Cartilage repair Flashcards
What are the two types of cartilage lesions?
Chondral lesions:
> lie entirely within the cartilage.
> do not heal spontaneously.
Osteochondral lesions:
> Penetrate into subchondral bone.
> some spontaneous healing as subchondral bone is vascularised.
What is debridement?
Areas of damaged cartilage are removed to reduce friction & inflammation.
What are the positives/negatives of debridement?
Positives:
> Offers pain relief & relieves swelling.
Negatives:
> Alters joint congruency.
> Does not repair cartilage.
What is microfracture?
Holes are made into subchondral bone beneath the lesion > bleeding into the lesion.
What are the positives/negatives of microfracture?
Positives:
> Lesion defect is filled.
Negatives:
> Lesion is filled with fibrocartilage.
What is an osteotomy?
A wedge of bone is removed from the tibia to correct the joint geometry.
What are the positives/negatives of osteotomy?
Positives:
> Re-establishes normal loading and gait.
Negatives:
> Highly invasive.
> Long recovery.
> No healing of the defect.
What is mosaicplasty?
A graft is taken from a non-load baring region of the joint & implanted into the lesion.
What are the positives/negatives of mosaicplasty?
Positives:
> Defect is filled with mature cartilage.
Negatives:
> Donor cartilage may be thinner/thicker.
> Causes a lesion in the donor site.
What is ACI?
Chondrocytes taken from non-load baring region > cultured ex-vivo > injected into lesion site under periosteal flap (from tibial plateau).
What is matrix-induced ACI?
Cultured chondrocytes are seeded onto a collagen matrix > matrix inserted into defect.
What are the advantaged of matrix-induced ACI over ACI?
Chondrocytes are distributed evenly.
No need for periosteal flap.
Scaffold may prevent fibrocartilage formation.
