Management of Articular Cartilage Defects of the Knee

Abstract

Articular cartilage has a poor intrinsic capacity for healing. The goal of surgical techniques to repair articular cartilage injuries is to achieve the regeneration of organized hyaline cartilage. Microfracture and other bone marrow stimulation techniques involve penetration of the subchondral plate in order to recruit mesenchymal stem cells into the chondral defect. The formation of a stable clot that fills the lesion is of paramount importance to achieve a successful outcome. Mosaicplasty is a viable option with which to address osteochondral lesions of the knee and offers the advantage of transplanting hyaline cartilage. However, limited graft availability and donor site morbidity are concerns. Transplantation of an osteochondral allograft consisting of intact, viable articular cartilage and its underlying subchondral bone offers the ability to address large osteochondral defects of the knee, including those involving an entire compartment. The primary theoretical advantage of autologous chondrocyte implantation is the development of hyaline-like cartilage rather than fibrocartilage in the defect, which presumably leads to better long-term outcomes and longevity of the healing tissue. Use of synthetic scaffolds is a potentially attractive alternative to traditional cartilage procedures as they are readily available and, unlike allogeneic tissue transplants, are associated with no risk of disease transmission. Their efficacy, however, has not been proven clinically.

A Review of Knowledge in Osteochondritis Dissecans: 123 Years of Minimal Evolution from König to the ROCK Study Group

“…Microfracture is commonly used for traumatic osteochondral defects [4], but its use in OCD is less defined. Traumatic cartilage defects typically have relatively intact subchondral bone in contrast to OCD, in which the subchondral bone is believed to be the primary site of pathology.…”

“…Autologous chondrocyte transplantation may be a good choice for large defects with authors reporting between 91% and 96% good to excellent results (based on multiple outcome scores both clinician-and patient-derived such as the Brittberg clinical rating, Cincinnati scoring, and five others and converted in each paper as excellent, good, fair, or poor) at 5 years [4,29,66]. Another possible salvage procedure with short-term results of IKDC improvement from 37 to 70 points, although not currently available in the United States, is matrix-supported autogenous chondrocyte implantation [75].…”

A Hydrogel-Mineral Composite Scaffold for Osteochondral Interface Tissue Engineering

“…Many of these techniques, however, result in suboptimal clinical outcome due to donorsite morbidity, poor graft-to-bone fixation, and formation of fibrocartilage instead of articular cartilage postrepair. [4][5][6] Alternative cartilage repair approaches focus on tissueengineered cartilage grafts that have been investigated for the treatment of full-thickness cartilage defects with promising results. A significant challenge remains in how to engineer a consistent and stable osteochondral interface for achieving integrative cartilage repair and osteointegration of the cartilage graft.…”

Effects of CD14 Macrophages and Proinflammatory Cytokines on Chondrogenesis in Osteoarthritic Synovium-Derived Stem Cells

“…1 Adult mesenchymal stem cells (MSCs) have become a highly attractive source for use in cartilage regeneration because of their ease of isolation, rapid rate of expansion, and a proven capability for both self-renewal and lineagespecific differentiation. 2,3 Among the various sources of MSCs, synovium-derived stem cells (SDSCs) possess a high proliferative capacity and multilineage differentiation potential, 4 particularly with respect to chondrogenic differentiation.…”