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Duke Orthopaedics
presents
Wheeless' Textbook of Orthopaedics

Chondral and Osteochondral Injuries of the Knee 

- See: Knee Joint Menu

- Discussion:
    - articular cartilage injury and potential for repair;
    - rotational forces in direct trauma is the most common cause of injury to the articular cartilage;
    - in adults, the tidemark zone is the weak link between the overlying cartilage and subchondral bone and therefore shearing injuries most often produce a chondral injury rather than an osteochondral injury;
    -injury is mostly in wt bearing regions of articular cartilage, and usually in medial compartment (4 times more common that lateral injuries); 
    - classification 
    - pediatric OCD: steochondritis dessicans 
    - natural history:
            - references:
                   - Isolated Full Thickness Chondral Injuries. Prevalance and Outcome of Treatment. A Retrospective Study of 5233 Knee Arthroscopies.
                   - Articular cartilage defects: study of 25,124 knee arthroscopies
                   - Articular cartilage lesions in 993 consecutive knee arthroscopies

 - Exam:
    - symptoms of intermittent locking, recurrent effusions, crepitus, and persistant pain may all be associated with chondral injuries;
    - however, similar symptoms are found in extensor mech injuries; and meniscal injuries
    - with knee flexion, the anterior and central face of the medial femoral can be palpated (as opposed to the posteromedial joint line which indicates a meniscal tear);
    - w/ a dashboard type injury, consider PCL tear;

 - Radiographs: 
      - The accuracy of magnetic resonance imaging scanning and its influence on management decisions in knee surgery.
      - Sensitivity of routine 1.0-Tesla MRI versus arthroscopy as gold standard in fresh traumatic chondral lesions of the knee in young adults.
      - Diagnosis of chondral lesions of the knee joint: can MRI replace arthroscopy? A prospective study
      - Evaluation of cartilage defects in the knee: validity of clinical, magnetic-resonance-imaging and radiological findings compared with arthroscopy
 
             

- Non Operative Treatment:
    - articular steroid injection
    - anti-inflammatories
    - valgus unloading knee brace;

- Surgical Treatment Options:
    - debridement of chondral defects and microfracture 
    - mosaicplasty and cartilage transplants for chrondral injuries:  
    - enhanced microfracture with autolgous hamstring resurfacing;
    - role of allografts in repairing chondral defects: (see allografts);
    - growth factors: (see BMP)
          - as noted by Sellers, et al (1997), treatment with rhBMP-2 significantly accelerated formation of new subchondral bone and improve the microscopic appearance of overlying articular cartilage;
                 - technical involved insertion of a BMP laden collagen sponge into a chondral defect;
                 - disadvantages: there may be a lack of integration of the repair tissue with the normal adjacent cartilage;
          - references:
                 - The repair of osteochondral defects using an exogenous fibrin clot. An experimental study in dogs. 
                 - The effect of recombinant human bone morphogenetic protein-2 (rhBMP-2) on the healing of full-thickness defects of articular cartilage.
    - arthroscopy of the degenerative knee (see osteoarthritis


Management of Articular Cartilage Injuries in the Knee (power point slide show)

Isolated chondral fractures of the knee.

The biological effect of continuous passive motion on the healing of full-thickness defects in articular cartilage. An experimental investigation in the rabbit.

Mesenchymal Cell Based Repair of Large Full Thickness Defects in Articluar Cartilage

Restoration of injured or degenerated articular cartilage.  

Spontaneous repair of superficial defects in articular cartilage in a fetal lamb model.   

Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial. 

An Analysis of the Quality of Cartilage Repair Studies.

Analysis of Stored Osteochondral Allografts at the Time of Surgical Implantation.

Activity levels are higher after osteochondral autograft transfer mosaicplasty than after microfracture for articular cartilage defects of the knee: a retrospective comparative study.

Alternatives to Total Knee Replacement:    Autologous Hamstring Resurfacing Arthroplasty






Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Friday, August 31, 2012 9:59 am