Repair of osteochondral defects in joints--how to achieve success.
Osteochondral defects in the knee are difficult to repair because intrinsic healing of cartilage is poor and gradual progression to "early-onset" osteoarthritis leads to severe pain and disability. Of all methods tested to achieve regeneration of hyaline cartilage and long-lasting repair, autologous chondrocyte transplantation (ACI-C and MACI) has been the most successful with 80% of good results and graft survival in this unit in a very large series over 10 years. The repair mechanism is unclear but our work shows that the criteria for success are: young patient age, no previous operative procedures on the defect, no obesity, no smoking, defect on femoral condyles or trochlea and no pre-existing degenerative joint changes. Future research is aimed at non-transplantation, single-stage procedures aided by use of new scaffolds and growth factors and the extension of such techniques into arthritic joints.
The Joint Replacement and Cartilage Transplantation Unit, R.N.O.H, and The Institute of Orthopaedics, University College, London, UK.
George
G
Bentley
Jagmeet Singh
JS
Bhamra
Panagiotis D
PD
Gikas
John A
JA
Skinner
Richard
R
Carrington
Timothy W
TW
Briggs
D001182:Arthroscopy / Q000379:methods*; D002358:Cartilage, Articular / Q000293:injuries / Q000473:pathology / Q000601:surgery*; D019902:Chondrocytes / Q000637:transplantation*; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D012038:Regeneration; D013997:Time Factors; D023822:Tissue Engineering / Q000379:methods; D016896:Treatment Outcome; D014945:Wound Healing