The Rheumatologist
COVID-19 NewsACR Convergence
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Axial Spondyloarthritis Resource Center
    • Gout Resource Center
    • Psoriatic Arthritis Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
    • Interprofessional Perspective
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Gout Resource Center
      • Axial Spondyloarthritis Resource Center
      • Psoriatic Arthritis
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / Basics of Biologic Joint Reconstruction

Basics of Biologic Joint Reconstruction

April 6, 2012 • By Andreas Gomoll, MD

  • Tweet
  • Email
Print-Friendly Version / Save PDF
The first stages of one method to reconstruct the cartilage in a damaged knee joint. Here, chondrocytes are removed from an undamaged area (left side joint) and placed in a cell culture bottle (right). This will produce a vial of millions of cartilage cells (lower right) to be injected into the damaged area (right side joint).

Articular cartilage defects are common, being encountered in more than half of all knee arthroscopies.1 While not all defects are symptomatic, those that are can cause disability comparable to that seen in patients awaiting knee replacement for advanced osteoarthritis.2 Early attempts at cartilage repair tended to focus on the defect itself, often disregarding articular comorbidities, such as malalignment or meniscal deficiency that were the root cause for the development of cartilage damage in the first place. Not surprisingly, early reports of cartilage repair were disappointing; for example, Brittberg reported good outcomes in only two of seven patients with autologous chondrocyte implantation (ACI) to the patella.3 In contrast to these disappointing early results, more recent studies have shown success in more than 70% of patients treated with patellar ACI.4-6 This substantial improvement has been attributed to the increased recognition and treatment of articular comorbidities concurrently with cartilage repair in a process termed biologic joint reconstruction. While many of the surgical procedures involved are technically challenging, there is wide consensus that the most challenging aspect of this field remains in correctly identifying the appropriate surgery for each patient’s problem.

You Might Also Like
  • Can Nasal Tissue Be Used to Repair a Damaged Knee Joint?
  • New Methodology to Improve Cartilage Repair
  • Post-Traumatic Osteoarthritis: Managing OA That Develops After Joint Injuries & Reconstructive Surgery
Explore This Issue
April 2012

Rationale for Biologic Joint Reconstruction

Knee replacement provides good pain relief with a relatively high patient satisfaction, ranging from 73% to 85%.7,8 Joint registries and large cohorts have demonstrated 10-year survival rates of 80% to 90% for total knee replacements.9,10 However, the majority of these studies were conducted in older patients, ranging in age from the late 60s to early 80s. Younger patients are less satisfied with the outcome and also demonstrate higher implant failure rates, with a three-year revision rate of 3% reported in patients younger than 55; only 50% of patients younger than 40 demonstrated either good or excellent Knee Society function scores following a total knee replacement, and the revision rate was 12.5% at eight years.11-13 These young patients will likely require multiple revision surgeries during their lifetime and these procedures result in progressively compromised outcomes.14,15 It therefore appears reasonable to attempt delaying arthroplasty as long as possible in young patients through early intervention to normalize the biomechanical environment and repair cartilage defects that have already developed.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

Diagnosis of Cartilage Defects

Symptomatic cartilage defects typically present with activity-related joint pain referable to the respective compartment (medial, lateral, or patellofemoral). Diffuse pain of the entire joint is atypical and should raise concerns for either more advanced tricompartmental osteoarthritis or other processes not generally amenable to cartilage repair. Swelling and effusion are seen especially with trochlear defects. Clicking and popping is a common, nonspecific joint complaint even in structurally sound knees, but can be associated with larger defects.

Pages: 1 2 3 4 5 6 7 | Single Page

Filed Under: Conditions, Osteoarthritis Tagged With: bone, cartilage repair, imaging, joint reconstruction, knee, Osteoarthritis, patient care, radiograph, rheumatologistIssue: April 2012

You Might Also Like:
  • Can Nasal Tissue Be Used to Repair a Damaged Knee Joint?
  • New Methodology to Improve Cartilage Repair
  • Post-Traumatic Osteoarthritis: Managing OA That Develops After Joint Injuries & Reconstructive Surgery
  • Mesenchymal Stem Cell Therapy May Help Slow, Repair Degenerative Signs of Osteoarthritis, Musculoskeletal Disease

Simple Tasks

Learn more about the ACR’s public awareness campaign and how you can get involved. Help increase visibility of rheumatic diseases and decrease the number of people left untreated.

Visit the Simple Tasks site »

Rheumatology Research Foundation

The Foundation is the largest private funding source for rheumatology research and training in the U.S.

Learn more »

ACR Convergence

Don’t miss rheumatology’s premier scientific meeting for anyone involved in research or the delivery of rheumatologic care or services.

Visit the ACR Convergence site »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use / Cookie Preferences

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2023 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)