Joint Preservation Techniques in Orthopaedic Surgery

Abstract

Context:With increasing life expectancy, there is growing demand for preservation of native articular cartilage to delay joint arthroplasties, especially in younger, active patients. Damage to the hyaline cartilage of a joint has a limited intrinsic capacity to heal. This can lead to accelerated degeneration of the joint and early-onset osteoarthritis. Treatment in the past was limited, however, and surgical treatment options continue to evolve that may allow restoration of the natural biology of the articular cartilage. This article reviews the most current literature with regard to indications, techniques, and outcomes of these restorative procedures.Evidence Acquisition:MEDLINE and PubMed searches relevant to the topic were performed for articles published between 1995 and 2016. Older articles were used for historical reference. This paper places emphasis on evidence published within the past 5 years.Study Design:Clinical review.Level of Evidence:Level 4.Results:Autologous chondrocyte implantation and osteochondral allografts (OCAs) for the treatment of articular cartilage injury allow restoration of hyaline cartilage to the joint surface, which is advantageous over options such as microfracture, which heal with less favorable fibrocartilage. Studies show that these techniques are useful for larger chondral defects where there is no alternative. Additionally, meniscal transplantation can be a valuable isolated or adjunctive procedure to prolong the health of the articular surface.Conclusion:Newer techniques such as autologous chondrocyte implantation and OCAs may safely produce encouraging outcomes in joint preservation.

The Surgical Treatment of Osteoarthritis

“…With increasing life expectancy, there is a growing demand for the preservation of native articular cartilage to delay or prevent osteoarthritis onset or the progression of symptomatic degeneration and the eventual need for joint arthroplasty, especially in younger and active patients [ 29 ]. An alternative to endoscopic-assisted preservation surgery and arthroplasty may therefore present periarticular or corrective, biomechanics restoring, osteotomy, whereas miscellaneous implantable devices also exist as an alternative for a fusion.…”

Mesenchymal stromal cell and bone marrow concentrate therapies for musculoskeletal indications: a concise review of current literature

“…Lesions in the cartilage can lead to pain and restricted mobility. Therefore, a lot of surgical interventions like microfracturing, autologous chondrocyte implantation (ACI), osteochondral autograft transplantation and others) were developed to treat these patients [73]. MSC therapy has been pioneered in this field by the treatment of osteochondral defects with autologously harvested and expanded chondrocytes.…”

Knee osteoarthritis - when arthroscopy can help

“…Aurégan et al 33 performed a systematic review of 60 studies and found local recurrence rates field are growing at an exponential rate and are rooted in procedures such as microfracture or osteochondral allografts, but today are shifting increasingly towards biologic treatments and autologous chondrocyte implantation. 36,37 While many of these treatments are still in their infancy and are typically reserved for younger patients with well -defined cartilage defects, as they continue to develop and the indications for their use broaden, it is not unreasonable to assume arthroscopy will play a role as a minimally invasive, site--specific delivery system for these treatments. diagnostic purposes Arthroscopy may play an important role as a diagnostic tool in cases in which the diagnosis is not clear with MRI or it is not possible to obtain an MRI scan in a timely manner.…”