Management of Articular Cartilage Defects of the Knee

Abstract Articular cartilage injuries of the knee present a difficult clinical dilemma and their treatment is controversial. Hyaline articular cartilage is an avascular, low-friction, and wear-resistant weightbearing surface that has limited capacity for self-repair. The optimal treatment for cartilage lesions has yet to be established. Various treatment methods are employed to reestablish a stable cartilage surface, including microfracture, autologous and allograft osteochondral transplantation, autologous chondrocyte implantation, matrix-associated chondrocyte implantation, and scaffold-assisted methods. Treatment algorithms help to guide physicians' decision making in the care of these injuries. In this article, results from outcomes studies as well as prospective randomized clinical trials comparing treatment methods are reviewed, and current practice guidelines are summarized.

[1]  E. Solheim,et al.  [Mosaicplasty in articular cartilage injuries of the knee]. , 1999, Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke.

[2]  Edward C. Jones,et al.  Reliability, Validity, and Responsiveness of Four Knee Outcome Scales for Athletic Patients , 2001, The Journal of bone and joint surgery. American volume.

[3]  Erik N. Kubiak,et al.  The Repair Response to Osteochondral Implant Types in a Rabbit Model , 2005, Cell and Tissue Banking.

[4]  Jiake Xu,et al.  Matrix-induced autologous chondrocyte implantation (MACI): biological and histological assessment. , 2007, Tissue engineering.

[5]  T. B. Kirk,et al.  Matrix‐induced autologous chondrocyte implantation in sheep: objective assessments including confocal arthroscopy , 2008, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[6]  A. Oztürk,et al.  Osteochondral autografting (mosaicplasty) in grade IV cartilage defects in the knee joint: 2- to 7-year results , 2006, International Orthopaedics.

[7]  Bert R. Mandelbaum,et al.  Articular Cartilage Lesions of the Knee , 1998, The American journal of sports medicine.

[8]  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.

[9]  E. Lautenschlager,et al.  The Effect of Angled Osteochondral Grafting on Contact Pressure , 2006, The American journal of sports medicine.

[10]  D G Disler,et al.  Detection of knee hyaline cartilage defects using fat-suppressed three-dimensional spoiled gradient-echo MR imaging: comparison with standard MR imaging and correlation with arthroscopy. , 1995, AJR. American journal of roentgenology.

[11]  A. Miniaci,et al.  Fixation of unstable osteochondritis dissecans lesions of the knee using arthroscopic autogenous osteochondral grafting (mosaicplasty). , 2007, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[12]  R. Parker,et al.  The forty-five-degree posteroanterior flexion weight-bearing radiograph of the knee. , 1988, The Journal of bone and joint surgery. American volume.

[13]  Lars Engebretsen,et al.  Articular Cartilage Lesions in 993 Consecutive Knee Arthroscopies , 2004, The American journal of sports medicine.

[14]  Y. Sun,et al.  The regenerative effect of platelet-rich plasma on healing in large osteochondral defects , 2010, International Orthopaedics.

[15]  R. E. Outerbridge The etiology of chondromalacia patellae. , 1961, The Journal of bone and joint surgery. British volume.

[16]  J. Steadman,et al.  Arthroscopic subchondral bone plate microfracture technique augments healing of large chondral defects in the radial carpal bone and medial femoral condyle of horses. , 1999, Veterinary surgery : VS.

[17]  A. Gross,et al.  The viability of articular cartilage in fresh osteochondral allografts after clinical transplantation. , 1990, The Journal of bone and joint surgery. American volume.

[18]  M Attawia,et al.  Platelet-rich plasma stimulates porcine articular chondrocyte proliferation and matrix biosynthesis. , 2006, Osteoarthritis and cartilage.

[19]  F. Noyes,et al.  A system for grading articular cartilage lesions at arthroscopy , 1989, The American journal of sports medicine.

[20]  P. A. Davidson,et al.  Clinical, Histologic, and Radiographic Outcomes of Distal Femoral Resurfacing with Hypothermically Stored Osteoarticular Allografts , 2007, The American journal of sports medicine.

[21]  D. Bae,et al.  Cartilage healing after microfracture in osteoarthritic knees. , 2006, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[22]  W. Akeson,et al.  Long-Term Survival of Chondrocytes in an Osteochondral Articular Cartilage Allograft. A Case Report* , 1996, The Journal of bone and joint surgery. American volume.

[23]  K. Briggs,et al.  An arthroscopic treatment regimen for osteoarthritis of the knee. , 2007, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

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

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

[26]  Joseph A Buckwalter,et al.  The Potential of Human Allogeneic Juvenile Chondrocytes for Restoration of Articular Cartilage , 2010, The American journal of sports medicine.

[27]  Douglas L. Cerynik,et al.  Outcomes of microfracture in professional basketball players , 2009, Knee Surgery, Sports Traumatology, Arthroscopy.

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

[29]  P. Robbins,et al.  Gene-mediated restoration of cartilage matrix by combination insulin-like growth factor-I/interleukin-1 receptor antagonist therapy , 2005, Gene Therapy.

[30]  B. Mandelbaum,et al.  Return to Sports Participation after Articular Cartilage Repair in the Knee , 2009, The American journal of sports medicine.

[31]  Georg Bachmann,et al.  Matrix-induced autologous chondrocyte implantation versus microfracture in the treatment of cartilage defects of the knee: a 2-year randomised study , 2010, Knee Surgery, Sports Traumatology, Arthroscopy.

[32]  T. Minas Autologous Chondrocyte Implantation for Focal Chondral Defects of the Knee , 2001, Clinical orthopaedics and related research.

[33]  G. Bentley,et al.  Does smoking influence outcome after autologous chondrocyte implantation?: A case-controlled study. , 2009, The Journal of bone and joint surgery. British volume.

[34]  David W. Levine,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. , 2009, The American journal of sports medicine.

[35]  I. V. Breuseghem,et al.  Epidemiology and imaging of the subchondral bone in articular cartilage repair , 2010, Knee Surgery, Sports Traumatology, Arthroscopy.

[36]  W. Akeson,et al.  Articular cartilage transplantation. Clinical results in the knee. , 1999, Clinical orthopaedics and related research.

[37]  Seung Jin Lee,et al.  Novel porous matrix of hyaluronic acid for the three-dimensional culture of chondrocytes. , 2009, International journal of pharmaceutics.

[38]  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.

[39]  R. Heekin,et al.  The Diagnostic Accuracy of History, Physical Examination, and Radiographs in the Evaluation of Traumatic Knee Disorders , 1996, The American journal of sports medicine.

[40]  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.

[41]  G. Knutsen,et al.  Arthroscopic assessment of cartilage repair: a validation study of 2 scoring systems. , 2005, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[42]  S. Marlovits,et al.  Scaffold-dependent differentiation of human articular chondrocytes. , 2008, International journal of molecular medicine.

[43]  L. Csönge,et al.  Osteochondral resurfacing of the knee joint with allograft , 1998, International Orthopaedics.

[44]  T. Strand,et al.  Microfracture treatment of single or multiple articular cartilage defects of the knee: a 5-year median follow-up of 110 patients , 2010, Knee Surgery, Sports Traumatology, Arthroscopy.

[45]  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.

[46]  C. W. Mcllwraith,et al.  Effects of Calcified Cartilage on Healing of Chondral Defects Treated with Microfracture in Horses , 2006, The American journal of sports medicine.

[47]  K. Briggs,et al.  Reproducibility and Reliability of the Outerbridge Classification for Grading Chondral Lesions of the Knee Arthroscopically , 2003, The American journal of sports medicine.

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

[49]  M. Brittberg,et al.  Two- to 9-Year Outcome After Autologous Chondrocyte Transplantation of the Knee , 2000, Clinical orthopaedics and related research.

[50]  J. Chow,et al.  Arthroscopic autogenous osteochondral transplantation for treating knee cartilage defects: a 2- to 5-year follow-up study. , 2004, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[51]  Freddie H. Fu,et al.  A Controlled Study of Autologous Chondrocyte Implantation Versus Microfracture for Articular Cartilage Lesions of the Femur (SS-82) , 2003 .

[52]  R. Salter The physiologic basis of continuous passive motion for articular cartilage healing and regeneration. , 1994, Hand clinics.

[53]  B. Mandelbaum,et al.  Autologous Chondrocyte Implantation of the Knee: Multicenter Experience and Minimum 3-Year Follow-Up , 2001, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[54]  Aaron M. King,et al.  Buffered platelet-rich plasma enhances mesenchymal stem cell proliferation and chondrogenic differentiation. , 2009, Tissue engineering. Part C, Methods.

[55]  B. Sennett,et al.  Results and Performance after Microfracture in National Basketball Association Athletes , 2009, The American journal of sports medicine.

[56]  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.

[57]  Hollis G Potter,et al.  An Autologous Cartilage Tissue Implant NeoCart for Treatment of Grade III Chondral Injury to the Distal Femur , 2009, The American journal of sports medicine.

[58]  J. Farr,et al.  A Prospective Study of Autologous Chondrocyte Implantation in Patients with Failed Prior Treatment for Articular Cartilage Defect of the Knee , 2009, The American journal of sports medicine.

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

[60]  R. Salter,et al.  The biologic concept of continuous passive motion of synovial joints. The first 18 years of basic research and its clinical application. , 1989, Clinical orthopaedics and related research.

[61]  E. Stankevičius,et al.  A prospective randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint in young athletes. , 2005, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[62]  M. Handl,et al.  Novel composite hyaluronan/type I collagen/fibrin scaffold enhances repair of osteochondral defect in rabbit knee. , 2008, Journal of biomedical materials research. Part B, Applied biomaterials.

[63]  J. Marzo,et al.  Chondrocyte viability in press‐fit cryopreserved osteochondral allografts , 2004, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[64]  H. Potter,et al.  Magnetic Resonance Imaging of Articular Cartilage in the Knee. An Evaluation with Use of Fast-Spin-Echo Imaging* , 1998, The Journal of bone and joint surgery. American volume.

[65]  M. Spector,et al.  Healing of canine articular cartilage defects treated with microfracture, a type‐II collagen matrix, or cultured autologous chondrocytes , 2000, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[66]  K. Pritzker,et al.  Long-term chondrocyte viability in a fresh osteochondral allograft. , 2002, The journal of knee surgery.

[67]  Albert C. Chen,et al.  Follow-Up of Osteochondral Plug Transfers in a Goat Model , 2004, The American journal of sports medicine.

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

[69]  C. Peterfy,et al.  Fixed-flexion radiography of the knee provides reproducible joint space width measurements in osteoarthritis , 2004, European Radiology.

[70]  E. Tanaka,et al.  Modulation of hyaluronan catabolism in chondrocytes by mechanical stimuli. , 2009, Journal of biomedical materials research. Part A.

[71]  B. Feeley,et al.  Management of articular cartilage defects of the knee. , 2010, The Journal of bone and joint surgery. American volume.

[72]  D. Zukor,et al.  Fresh osteochondral allografts for post-traumatic defects in the knee. A survivorship analysis. , 1992, The Journal of bone and joint surgery. British volume.

[73]  D. W. Jackson,et al.  Chondrocyte transplantation. , 1996, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[74]  Marcus K. Taylor,et al.  Reliability and validity of the International Knee Documentation Committee (IKDC) Subjective Knee Form. , 2007, Joint, bone, spine : revue du rhumatisme.

[75]  Charalambos P. Charalambous,et al.  Articular Cartilage. Part II: Degeneration and Osteoarthrosis, Repair, Regeneration, and Transplantation , 2014 .

[76]  R. Wright Knee Injury Outcomes Measures , 2009, The Journal of the American Academy of Orthopaedic Surgeons.

[77]  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.

[78]  N. Ghanem,et al.  Classification of graft hypertrophy after autologous chondrocyte implantation of full-thickness chondral defects in the knee. , 2007, Osteoarthritis and cartilage.

[79]  J. Steadman,et al.  Early Events in Cartilage Repair After Subchondral Bone Microfracture , 2003, Clinical orthopaedics and related research.

[80]  D. Saris,et al.  Patient Profiling in Cartilage Regeneration: Prognostic Factors Determining Success of Treatment for Cartilage Defects , 2009, The American journal of sports medicine.

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

[82]  José Becerra,et al.  Articular cartilage: structure and regeneration. , 2010, Tissue engineering. Part B, Reviews.

[83]  Toshio Yamamoto,et al.  Cellular origin of endochondral ossification from grafted periosteum , 2001, The Anatomical record.

[84]  M. Marcacci,et al.  Arthroscopic second generation autologous chondrocyte implantation , 2007, Knee Surgery, Sports Traumatology, Arthroscopy.

[85]  Z. You,et al.  Mechanical compression of articular cartilage induces chondrocyte proliferation and inhibits proteoglycan synthesis by activation of the ERK pathway: implications for tissue engineering and regenerative medicine , 2009, Journal of tissue engineering and regenerative medicine.

[86]  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.

[87]  S D Gillogly,et al.  Surgical management of articular cartilage defects of the knee. , 2010, The Journal of bone and joint surgery. American volume.

[88]  B. Cole,et al.  Prospective Evaluation of Prolonged Fresh Osteochondral Allograft Transplantation of the Femoral Condyle , 2006, The American journal of sports medicine.

[89]  E. Thonar,et al.  Continuous passive motion stimulates repair of rabbit knee articular cartilage after matrix proteoglycan loss. , 1994, Clinical orthopaedics and related research.

[90]  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.

[91]  L. Hangody,et al.  Experimental results of donor site filling for autologous osteochondral mosaicplasty. , 2003, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[92]  Edward C. Jones,et al.  Chondral resurfacing of articular cartilage defects in the knee with the microfracture technique. Surgical technique. , 2006, The Journal of bone and joint surgery. American volume.

[93]  Johan Bellemans,et al.  Treatment of Symptomatic Cartilage Defects of the Knee , 2009, The American journal of sports medicine.

[94]  A. Gross,et al.  Immunogenicity of allograft articular cartilage. , 1974, The Journal of bone and joint surgery. American volume.

[95]  William D Bugbee,et al.  The Effects of Storage on Fresh Human Osteochondral Allografts , 2004, Clinical orthopaedics and related research.

[96]  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.

[97]  Riley J. Williams,et al.  Chondrocyte Death and Cartilage Degradation after Autologous Osteochondral Transplantation Surgery in a Rabbit Model , 2009, The American journal of sports medicine.

[98]  Maurilio Marcacci,et al.  Patellofemoral Full-Thickness Chondral Defects Treated with Hyalograft-C , 2006, The American journal of sports medicine.

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

[100]  Pierre Hepp,et al.  The autologous osteochondral transplantation of the knee: clinical results, radiographic findings and histological aspects , 2005, Archives of Orthopaedic and Trauma Surgery.

[101]  W. Enneking,et al.  Retrieved Human Allografts: A Clinicopathological Study , 2001, The Journal of bone and joint surgery. American volume.

[102]  M. Shive,et al.  Chitosan-glycerol phosphate/blood implants improve hyaline cartilage repair in ovine microfracture defects. , 2005, The Journal of bone and joint surgery. American volume.

[103]  A. Miniaci,et al.  Intra-articular hyaluronan following autogenous osteochondral grafting of the knee. , 2005, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[104]  J. Sun,et al.  Chitosan-glycerol phosphate/blood implants increase cell recruitment, transient vascularization and subchondral bone remodeling in drilled cartilage defects. , 2007, Osteoarthritis and cartilage.

[105]  B. F. Morrey,et al.  High-Impact Athletics After Knee Articular Cartilage Repair: A Prospective Evaluation of the Microfracture Technique , 2008 .

[106]  G. Lust,et al.  Phenotypic expression of equine articular chondrocytes grown in three-dimensional cultures supplemented with supraphysiologic concentrations of insulin-like growth factor-1. , 2002, American journal of veterinary research.

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

[108]  Konrad Malinowski,et al.  Treatment of full thickness chondral lesions of the knee with microfracture in a group of athletes , 2005, Knee Surgery, Sports Traumatology, Arthroscopy.

[109]  N. Verdonschot,et al.  Press-fit stability of an osteochondral autograft: Influence of different plug length and perfect depth alignment , 2006, Acta orthopaedica.

[110]  R. T. Allen,et al.  Analysis of Cartilage Tissue on a Cellular Level in Fresh Osteochondral Allograft Retrievals , 2007, The American journal of sports medicine.

[111]  R. Hawkins,et al.  The microfracture technique in the treatment of full-thickness chondral lesions of the knee in National Football League players. , 2003, The journal of knee surgery.

[112]  C. Toma,et al.  Repair of articular cartilage defects treated by microfracture and a three-dimensional collagen matrix. , 2005, Biomaterials.

[113]  R. Heitman,et al.  Chondrocyte Viability in Refrigerated Osteochondral Allografts Used for Transplantation within the Knee , 2004, The American journal of sports medicine.

[114]  T. Wickiewicz,et al.  Magnetic Resonance Imaging and Clinical Evaluation of Patellar Resurfacing with Press-Fit Osteochondral Autograft Plugs , 2008, The American journal of sports medicine.

[115]  W. Bugbee,et al.  Etanercept Enhances Preservation of Osteochondral Allograft Viability , 2011, The American journal of sports medicine.

[116]  A J Palfrey,et al.  Chondrocyte distribution in the articular cartilage of human femoral condyles. , 1988, Journal of anatomy.

[117]  D. Carnes,et al.  Pretreatment with platelet derived growth factor-BB modulates the ability of costochondral resting zone chondrocytes incorporated into PLA/PGA scaffolds to form new cartilage in vivo. , 2000, Biomaterials.

[118]  M. McKee,et al.  Aged bovine chondrocytes display a diminished capacity to produce a collagen‐rich, mechanically functional cartilage extracellular matrix , 2005, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[119]  W. Bugbee,et al.  Fresh osteochondral allografts: results in the patellofemoral joint. , 2005, Clinical orthopaedics and related research.

[120]  W. Enneking,et al.  Observations on massive retrieved human allografts. , 1991, The Journal of bone and joint surgery. American volume.

[121]  B. Boyan,et al.  Platelet derived growth factor stimulates chondrocyte proliferation but prevents endochondral maturation , 1997, Endocrine.

[122]  T. Aigner,et al.  Autologous Chondrocyte Implantation and Osteochondral Cylinder Transplantation in Cartilage Repair of the Knee Joint: A Prospective, Comparative Trial , 2003, The Journal of bone and joint surgery. American volume.

[123]  G. Bentley,et al.  Autologous chondrocyte implantation at the knee using a bilayer collagen membrane with bone graft. A preliminary report. , 2005, The Journal of bone and joint surgery. British volume.

[124]  J. Prieto,et al.  Apoptosis and nitric oxide in an experimental model of osteoarthritis in rabbit after hyaluronic acid treatment , 2005, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[125]  K. Pritzker,et al.  Articular cartilage transplantation. , 1977, Human pathology.

[126]  A. Miniaci,et al.  Treatment of unstable osteochondritis dissecans lesions of the knee using autogenous osteochondral grafts (mosaicplasty). , 1999, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[127]  A. Palfrey,et al.  A histological study of human femoral condylar articular cartilage. , 1987, Journal of anatomy.

[128]  T. Briggs,et al.  Autologous chondrocyte implantation: where do we stand now? , 2008, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association.

[129]  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.

[130]  M. Brittberg,et al.  Evaluation of Cartilage Injuries and Repair , 2003, The Journal of bone and joint surgery. American volume.

[131]  G. Lust,et al.  Insulin-like growth factor-I enhances cell-based repair of articular cartilage. , 2002, The Journal of bone and joint surgery. British volume.

[132]  D. Saris,et al.  Joint homeostasis. The discrepancy between old and fresh defects in cartilage repair. , 2003, The Journal of bone and joint surgery. British volume.

[133]  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.

[134]  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.

[135]  A. Hollander,et al.  Matrix turnover in human cartilage repair tissue in autologous chondrocyte implantation. , 2001, Arthritis and rheumatism.

[136]  B. Mandelbaum,et al.  Articular cartilage repair in athletes. , 2007, Instructional course lectures.

[137]  H. J. Mankin,et al.  Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Articular Cartilage. Part II: Degeneration and Osteoarthrosis, Repair, Regeneration, and Transplantation*† , 1997 .

[138]  W. Bugbee,et al.  Fresh Osteochondral Allografts , 2005, The journal of knee surgery.

[139]  L. Hangody,et al.  Primary stability of osteochondral grafts used in mosaicplasty. , 2006, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[140]  J. Koh,et al.  The Effect of Graft Height Mismatch on Contact Pressure following Osteochondral Grafting , 2004, The American journal of sports medicine.

[141]  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.

[142]  A. Davis,et al.  Fresh osteochondral allografts for post-traumatic osteochondral defects of the knee. , 1997, The Journal of bone and joint surgery. British volume.

[143]  Maurilio Marcacci,et al.  Articular Cartilage Engineering with Hyalograft® C: 3-Year Clinical Results , 2005, Clinical orthopaedics and related research.

[144]  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.

[145]  S. Cannon,et al.  The use of chondrogide membrane in autologous chondrocyte implantation. , 2004, The Knee.

[146]  Leif E. Peterson,et al.  Advanced techniques in autologous chondrocyte transplantation. , 1999, Clinics in sports medicine.

[147]  J A Skinner,et al.  Autologous chondrocyte implantation versus matrix-induced autologous chondrocyte implantation for osteochondral defects of the knee: a prospective, randomised study. , 2005, The Journal of bone and joint surgery. British volume.

[148]  R. Zernicke,et al.  Transplantation of cryopreserved osteochondral dowel allografts for repair of focal articular defects in an ovine model , 1999, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[149]  M. Bhargava,et al.  Mechanical load inhibits IL-1 induced matrix degradation in articular cartilage. , 2010, Osteoarthritis and cartilage.

[150]  M. Recht,et al.  Advances in Magnetic Resonance Imaging of Articular Cartilage , 2011, The Journal of the American Academy of Orthopaedic Surgeons.

[151]  S. Marlovits,et al.  Early postoperative adherence of matrix-induced autologous chondrocyte implantation for the treatment of full-thickness cartilage defects of the femoral condyle , 2005, Knee Surgery, Sports Traumatology, Arthroscopy.

[152]  G. Vásárhelyi,et al.  Autologous osteochondral grafting--technique and long-term results. , 2008, Injury.

[153]  M. Hans,et al.  Condylar cartilage response to continuous passive motion in adult guinea pigs: A pilot study. , 1999, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[154]  U. Wyss,et al.  Impact loading of articular cartilage during transplantation of osteochondral autograft. , 2005, The Journal of bone and joint surgery. British volume.

[155]  W. Bugbee,et al.  Osteochondral allograft transplantation. , 2021, Clinics in sports medicine.

[156]  Riley J. Williams,et al.  Microfracture: indications, technique, and results. , 2007, Instructional course lectures.

[157]  Riley J. Williams,et al.  Cartilage Repair Strategies , 2008 .

[158]  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.

[159]  F. Barber,et al.  Treatment of grade III femoral chondral lesions: mechanical chondroplasty versus monopolar radiofrequency probe. , 2006, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[160]  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.

[161]  Riley J. Williams,et al.  Chondrocyte Survival and Material Properties of Hypothermically Stored Cartilage , 2004, The American journal of sports medicine.

[162]  T. Briggs,et al.  Histological evaluation of chondral defects after autologous chondrocyte implantation of the knee. , 2003, The Journal of bone and joint surgery. British volume.

[163]  J. Agel,et al.  Refrigerated osteoarticular allografts to treat articular cartilage defects of the femoral condyles. A prospective outcomes study. , 2009, The Journal of bone and joint surgery. American volume.

[164]  B. Mandelbaum,et al.  Outcomes After a Single-Stage Procedure for Cell-Based Cartilage Repair , 2011, The American journal of sports medicine.

[165]  J. Garrett Fresh osteochondral allografts for treatment of articular defects in osteochondritis dissecans of the lateral femoral condyle in adults. , 1994, Clinical orthopaedics and related research.

[166]  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.

[167]  W. Bugbee,et al.  Allografts in articular cartilage repair. , 2006, Instructional course lectures.

[168]  E. Strauss,et al.  The Efficacy of Intra-Articular Hyaluronan Injection after the Microfracture Technique for the Treatment of Articular Cartilage Lesions , 2009, The American journal of sports medicine.

[169]  L. Hangody,et al.  Autologous Osteochondral Mosaicplasty for the Treatment of Full-Thickness Defects of Weight-Bearing Joints: Ten Years of Experimental and Clinical Experience , 2003, The Journal of bone and joint surgery. American volume.

[170]  R. T. Allen,et al.  Prolonged storage effects on the articular cartilage of fresh human osteochondral allografts. , 2003, The Journal of bone and joint surgery. American volume.

[171]  R. T. Allen,et al.  Analysis of Stored Osteochondral Allografts at the Time of Surgical Implantation , 2005, The American journal of sports medicine.

[172]  R. M. D'aubigne,et al.  Functional results of hip arthroplasty with acrylic prosthesis. , 1954, The Journal of bone and joint surgery. American volume.