New Options for Management of Posttraumatic Articular Cartilage Defects
Authors:
L. Plánka 1; D. Starý 1; R. Srnec 2; A. Nečas 2; P. Gál 1
Authors‘ workplace:
Klinika dětské chirurgie, ortopedie a traumatologie FN Brno
1; Klinika chorob psů a koček Veterinární a farmaceutické univerzity Brno
2
Published in:
Rozhl. Chir., 2008, roč. 87, č. 1, s. 42-45.
Category:
Monothematic special - Original
Overview
Articular cartilage trauma, in particular due to its poor healing potential remains a complicated problem in both the adult and paediatric traumatology and orthopedics. In older patients, total endoprosthesis of the joint is a method of choice, however, in younger patients, the situation remains more complicated. In case of osteochondral lesions (arthrosis, chondral fractures, osteochondrosis dissecans) the ideal management should result in complete recovery of the hyaline cartilage on the traumatized joint surface. Contemporary medicine uses some therapeutic procedures resulting in partial recovery of the articular cartilage structure at the lesion site and several techniques of excisionining the articular surface’s injured part and of transplantations of biological grafts.
Regarding the above first approach, abrasive methods (micro fractures, small drill holes), which are expected to result in recovery of the articular cartilage through progenitor cells that migrate from the bone marrow to the defect site following subchondral fracturing. In case the injury is managed early, the osteochondral fragment may be fixed and the articular congruence be recovered.
Mosaicoplasty using osteochondral auto grafts or other autologous grafts, or more recently using transplantations of autologous chondrocytes, which seem to have a major potential in the hyaline cartilage healing process. However, methodology of the transplant retention at the defect site remains a problem. Furthermore, the use of mesenchymal stem cells, so far in the experimental phase, appears prospective. Pivotal articular cartilage treatment research activities have progressed to a level of searching for a suitable scaffold of perfect qualities. This is the task for cooperation with bioengineering, requiring provision of the most exact differentiation protocol for hyline cartilage producing mesenchymal stem cells (MSCs).
Key words:
articular cartilage – scaffold – MSCs – biomaterials
Sources
1. Calandruccio, R.A., Gilmer, W. S. Proliferation, regeneration, and repair of articular cartilage of immature animals. J. Bone and Joint Surg., 1962, roč. 44-A, s. 431–455.
2. Convery, F. R., Akeson, W. H., Keown, G. H. The repair of large osteochondral defects. An experimental study in horses. Clin. Orthop., 1972, roč. 82, s. 253–262.
3. Mitchell, N., Shepard, N. The resurfacing of adult rabbit articular cartilage by multiple perforations through the subchondral bone. J. Bone and Joint Surg., 1976, roč. 58-A, s. 230-233.
4. Hardaker, W. T., Garrett, W. E., Bassett, F. H. Evaluation of acute traumatic hemarthrosis of the knee joint. Southern Med. J., 1990, roč. 83, s. 640–644.
5. Rand, J. A., Ilstrup, D. M. Survivorship analysis of total knee arthroplasty. Cumulative rates of survival of 9200 total knee arthroplasties. J. Bone and Joint Surg., 1991, roč. 73-A, s. 397–409.
6. Šnajdauf, J., Cvachovec, K., Trč, T. Dětská traumatologie. 1 vyd. Praha, 2002, 180 s.
7. O‘Driscoll, S. W. Current concepts review: The healing and regeneration of articular cartilage. J Bone and Joint Surg. (American volume), 1998, roč. 80, s. 1795–1812.
8. Dungl, P. Ortopedie. 1 vyd. Praha: GRADA, 2005. 1280 s.
9. Meachim, G. The effect of scarification on articular cartilage in the rabbit. J. Bone and Joint Surg., 1963, roč. 45-B (1), s. 150–161.
10. Vachon, A., Bramlage, L. R., Gabel, A. A., Weisbrode, S. Evaluation of the repair process of cartilage defects of the equine third carpal bone with and without subchondral bone perforation. Am. J. Vet. Res., 1986, roč. 47, s. 2637–2645.
11. Gao J, Yao J. Q., Caplan A. I. Stem cells for tissue engineering of articular cartilage. Proc. IMechE, 2007, roč. 221, s. 441–450.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2008 Issue 1
Most read in this issue
- New Options for Management of Posttraumatic Articular Cartilage Defects
- K-ras Mutation as a Prognostic Factor in Colorectal Carcinoma
- Variations of Primary Spontaneous Pneumothorax Management
- Implementation of POSSUM Scoring System in Assessing Morbidity after Laparoscopic Colorectal Surgery