Cartilage injuries of the knee

Abstract

Cartilage injuries of the knee are common and can be managed in a variety of ways. Choice of management must take into account the demands and expectations of the patient as well as the size, depth and location of the defect, how chronic it is and any concomitant intra-articular, extraarticular or general conditions. Previous treatments and injuries should be addressed before starting the treatment. Defect size is one of the most important parameters to take into account for pre-operative planning. All symptomatic cartilage defects of type III or IV using the International Cartilage Repair Society grading system should be managed surgically. No more than three localized cartilage defects can be treated successfully at the same time. Cartilage lesions can be managed with a wide spectrum of different techniques that can be used isolated or in combination according to surgeon’s choice. These techniques can be classified into five main groups: (1) cartilage reparative techniques (microfracture, drilling, cartilage shaving), (2) cartilage restoration techniques (fresh allograft transplantation or autograft transplantation - mosaicplasty), (3) autologous chondrocyte implantation (ACI) or matrix-induced autologous chondrocyte implantation (MACI), (4) other biologic approaches, including repair with gene- activated matrices (GAMs), scaffolds, mesenchymal stem cell (MSCs), platelet-rich plasma (PRP), growing factors (GRs), magnetically labelled synovium-derived cells (M-SDCs), bone morphogenetic proteins (BMPs) and elastic-like polypeptide gels, and (5) other therapies such as osteotomies, stem cell-coated titanium implants and chondroprotection with pulsed electromagnetic fields (PEMFs).