- 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;
- in most cases injury is in wt bearing regions of articular cartilage, and usually in the 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:
- 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. Study in dogs. GA Paletta Am J. Sports Med Vol 20. 1992. p 725-731.
- The effect of (rhBMP-2) on the healing of full thickness defects of articualr cartilage. RS Sellers JBJS Vol 79-A. No 10. Oct 1997. p 1452.
-
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. (from Bauer and Jackson: J. Arthoscopic and Related Surgery, 1988)
The biological effect of continuous passive motion on the healing of full-thickness defects in articular cartilage: An experimental investigation in the rabbit.
Salter RB, Simmonds DF, Malcolm BW, et al: J Bone Joint Surg 1980;62A:1232.
Isolated chondral fractures of the knee.
Mesenchymal Cell Based Repair of Large Full Thickness Defects in Articluar Cartilage. S Wakitani. JBJS Vol 76-A. 1994. p 579-592.
Restoration of injured or degenerated articular cartilage. JA Buckwalter et al. J. Am. Acad of Orthopaedic Surgeons. 1994. 192-201.
Spontaneous repair of superficial defects in articular cartilage in a fetal lamb model. RS Namba MD et al. JBJS. Vol 80-A. No 1. Jan 1988.
Autologous Chondrocyte Implantation Compared with Microfracture in the Knee.
An Analysis of the Quality of Cartilage Repair Studies.
Analysis of Stored Osteochondral Allografts at the Time of Surgical Implantation.
Oslo Cartilage Research Group-A multidisciplinary group
Alternatives to Total Knee Replacement:
Autologous Hamstring Resurfacing Arthroplasty
