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