The Effectiveness of Various Surgical Techniques in the Treatment of Local Knee Cartilage Lesions (Review)

Abstract

Introduction. To restore the knee local cartilage lesions, a large number of alternative surgical techniques are used in clinical practice: isolated debridement of the lesion area, chondrogenesis stimulation, mosaic osteochondral grafting, cell technologies, collagen membranes (matrices), and a combination of the above methods. The purpose of this article was to compare the effectiveness of various surgical methods of treating patients with local cartilage lesions of the femur based on analysis of relevant publications. Materials and Methods. The review included 85 publications of domestic and foreign authors within 2005 to 2020. The search was carried out in electronic scientific databases PubMed and eLIBRARy. Results. The medium and long term outcomes of debridement and/or various options of chondrogenesis stimulating, despite their wide popularity, in terms of clinical, radiological, and histological indicators, are inferior to all other surgical techniques. Mosaic osteochondral auto-and/or allografting, as well as transplantation of autologous chondrocytes culture with a collagen membrane, are characterized by the best 15 to 20-year outcomes, allowing most patients to maintain the same level of activity as before the lesion occurred. The combination of matrices with other cellular products or microfracturing shows similar medium-term results, but it long-term efficacy remains unknown. Conclusion. The use of debridement and/or chondrogenesis stimulation should be limited to minimal defects. From both a clinical and an economic point of view, mosaic osteochondral grafting is the optimal method for the treatment of knee local cartilage lesions with an area up to 4 to 6 cm 2 . The combination of membranes with various cellular products or microfracturing is indicated in case of extensive local cartilage lesions or if mosaic osteochondral grafting is not appropriate.

Effect of recombinant Sox9 protein on the expression of cartilage-specific genes in human dermal fibroblasts cell culture

“…Hyaline cartilage has a limited ability for recovery, and its defects only increase over time and lead to further tissue degradation and dysfunction of the joint (Bozhokin et al 2017). The factors which promote a start of articular surface damage are: age-related changes (Anderson and Loeser 2010;Lotz and Loeser 2012), excessive exercise (Flanigan et al 2010), genetic predisposition (Zabello et al 2015), overweight (Kulkarni et al 2016), inflammatory diseases of the joints, defects of the ligamentous apparatus, as well as native avascular and less cellular hyaline cartilage structure (Komarraju et al 2020;Kulyaba et al 2020).…”

Methods of Modification of Mesenchymal Stem Cells and Conditions of Their Culturing for Hyaline Cartilage Tissue Engineering

“…Biomedicines 2021, 9, 1666 2 of 28 Currently, there are many technologies available to surgeons for replacing the damaged layer of the hyaline cartilage [14], the problem of restoring the surface of the articular cartilage has not yet been fully solved [15,16]. One promising approach to replacing defects in the surface layer of large joints is provided by cell and tissue engineering technologies [17,18].…”

Transfection of Mesenchymal Stem Cells (Msc) for Modifying Cell Culture for Recovery Hyaline Cartilage Defects

“…различных методов, позволяющих приостановить дегенеративные процессы, однако в полном объёме данная проблема до сих пор не решена [2][3][4]. Перспективным направлением является использование клеточно-инженерных конструкций (КИК), представляющих собой биодеградируемый полимер (скаффолд), покрытый модифицированной культурой клеток [5].…”