Articular Cartilage Injury and Potential Remedies

Abstract

Osteoarthritis affects millions of people worldwide, is associated with joint stiffness and pain, and often causes significant disability and loss of productivity. Osteoarthritis is believed to occur as a result of ordinary "wear and tear" on joints during the course of normal activities of daily living. Posttraumatic osteoarthritis is a particular subset of osteoarthritis that occurs after a joint injury. Developing clinically relevant animal models will allow investigators to delineate the causes of posttraumatic osteoarthritis and develop means to slow or prevent its development after joint injury. Chondroprotectant compounds, which attack the degenerative pathways at a variety of steps, are being developed in an effort to prevent posttraumatic osteoarthritis and offer great promise. Often times, cartilage degradation after joint injury occurs despite our best efforts. When this happens, there are several evolving techniques that offer at least short-term relief from the effects of posttraumatic osteoarthritis. Occasionally, these traumatic lesions are so large that dramatic steps must be taken in an attempt to restore articular congruity and joint stability. Fresh osteochondral allografts have been used in these settings and offer the possibility of joint preservation. For patients presenting with neglected displaced intra-articular fractures that have healed, intra-articular osteotomy techniques are being developed in an effort to restore joint congruity and function. This article reviews the results of a newly developed animal model of posttraumatic osteoarthritis, several promising chondroprotectant compounds, and also cartilage techniques that are used when degenerative cartilage lesions develop after joint injury.

Microfracture Versus Drilling of Articular Cartilage Defects: A Systematic Review of the Basic Science Evidence

“…Due to its limited vascular supply, articular cartilage has limited to no ability to spontaneously repair after injury, 5 with full-thickness lesions leading to pain and joint swelling if left untreated. 11 Focal chondral defects (FCDs) are common, with a reported incidence of 48% in the medial compartment of the knee and 25% in the lateral compartment among patients undergoing knee arthroscopy. 12 MFx was first described by Steadman et al 38 as an alternative technique to treat full-thickness cartilage defects in the knee joint by using an awl to make multiple perforations in the subchondral bone plate, thereby releasing bone marrow elements in an effort to enhance tissue regeneration.…”

Clinical and Radiological Outcomes After Autologous Matrix-Induced Chondrogenesis Versus Microfracture of the Knee: A Systematic Review and Meta-analysis With a Minimum 2-Year Follow-up

“… 11 , 30 , 35 , 41 , 42 If untreated, full-thickness chondral lesions may develop and potentially lead to pain, recurrent effusion, decreased activity, and progression of osteoarthritis in the long term. 12 , 26 Chondral lesions accompanying such symptoms usually necessitate surgical treatment. Several options are currently available to repair articular chondral lesions including a marrow stimulation method, autologous chondrocyte implantation, and osteochondral autograft and allograft transplantation.…”

Komplexe Gelenkrekonstruktion und Gelenktransplantation mit dem FLOCSAT-Konzept – Planung und chirurgische Umsetzung

“…Mikrofrakturierung (MF), autologe Chondrozytentransplantation (ACT), autologe matrixinduzierte Chondrogenese (AMIC) und andere Therapien sind wichtige Optionen zur Behandlung chondraler Läsionen. Bei großen subchondralen Läsionen, fehlendem intakten Knorpelrand [2,4,7,11,14], gegenüberliegenden ("kissing") Läsio- nen oder großen Knorpel-KnochenDefekten (> 10 cm 2 ) sind sie jedoch weniger geeignet. Die Heilung erfolgt hier über die Bildung eines Faserknorpels, dieser entspricht jedoch histologisch und somit auch biomechanisch nicht dem eines vollwertigen hyalinen Knorpels.…”