Techniques in Cartilage Repair Surgery

381 Pages·2014·18.86 MB·English

by  A. Ananthram Shetty, Seok-Jung Kim, Norimasa Nakamura, Mats Brittberg (eds.)

A. Ananthram Shetty
Seok-Jung Kim
Norimasa Nakamura
Mats Brittberg
Editors
Techniques in
Cartilage Repair
Surgery
123
Techniques in Cartilage Repair Surgery

Asode Ananthram Shetty
Seok-Jung K im (cid:129) N orimasa Nakamura
Mats Brittberg
Editors
Techniques in Cartilage
Repair Surgery
Editors
Asode Ananthram Shetty, MD, PhD, Norimasa Nakamura, MD, PhD
MCh, FRCS Ed., FRCS Eng., Institute for Medical Science in Sports
FRCS Orth Osaka Health Science University
Department of Minimally Invasive Osaka
Surgery, Faculty of Health Japan
and Social Sciences
Canterbury Christ Church University Center for Advanced Medical
Chatham Maritime Engineering and Informatics
Kent , UK Osaka University
Suita
Faculty of Stem Cell Research
Osaka
and Regenerative Medicine
Japan
NITTE University
Mangalore , India
Mats Brittberg, MD, PhD
Cartilage Research Unit
Seok-Jung Kim, MD, PhD, FRCS
Department of Orthopaedic
Department of Orthopaedic Surgery
University of Gothenburg
Uijeongbu St. Mary’s Hospital
Kungsbacka
College of Medicine
Sweden
The Catholic University of Korea
Gyeonggi-do
Region Halland Orthopaedics
Korea, Republic of (South Korea)
Kungsbacka Hospital
Faculty of Stem Cell Research Kungsbacka
and Regenerative Medicine Sweden
NITTE University
Mangalore , India
ESSKA ASBL
Centre Médical
Fondation Norbert Metz
76, rue d’Eich
1460 Luxembourg
Luxembourg
ISBN 978-3-642-41920-1 ISBN 978-3-642-41921-8 (eBook)
DOI 10.1007/978-3-642-41921-8
Springer Heidelberg New York Dordrecht London
Library of Congress Control Number: 2014934310
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Foreword
I t is a privilege for me to write the Foreword for this excellent text which cov-
ers all current techniques for repair of articular cartilage. A great deal has
happened since we fi rst described successful transplantation of viable chon-
drocytes into joint surfaces of animals with normal and papain arthritic joints
in 1971. This laid the foundations of the present-day widespread acknowl-
edgement of the requirement for this repair and also the application of such
cellular techniques to the human patient. After some years of experimenting
with various matrices to support the formation of hyaline cartilage, Brittberg
et al. published the pivotal report of the results of isolated articular chondro-
cyte grafts in human knees which led to the development of ACI (autologous
chondrocyte implantation) and many other studies over the years involving
various methods to regenerate the unique hyaline cartilage structure of joints
after the loss of osteochondral and chondral fragments.
I n essence, the vital question is whether cells from the subchondral bone
marrow or elsewhere in the haematopoietic system can transform into hyaline
cartilage permanently or whether transplantation of differentiated chondro-
cytes is necessary to achieve this. Persuasive reports on microfracture and
stem cell grafts suggest, but have not proven, this despite genetic manipula-
tion of the cells or stimulation of cell division differentiation and proliferation
by growth factors. To date, the longest and largest follow-up of successful
results for treatment of osteochondral defects has been with ACI and MACI
(matrix assisted chondrocyte implantation). It appears defi nite that isolated
cells, free from matrix, are essential for perfect cartilage regeneration.
However, no method has yet been shown to be effective for a prolonged
period of time or in established osteoarthritis.
N evertheless, the ACI/MACI method is two-stage, time consuming and
expensive, and involves two operations with a long rehabilitation period.
Clearly, a one-stage procedure with rapid rehabilitation is required so that
overall the treatment is quicker, cheaper and as effective as ACI/MACI.
T his excellent book, with its internationally famous faculty, addresses all
these problems, describing in detail the current techniques, the pros and cons
of each method, accompanied by visionary theories for the future. Thus the
basic science, the experimental and the clinical results of the whole range of
methods available, is covered. The long-term goal is not only the curing of
v
vi Foreword
pain and healing of acute osteochondral injuries, but the prevention of osteo-
arthritis which affects 50 % of the population over 60 in the Western world
and is a major cause of disability and healthcare expenditure for the future.
This book provides many of the clues and hopes for that future.
London, UK George Bentley, MB, ChM, DSc,
FRCS, FRCS(E), FMedSci
Pref ace
It is 55 years since Pridie described the drilling technique for the treatment of
cartilage defects and 26 years since the fi rst human chondrocyte implantation
was done. Yet we are still looking for the perfect cartilage repair and regen-
eration method. However, when you realise that cartilage takes over 20 years
to mature into adult cartilage tissue, you begin to appreciate that cartilage
treatment is indeed a diffi cult task.
There is no single treatment for all types of cartilage injuries. First of all,
we need to defi ne what a local cartilage defect is, as opposed to an osteoar-
thritic lesion. Also, where does the transition begin when we have pre-osteo-
arthritic cartilage? Secondly, is it possible to use only intrinsic derived repairs
with or without augmentations with scaffolds or should we also use extrinsic
repairs with manipulated cells to improve the repair? Thirdly, do we need to
have a different philosophy when treating other joint besides the most treated
joint, the knee joint?
T hese are the questions that this book tries to answer in the different chap-
ters: from the histology and biology of cartilage repair with different biologi-
cal repair alternatives available today. Finally, but not least, the extremely
important post-operative rehabilitation is also presented.
U nfortunately, we do not have a perfect regeneration solution in this book,
but there are several interesting tools in the cartilage toolbox that are put for-
ward in the different chapters.
After reading this book, we hope that you can feel more comfortable when
treating your future patients with cartilage defects and be able to offer the
patient a larger number of alternatives for size, location and quality of sur-
rounding cartilage.
Each chapter has been edited by a specialist who has experience and exper-
tise in different types of cartilage repair, cartilage radiology and cartilage
repair rehabilitation. All the described knowledge in this book will help sur-
geons and others involved in cartilage repair to take better care of their patients.
Hopefully this will benefi t the patient with much improved treatment and care.
On behalf of the editors,
Kungsbacka, Sweden Mats Brittberg, MD, PhD
vii

Contents
Part I Introduction
1 The History of the Treatment of Cartilage Injuries . . . . . . . . . 3
Mats Brittberg
2 Articular Cartilage: Histology and Physiology . . . . . . . . . . . . 17
Chan Kwon Jung
3 Treatment Algorithm for Articular Cartilage
Repair of the Knee: Towards Patient Profi ling
Using Evidence-Based Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Tommy S. de Windt and Daniel B.F. Saris
Part II Marrow Stimulation Techniques
4 Stimulation Techniques: Microfracturing, Drilling . . . . . . . . . 35
Christoph Erggelet
Part III Acellular Matrix Based Cartilage Regeneration Techniques
5 Matrix-Enhanced Microfracture: Autologous Matrix-Induced
Chondroneogenesis (AMICTM) . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Matthias Reinhard Steinwachs,
B. Waibl, and M. Mumme
6 Autologous Collagen-Induced Chondrogenesis (ACIC™) . . . 59
Asode Ananthram Shetty, Seok-Jung Kim,
and Vishvas A. Shetty
7 TruFit® . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Richard W. Kang, Richard Ma, Delia A. Pais,
and Riley J. Williams III
8 MaioRegen: Our Experience . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Elizaveta Kon, Francesco Perdisa, Giuseppe Filardo,
and Maurilio Marcacci
9 BST-CarGel®: An Enhanced Bone Marrow
Stimulation Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Alberto Restrepo, Stéphane Méthot,
William D. Stanish, and Matthew S. Shive
ix