Treatment for cartilage injuries of the knee with a new treatment algorithm

Abstract

Treatment of articular cartilage injuries to the knee remains a considerable challenge today. Current procedures succeed in providing relief of symptoms, however damaged articular tissue is not replaced with new tissue of the same biomechanical properties and long-term durability as normal hyaline cartilage. Despite many arthroscopic procedures that often manage to achieve these goals, results are far from perfect and there is no agreement on which of these procedures are appropriate, particularly when full-thickness chondral defects are considered.Therefore, the search for biological solution in long-term functional healing and increasing the quality of wounded cartilage has been continuing. For achieving this goal and apply in wide defects, scaffolds are developed.The rationale of using a scaffold is to create an environment with biodegradable polymers for the in vitro growth of living cells and their subsequent implantation into the lesion area. Previously a few numbers of surgical treatment algorithm was described in reports, however none of them contained one-step or two -steps scaffolds. The ultimate aim of this article was to review various arthroscopic treatment options for different stage lesions and develop a new treatment algorithm which included the scaffolds.

Keywords: Autologous chondrocyte implantation; Chondral lesion; Microfracture; Osteochondral transplantation; Scaffolds.

Figure 1

In small defects in high-demand patients, autologous osteochondral transplantation seems to be a reliable treatment alternative. AOT: Autologous osteochondral transplantation; ACI: Autologous chondrocyte implantation; MACI: Matrix-induced chondrocyte implantation; OAT: Osteochondral allograft transplantation; AMIM: Acellular matrix-induced microfracture.