Current strategies for knee cartilage repair

Defects in knee articular cartilage (AC) can cause pain and disability and present the clinician with an extremely challenging clinical situation. This article describes the most up‐to‐date surgical techniques that aim to repair and/or regenerate symptomatic focal defects in AC, which include arthroscopic debridement, microfracture bone marrow stimulation and autologous osteochondral allografting, with an emphasis on autologous chondrocyte implantation. In the future, refinement of tissue‐engineering approaches promises to further improve outcome for these patients.

[1]  Freddie H. Fu,et al.  Treatment Outcomes of Autologous Chondrocyte Implantation for Full-Thickness Articular Cartilage Defects of the Trochlea , 2007, The American journal of sports medicine.

[2]  F. Eckstein,et al.  MR imaging of cartilage and its repair in the knee - a review , 2009, European Radiology.

[3]  J. Slauterbeck,et al.  An analysis of the quality of cartilage repair studies. , 2005, The Journal of bone and joint surgery. American volume.

[4]  L. Hangody,et al.  A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. , 2004, The Journal of bone and joint surgery. British volume.

[5]  Edward C. Jones,et al.  The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospective cohort study. , 2005, The Journal of bone and joint surgery. American volume.

[6]  M. Aşik,et al.  The microfracture technique for the treatment of full-thickness articular cartilage lesions of the knee: midterm results. , 2008, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[7]  C. Hettrich,et al.  Cartilage Repair: Third-Generation Cell-based Technologies—Basic Science, Surgical Techniques, Clinical Outcomes , 2008, Sports medicine and arthroscopy review.

[8]  RockOn Team,et al.  Re: Attenuation compensation in single-photon emission tomography: a comparative evaluation. , 1983, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[9]  L. Hangody,et al.  Mosaicplasty: long-term follow-up. , 2005, Bulletin (Hospital for Joint Diseases (New York, N.Y.)).

[10]  T. Gill,et al.  Chondral Defect Repair after the Microfracture Procedure , 2005, The American journal of sports medicine.

[11]  M. Glimcher,et al.  Biochemical studies on repair cartilage resurfacing experimental defects in the rabbit knee. , 1980, The Journal of bone and joint surgery. American volume.

[12]  J. Steadman,et al.  Microfracture: surgical technique and rehabilitation to treat chondral defects. , 2001, Clinical orthopaedics and related research.

[13]  N. Südkamp,et al.  Is microfracture of chondral defects in the knee associated with different results in patients aged 40 years or younger? , 2006, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[14]  F. Luyten,et al.  Characterized Chondrocyte Implantation Results in Better Structural Repair When Treating Symptomatic Cartilage Defects of the Knee in a Randomized Controlled Trial versus Microfracture , 2008, The American journal of sports medicine.

[15]  M. Ferguson,et al.  The development of articular cartilage: I. The spatial and temporal patterns of collagen types. , 1996, Journal of anatomy.

[16]  G. Bentley,et al.  An overview of autologous chondrocyte implantation. , 2009, The Journal of bone and joint surgery. British volume.

[17]  Anders Lindahl,et al.  Indentation Stiffness of Repair Tissue after Autologous Chondrocyte Transplantation , 2005, Clinical orthopaedics and related research.

[18]  Bert R. Mandelbaum,et al.  Clinical Efficacy of the Microfracture Technique for Articular Cartilage Repair in the Knee , 2009, The American journal of sports medicine.

[19]  G. Vásárhelyi,et al.  Autologous osteochondral mosaicplasty. Surgical technique. , 2004, The Journal of bone and joint surgery. American volume.

[20]  P. Kasten,et al.  Surgical options for patients with osteoarthritis of the knee , 2009, Nature Reviews Rheumatology.

[21]  Stefano Zaffagnini,et al.  Arthroscopic Autologous Osteochondral Grafting for Cartilage Defects of the Knee , 2007, The American journal of sports medicine.

[22]  Lars Engebretsen,et al.  A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years. , 2007, The Journal of bone and joint surgery. American volume.

[23]  C. Ohlsson,et al.  Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. , 1994, The New England journal of medicine.

[24]  T. Trzaska,et al.  Articular cartilage defects: study of 25,124 knee arthroscopies. , 2007, The Knee.

[25]  R. Ojala,et al.  Fat suppression gradient‐echo magnetic resonance imaging of experimental articular cartilage lesions: Comparison between phase‐contrast method at 0.23T and chemical shift selective method at 1.5T , 2003, Journal of magnetic resonance imaging : JMRI.

[26]  Peter Behrens,et al.  Matrix-associated autologous chondrocyte transplantation/implantation (MACT/MACI)--5-year follow-up. , 2006, The Knee.

[27]  B. F. Morrey,et al.  Autologous Chondrocyte Implantation Using the Original Periosteum-Cover Technique Versus Matrix-Associated Autologous Chondrocyte Implantation: A Randomized Clinical Trial , 2011 .

[28]  G. Scuderi**,et al.  9 Autologous Cartilage Implantation: Cartilage Biopsy, Cartilage Implantation , 2005 .

[29]  T. H.,et al.  The Journal of Bone and Joint Surgery , 2006 .

[30]  T Minas,et al.  Chondrocyte implantation in the repair of chondral lesions of the knee: economics and quality of life. , 1998, American journal of orthopedics.

[31]  M. Marcacci,et al.  Knee osteochondral autologous transplantation: long-term MR findings and clinical correlations. , 2010, European journal of radiology.

[32]  P. Schwartz.  Surgical Options , 1989 .

[33]  G. Vásárhelyi,et al.  Autologous osteochondral mosaicplasty. Surgical technique. , 2004, The Journal of bone and joint surgery. American volume.

[34]  W. Garrett,et al.  Chondral Delamination of the Knee in Soccer Players , 1996, The American journal of sports medicine.

[35]  A. Gomoll,et al.  Increased Failure Rate of Autologous Chondrocyte Implantation after Previous Treatment with Marrow Stimulation Techniques , 2009, The American journal of sports medicine.

[36]  E S Grood,et al.  Arthroscopy in acute traumatic hemarthrosis of the knee. Incidence of anterior cruciate tears and other injuries. , 1980, The Journal of bone and joint surgery. American volume.

[37]  D. Saris,et al.  Treatment Selection in Articular Cartilage Lesions of the Knee , 2009, The American journal of sports medicine.

[38]  B. P. Smith,et al.  Cartilage injuries: a review of 31,516 knee arthroscopies. , 1997, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[39]  J. Steadman,et al.  Treatment of articular cartilage defects in athletes: an analysis of functional outcome and lesion appearance. , 1998, Orthopedics.

[40]  G. Bentley,et al.  A correlation between the timing of biopsy after autologous chondrocyte implantation and the histological appearance. , 2009, The Journal of bone and joint surgery. British volume.

[41]  T. Aigner,et al.  Autologous Chondrocyte Transplantation and Osteochondral Cylinder Transplantation in Cartilage Repair of the Knee Joint : A Prospective, Comparative Trial , 2002 .

[42]  C. Clar,et al.  Autologous cartilage implantation for full thickness articular cartilage defects of the knee. , 2002, The Cochrane database of systematic reviews.

[43]  Mitsuo Ochi,et al.  Articular cartilage repair using tissue engineering technique--novel approach with minimally invasive procedure. , 2004, Artificial organs.

[44]  M. Brittberg,et al.  Treatment of Osteochondritis Dissecans of the Knee with Autologous Chondrocyte Transplantation: Results at Two to Ten Years , 2003, The Journal of bone and joint surgery. American volume.

[45]  William D Bugbee,et al.  Fresh Osteochondral Allografting in the Treatment of Osteochondritis Dissecans of the Femoral Condyle , 2007, The American journal of sports medicine.

[46]  B. J. Brewer,et al.  In vitro synthesis of tissue-specific type II collagen by healing cartilage. I. Short-term repair of cartilage by mature rabbits. , 1980, Arthritis and rheumatism.

[47]  P. Indelicato,et al.  A perspective of lesions associated with ACL insufficiency of the knee. A review of 100 cases. , 1985, Clinical orthopaedics and related research.

[48]  K. Shelbourne,et al.  Outcome of Untreated Traumatic Articular Cartilage Defects of the Knee: A Natural History Study , 2003, The Journal of bone and joint surgery. American volume.

[49]  F. Luyten,et al.  Autologous chondrocyte implantation versus microfracture for knee cartilage injury: a prospective randomized trial, with 2-year follow-up , 2010, Knee Surgery, Sports Traumatology, Arthroscopy.

[50]  M. Hochberg,et al.  Joint Injury in Young Adults and Risk for Subsequent Knee and Hip Osteoarthritis , 2000, Annals of Internal Medicine.

[51]  H. Potter,et al.  MR imaging of cartilage repair in the knee and ankle. , 2008, Radiographics : a review publication of the Radiological Society of North America, Inc.

[52]  A. Davis,et al.  FRESH OSTEOCHONDRAL ALLOGRAFTS FOR POST-TRAUMATIC OSTEOCHONDRAL DEFECTS OF THE KNEE , 1997 .

[53]  H. Grüneberg.  An Analysis of the , 1938 .

[54]  L. L. Johnson.  Arthroscopic Abrasion Arthroplasty: A Review , 2001, Clinical orthopaedics and related research.

[55]  R. Cancedda,et al.  Comparative Evaluation of Autologous Chondrocyte Implantation and Mosaicplasty: A Multicentered Randomized Clinical Trial , 2005, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[56]  M. Kocher,et al.  Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. , 2003, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[57]  Eda T Bloom,et al.  Autologous cultured chondrocytes: adverse events reported to the United States Food and Drug Administration. , 2006, The Journal of bone and joint surgery. American volume.

[58]  T. Wickiewicz,et al.  Magnetic Resonance Imaging Appearance of Cartilage Repair in the Knee , 2004, Clinical orthopaedics and related research.

[59]  Lars Engebretsen,et al.  Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial. , 2004, The Journal of bone and joint surgery. American volume.

[60]  W. Richter,et al.  Autologous Chondrocyte Implantation Using the Original Periosteum-Cover Technique versus Matrix-Associated Autologous Chondrocyte Implantation , 2010, The American journal of sports medicine.

[61]  L. Peterson,et al.  Autologous chondrocyte implantation. , 2006, Instructional course lectures.

[62]  E. Berkson,et al.  The treatment of articular cartilage defects using the microfracture technique. , 2006, The Journal of orthopaedic and sports physical therapy.

[63]  K. Spindler,et al.  Intraarticular Injuries Associated with Anterior Cruciate Ligament Tear: Findings at Ligament Reconstruction in High School and Recreational Athletes , 2003, The American journal of sports medicine.

[64]  T. Aigner,et al.  Autologous Chondrocyte Implantation and Osteochondral Cylinder Transplantation in Cartilage Repair of the Knee Joint , 2003 .

[65]  G. Bentley,et al.  A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. , 2003, The Journal of bone and joint surgery. British volume.

[66]  K. Hjelle,et al.  Articular cartilage defects in 1,000 knee arthroscopies. , 2002, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[67]  B. Cole,et al.  A randomized trial comparing autologous chondrocyte implantation with microfracture. , 2008, The Journal of bone and joint surgery. American volume.

[68]  J. Wasiak,et al.  Autologous chondrocyte implantation for full thickness articular cartilage defects of the knee. , 2010, The Cochrane database of systematic reviews.

[69]  W. Dunn,et al.  Treatment of Focal Articular Cartilage Defects in the Knee , 2008, Clinical orthopaedics and related research.

[70]  M. Marcacci,et al.  Second Generation Issues in Cartilage Repair , 2008, Sports medicine and arthroscopy review.

[71]  T. Strand,et al.  Osteochondral autografting (mosaicplasty) in articular cartilage defects in the knee: results at 5 to 9 years. , 2010, The Knee.

[72]  Stefano Zaffagnini,et al.  Arthroscopic Second-Generation Autologous Chondrocyte Implantation Compared with Microfracture for Chondral Lesions of the Knee , 2009, The American journal of sports medicine.

[73]  W. Widuchowski,et al.  Isolated full thickness chondral injuries. Prevalance and outcome of treatment. A retrospective study of 5233 knee arthroscopies. , 2008, Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca.

[74]  Anders Lindahl,et al.  Autologous Chondrocyte Transplantation , 2002, The American journal of sports medicine.

[75]  C. Rolf,et al.  Evaluation of microfracture of traumatic chondral injuries to the knee in professional football and rugby players , 2009, Journal of orthopaedic surgery and research.

[76]  N. Südkamp,et al.  Results after microfracture of full-thickness chondral defects in different compartments in the knee. , 2006, Osteoarthritis and cartilage.

[77]  T. Minas.  Autologous Chondrocyte Implantation in the Osteoarthritic Knee , 2004 .

[78]  A. Krych,et al.  The Microfracture Technique : Pearls and Pitfalls , 2022 .