Diseases of the knee cartilage and the repair options

Czech version

Authors: P. Polan; R. Totkovič; T. Ševčík
Authors‘ workplace: Ortopedické oddelenie ; Primár: MUDr. Roman Totkovič ; 1. súkromná nemocnica Košice-Šaca a. s., Slovenská republika
Published in: Prakt. Lék. 2012; 92(6): 316-321
Category: Reviews

Overview

Articular cartilage is a highly-specified tissue ideally built-up to fit its function on the surface of weight-bearing mobile joints. The cartilage is biomechanically composed of a complex matrix, strengthened by fibres and it is able to bear and distribute the physiological load without mechanic failure. For many people the cartilage functions and provides great joint mobility all their life, nevertheless cartilage injury and degeneration still remain a serious medical problem. There has been substantial progress in the field of treatment recently. The principal premise of finding an optimal therapeutic plan is the understanding of cartilage structure and metabolism, optimal diagnostics and correct classification of the type of cartilage injury, according to which we designate a therapeutic algorithm. The options of treatment include the stimulation of bone marrow through microfractures, autologous osteochondral mosaicplasty, transplantation of osteochondral allograft, implantation of autologous chondrocytes, cell methods and methods applying biological carriers or conservative methods including the application of growth factors, preparations containing hyaluronic acid and platelet-rich plasma.

Key words:
cartilage, cartilage treatment, current options of cartilage treatment

Sources

1. Buckwalter, J.A., Mankin, H.J. Articular cartilage I. Tissue design and chondrocyte-matrix interactions. J Bone Joint Surg 1997, 79A(4): 600–611.

2. Buckwalter, J.A., Martin, J.A., Mankin, H.J. Synovial joint degeneration and the syndrome of osteoarthritis. Instr Course Lect, 2007, 49: 481–489.

3. Višňa, P., Hart, R. a kol. Chrupavka kolena. Praha: Maxdorf, 2006.

4. Dungl, P. a kol. Ortopedie. Praha: Grada, 2005, 978–992.

5. Šteňo, B., Šeliga, J. Farmakologická liečba osteoartrózy. Ambulantná terapia, 2008, 6: 164–168.

6. Kokavec, M., Novorolský, K., Bdžoch, M. Pohľad ortopéda na komplexnú liečbu artróz. Ambulantná terapia, 2005, 3: 26–28.

7. Simon, T.M., Jackson, D.W. Articular cartilage: injury pathways and treatment options. Sports Med Arthrosc. 2006; 14: 146–154.

8. Bedi, A., Feeley, B.T., Williams, R.J. Management of articular cartilage defects of the knee. J Bone Joint Surg Am, 2010, 92: 994–1009.

9. Brittberg, M., Imhoff, A., Madry, H., Mandelbaum, B. (Eds.) Cartilage repair-current concepts. Guildford, UK: DJO Publications, 2010.

10. Williams, R.J. III. Cartilage repair strategies. Totowa, NJ: Humana Press, 2007.

11. Frisbie, D.D., Trotter, G.W., Powers, B.E., et al. Arthroscopic subchondral bone plate microfracture technique augments healing of large chondral defects in the radial carpal bone and medial femoral condyle of horses. Vet Surg. 1999, 28: 242–255.

12. Bae, D.K., Yoon, K.H., Song, S.J. Cartilage healing after microfracture in osteoarthritic knees. Arthroscopy 2006, 22: 367–374.

13. Frisbie, D.D., Morisset, S., Ho, C.P., et al. Effects of calcified cartilage on healing of chondral defects treated with microfracture in horses. Am J Sports Med. 2006, 34: 1824–1831.

14. Steadman, J.R., Briggs, K.K., Rodrigo, J.J., et al. Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year followup. Arthroscopy 2003, 19: 477–484.

15. Fortier, L.A., Nixon, A.J., Lust, G. Phenotypic expression of equine articular chondrocytes grown in three-dimensional cultures supplemented with supraphysiologic concentrations of insulin-like growth factor-1. Am J Vet Res, 2002; 63: 301–305.

16. Kieswetter, K., Schwartz, Z., Alderete, M., et al. Platelet derived growth factor stimulates chondrocyte proliferation but prevents endochondral maturation. Endocrine, 1997, 6: 257–264.

17. Lohmann, C.H., Schwartz, Z., Niederauer, G.G., et al. Pretreatment with platelet derived growth factor-BB modulates the ability of costochondral resting zone chondrocytes incorporated into PLA/PGA scaffolds to form new cartilage in vivo. Biomaterials, 2000, 21: 49–61.

18. Sun, Y., Feng, Y., Zhang, C.Q., et al. The regenerative effect of platelet-rich plasma on healing in large osteochondral defects. Int Orthop, 2010, 34(4): 589–597.

19. Akeda, K., An, H.S., Okuma, M., et al. Platelet-rich plasma stimulates porcine articular chondrocyte proliferation and matrix biosynthesis. Osteoarthritis Cartilage, 2006, 14: 1272–1280.

20. Lacko, M., Tóthová, T., Rosocha, J., a kol. Liečba osteoartrózy kolenného kľbu intraartikulárnou aplikáciou autológnej plazmy bohatej na trombocyty. Ortopedie, 2010, 4: 251–257.

21. Lane, J.G., Massie, J.B., Ball, S.T., et al. Follow-up of osteochondral plug transfers in a goat model: a 6-month study. Am J Sports Med, 2004, 32: 1440–1450.

22. Hangody, L., Vásáhelyi, G., Hangody, L.R., et al. Autologous osteochondral grafting-technique and long-term results. Injury, 2008; 39, Suppl 1: S32–39.

23. Bugbee, W.D. Fresh osteochondral allografts. J Knee Surg, 2002; 15: 191–195.

24. Bakay, A., Csönge, L., Papp, G., Fekete, L. Osteochondral resurfacing of the knee joint with allograft. Clinical analysis of 33 cases. Int Orthop, 1998, 22: 277–281.

25. Beaver, R.J., Mahomed, M., Backstein, D., et al. Fresh osteochondral allografts for post-traumatic defects in the knee. A survivorship analysis. J Bone Joint Surg Br, 1992, 74: 105–110.

26. Brittberg, M., Lindahl, A., Nillson, A., et al. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med, 1994, 331: 889–895.

27. Kish, G., Hangody, L. A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. J Bone Joint Surg Br, 2004, 86: 619.

28. Gikas, P.D., Aston, W.J., Briggs, T.W. Autologous chondrocyte implantation: where do we stand now? J Orthop Sci, 2008, 13: 283–292.