Cartilage repair surgery

Nature of the lesions : it is essential to differentiate acute lesions, which often result from a trauma, from chronic lesions, which develop gradually over time.

Acute lesions : for lesions that have occurred recently (within less than 4 weeks), it may be possible to reattach a displaced cartilage fragment. Whether or not this intervention is chosen depends on the time that has elapsed since the injury, the quality of the fragment, as well as the patient’s overall condition. If the fragment cannot be re-implanted, treatment techniques for chronic lesions are considered.

Chronic lesions : there are several approaches for these, each with advantages and limitations :
1. Stimulation of the subchondral bone :
- Objective : to encourage the underlying bone marrow to form fibrocartilage and repair the lesion.
- Method : the intervention is often arthroscopic and consists of stimulating the bone marrow. Stabilising the blood clot from the marrow may require the addition of membranes.

2. Autologous osteochondral transplant (mosaicplasty) :
- Objective : replace the damaged area with a healthy graft (bone cartilage) taken from the patient.
- Method : the surgery can be open or arthroscopic. The graft (bone cartilage) is taken from the patient and implanted at the site of the lesion.

3. Osteochondral allograft :
- Objective : implant a graft (bone cartilage) from a donor.
- Note : this solution is considered in specific situations, or after another procedure has failed. There is a risk of the body rejecting the graft, and availability is limited.

4. Autologous chondrocyte implantation :
- Objective : cultivate the patient's cartilage cells to re-implant them later.
- Method : two procedures are necessary. After harvesting, the cells are cultured in the laboratory before being injected into the lesion; these cells are protected by a membrane.
- Note : there is an extended rehabilitation period.

5. Stem cell transplant :
- Objective : inject stem cells taken from the patient directly into the joint.
- Method : collection of stem cells (bone marrow or adipose tissue) to be injected into the injured joint.
- Note : The effectiveness of this method is not yet scientifically established, so this solution is not preferred.
Conclusion : each lesion and each patient are unique. The optimal approach is determined after thorough clinical evaluation, taking into account the advantages, disadvantages and patient expectations.
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