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Tibial Cartilage Defects

  • Kevin C. Wang
  • Rachel M. Frank
  • Brian J. ColeEmail author
Chapter

Abstract

Tibial plateau defects present a challenging clinical entity, as their location, geometry, and proximity to surrounding structures make them technically challenging to treat. Additionally, the literature on the management of tibial plateau cartilage defects is not well-developed. Techniques such as osteochondral allografts or autografts are technically complicated in these regions and should be approached with caution. Microfracture is a well-established technique that is technically simple and has low rates of complications, and it is well-suited for treating tibial plateau defects. However, concerns about the long-term outcomes of microfracture have been raised, likely secondary to the generation of fibrocartilage. Newer treatments that are available including BioCartilage (Arthrex, Naples, FL) and matrix-associated autologous chondrocyte implantation (MACI) may have promise in this technically demanding area.

References

  1. 1.
    Wajsfisz A, Makridis KG, Djian P. Arthroscopic retrograde osteochondral autograft transplantation for cartilage lesions of the tibial plateau: a prospective study. Am J Sports Med. 2013;41(2):411–5.CrossRefGoogle Scholar
  2. 2.
    Frank RM, Cotter EJ, Nassar I, Cole B. Failure of bone marrow stimulation techniques. Sports Med Arthrosc Rev. 2017;25(1):2–9.CrossRefGoogle Scholar
  3. 3.
    Cole BJ, Pascual-Garrido C, Grumet RC. Surgical management of articular cartilage defects in the knee. J Bone Joint Surg Am. 2009;91(7):1778–90.PubMedGoogle Scholar
  4. 4.
    Miller BS, Briggs KK, Downie B, Steadman JR. Clinical outcomes following the microfracture procedure for chondral defects of the knee: a longitudinal data analysis. Cole BJ, Kercher JS, editors. Cartilage. 2010;1(2):108–12.CrossRefGoogle Scholar
  5. 5.
    Frank RM, Lee S, Levy D, Poland S, Smith M, Scalise N, et al. Osteochondral allograft transplantation of the knee: analysis of failures at 5 years. Am J Sports Med. 2017:036354651667607.Google Scholar
  6. 6.
    Oliver-Welsh L, Griffin JW, Meyer MA, Gitelis ME, Cole BJ. Deciding how best to treat cartilage defects. Orthopedics. 2016;39(6):343–50.CrossRefGoogle Scholar
  7. 7.
    Gross AE, Shasha N, Aubin P. Long-term followup of the use of fresh osteochondral allografts for posttraumatic knee defects. Clin Orthop. 2005;NA(435):79–87.CrossRefGoogle Scholar
  8. 8.
    Ronga M, Grassi FA, Bulgheroni P. Arthroscopic autologous chondrocyte implantation for the treatment of a chondral defect in the tibial plateau of the knee. Arthrosc J Arthrosc Relat Surg. 2004;20(1):79–84.CrossRefGoogle Scholar
  9. 9.
    Ueblacker P, Burkart A, Imhoff AB. Retrograde cartilage transplantation on the proximal and distal tibia. Arthrosc J Arthrosc Relat Surg. 2004;20(1):73–8.CrossRefGoogle Scholar
  10. 10.
    Kim K-I, Seo M-C, Song S-J, Bae D-K, Kim D-H, Lee SH. Change of chondral lesions and predictive factors after medial open-wedge high tibial osteotomy with a locked plate system. Am J Sports Med. 2017:036354651769486.Google Scholar
  11. 11.
    Fortier LA, Chapman HS, Pownder SL, Roller BL, Cross JA, Cook JL, et al. BioCartilage improves cartilage repair compared with microfracture alone in an equine model of full-thickness cartilage loss. Am J Sports Med. 2016;44(9):2366–74.CrossRefGoogle Scholar
  12. 12.
    Fortier LA, Potter HG, Rickey EJ, Schnabel LV, Foo LF, Chong LR, et al. Concentrated bone marrow aspirate improves full-thickness cartilage repair compared with microfracture in the equine model. J Bone Jt Surg Am. 2010;92(10):1927–37.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Kevin C. Wang
    • 1
  • Rachel M. Frank
    • 2
  • Brian J. Cole
    • 3
    Email author
  1. 1.Department of OrthopedicsIcahn School of Medicine at Mount SinaiNew YorkUSA
  2. 2.Department of Orthopaedic SurgeryUniversity of Colorado School of MedicineAuroraUSA
  3. 3.Department of Orthopedic SurgeryRush University Medical CenterChicagoUSA

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