In the first stage, the surgeon harvests healthy cartilage and sends it to the laboratory for culture. This, of course, is inferior to that of native articular cartilage.Ĭell-based therapies include the gold-standard autologous chondrocyte implantation (ACI), a two-stage surgery. This allows for marrow stimulation which will form blood clots, which in turn will mature into fibrocartilage to fill up the defect. With the use of microfracture, the surgeon creates holes through the tidemark of the subchondral bone after debriding the nonviable cartilage.
The gold standard for non-cell-based therapy is that of intrinsic repair enhancement. In addition to the symptoms of knee osteoarthritis, the detached fragment may be a loose body and might cause locking of the knee joint.įigure 1 Arthroscopic pictures of chondral injuries in two different groups of patientsĬURRENT ROUTINE CARTILAGE REPAIR STRATEGIES AND THEIR LIMITATIONSĬartilage regeneration strategies can be broadly divided into non-cell-based therapy versus cell-based therapy. The chondral defect may be accompanied by bone loss, leading to an osteochondral defect. Instead, a focal chondral defect is created due to an acute injury such as a sporting injury (e.g., anterior cruciate ligament tear via twisting injury, patella dislocation, landing from a jump of significant height). There is no generalised wear of the cartilage. This generally occurs in the younger age group of patients from paediatric to 45 years. The defect side causes acute joint pain and swelling, and patients have pain on weightbearing and stair climbing.
The wear of the cartilage is generalised and chondral defects can occur from minor trauma, such as light jogging or twisting injuries, leading to a chondral flap tear and resultant defect when the tear detaches. Inflammatory factors such as gout and rheumatoid arthritis.Previous injury factors such as previous meniscus injuries which reduce shock absorption on the cartilage.Biomechanical factors with malalignment being the most common.Osteoarthritis is the gradual wear of the cartilage due to various factors such as: This generally occurs in the older age group of patients 45 years and above. Patients can suffer from chondral defects from two main knee conditions: knee osteoarthritis and acute focal chondral injury. This makes natural healing of chondral defects almost impossible. The treatment of articular chondral defects of the knee has classically been challenging, due to the cartilage's aneural, avascular and alymphatic nature. Find out more about the promising developments on the horizon and what they could mean for patients. With ongoing advancements in cell-based therapies for cartilage repair, we can look forward to more accessible treatments and better patient outcomes for knee osteoarthritis and chondral defects of the knee.
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