Many new techniques for the treatment of articular cartilage damage exist with very good results.
OSTEOCHONDRAL FRAGMENT STABILIZATION WITH SPECIAL PINS (ABSORBABLE)
The stabilization of osteochondral section shall be posted when the part is not separated completely from the anatomical position.
The procedure is done with arthroscopy of the knee where with the help of special tools placed by pin absorbable material so as to provide maximum stability.
Special absorbable pins for osteochondral fragment stabilization
Special arthroscopically viewfinder for pin placement
The absorbable pin are positioned to provide stabilization of diseased osteochondral section
Microfracture is indicated as first-line treatment for focal Outerbridge grade III and IV lesions under 3–4 cm2 in an otherwise nonarthritic knee in a symptomatic, active, and relatively young patient willing to respect the postoperative rehabilitation requirements.
Τhe microfracture techniques during knee arthroscopy. For older and low-demand patients, microfracture may be useful even in lesions larger than 3–4 cm2.
AMIC technique on knee chondral lesion - animated
Severe chondral patellar lesion in man 28 years old. AMIC technique
The microfracture is already done.
The blood contain special substance for remake the new cartilage.
A case report
16-year-old Basketball athlete, suffers from knee joint pain left during the athletic activities initially but also during everyday activities.Clinical examination of the affected joint reproduce intense pain, especially during tibial torsion tests.
MRI of the left knee. Osteochondritis Dissecans of the lateral femoral condyle completely detached
The damage of articular cartilage to the knee of the femoral condyle due to osteochondritis is completely detached from the surrounding healthy tissues and is removed.
The buried osteochondral part is removed. The image shows the anatomical area after the part was removed
The necrotic part of the articular cartilage, which reaches a length of 2 cm
The nanofractures (Linvatec Conmed), in the crater of the damage
Apply the autografts to the base of the lession. The autografts come from the patient's pelvis.
Collagen membrane - AMIC technique above the grafts with special biologic glue
Taking bone marrow from the patient's pelvis (iliac bone). Advanced processing and isolation of autologous stem cell
Applying the stem cells to the surface of the collagen insert and stabilizing them with a bioadhesive agent
The space created by removal of the necrotic portion in the femoral condyle is covered by autologous grafts, collagen insert and stem cells
OSTEOCHONDRAL AUTOGRAFT TRANSPLANTATION
Osteochondral autograft transplantation is a well-established technique in the treatment of chondral and osteochondral defect. Cylindrical osteochondral plug are harvested from areas of the articular surface with a lesser weight – bearing role and transferred to areas of osteochondral damage.
Using a press fit- technique, the plugs are inserted to replace damage or missing articular cartilage and to supply the chondral lesion with island of viable and immediately functional hyaline cartilage. The presence of focal unipolar cartilage defects in the knee measuring 1-4 sq.cm is a current indication for osteochondral autograft transplantation.
Donor site upper left, osteochondral press-fit right. (Operative technique Sports Knee Surgery, Saunders Publication)
The plugs are inserted to replace damage articular cartilage.
Osteochondral imlantation. (3 cylinders). (Μaster Techniques in Orthopeaedic Surgery. Knee reconstruction 3rd edition).
The procedure is not indicated for the condition as:
Generalized arthritis, rheumatoid and/or degenerative type
Lack of appropriate donor area
Infectious or tumor defects
Age greater than 50 years
Osteochondral defects deeper than 10 mm
AUTOLOGOUS CHONDROCYTE IMPLANTATION
Injuries to joint surfaces can result from acute high-impact or repetitive shear and torsional loads to the superficial zone of the articular cartilage architecture. The use of autologous chondrocyte implantation is promising and is associated with several potential long-term benefit.
Autologous chondrocyte implantation is ideally suited for symptomatic deep chondral lesion along the femoral condyle or trochlear region. High-demand patient between 15-55 years of age with excellent motivation and potential for compliance are the best candidates.
However autologous chondrocyte implantation is a viable option for a symptomatic patient with a lesion of >2 sq.cm but <12 sq.cm. and for a patient who continues to have pain after mosaicplasty or microfracture procedure. Bone involvement is not contraindication, but staged or concomitant autologous bone grafting should be undertaken when the bone involvement is deeper than 6-8 mm.
Autologous chondrocyte transplantation is not a treatment for osteoarthritis (general joint disease), gout, and rheumatoid arthritis or other systemic joint diseases.
femoral condyle chondral lesion. Arthroscopic evaluation.
Chondral lesion mesuring during arthroscopy.
Autologous chondrocyte are arthroscopicaly harvested from a less weight-bearing area, commercially extracted from the harvested cartilage (200-500mg), and multiplied in vitro (labor cell culture).
Chondrocyte cultivation in Bioengineer Lab
Elective reinplantation is performed 4-6 weeks after cartilage harnesting by debridement of the defect to an intact margin, carelully avoiding osseous bleeding from the bed of the defect.
Clear the lesion area with curette.
The lesion area is already clear and ready to receveive the autologous chondrocyte.
The surgeon cut the chondrocyte film like the shape of the chondral defect.
The autologous chondrocyte is ready to implant.
The autologous chondrocyte is transplanted. The chondral defect is covered.
Chondral defect due to trauma.
The autologous chondlal cell filling the defect.
The chondral defect covered by autologous chondrocyte atrhoscopically.
The arthroscopy procedure is finished. The knee movement is without any problem.