Management of Articular Cartilage Injuries in the Knee

Chondral injuries of the knee are a common source of disability in a military population. These lesions may limit activities of daily living and military duty requirements and may compromise the readiness of the individual and the unit. The ability to avoid or modify activities is often not an option in this population. At the US Air Force Academy, we treat active duty and retired patients, as well as their dependents. In addition, we care for over 4,400 cadets including athletes from 27 intercollegiate sports. This patient population presents a considerable experience with these injuries. Treatment of knee chondral lesions in our population begins with a thorough history and physical examination. Radiographic studies including x-rays, magnetic resonance imaging, computed tomography scans, and alignment films are often used in the preoperative plan. Lesions are characterized according to their size and surrounding environment, including quality of surrounding cartilage and mechanical alignment. Based on the preoperative evaluation, we use a variety of surgical techniques including microfracture, osteoarticular autograft and allograft transplantion, and autologous chondrocyte transplantation. Osteotomies are also used to correct malaligment when necessary. The postoperative regimen is specific and critical to the success of the procedure. With careful attention to preoperative workup, meticulous surgical technique, and compliance with a specific postoperative regimen, cadets and active duty members can recover from these injuries and return to activities including intercollegiate athletics, military readiness, and overseas deployment duties.