Debridement of the Injured Cartilage

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Chapter 3 Debridement of the Injured Cartilage

Mats Brittberg

Introduction

• Debridement of the injured cartilage
• Indications related to type of lesions
• Arthroscopic procedure or open

Cartilage lesions could be either traumatic or nontramatic. Common for all lesions are that they are irregular and need to be cleaned for a secure repair possibility, irrespective of which type of repair is to be used (Fig. 3-1):

• Defects that extend into the cartilage tissue but involve <50% of the cartilage thickness are classified as ICRS 21,2 (Figs. 3-2 and 3-3).
• These lesions are often unstable, with partly detached fragments that need to be debrided to form stable lesions.
• The prognosis for ICRS-2 partial-thickness lesions seems good, with diminished mechanical symptoms following a simple debridement that involves excision of the unstable cartilage fragments back to smooth edges and leaves the base intact.
• In the literature, the deep to bare-bone lesions seem troublesome. Lesions that extend through >50% of the cartilage thickness are classified as ICRS 31,2 (Figs. 3-3 and 3-4).

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FIGURE 3-1 An irregular defect to be debrided. The defect has been treated before with bone marrow stimulation.

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FIGURE 3-2 The ICRS cartilage defect classification.

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FIGURE 3-3 ICRS Grade 2.

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FIGURE 3-4 ICRS Grade 3 a-d.

There are four subgroups of this grade:

• Deep defects that extend through >50% of the cartilage depth but not to the calcified layer are classified as ICRS 3a.1,2
• Deep defects that extend through >50% of the cartilage down to the calcified layer are classified as ICRS 3b.1,2
• Defects that extend down to but not through the subchondral bone plate are classified as ICRS 3c.
• Finally, blisters are classified as ICRS 3d.1,2

All of the lesions in category ICRS 3 are simply defined as defects that extend through >50% of the cartilage thickness, through the cartilage but not through subchondral bone plate.

While debridement of unstable edges (as is suggested for ICRS-2 lesions) is suitable for ICRS-3 lesions, further treatment is recommended for these more extensive lesions.

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