REPARATIVE METHODS OF SURGICAL TREATMENT FOR DEFECTS IN KNEE CARTILAGE
Kharkiv National Medical University, Ukraine
Local damage of the cartilage knee is violation of the integrity of cartilage covering mainly in one department, which arise as a result of injuries and illnesses. The methods of reparative treatment of local cartilage knee defects are abrasive сhondroplastiс, microfracturization of the defect bed, subchondral tunneling aimed to stimulate chondrogenesis due to the release of pluripotent bone marrow stem cells of mesenchymal origin. The purpose of the work was to substantiate experimentally and clinically the optimal reparative surgical method of treatment of hyaline cartilage defects. To study the mechanisms of reparative chondrogenesis against a background of chondromalacia of the articular cartilage immunohistochemical study of 45 adult male rats was performed. Clinical material included 20 patients with chondromalacia of the articular cartilage of the knee joint of grade 3−4 by R. Outerbridge (1961), which were performed subchondral tunneling of the defect bed, clinical group 1. Twenty−one patients underwent a deep tunneling of the cartilage defect, clinical group 2. Bone marrow stem cells with subchondral tunneling of the zone of chondromalacia produce a few clones of proliferating chondroblasts, which migrate into the deeper layer of cartilage plates, dividing and differentiating into chondrocytes. Formation of through «tunnel» in the medullary cavity provides a mass migration to the cartilage of dividing cells, bone marrow−derived stem cells. The outcomes in clinical group 2 was significantly better. Reparative surgical technique for treatment of local cartilage defects of the knee (deep tunneling to the medullary cavity) is promising.
Key words: knee, chondromalacia, articular cartilage.