To demonstrate the current strategies for treating cartilage defects of knees and the related research. Published papers about cartilage defects were searched and reviewed. The current strategies for the treatment were summarized. Based on the research of our study and others, the conclusion how to treat cartilage defects was made. The current ways for treating cartilage defects include micro-fractures, chondrocytes transplantation, mosaicplasty and tissue engineering; Research on functional magnetic resonance imaging in the early diagnosis of cartilage defects, cartilage degeneration is gradually increasing. There is still no effective treatment of cartilage defects and tissue engineering has brought new hopes for the treatment of cartilage defects , functional magnetic resonance imaging has some significance in early diagnosis of cartilage defects, cartilage degeneration.
Animals ; Cartilage Diseases ; surgery ; therapy ; Cartilage, Articular ; surgery ; Humans ; Knee ; surgery ; Tissue Engineering ; Transplantation, Autologous

Bone Neoplasms/surgery* ; Cartilage Diseases ; Cartilage, Articular ; Humans ; Lipoma/surgery* ; Tibia/surgery*

Knee joint distraction is a new technology for the treatment of knee osteoarthritis in recent years. It could reduce knee pain and improve knee function, which is inseparable from the role of cartilage repair. The mechanism and influencing factors of knee joint distraction in repairing cartilage are the focus of current research. In this paper, the author reviewed literature and found that knee joint distraction could reduce knee joint load and provide a appropriate mechanical environment for cartilage repair, and it is resulting hydrostatic pressure fluctuation in the knee joint not only helps cartilage to absorb nutrients, but also promotes cartilage formation genes and inhibits cartilage matrix degrading enzyme gene expression. In addition, knee joint distraction creates conditions for synovial mesenchymal stem cells to be collected to cartilage injury, and improves ability of synovial mesenchymal stem cells to proliferate and differentiate into a chondrogenic lineage. Knee joint distraction could reduce inflammatory reaction and cartilage injury of knee joint by reducing content of inflammatory factors and inhibiting expression of inflammatory genes. At present, it is known that the factors affect repair of cartilage by knee joint distraction include, increasing weight-bearing activity and height and time of distraction is helpful for cartilage repair, male patients and patients with higher severity of knee osteoarthritis have better cartilage repair effect after knee joint distraction.The better efficacy of cartilage repair on the first year after knee joint distraction predicts a higher long-term survival rate of knee joint distraction with knee preservation. However, the research on the above hot spots is only at the initial stage and further exploration is still needed, in order to better guide clinical application of knee joint distraction.
Humans ; Male ; Osteoarthritis, Knee ; External Fixators ; Knee Joint/surgery* ; Osteogenesis, Distraction/methods* ; Cartilage ; Cartilage, Articular/surgery*

Articular cartilage damage is very common in clinical practices. Due to the low self-healing abilities of articular cartilage, the repair strategies for articular cartilage such as arthroscopic lavage and debridement,osteaochondral or chondrocytes transplantation, tissue engineering and hydrogel based artificial cartilage materials are the primary technologies of repairing articular cartilage defect. In this paper,the main repair strategies for the articular cartilage damage and the advantages or disadvantages of each repair technology are summarized. The arthroscopic lavage and debridement is successful in treating the early stage of osteoarthritis. Osteochondral and chondrocytes transplantation are beneficial to treat small full thickness defects. The technology of tissue engineering becomes a new method to heal articular cartilage damage, but the major problem is the absence of bonding strength between the implants and natural defect surfaces. Hydrogel based artificial cartilage possesses similar bio-mechanical and bio-tribological performances to that of natural articular cartilage. However, both bioactivity and interfacial bonding strength between the implant and natural cartilage could be further improved. How to simultaneously optimize the mechanical and bioactive as well as biotribological properties of hydrogel based materials is a focus problem concerned.
Arthroscopy ; Biomechanical Phenomena ; Cartilage ; transplantation ; Cartilage, Articular ; surgery ; Chondrocytes ; transplantation ; Debridement ; Humans ; Tissue Engineering

OBJECTIVE: To provide an overview of the incidence of knee donor -site morbidity after autologous osteochondral mosaicplasty. METHODS: A comprehensive search was conducted in PubMed, EMbase, Wanfang Medical Network, and CNKI databases from January 2010 to April 20, 2021. Relevant literature was selected based on predefined inclusion and exclusion criteria, and data were evaluated and extracted. The correlation between the number and size of transplanted osteochondral columns and donor-site morbidity was analyzed. RESULTS: A total of 13 literatures were included, comprising a total of 661 patients. Statistical analysis revealed an incidence of knee donor-site morbidity at 8.6% (57/661), with knee pain being the most common complaint, accounting for 4.2%(28/661). There was no significant correlation between the number of osteochondral columns and postoperative donor-site incidence (P=0.424, N=10), nor between the diameter size of osteochondral columns and postoperative donor-site incidence(P=0.699, N=7). CONCLUSION Autologous osteochondral mosaicplasty is associated with a considerable incidence of knee donor-site morbidity, with knee pain being the most frequent complaint. There is no apparent correlation between donor-site incidence and the number and size of transplanted osteochondral columns. Donors should be informed about the potential risks.
Humans ; Incidence ; Cartilage/transplantation* ; Knee ; Knee Joint/surgery* ; Pain ; Cartilage, Articular ; Transplantation, Autologous ; Bone Transplantation

Chondral injuries are short of self-healing ability and need to surgical repair after articular cartilage injury. Conventional treatment includes debridement and drainage under arthroscope, micro-fracture, osteochondral autograft transplantation (OATS), mosaiplasty and osteochondral allografts (OCA), autologous chondrocyte implantation (ACI). Debridement and drainage could remove pain factor, and has advantages of simple operation, wide clinical application and early clinical effect. Micro-fracture and osteochondral autograft transplantation is suitable for small area of cartilage repair, while the further effect showed that fibrous cartilage permeated by drill could decrease postoperative clinical effect. Osteochondral autograft transplantation has better advantages for reconstruction complete of wear-bearing joint. Autologous chondrocyte implantation and allogeneic cartilage transplantation are suitable for large area of cartilage defect, postoperative survival of allogeneic cartilage transplantation is effected by local rejection reaction and decrease further clinical effect. Cartilage tissue engineering technology could improve repair quality of autologous chondrocyte implantation, and make repair tissue close to transparent cartilage, but has limit to combined subchondral bone plate, reactive bone edema, bone loss and bad axis of lower limb. New technology is applied to cartilage injury, and has advantages of less trauma, simple operation, rapid recover, good clinical effect and less cost;and could be main method for treat cartilage injury with surgical repair technology. How to improve repair quality with compression resistance and abrasive resistance are expected to be solved.
Cartilage, Articular ; injuries ; surgery ; Chondrocytes ; transplantation ; Humans ; Knee Injuries ; surgery ; Knee Joint ; surgery ; Transplantation, Autologous

The defects of the articular cartilage structure are not replaced unless the subchondral plate has been breached. However, following the creation of a defect in the subchondral plate, the area is filled in with a fibrous tissue which gradually transforms to hyaline cartilage. The porous nontoxic materials of both biologic and synthetic origin have reportedly been used as matrices for repairing bone and cartilage. Following implantation, carbon fibre, chemically inert and well-tolerated by the body, induces a proliferation of ordered fibrous tissue. We implanted carbon fiber pads in osteochondral defects in rabbits. Those repairs were compared to control holes with no implants. The pads appeared to induce the gross appearance of a restored joint surface, mechanically strong to loading for periods from 2 to 6 weeks. Also, carbon fiber pads promoted the healing of the osteochondral defects in the rabbit femoral condyle, supplying well-organized cartilagenous tissue over repaired subchondral bone. The use of carbon fiber pads as implant material is suggested for the restoration of articular surface in osteoarthritis and osteochondritis dissecans.
Animals ; *Carbon ; Cartilage, Articular/surgery/*ultrastructure ; Knee Joint/surgery/*ultrastructure ; Microscopy, Electron, Scanning ; *Prostheses and Implants ; Rabbits

OBJECTIVETo trace the pathological changes of the cultured autologous chondrocytes mass after implanted in cartilage defects and investigate the pathophysiological mechanisms of the antologous chondrocytes mass transplantation in the repair of cartilage defects.

METHODSTwenty-four New Zealand white rabbits of 4 to 6 month-old and weighing more than 3.0 kg (female and male was unrestricted) were randomly divided into experiment group and the control group. For 12 rabbits of experiment group, the cartilage defects were repaired with the autologous chondrocytes mass and sealed with one piece of periosteum. Firstly, cartilage tissue of 10 to 30 mg was obtained from the shoulder of the rabbits after anaesthetized by 1 mg/kg 20% sumianxin. Then, chondrocytes were isolated from the cartilage tissue with 0.2% type II collagenase digestion and were cultured in DMEM/F-12 supplemented with 20% fetal bovine serum (FBS), 50 microg/ml ascorbic acid-2-phosphate, 0.4 mM proline, 5 microg/ml insulin and 1 mM non-essential amino acids (NEAA) in flasks in vitro. The cells were harvested until a thin film of the cells covered the bottom of the flask could be seen with naked eyes. Then the film was collected with a curled glass stick and formed a solid mass. On this time, the animal was anaesthetized again and the full-thickness cartilage square defect of 4.0 mm x 6.0 mm was fabricated in the patellar grove of distal femur, and then the cellular mass was transplanted into the defect covered by one piece of periosteum which obtained from the upper anterior of tibia and sealed with the femoral condyles. For 12 rabbits of the control group, the defects were sealed with one piece of periosteum only. The animals were sacrificed in the 1st, 3rd, 6th and 12th weeks after the operation respectively. The histologic sections were stained with safranin O-fast green, hematoxylin-eosin (H&E) and picric acid-Sirius red and immunostained for type II collagen and aggrecan.

RESULTSIn the 1st week, the transplanted cells oriented to articular surface differentiated to matured hyaline chondrocytes and excrete large amount cartilage matrix. In the 3rd week, the trend was more obvious and the periosteum was union to the cell mass. In the 12th week, the defects were repaired with hyaline-like cartilage tissue, and in the 24th week, the repair tissue turned to matured hyaline cartilage. In the control group, the defects were repaired with fibrocartilage tissues.

CONCLUSIONIt was evidenced that the defects were repaired by the autologous chondrocytes mass transplantation. The procedure was gradual and initialed from up toward joint to down to the deep of the defect.

Animals ; Cartilage, Articular ; pathology ; surgery ; Chondrocytes ; transplantation ; Female ; Knee Joint ; pathology ; surgery ; Male ; Rabbits ; Transplantation, Autologous

OBJECTIVETo study the effects of pressure changes on the experimental articular cartilage by utilizing Ilizarov distraction technique.

METHODSThe Ilizarov external fixators were fixed at the left ankle joints of 18 experimental dogs, and the fixators were stretched with a speed of 1 mm/d to create a varus deformity. After three weeks, the ankle varus was 15 degree; when the degree was confirmed by X-ray film, the same traction was retained for 3 weeks. Then the traction decreased at the same speed of 1 mm/d to correct the deformity for 3 weeks. At the 3rd, 7th and 9th weeks, articular cartilages were separated from medial foot of the experimental and normal side to do morphology observation after HE stain, which were group A, group B, group C and group D respectively separately. The gray scale values were obtained using Image-Pro Plus 6.0 software and compared among the 4 groups using SPSS 13.0. The microstructure of cartilage was observed through transmission electron microscopy.

RESULTS(1) The Mankin scores: there was significant difference between group A and group B (P=0.043<0.05); and significant difference between group B and group C (P=0.038<0.05). (2) The values of gray scale: there was significant difference between group A and group B (P=0.047<0.05); significant difference between group B and group C (P=0.045<0.05); significant difference between group A and group D (P=0.039<0.05); no significant difference between group C and group D (P=1.23>0.05).

CONCLUSIONUsing Ilizarov technique, when the pressure between the cartilage surface of the ankle joint increases, the necrosis of articular cartilage occurred; and when the stress between the articular cartilage surface decreases, the damaged articular cartilage can be restored.

Animals ; Ankle Joint ; surgery ; Bone Regeneration ; Cartilage, Articular ; surgery ; Dogs ; Female ; Ilizarov Technique ; Male ; Random Allocation

OBJECTIVE: To investigate the correlation between the medial meniscal indentation index (MDI) and medial tibiofemoral articular cartilage damage more than 3 degrees in patients aged 40 to 60 years old with suspected or complicated knee osteoarthritis at non-weight-bearing position, and to determine the predictive threshold. METHODS: From June 2016 to June 2020, a total of 308 patients who underwent initial knee arthroscopic exploration for chronic knee pain were collected. The age ranged from 36 to 71 years old with an average of(56.40±1.82) years old, including 105 males and 203 females. And patients with extra-articular malformations (abnormal force lines), a history of trauma, inflammatory arthritis and other specific arthritis were excluded. Finally, 89 eligible cases were obtained, aged from 42 to 60 years old with an average of (59.50±0.71) years old, including 45 males and 44 females. The degree of cartilage damage in the medial compartment of the knee joint was recorded, which was divided into two groups(≥degree 3 andcartilage injury of more than grade 3 were determined by further binary Logistic regression analysis. If MDI was taken as an independent risk factor, receiver operating characteristic (ROC) analysis was performed to confirm whether it had diagnostic value for cartilage damage of above degree 3 and calculate the critical value of MDI. RESULTS: A total of 89 eligible patients were obtained. Univariate analysis showed age, BMI, MDI and meniscus injury may be the independent risk factors for cartilage damage of more than 3 degrees, further binary Logistic regression analysis confirmed that MDI[OR=1.66, 95%CI(1.64, 1.69), P=0.01]and BMI [OR=1.58, 95%CI(1.17, 2.15), P=0.03] were independent risk factors for cartilage injury of more than degree 3 in enrolled patients. ROC analysis showed that MDI had more diagnostic value than BMI, and the critical value was 0.355 with a sensitivity of 89.1% and a specificity of 88.2%. CONCLUSION In doubt or accompanied by 40 to 60 years old patients with knee osteoarthritis, the MDI measured by non-weight-bearing knee MRI has predictive value for cartilage injury of more than degree 3 in medial tibiofemoral joint, and the critical value for diagnosis of cartilage injury of more than degree 3 is 0.355.
Male ; Female ; Humans ; Adult ; Middle Aged ; Aged ; Osteoarthritis, Knee/surgery* ; Cartilage, Articular/surgery* ; Knee Joint/surgery* ; Meniscus ; Menisci, Tibial/surgery* ; Cartilage Diseases ; Magnetic Resonance Imaging/adverse effects*