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№2' 2018

ORTHOPEDICS

MORPHOFUNCTIONAL STATE OF HYALINE CARTILAGE AT REPARATIVE TECHNIQUES OF LOCAL KNEE JOINT CARTILAGE DEFECTS TREATMENT

A. V. LITOVCHENKO, L. A. RUBAN, O. V. MIROSHNICHENKO

Kharkiv Academy of Physical Culture

Kharkiv National Medical University, Ukraine

Based on the differences in the morphofunctional state of hyaline cartilage, a surgical reparative technique for the treatment of local knee joint cartilage defects was substantiated. With this purpose three series of experimental studies were performed on 60 mature male rats: study 1 −− of modeled chondromalacia; study 2 −− the prototype of the microfracturing of the bottom of the cartilaginous defect; study 3 −− the prototype of the subchondral tunneling. Microscopic, morphometric, immunohistochemical, and cytomorphometric comparative studies were performed on days 7, 14 and 21. The findings of the work suggest that deep tunneling procedure of the cartilage defect zone provides an adequate number of cells−precursors of chondrogenesis of mesenchymal origin. It is these changes in the morphofunctional state of hyaline cartilage in conditions of chondromalacia that are most significant. When the bottom of the cartilage defect is mechanically damaged, the process of almost complete restoration of the articular cartilage thickness is noted, in contrast to the damage to the bone plate of the defect bottom or tunneling to the spongy substance of the hyaline cartilage, but not in full measure. The zonal structure of the cartilage on the periphery is not disturbed. Mechanical stimulation of the bone marrow by damaging the bone plate corresponds to the reparative technique of surgical treatment of cartilage defects −− microfracturing, to the bone marrow substance −− subchondral tunneling, and only deep tunneling to the bone marrow cavity leads to an adequate flow of reparative chondrogenesis and preservation of the zonal structure of the cartilage in undamaged areas, and thus provides prevention of osteoarthritis. The reparative surgical technique of deep tunneling to the bone marrow cavity has regenerative advantages over reparative methods by microfracturing and subchondral tunneling. Deep tunneling of the bottom of the cartilage defect by invasiveness, traumatism and surgical technology is equivalent to microfracturing or subchondral tunneling. Arthroscopic deep tunneling of local cartilage defects has pathogenetic priority.

Key words: microfracturing, subchondral tunneling, deep tunneling, chondromalacia, hyaline cartilage.

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