Bipolar articular chondral lesions of the knee

Abstract

Bipolar chondral defects cause a high degree of dysfunction in patients, namely athletes, and are often less common and more difficult to treat than isolated chondral lesions. Patients often present with a more degenerative rather than traumatic etiology, and while bipolar lesions are often a relative contraindication for cartilage procedures, undertreatment may contribute to further degeneration. This is complicated by the relative dearth of literature detailing evidence-based treatment strategies for bipolar lesions. Despite a number of cartilage restoration techniques and orthobiologics available, further research is needed in order to determine the most appropriate and effective treatment for this complicated pathology. This chapter presents two cases of former athletes with symptomatic bipolar lesions - one which was treated with a particulated juvenile allograft cartilage transplantation, microfracture, and tibial tubercle osteotomy with anteromedialization while the other with an osteochondral allograft transplantation, microfracture, and lateral meniscal allograft transplantation.