Currently, there are many options in cartilage repair. These cartilage repair techniques can generally be categorized into 3 groups: marrow stimulation—based techniques, osteochondral transfer techniques, and cell-based cartilage repair techniques. This review article presents an overview of these techniques, indications for usage, advantages and disadvantages of each, and a current review of applications in foot and ankle surgery.
Bock P., Kristen KH, Kröner A., Engel A.Hallux valgus and cartilage degeneration in the first metatarsophalangeal joint. J Bone Joint Surg Br. 2004;86(5):669-673.
2.
Largey A., Canovas F., Roussanne Y., Hebrard W., Bonnel F.Degenerative cartilage changes in metatarsosesamoidal joint and Scarf procedure results for hallux valgus: a prospective study of 100 cases [in French]. Rev Chir Orthop Reparatrice Appar Mot. 2008;94(7): 685-692.
3.
Athanasiou KA , Liu GT, Lavery LA, Lanctot DR, Schenck RC Jr.Biomechanical topography of human articular cartilage in the first metatarsophalangeal joint . Clin Orthop Relat Res. 1998;348:269-281.
4.
Muehleman C. , Bareither D., Huch K., Cole AA, Kuettner KEPrevalence of degenerative morphological changes in the joints of the lower extremity. Osteoarthritis Cartilage . 1997;5(1):23-37.
5.
Shereff MJ, Baumhauer JFHallux rigidus and osteoarthrosis of the first metatarsophalangeal joint. J Bone Joint Surg Am. 1998;80(6):898-908.
6.
Unger K., Rahimi F., Bareither D., Muehleman C.The relationship between articular cartilage degeneration and bone changes of the first metatarsophalangeal joint. J Foot Ankle Surg . 2000;39(1):24-33.
7.
Weinfeld SB, Schon LCHallux metatarsophalangeal arthritis. Clin Orthop Relat Res . 1998;349:9-19.
8.
Navid DO, Myerson MSApproach alternatives for treatment of osteochondral lesions of the talus . Foot Ankle Clin. 2002;7(3): 635-649.
9.
Schafer DBCartilage repair of the talus. Foot Ankle Clin. 2003;8(4):739-749.
10.
Shea MP, Manoli A. II.Osteochondral lesions of the talar dome. Foot Ankle . 1993;14(1):48-55.
11.
Athanasiou KA, Niederauer GG, Schenck RC Jr.Biomechanical topography of human ankle cartilage. Ann Biomed Eng. 1995;23(5):697-704.
12.
Calhoun JH, Li F., Ledbetter BR, Viegas SFA comprehensive study of pressure distribution in the ankle joint with inversion and eversion. Foot Ankle Int. 1994;15(3): 125-133.
13.
Kimizuka M., Kurosawa H., Fukubayashi T.Load-bearing pattern of the ankle joint: contact area and pressure distribution . Arch Orthop Trauma Surg. 1980 ;96(1):45-49.
14.
Shepherd DE, Seedhom BBThickness of human articular cartilage in joints of the lower limb . Ann Rheum Dis. 1999;58(1):27-34.
15.
Buckwalter JA , Mankin HJArticular cartilage repair and transplantation . Arthritis Rheum. 1998;41(8):1331-1342.
16.
Buckwalter JA, Mankin HJArticular cartilage: degeneration and osteoarthritis, repair, regeneration, and transplantation. Instr Course Lect . 1998;47:487-504.
Jackson DW, Scheer MJ, Simon TMCartilage substitutes: overview of basic science and treatment options . J Am Acad Orthop Surg. 2001;9(1):37-52.
19.
Mankin HJThe response of articular cartilage to mechanical injury. J Bone Joint Surg Am. 1982;64(3):460-466.
20.
Alford JW, Cole BJCartilage restoration, part 2: techniques, outcomes, and future directions . Am J Sports Med. 2005;33(3):443-460.
21.
Alford JW, Cole BJCartilage restoration, part 1: basic science, historical perspective, patient evaluation, and treatment options. Am J Sports Med. 2005;33(2):295-306.
22.
Blevins FT, Steadman JR, Rodrigo JJ, Silliman J.Treatment of articular cartilage defects in athletes: an analysis of functional outcome and lesion appearance. Orthopedics. 1998;21(7):761-767.
Giannini S. , Buda R., Vannini F., Di Caprio F., Grigolo B.Arthroscopic autologous chondrocyte implantation in osteochondral lesions of the talus: surgical technique and results. Am J Sports Med. 2008;36(5): 873-880.
25.
Gross AE, Agnidis Z., Hutchison CROsteochondral defects of the talus treated with fresh osteochondral allograft transplantation. Foot Ankle Int. 2001;22(5): 385-391.
26.
Gross AE, Aubin P., Cheah HK, Davis AM, Ghazavi MTA fresh osteochondral allograft alternative. J Arthroplasty . 2002;17(4 suppl 1):50-53.
27.
Hangody L.The mosaicplasty technique for osteochondral lesions of the talus . Foot Ankle Clin. 2003;8(2):259-273.
28.
Hangody L., Fules P.Autologous osteochondral mosaicplasty for the treatment of full-thickness defects of weight-bearing joints: ten years of experimental and clinical experience . J Bone Joint Surg Am. 2003;85-A(suppl 2):25-32.
29.
Hangody L., Kish G., Módis L., et al. Mosaicplasty for the treatment of osteochondritis dissecans of the talus: two to seven year results in 36 patients. Foot Ankle Int. 2001;22(7):552-528.
Jakobsen RB , Engebretsen L., Slauterbeck JRAn analysis of the quality of cartilage repair studies. J Bone Joint Surg Am. 2005;87(10):2232-2239.
32.
Knutsen G., Drogset JO, Engebretsen L., et al. A randomized trial comparing autologous chondrocyte implantation with microfracture: findings at five years. J Bone Joint Surg Am. 2007;89(10):2105-2112.
33.
McNickle AG , Provencher MT, Cole BJOverview of existing cartilage repair technology . Sports Med Arthrosc. 2008;16(4):196-201.
34.
Frisbie DD, Oxford JT, Southwood L., et al. Early events in cartilage repair after subchondral bone microfracture . Clin Orthop Relat Res. 2003;407:215-227.
35.
Mithoefer K. , McAdams T., Williams RJ, Kreuz PC, Mandelbaum BRClinical efficacy of the microfracture technique for articular cartilage repair in the knee: an evidence-based systematic analysis . Am J Sports Med. Epub ahead of print, Febuary29, 2009.
36.
Mithoefer K. , Williams RJ III, Warren RF, et al. The microfracture technique for the treatment of articular cartilage lesions in the knee: a prospective cohort study. J Bone Joint Surg Am. 2005;87(9):1911-1920.
37.
Steadman JR , Miller BS, Karas SG, Schlegel TF, Briggs KK, Hawkins RJThe microfracture technique in the treatment of full-thickness chondral lesions of the knee in National Football League players. J Knee Surg. 2003;16(2):83-86.
38.
Barnes CJ, Ferkel RDArthroscopic debridement and drilling of osteochondral lesions of the talus . Foot Ankle Clin. 2003;8(2):243-257.
39.
Bryant DD III, Siegel MGOsteochondritis dissecans of the talus: a new technique for arthroscopic drilling. Arthroscopy. 1993;9(2):238-241.
40.
Kumai T., Takakura Y., Higashiyama I., Tamai S.Arthroscopic drilling for the treatment of osteochondral lesions of the talus . J Bone Joint Surg Am. 1999;81(9):1229-1235.
41.
Lahm A., Erggelet C., Steinwachs M., Reichelt A.Arthroscopic management of osteochondral lesions of the talus: results of drilling and usefulness of magnetic resonance imaging before and after treatment . Arthroscopy. 2000;16(3):299-304.
Takao M., Uchio Y., Kakimaru H., Kumahashi N., Ochi M.Arthroscopic drilling with debridement of remaining cartilage for osteochondral lesions of the talar dome in unstable ankles. Am J Sports Med. 2004;32(2):332-336.
44.
Brown WE, Potter HG, Marx RG, Wickiewicz TL, Warren RFMagnetic resonance imaging appearance of cartilage repair in the knee . Clin Orthop Relat Res. 2004;422:214-223.
45.
Kuo AC, Rodrigo JJ, Reddi AH, Curtiss S., Grotkopp E., Chiu M.Microfracture and bone morphogenetic protein 7 (BMP-7) synergistically stimulate articular cartilage repair. Osteoarthritis Cartilage. 2006;14(11):1126-1135.
46.
Neumann K., Dehne T., Endres M., et al. Chondrogenic differentiation capacity of human mesenchymal progenitor cells derived from subchondral corticospongious bone. J Orthop Res. 2008; 26(11):1449-1456.
47.
Morisset S. , Frisbie DD, Robbins PD, Nixon AJ, McIlwraith CWIL-1ra/IGF-1 gene therapy modulates repair of microfractured chondral defects. Clin Orthop Relat Res . 2007;462:221-228.
48.
Hoemann CD, Sun J., Légaré A., McKee MD, Buschmann MDTissue engineering of cartilage using an injectable and adhesive chitosan-based cell-delivery vehicle. Osteoarthritis Cartilage. 2005;13(4):318-329.
49.
Hoemann CD, Sun J., McKee MD, et al. Chitosan-glycerol phosphate/blood implants elicit hyaline cartilage repair integrated with porous subchondral bone in microdrilled rabbit defects . Osteoarthritis Cartilage. 2007;15(1):78-89.
50.
Wang DA, Varghese S., Sharma B., et al. Multifunctional chondroitin sulphate for cartilage tissue-biomaterial integration. Nat Mater. 2007;6(5):385-392.
51.
Assenmacher JA, Kelikian AS, Gottlob C., Kodros S.Arthroscopically assisted autologous osteochondral transplantation for osteochondral lesions of the talar dome: an MRI and clinical follow-up study. Foot Ankle Int. 2001;22(7):544-551.
52.
Zelent ME, Neese DJOsteochondral autograft transfer of the first metatarsal head: a case report . J Foot Ankle Surg. 2005;44(5):406-411.
53.
Williams RJ III, Dreese JC, Chen CTChondrocyte survival and material properties of hypothermically stored cartilage: an evaluation of tissue used for osteochondral allograft transplantation. Am J Sports Med . 2004;32(1):132-139.
54.
Gross AE, Shasha N., Aubin P.Long-term followup of the use of fresh osteochondral allografts for posttraumatic knee defects. Clin Orthop Relat Res. 2005;435:79-87.
55.
Shasha N., Aubin PP, Cheah HK, Davis AM, Agnidis Z., Gross AELong-term clinical experience with fresh osteochondral allografts for articular knee defects in high demand patients. Cell Tissue Bank. 2002;3(3):175-182.
56.
Vickers S., et al. Effects of a regionally-specific collagen-based implant on repair of osteochondral defects in a caprine model. Paper presented at: International Cartilage Repair Society; 2007; Warsaw, Poland.
57.
Seliktar D., et al. Articular cartilage repair using in situ polymerizable hydrogel implant in osteochondral defects. Paper presented at: International Cartilage Repair Society; 2007; Warsaw, Poland.
58.
Williams RJ , Gamradt SCArticular cartilage repair using a resorbable matrix scaffold. Instr Course Lect. 2008;57:563-571.
59.
Goodman SBThe effects of micromotion and particulate materials on tissue differentiation: bone chamber studies in rabbits. Acta Orthop Scand Suppl. 1994;258:1-43.
60.
Brittberg M. , Lindahl A., Nilsson A., Ohlsson C., Isaksson O., Peterson L.Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation . N Engl J Med. 1994;331(14):889-895.
61.
Knutsen G., Engebretsen L., Ludvigsen TC, et al. Autologous chondrocyte implantation compared with microfracture in the knee: a randomized trial. J Bone Joint Surg Am. 2004;86-A(3):455-464.
62.
Mithofer K. , Minas T., Peterson L., Yeon H., Micheli LJFunctional outcome of knee articular cartilage repair in adolescent athletes. Am J Sports Med. 2005;33(8):1147-1153.
63.
Mithofer K. , Peterson L., Mandelbaum BR, Minas T.Articular cartilage repair in soccer players with autologous chondrocyte transplantation: functional outcome and return to competition. Am J Sports Med. 2005;33(11):1639-1646.
64.
Peterson L. , Brittberg M., Kiviranta I., Akerlund EL, Lindahl A.Autologous chondrocyte transplantation: biomechanics and long-term durability. Am J Sports Med. 2002;30(1):2-12.
65.
Peterson L. , Minas T., Brittberg M., Nilsson A., Sjögren-Jansson E., Lindahl A.Two- to 9-year outcome after autologous chondrocyte transplantation of the knee. Clin Orthop Relat Res. 2000;374:212-234.
66.
Giannini S. , Buda R., Grigolo B., Vannini F.Autologous chondrocyte transplantation in osteochondral lesions of the ankle joint. Foot Ankle Int. 2001;22(6):513-517.
67.
Peterson L. , Minas T., Brittberg M., Lindahl A.Treatment of osteochondritis dissecans of the knee with autologous chondrocyte transplantation: results at two to ten years. J Bone Joint Surg Am. 2003;85-A(suppl 2):17-24.
68.
Whittaker JP , Smith G., Makwana N., et al. Early results of autologous chondrocyte implantation in the talus. J Bone Joint Surg Br. 2005;87(2):179-183.
69.
Giannini S. , Vannini F.Operative treatment of osteochondral lesions of the talar dome: current concepts review. Foot Ankle Int . 2004;25(3):168-175.
70.
Saris DB, Vanlauwe J., Victor J., et al. Characterized chondrocyte implantation results in better structural repair when treating symptomatic cartilage defects of the knee in a randomized controlled trial versus microfracture. Am J Sports Med. 2008;36(2):235-246.
71.
Bartlett W. , Gooding CR, Carrington RW, Skinner JA, Briggs TW, Bentley G.Autologous chondrocyte implantation at the knee using a bilayer collagen membrane with bone graft: a preliminary report . J Bone Joint Surg Br. 2005;87(3):330-332.
72.
Kon E., Delcogliano M., Filardo G., Montaperto C., Marcacci M.Second generation issues in cartilage repair. Sports Med Arthrosc . 2008;16(4):221-229.
73.
Chou CH, Cheng WT, Lin CC, Chang CH, Tsai CC, Lin FHTGF-beta1 immobilized tri-co-polymer for articular cartilage tissue engineering . J Biomed Mater Res B Appl Biomater. 2006 ;77(2):338-348.
74.
Marcacci M. , Berruto M., Brocchetta D., et al. Articular cartilage engineering with Hyalograft C: 3-year clinical results. Clin Orthop Relat Res . 2005;435:96-105.
75.
Marcacci M. , Kon E., Zaffagnini S., et al. Arthroscopic second generation autologous chondrocyte implantation. Knee Surg Sports Traumatol Arthrosc . 2007;15(5):610-619.
76.
Ossendorf C. , Kaps C., Kreuz PC, Burmester GR, Sittinger M., Erggelet C.Treatment of posttraumatic and focal osteoarthritic cartilage defects of the knee with autologous polymer-based three-dimensional chondrocyte grafts: 2-year clinical results. Arthritis Res Ther. 2007;9(2):R41.
77.
Bartlett W. , Skinner JA, Gooding CR, et al. Autologous chondrocyte implantation versus matrix-induced autologous chondrocyte implantation for osteochondral defects of the knee: a prospective, randomised study. J Bone Joint Surg Br. 2005;87(5):640-645.
78.
Kon E., Gobbi A., Filardo G., Delcogliano M., Zaffagnini S., Marcacci M.Arthroscopic second-generation autologous chondrocyte implantation compared with microfracture for chondral lesions of the knee: prospective nonrandomized study at 5 years. Am J Sports Med. 2009;37(1): 33-41.
79.
Lu Y., Dhanaraj S., Wang Z., et al. Minced cartilage without cell culture serves as an effective intraoperative cell source for cartilage repair. J Orthop Res. 2006;24(6): 1261-1270.
80.
Mizuno S., Tateishi T., Ushida T., Glowacki J.Hydrostatic fluid pressure enhances matrix synthesis and accumulation by bovine chondrocytes in three-dimensional culture. J Cell Physiol . 2002;193(3):319-327.
81.
Steinert AF, Noth U., Tuan RSConcepts in gene therapy for cartilage repair. Injury. 2008;39(suppl 1):S97-S113.
82.
Steinert AF, Palmer GD, Pilapil C., Nöth U., Evans CH, Ghivizzani SCEnhanced in vitro chondrogenesis of primary mesenchymal stem cells by combined gene transfer. Tissue Eng Part A.2009;15(5):1127-1139.
83.
Hui JH, Chen F., Thambyah A., Lee EHTreatment of chondral lesions in advanced osteochondritis dissecans: a comparative study of the efficacy of chondrocytes, mesenchymal stem cells, periosteal graft, and mosaicplasty (osteochondral autograft) in animal models . J Pediatr Orthop. 2004;24(4):427-433.
84.
Schade VL, Roukis TSPercutaneous bone marrow aspirate and bone graft harvesting techniques in the lower extremity. Clin Podiatr Med Surg. 2008; 25(4):733-742.
85.
Chong AK, Ang AD, Goh JC, et al. Bone marrow-derived mesenchymal stem cells influence early tendon-healing in a rabbit Achilles tendon model. J Bone Joint Surg Am. 2007;89(1):74-81.
86.
Hernigou P. , Mathieu G., Poignard A., Manicom O., Beaujean F., Rouard H.Percutaneous autologous bone-marrow grafting for nonunions: surgical technique. J Bone Joint Surg Am. 2006;88(suppl 1 pt 2):322-327.