Abstract
Articular cartilage injury is a common disorder of the knee and untreated chondral lesions are thus likely to predispose patients to develop osteoarthritis. In the USA more than 500,000 procedures are performed for cartilage-related injuries. Chondral lesions are found in more than 60 % of arthroscopic knee surgeries, according to several authors [1].
Most of the times the diagnosis of the cartilage lesions is performed by the orthopedic surgeon at the time of the arthroscopic evaluation and, in many cases, this is the only opportunity to attempt repairing the damaged cartilage (“the golden moment”).
Cartilage repair has developed rather fast in the past 20 years, and so have arthroscopic repair techniques. Despite substantial differences in the complexity and technical application of each method, all are united in the endeavor to restore joint function and prevent joint degeneration.
Surgical techniques to treat cartilage lesions can be grouped in three basic categories: palliative (debridement), restorative (microfracture and retrodrilling) and reparative (mosaicoplasty & MACI).
Debridement smooth fibrillated cartilage, providing relief that may last several years. Microfracture and Retrodrilling techniques stimulate the release of marrow derived cells and growth factors that contribute to fibrocartilage formation with only limited durability. Transplantation techniques as mosaicplasty can result in more durable hyaline cartilage and better integrated weight bearing tissue improving the joint biomechanical loads. Matrix Autologous Chondrocyte Implantation (MACI) uses biomaterials seeded with chondrocytes as carriers and scaffolds for cell growth that improve arthroscopy delivery providing satisfactory outcomes up to 5 years.
One of the most important issues of cartilage lesions is to perform an appropriate arthroscopic diagnosis of the whole articular surface of the knee, and to enhance the availability of minimally-invasive arthroscopic surgical techniques for the first surgical stage, or as the first or second step of a two-stage arthroscopic chondral repair technique.
This chapter assesses current arthroscopic techniques for chondral repair enhancing the most appropriate indications, advantages and disadvantages of every procedure.
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Villalobos, E., Olivos-Meza, A., Izaguirre, A., Ibarra, C. (2014). Arthroscopic Approaches for Cartilage Repair in the Knee Joint. In: Emans, P., Peterson, L. (eds) Developing Insights in Cartilage Repair. Springer, London. https://doi.org/10.1007/978-1-4471-5385-6_13
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DOI: https://doi.org/10.1007/978-1-4471-5385-6_13
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