Articular Surface Reconstruction: Grafting, CVOs & Salvage

In this episode of BoardsCast, we focus on the high-stakes realm of articular surface reconstruction — where perfect joint congruity meets imperfect reality.

We explore:

• What defines “reconstructable” vs. “non-reconstructable” articular injury
• Osteochondral autografts, allografts, and synthetic options
• Corrective valgus and varus osteotomies (CVOs) and how they redistribute load
• How to use realignment to buy time or avoid joint replacement
• Salvage strategies: excision arthroplasty, arthrodesis, and the trade-offs involved
• Board-relevant distinctions between cartilage resurfacing and functional joint preservation

If you’ve ever been stuck between “repair it” and “replace it,” this episode breaks down what’s possible, what’s reasonable — and when salvage is the smartest fix.

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Chapters

• 0:00 Introduction: The Challenge of Articular Surface Damage
• 1:06 Stifle Anatomy and the Crucial Role of the Meniscus
• 2:08 Cranial Cruciate Ligament (CCL) Disease and the "Wedge Effect"
• 3:46 Marrow Stimulation Techniques: Microfracture and Fibrocartilage Formation
• 5:28 Grafting Principles: Autografts, Allografts, and the Weakness of Incorporation
• 6:54 Synthetics, Stress Shielding, and Scaffolds
• 8:10 Mechanics-Altering Osteotomies for CCL Disease (TPLO, CWO, TTA)
• 11:43 Notchplasty: Preventing Impingement
• 12:41 Salvage Options: Arthrodesis (Joint Fusion)
• 13:26 Total Knee Replacement (TKR)
• 14:42 Board-Style Question: CCL Deficiency and Meniscal Tears
• 15:03 Flashcard Recap: Key Surgical Concepts and Goals
• 16:24 Conclusion: The Persistent Challenge of True Cartilage Regeneration