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Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 10/2011

01-10-2011 | Symposium: Clinically Relevant Strategies for Treating Cartilage and Meniscal

Clinical Cartilage Restoration: Evolution and Overview

Authors: Jack Farr, MD, Brian Cole, MD, MBA, Aman Dhawan, MD, James Kercher, MD, Seth Sherman, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 10/2011

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Abstract

Background

Clinical cartilage restoration is evolving, with established and emerging technologies. Randomized, prospective studies with adequate power comparing the myriad of surgical techniques used to treat chondral injuries are still lacking and it remains a challenge for the surgeon treating patients to make evidence-based decisions.

Questions/purposes

We reviewed the history of the major cartilage repair/restorative procedures, indications for currently available repair/restorative procedures, and postoperative management.

Methods

We performed searches using MEDLINE and cartilage-specific key words to identify all English-language literature. Articles were selected based on their contributions to our current understanding of the basic science and clinical treatment of articular cartilage lesions or historical importance. We then selected 77 articles, two of which are articles of historical importance.

Results

Current cartilage restorative techniques include débridement, microfracture, osteochondral fragment repair, osteochondral allograft, osteochondral autograft, and autologous chondrocyte transplantation. Pending techniques include two-staged cell-based therapies integrated into a variety of scaffolds, single-stage cell-based therapy, and augmentation of marrow stimulation, each with suggested indications including lesion size, location, and activity demands of the patient. The literature demonstrates variable improvements in pain and function contingent upon multiple variables including indications and application.

Conclusions

For the patient with symptomatic chondral injury, numerous techniques are available to the surgeon to relieve pain and improve function. Until rigorous clinical trials (prospective, adequately powered, randomized control) are available, treatment decisions should be guided by expert extrapolation of the available literature based in historically sound principles.
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Metadata
Title
Clinical Cartilage Restoration: Evolution and Overview
Authors
Jack Farr, MD
Brian Cole, MD, MBA
Aman Dhawan, MD
James Kercher, MD
Seth Sherman, MD
Publication date
01-10-2011
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 10/2011
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-010-1764-z

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