ISSN:1062-8592    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The repair of articular cartilage is an area of orthopedic research that has seen explosive growth over the past ten years. Researchers who had previously disregarded cartilage repair because of its poor intrinsic reparative capability have changed their outlook with the advent of new technologies. Our review examines the damage of cartilage and its response on a cellular level. There is an overview of some new methods that are being used to modulate the repair of articular cartilage through different perioperative techniques, the use of gene therapy, utilization of various growth factors such as transforming growth factor-beta, insulin-like growth factor, and bone-morphogenic proteins; also the use of new bioactive materials such as chyrsalin, platelet rich plasma, and processed marrow is reviewed. We describe the different types of scaffolds being studied. In conclusion we examine issues that will be important for future study such as the use of proper in vivo models and further discuss some of the more controversial areas of research such as the use of hyaluronic acid, postoperative immobilization, and careful retention of the subchondral plate for successful outcomes.

ISSN:1062-8592    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

MRI has the potential to provide information regarding the molecular state of cartilage in both bench and clinical studies. MRI indices of cartilage collagen and glycosaminoglycan (GAG) are both potentially available, and a combination of techniques will most likely provide a fuller assessment of cartilage state than either alone. As a paradigm of the type of information available from MRI, the dGEMRIC technique, which provides a measure of GAG distribution, is reviewed in this article. dGEMRIC demonstrates good correlations with known biochemical and biomechanical properties of the tissue. Furthermore, the dGEMRIC index demonstrates measurable and reproducible changes with physiologic and pathologic processes in vitro and in vivo, opening the possibility for studies of molecular effects of disease progression and therapeutic interventions longitudinally in living cartilage. With continued development and with added insight from pilot clinical studies, these or related methods are on the horizon for customary use.

ISSN:1062-8592    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Most clinicians treating focal articular cartilage lesions in the knee will be faced with the challenge of deciding which lesions should be treated and which procedure should be selected. Furthermore, questions may arise as to when surgery should be performed and if asymptomatic lesions should be operated on. Multiple surgical techniques have been reported and continue to be refined as evolving technologies, equipment, and approaches expand. The unpredictable nature and variable presentation of articular cartilage pathology results in numerous clinical scenarios. An individualized approach to each case requires sound judgment to appropriately counsel patients about the type and timing of treatment. Indications are reviewed including current surgical options that may be defined as first line versus second line or advanced techniques. The various surgical options are discussed and outlined to highlight their advantages and disadvantages. A clinical practice guideline algorithm is described.

ISSN:1062-8592    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Future trends in the treatment of articular cartilage defects will focus upon improved understanding of chondrocyte biology, sophisticated and early diagnosis of articular cartilage injury, and functional tissue engineering. Chondrocyte resuscitation following mechanical injury may assist in preventing proteoglycan loss leading to structural breakdown. Reconstruction with tissue engineering technology will add further options and techniques for larger symptomatic defects. These new technologies must be capable of generating articular cartilage that is both histomorphologically and biomechanically similar to normal articular cartilage. New imaging methods permitting nondestructive assessment of the articular cartilage micro-architecture and metabolic viability will assist in earlier diagnosis of injured articular cartilage. These new technologies can then be used for controlled and randomized follow-up evaluations of cartilage treatment modalities.

ISSN:1062-8592    

出版商:OVID    

年代:2003

数据来源: OVID