Surgical treatment of the knee joint for chondral defects and a new approach to the role and place of mosaic autochondroplasty

Abstract

The review article presents the analysis of current organ-preserving surgical treatment methods for chondral defects of the knee joint from the standpoint of their pathogenesis. We systematized and provided comparative characteristics of the methods of joint-preserving surgical treatment of patients of this category with a critical analysis of various types of operations used for full-thickness and penetrating hyaline cartilage defects. Mosaic chondroplasty, one of the leading methods of surgical treatment for III- and IV-degrees defects (according to the ICRS classification), was considered in detail. The indications, contraindications and conditions for performing mosaic autoplasty of the articular surfaces of the knee joint were analyzed using the historical retrospective and the results of current research. We outlined several debatable provisions and problems of using the classical version of mosaic chondroplasty in case of destructive-dystrophic genesis of the osteochondral defect. The dogmatic approaches to chondroplasty were raised for discussion, as we consider them requiring critical revision. The authors presented a detailed description of the developed new methods of mosaic chondroplasty relying on the current understanding of the pathogenesis of the knee osteoarthritis and osteonecrosis, as well as the role of the subchondral bone in the development of both these conditions and associated articular cartilage defects. The surgical instruments developed by the authors for the new methods of chondroplasty were described.

Keywords

• osteoarthritis
• hyaline cartilage
• cartilage defect
• knee joint
• chondroplasty
• mosaic chondroplasty