Treatment of knee cartilage defect in 2010

Service de chirurgie orthopédique, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France.
Orthopaedics & Traumatology Surgery & Research (Impact Factor: 1.26). 12/2011; 97(8 Suppl):S140-53. DOI: 10.1016/j.otsr.2011.09.007
Source: PubMed


Treatment of knee cartilage defect, a true challenge, should not only reconstruct hyaline cartilage on a long-term basis, but also be able to prevent osteoarthritis. Osteochondral knee lesions occur in either traumatic lesions or in osteochondritis dissecans (OCD). These lesions can involve all the articular surfaces of the knee in its three compartments. In principle, this review article covers symptomatic ICRS grade C or D lesions, depth III and IV, excluding management of superficial lesions, asymptomatic lesions that are often discovered unexpectedly, and kissing lesions, which arise prior to or during osteoarthritis. For clarity sake, the international classifications used are reviewed, for both functional assessment (ICRS and functional IKDC for osteochondral fractures, Hughston for osteochondritis) and morphological lesion evaluations (the ICRS macroscopic evaluation for fractures, the Bedouelle or SOFCOT for osteochondritis, and MOCART for MRI). The therapeutic armamentarium to treat these lesions is vast, but accessibility varies greatly depending on the country and the legislation in effect. Many comparative studies have been conducted, but they are rarely of high scientific quality; the center effect is nearly constant because patients are often referred to certain centers for an expert opinion. The indications defined herein use algorithms that take into account the size of the cartilage defect and the patient's functional needs for cases of fracture and the vitality, stability, and size of the fragment for cases of osteochondritis dissecans. Fractures measuring less than 2 cm(2) are treated with either microfracturing or mosaic osteochondral grafting, between 2 and 4 cm(2) with microfractures covered with a membrane or a culture of second- or third-generation chondrocytes, and beyond this size, giant lesions are subject to an exceptional allografting procedure, harvesting from the posterior condyle, or chondrocyte culture on a 3D matrix to restore volume. Cases of stable osteochondritis dissecans with closed articular cartilage can be simply monitored or treated with perforation in cases of questionable vitality. Cases of open joint cartilage are treated with a PLUS fixation if their vitality is preserved; if not, they are treated comparably to osteochondral fractures, with the type of filling depending on the defect size.


Available from: Frédéric Dubrana, Jan 03, 2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The three-dimensional scaffolds play a very important role in regulating cell adhesion and the production of extracellular matrix molecules in in vitro regeneration of cartilage. This study evaluates how the three-dimensional structure and physicochemical properties of the polymeric scaffolds influence in vitro regeneration of cartilage tissue. A synthetic poly(vinyl alcohol)-poly(caprolactone) semi-interpenetrating polymer network (IPN) scaffold and gelatin-albumin, made of natural polymers, are used for the study. The polymers in the semi-IPN synthetic scaffold mimic the properties of collagen and glycosaminoglycans present in native cartilage. Its appropriate swelling and pore structure enabled cell-cell and cell-matrix interactions. This helped the chondrocytes to retain its spherical morphology and resulted in enhanced secretion of extracellular matrix components. In contrast, the biomimetic structure in gelatin-albumin scaffold induced chondrocytes to loose its phenotype by spreading and becoming fibroblastic in morphology. Its high swelling and the large pore size failed to recreate an appropriate microenvironment for chondrogenesis that resulted in less secretion of cartilage-specific molecules. Mesenchymal stem cell differentiation to chondrocytes in the presence of growth factors is also enhanced in the synthetic semi-IPN scaffold. The study thus indicates that the chemical composition and the physicochemical properties of the scaffolds play a very important role in providing appropriate niche in in vitro tissue regeneration.
    Tissue Engineering Part A 07/2009; 16(2):373-84. DOI:10.1089/ten.TEA.2009.0314 · 4.64 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Patellofemoral chondral lesions are unique and difficult-to-treat entities often affecting a young and active patient population. Recent advances in our understanding of cartilage injuries, surgical techniques, and surgical technology have provided treatment options for symptomatic patients with lesions of the patellofemoral compartment. A number of surgical treatment options are available, including surgical microfracture, autologous or juvenile chondrocyte implantation, osteochondral autograft transfer, and osteochondral allograft implantation. Management decisions are based on a number of patient- and lesion-related factors in an effort to relieve pain, restore function, and preserve the patellofemoral articulation. The present article reviews the evaluation and management of cartilage injuries affecting the patellofemoral joint.
    Current Reviews in Musculoskeletal Medicine 02/2013; 6(2). DOI:10.1007/s12178-013-9157-z
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to evaluate trends in surgical treatment of articular cartilage defects of the knee in the United States. The current procedural terminology (CPT) billing codes of patients undergoing articular cartilage procedures of the knee were searched using the PearlDiver Patient Record Database, a national database of insurance billing records. The CPT codes for chondroplasty, microfracture, osteochondral autograft, osteochondral allograft, and autologous chondrocyte implantation (ACI) were searched. A total of 163,448 articular cartilage procedures of the knee were identified over a 6-year period. Microfracture and chondroplasty accounted for over 98 % of cases. There was no significant change in the incidence of cartilage procedures noted from 2004 (1.27 cases per 10,000 patients) to 2009 (1.53 cases per 10,000 patients) (p = 0.06). All procedures were performed more commonly in males (p < 0.001). This gender difference was smallest in patients undergoing chondroplasty (51 % males and 49 % females) and greatest for open osteochondral allograft (61 % males and 39 % females). Chondroplasty and microfracture were most commonly performed in patients aged 40-59, while all other procedures were performed most frequently in patients <40 years old (p < 0.001). Articular cartilage lesions of the knee are most commonly treated with microfracture or chondroplasty in the United States. Chondroplasty and microfracture were most often performed in middle-aged patients, whereas osteochondral autograft, allograft, and ACI were performed in younger patients, and more frequently in males. Cross-sectional study, Level IV.
    Knee Surgery Sports Traumatology Arthroscopy 07/2013; 22(9). DOI:10.1007/s00167-013-2614-9 · 3.05 Impact Factor
Show more