MODERN TRENDS IN THE TREATMENT OF FOCAL CARTILAGE DEFECTS OF THE KNEE

The article is devoted to the current trend of modern orthopedics – the surgical treatment of local full-thickness defects in the hyaline cartilage of the knee joint. This pathology is diagnosed in 5-10% of patients with diseases and injuries of the knee joint.
Materials and methods: The authors of the article presented one of the most modern and available technologies for the restoration of cartilage defects – the technology of matrix-induced autochondrogenesis (AMIC – autologous matrix-induced chondrogenesis). This operation technique was used in 63 patients. The article presents the indications and technique of surgery, considers possible errors, complications, criteria for evaluating treatment outcomes.
Results: treatment outcomes in terms of up to 13 years were studied in 56 patients. Good treatment results were observed in 53 patients. In all cases, high-quality and regeneration of the cartilaginous surface of the femoral condyles was achieved.
Conclusion: Analysis of the outcomes of treatment of patients after implantation of collagen membranes in various modifications allows the authors of the article to recommend this technique for widespread use in clinical practice.

1. Devitt BM, Bell SW, Webster KE, Feller JA, Whitehead TS. Surgical treatments of cartilage defects of the knee: Systematic review of randomised controlled trials. Knee. 2017;24(3):508–17. https://doi.org/10.1016/j.knee.2016.12.002

2. Keudell AV, Bryant T, Minas T, Center CR. Radiographic and clinical analysis of autologous chondrocyte transplantation to the patella. Bone. 2012;50:S187. https://doi.org/10.1016/j.bone.2012.02.592

3. Anders S, Volz M, Frick H, Gellissen J. A Randomized, Controlled Trial Comparing Autologous Matrix-Induced Chondrogenesis (AMIC®) to Microfracture: Analysis of 1- and 2-Year Follow-Up Data of 2 Centers. Open Orthop J. 2013;7(1):133–43. https://doi.org/10.2174/1874325001307010133

4. Bentley G, Bhamra JS, Gikas PD, Skinner JA, Carrington R, Briggs TW. Repair of osteochondral defects in joints – How to achieve success. Inj. 2013;44:S3–10. https://doi.org/10.1016/S0020-1383(13)70003-2

5. Bradley, J. Osteochondral autograft transplantation clinical outcome study. Proceedings of the Metcalf Memorial Meeting. 1999.

6. Brennan SA, Devitt BM, O’Neill CJ, Nicholson P. Focal femoral condyle resurfacing. Bone Jt J. 2013;95-B(3):301–4. https://doi.org/10.1302/0301-620X.95B3.29998

7. Dandy DJ, Eds PM, Airchorth WD, Cannon DV. Chondral and osteochondral lesions of femoral condyles . Knee surgery. Current Practice. 1992:443-448.

8. Kraeutler MJ, Belk JW, Purcell JM, McCarty EC. Microfracture Versus Autologous Chondrocyte Implantation for Articular Cartilage Lesions in the Knee: A Systematic Review of 5-Year Outcomes. Am J Sports Medicine. 2018;46(4):995–9. https://doi.org/10.1177/ 0363546517701912

9. Bruns J, Werner M, Soyka M. Is vitamin D insufficiency or deficiency related to the development of osteochondritis dissecans? Knee Surg Sports Traumatology Arthrosc. 2016;24(5):1575–9. https://doi.org/10.1007/s00167-014-3413-7

10. Hirschmann A, Hirschmann M. Chronic Knee Pain: Clinical Value of MRI versus SPECT/CT. Semin Musculoskel R. 2016;20(01):003–11. https://doi.org/10.1055/s-0036-1579674

11. Kim MK, Choi SW, Kim SR, Oh IS, Won MH. Autologous chondrocyte implantation in the knee using fibrin. Knee Surg Sports Traumatology Arthrosc. 2010;18(4):528–34. https://doi.org/10.1007/ s00167-009-0905-y

12. Lahner M, Duif C, Ficklscherer A, Kaps C, Kalwa L, Seidl T. Arthroscopic Fixation of Cell Free Polymer-Based Cartilage Implants with a Bioinspired Polymer Surface on the Hip Joint: A Cadaveric Pilot Study. Biomed Res Int. 2014;2014:1–6. https://doi.org/10.1155/ 2014/717912

13. Hsu AC, Tirico LEP, Lin AG, Pulido PA, Bugbee WD. Osteochondral Allograft Transplantation and Opening Wedge Tibial Osteotomy: Clinical Results of a Combined Single Procedure. Cartilage. 2018;9(3):248–54. https://doi.org/10.1177/1947603517710307

14. Bucach D.V., Eismont O.L. Repair of Full-Layer Articular Cartilage Damage by Means of Mesenchymal Stem Cell Autotransplantation. Sbornik tezisov III Mezhdunarodnogo Kongressa ASTAOR v sotrudnichestve s ESSKA i ISAKOS. Moscow. 2016:63. (In Russ.)

15. Alsousou J, Ali A, Willett K, Harrison P. The role of platelet-rich plasma in tissue regeneration. Platelets. 2012;24(3):173–82. https://doi.org/10.3109/09537104.2012.684730

16. Anders, S. A randomized, controlled trial comparing autologous matrix – induced chondrogenesis (amic(r)) to microfracture: analysis of 1 – and 2 – year follow – up data of 2 centers. The Open Orthopaedics Journal. 2013. Vol. 7. P. 133-143.

17. Lazishvili G.D., Egiazarjan K.A., Rat'ev A.P. Hybrid osteoarticular transplantation – the innovation technique of operational treatment of the cutting osteochondritis of a knee joint. Kafedra travmatologii i ortopedii. Moscow. 2020;1(39):59-66. (In Russ.) http://doi.org/10.17238/issn2226-2016.2020.1.59-66

18. Lazishvili G.D., Egiazarjan K.A., Ratyev A.P. Hybrid bone-cartilage transplantation is an innovative technology for surgical treatment of extensive bone-cartilage defects of the knee joint. Hirurgicheskaja praktika. 2019;4:10-18. (In Russ.)]https://doi.org/ 10.38181/issn2223-2427.2019.4.10-