The Sports Docs Podcast

186: From Defect to Comeback: Modern Cartilage Treatment Strategies: Dr. Aaron Krych LIVE at AOSSM 2026

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0:00 | 23:39

Recorded live from the American Orthopaedic Society for Sports Medicine (AOSSM) Annual Meeting in Seattle, Dr. Aaron Krych joins Drs. Catherine Logan and Ashley Bassett for an in-depth discussion on the rapidly evolving field of cartilage restoration. The conversation explores how treatment has shifted from simply filling cartilage defects to restoring the entire knee joint through comprehensive patient evaluation, biologic innovations, and advanced surgical techniques.

The Evolution of Cartilage Restoration

  • Why focal cartilage defects should be viewed as a "whole joint disease"
  • Moving beyond isolated microfracture
  • The growing importance of correcting alignment, instability, and meniscal deficiency
  • Earlier intervention in young athletic patients to preserve long-term joint health

Understanding Natural History

  • Why untreated cartilage defects can enlarge over time
  • Risk factors for lesion progression and development of secondary cartilage injuries
  • Counseling patients on long-term consequences and timing of intervention

Modern Treatment Algorithms

  • Why strict size-based algorithms are becoming less relevant
  • Patient-specific factors influencing procedure selection:
    • Age
    • Activity level
    • Defect size and location
    • Subchondral bone involvement
    • Previous surgery
    • Overall joint health

Diagnostic Evaluation

  • The expanding role of advanced MRI
  • When diagnostic arthroscopy remains essential
  • Emerging applications of nano-arthroscopy for:
    • Preoperative lesion evaluation
    • Assessment of graft incorporation
    • Evaluation of persistent postoperative symptoms

Single-Stage Cartilage Restoration Techniques

AutoCart

  • Single-stage autologous cartilage restoration
  • Surgical technique pearls
  • Cartilage harvest using GraftNet technology
  • PRP/BMAC augmentation
  • Technical considerations for successful implantation

Osteochondral Options

  • When bone involvement changes the treatment strategy
  • Indications for:
    • Osteochondral Autograft Transfer (OATS)
    • Fresh Osteochondral Allograft Transplantation
  • Choosing between autograft and allograft techniques

Alignment Matters

  • Why cartilage restoration cannot succeed in an overloaded compartment
  • Indications for combining osteotomy with cartilage restoration
  • Medial high tibial osteotomy (HTO)
  • Distal femoral osteotomy (DFO)
  • Benefits of patient-specific instrumentation for osteotomy planning and execution

Lessons Learned

Dr. Krych shares valuable experience on why successful cartilage restoration depends on more than the graft itself.

Key factors influencing outcomes include:

  • Proper patient selection
  • Mechanical alignment
  • Knee stability
  • Meniscal integrity
  • Patient commitment to rehabilitation

Key Takeaways

  • Cartilage restoration has evolved from treating isolated defects to preserving the entire joint.
  • Modern decision-making is individualized rather than based solely on defect size.
  • Addressing alignment, instability, and meniscal deficiency is often just as important as restoring cartilage.
  • Biologic augmentation and single-stage procedures continue to expand treatment options.
  • Successful outcomes rely on appropriate patient selection and meticulous surgical technique.

Featured Guest

Dr. Aaron Krych is an orthopedic sports medicine surgeon at Mayo Clinic specializing in cartilage restoration, complex knee preservation, ligament reconstruction, and sports-related injuries. His clinical expertise and research have helped shape many of today's modern cartilage restoration strategies.

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www.cloganmd.com

https://orthopedicnj.com/physicians/ashley-bassett