Traumatic articular cartilage injuries of the knee (original) (raw)
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Articular cartilage lesions of the knee
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 1989
The pathogenesis and clinical significance of articular cartilage lesions of the knee persist as topics of considerable interest among orthopedic surgeons. This study was designed to assess the association of articular cartilage degeneration with concomitant intraarticular abnormalities and to correlate the prevalence and severity of articular cartilage damage with preoperative historical and physical exam findings in patients presenting with knee pain. Twenty-six history and physical exam data points were prospectively collected from 192 patients (200 knees), consecutively undergoing arthroscopic knee surgery. During surgery, all articular cartilage lesions were recorded with respect to size, location, and character and were graded according to Oglivie-Harris et al. (1). All concomitant knee joint abnormalities were simultaneously recorded. Of 200 knees examined arthroscopically, 12 knees revealed no demonstrable etiology for the presenting symptoms, 65 knees revealed assorted intraarticular pathology but no articular cartilage degeneration, and the remaining 123 knees revealed a total of 211 articular cartilage lesions (103 femoral, 72 patellar, 36 tibial); 7 femoral, 6 pate&r and 0 tibia1 lesions were completely isolated (no concomitant knee joint pathology). The concomitance of femoral defects with tibia1 lesions was highly significant (p = 0.01). Femoral and tibia1 articular cartilage lesions were strikingly correlated with the presence of an unstable torn meniscus (p < 0.001). Medial compartment articular cartilage lesions were significantly more common (p = O.OOl), more closely associated with meniscal derangement, and appreciably more severe than lateral compartment lesions. In 75% of anterior cruciate ligament-deficient knees with concomitant articular cartilage degeneration, the duration from injury to surgery was greater than 9 months, and in each of these cases, a history of reinjury to the knee was elicited. From these data one can conclude that: (a) in some patients with painful knees, isolated articular cartilage lesions may be the only abnormality noted at arthroscopy; (b) unstable meniscal tears are significantly associated with destruction of articular cartilage; (c) the medial compartment is particularly susceptible to articular cartilage degeneration; and (d) in our series, anterior cruciate ligament tears were increasingly associated with articular cartilage destruction as the elapsed time from injury to arthroscopy increased.
2006
important functions: joint lubrication, stress distribution to subchondral bone to minimize peak stress, and provision of a smooth low-friction surface. Repetitive and acute impact, as well as torsional joint loading can damage articular cartilage surfaces of the knee joint. Injury to articular cartilage can lead to pain, swelling, joint dysfunction, and possibly progressive joint degeneration. Nonsurgical treatment options include oral medications, simple bracing, and physical therapy. Surgical interventions range from simple arthroscopic debridement to complex tissue engineering, including autologous chondrocyte implantation. To determine the proper treatment option, each patient's age, intensity of symptoms, activity level, and lesion characteristics should be considered. The purpose of this chapter is to provide a comprehensive overview of the etiology, diagnosis, and management of articular cartilage lesions.
Treatment of knee cartilage defect in 2010
Orthopaedics & traumatology, surgery & research : OTSR, 2011
Treatment of knee cartilage defect, a true challenge, should not only reconstruct hyaline cartilage on a long-term basis, but also be able to prevent osteoarthritis. Osteochondral knee lesions occur in either traumatic lesions or in osteochondritis dissecans (OCD). These lesions can involve all the articular surfaces of the knee in its three compartments. In principle, this review article covers symptomatic ICRS grade C or D lesions, depth III and IV, excluding management of superficial lesions, asymptomatic lesions that are often discovered unexpectedly, and kissing lesions, which arise prior to or during osteoarthritis. For clarity sake, the international classifications used are reviewed, for both functional assessment (ICRS and functional IKDC for osteochondral fractures, Hughston for osteochondritis) and morphological lesion evaluations (the ICRS macroscopic evaluation for fractures, the Bedouelle or SOFCOT for osteochondritis, and MOCART for MRI). The therapeutic armamentarium...
2021
Treatment of articular cartilage injuries have been a challenge for orthopedic surgeons for decades. The following study protocol add knowledge about ongoing research in the field and outline the ongoing long-term follow-up on the transplantation of bone marrow derived stem cells in a clinical trial with 10 years follow-up. The study protocol describes a method to save chondral fractures, which in the past frequently treated with removal of the detached fragments.
Arthroscopy, Sports Medicine, and Rehabilitation
Purpose: To evaluate trends in procedures for the treatment of chondral injuries of the knee using the MarketScan database in the hope that further work can be performed to refine the indications for chondral intervention Methods: The MarketScan Research Database was searched using Current Procedure Terminology, 4th edition, codes to identify patients who underwent chondral procedures of the knee from 2005-2014. Combined procedures, including meniscal transplant or osteotomy, were also identified. Patients were characterized by gender, age group and year of initial procedure. A c 2 test was used to evaluate differences in surgical trends between individual patient groups delineated by age and gender. The Cochran-Armitage trend test was used to identify significant differences in surgical trends yearly. Results: Of 148,373,254 unique patients, 520,934 patients underwent a total of 599,119 procedures. Arthroscopy with debridement/shaving of articular cartilage decreased in proportion from 75% of all procedures in 2005 to 51% of all procedures in 2014 (P < .0001). Open osteochondral allograft saw the greatest change during the study period; a higher number of females than males underwent condral procedures (P < .0001). Patients aged 45-54 underwent the most procedures (32.9% of all procedures). A total of 483 patients underwent chondral procedures in conjunction with meniscal transplant with variable incidence during the study period. A total of 1,418 patients underwent chondral procedures in conjunction with osteotomy; cumulative incidence decreased from 4.5 procedures per 1,000,000 patients/year in 2005 to 2.6 procedures per 1,000,000 patients/year in 2014 (P < .0001). Conclusions: Knee arthroscopy with debridement/shaving of articular cartilage remains the most common procedure performed. Although open allograft and autograft transplantation saw a sustained increase in incidence, the overall incidence of cartilage procedures, as well as those performed with osteotomies, declined. Level of Evidence: Level IV, cross-sectional study.