The Effectiveness of Various Surgical Techniques in the Treatment of Local Knee Cartilage Lesions (Review)

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Abstract

Introduction. To restore the knee local cartilage lesions, a large number of alternative surgical techniques are used in clinical practice: isolated debridement of the lesion area, chondrogenesis stimulation, mosaic osteochondral grafting, cell technologies, collagen membranes (matrices), and a combination of the above methods. The purpose of this article was to compare the effectiveness of various surgical methods of treating patients with local cartilage lesions of the femur based on analysis of relevant publications. Materials and Methods. The review included 85 publications of domestic and foreign authors within 2005 to 2020. The search was carried out in electronic scientific databases PubMed and eLIBRARy. Results. The medium and long term outcomes of debridement and/or various options of chondrogenesis stimulating, despite their wide popularity, in terms of clinical, radiological, and histological indicators, are inferior to all other surgical techniques. Mosaic osteochondral auto- and/or allografting, as well as transplantation of autologous chondrocytes culture with a collagen membrane, are characterized by the best 15 to 20-year outcomes, allowing most patients to maintain the same level of activity as before the lesion occurred. The combination of matrices with other cellular products or microfracturing shows similar medium-term results, but it long-term efficacy remains unknown. Conclusion. The use of debridement and/or chondrogenesis stimulation should be limited to minimal defects. From both a clinical and an economic point of view, mosaic osteochondral grafting is the optimal method for the treatment of knee local cartilage lesions with an area up to 4 to 6 cm2 . The combination of membranes with various cellular products or microfracturing is indicated in case of extensive local cartilage lesions or if mosaic osteochondral grafting is not appropriate.

About the authors

T. A. Kulyaba

Vreden National Medical Research Center of Traumatology and Orthopaedics

Email: fake@neicon.ru
ORCID iD: 0000-0003-3175-4756

Taras A. Kulyaba — Dr. Sci. (Med.), Head of the Knee Pathology Department

St. Petersburg

Russian Federation

S. A. Bantser

Vreden National Medical Research Center of Traumatology and Orthopaedics

Author for correspondence.
Email: serg249_spb@mail.ru
ORCID iD: 0000-0002-7291-7032

Sergei A. Bantser — Cand. Sci. (Med.), Lecturer, Chair of Traumatology and Orthopedics

St. Petersburg

Russian Federation

P. A. Trachuk

Pavlov First Saint-Petersburg State Medical University

Email: fake@neicon.ru

Pavel A. Trachuk – Doctor

St. Petersburg

Russian Federation

T. N. Vorontsova

Vreden National Medical Research Center of Traumatology and Orthopaedics

Email: fake@neicon.ru
ORCID iD: 0000-0002-4594-6655

Tatyana N. Vorontsova — Dr. Sci. (Med.), Head of Organization and Methodological Department

St. Petersburg

Russian Federation

N. N. Kornilov

Vreden National Medical Research Center of Traumatology and Orthopaedics; Mechnikov North-Western State Medical University

Email: fake@neicon.ru
ORCID iD: 0000-0001-6905-7900

Nikolai N. Kornilov — Dr. Sci. (Med.), Professor, Chair of Traumatology and Orthopedics, Head of Knee Surgery Department, Vreden National Medical Research Center of Traumatology and Orthopedics; Assistant Professor, Department of Traumatology and Orthopedics, Mechnikov North-Western State Medical University

St. Petersburg

Russian Federation

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