Cartilage repair: A review of Stanmore experience in the treatment of osteochondral defects in the knee with various surgical techniques

Abstract

Articular cartilage damage in the young adult knee, if left untreated, it may proceed to degenerative osteoarthritis and is a serious cause of disability and loss of function. Surgical cartilage repair of an osteochondral defect can give the patient significant relief from symptoms and preserve the functional life of the joint. Several techniques including bone marrow stimulation, cartilage tissue based therapy, cartilage cell seeded therapies and osteotomies have been described in the literature with varying results. Established techniques rely mainly on the formation of fibro-cartilage, which has been shown to degenerate over time due to shear forces. The implantation of autologous cultured chondrocytes into an osteochondral defect, may replace damaged cartilage with hyaline or hyaline-like cartilage. This clinical review assesses current surgical techniques and makes recommendations on the most appropriate method of cartilage repair when managing symptomatic osteochondral defects of the knee. We also discuss the experience with the technique of autologous chondrocyte implantation at our institution over the past 11 years.

Revision cartilage cell transplantation for failed autologous chondrocyte transplantation in chronic osteochondral defects of the knee

“…When compared with previous reports from this unit, [2][3][4][8][9][10][11] the patients in this study were older, with a longer overall mean duration of symptoms, a poorer level of pre-operative function and had undergone multiple (≥ two) previously failed surgical procedures. Such factors have been shown to negatively influence outcome and make this sub-group of patients the most complex to treat.…”

“…2 MACI resulted in shorter operating times and a more even distribution of cells, which led to its increased popularity among surgeons. 2,3 ACI or MACI can be offered as an option to patients who have failed conventional methods of cartilage repair including drilling, microfracture and mosaicplasty. [3][4][5] The institutional costs and prolonged post-operative patient rehabilitation associated with primary cartilage transplantation make the management of failed ACI or MACI grafts particularly difficult.…”

“…2,3 ACI or MACI can be offered as an option to patients who have failed conventional methods of cartilage repair including drilling, microfracture and mosaicplasty. [3][4][5] The institutional costs and prolonged post-operative patient rehabilitation associated with primary cartilage transplantation make the management of failed ACI or MACI grafts particularly difficult. We report our experience of revision cartilage transplantation, performed in patients with chronically symptomatic articular cartilage lesions after failed ACI or MACI.…”

A biomimetic multi-layered collagen-based scaffold for osteochondral repair

“…Due to the body's extremely limited capacity to repair such defects, the prognosis is chronic degradation and surgical intervention is frequently required [2]. The treatment options dependent on factors such as age, lesion diameter and depth, and location within the joint [3,4].…”

Mesenchymal stem cells produce functional cartilage matrix in three-dimensional culture in regions of optimal nutrient supply

“…However, the tissue is avascular in the adult, and as a consequence, has a limited nutrient supply and poor intrinsic healing capacity. Short of total joint replacement, current clinical practices for cartilage repair include microfracture (broaching the subchondral bone interface to allow stem cells to access the wound site from the marrow) or delivery of exogenously expanded autologous chondrocytes (autologous chondrocyte implantation; ACI) (Vijayan et al, 2010). In both cases, limited defect size, fragile fibrocartilaginous repair tissue and long recovery periods reduce efficacy and widespread application (LaPrade et al, 2008;Nehrer et al, 1999;Van Assche et al, 2010).…”