Restoring Cartilage: The Holy Grail of Orthopaedics

For decades, researchers have been investigating different methods of cartilage repair, but no approach has yet risen to “gold standard” status. In the June 24, 2015 edition of JBJS Case Connector, “Case Connections” looks at three different restorative/replacement approaches to cartilage defects.

In the springboard case by Ramirez et al., a high school athlete’s full-thickness glenoid osteochondral defect was filled arthroscopically with particulated juvenile cartilage allograft (see image below).

F1.largeIn an earlier case report by Convery et al., the authors recommended placing additional autogenous bone beneath allografts to augment the host bed and enhance incorporation of the allograft’s osseous shell.

Welsch et al. alert surgeons to the possibility of hypertrophic cartilage opposite a defect that’s treated with a matrix-associated autologous chondrocyte transplant (MACT). And finally, Adachi et al. report on osteonecrosis of the femoral condyles that was treated with tissue-engineered cartilage combined with a hydroxyapatite scaffold enhanced with mesenchymal stem cells.

Although prospective studies with suitable control groups will be needed to prove the efficacy of these and other restorative techniques, early intervention with biologic restoration of the articular surface could eventually have a profound influence on patients with cartilage damage.

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