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3 years ago

Berkson Managment Cartilage3 (2) [Compatibility Mode].pdf

Berkson Managment Cartilage3 (2) [Compatibility Mode].pdf

Radiographic

Radiographic Evaluation• Patellar skyline (Merchant)• PA Weightbearing 45 degree flexion• MRI• Arthroscopic evaluationMGH Sports MedicineTypes of Cartilage Repair1) Bone-marrow stimulation– abrasion, drilling, microfracture2) Transplantation of osteochondralgrafts– OATS, mosaicplasty, allografts3) Implantation of autologous cells(chondrocytes)– ACI4) Matrices / scaffolds– +/- cells, +/- growth factorsMGH Sports MedicinePrerequisites for Healing of Articular Cartilage1) Source of cells2) Provision of a matrix3) Removal stressconcentration4) Intact subchondral plate5) Mechanical stimulationMGH Sports Medicine4

Marrow Stimulation Techniques• Goal- initiate bleeding• in the hope of forming fibrocartilagenous scar• Goal blood = Fibrin clot = primitiveundifferentiated mesenchymal stem cellsFibrocartilage• non hyaline repair tissue resultsMGH Sports MedicineMarrow-Stimulating Techniques• Abrasion Arthroplasty– Remove 1-2mm of sclerotic bonedown to vasculature ofsubchondral plate– Fibrin clot fibrocartilage– Debridement vs. Abrasionarthroplasty 1• 33% worse HSS score than beforesurgey– Technique sensitive– Not recommended1 Bert Arthroscopy 1999MGH Sports MedicineMicrofracture• Improvement uponabrasion• Subchondral architectureleft intact except areasbroached with small metalpicks• Fibrin clot = FibrocartilageMicrofractureAAOS ICLS p 47MGH Sports Medicine5

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