What is it about?
In clinical practice, there is still no definite treatment algorithm for focal, partial thickness cartilage lesions (grade II - III). It is well-established that debridement (shaving/lavage) of large degenerative cartilage lesions is not recommended, but there is no such recommendation in the case of focal, partial thickness cartilage defects. In this article, Kolja Gelse and Gunter Spahn provide a comprehensive review on the issue of debridement of cartilage defects and give treament recommendations of the Working Group "Tissue Regeneration" of the German Orthopedic and Trauma Society.
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Why is it important?
The benefit of a joint lavage or surface smoothening of focal partial thickness has not been proved. Even more importantly, the mechanical or thermal resection of cartilage tissue even induces a zone of necrosis in adjacent cartilage, and thus leads to additional injury. Therefore, large scale smoothening (shaving) of clinically asymptomatic, fibrillated or irregular cartilage defects should not be performed. However, if there are clinical symptoms, resection of unstable and delaminated cartilage fragments may be reasonable, as it can reduce harmful shear tension in residual tissue. This can help to brake the progression of the damage and avoid formation of free bodies.
Perspectives
The decision criteria for debridement of partial thickness focal cartilage lesions are multifactorial and include the clinical symptoms, the size and the degree of the defect, the stability of remaining cartilage, localisation of the defect, and individual patient-specific parameters. Debridement is not recommended for asymptomatic lesions, but may be reasonable for symptomatic cases with unstable tissue.
Philipp Niemeyer
OCM Clinic Munich, Germany
Read the Original
This page is a summary of: Stellenwert des Débridements bei der Behandlung fokaler (Grad II – III) Knorpelschäden des Kniegelenks. Systematische Literaturübersicht und Empfehlungen der AG Geweberegeneration (DGOU), Zeitschrift für Orthopädie und Unfallchirurgie, March 2018, Thieme Publishing Group,
DOI: 10.1055/s-0044-101470.
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