Treatment options for cartilage damage in the knee joint
Ahlers, J.
Versicherungsmedizin 60(3): 114-117
2008
ISSN/ISBN: 0933-4548 PMID: 18807341 Document Number: 623805
The complex structure of articular cartilage is essential for understanding biology and function. Despite performing with a relatively low metabolic activity, healthy articular cartilage has amazing capacity to sustain itself and carry out its function. Chondrocytes are active in maintaining the tissue's matrix, showing differences in the anatomic structure. Articular cartilage has extraordinary mechanical properties and lasting durability. It is only a few millimetres thick. The cartilage wears resistance while bearing large loads throughout a person's lifetime. Otherwise we see cartilage destructions in young patients without a trauma. It is important to know that the articular cartilage decreases with age. The ability of the MRI to obtain reproducible, accurate images of cartilage has enabled early detection of cartilage lesions and provides clinically relevant information when planning cartilage repair. MRI depicts the subchondral bone and all other anatomic structures of the knee. This information is vital when planning for complex techniques that require careful size delineation of the cartilage lesion and evaluation of the surrounding subchondral bone. In addition to aiding in preoperative planning, the MRI offer an important objective evaluation of cartilage repair to be correlated with the more subjective clinical outcome instruments and provide insight into the biology of the repair process. The repair strategies are currently available for clinical use when treating articular cartilage lesions. These strategies fall into one of the following categories: 1. Palliative-conservative treatment (local or systemic application), 2. Intrinsic-repair enhancement/marrow stimulation (drilling, microfracture, arthroplasty), 3. Cell-based repair (collagen associated chondrocyte transplantation or microfracture with collagen). The use of biodegradable scaffolds can be used either alone or as delivery vehicles for growths factors. This technique could be a new way for winning structurally and biomechanically appropriate tissue.