restoration of hyaline cartilage, chondral repair
resurface = To cover with a new surface
Partial- and full-thickness cartilage injuries, as well as osteochondral pathology in weightbearing joints, have produced deleterious effects in knees in both the short and long term. The decreased capacity of damaged articular cartilage to heal or regenerate has contributed measurably to these effects. Surgeons, therefore, are challenged to search for ways to overcome this inadequacy in order to reestablish normal joint function in the face of trauma or disease.
Attempts to resurface focal areas of damage in weightbearing joints have been made, but ultimate and lasting success has remained elusive. Multiple studies in laboratory animals document various techniques, procedures, and biochemical manipulations used in the hope of remedying these articular surface defects. None, however, has resulted in viable lasting hyaline cartilage.
Recently, attempts to restore weightbearing hyaline cartilage via clinical techniques of ***joint resurfacing*** have been described. The implications of successful biological repair for chondral or osteochondral lesions are enormous. Although elderly patients can benefit from total joint replacement surgery when singular lesions or global arthrosis has affected the joint, younger patients have higher rates of failure with these procedures. Therefore, it would be advantageous to resurface symptomatic chondral and osteochondral defects to relieve the pain of those lesions and halt the progression of degenerative arthrosis.
Although biological resurfacing may not be an appropriate first choice procedure for patients with these problems, a large population of patients with articular surface lesions exists in whom simple debridement, having no ability to resurface the damage, has failed to alleviate symptoms. Within this population, many patients are too young to consider a total joint replacement. Others simply refuse total joint replacement (regardless of age), although joint surface incongruity and/or defects due to cartilage lesions have left them handicapped. With disability derived solely from articular disorders of the patellofemoral joint, trochlear replacement systems may be an option in a limited number of instances.
History of the Procedure: In the past, articular cartilage lesions have been treated by subchondral bone abrasions or drilling at the site of focal damage with procedures popularized by Pridie and Johnson. For osteochondral lesions, bulk autografts and allografts have been used. However, these generally are reserved for massive (ie, >10 cm2) lesions. These procedures have evolved to modern day techniques, but to date, no single procedure has gained universal acceptance. Both small and large articular surface lesions continue to pose challenges to surgeons.
When an unexpected chondral or osteochondral lesion is found during surgery or when simple debridement of damaged tissue does not suffice, a limited number of procedures appear to be available. Techniques such as microfracture, popularized by Steadman, and autologous chondrocyte transplantation (ACT) have shown some promise. However, the former actually does not recreate a hyaline cartilage surface. The latter requires 2 procedures, is dependent upon an outside lab, is very expensive, and requires an arthrotomy. For this reason, transplants of autogenous or allogenic osteochondral plugs have become popular because they (1) offer the chance at true hyaline cartilage resurfacing, (2) can be performed in a single procedure, (3) utilize reusable equipment, and (4) do not require outside laboratory assistance. However, unlike microfracture, osteochondral grafts are not always amenable to arthroscopic technique and may require an arthrotomy.
Hangody helped promote the use of small diameter osteochondral cylinders to resurface damaged chondral surfaces. His inspiration came from the noted longevity of the wooden mosaic walkways on the shores of Lake Balaton in Hungary. In Japan, Matsusue began using multiple autogenous osteochondral pegs, expanding on the work of Yamashita, who used autogenous shell autografts obtained from the noncontact areas of the femoral condyles...
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Native speaker of: Russian