Treatment for Large or Chronic Cartilage Tears of the KneeCartilage tears in the knee are no longer just removed. Now they are repaired to prevent osteoarthritis later. There are at least a half dozen ways to repair cartilage injuries. This study compares the results for two methods used: debridement versus autologous chondrocyte implantation (ACI). All patients had full-thickness cartilage tears at the end of the femur (thigh bone).
Debridement works well for small cartilage tears. The surgeon carefully scrapes away any loose fragments or flaps of cartilage. The goal is to get back to a smooth, seamless interface between cartilage and bone.
ACI involves removing cartilage cells and growing more of them in a laboratory. The new cells are injected into the defect in the damaged cartilage. Any other repairs needed of nearby ligaments or meniscus were made at the same time.
Results were measured in terms of pain, swelling, and function for three years. Researchers made note if the patients reported the leg giving way either partially or fully. Anyone having a second operation was also reported.
The authors report both groups were better during the follow-up visits. The ACI group had more function and fewer symptoms when compared to the debridement group. They found the type of defect affected the outcomes for the debridement group only. Failure rate was equal between the two groups.
This first study comparing ACI and debridement showed ACI to be the better treatment. It may be the optimal treatment for large or chronic cartilage defects.
Freddie H. Fu, MD, et al. Autologous Chondrocyte Implantation Versus Debridement for Treatment of Full-Thickness Chondral Defects of the Knee. In The American Journal of Sports Medicine. November 2005. Vol. 33. No. 11. Pp. 1658-1666.
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