Copyright â Springer - 2014
1: The History of the Treatment of Cartilage Injuries
1.2 Shaving, Abrasion or Debridement of Fibrillated Cartilage
1.3 Drilling, Resection or Abrasion of Subchondral Bone Plate
1.4 Osteochondral Allo- and Autografting Techniques
1.5 Periosteal and Perichondral Resurfacing (Soft Tissue Arthroplasty)
1.6 Chondrogenic Cell Transplantation
1.7 Implantation of Stem Cells
2: Articular Cartilage: Histology and Physiology
2.4 Extracellular Matrix Zone
2.10 Cartilage Regeneration
2.8 Noncollagenous Proteins and Glycoproteins
2.9 Cartilage Degeneration
3: Treatment Algorithm for Articular Cartilage Repair of the Knee: Towards Patient Profiling Using Evidence-Based Tools
3.2 General Indications and Contraindications for Cartilage Repair
3.3 Indicators for Treatment
3.4 Treatment Selection for Patients with Smaller Defects
3.5 Treatment Selection for Patients with Larger Defects
3.6 Treatment Selection for Patients with Defects in the Patellofemoral Joint
3.7 Early Osteoarthritic Defects and Salvage Repair
3.8 Treatment Algorithm: Summarizing the Findings from the Literature
3.9 Addendum: Treatment Selection for (Professional) Athletes
Part II:
Marrow Stimulation Techniques
4: Stimulation Techniques: Microfracturing, Drilling
4.5 Postoperative Treatment
4.12 Amplified Results/Literature
4.13.1 Durability of Microfracture
4.13.2 Quality of Cartilage Repair Tissue Following Microfracture
4.13.3 Effect of Age on the Outcome of Microfracture
4.13.4 Effect of Lesion Location on the Outcome of Microfracture
4.13.5 Effect of Lesion Size on the Outcome of Microfracture
4.13.6 How Important Are Postoperative CPM and Weight Bearing for the Outcome of Microfracture
Part III:
Acellular Matrix Based Cartilage Regeneration Techniques
5: Matrix-Enhanced Microfracture: Autologous Matrix-Induced Chondroneogenesis (AMIC TM)
5.3.1 Chondral Reconstruction
5.3.2 Osteochondral Reconstruction
5.5 Postoperative Follow-Up
6: Autologous Collagen-Induced Chondrogenesis (ACIC)
6.4 Theatre and Patient Setup
6.5.1 Preparation of Atelocollagen Mixture
6.6 Preparation of Chondral Defect for Implantation
6.7 Postoperative Rehabilitation
7.3 Patient Setup and Bone Marrow Concentrate (BMC) Preparation
7.5 Potential Complications and Troubleshooting
7.7 Postoperative Follow-Up
8: MaioRegen: Our Experience
8.2.1 Scaffold Preparation
8.2.2 Composite Characterization and Biological Validation
8.4.3 Surgical Technique [ 19 ]
8.4.4 Postoperative Rehabilitation
8.6 Discussion and Conclusion
9: BST-CarGel đ : An Enhanced Bone Marrow Stimulation Treatment
9.2 BST-CarGel đ Background
9.2.2 Primary Mode of Action
9.3.1 Indications/Contraindications
9.3.2 Concomitant Medications
Lesion Positioning and BST-ưCarGel đ Delivery
9.3.4 Potential Complications and Troubleshooting
9.4 BST-CarGel đ Rehabilitation
9.5 BST-CarGel đ Clinical Experience
9.5.2 BST-CarGel đ Randomized Clinical Trial
Part IV:
Concentrated Cell Based Chondrogenesis
10: Mesenchymal Stem Cell Induced Chondrogenesis (MCIC)
10.2.1 Surgical Technique
10.4 Theatre and Patient Setup
10.5.1 Bone Marrow Harvest and Concentration
10.5.2 Preparation of BMAC and Fibrin Gel (Tissellđ, Baxter, Thetford, UK) Mixture (Fig. 10.10)
10.5.3 Preparation of Chondral Defect for Implantation
10.5.4 Implantation of Graft
10.6 Postoperative Rehabilitation
Part V:
Repair Techniques
11: Surgical Techniques in Cartilage Repair Surgery: Osteochondral Autograft Transfer (OATS, Mosaicplasty)
11.2 Indications and Contraindications for Surgery
11.3.1 Recommendations for Preoperative Preparation
11.3.2 Mosaicplasty Technique
11.3.2.1 Surgical Approach
Portal Selection for Arthroscopic Approach
11.3.2.2 Defect Preparation
11.3.2.4 Implantation of the Grafts: Drill
Dilate
Deliver
11.3.3 Recommendations for Postoperative Care
12: Osteochondral Allograft Transplantation For: Surgical Techniques in Cartilage Repair Surgery
12.1 Principles of the Osteochondral Allografting Technique
12.2 Indications for Osteochondral Allografts
12.3 Preoperative Preparation: Graft Sizing
12.4 Decision Making for Dowel or Shell Technique
12.6 Lesion Inspection and Preparation
12.9 Shell Allograft Technique
12.10 Postoperative Management
12.11 Potential Complications
13: ESSKA Book Series – Techniques in Cartilage Repair Surgery Minced Cartilage: DeNovo and CAIS
13.2.1 DeNovo NT (NT:ISTO, St. Louis, MO)
13.2.2 CAIS (DePuy/Mitek, Raynham, MA)
13.4 Preoperative Planning
13.6.1 Diagnostic Arthroscopy
13.6.3 Defect Preparation
13.7 Potential Complications and Troubleshooting
13.10 Comparison to Other Techniques
13.9 Postoperative Follow-Up
Part VI:
Cultured Cells for Cartilage Tissue Engineering
14: Classical ACI for Chondral and Osteochondral Defects
14.2 Prospective Data and Audit
14.5.2 First Stage: Harvest Biopsy
14.5.3 Second Stage: Cell Implantation
14.6 Preparation of the Defect
14.7 Application of the Chondrogide Patch
14.8 Testing and Cell Insertion
14.10 Osteochondral Defects
15: Gel ACI (GACI): Articular Cartilage Repair Technique
15.2 Indications and Preoperative Planning
15.2.1 Surgical Technique
Biopsy and Chondrocyte Harvest
Transportation of Cultured Cells
In-Theater Mixing Procedure
15.3 Postoperative Rehabilitation
16: A Scaffold-Free Mesenchymal Stem Cells-Based Implant to Repair a Three-Dimensional Chondral Lesion
16.2 Characterization of Cultured Cells Derived from the Human Synovium
16.3 Development of the Basic TEC
16.4 The Basic Human TEC Has Adhesive Properties Which Facilitate Association and Adhesion to Cartilage Matrix
16.5 Chondrogenic Differentiation Capacity of a Human TEC
16.6 A Basic Porcine TEC Can Effectively Repair Chondral Defects In Vivo and Inhibit the Progression of Chondral Defects to Overt Osteoarthritis for a Wide Range of Ages
16.7 The Mechanical Properties of Porcine Chondral Defects Treated with a Porcine-ưDerived TEC Approximates Those of Normal Cartilage 6 Months Postimplantation
16.8 The TEC Derived from Synovial MSCs
16.8.1 The Next-Generation Cell-ưBased Strategy to Regenerate Cartilage
17: Injectable Autologous Bone-Marrow-ưDerived Mesenchymal Stem Cells for Cartilage Repair: The Singapore Technique
17.2 The Proposed Solution
17.3 Patient Selection: Indications and Contraindications
17.4 Preoperative Preparation
17.5 Patient Setup and Surgical Approach
17.6 Arthroscopic Evaluation and Initial Surgical Treatment
17.7 Bone Marrow-Derived Mesenchymal Stem Cell Preparation
17.9 Postoperative Follow-Up
17.11 Initial Results and Future Directions
18: Stem Cell Research in Orthopaedic and Trauma Surgery
18.3 ACIC (Autologous ưCollagen-ưInduced Chondrogenesis)
18.3.1 Surgical Procedure
18.3.2 Injection of Atelocollagen and Fibrin Mixture
18.4 Autologous Chondrocyte Implantation (ACI)
18.4.3 Evaluation of Patient Suitability for Study Participation (Inclusion and Exclusion Criteria)
18.4.4 Surgical Techniques
18.4.5 Cell and Gel Mixture Ex Vivo Evaluation
18.4.6 Gel ACI for RA or OA
19: Knee Cartilage Repair with Hyalograftđ (Hyaff-11 Scaffold with Seeded Autologous Chondrocytes)
19.2 Cell Isolation, Expansion and Scaffold Culture
19.4 The Operative Technique
19.4.1 Harvest of Cartilage for Cell Expansion
19.4.2 Operative Technique for the Knee
Transarthroscopic Technique
Hyalograft with Seeded Chondrocytes + Bone Grafting for Osteochondral Defects
Open Surgery Hyalograft Implantation
19.5 Postoperative Rehabilitation for an Implanted Knee Joint
20: Matrix-Induced Autologous Chondrocyte Implantation
20.1.2 Chondrocyte Implantation
20.3.1 Patient Assessment
20.3.2 Assessment of Injury
20.4 Preoperative Management
20.4.2 Preoperative Physiotherapy
20.5.2 Preparation of the Defect
20.5.3 Implantation of Cultured Chondrocytes
20.6 Post-operative Management
20.7 Post-operative Evaluation
20.7.1 Assessment of the Defect
20.7.2 Assessment of Clinical Outcomes
21: CaReSđ, Cartilage Regeneration System: Autologous Chondrocyte Transplantation in a Collagen Gel
21.3 Surgical Procedures and Techniques
21.3.3 Implantation Procedure
21.3.4 Concomitant Surgery
21.3.6 Postoperative Follow-Up
Part VII:
Cartilage Repair of Other Joints
22: Autologous Matrix-Induced Chondrogenesis (AMIC)-Aided Repair of Osteochondral Lesions of the Talus
22.1 Historical Development
22.4 Preoperative Preparation
22.5 Patient Setup/Patient Positioning
22.10 Comparison to Other Techniques
22.7 Potential Complications and Troubleshooting
22.9 Postoperative Follow-Up
23: Cartilage Repair in the Hip
23.2 Peculiarities Pertinent to the Hip
23.3 Differences with Location in Joints
23.4 Microfracture for Repair of Cartilage in the Hip
23.5 Osteochondral Autograft Transplants in Femoral Head
23.6 Autologous Chondrocyte Implantation in the Hip
23.7 Post-operative Rehabilitation
Part VIII:
Alignment, Stability and Meniscal Replacement
24: High Tibial Osteotomy in Cartilage Repair
24.2 Indications and Contraindications of HTO in Cartilage Repair
24.3.1 Clinical Examination
24.3.2 Preoperative Planning
24.3.4 Positioning of the Patient
24.3.8 Incision and Exposure
24.4.1 Opening the Osteotomy Gap
24.4.2 Postoperative Follow-Up
24.4.3 Complications and Troubleshooting
Alteration of Tibial Slope
Delayed Union, Nonunion, and Loss of Angular Correction
24.5 Adjuvant Tibial Tuberosity Osteotomy (TTO) for the Treatment of Patellofemoral Chondral Ulcer: Technical Details
24.5.2 Patient Selection: Indications and Contraindications
24.5.3 Preoperative Preparation
Examination Under Anesthesia
24.5.9 Post-operative Follow-up
25: Distal Femoral Varus Osteotomy for Correction of Valgus Deformity
25.5 Potential Complications
26: Meniscal Allograft Transplantation
26.2 Patient Selection and Preoperative Evaluation
26.2.3 Clinical Evaluation
26.2.4 Radiological Evaluation
26.3.1 Graft Preservation
Deep-Frozen (Fresh-Frozen)
Anthropometric-Based Sizing
Double Bone-Plug Technique
Trough (Bridge-in-ưSlot) Technique
26.4.2 Arthroscopically Assisted
Double Bone-Plug Technique
Trough (Bridge-in-ưSlot) Technique
26.4.3 Arthroscopic Techniques
26.5 Associated Procedures
26.5.2 MAT and Cartilage Treatment
26.5.3 MAT and Osteotomies
26.7 Risks and Complication
26.7.1 Immunological Reaction
26.7.2 Disease Transmission
Uncorrect Position of the Graft
Uncorrect Size of the Graft
Part IX:
ation, Pain Management and Follow-Up
27: Rehabilitation After Cartilage Repair Surgery: Part II Practical Issues
27.3 Rehabilitation Phase (I): Protection Phase
27.3.1 Restoring Joint Homeostasis
27.3.2 Improvement of Range of Motion
27.3.3 Improvement of Neuromuscular Function
27.3.4 Weight Bearing and Gait Training
27.4 Rehabilitation Phase II: Transitional Phase
27.4.1 Improvement in Range of Motion
27.4.2 Improvement of Sensomotoric Function, Endurance, and Strength
27.5 Rehabilitation Phase III: Remodeling Phase
27.5.1 Improvement in Range of Motion
27.5.2 Improvement of Sensomotoric Function, Endurance, and Strength
27.6 Rehabilitation Phase IV: Maturation (Sports-Specific Recovery)
28.1.2 Viscosupplementation
28.2 Platelet-Rich Plasma
28.2.2 PRP and Articular Cartilage Injury
28.2.3 PRP and Osteoarthritis
28.4 Bone Marrow Aspirate Concentrate
29: Anaesthesia in Cartilage Repair Surgery
29.3 Regional Anaesthesia
29.3.1 Epidural Anaesthesia
29.3.2 Spinal Anaesthesia
29.3.3 Spinal Anaesthesia for Ambulatory Surgery
29.3.4 Peripheral Nerve Blockade
29.3.5 Continuous Femoral Nerve Blockade
29.4 Carbon Dioxide Arthroscopy
30: Preoperative and Postoperative Radiological Assessment
30.2 Basic Requirements and Cartilage-Specific Sequences
30.2.3 Preoperative Assessment
30.3 Cartilage Classification Systems Based on Morphology
30.4.1 Delayed Gadolinium-ưEnhanced MRI of Cartilage (dGEMRIC)
30.4.3 GAG-Specific Chemical Exchange Saturation Transfer (gagCEST)
31: The Future of Cartilage Repair Surgery
31.2 Surgical Options for Cartilage Repair
31.3 Mesenchymal Stem Cells
31.4 One-Step Surgery: Bone Marrow Aspirate Concentrate and a Collagen I/III-Based Matrix
31.4.1 Surgical Technique
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