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Articular Cartilage Repair

Articular Cartilage Repair

 In general, soft tissue is difficult to treat mainly because the progression of recovery in injuries of joint surface is very slow.

Articular cartilage has no veins or nerves. It enables smooth articulation of joints as it provides them with a bearing surface. One of its main characteristics is that articular cartilage cells live for a lifetime without intercellular connections. For that reason, articular cartilage repair does not happen by itself, and the development of an injury leads to the degeneration of the surface, which rarely heals.cartilage-ligament-repair_Small

In contrast with ligament repair (links bones to each other to provide support for joints), articular cartilage repair is very difficult to carry out.

Articular Cartilage Reconstructive Procedures

The intentions of surgical management are to reduce symptoms, to restore joint surface and prevent deterioration. In spite of the attempts to develop treatment procedures, most articular cartilage repair techniques are not successful and the treatment options are still limited.

Articular cartilage repair treatments can be:

  • Palliative – for smaller injuries, limited symptoms: debridement and lavage.
  • Reparative – for mid-sized lesions with moderate symptoms, in order to promote fibrocartilage healing response: marrow-stimulating technique.
  • Restorative – for larger lesions are less favorable: Osteochondral Autologous Graft Transplantation (OATS) or Antologous Chondrocyte Implantation (ACI).

Different articular cartilage procedures vary in the technologies and surgical techniques. They aim to repair articular cartilage and at the same time keep the possibility for alternative treatments.

The most common treatments for articular cartilage repair:

  • Arthroscopic Lavage: consists of a debridement or cleaning of the joint. As we have seen it is a palliative treatment. That means it reduces pain, inflammation and mechanical restriction.
  • Marrow stimulation: it is an arthroscopic procedure, in which the bone is exposed through subchondral perforations across the damaged cartilage to generate blood clot. It takes around 4 months to become fibrocartilage.
  • Osteochondral Autografts: requires transplant of bone and cartilage from deceased donors.
  • Cell Based Procedures: refers to Autologous Chondroctyte Implantation (ACI) in which, firstly, cartilage cells are extracted from healthy articular cartilage, secondly transferred to in vitro environment to grow and replicate (six weeks), and finally the chondocytes are applied to the damaged area along with a matrix structure.
  • Antologous Mesenchymal Stem cell Transplant