management of cartilage injuries

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1、ArticularCartilageInjuriesofKneejointDrCuiZhigangNewwordsHyalinecartilagefragmentationfissuringResiliencecrackfibrillationcavetationPerichondriumChrondralinjuriesOsteochrondralinjuriesAcutereplacedandinternallyfixedChronicdefectsosteochondralallograftChrondralinjurieschallengingLimited

2、healingpotentialofarticularcartilageChondralandosteochondralinjuriesarecommontypicallyaffectayoung,athleticpopulation.Inarespectivereviewofmorethan31,000kneearthrocopies,Curletalreportedarticularcartilagedamaged63%ofpatients,withmorethan60%havingagradeIIIorgradeIVlesion.Failuretorecogn

3、izetheseinjurienresultinlong-termdisability.Outerbridgeclassification-grade0:normalcartilage;      -gradeI:cartilagewithsofteningandswelling;      -gradeII:apartial-thicknessdefectwithfissuresonthesurfacethatdonotreachsubchondralboneorexceed1.5cmindiameter;      -gradeIII:fissuringt

4、othelevelofsubchondralboneinanareawithadiametermorethan1.5cm;      -gradeIV,exposedsubchondralbone.Noyessystem-gradeI:cartilagesurfaceintact(1A=someremainingresilience;1B=deformation)  -gradeII:cartilagesurfacedamage(cracks,fibrillation,fissuring,offragmentationwithlessthanhalfofcart

5、ilagefthicknessinvolved);  -gradeIII:depthofinvovementgreaterthanhjalfofcartilagethicknessbutwithoutexposedbone-gradeIV,boneexposed（3A=surfaceintact3B=surfacecavitation)ArticularcartilagerepairstrategiesSubchondralbonepenetrationOsteochrondralgraftingcellandtissueengineeringSubchondra

6、lbonepenetrationDrilling,abasion,andmicrofractureofthesubchondralbonetostimulatehealingreaponsebymarrow-derivedOsteochrondralgraftingTheefficacyoftheseproceduresremainstovedetermined.Problems:ifthedonorcartilagehealtheadjacentrecipient?Sizeanddepthindication?>2.5cm2maynotappropriatefor

7、thistechnique.Figure4:Debridementofthecartilagedefect.Theedgesarebroughtbacktoarightangleandanydetachedcartilageisremoved.Figure5:ThebaseofthelesionisabradedtoviablesubchondralboneFigure6:Underdirectvisualization,thefirstrecipienttunnelisdrilledperpendiculartothesurfaceofthecondyle.F