Table 1 Comparison of three surgical techniques in the treatment of OCLA
Arthroscopy, BMS | Retrograde drilling | ACI | |
|---|---|---|---|
Advantages | - Indicated for chondral and osteochondral lesions [17] - Reported reduction of pain and improvement of function (e.g. AOFAS score) [9] - Low complication rate [9] - Re-BMS is possible [17] | - Indicated for subchondral lesions [9] - Can be performed with intraoperative imaging and/or targeting device [18] - Good reported outcomes in patients with open growth plates and when performed as first-line surgical intervention [9] - Can be combined with bone grafting (lesion diameter > 1 cm, depth > 1 cm, cysts > 100 mm3) [18] | - Indicated for lesions with size > 1 cm2 with or without cysts [19]; vs other recommendations: lesion size ≥ 1.5 cm2 [20] - Good reported functional outcomes, even when performed after failed first-line surgical treatment [9] - Can be combined with bone grafting |
Limitations | - Formation of fibrocartilage instead of hyaline cartilage [9] - Lesions < 10 mm in diameter, < 100 mm2 in area and < 5 mm in depth [17]; vs. other recommendations: lesion size < 1.5 cm2 [20] | - Overlaying cartilage must be intact to achieve good outcome [9, 18] | - Two-step procedure (harvesting and implantation) [9] - Harvest-site morbidity - Open procedure might be needed for implantation |