Cartilage Injury and Treatment: a Human Perspective

Prevalence of cartilage injury and its lack of an inherent response to heal has lead to a dilemma regarding current treatment protocols. Surgical procedures designed to treat focal chondral injuries are evolving in the human population and are supported by the basic science principles of cartilage physiology and known response to injury. Curl et al retrospectively reviewed 31, 516 knee arthroscopies of patients in all age groups and reported 19,827 chondral lesions (63%), with a mean of 2.7 injuries per knee. While some of these lesions are clinically asymptomatic, the International Cartilage Repair Society (ICRS) estimates that 11% of these lesions in a age cohort averaging 35 years, would befit from surgical intervention. The first arthroscopic treatments for chondral injuries in the human population focused on the mechanical effects of these injuries , with a surgical goal to debride the cartilage lesion reducing both the mechanical effects and its associated inflammation. As understanding of these injuries has evolved, so have the treatments . Treatment goals have escalated to not only decreasing the current level symptoms, but have expanded to attempt to regenerate the chondral surface that has been injured. Current techniques can be separated into marrow stimulating techniques, osteochondral grafting , and cartilage transplantation of cell based technologies. Decisions regarding these different options are based on lesion size, depth, and location of the injury within the knee. Importance of addressing the non-cartilaginous injuries in the knee including both ligaments and menisci, as well as assymetry in limb alignment are crucial for success in treating these injuries.