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Knee Cartilage Repair

  • Lars G. PetersonEmail author
  • Haris S. VasiliadisEmail author

Abstract

The incidence of the injuries of knee articular cartilage is found to be increasing among athletes, especially of contact sports like football. It has been shown that foul play is responsible for about 30 % of all injuries and that knee injuries are among the most common injuries and may be career ending.

A careful assessment of the patient-player is required along with a detailed discussion of the treatment options, the possibilities, the anticipated outcomes and all the parameters related to the anticipated rehabilitation time, the complication rate and the potential long term impact on the knee joint. The treatment strategy is usually individualized according to many factors, including the priorities of the patient-athlete. There are three main treatment groups that may differ in the approach and treatment possibilities and also prognosis; the teenage player in the beginning of his career, the established player in his active career between 20–35 years and the player in the end of his career or post career.

Generally, the currently available evidence shows a superiority of ACI in terms of return to sports, return to preinjury levels and durability of good outcomes. However, the ACI is a two stage operation, associated with a longer and more demanding rehabilitation protocol. On the other hand, although MF is associated with a less postoperative morbidity and a short term good outcome may be observed, it is associated with a lower sports performance, higher rate of retirement and long term deterioration of the clinical outcomes. Regarding MP-OATS, although good results have been reported, there is not much evidence to allow for safe conclusions.

Keywords

Cartilage Subchondral bone Osteochondritis dissecans Femoral condyle Autologous chondrocyte implantation 

References

  1. 1.
    Mithoefer K, Williams RJ, Warren RF, Wickiewicz TL, Marx RG (2006) High-impact athletics after knee articular cartilage repair: a prospective evaluation of the microfracture technique. Am J Sports Med 34:1413–1418CrossRefPubMedGoogle Scholar
  2. 2.
    Noyes FR, Bassett RW, Grood ES, Butler DL (1980) Arthroscopy in acute traumatic hemarthrosis of the knee. Incidence of anterior cruciate tears and other injuries. J Bone Joint Surg Am 62:687–695, 757PubMedGoogle Scholar
  3. 3.
    Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG (1997) Cartilage injuries: a review of 31,516 knee arthroscopies. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 13:456–460CrossRefGoogle Scholar
  4. 4.
    Hjelle K, Solheim E, Strand T, Muri R, Brittberg M (2002) Articular cartilage defects in 1,000 knee arthroscopies. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 18:730–734CrossRefGoogle Scholar
  5. 5.
    Mithoefer K, Hambly K, Della Villa S, Silvers H, Mandelbaum BR (2009) Return to sports participation after articular cartilage repair in the knee: scientific evidence. Am J Sports Med 37(Suppl 1):167S–176SCrossRefPubMedGoogle Scholar
  6. 6.
    Piasecki DP, Spindler KP, Warren TA, Andrish JT, Parker RD (2003) Intraarticular injuries associated with anterior cruciate ligament tear: findings at ligament reconstruction in high school and recreational athletes. An analysis of sex-based differences. Am J Sports Med 31:601–605PubMedGoogle Scholar
  7. 7.
    Brophy RH, Rodeo SA, Barnes RP, Powell JW, Warren RF (2009) Knee articular cartilage injuries in the National Football League: epidemiology and treatment approach by team physicians. J Knee Surg 22:331–338CrossRefPubMedGoogle Scholar
  8. 8.
    Noyes FR, Mooar PA, Matthews DS, Butler DL (1983) The symptomatic anterior cruciate-deficient knee. Part I: the long-term functional disability in athletically active individuals. J Bone Joint Surg Am 65:154–162PubMedGoogle Scholar
  9. 9.
    Drawer S, Fuller CW (2001) Propensity for osteoarthritis and lower limb joint pain in retired professional soccer players. Br J Sports Med 35:402–408CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Kujala UM, Kettunen J, Paananen H, Aalto T, Battié MC, Impivaara O, Videman T, Sarna S (1995) Knee osteoarthritis in former runners, soccer players, weight lifters, and shooters. Arthritis Rheum 38:539–546CrossRefPubMedGoogle Scholar
  11. 11.
    Harris JD, Brophy RH, Siston RA, Flanigan DC (2010) Treatment of chondral defects in the athlete’s knee. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 26:841–852CrossRefGoogle Scholar
  12. 12.
    Gudas R, Stankevicius E, Monastyreckiene E, Pranys D, Kalesinskas RJ (2006) Osteochondral autologous transplantation versus microfracture for the treatment of articular cartilage defects in the knee joint in athletes. Knee Surg Sports Traumatol Arthrosc Off ESSKA 14:834–842CrossRefGoogle Scholar
  13. 13.
    Steadman JR, Miller BS, Karas SG, Schlegel TF, Briggs KK, Hawkins RJ (2003) The microfracture technique in the treatment of full-thickness chondral lesions of the knee in National Football League players. J Knee Surg 16:83–86PubMedGoogle Scholar
  14. 14.
    Namdari S, Baldwin K, Anakwenze O, Park M-J, Huffman GR, Sennett BJ (2009) Results and performance after microfracture in National Basketball Association athletes. Am J Sports Med 37:943–948CrossRefPubMedGoogle Scholar
  15. 15.
    Cerynik DL, Lewullis GE, Joves BC, Palmer MP, Tom JA (2009) Outcomes of microfracture in professional basketball players. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 17:1135–1139CrossRefGoogle Scholar
  16. 16.
    Cole BJ, Pascual-Garrido C, Grumet RC (2009) Surgical management of articular cartilage defects in the knee. J Bone Joint Surg Am 91:1778–1790PubMedGoogle Scholar
  17. 17.
    Nagel A, Insall JN, Scuderi GR (1996) Proximal tibial osteotomy. A subjective outcome study. J Bone Joint Surg Am 78:1353–1358PubMedGoogle Scholar
  18. 18.
    Peterson L, Vasiliadis HS, Brittberg M, Lindahl A (2010) Autologous chondrocyte implantation: a long-term follow-up. Am J Sports Med 38:1117–1124CrossRefPubMedGoogle Scholar
  19. 19.
    Peterson L (2003) Autologous Chondrocyte Implantation, In; Master Techniques in Orthopaedic Surgery: Reconstructive Knee Surgery. Second Edition. Douglas W. Jackson (Ed). Lippincott Williams & Wilkins, Philadelphia, 2002; 353–373Google Scholar
  20. 20.
  21. 21.
    Peterson L (2003) Articular Cartilage lesions in football players. In; Football Traumatology: Current Concepts: from Prevention to Treatment. Piero Volpi (ed), Springer Milan, pp 255–261Google Scholar
  22. 22.
    Mithöfer K, Peterson L, Mandelbaum BR, Minas T (2005) Articular cartilage repair in soccer players with autologous chondrocyte transplantation: functional outcome and return to competition. Am J Sports Med 33:1639–1646CrossRefPubMedGoogle Scholar
  23. 23.
    Mithöfer K, Minas T, Peterson L, Yeon H, Micheli LJ (2005) Functional outcome of knee articular cartilage repair in adolescent athletes. Am J Sports Med 33:1147–1153CrossRefPubMedGoogle Scholar
  24. 24.
    Vanlauwe J, Saris DB, Victor J, Almqvist KF, Bellemans J, Luyten FP, TIG ACT (2011) Five-year outcome of characterized chondrocyte implantation versus microfracture for symptomatic cartilage defects of the knee: early treatment matters. Am J Sports Med 39:2566–2574CrossRefPubMedGoogle Scholar
  25. 25.
    De Windt TS, Bekkers JEJ, Creemers LB, Dhert WJA, Saris DBF (2009) Patient profiling in cartilage regeneration: prognostic factors determining success of treatment for cartilage defects. Am J Sports Med 37(Suppl 1):58S–62SCrossRefPubMedGoogle Scholar
  26. 26.
    Knutsen G, Drogset JO, Engebretsen L, Grøntvedt T, Isaksen V, Ludvigsen TC, Roberts S, Solheim E, Strand T, Johansen O (2007) A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years. J Bone Joint Surg Am 89:2105–2112CrossRefPubMedGoogle Scholar
  27. 27.
    Riyami M, Rolf C (2009) Evaluation of microfracture of traumatic chondral injuries to the knee in professional football and rugby players. J Orthop Surg 4:13CrossRefGoogle Scholar
  28. 28.
    Minas T, Gomoll AH, Rosenberger R, Royce RO, Bryant T (2009) Increased failure rate of autologous chondrocyte implantation after previous treatment with marrow stimulation techniques. Am J Sports Med 37:902–908CrossRefPubMedGoogle Scholar
  29. 29.
    Peterson L, Brittberg M, Kiviranta I, Akerlund EL, Lindahl A (2002) Autologous chondrocyte transplantation. Biomechanics and long-term durability. Am J Sports Med 30:2–12PubMedGoogle Scholar
  30. 30.
    Peterson L, Minas T, Brittberg M, Nilsson A, Sjögren-Jansson E, Lindahl A (2000) Two – to 9-year outcome after autologous chondrocyte transplantation of the knee. Clin Orthop 374:212–234CrossRefPubMedGoogle Scholar
  31. 31.
    Blevins FT, Steadman JR, Rodrigo JJ, Silliman J (1998) Treatment of articular cartilage defects in athletes: an analysis of functional outcome and lesion appearance. Orthopedics 21:761–767, discussion 767–768PubMedGoogle Scholar
  32. 32.
    Gobbi A, Nunag P, Malinowski K (2005) Treatment of full thickness chondral lesions of the knee with microfracture in a group of athletes. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 13:213–221CrossRefGoogle Scholar
  33. 33.
    Kon E, Gobbi A, Filardo G, Delcogliano M, Zaffagnini S, Marcacci M (2009) Arthroscopic second-generation autologous chondrocyte implantation compared with microfracture for chondral lesions of the knee: prospective nonrandomized study at 5 years. Am J Sports Med 37:33–41CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Department of OrthopaedicsSahlgrenska Academy, Gothenburg UniversityGothenburgSweden
  2. 2.Department of OrthopaedicsUniversity of IoanninaIoanninaGreece

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