Lower Extremity-Articular Cartilage Injuries

  • S. Bajaj
  • M. O. Petrera
  • B. J. Cole


Articular cartilage provides for a smooth low-friction articulation, joint lubrication, and proper stress distribution in order to minimize peak force on the subchondral bone. Acute or repetitive impact can result in articular cartilage lesions, but fortunately in most cases these are asymptomatic. However, when symptomatic, these lesions cause pain, swelling, joint dysfunction, and instability. Multiple non-surgical and surgical therapeutic options are available to treat such chondral injuries. Non-surgical options include oral medications, injections, bracing, and physical therapy. Surgical interventions range from a simple arthroscopic debridement and lavage to allograft transplantation. To determine the proper treatment approach, it is crucial for the operating surgeon to consider the patient’s age, symptom intensity, clinical history, post-operative expectations, and lesion characteristics. This chapter provides an overview of the etiology, diagnosis, and management of articular cartilage lesions.


Articular Cartilage Subchondral Bone Cartilage Repair Autologous Chondrocyte Implantation Chondral Lesion 
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  1. 1.
    Sellards RA, Nho SJ, Cole BJ (2002) Chondral injuries. Curr Opin Rheumatol 14:134–141PubMedCrossRefGoogle Scholar
  2. 2.
    Widuchowski W, Widuchowski J, Trzaska T (2007) Aricular cartilage defects: 25124 knee arthroscopies. The Knee 14:177–182PubMedCrossRefGoogle Scholar
  3. 3.
    Outerbridge RE (1961) The etiology of chondromalacia patella. J Bone Joint Surg 43(B):752–757Google Scholar
  4. 4.
    Curl WW, Krome J, Gorodon ES et al (1997) Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy 13:460–466Google Scholar
  5. 5.
    Hunt N, Sanchez-Ballester J, Pandit R et al (2001) Chondral lesions of the knee: a new localization method and coorelation with associated pathology. Arthroscopy 17:481–490PubMedCrossRefGoogle Scholar
  6. 6.
    Brittberg M (2000) Evaluation of cartilage injuries and cartilage repair. Osteologie 9:17–25Google Scholar
  7. 7.
    Tomford WW (2000) Chondroprotective agents in the treatment of articular cartilage degeneration. Operative Tech Sport Med 8:120–121CrossRefGoogle Scholar
  8. 8.
    Barclay TS, Tsourounis C, McGart GM (1998) Glucosamine. Ann Pharmacother 32:574–579PubMedCrossRefGoogle Scholar
  9. 9.
    Da Camara CC, Dowless GV (1998) Glucosamine sulfate for osteoarthritis. Ann Pharmacother 32:580–587PubMedCrossRefGoogle Scholar
  10. 10.
    Hepper CT, Halvorson JJ, Duncan ST et al (2009) The efficacy and duration of intra-articular corticosteroid injection for knee osteoarthritis: a systematic review of level I studies. J Am Acad Orthop Surg 17:638–646PubMedGoogle Scholar
  11. 11.
    Watterson JR, Esdaile JM (2000) Viscosuplementation: therapeutic mechanisms and clinical potential in osteoarthritis of the knee. J Am Acad Orthop Surg 8:277–284PubMedGoogle Scholar
  12. 12.
    Strauss EJ, Hart JA, Miller MD et al (2009) Hyaluronic acid viscosupplementation and osteoarthritis: current uses and future directions. Am J Sports Med 37:1636–44PubMedCrossRefGoogle Scholar
  13. 13.
    Miller M, Cole B (2009) (eds) Text of arthroscopy: knee cartilage: diagnosis and decision making. Saunder, Philadelphia, pp 555–567Google Scholar
  14. 14.
    Fond J, Rodin D, Ahmad S, Nirschl RP (2002) Arthroscopic debridement for the treatment of osteoarthritis of the knee: 2-and 5-year results. Arthroscopy 18:829–834PubMedCrossRefGoogle Scholar
  15. 15.
    Steadman J, Rodkey W, Singleton S et al (1997) Microfracture technique for full thickness condral defects: technique and clinical results. Oper Tech Ortho 7:300–304CrossRefGoogle Scholar
  16. 16.
    Cole BJ, Pascual Garrido C, Grumet RC (2009) Surgical management of articular cartilage defects in the knee. J Bone Joint Surg Am 91:1778–179PubMedGoogle Scholar
  17. 17.
    Magnussen R, Dunn W, Carey J, Spindler K (2008) Treatment of focal articular cartilage defects in the knee: a systematic review. Clin Orthop Relat Res 466:952–962PubMedCrossRefGoogle Scholar
  18. 18.
    William R, Harnly H (2007) Microfracture: indications, technique and results. Instr Course Lect 56:419–428Google Scholar
  19. 19.
    Knutsen G, Drogset JO, Engebretsen L et al (2007) A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at 5 years. J Bone Joint Surg Am 89:2105–2112PubMedCrossRefGoogle Scholar
  20. 20.
    Solheim E, Oyen J, Hegna J et al (2009) Microfracture treatment of single or multiple articular cartilage defects of the knee: a 5-year median follow-up of 110 patients. Knee Surg Sports Traumatol Arthrosc 18:504–508PubMedCrossRefGoogle Scholar
  21. 21.
    Steadman JR, Briggs KK, Rodrigo JJ et al (2003) Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy 19:477–484PubMedCrossRefGoogle Scholar
  22. 22.
    Farr J, Schepsis A, Cole B et al (2007) Anteromedialization. J Knee Surg 20:120–128PubMedGoogle Scholar
  23. 23.
    Mandelbaum B, Browne JE, Fu F et al (2007) Treatment outcomes of autologous chondrocyte implantation for full thickness articular cartilage defects of the troclea. Am J Sports Med 35:915–921PubMedCrossRefGoogle Scholar
  24. 24.
    Zaslav K, Cole B, Brewster R et al; STAR Study Principal Investigators (2009) A prospective study of autologous chondrocyte implantation in patients with failed prior treatment for articular cartilage defect of the knee: results of the Study of the Treatment of Articular Repair (STAR) clinical trial. Am J Sports Med 37:42–55PubMedCrossRefGoogle Scholar
  25. 25.
    Rosenberger RE, Gomoll AH, Bryant T, Minas T (2008) Repair of large chondral defects of the knee with autologous chondrocyte implantation in patients 45 years or older. Am J Sports Med 36:2336–2344PubMedCrossRefGoogle Scholar
  26. 26.
    Steinwachs M, Kreuz PC (2007) Autologous chondrocyte implantation in chondral defects of the knee with a type I/III collagen membrane: a prospective study with a 3-year followup. Arthroscopy 23:381–387PubMedCrossRefGoogle Scholar
  27. 27.
    Kreuz PC, Steinwachs M, Erggelet C et al (2007) Importance of sports in cartilage regeneration after autologous chondrocyte implantation: a prospective study with a 3-year followup. Am J Sports Med 35:1261–1268PubMedCrossRefGoogle Scholar
  28. 28.
    McNickle AG, L’Heureux DR, Yanke AB, Cole BJ (2009) Outcomes of autologous chondrocyte implantation in a diverse patient population. Am J Sports Med 37:1344–1350PubMedCrossRefGoogle Scholar
  29. 29.
    Hangody L, Vasarhelyi G, Hangody LR et al (2008) Autologous osteochondral grafting-technique and long term results. Injury 39(Suppl 1):S32–S39PubMedCrossRefGoogle Scholar
  30. 30.
    Marcacci M, Kon E, Delcogliano M et al (2007) Arthroscopic autologous osteochondral grafting for cartilage defects of the knee: prospective study results at a minimum 7-year followup. Am J Sports Med 35:2014–2021PubMedCrossRefGoogle Scholar
  31. 31.
    Dozin B, Malpeli M, Cancedda R et al (2005) Comparative evaluation of autologous chondrocyte implantation and mosaicplasty: a multicentered randomized clinical trial. Clin J Sport Med 15:220–226PubMedCrossRefGoogle Scholar
  32. 32.
    Ball ST, Amiel D, Williams SK et al (2004) The effects of storage on fresh human osteochondral allografts. Clin Orthop Relat Res 418:246–252PubMedCrossRefGoogle Scholar
  33. 33.
    Wingenfeld C, Egli RJ, Hempfing A et al (2002) Cryopreservation of osteochondral allografts: dimethyl sulfoxide promotes angiogenesis and immune tolerance in mice. J Bone Joint Surg Am 84-A(8):1420–1429PubMedGoogle Scholar
  34. 34.
    Wang CJ (2002) Treatment of focal articular cartilage lesions of the knee with autogenous osteochondral grafts. 2-to 4-year follow-up study. Arch Orthop Trauma Surg 122:169–172PubMedCrossRefGoogle Scholar
  35. 35.
    Williams JM, Virdi AS, Pylawka TK et al (2005) Prolonged-fresh preservation of intact whole canine femoral condyles for the potential use as osteochondral allografts. J Orthop Res 23:831–837PubMedCrossRefGoogle Scholar
  36. 36.
    Williams SK, Amiel D, Ball ST et al (2003) Prolonged storage effects on the articular cartilage of fresh human osteochondral allografts. J Bone Joint Surg Am 85(A):2111–2120PubMedGoogle Scholar
  37. 37.
    Gross AE, Shasha N, Aubin P (2005) Long term follow-up of the use of fresh osteochondral allografts for post-traumatic knee defects. Clin Orthop Relat Res 435:79–87PubMedCrossRefGoogle Scholar
  38. 38.
    Davidson PA, Rivenburgh DW, Dawson PE et al (2007) Clinical, histologic and radiographic outcomes of distal femoral resurfacing with hypotermically stored osteoarticular allografts. Am J Sports Med 35:1082–1090PubMedCrossRefGoogle Scholar
  39. 39.
    McCulloch PC, Kang RW, Sobhy MH et al (2007) Prospective evaluation of prolonged fresh osteochondral allograft transplantation of the femoral condyle: minimum 2-year follow-up. Am J Sports Med 35:411–420PubMedCrossRefGoogle Scholar
  40. 40.
    Jamali AA, Emmerson BC, Chung C et al (2005) Fresh osteochondral allografts: results in the patellofemoral joint. Clin Orthop Relat Res 437:176–185PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2011

Authors and Affiliations

  • S. Bajaj
  • M. O. Petrera
  • B. J. Cole

There are no affiliations available

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