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World J Orthop. Nov 18, 2014; 5(5): 677-684
Published online Nov 18, 2014. doi: 10.5312/wjo.v5.i5.677
Treatment for cartilage injuries of the knee with a new treatment algorithm
Ahmet Özmeriç, Kadir Bahadır Alemdaroğlu, Nevres Hürriyet Aydoğan
Ahmet Özmeriç, Kadir Bahadır Alemdaroğlu, Nevres Hürriyet Aydoğan, Department of Orthopedics and Traumatology, Ankara Training and Research Hospital, 06340 Ankara, Turkey
Author contributions: Özmeriç A contributed to data review, drafting of paper; Alemdaroğlu KB contributed to review and approval of paper; Aydoğan NH was the consultant supervisor.
Correspondence to: Ahmet Özmeriç, MD, Department of Orthopedics and Traumatology, Ankara Training and Research Hospital, Sukriye Mahallesi Ulucanlar Caddesi No:89 Altindag, 06340 Ankara, Turkey.
Telephone: +90-532-5052520477 Fax: +90-312-3633396
Received: February 11, 2014
Revised: April 19, 2014
Accepted: June 20, 2014
Published online: November 18, 2014

Treatment of articular cartilage injuries to the knee remains a considerable challenge today. Current procedures succeed in providing relief of symptoms, however damaged articular tissue is not replaced with new tissue of the same biomechanical properties and long-term durability as normal hyaline cartilage. Despite many arthroscopic procedures that often manage to achieve these goals, results are far from perfect and there is no agreement on which of these procedures are appropriate, particularly when full-thickness chondral defects are considered.Therefore, the search for biological solution in long-term functional healing and increasing the quality of wounded cartilage has been continuing. For achieving this goal and apply in wide defects, scaffolds are developed.The rationale of using a scaffold is to create an environment with biodegradable polymers for the in vitro growth of living cells and their subsequent implantation into the lesion area. Previously a few numbers of surgical treatment algorithm was described in reports, however none of them contained one-step or two –steps scaffolds. The ultimate aim of this article was to review various arthroscopic treatment options for different stage lesions and develop a new treatment algorithm which included the scaffolds.

Keywords: Chondral lesion, Microfracture, Osteochondral transplantation, Autologous chondrocyte implantation, Scaffolds

Core tip: This paper discusses the current arthroscopic treatment options of cartilage injuries. Over 1 cm2 full thickness chondral lesions are seen in 4%-5% of patients under 40 years undergone arthroscopy. Conventional arthroscopic treatment may not have successful results although chondral defects are observed with such a high incidence. Addition of novel scaffolds to conventional methods will provide beneficial effects on healing of articular cartilage lesions with hyaline. We now formulate a new treatment algorithm with scaffolds under the light of existing literature. In future, we expect the widespread use of arthroscopic surgery in chondral defects.