Editorial Commentary: To Treat or Not to Treat? Are We Any Closer to Knowing What to Do With Cartilage Lesions of the Tibia?

The increasing interest and use of cartilage repair procedures in the knee has led to a better understanding of when and how chondral lesions should be treated. Nonetheless, there are still key areas where we lack understanding and need better data to guide clinical decision making. One of these areas is how to manage lesions of the tibia, particularly when they occur in conjunction with the more commonplace lesions of the femoral condyle. In this setting, a tibial chondral lesion may reflect a bigger clinical problem-a "bipolar defect" or more advanced joint disease-"established osteoarthritis." My preferred treatment for these tibial lesions is to ignore the lesion (or perform a chondroplasty at most), except in cases of osteochondritis dissecans, focal defects in association with cysts, or tibial plateau fracture malunion.