Abstract
Cartilage deficiency has increasingly been a consideration for non-arthroplasty approaches – particularly for smaller, limited defects.
Initially, simple debridement was advocated by Pridie and subsequently by the late John Insall, with modest results and rarely regeneration of a joint space. Subsequently, articular grafting with plugs was suggested by Mueller and later on, Hangody. Mosaicplasty has been used by many for smaller defects of 1–2 cm and by a few with multiple grafts for large defects. Problems concern the source and the technique itself, since it is difficult to achieve a smooth configuration.
Presently, I utilise micro fracture for small < 2 cm defects in active patients. If there is bone loss then a mosaic is considered. Larger defects are managed with cell cultured chrondrocytes. If the bone loss is significant an allograft may be utilised. Micro fracture, if the postoperative protocol is carefully followed, appears to help ~75% of patients. All cellular techniques as described by Lars Peteson claim 80–85% success in the short term. Our own results are more in the 50% range. Younger, active patients with defects of 2 x 2 or larger may be candidates for ACI treatment. Our average defect size is ~460 mm2. Our major problem has consisted of periosteum over-growth in about 25% of our patients. Using thin periosteum and good surgical technique may decrease this problem.
The abstracts were prepared by Mrs Dorothy L. Granchi, Course Coordinator. Correspondence should be addressed to her at PMB 295, 8000 Plaza Boulevard, Mentor, Ohio 44060, USA.
