Treatment for cartilage injuries of the knee with a new treatment algorithm

Table 1 Classification of articular lesions by severity

Grade	Outerbridge	Modified outerbridge	ICRS
0	Normal cartilage	Intact cartilage	Intact cartilage
I	Softening and swelling	Chondral softening or blistering with intact surface	Superficial (soft indentation or superficial fissures and cracks)
II	Fragmentation and fissures in area less than 0.5 inch in diameter	Superficial ulceration, fibrillation, or fissuring less than 50% of depth of cartilage	Lesion less than half the thickness of articular cartilage
III	Fragmentation and fissures in area larger than 0.5 inch in diameter	Deep ulceration, fibrillation, fissuring or chondral flap more than 50% of cartilage without exposed bone	Lesion more than half the thickness of articular cartilage
IV	Exposed subchondral bone	Full-thickness wear with exposed subchondral bone	Lesion extending to subchondral bone

ICRS: International Cartilage Repair Society.

Table 2 Treatment options for articular cartilage lesions

Procedure	Indications	Outcome
Arthroscopic debridement and lavage	Minimal symptoms	Palliative
Marrow stimulation	Smaller lesions, low-demand patient	Reparative
Osteochondral autograft	Smaller lesions, low-or high-demand patients	Restorative
Osteochondral allograft	Larger lesions with bone loss, low-or high-demand patients	Restorative
Autologous chondrocyte implantation	Small and large lesions with and without bone loss, high-demand patients	Restorative
Genetic engineering	Investigational	Restorative

From Garrick JG, editor: Orthopaedic knowledge update: sports medicine, 3^rd ed, Rosemont, IL, 2004, American Academy of Orthopaedic Surgeons.