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Current Surgical Options for Articular Cartilage Repair

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Advances in Minimally Invasive Surgery and Therapy for Spine and Nerves

Part of the book series: Acta Neurochirurgica Supplementum ((NEUROCHIRURGICA,volume 108))

Abstract

The articular cartilage lesions represent one of the major unsolved problems in the orthopaedic surgery. This is because articular cartilage has a limited capacity of self-repair following trauma. The aim of this study is to review the different surgical options for articular cartilage repair. They can be divided into three groups: techniques without transplant of cells or tissues; techniques based on the transplantation of tissues; the tissue engineering techniques.

The first group includes the joint debridement and the techniques based on the bone marrow-stimulation principle.

The second group includes the transplantation of periosteum and the transplantation of autologous or allogeneic osteochondral plugs. The tissue engineering techniques could be further divided as follows: methods based on the transplantation of cells either in solution, or in the form of microspheres, or carried on a biocompatible scaffold; the transplant of cartilage fragments; the cell-free techniques, based on the use of an acellular scaffold, able to entrap the reparative cells recruited from the host tissue and to guide their differentiation toward a chondral phenotype.

In this work we present various options for the treatment of chondral or osteochondral lesions. Today, however, due to the lack of comparative studies, it is not always possible to define the best treatment choice for the different cartilage pathologies.

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References

  1. Andereya S, Maus U, Gavenis K, Gravius S, Stanzel S, Müller-Rath R, Miltner O, Mumme T, Schneider U (2007) Treatment of patellofemoral cartilage defects utilizing a 3D collagen gel: two-year clinical results. Z Orthop Unfall;145(2):139–45.

    Article  PubMed  CAS  Google Scholar 

  2. Attmanspacher W, Dittrich V, Stedtfeld H (2000) Experiences with arthroscopic therapy of chondral and ostreochondral defect of the knee joint with OATS (Osteochondral Autograft Transfer System). Zentralbl Chir; 125:494–9.

    PubMed  CAS  Google Scholar 

  3. Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L (1994) Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med;331(14):889–95.

    Article  PubMed  CAS  Google Scholar 

  4. Buckwalter JA, Mankin HJ (1997) Articular cartilage. 2: Degeneration and osteoarthrosis, repair, regeneration, and transplantation. J Bone Joint Surg 79A:612–32.

    Google Scholar 

  5. Chao PH, Grayson W, Vunjak-Novakovic G (2007) Engineering cartilage and bone using human mesenchymal stem cells. J Orthop Sci;12(4):398–404.

    Article  PubMed  Google Scholar 

  6. Cherubino P, Bulgheroni P, Ronga M (2003) Autologous chondrocyte implantation using a bilayer collagen membrane. A preliminary report. J Orthop Surg;11(1):10–5.

    CAS  Google Scholar 

  7. Ferruzzi A, Calderoni P, Grigolo B, Gualtieri G (2004) Autologous chondrocytes implantation: indications and results in the treatment of articular cartilage lesions of the knee. Chir Organi Mov; 89(2):125–34.

    PubMed  CAS  Google Scholar 

  8. Grayson WL, Chao PH, Marolt D, Kaplan DL, Vunjak-Novakovic G (2008) Engineering custom-designed osteochondral tissue grafts. Trends Biotechnol;26(4):181–9.

    Article  PubMed  CAS  Google Scholar 

  9. Hunziker EB (2002) Articular cartilage repair: basic science and clinical progress. A review of the current status and prospects. Osteoarthr Cartil;10(6):432–63.

    Article  PubMed  CAS  Google Scholar 

  10. Insall JN (1974) The Pridie debridement operation for osteoarthritis of the knee. Clin Orthop;101:61–7.

    PubMed  Google Scholar 

  11. Jackson DW, Scheer MJ, Simon TM (2001) Cartilage substitutes: overview of basic science and treatment options. J Am Acad Orthop Surg;9(2):147.

    Google Scholar 

  12. Kessler MW, Ackerman G, Dines JS, Grande D (2008) Emerging technologies and fourth generation issues in cartilage repair. Sports Med Arthrosc;16(4):246–54.

    Article  PubMed  Google Scholar 

  13. Khan IM, Gilber SJ, Singhrao SK, Duance VC, Archer CW (2008) Cartilage integration: evaluation of the reasons for failure of integration during cartilage repair. A review. Eur Cell Mater;16:26–39.

    PubMed  CAS  Google Scholar 

  14. 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(1):33–41.

    Article  PubMed  Google Scholar 

  15. Kreuz PC Müller S, Ossendorf C, Kaps C, Erggelet C (2009) Treatment of focal degenerative cartilage defects with polymer-based autologous chondrocyte grafts: four-year clinical results. Arthritis Res Ther;11(2):R33.

    Article  PubMed  Google Scholar 

  16. Magnusson PB (1941) Joint debridement: surgical treatment of degenerative arthritis. Surg Gynaecol Obstet;73:1–9.

    Google Scholar 

  17. Marlovits S, Zeller P, Singer P, Resinger C, Cècsei V (2006) Cartilage repair: generations of autologous chondrocyte transplantation. Eur J Radiol;57(1):24–31.

    Article  PubMed  Google Scholar 

  18. Martin JA, Buckwalter JA (2001) Telomere erosion and senescence in human articular cartilage chondrocytes. J Gerontol A Biol Sci Med Sci;56(4):B172–9.

    Article  PubMed  CAS  Google Scholar 

  19. Mikos AG, Herring SW, Ochareon P, Elisseeff J, Lu HH, Kandel R, Schoen FJ, Toner M, Mooney D, Atala A, Van Dyke ME, Kaplan D, Vunjak-Novakovic G (2006) Engineering complex tissues. Tissue Eng;12(12):3307–39.

    Article  PubMed  CAS  Google Scholar 

  20. Ochs BG, Müller-Horvat C, Rolauffs B, Fritz J, Weise K, Schewe B (2007) Treatment of osteochondritis dissecans of the knee: one-step procedure with bone grafting and matrix-supported autologous chondrocyte transplantation. Z Orthop Unfall; 145(2):146–51.

    Article  PubMed  CAS  Google Scholar 

  21. Samuels J, Krasnokutsky S, Abramson SB (2008) Osteoarthritis: a tale of three tissues. Bull NYU Hosp Jt Dis;66(3):244–50.

    PubMed  Google Scholar 

  22. Schreiber RE, Dunkelman NS, Naughton G, Ratcliffe A (1999) A method for tissue engineering of cartilage by cell seeding on bioresorbable scaffolds. Ann NY Acad Sci;875:398–404.

    Article  PubMed  CAS  Google Scholar 

  23. Selmi TA, Verdonk P, Chambat P, Dubrana F, Potel JF, Barnouin L, Neyret P (2008) Autologous chondrocyte implantation in a novel alginate-agarose hydrogel: outcome at two years. J Bone Joint Surg Br;90(5):597–604.

    Article  PubMed  CAS  Google Scholar 

  24. Shapiro F, Koide S, Glimcher MJ (1993) Cell origin and differentiation in the repair of full-thickness defects of articular cartilage. J Bone Joint Surg Am;75(4):532–53.

    PubMed  CAS  Google Scholar 

  25. Simon TM, Jackson DW (2006) Articular cartilage: injury pathways and treatment options. Sports Med Arthrosc;14(3):146–54.

    Article  PubMed  Google Scholar 

  26. Tognana E, Borrione A, De Luca C, Pavesio A (2007) Hyalograft C: hyaluronan-based scaffolds in tissue-engineered cartilage. Cells Tissues Organs 186(2):97–103.

    Article  PubMed  CAS  Google Scholar 

  27. Wakitani S, Kawaguchi A, Tokuhara Y, Takaoka K (2008) Present status of and future direction for articular cartilage repair. J Bone Miner Metab;26(2):115–22.

    Article  PubMed  Google Scholar 

  28. Williams RJ, Gamradt SC (2008) Articular cartilage repair using a resorbable matrix scaffold. Instr Course Lect ;57:563–71.

    PubMed  Google Scholar 

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Correspondence to F. Pellacci .

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Peretti, G.M., Pozzi, A., Ballis, R., Deponti, D., Pellacci, F. (2011). Current Surgical Options for Articular Cartilage Repair. In: Alexandre, A., Masini, M., Menchetti, P. (eds) Advances in Minimally Invasive Surgery and Therapy for Spine and Nerves. Acta Neurochirurgica Supplementum, vol 108. Springer, Vienna. https://doi.org/10.1007/978-3-211-99370-5_33

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  • DOI: https://doi.org/10.1007/978-3-211-99370-5_33

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