Articular cartilage: structure, injuries and review of management

Introduction: Chondral and osteochondral injuries are commonly seen in today's clinical practice. Articular cartilage provides an ultimate low-friction gliding surface, which none of the artificial constructs have been able to replace successfully. Retrospective review of the knee arthroscopies has revealed an underestimated incidence of this complex problem. Cartilage injuries in the knee joint if left untreated lead to pre-mature early arthritis and affect the activities of daily living. Various different treatment methods of cartilage regeneration have shown encouraging results, but unfortunately none has proved to be the ultimate solution. Sources of data: This article re-visits the intricate structure of articular cartilage and reviews the different methods of regeneration described in the literature, based on evidence-based effectiveness. The methods described by their originators and their results are considered gold standards for those methods, as being the best available evidence. Areas of agreement: Majority of the authors agree that cartilage injuries are complex and difficult to treat. If untreated, cartilage defects lead to early osteoarthritis. Great debate still persists about the best available treatment for symptomatic chondral or osteochondral defect(s). Areas of controversy: The controversy about the management outplays its aetiological theories. Several authors have reported good results with different techniques; however none has proved to be the solution for the problem. Growing points: Up until 1990, marrow stimulation techniques were routine form of management for chondral defects. However, ever since autologous chondrocyte implantation was successfully introduced in humans, it has provided a new dimension for the treatment of chondral defects. Areas timely for developing research: The success of any treatment lies in its longevity. The new minimally invasive techniques are being invented. However, timely research, on the basis of randomized controlled trial comparing different methods of cartilage reconstruction is necessary for decision-making in today's evidence-based medical world.