Pickett Adam M, Hensley Dana T
Department of Orthopedics, John A. Feagin Sports Medicine Fellowship, United States Military Academy, Keller Army Community Hospital, West Point, New York.
J Knee Surg. 2019 Feb;32(2):127-133. doi: 10.1055/s-0038-1676378. Epub 2019 Jan 10.
As our patients become more physically active at all ages, the incidence of injuries to articular cartilage is increasing causing significant pain and disability. The intrinsic healing response of articular cartilage is poor because of its limited vascular supply and capacity for chondrocyte division. Nonsurgical management for the focal cartilage lesion is successful in the majority of patients. Those patients who fail conservative management may be candidates for a cartilage reparative or reconstructive procedure. The type of treatment available depends on a multitude of lesion-specific and patient-specific variables. First-line therapies for isolated cartilage lesions have demonstrated good clinical results in the correct patient, but typically repair cartilage with fibrocartilage, which has inferior stiffness, inferior resilience, and poorer wear characteristics. Advances in cell-based cartilage restoration have provided the surgeon a means to address focal cartilage lesions utilizing mesenchymal stem cells, chondrocytes, and biomimetic scaffolds to restore hyaline cartilage.
随着我们各个年龄段的患者身体活动日益增多，关节软骨损伤的发生率不断上升，导致严重疼痛和功能障碍。由于关节软骨的血管供应有限且软骨细胞分裂能力受限，其自身的愈合反应较差。对于大多数患者而言，非手术治疗局灶性软骨损伤是成功的。那些保守治疗失败的患者可能适合进行软骨修复或重建手术。可用的治疗类型取决于多种病变特异性和患者特异性变量。针对孤立性软骨损伤的一线治疗方法在合适的患者中已显示出良好的临床效果，但通常是用纤维软骨修复软骨，而纤维软骨的硬度较低、弹性较差且磨损特性更差。基于细胞的软骨修复技术的进展为外科医生提供了一种利用间充质干细胞、软骨细胞和仿生支架来修复透明软骨以治疗局灶性软骨损伤的方法。
