Re-evaluating Cartilage Defect Measurement Methods and Standard Surgical Thresholds: An Opinion Piece

Abstract

Cartilage lesion size is an essential component in treatment algorithms for various therapeutic and surgical interventions. Obtaining accurate and precise measurements is critical to formulating a comprehensive treatment plan. Standard measurement methods overestimate lesion size due to inadequate shape evaluation. Furthermore, currently accepted surgical intervention thresholds are elevated beyond the level at which rim stress demonstrates significant load distribution within the knee. Based on the current literature, evaluating a chondral lesion based on the oval area proved to be a novel proposition. The excess area (EA) that accounted for in following the rectangular area (RA) measurement method is described by the following equation: EA 0.858 (r₁ x r₂). Furthermore, the EA occupies roughly 21.45% of the defect area regardless of lesion size.

Additionally, the lesion size threshold within the knee has significant implications beginning at 1cm², as opposed to the currently accepted surgical threshold of 2cm². However, how cartilage defects are measured needs to be rooted in more scientific and precise manners to best aid in clinical and pre-operative decision-making. Utilizing the alternative measurement method, surgeons can make more informed treatment plans with each patient. While the decision to treat cartilage defects is multifactorial, surgical intervention algorithms should be re-evaluated, provided the refined measurement methods and newer threshold recommendations.