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Review
. 2017 Nov/Dec;9(6):545-554.
doi: 10.1177/1941738117712203. Epub 2017 Jun 20.

Joint Preservation Techniques in Orthopaedic Surgery

Philip J York  1 , Frank B Wydra  1 , Matthew E Belton  1 , Armando F Vidal  1
Affiliations
Review

Joint Preservation Techniques in Orthopaedic Surgery

Philip J York et al. Sports Health. 2017 Nov/Dec.

Abstract

Context: With increasing life expectancy, there is growing demand for preservation of native articular cartilage to delay joint arthroplasties, especially in younger, active patients. Damage to the hyaline cartilage of a joint has a limited intrinsic capacity to heal. This can lead to accelerated degeneration of the joint and early-onset osteoarthritis. Treatment in the past was limited, however, and surgical treatment options continue to evolve that may allow restoration of the natural biology of the articular cartilage. This article reviews the most current literature with regard to indications, techniques, and outcomes of these restorative procedures.

Evidence acquisition: MEDLINE and PubMed searches relevant to the topic were performed for articles published between 1995 and 2016. Older articles were used for historical reference. This paper places emphasis on evidence published within the past 5 years.

Study design: Clinical review.

Level of evidence: Level 4.

Results: Autologous chondrocyte implantation and osteochondral allografts (OCAs) for the treatment of articular cartilage injury allow restoration of hyaline cartilage to the joint surface, which is advantageous over options such as microfracture, which heal with less favorable fibrocartilage. Studies show that these techniques are useful for larger chondral defects where there is no alternative. Additionally, meniscal transplantation can be a valuable isolated or adjunctive procedure to prolong the health of the articular surface.

Conclusion: Newer techniques such as autologous chondrocyte implantation and OCAs may safely produce encouraging outcomes in joint preservation.

Keywords: articular cartilage; autologous chondrocyte implantation; meniscal transplantation; osteochondral allograft.

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Conflict of interest statement

The following author declared potential conflicts of interest: Armando F. Vidal, MD, is a paid consultant for Arthrocare and Stryker and has been a paid presenter for Arthrex, Inc, and Ceterix.

Figures

Figure 1.
Figure 1.
(a) Chondral lesion in the distal femur postdebridement with microfracture awl in place. (b) Postmicrofracture with bleeding subchondral bone.
Figure 2.
Figure 2.
Autologous chondrocyte implantation. (a) A contained chondral lesion in the distal femur predebridement. (b) The same lesion postdebridement. (c) Vial containing the prepared autologous cultured chondrocytes (ACC). (d) Injection of the ACC into the defect. (e) A harvested periosteal patch matching the defect size. (f) The periosteal patch sewn into place, covering the injected ACC.
Figure 3.
Figure 3.
Preparation of the osteochondral allograft. (a) The packaged distal femoral allograft. (b) Allograft removed and washed. (c) Coring reamer used to remove graft to be implanted. (d) The graft is cut to the appropriate depth measured for each quadrant.
Figure 4.
Figure 4.
Osteochondral allograft implantation. (a) Arthroscopic image of a large osteochondral lesion. (b) Coring reamer used to prepare the lesion. (c) The prepared graft is placed into the defect. (d) The graft is gently tapped into position taking care to line up the predetermined quadrants.
Figure 5.
Figure 5.
Implanted osteochondral allografts (OCAs) of the femoral condyle. (a) Arthroscopic image of a freshly implanted OCA. (b) An OCA 6 months after implantation.
Figure 6.
Figure 6.
Arthroscopic image of an implanted meniscal allograft.
See this image and copyright information in PMC

References

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