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Bone marrow stimulation techniques for the treatment of articular cartilage defects such as microfracture so far have solely reproduced mechanically inferior fibrous cartilage tissue, which might result in unsatisfactory clinical results at midterm follow-up. A recent study has shown an improvement in repair tissue quality by enhancing microfracture with a chitosan-based biomaterial (BST-CarGel; Piramal, Laval, Quebec, Canada). BST-CarGel so far has only been applied by arthrotomy, which might lead to increased scar tissue formation and thus compromise recovery time and clinical outcome. We describe a surgical technique for an arthroscopic treatment of cartilage defects of the knee with microfracture in combination with BST-CarGel to benefit from improved repair tissue quality and to reduce arthrotomyrelated morbidity.

In patients with posteroinferior shoulder instability, good results can be obtained with the arthroscopic treatment of all identified pathologies. Categorization into one of four subgroups might be a valuable tool regarding the choice of the operative treatment options.

Bone marrow stimulation techniques such as microfracture for the treatment of articular cartilage defects so far solely reproduce mechanically inferior fibrous cartilage tissue, which might result in unsatisfactory clinical results at midterm. The combination of microfracture and biomaterialsdfor example, autologous matrix-induced chondrogenesis technologydhas not yet proved that the disadvantages of the marrow stimulation techniques can be overcome. At present, only laboratory-cultivated autologous chondrocytes are able to restore a biomechanically superior cartilage layer and might lead to superior functional results. However, the costs are high and the patient must undergo a 2-stage procedure. By selecting the appropriate cell fraction in conjunction with a controlled release of differentiating growth factors, sufficient cartilage regeneration might be achievable on the basis of bone marrow aspirate as well. We thus describe an advanced surgical technique for the treatment of articular cartilage defects based on platelet-rich plasma and bone marrow aspirate concentrate to overcome these drawbacks.