Articular cartilage repair & joint preservation: A review of the current status of biological approach

Abstract

The articular cartilage of the joint is the thin viscoelastic layer of the connective tissue. It has a unique anatomy and physiology, which makes the repair of the articular cartilage damage more difficult and challenging due to its limited healing capacity. Increasing knowledge regarding the importance of articular cartilage for joint preservation has led to increased attention on early identification of cartilage damage as well as degeneration in order to delay osteoarthritis. There are various treatment modalities ranging from preventive management, physical therapy, pharmacological, non-pharmacological and surgical treatments exist in current literature. However most of the studies have limited long term follow up and mainly consists of small case series and case reports. This is an up to date concise review discussing the available management options for articular cartilage damage starting to lifestyle modification to pharmacotherapy, physiotherapy, and osteobiologics till various joint preservation techniques that have been in use currently.

Keywords: Arthroscopy; Articular cartilage lesions; Joint preservation; Orthobiologics; Osteoarthritis.

Fig. 1

Cartilage lesion on the medial femoral condyle, 54 year old female.

Fig. 2

Preparation of PRP by centrifugation of peripheral blood.

Fig. 3

BMAC procedure. A. Bone marrow aspiration, B. Loading bone marrow aspirate to the kit. C. Extraction of BMAC. D. BMAC application to the chondral lesion.

Fig. 4

Microfracture procedure. A. Chondral lesion of medial femoral condyle, B. After microfracture. C. 2nd look arthroscopic finding, post op 2 year.

Fig. 5

A. Abrasion of sclerotic subchondral bone with burr. B. Multiple drilling.

Fig. 6

A. Multiple drilling after cartilage lesion preparion. B. ACI through the patient's rib cartilage culture.