Gelse, Kolja and Angele, Peter and Behrens, Peter and Brucker, Peter U. and Fay, Jakob and Guenther, Daniel and Kreuz, Peter and Luetzner, Joerg and Madry, Henning and Mueller, Peter E. and Niemeyer, Philipp and Pagenstert, Geert and Tischer, Thomas and Walther, Markus and Zinser, Wolfgang and Spahn, Gunter (2018) Debridement in Focal Cartilage Damage of the knee. Systematical review of the literature and recommendations of the working group "clinical tissue regeneration" of the German Society of Orthopaedics and Trauma (DGOU). ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE, 156 (4). pp. 423-435. ISSN 1864-6697, 1864-6743
Full text not available from this repository. (Request a copy)Abstract
Background 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. Materials and Methods The scientific rationale of cartilage shaving and joint lavage was investigated and a systematic analysis was performed of the literature on the clinical effect of cartilage debridement. Furthermore, a consensus statement on this issue was developed by the working group on Clinical Tissue Regeneration of the German Society of Orthopaedics and Trauma (DGOU). Results The therapeutic approach is different for asymptomatic lesions with biomechanical stable residual cartilage tissue and clinically symptomatic defects with unstable fragments. 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. Conclusion 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.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | HUMAN ARTICULAR-CARTILAGE; AUTOLOGOUS CHONDROCYTE IMPLANTATION; 3-YEAR FOLLOW-UP; RADIOFREQUENCY ENERGY; CHONDRAL LESIONS; MECHANICAL DEBRIDEMENT; ARTHROSCOPIC SURGERY; IN-VITRO; BIPOLAR RADIOFREQUENCY; THICKNESS DEFECTS; focal cartilage defect; debridement; shaving; arthroscopy; radiofrequency |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Unfallchirurgie |
| Depositing User: | Petra Gürster |
| Date Deposited: | 03 Jul 2020 05:38 |
| Last Modified: | 03 Jul 2020 05:38 |
| URI: | https://pred.uni-regensburg.de/id/eprint/14116 |
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