Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.
Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.
J Knee Surg. 2020 Nov;33(11):1056-1068. doi: 10.1055/s-0040-1712944. Epub 2020 Jun 24.
The joint is an organ with each tissue playing critical roles in health and disease. Intact articular cartilage is an exquisite tissue that withstands incredible biologic and biomechanical demands in allowing movement and function, which is why hyaline cartilage must be maintained within a very narrow range of biochemical composition and morphologic architecture to meet demands while maintaining health and integrity. Unfortunately, insult, injury, and/or aging can initiate a cascade of events that result in erosion, degradation, and loss of articular cartilage such that joint pain and dysfunction ensue. Importantly, articular cartilage pathology affects the health of the entire joint and therefore should not be considered or addressed in isolation. Treating articular cartilage lesions is challenging because left alone, the tissue is incapable of regeneration or highly functional and durable repair. Nonoperative treatments can alleviate symptoms associated with cartilage pathology but are not curative or lasting. Current surgical treatments range from stimulation of intrinsic repair to whole-surface and whole-joint restoration. Unfortunately, there is a relative paucity of prospective, randomized controlled, or well-designed cohort-based clinical trials with respect to cartilage repair and restoration surgeries, such that there is a gap in knowledge that must be addressed to determine optimal treatment strategies for this ubiquitous problem in orthopedic health care. This review article discusses the basic science rationale and principles that influence pathology, symptoms, treatment algorithms, and outcomes associated with articular cartilage defects in the knee.
关节是一个器官，每个组织在健康和疾病中都起着关键作用。完整的关节软骨是一种精致的组织，能够承受允许运动和功能的难以置信的生物力学和生物力学需求，这就是为什么必须将透明软骨维持在非常狭窄的生化组成和形态结构范围内，以满足需求，同时保持健康和完整。不幸的是，侮辱、伤害和/或衰老会引发一连串的事件，导致关节软骨的侵蚀、退化和丧失，从而导致关节疼痛和功能障碍。重要的是，关节软骨病理学影响整个关节的健康，因此不应孤立地考虑或处理。治疗关节软骨病变具有挑战性，因为如果不加以处理，组织就无法再生或进行高度功能和持久的修复。非手术治疗可以缓解与软骨病理学相关的症状，但不能治愈或持久。目前的手术治疗方法从刺激内在修复到全面表面和全面关节修复不等。不幸的是，关于软骨修复和修复手术，前瞻性、随机对照或精心设计的基于队列的临床试验相对较少，因此在确定这种普遍存在的骨科健康问题的最佳治疗策略方面存在知识差距，必须加以解决。本文讨论了影响膝关节关节软骨缺损的病理、症状、治疗算法和结果的基础科学原理和原则。
