Cartilage Repair
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Therapy Methods: Non-Implantation
Cartilage Shaving or Debridement (9):
Cartilage shaving has been shown to be the most popular method of treatment for cartilage tears and deterioration over the last 20 years. This method includes the use of arthroscopic scopes and a small arthroscopic blade device. A surgeon will maneuver through the shoulder joint using the arthroscopic blade to smoothen the frayed edges of the articular cartilage tear. The goal of this technique is to reduce friction and thus inflammation within the joint in order to relieve pain and swelling. Shaving allows for return to sports for althetes in 4 to 6 months depending on the magnitude of the dissorder. The major dissadvantage of this current therapy is the high rate of reinjury due to instability of the joint after cartilage damage and removal. Optimally a therapy is needed that replaces the cartilage that is smoothened.
For more information see: http://orthoinfo.aaos.org
Microfracture or Abrasion (9, 10)
Microfracture healing of cartilage utilizes the bones ability to remodel itself and to differentiate into morphologically similar cartilage cells that infiltrate the repair site. This technique is most commonly utilized for patients with full thickness cartilage defects in knees rather than shoulders. The surgeon perforates, scores, or picks at the surface of the bone under the cartilage damage location until bleeding of the bone occurs. Depth of the groove should exceed that of the calcified cartilage layer. Disruption of the bone vasculature will recruit blood clotting and lead to scar cartilage formation. Although the scar cartilage, fibrocartilage, is functional within the joints the remodeled tissue is not hyaline cartilage and therefore may not have the same durability and strength of the original cartilage that existed before injury. For competitive athletes the scar cartilage restricts mobility, can deteriorate more rapidly, and may lead to reinjury associated with continued stress. Therefore a better hyaline-morphological cartilage is necessary for complete recovery of athletic performance.
Created by: Blair Smith, Connie Lee, Daniel Solomon, Matthew Whitson and Stephanie Chang
Date last modified: 5/2/2004