What is the most appropriate articular procedure for a patient with a grade IV focal articular cartilage lesion?

• A. Mosaicplasty
• B. Autologous chondrocyte transplant
• C. Microfracture
• D. Osteochondral grafting

Answer: (C)

The best choice for treating a grade IV focal articular cartilage lesion is microfracture. This technique is particularly suitable for lesions that involve the full thickness of cartilage down to the subchondral bone. Microfracture involves creating small holes in the bone beneath the damaged cartilage, which allows marrow-borne stem cells and growth factors to migrate to the surface and form a blood clot. This clot serves as a scaffold for new cartilage formation, allowing the body to heal the defect naturally.

In the case of a grade IV lesion, which indicates severe damage that exposes subchondral bone, microfracture is often the most accessible and effective procedure. It is less invasive compared to other options and can be performed arthroscopically. The method also provides a relatively short recovery period, allowing patients to return to their activities more quickly.

Other options may be less effective for grade IV lesions. Mosaicplasty is typically reserved for less extensive lesions as it requires harvesting small cylindrical plugs of healthy cartilage from a donor site to fill in defects, which can be more challenging with larger defects. Autologous chondrocyte transplantation is suitable for larger or more complex lesions but involves a two-step process and surgical interventions that might not be necessary for a focal defect