Skip to main content
SpringerLink
Log in

Chondral and osteochondral operative treatment in early osteoarthritis

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

In recent years treatment of early osteoarthritis came more and more into focus of orthopaedic research. In particular regenerative therapy options seem to have a high potential to fill the existing treatment gap for patients with early osteoarthritic changes. This article focuses on basic science, recent developments and available clinical data in the important field of operative regeneration procedures for treatment of chondral and osteochondral defects in early degenerative joints. It highlights current knowledge and perspectives of treatment options like microfracture, autologous or allogenous osteochondral transplantations and autologous chondrocyte transplantation. Further the role of biomaterials in a degenerative joint environment is illuminated. First clinical data of regenerative therapy in early osteoarthritis are encouraging to intensify research efforts in this important field. Future treatment perspectives for patients who suffer from early degenerative cartilage changes are discussed.

Level of evidence IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Albrecht C, Tichy B, Zak L, Aldrian S, Nurnberger S, Marlovits S (2014) Influence of cell differentiation and IL-1beta expression on clinical outcomes after matrix-associated chondrocyte transplantation. Am J Sports Med 42(1):59–69

    Article  PubMed  Google Scholar 

  2. Angele P, Fritz J, Albrecht D, Koh J, Zellner J (2015) Defect type, localization and marker gene expression determines early adverse events of matrix-associated autologous chondrocyte implantation. Injury 46(Suppl 4):S2–S9

    Article  PubMed  Google Scholar 

  3. Bae DK, Yoon KH, Song SJ (2006) Cartilage healing after microfracture in osteoarthritic knees. Arthroscopy 22(4):367–374

    Article  PubMed  Google Scholar 

  4. Berruto M, Delcogliano M, de Caro F, Carimati G, Uboldi F, Ferrua P, Ziveri G, De Biase CF (2014) Treatment of large knee osteochondral lesions with a biomimetic scaffold: results of a multicenter study of 49 patients at 2-year follow-up. Am J Sports Med 42(7):1607–1617

    Article  PubMed  Google Scholar 

  5. Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L (1994) Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. New Engl J Med 331(14):889–895

    Article  CAS  PubMed  Google Scholar 

  6. Brittberg M, Winalski CS (2003) Evaluation of cartilage injuries and repair. J Bone Joint Surg (Am) 85-A(Suppl 2):58–69

    Google Scholar 

  7. Cole BJ, Pascual-Garrido C, Grumet RC (2009) Surgical management of articular cartilage defects in the knee. J Bone Joint Surg (Am) 91(7):1778–1790

    Google Scholar 

  8. Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG (1997) Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy 13(4):456–460

    Article  CAS  PubMed  Google Scholar 

  9. de Windt TS, Vonk LA, Brittberg M, Saris DB (2013) Treatment and prevention of (early) osteoarthritis using articular cartilage repair-fact or fiction? A systematic review. Cartilage 4(3 Suppl):5S–12S

    Article  PubMed  PubMed Central  Google Scholar 

  10. Dearing J, Nutton RW (2008) Evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 15(3):159–163

    Article  PubMed  Google Scholar 

  11. Filardo G, Kon E, Di Matteo B, Di Martino A, Marcacci M (2014) Single-plug autologous osteochondral transplantation: results at minimum 16 years’ follow-up. Orthopedics 37(9):e761–e767

    Article  PubMed  Google Scholar 

  12. Filardo G, Kon E, Perdisa F, Balboni F, Marcacci M (2014) Autologous osteochondral transplantation for the treatment of knee lesions: results and limitations at two years’ follow-up. Int Orthop 38(9):1905–1912

    Article  PubMed  Google Scholar 

  13. Filardo G, Kon E, Perdisa F, Tetta C, Di Martino A, Marcacci M (2015) Arthroscopic mosaicplasty: long-term outcome and joint degeneration progression. Knee 22(1):36–40

    Article  PubMed  Google Scholar 

  14. Gomoll AH, Filardo G, de Girolamo L, Espregueira-Mendes J, Marcacci M, Rodkey WG, Steadman JR, Zaffagnini S, Kon E (2012) Surgical treatment for early osteoarthritis. Part I: cartilage repair procedures. Knee Surg Sports Traumatol Arthrosc 20(3):450–466

    Article  CAS  PubMed  Google Scholar 

  15. Hangody L, Dobos J, Balo E, Panics G, Hangody LR, Berkes I (2010) Clinical experiences with autologous osteochondral mosaicplasty in an athletic population: a 17-year prospective multicenter study. Am J Sports Med 38(6):1125–1133

    Article  PubMed  Google Scholar 

  16. Harris JD, Hussey K, Wilson H, Pilz K, Gupta AK, Gomoll A, Cole BJ (2015) Biological knee reconstruction for combined malalignment, meniscal deficiency, and articular cartilage disease. Arthroscopy 31(2):275–282

    Article  PubMed  Google Scholar 

  17. Hjelle K, Solheim E, Strand T, Muri R, Brittberg M (2002) Articular cartilage defects in 1,000 knee arthroscopies. Arthroscopy 18(7):730–734

    Article  PubMed  Google Scholar 

  18. Hollander AP, Dickinson SC, Sims TJ, Brun P, Cortivo R, Kon E, Marcacci M, Zanasi S, Borrione A, De Luca C, Pavesio A, Soranzo C, Abatangelo G (2006) Maturation of tissue engineered cartilage implanted in injured and osteoarthritic human knees. Tissue Eng 12(7):1787–1798

    Article  CAS  PubMed  Google Scholar 

  19. Kaul G, Cucchiarini M, Remberger K, Kohn D, Madry H (2012) Failed cartilage repair for early osteoarthritis defects: a biochemical, histological and immunohistochemical analysis of the repair tissue after treatment with marrow-stimulation techniques. Knee Surg Sports Traumatol Arthrosc 20(11):2315–2324

    Article  PubMed  Google Scholar 

  20. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16(4):494–502

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Kon E, Drobnic M, Davidson PA, Levy A, Zaslav KR, Robinson D (2014) Chronic posttraumatic cartilage lesion of the knee treated with an acellular osteochondral-regenerating implant: case history with rehabilitation guidelines. J Sport Rehabil 23(3):270–275

    Article  PubMed  Google Scholar 

  22. Kon E, Filardo G, Perdisa F, Di Martino A, Busacca M, Balboni F, Sessa A, Marcacci M (2014) A one-step treatment for chondral and osteochondral knee defects: clinical results of a biomimetic scaffold implantation at 2 years of follow-up. J Mater Sci Mater M 25(10):2437–2444

    Article  CAS  Google Scholar 

  23. Kon E, Roffi A, Filardo G, Tesei G, Marcacci M (2015) Scaffold-based cartilage treatments: with or without cells? A systematic review of preclinical and clinical evidence. Arthroscopy 4:767–775

    Article  Google Scholar 

  24. Kon EFG, Perdisa F, Venieri G, Marcacci M (2014) Clinical results of multilayered biomaterials for osteochondral regeneration. J Exp Orthop 1(10):1–8

    Google Scholar 

  25. Kreuz PC, Erggelet C, Steinwachs MR, Krause SJ, Lahm A, Niemeyer P, Ghanem N, Uhl M, Sudkamp N (2006) Is microfracture of chondral defects in the knee associated with different results in patients aged 40 years or younger? Arthroscopy 22(11):1180–1186

    Article  PubMed  Google Scholar 

  26. Kreuz PC, Steinwachs MR, Erggelet C, Krause SJ, Konrad G, Uhl M, Sudkamp N (2006) Results after microfracture of full-thickness chondral defects in different compartments in the knee. Osteoarthr Cartil 14(11):1119–1125

    Article  CAS  PubMed  Google Scholar 

  27. Lee YH, Suzer F, Thermann H (2014) Autologous matrix-induced chondrogenesis in the knee: a review. Cartilage 5(3):145–153

    Article  PubMed  PubMed Central  Google Scholar 

  28. Li CS, Karlsson J, Winemaker M, Sancheti P, Bhandari M (2014) Orthopedic surgeons feel that there is a treatment gap in management of early OA: international survey. Knee Surg Sports Traumatol Arthrosc 2:363–378

    Article  Google Scholar 

  29. Luyten FP, Denti M, Filardo G, Kon E, Engebretsen L (2012) Definition and classification of early osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 20(3):401–406

    Article  PubMed  Google Scholar 

  30. Meric G, Gracitelli GC, Gortz S, De Young AJ, Bugbee WD (2015) Fresh osteochondral allograft transplantation for bipolar reciprocal osteochondral lesions of the knee. Am J Sports Med 43(3):709–714

    Article  PubMed  Google Scholar 

  31. Miller BS, Steadman JR, Briggs KK, Rodrigo JJ, Rodkey WG (2004) Patient satisfaction and outcome after microfracture of the degenerative knee. J Knee Surg 17(1):13–17

    PubMed  Google Scholar 

  32. Minas T, Gomoll AH, Solhpour S, Rosenberger R, Probst C, Bryant T (2010) Autologous chondrocyte implantation for joint preservation in patients with early osteoarthritis. Clin Orthop Rel Res 468(1):147–157

    Article  Google Scholar 

  33. Mithoefer K, McAdams T, Williams RJ, Kreuz PC, Mandelbaum BR (2009) Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: an evidence-based systematic analysis. Am J Sports Med 37(10):2053–2063

    Article  PubMed  Google Scholar 

  34. Mithoefer K, Williams RJ III, Warren RF, Potter HG, Spock CR, Jones EC, Wickiewicz TL, Marx RG (2005) The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospective cohort study. J Bone Joint Surg (Am) 87(9):1911–1920

    Article  Google Scholar 

  35. Muschler GF, Nitto H, Boehm CA, Easley KA (2001) Age- and gender-related changes in the cellularity of human bone marrow and the prevalence of osteoblastic progenitors. J Orthop Res 19(1):117–125

    Article  CAS  PubMed  Google Scholar 

  36. Niemeyer P, Andereya S, Angele P, Ateschrang A, Aurich M, Baumann M, Behrens P, Bosch U, Erggelet C, Fickert S, Fritz J, Gebhard H, Gelse K, Gunther D, Hoburg A, Kasten P, Kolombe T, Madry H, Marlovits S, Meenen NM, Muller PE, Noth U, Petersen JP, Pietschmann M, Richter W, Rolauffs B, Rhunau K, Schewe B, Steinert A, Steinwachs MR, Welsch GH, Zinser W, Albrecht D (2013) Autologous chondrocyte implantation (ACI) for cartilage defects of the knee: a guideline by the working group “Tissue Regeneration” of the German Society of Orthopaedic Surgery and Traumatology (DGOU). Z Orthop Unfall 151(1):38–47

    CAS  PubMed  Google Scholar 

  37. Niemeyer P, Schweigler K, Grotejohann B, Maurer J, Angele P, Aurich M, Becher C, Fay J, Feil R, Fickert S, Fritz J, Hoburg A, Kreuz P, Kolombe T, Laskowski J, Lutzner J, Marlovits S, Muller PE, Niethammer T, Pietschmann M, Ruhnau K, Spahn G, Tischer T, Zinser W, Albrecht D (2015) The German Cartilage Registry (KnorpelRegister DGOU) for evaluation of surgical treatment for cartilage defects: experience after six months including first demographic data. Z Orthop Unfall 153(1):67–74

    Article  CAS  PubMed  Google Scholar 

  38. Ochs BG, Muller-Horvat C, Albrecht D, Schewe B, Weise K, Aicher WK, Rolauffs B (2011) Remodeling of articular cartilage and subchondral bone after bone grafting and matrix-associated autologous chondrocyte implantation for osteochondritis dissecans of the knee. Am J Sports Med 39(4):764–773

    Article  PubMed  Google Scholar 

  39. Panics G, Hangody LR, Balo E, Vasarhelyi G, Gal T, Hangody L (2012) Osteochondral autograft and mosaicplasty in the football (soccer) athlete. Cartilage 3(1 Suppl):25S–30S

    Article  PubMed  PubMed Central  Google Scholar 

  40. Perdisa F, Filardo G, Di Matteo B, Marcacci M, Kon E (2014) Platelet rich plasma: a valid augmentation for cartilage scaffolds? A systematic review. Histol Histopathol 29(7):805–814

    CAS  PubMed  Google Scholar 

  41. Peterson L, Brittberg M, Kiviranta I, Akerlund EL, Lindahl A (2002) Autologous chondrocyte transplantation. Biomechanics and long-term durability. Am J Sports Med 30(1):2–12

    PubMed  Google Scholar 

  42. Salzmann GM, Sah B, Sudkamp NP, Niemeyer P (2013) Clinical outcome following the first-line, single lesion microfracture at the knee joint. Arch Orthop Trauma Surg 133(3):303–310

    Article  CAS  PubMed  Google Scholar 

  43. Salzmann GM, Sah B, Sudkamp NP, Niemeyer P (2013) Reoperative characteristics after microfracture of knee cartilage lesions in 454 patients. Knee Surg Sports Traumatol Arthrosc 21(2):365–371

    Article  CAS  PubMed  Google Scholar 

  44. Shasha N, Krywulak S, Backstein D, Pressman A, Gross AE (2003) Long-term follow-up of fresh tibial osteochondral allografts for failed tibial plateau fractures. J Bone Joint Surg Am 85-A(Suppl 2):33–39

    PubMed  Google Scholar 

  45. Sherman SL, Garrity J, Bauer K, Cook J, Stannard J, Bugbee W (2014) Fresh osteochondral allograft transplantation for the knee: current concepts. J Am Acad Orthop Surg 22(2):121–133

    PubMed  Google Scholar 

  46. Shive MS, Restrepo A, Totterman S, Tamez-Pena J, Schreyer E, Steinwachs M, Stanish WD (2014) Quantitative 3D MRI reveals limited intra-lesional bony overgrowth at 1 year after microfracture-based cartilage repair. Osteoarthr Cartil 22(6):800–804

    Article  CAS  PubMed  Google Scholar 

  47. Solheim E, Hegna J, Inderhaug E, Øyen J, Harlem T, Strand T (2014) Results at 10–14 years after microfracture treatment of articular cartilage defects in the knee. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-3443-1

  48. Steinwachs MR, Guggi T, Kreuz PC (2008) Marrow stimulation techniques. Injury 39(Suppl 1):S26–S31

    Article  PubMed  Google Scholar 

  49. Steinwachs MR, Waibl B, Niemeyer P (2011) Use of human progenitor cells in the treatment of cartilage damage. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz 54(7):797–802

    Article  CAS  PubMed  Google Scholar 

  50. Vaquero J, Forriol F (2012) Knee chondral injuries: clinical treatment strategies and experimental models. Injury 43(6):694–705

    Article  PubMed  Google Scholar 

  51. Vavken P, Samartzis D (2010) Effectiveness of autologous chondrocyte implantation in cartilage repair of the knee: a systematic review of controlled trials. Osteoarthr Cartil 18(6):857–863

    Article  CAS  PubMed  Google Scholar 

  52. Vijayan S, Bartlett W, Bentley G, Carrington RW, Skinner JA, Pollock RC, Alorjani M, Briggs TW (2012) Autologous chondrocyte implantation for osteochondral lesions in the knee using a bilayer collagen membrane and bone graft: a two- to eight-year follow-up study. J Bone Joint Surg (Br) 94(4):488–492

    Article  CAS  Google Scholar 

  53. Vonk LA, Kragten AH, Dhert WJ, Saris DB, Creemers LB (2014) Overexpression of hsa-miR-148a promotes cartilage production and inhibits cartilage degradation by osteoarthritic chondrocytes. Osteoarthr Cartil 22(1):145–153

    Article  CAS  PubMed  Google Scholar 

  54. Widuchowski W, Widuchowski J, Trzaska T (2007) Articular cartilage defects: study of 25,124 knee arthroscopies. Knee 14(3):177–182

    Article  CAS  PubMed  Google Scholar 

  55. Zellner J, Angele P, Zeman F, Kujat R, Nerlich M (2013) Is the transplant quality at the time of surgery adequate for matrix-guided autologous cartilage transplantation? A pilot study. Clin Orthop Relat Res 471(9):2852–2861

    Article  PubMed  PubMed Central  Google Scholar 

  56. Zhang Q, Li H, Zhang Z, Yang F, Chen J (2015) Serum metabolites as potential biomarkers for diagnosis of knee osteoarthritis. Dis Markers 2015:684794

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Trauma Surgery, University Medical Center of Regensburg, Franz-Josef Strauss Allee 11, 93042, Regensburg, Germany

    Peter Angele & Johannes Zellner

  2. Sporthopaedicum Regensburg, Hildegard von Bingen Strasse 1, 93053, Regensburg, Germany

    Peter Angele

  3. Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Hugstetter Strasse 55, 79106, Freiburg, Germany

    Philipp Niemeyer

  4. SportClinic Zurich, Hirslandenklinik, Witellikerstrasse 40, 8032, Zurich, Switzerland

    Matthias Steinwachs

  5. Biomechanics Laboratory, II Orthopaedics and Traumatology Clinic, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy

    Giuseppe Filardo & Elizaveta Kon

  6. Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Andreas H. Gomoll

  7. Center of Experimental Orthopaedics, Saarland University, Homburg/Saar, Germany

    Henning Madry

  8. Department of Orthopaedic Surgery, Saarland University Medical Center, Kirrberger Strasse 100, Building 37-38, 66421, Homburg/Saar, Germany

    Henning Madry

Authors
  1. Peter Angele
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Philipp Niemeyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthias Steinwachs
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giuseppe Filardo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andreas H. Gomoll
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Elizaveta Kon
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Johannes Zellner
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Henning Madry
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter Angele.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Angele, P., Niemeyer, P., Steinwachs, M. et al. Chondral and osteochondral operative treatment in early osteoarthritis. Knee Surg Sports Traumatol Arthrosc 24, 1743–1752 (2016). https://doi.org/10.1007/s00167-016-4047-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-016-4047-8

Keywords

Search

Navigation