scholarly journals Surgical Treatment of Articular Cartilage Defects in the Knee: Are We Winning?

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
A. R. Memon ◽  
J. F. Quinlan
Keyword(s):  
Articular Cartilage ◽  
Cartilage Regeneration ◽  
Current Level ◽  
Cartilage Defects ◽  
Level Of Evidence ◽  
Bone Marrow Stimulation ◽  
Marrow Stimulation ◽  
Ac Injury ◽  
Articular Cartilage Defects ◽  
And Cartilage

Articular cartilage (AC) injury is a common disorder. Numerous techniques have been employed to repair or regenerate the cartilage defects with varying degrees of success. Three commonly performed techniques include bone marrow stimulation, cartilage repair, and cartilage regeneration. This paper focuses on current level of evidence paying particular attention to cartilage regeneration techniques.

scholarly journals Microfracture Versus Drilling of Articular Cartilage Defects: A Systematic Review of the Basic Science Evidence

2020 ◽  
Vol 8 (8) ◽  
pp. 232596712094531 ◽  
Author(s):  
Matthew J. Kraeutler ◽  
Gianna M. Aliberti ◽  
Anthony J. Scillia ◽  
Eric C. McCarty ◽  
Mary K. Mulcahey
Keyword(s):  
Systematic Review ◽  
Articular Cartilage ◽  
Cartilage Repair ◽  
Basic Science ◽  
Science Studies ◽  
Cartilage Regeneration ◽  
Cartilage Defects ◽  
Repair Tissue ◽  
Marrow Stimulation

Background: Microfracture (MFx) is one of the most common techniques used for the treatment of articular cartilage defects, although recently there has been a trend toward the use of drilling rather than MFx for the treatment of these defects. Purpose: To perform a systematic review of basic science studies to determine the effect of microfracture versus drilling for articular cartilage repair. Study Design: Systematic review. Methods: A systematic review was performed by searching PubMed, the Cochrane Library, and EMBASE to identify basic science studies comparing outcomes of MFx versus drilling. The search phrase used was microfracture AND (drilling OR microdrilling). Inclusion criteria were basic science studies that directly compared the effect of MFx versus drilling on subchondral bone, bone marrow stimulation, and cartilage regeneration. Results: A total of 7 studies met the inclusion criteria and were included in this systematic review. Of these, 4 studies were performed in rabbits, 1 study in sheep, and 2 studies in humans. All of the included studies investigated cartilage repair in the knee. In the animal studies, microfracture produced fractured and compacted bone and led to increased osteocyte necrosis compared with drilling. Deep drilling (6 mm) was superior to both shallow drilling (2 mm) and MFx in terms of increased subchondral hematoma with greater access to marrow stroma, improved cartilage repair, and increased mineralized bone. However, the overall quality of cartilage repair tissue was poor regardless of marrow stimulation technique. In 2 studies that investigated repair tissue after MFx and/or drilling in human patients with osteoarthritis and cartilage defects, the investigators found that cartilage repair tissue did not achieve the quality of normal hyaline articular cartilage. Conclusion: In the limited basic science studies that are available, deep drilling of cartilage defects in the knee resulted in improved biological features compared with MFx, including less damage to the subchondral bone and greater access to marrow stroma. Regardless of marrow stimulation technique, the overall quality of cartilage regeneration was poor and did not achieve the characteristics of native hyaline cartilage. Overall, there is a general lack of basic science literature comparing microfracture versus drilling for focal chondral defects.

scholarly journals Recent Progress in 3D Printing of Elastic and High-Strength Hydrogels for the Treatment of Osteochondral and Cartilage Diseases

2020 ◽  
Vol 8 ◽  
Author(s):  
Wenli Dai ◽  
Muyang Sun ◽  
Xi Leng ◽  
Xiaoqing Hu ◽  
Yingfang Ao
Keyword(s):  
Articular Cartilage ◽  
3D Printing ◽  
Recent Progress ◽  
High Strength ◽  
Cartilage Defects ◽  
High Water Content ◽  
Covalent Bonds ◽  
Cartilage Diseases ◽  
Articular Cartilage Defects ◽  
And Cartilage

Despite considerable progress for the regenerative medicine, repair of full-thickness articular cartilage defects and osteochondral interface remains challenging. This low efficiency is largely due to the difficulties in recapitulating the stratified zonal architecture of articular cartilage and engineering complex gradients for bone-soft tissue interface. This has led to increased interest in three-dimensional (3D) printing technologies in the field of musculoskeletal tissue engineering. Printable and biocompatible hydrogels are attractive materials for 3D printing applications because they not only own high tunability and complexity, but also offer favorable biomimetic environments for live cells, such as porous structure, high water content, and bioactive molecule incorporation. However, conventional hydrogels are usually mechanically weak and brittle, which cannot reach the mechanical requirements for repair of articular cartilage defects and osteochondral interface. Therefore, the development of elastic and high-strength hydrogels for 3D printing in the repairment of cartilage defects and osteochondral interface is crucial. In this review, we summarized the recent progress in elastic and high-strength hydrogels for 3D printing and categorized them into six groups, namely ion bonds interactions, nanocomposites integrated in hydrogels, supramolecular guest–host interactions, hydrogen bonds interactions, dynamic covalent bonds interactions, and hydrophobic interactions. These 3D printed elastic and high-strength hydrogels may provide new insights for the treatment of osteochondral and cartilage diseases.

scholarly journals Matrix-Assisted Bone Marrow Stimulation: A Surgical Technique

2021 ◽  
Vol 1 (2) ◽  
pp. 263502542110038
Author(s):  
Christoph Lutter ◽  
Robert Lenz ◽  
Thomas Tischer
Keyword(s):  
Bone Marrow ◽  
Surgical Technique ◽  
Cartilage Regeneration ◽  
Defect Size ◽  
Joint Fluid ◽  
Cartilage Defects ◽  
Bone Marrow Stimulation ◽  
Regulatory Issues ◽  
Marrow Stimulation ◽  
The Matrix

Background: Microfracture is an established technique for cartilage regeneration but is limited by many factors such as small defect size, intralesional osteophytes, and lower quality of cartilage regeneration. Therefore, methods to improve results after microfracture like additional matrix augmentation or autologous cell addition are promising techniques. An all-arthroscopic surgical technique for matrix-augmented bone marrow stimulation will be presented here. Indications: Cartilage lesions of moderate size (>1 cm2) that appear too large or unsuitable for pure microfracture but do not yet meet the criteria for autologous cartilage transplantation (>2.5 cm2). The exact size of suitable lesions is currently evolving with only few evidence-based data available. Technique Description: The arthroscopic procedure largely follows the standard microfracture technique. First, the cartilage defect is extensively debrided with removal of calcific cartilage layer. Stable cartilage margins have to be created with removal of all unstable fragments. The resulting well-defined defect is then measured with the use of a marking probe. The subchondral bone is then penetrated and opened using a microfracture awl. Next, the matrix based on hyaluronic acid (Hyalofast) is cut to the appropriate size. All joint fluid is removed, and the matrix is inserted through a previously placed canula and modeled into the defect with the probe. When the defect is well contained, no other fixation material is necessary. Otherwise, the matrix can be additionally fixed using fibrin clue. Cell application (dependent on regulatory issues) can be performed. Before closure, the joint should be moved to ensure safe fixation of the matrix. Results: Currently, there are only insufficient data to exactly define the defect size for microfracture or matrix-assisted bone marrow stimulation. Some studies show an advantage of using biomaterials compared with microfracture alone, but further studies are necessary. Discussion/Conclusion: The presented arthroscopic matrix-assisted bone marrow stimulation is a technically simple, inexpensive way of treating cartilage defects and should therefore be considered when treating affected patients. It can be used in a variety of joints. An additional combination with bone marrow–derived mesenchymal stem cells might be promising but is subject to country-specific regulatory issues.

Covalently conjugated transforming growth factor-β1 in modular chitosan hydrogels for the effective treatment of articular cartilage defects

2015 ◽  
Vol 3 (5) ◽  
pp. 742-752 ◽  
Author(s):  
Bogyu Choi ◽  
Soyon Kim ◽  
Jiabing Fan ◽  
Tomasz Kowalski ◽  
Frank Petrigliano ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Growth Factor ◽  
Transforming Growth Factor ◽  
Cartilage Regeneration ◽  
Transforming Growth Factor Β1 ◽  
Cartilage Defects ◽  
Chitosan Hydrogel ◽  
Chitosan Hydrogels ◽  
Articular Cartilage Defects ◽  
Tgf Β1

We developed strategies to stabilize TGF-β1 signaling in visible blue-light inducible chitosan hydrogel systems for specific use in cartilage regeneration.

Small Subchondral Drill Holes Improve Marrow Stimulation of Articular Cartilage Defects

2014 ◽  
Vol 42 (11) ◽  
pp. 2741-2750 ◽  
Author(s):  
Mona Eldracher ◽  
Patrick Orth ◽  
Magali Cucchiarini ◽  
Dietrich Pape ◽  
Henning Madry
Keyword(s):  
Articular Cartilage ◽  
Cartilage Defects ◽  
Marrow Stimulation ◽  
Drill Holes ◽  
Articular Cartilage Defects ◽  
Stimulation Of

Polycaprolactone Based Biomaterials and Sodium Hyaluronate Nanoreservoirs for Cartilage Regeneration

2021 ◽  
Author(s):  
Rana Smaida ◽  
Henri Favreau ◽  
Moustafa Naja ◽  
Guoqiang Hua ◽  
Florence Fioretti ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Chondrogenic Differentiation ◽  
Sodium Hyaluronate ◽  
Cartilage Regeneration ◽  
Vinyl Pyrrolidone ◽  
Cartilage Defects ◽  
Treatment And Prevention ◽  
Poly Vinyl Pyrrolidone ◽  
Articular Cartilage Defects

Obstacles persist in the treatment and prevention of articular cartilage defects. Polycaprolactone (PCL) and poly(vinyl-pyrrolidone) (PVP) biomaterials were obtained by electrospinning and electrospraying to inspect their potential application for cartilage regeneration. Sodium hyaluronate (SH) was then added into nanofibers of PCL and particles of PVP. The aim of incorporating sodium hyaluronate to this polymer is to enhance the capacity of articular cartilage to regenerate. Human bone marrow-derived mesenchymal stem cells (hBM-MSCs) were seeded onto these tissue engineering (TE) products. The cell viability in vitro and the ability of biomaterials to support the chondrogenic differentiation of hBM-MSCs have been assessed. We report here that hBM-MSCs on these biomaterials were not able to regenerate articular cartilage mainly due to unsuitable culture environment.

Randomized Study of Long-term (15-17 Years) Outcome After Microfracture Versus Mosaicplasty in Knee Articular Cartilage Defects

2017 ◽  
Vol 46 (4) ◽  
pp. 826-831 ◽  
Author(s):  
Eirik Solheim ◽  
Janne Hegna ◽  
Torbjørn Strand ◽  
Thomas Harlem ◽  
Eivind Inderhaug
Keyword(s):  
Articular Cartilage ◽  
Controlled Trial ◽  
Randomized Study ◽  
Lysholm Score ◽  
Outcome Variable ◽  
Cartilage Defects ◽  
Level Of Evidence ◽  
Articular Cartilage Defects

Background: Few comparative randomized long-term studies on microfracture versus mosaicplasty have been published, and only 2 studies reported a follow-up of 10 years. Hypothesis/Purpose: The purpose was to compare the clinical outcome of microfracture versus mosaicplasty/osteochondral autograft transfer in symptomatic cartilage lesions. The null hypothesis was that the outcome was not statistically different at any point of time. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Forty patients with articular cartilage defects were randomized to undergo cartilage repair by either microfracture (n = 20) or mosaicplasty (n = 20). Inclusion criteria were as follows: age 18 to 50 years at the time of surgery, 1 or 2 symptomatic focal full-thickness articular chondral defects on the femoral condyles or trochlea, and size 2 to 6 cm2. The main outcome variable was the Lysholm knee score recorded before the surgery and at 12 months, median 5 years, median 10 years, and minimum 15 years after the surgery. Results: Forty patients were included in the study (28 men, 12 women; median age, 32 years; range, 18-48 years). Defects with a median size of 3.5 cm2 (range, 2-5 cm2) were treated. A significant increase in the Lysholm score was seen for all subjects— from a mean 53 (SD, 16) at baseline to 69 (SD, 21) at the minimum 15-year follow-up ( P = .001). The mean Lysholm score was significantly higher in the mosaicplasty group than the microfracture group at 12 months, median 5 years, median 10 years, and minimum 15 years: 77 (SD, 17) versus 61 (SD, 22), respectively ( P = .01), at the last follow-up. At all follow-up time points, the difference in mean Lysholm score was clinically significant (>10 points). Conclusion: At short, medium, and long term (minimum 15 years), mosaicplasty results in a better, clinically relevant outcome than microfracture in articular cartilage defects (2-5 cm2) of the distal femur of the knee in patients aged 18 to 50 years.

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