Summary: When a revision surgery is indicated, the preoperative plan must include an assessment of the mechanism of failure and careful evaluation of all associated pathologies, which will need to be recognized and addressed in the treatment plan. Osteochondral allografts is the preferred technique for most revision cases of cartilage repair procedures (when indicated) and will usually require replacing the failed cartilage repair tissue in its whole.
Conclusion: The preoperative plan for revision cases must always include an assessment of the mechanism of failure. It is usually determined by history and symptoms, physical examination, imaging (prior and post index procedure) and intraoperative findings during the index procedure (operation notes). An additional part of the preoperative assessment is the diagnostic arthroscopy portion of the revision itself. Careful evaluation of all intra-articular structures in all 3 compartments is essential.
Niv Marom MD, William Bugbee MD, Riley J.Williams III MD."Osteochondral Grafts Failures". Operative Techniques in Sports Medicine. Volume 28, Issue 1, March 2020.