Branam Grant M., Saber Ahmed Y.
Western University Of Health Sciences
Calderdale and Huddersfield NHS Foundation Trust
There have been different procedures described for the treatment of cartilage defects. When the defect is full thickness, the chances of “self-repair” are small. Historically, micro-fracture surgery has been utilized for smaller defects. However, this promotes healing through the formation of fibrocartilage, which is not ideal in the setting of repetitive weight-bearing and compressive forces, which can be detrimental to the joint over time and linked to worse patient outcomes. Other procedures utilizing autologous cells have been described. Autologous chondrocyte implantation, a procedure involving placement of cultured chondrocytes into the defect and sutured into place, has been described downfall being the technically demanding nature of the procedure; however, it can be a good option for larger lesions. Osteochondral autograft transplantation can consist of a single plug or multiple plugs used to fill a larger defect. The use of multiple plugs to fill a defect is termed mosaicplasty. The single plug technique requires the donor surface architecture to be similar to the recipient site for the procedure to be successful. With mosaicplasty, the donor site architecture can be less congruent since multiple donor plugs are placed into the defect. The spaces between the multiple plugs will fill with fibrocartilage. In the past, articular cartilage lesions have been treated by subchondral bone abrasions or drilling at the site of focal damage. For osteochondral lesions, bulk autografts and allografts have been used. But these are reserved for massive lesions, which are larger than 10 cm2. Autogenous or allogenic osteochondral plugs have become popular due to the following reasons: They can be performed in a single procedure. They offer a chance at true hyaline cartilage resurfacing. No outside laboratory assistance required. It can be performed with reusable equipment.
针对软骨缺损的治疗，已有多种不同的手术方法被描述。当缺损为全层时，“自我修复”的可能性较小。从历史上看，微骨折手术一直用于较小的缺损。然而，这会通过纤维软骨的形成来促进愈合，在反复负重和压缩力的情况下，这并不理想，随着时间的推移，这可能会对关节有害，并导致更差的患者预后。也有其他使用自体细胞的手术方法被描述。自体软骨细胞植入术，即一种将培养的软骨细胞植入缺损处并缝合到位的手术，其缺点是该手术技术要求高；然而，对于较大的损伤，它可能是一个不错的选择。骨软骨自体移植可以由单个移植物或多个移植物组成，用于填充较大的缺损。使用多个移植物填充缺损被称为镶嵌成形术。单移植物技术要求供体表面结构与受体部位相似，手术才能成功。对于镶嵌成形术，由于将多个供体移植物放入缺损处，供体部位结构的一致性可以稍差一些。多个移植物之间的间隙将充满纤维软骨。过去，关节软骨损伤通过在局灶性损伤部位进行软骨下骨磨削或钻孔来治疗。对于骨软骨损伤，已使用大块自体移植物和异体移植物。但这些仅用于大于10平方厘米的大面积损伤。自体或异体骨软骨移植物因其以下原因而变得流行：它们可以在一次手术中完成。它们提供了真正的透明软骨表面修复的机会。无需外部实验室协助。可以使用可重复使用的设备进行操作。
