Valdivia Zúñiga Carlos A., De Cicco Franco L.
Mexican Institute of Social Security
Hospital Italiano de Buenos Aires
Injuries involving subchondral bone and chondral tissues are found in up to 63 to 66% arthroscopic procedures and represent a challenging entity to treat with an important propensity to progress to osteoarthritis. Treatment options include osteotomy, microfracture, abrasion arthroplasty, autologous chondrocyte transplantation, mosaicplasty, autologous osteochondral graft, and arthroplasty; however, all these options have limitations and are not suitable to larger, contained full-thickness cartilage defects. Since its early description by Eric Lexner in 1908, osteochondral allograft techniques have evolved to our days with different success rates depending on the technique used. They are mainly indicated for symptomatic defects greater than 3 cm in active young patients in which native cartilage is preferred over arthroplasty. Osteochondral allografts provide viable hyaline cartilage with metabolically active chondrocytes and subchondral bone with remodeling potential to the articular surface and promising results according to evidence. Osteochondral allografts have been used widely in femoral condyles, tibial plateau, patella, and ankle; however, they have been used in other joints recently, such as the elbow and shoulder.
在高达63%至66%的关节镜手术中可发现涉及软骨下骨和软骨组织的损伤，这类损伤是治疗上的一个难题，且极易发展为骨关节炎。治疗选择包括截骨术、微骨折术、磨削关节成形术、自体软骨细胞移植、镶嵌成形术、自体骨软骨移植和关节成形术；然而，所有这些选择都有局限性，不适用于较大的、完整的全层软骨缺损。自1908年埃里克·莱克斯纳首次描述以来，骨软骨异体移植技术不断发展，根据所使用的技术不同，成功率也有所差异。它们主要适用于活跃的年轻患者中大于3厘米的有症状缺损，对于这些患者，天然软骨比关节成形术更受青睐。骨软骨异体移植可提供具有代谢活性软骨细胞且有活力的透明软骨以及具有向关节表面重塑潜力的软骨下骨，并且根据现有证据显示效果良好。骨软骨异体移植已广泛应用于股骨髁、胫骨平台、髌骨和踝关节；然而，最近它们也被用于其他关节，如肘部和肩部。
