J Knee Surg 2011; 24(3): 159-166
DOI: 10.1055/s-0031-1286052
SPECIAL FOCUS SECTION

© Thieme Medical Publishers

A Military Perspective to Articular Cartilage Defects

CPT Kelly Fitzpatrick1 , Lt Col John M. Tokish1
  • 1Department of Orthopaedics, Tripler Army Medical Center, Honolulu, Hawaii
Further Information

Publication History

Publication Date:
19 August 2011 (online)

ABSTRACT

Articular cartilage injuries present a challenge in terms of definitive treatment in the United States military population. Active duty soldiers' physical demands are unlike the general population in that a military career requires soldiers to maintain a physical activity level similar to that of an athletic population. Current treatment options for the chondral defect include microfracture, osteochondral transplantation, and autologous chondrocyte implantation. These treatment modalities carry specific advantages and disadvantages and must be considered when evaluating and treating patients with chondral injuries. It is unclear which procedure is the best first-line treatment for these injuries, but newer studies are beginning to evaluate these procedures over time and in high demand populations. The purpose of this article is to review current treatment options as they relate to return to full activity of the young “combat athlete.” Results of each treatment option from published data will be compared and reviewed throughout this article.

REFERENCES

  • 1 Linden B. Osteochondritis dissecans of the femoral condyles: a long-term follow-up study.  J Bone Joint Surg Am. 1977;  59 (6) 769-776
  • 2 Messner K, Gillquist J. Cartilage repair. A critical review.  Acta Orthop Scand. 1996;  67 (5) 523-529
  • 3 Cross J. Orthopaedic Impact on Disabling Conditions Resulting from Combat Wounds. Extremity War Injury V: Barriers to Return of Function and Duty. Washington DC; 2010. 
  • 4 Steadman J R, Rodkey W G, Singleton S, Briggs K K. Microfracture technique forfull-thickness chondral defects: Technique and clinical results.  Oper Tech Orthop. 1997;  7 300-304
  • 5 Salter R B, Simmonds D F, Malcolm B W, Rumble E J, MacMichael D, Clements N D. The biological effect of continuous passive motion on the healing of full-thickness defects in articular cartilage. An experimental investigation in the rabbit.  J Bone Joint Surg Am. 1980;  62 (8) 1232-1251
  • 6 Pridie K H. A method of resurfacing osteoarthritic knee joints.  J Bone Joint Surg. 1959;  41B 618-619
  • 7 Mithoefer K, Williams III R J, Warren R F 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
  • 8 Mithoefer K, McAdams T, Williams R J, Kreuz P C, Mandelbaum B R. Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: an evidence-based systematic analysis.  Am J Sports Med. 2009;  37 (10) 2053-2063
  • 9 Namdari S, Baldwin K, Anakwenze O, Park M J, Huffman G R, Sennett B J. Results and performance after microfracture in National Basketball Association athletes.  Am J Sports Med. 2009;  37 (5) 943-948
  • 10 Steadman J R, Miller B S, Karas S G, Schlegel T F, Briggs K K, Hawkins R J. The 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
  • 11 Mithoefer K, Williams III R J, Warren R F, Wickiewicz T L, Marx R G. High-impact athletics after knee articular cartilage repair: a prospective evaluation of the microfracture technique.  Am J Sports Med. 2006;  34 (9) 1413-1418
  • 12 Yamashita F, Sakakida K, Suzu F, Takai S. The transplantation of an autogeneic osteochondral fragment for osteochondritis dissecans of the knee.  Clin Orthop Relat Res. 1985;  201 (201) 43-50
  • 13 Hangody L, Füles 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
  • 14 Chow J C, Hantes M E, Houle J B, Zalavras C G. Arthroscopic autogenous osteochondral transplantation for treating knee cartilage defects: a 2- to 5-year follow-up study.  Arthroscopy. 2004;  20 (7) 681-690
  • 15 Kish G, Módis L, Hangody L. Osteochondral mosaicplasty for the treatment of focal chondral and osteochondral lesions of the knee and talus in the athlete. Rationale, indications, techniques, and results.  Clin Sports Med. 1999;  18 (1) 45-66 vi
  • 16 Lexer E. Substitution of whole or half joints from freshly amputated extremities by free plastics operations.  Surg Gynecol Obstet. 1908;  6 601-607
  • 17 Ohlendorf C, Tomford W W, Mankin H J. Chondrocyte survival in cryopreserved osteochondral articular cartilage.  J Orthop Res. 1996;  14 (3) 413-416
  • 18 Schachar N S, Novak K, Hurtig M et al.. Transplantation of cryopreserved osteochondral Dowel allografts for repair of focal articular defects in an ovine model.  J Orthop Res. 1999;  17 (6) 909-919
  • 19 Tomford W W, Duff G P, Mankin H J. Experimental freeze-preservation of chondrocytes.  Clin Orthop Relat Res. 1985;  197 (197) 11-14
  • 20 Bugbee W D, Convery F R. Osteochondral allograft transplantation.  Clin Sports Med. 1999;  18 (1) 67-75
  • 21 Garrett J C. Fresh osteochondral allografts for treatment of articular defects in osteochondritis dissecans of the lateral femoral condyle in adults.  Clin Orthop Relat Res. 1994;  303 (303) 33-37
  • 22 Ghazavi M T, Pritzker K P, Davis A M, Gross A E. Fresh osteochondral allografts for post-traumatic osteochondral defects of the knee.  J Bone Joint Surg Br. 1997;  79 (6) 1008-1013
  • 23 Gross A E, Shasha N, Aubin P. Long-term followup of the use of fresh osteochondral allografts for posttraumatic knee defects.  Clin Orthop Relat Res. 2005;  435 (435) 79-87
  • 24 Emmerson B C, Görtz S, Jamali A A, Chung C, Amiel D, Bugbee W D. Fresh osteochondral allografting in the treatment of osteochondritis dissecans of the femoral condyle.  Am J Sports Med. 2007;  35 (6) 907-914
  • 25 Scully W, Arrington E, Parada S. Osteochondral allograft transplantation in the knee in the active duty population. Society of Military Orthopaedic Surgeons. Honolulu, HI; 2009. 
  • 26 Grande D A, Pitman M I, Peterson L, Menche D, Klein M. The repair of experimentally produced defects in rabbit articular cartilage by autologous chondrocyte transplantation.  J Orthop Res. 1989;  7 (2) 208-218
  • 27 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
  • 28 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
  • 29 Peterson L, Vasiliadis H S, Brittberg M, Lindahl A. Autologous chondrocyte implantation: a long-term follow-up.  Am J Sports Med. 2010;  38 (6) 1117-1124
  • 30 Peterson L, Brittberg M, Kiviranta I, Akerlund E L, Lindahl A. Autologous chondrocyte transplantation. Biomechanics and long-term durability.  Am J Sports Med. 2002;  30 (1) 2-12
  • 31 Moseley Jr J B, Anderson A F, Browne J E et al.. Long-term durability of autologous chondrocyte implantation: a multicenter, observational study in US patients.  Am J Sports Med. 2010;  38 (2) 238-246
  • 32 Niemeyer P, Köstler W, Salzmann G M, Lenz P, Kreuz P C, Südkamp N P. Autologous chondrocyte implantation for treatment of focal cartilage defects in patients age 40 years and older: A matched-pair analysis with 2-year follow-up.  Am J Sports Med. 2010;  38 (12) 2410-2416
  • 33 Mithöfer K, Peterson L, Mandelbaum B R, 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
  • 34 Della Villa S, Kon E, Filardo G et al.. Does intensive rehabilitation permit early return to sport without compromising the clinical outcome after arthroscopic autologous chondrocyte implantation in highly competitive athletes?.  Am J Sports Med. 2010;  38 (1) 68-77
  • 35 Minas T, Gomoll A H, Rosenberger R, Royce R O, Bryant T. Increased failure rate of autologous chondrocyte implantation after previous treatment with marrow stimulation techniques.  Am J Sports Med. 2009;  37 (5) 902-908
  • 36 Bentley G, Biant L C, Carrington R W et al.. A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee.  J Bone Joint Surg Br. 2003;  85 (2) 223-230
  • 37 Horas U, Pelinkovic D, Herr G, Aigner T, Schnettler R. Autologous chondrocyte implantation and osteochondral cylinder transplantation in cartilage repair of the knee joint. A prospective, comparative trial.  J Bone Joint Surg Am. 2003;  85-A (2) 185-192
  • 38 Knutsen G, Drogset J O, 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
  • 39 Gudas R, Kalesinskas R J, Kimtys V et al.. A prospective randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint in young athletes.  Arthroscopy. 2005;  21 (9) 1066-1075
  • 40 Mithoefer K, Hambly K, Della Villa S, Silvers H, Mandelbaum B R. Return to sports participation after articular cartilage repair in the knee: scientific evidence.  Am J Sports Med. 2009;  37 (Suppl 1) 167S-176S

Lt Col John M TokishM.D. 

Department of Orthopaedics, Tripler Army Medical Center

1 Jarrett White Dr. Honolulu, HI 96859

Email: jtoke95@aol.com

    >