[Repair of cartilage defects. Technical aspects]

Efficacious treatment of chondral and osteochondral defects of the weight bearing surfaces represents a real challenge for the orthopaedic surgeon. Treatment options for full thickness cartilage defects are discussed in this paper. Poor biomechanical characteristics of the reparative fibrocartilage promoted by "traditional resurfacing techniques" provide only moderate clinical outcome in the treatment of such lesions. During the last decade several new efforts have been expressed to provide a hyaline or hyaline-like gliding surface for a full thickness defected area on the weight bearing surface. Among several surgical procedures, autologous osteochondral transplantation methods, including osteochondral mosaicplasty, chondrocyte transplantation, periosteal and perichondrial resurfacement and allograft transplantation are the favoured "new methods". Experimental background, operative techniques and clinical results of these new procedures are detailed in this overview. According to the early and medium term experiences of these methods it seems that a hyaline or hyaline-like resurfacement of the defected area can provide a more durable gliding surface and a better clinical outcome than the so called "traditional resurfacing techniques". Autologous osteochondral mosaicplasty--as an easy, one-step procedure, providing a relatively quick rehabilitation--can be an alternative in the treatment of small and medium sized lesions. Excellent clinical outcome, low costs of the treatment and short rehabilitation time represent the main advantages of this method. Autologous chondrocyte transplantation seems to be a promising option in the treatment of larger full thickness defects but requires relatively expensive two-step procedure and longer rehabilitation period. Both of the above mentioned techniques have femoral, tibial, patellofemoral and talar applications as well. According to the present recommendations transplantation of osteochondral allografts can be indicated at massive osteochondral lesions. There are less experiences with the clinical use of periosteal and perichondrial resurfacing techniques and biomaterials. Beside the promising early and medium term results of these methods the authors express that a successful treatment of the full-thickness cartilage damages of the weight bearing surfaces depends not only the way of the cartilage repair but on the treatment of the underlying cause as well. According to this statement for an effective treatment of full thickness defects on the weight bearing surfaces requires careful patient selection, complex operative plan and well organized treatment course.