Techniques in Cartilage Repair Surgery

Book Preface

It is a privilege for me to write the Foreword for this excellent text which covers all current techniques for repair of articular cartilage. A great deal has happened since we first described successful transplantation of viable chondrocytes into joint surfaces of animals with normal and papain arthritic joints in 1971. This laid the foundations of the present-day widespread acknowledgement of the requirement for this repair and also the application of such cellular techniques to the human patient. After some years of experimenting with various matrices to support the formation of hyaline cartilage, Brittberg et al. published the pivotal report of the results of isolated articular chondrocyte grafts in human knees which led to the development of ACI (autologous chondrocyte implantation) and many other studies over the years involving various methods to regenerate the unique hyaline cartilage structure of joints after the loss of osteochondral and chondral fragments.

In essence, the vital question is whether cells from the subchondral bone marrow or elsewhere in the haematopoietic system can transform into hyaline cartilage permanently or whether transplantation of differentiated chondrocytes is necessary to achieve this. Persuasive reports on microfracture and stem cell grafts suggest, but have not proven, this despite genetic manipulation of the cells or stimulation of cell division differentiation and proliferation by growth factors. To date, the longest and largest follow-up of successful results for treatment of osteochondral defects has been with ACI and MACI (matrix assisted chondrocyte implantation). It appears defi nite that isolated cells, free from matrix, are essential for perfect cartilage regeneration. However, no method has yet been shown to be effective for a prolonged period of time or in established osteoarthritis.

Nevertheless, the ACI/MACI method is two-stage, time consuming and expensive, and involves two operations with a long rehabilitation period. Clearly, a one-stage procedure with rapid rehabilitation is required so that overall the treatment is quicker, cheaper and as effective as ACI/MACI.

This excellent book, with its internationally famous faculty, addresses all these problems, describing in detail the current techniques, the pros and cons of each method, accompanied by visionary theories for the future. Thus the basic science, the experimental and the clinical results of the whole range of methods available, is covered. The long-term goal is not only the curing of pain and healing of acute osteochondral injuries, but the prevention of osteoarthritis which affects 50 % of the population over 60 in the Western world and is a major cause of disability and healthcare expenditure for the future. This book provides many of the clues and hopes for that future.