Management of Focal Chondral Lesion in the Knee Joint

Abstract

Articular cartilage does not contain vascular, nervous and lymphatic tissue and chondrocytes hardly participate in the healing or repair process of chondral tissue because of being surrounded by plenty of extracellular matrix. Therefore, the injury to articular cartilage frequently requires an operative treatment. The goal of surgical repair of articular cartilage is to regenerate nearly normal chondral tissue and prevent degenerative arthritis caused by the articular cartilage defect. Microfracture is a kind of cartilage repair procedure that makes a fibrin clot containing mesenchymal stem cells in the chondral lesion. Microfracture is a simple procedure but it has a disadvantage that the repaired tissue is fibrocartilage. Autologous chondrocyte implantation has an advantage that it implants fully differentiated chondrocytes to the lesion, which theoretically produces hyaline cartilage. Its disadvantages are that it is a two stage and a costly procedure. Osteochondral autograft transplantation is a one stage procedure and repairs the lesion with hyaline cartilage. But its limitation is the lack of donor site availability. Surgeons who understand the theoretical background, indications, surgical methods, rehabilitation, complications, and clinical course of cartilage repair procedures can achieve the goal of preventing degenerative arthritis.

Cartilage Regeneration in Osteoarthritic Patients by a Composite of Allogeneic Umbilical Cord Blood-Derived Mesenchymal Stem Cells and Hyaluronate Hydrogel: Results from a Clinical Trial for Safety and Proof-of-Concept with 7 Years of Extended Follow-Up

“…Articular cartilage has very limited capacity for self‐regeneration . Current treatment of cartilage defects in osteoarthritic patients is primarily palliative and includes medication and activity modification.…”

Effect of Transplanting Various Concentrations of a Composite of Human Umbilical Cord Blood-Derived Mesenchymal Stem Cells and Hyaluronic Acid Hydrogel on Articular Cartilage Repair in a Rabbit Model

“…Articular cartilage is known as a highly differentiated avascular tissue with low self-regeneration capacity [1]. Many researchers have attempted to increase the regeneration potential of damaged cartilage using cell-based therapies such as autologous chondrocyte implantation (ACI) [2].…”

Animal Models of Osteochondral Defect for Testing Biomaterials

“…Current methods for treatment of cartilage lesions mainly include medical treatments (nonsteroid anti-inflammatory drugs (NSAIDs), pain killers, and hormones, etc.) and surgical treatment (arthroscopic lavage and debridement, cell-based therapy, and tissue-based therapy) [9]. Unfortunately, the medical treatments only relieve pain, rather than restoring the structural integrity of the articular cartilage [10], and the surgical treatments cannot restore neo-tissue close to normal cartilage [9].…”

“…and surgical treatment (arthroscopic lavage and debridement, cell-based therapy, and tissue-based therapy) [9]. Unfortunately, the medical treatments only relieve pain, rather than restoring the structural integrity of the articular cartilage [10], and the surgical treatments cannot restore neo-tissue close to normal cartilage [9]. erefore, the treatment effect is not ideal, and the development of new treatment strategies is an urgent need.…”