Evolution of surgical treatment of cartilaginous lesions

Osteochondral lesion (OLT) of the ankle joint is an injury involving the chondral layer and the subchondral bone, usually traumatic in etiology. OLT treatment is debated and no clear guidelines exist. Reparative procedures are effective in small-size lesions, but a fibrocartilage layer with low biomechanical properties is generated. Regenerative techniques, supplying a layer of hyaline cartilage, are welcomed. Open-field autologous chondrocytes implantation (ACI) was the first regenerative technique relying on cells to be adopted, but it was rich in technical drawbacks. Arthroscopic ACI was developed thanks to scaffold introduction and a specific instrumentation. The technique was simplified, and the clinical and MRI results were comparable with open-field ACI. Bone marrow-derived cells transplantation (BMDCT) was then developed to overcome the two-step surgery, the high costs, and the laboratoristic phase. BMDCT is based on autologous mesenchymal stem cells, more useful in case of large bony defects and even degenerated joint environment. The clinical, MRI, and histological outcomes were good at midterm follow-up. Regenerative techniques are reliable procedures: Nevertheless, more biological studies are needed to understand the applicability and the possible improvements of these procedures.