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Review
. 2012 Sep;94(6):381-7.
doi: 10.1308/003588412X13171221592573.

The present state of treatments for articular cartilage defects in the knee

J R Perera  1 , P D Gikas, G Bentley
Affiliations
Review

The present state of treatments for articular cartilage defects in the knee

J R Perera et al. Ann R Coll Surg Engl. 2012 Sep.

Abstract

Introduction: Chondral and osteochondral lesions of the knee are notoriously difficult to treat due to the poor healing capacity of articular cartilage and the hostile environment of moving joints, ultimately causing disabling pain and early osteoarthritis. There are many different reconstructive techniques used currently but few are proven to be of value. However, some have been shown to produce a better repair with hyaline-like cartilage rather than fibrocartilage.

Methods: A systematic search of all available online databases including PubMed, MEDLINE(®) and Embase™ was undertaken using several keywords. All the multiple treatment options and methods available were considered. These were summarised, and the evidence for and against them was scrutinised.

Results: A total of 460 articles were identified after cross-referencing the database searches using the keywords. These revealed that autologous and matrix assisted chondrocyte implantation demonstrated both 'good to excellent' histological results and significant improvement in clinical outcomes.

Conclusions: Autologous and matrix assisted chondrocyte implantation have been shown to treat symptomatic lesions successfully with significant histological and clinical improvement. There is, however, still a need for further randomised clinical trials, perfecting the type of scaffold and the use of adjuncts such as growth factors. A list of recommendations for treatment and the potential future trends of managing these lesions are given.

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Figures

Figure 1
Figure 1
Spatial relations of collagen, proteoglycans and cells in cartilage
Figure 2
Figure 2
Coronal T1 weighted magnetic resonance imaging of the knee showing an area of osteochondritis dissecans affecting the medial femoral condyle (A) and an osteochondral lesion affecting the medial femoral condyle (B)
Figure 3
Figure 3
Arthroscopic view of the microfracture process
Figure 4
Figure 4
Autologous chondrocyte implantation in a medial femoral condyle, demonstrating the injection of chondrocytes in suspension under a collagen type I/III membrane. The extent of the filling can be seen by the ‘tidemark’ on the membrane, produced by the liquid suspension.
Figure 5
Figure 5
Matrix assisted chondrocyte implantation in a lateral patella facet. The scaffold is held in place with fibrin glue.
See this image and copyright information in PMC

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