill creates clear osseous channels, avoiding compaction of the surrounding bone and obstruction of the channels. Furthermore, this technique allows for better control of the angle and depth of the drill holes, which enhances reproducibility and may yield improved clinical outcomes.

Clinical trials of various procedures, including bone marrow stimulation, mosaicplasty, and autologous chondrocyte implantation, have been explored to treat articular cartilage defects. However, all of them have some demerits. We focused on autologous culture-expanded bone marrow mesenchymal stem cells (BMSC), which can proliferate without losing their capacity for differentiation. First, we transplanted BMSC into the defective articular cartilage of rabbit and succeeded in regenerating osteochondral tissue. We then applied this transplantation in humans. Our previous reports showed that treatment with BMSC relieves the clinical symptoms of chondral defects in the knee and elbow joint. We investigated the efficacy of BMSC for osteoarthritic knee treated with high tibial osteotomy, by comparing 12 BMSC-transplanted patients with 12 cell-free patients. At 16-month follow-up, although the difference in clinical improvement between both groups was not significant, the arthroscopic and histological grading score was better in the cell-transplanted group. At the over 10-year follow-up, Hospital for Special Surgery knee scores improved to 76 and 73 in the BMSC-transplanted and cell-free groups, respectively, which were better than preoperative scores. Additionally, neither tumors nor infections were observed in all patients, and in the clinical study, we have never observed hypertrophy of repaired tissue, thereby guaranteeing the clinical safety of this therapy. Although we have never observed calcification above the tidemark in rabbit model and human histologically, the repair cartilage was not completely hyaline cartilage. To elucidate the optimum conditions for cell therapy, other stem cells, culture conditions, growth factors, and gene transfection methods should be explored.

Microfracture is considered as the first-line procedure for knee cartilage repair, but the results of microfracture seem less predictable and rather controversial in a salvage situation. Thus, the purpose of the study was to histomorphochemically compare microfracture as a salvage procedure with microfracture as a first-line procedure in a rabbit model. We hypothesized that microfracture in a salvage situation would result in histomorphochemically inferior cartilage repair compared to microfracture as a first-line procedure, and the inferiority would be attributed to less migration of reparable marrow cells to the defect due to destruction of microarchitecture of the subchondral bone. Thirty-six New Zealand white rabbits were divided into three groups: (i) untreated full- thickness chondral defect, (ii) single microfracture treatment (first microfracture group), and (iii) repeated microfracture in 8 weeks after the first procedure (second microfracture group). In each group, rabbits were sacrificed at the end of 8 weeks, and osteochondral specimens at the repair sites were obtained for histomorphochemical analysis. Results showed that microfracture as a salvage procedure resulted in overall inferior cartilage repair histomorphochemically compared with microfracture as a first-line procedure, which correlated with deteriorative changes in the quality of underlying subchondral bone rather than intrinsic incapability to recruit the reparative cells in the defect area. In conclusion, although a comparable number of reparable cells and a mechanically weakened subchondral bone are anticipated, more study is necessary to clearly determine when a microfracture should be performed in a situation. 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res

Recently, many clinical studies have been published regarding platelet-rich plasma (PRP) injection for early degenerative joint disease. We evaluated the cartilage repair potential of platelet-rich plasma when injected into the knee joint. Articular, cartilage defects 4 mm in diameter and circular in shape were made in the trochlear region of 20 knees in 10 New Zealand white rabbits who were divided into two groups. The left knees in the control group underwent microfracture, and the right knees in the experimental group underwent microfracture with subsequent injection of platelet-rich plasma. At week 12 following the surgery, the cartilage was observed macroscopically and histologically compared in the two groups. The control group showed incomplete and irregular fibrous tissue formation in the defect. The experimental group showed nearly complete defect coverage with neo-cartilage. In the histologic scoring, comparison of the control group and the experimental group differed significantly (p < 0.05).Therefore, injection of platelet-rich plasma used to treat articular cartilage defects of the knee appears to have some effect for cartilage regeneration.

Previous studies report professional athletes return to play following arthroscopic microfracture of the hip for chondral defects. Our hypothesis is that professional hockey players undergoing arthroscopic microfracture for chondral defects of the hip achieve the same performance they had pre-injury and compared to matched controls. Seventeen professional hockey players underwent arthroscopic microfracture for an Outerbridge grade IV chondral lesion. Concomitant procedures for labral pathology or FAI were included. Performance data for the full season preceding and following index procedure were analysed, in addition to two matched control players per subject. Data were collected at two points, 2 years apart. Eighty-two per cent (14/17) of players who underwent arthroscopic microfracture returned to play. The year prior to injury for the 14 players who returned was compared to the average of their individual controls. There was no statistical difference between the groups for age, number of seasons in the league, games played, time on ice, points, save percentage, and shots against goal. Post-operatively, there was no statistical difference between the treatment and control groups regarding performance measures. There was a trend towards a decrease in games played and points post-operatively compared with controls. The treatment group decreased 11 games played, while the controls decreased five games. The treatment group also decreased 14 points, while the controls decreased three points for the season. Professional hockey players with a discrete, full-thickness chondral defect of the hip are able to return to elite performance level following an arthroscopic microfracture procedure when compared to pre-injury outcomes and controls. III.

The biomechanical functionality of articular cartilage is derived from both its biochemical composition and the architecture of the collagen network. Failure to replicate this normal Benninghoff architecture in regenerating articular cartilage may in turn predispose the tissue to failure. In this article, the influence of the maturity (or functionality) of a tissue-engineered construct at the time of implantation into a tibial chondral defect on the likelihood of recapitulating a normal Benninghoff architecture was investigated using a computational model featuring a collagen remodeling algorithm. Such a normal tissue architecture was predicted to form in the intact tibial plateau due to the interplay between the depth-dependent extracellular matrix properties, foremost swelling pressures, and external mechanical loading. In the presence of even small empty defects in the articular surface, the collagen architecture in the surrounding cartilage was predicted to deviate significantly from the native state, indicating a possible predisposition for osteoarthritic changes. These negative alterations were alleviated by the implantation of tissue-engineered cartilage, where a mature implant was predicted to result in the formation of a more native-like collagen architecture than immature implants. The results of this study highlight the importance of cartilage graft functionality to maintain and/or re-establish joint function and suggest that engineering a tissue with a native depth-dependent composition may facilitate the establishment of a normal Benninghoff collagen architecture after implantation into load-bearing defects.

Objective: Autologous osteochondral cartilage repair is a valuable reconstruction option for cartilage defects, but the accuracy to harvest and deliver osteochondral grafts remains problematic. We investigated whether image-guided methods (optically guided and template guided) can improve the outcome of these procedures. Design: Fifteen sheep were operated to create traumatic chondral injuries in each knee. After 4 months, the chondral defect in one knee was repaired using (a) conventional approach, (b) optically guided method, or (c) template-guided method. For both image-guided groups, harvest and delivery sites were preoperatively planned using custom-made software. During optically guided surgery, instrument position and orientation were tracked and superimposed onto the surgical plan. For the template-guided group, plastic templates were manufactured to allow an exact fit between template and the joint anatomy. Cylindrical holes within the template guided surgical tools according to the plan. Three months postsurgery, both knees were harvested and computed tomography scans were used to compare the reconstructed versus the native pre-injury joint surfaces. For each repaired defect, macroscopic (International Cartilage Repair Society [ICRS]) and histological repair (ICRS II) scores were assessed. Results: Three months after repair surgery, both image-guided surgical approaches resulted in significantly better histology scores compared with the conventional approach (improvement by 55%, P < 0.02). Interestingly, there were no significant differences found in cartilage surface reconstruction and macroscopic scores between the image-guided and the conventional surgeries.

Objective: Autologous chondrocyte implantation (ACI) involves the application of a chondrocyte suspension into a membrane-sealed cartilage defect. Recently, “cell-seeded collagen matrix-supported” ACI has been developed wherein chondrocytes are seeded on a biomembrane. This study aimed at preclinically comparing 4 variant ACI techniques in a refined goat model: 2 traditional procedures, whereby the defect is sealed by a periosteal flap or collagen membrane, and 2 cell-seeding methods, with the collagen membrane either sutured or glued into the defect. Design: The efficacy of the surgical techniques was evaluated in an acute critical size chondral defect in the medial condyle of 32 skeletally mature goats, randomly assigned to 1 of the 4 aforementioned treatment groups. After 10 weeks in vivo, the quality of the repair was graded histologically by 2 independent, blinded readers using the “modified O’Driscoll” score. Results: The cell-seeding procedure whereby the membrane is sutured into the defect has a similar structural repair capacity than traditional ACI techniques. However, when the cell-seeded membrane was glued into the defect, the outcome appeared inferior. Conclusion: These findings indicate that optimizing the goat model and the postoperative recovery does allow preclinical evaluation of ACI-based cartilage implants in a load-bearing setting. This preclinical observation provides support to the clinical utilization of the sutured membrane-seeded (ACI-CS) technique, provided sutures, but not fibrin sealants, are used to fix the cell-seeded membrane in the defect bed.

The hip arthroscopy is a surgical technique in the rapidly changing and increasingly common treatment for many painful conditions of the hip in top-level athletes. There is growing evidence that demonstrates the utility of this technique in the treatment of numerous causes of coxalgia [1, 2], including femoro-acetabular impingement (FAI) and microfracture. This approach, certainly less invasive than traditional open surgery, was effective in facilitating a quick return to the sport by the athletes [3].

BACKGROUND Acetabular chondral defect are very frequently associated to FAI. Treatment options are still questionable. METHODS Between 2008 and 2014, 201 patients over 583 have been arthroscopically treated with the AMIC procedure for grade III and/or IV acetabular chondral lesions. Patients age was between 18 and 50 years; acetabular chondral lesion size was between 2 and 4 cm2; radiological Tonnis degree of osteoarthritis was ≤ 2. RESULTS The mean follow up of the entire group of 201 patients was 5 years (from 8 to 2). Significant improvement, as measured by the mHHS, was observed at 6 months in comparison to preoperative levels (80.3 ± 8.3) (p