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• W4319754574 abstract "There is growing demand for preservation of native articular cartilage, especially in younger, active patients.1Hinckel BB Thomas D Vellios EE Hancock KJ Calcei JG Sherman SL et al.Algorithm for treatment of focal cartilage defects of the knee: classic and new procedures.Cartilage. 2021; 13: 473S-495Shttps://doi.org/10.1177/1947603521993219Crossref PubMed Scopus (22) Google Scholar Joint preservation techniques aim to reduce symptoms and increase function while delaying the need for joint arthroplasty. Hyaline cartilage has limited intrinsic healing capacity and damage can lead to accelerated joint degeneration and early-onset osteoarthritis. Historically, management options were limited, but surgical techniques have evolved such that restoration of the joint function and even the natural biology of the articular cartilage can now be achieved.2Murray IR Benke MT Mandelbaum BR. Management of knee articular cartilage injuries in athletes: chondroprotection, chondrofacilitation, and resurfacing.Knee Surg Sports Traumatol Arthrosc. 2016; 24: 1617-1626https://doi.org/10.1007/s00167-015-3509-8Crossref PubMed Scopus (48) Google Scholar The COVID-19 pandemic has highlighted many challenges to our field with patients presenting later than ever with more advanced disease. However, the pandemic has also forced the orthopedic community to embrace new ways to communicate and share knowledge virtually and this has fueled collaboration and innovation. In this special issue, we showcase a selection of state-of-the-art technique-based articles all with the overarching aim of joint preservation. This includes 4 articles that outline techniques that aim to address chondral defects directly with 4 articles outlining how osteotomy and distraction can be utilized to protect chondral surfaces and potentially interfere with the osteoarthritic disease process. Finally, 4 articles then outline techniques that seek to preserve or replace meniscus tissue—a primary role of which is to distribute load and protect underlying articular cartilage. There have been considerable recent advances in techniques to restore articular cartilage—some of which represent newer iterations of established treatments and others which represent entirely novel concepts. The technique articles within this special edition include autologous surface repair techniques, techniques involving cell transplantation and advances in osteochondral allograft. Gian Salzman et al present techniques for surface repair including autologous matrix-induced chondrogenesis and minced cartilage treatment. Both of these procedures can be performed arthroscopically as a single stage. Autologous matrix-induced chondrogenesis represents an evolution of microfracture where a matrix is implanted following microfracture. With minced cartilage implantation, autologous cartilage debrided from the lesion edge or from a nonweightbearing portion of the knee is then reimplanted to the lesion in a thrombin-based substrate. Elias et al present 2 cell transplantation techniques for managing symptomatic chondral lesions. These transplantation techniques offer a unique solution to address larger defects by engineering chondrocytes to integrate with the subchondral bone of the lesion and regenerate the cartilage. The chondrocytes used for these transplantations may come in the form of patients’ own chondrocytes embedded into a collagen membrane as a matrix-induced autologous chondrocyte implantation, or minced donor cartilage that is then implanted into a scaffold as a particulated juvenile allograft cartilage procedure. Both of these procedures have shown clinically significant improvements in outcome scores and low rates of complications. Medina and Goertz then present a range of techniques for transplantation of osteochondral grafts of both autologous and allogeneic origin. These techniques represent the only restorative methods that reintroduce structurally mature hyaline cartilage and subchondral tissue into defects, with survival rates of more than 80% reported after 10 years. Although the techniques are not complicated, they require precision to obtain predictable and reliable results. The final article of the cartilage restoration portion of this special issue explores the challenges and potential merits treating the subchondral bone. The research group of Alberto Gobbi presents a clear rationale and convincing argument for osteo-core plasty. The technique they describe seeks to decompress the bone marrow in the affected location while administering bone marrow aspirate concentrate to promote tissue healing. The implantation of bone marrow autograft at the location also provides mechanical support. In addition to describing the technique and outcomes in 24 patients, they provide an extremely clear overview on the conditions bone marrow edema, spontaneous insufficiency fractures of the knee, and spontaneous osteonecrosis of the knee. Four articles in this series explore a range of techniques that involve osteotomy or distraction to achieve joint preservation. The research team of Matthieu Ollivier presents state-of-the-art strategies to perform closing wedge distal femoral osteotomies, including the indications, ideal corrections, surgical techniques, and outcomes. Daniel Saris’ group then provides a comprehensive summary of the current state of utilization of tibial osteotomies in conjunction with other joint preserving procedures. Due to concerns of the durability and complications of osteotomy procedures and arthroplasty, there has been an ongoing search for alternative strategies for managing established osteoarthritis. Observations of the reversal of tissue degeneration following joint distraction have led to the evolution of a number of techniques to achieve this. The group of Anil Ranawat presents the latest developments in joint distraction techniques and the most recent clinical outcome data. Finally, the group led by Seth L. Sherman provides some historical context and an overview of recent advancements in the use of tibial tubercle osteotomy to unload and treat chondral defects in the patellofemoral joint. The indications and technique for performing classic Fulkerson anteromedialization are presented alongside a novel multidirectional tibial tubercle transfer technique for precise and reproducible 1 to 3 plane corrections. Four articles in the present issue outline current techniques to preserve meniscus tissue. Appreciation of the biomechanical importance of root integrity to meniscus function has led to considerable interest in understanding the natural history of meniscus root tears and how the accelerated degenerative process associated with root dysfunction can be averted. The research group led by LaPrade has led advancements in the field and in their article outlines current and emerging thinking in biomechanics, classification, indications for surgery, and repair methods including salvage techniques. Qin and Flanagan review the existing literature on the biomechanical and clinical outcomes following treatment of radial, horizontal cleavage, and ramp meniscus tears, while highlighting meniscus repair strategies for these tear patterns. Despite our best efforts, it is not always possible to “save the meniscus” and repair meniscal defects. Segmental meniscal replacement using scaffolds that form a substrate for ingrowth and colonization of native cells offers a genuine alternative. The research teams led by Rene and Peter Verdonk present their techniques for segmental meniscal substitution with 2 meniscus scaffolds currently used in clinical practice, sharing their outcomes and the outcomes of others in the published literature. Dr Gersoff presents further insights into potential solutions for managing postmenisectomy pain syndrome, providing interventions that seek to address symptoms and prevent progression to osteoarthritis. These include the use of allograft tissue, synthetics, and scaffolds. We now have more techniques at our disposal than ever to prevent, protect, and address articular cartilage damage. Responsibility now lies within the orthopedic community to evaluate these exciting techniques in high-quality randomized controlled trials to establish if these techniques and innovations translate into sustained benefits for patients." @default.
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• W4319754574 title "Joint preservation techniques: where are we in 2023?" @default.
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