Cartilage Repair in the Knee: Part IV

With all journeys, there is some trepidation during the planning process, some tediousness during the trek, and then satisfaction upon completion followed by some sadness that the journey is over. That is the case with this four-part series on cartilage repair in the knee. This fourth and final issue will complete what has become a very comprehensive overview of the current status of cartilage restoration from basic science to clinical applications and clinical outcomes.

This fourth issue looks ahead at new challenges. Dhollander and the Verdonk team have prepared an extensive well-annotated catalog of all current scaffold applications both in the laboratory and in the clinical setting: ranging from scaffold-only to scaffold plus cells to three-dimensional osteochondral constructs. O'Connell, backed by the longstanding work of Hung, Cook, and Ateshian, gives us a peek into the intricacies and barriers to producing a biologic knee replacement. As knee surgeons, you know that cartilage repair outcomes are often focused on second-look, MRI, or patient reported outcomes. Quatman, Harris, and Hewett focus on biomechanical outcomes noting the paucity of high-level evidence-based literature, specifically regarding strength and gait, and how these outcomes are interrelated with optimal postoperative management. Surgeons understand the concept that we are “planting the garden” with surgical implantation and that proper rehabilitation is crucial to allow the “garden of cartilage” to grow and flourish. Stone and Schaal review the evidence-based medicine approach to this often empiric area of cartilage restoration.

We both have enjoyed this journey with you. We hope you found the information as exciting as we did during the editing process and that you can use these articles as a source of valuable reference material in the future. We would like to thank our authors for their thoroughness and well written manuscripts, Jim Stannard as Editor-in-Chief who gave us a great mission and kept us on track, and David Stewart at the publisher whose goal throughout this process was a polished and useful end result.