Surgical treatment of chondral defects of the knee joint and a new look at the role and position of mosaic autochondroplasty

Abstract

The article presents an analytical review of currently used methods of organ-preserving surgical treatment of chondral defects of the knee joint from the standpoint of their pathogenetic orientation. The systematization and comparative characteristics of the methods of joint-preserving surgical treatment of patients of this category are presented with a critical analysis of various types of operations used for full-thickness and penetrating hyaline cartilage defects. One of the main methods of surgical treatment of defects of III and IV degrees (according to the classification ICRS) mosaic chondroplasty is considered in detail. An analytical assessment of the indications, contraindications and conditions for performing mosaic autoplasty of the articular surfaces of the knee joint is given in the aspect of historical retrospective and the results of current research. The debatable provisions and problems of using the classical version of mosaic chondroplasty in its application in the case of destructive-dystrophic genesis of osteochondral defect are formulated. Dogmatic attitudes regarding mosaic chondroplasty, which require critical revision in relation to themselves, have been submitted for discussion. The authors present and describe in detail the developed new methods of mosaic chondroplasty, based on the current understanding of the pathogenesis of osteoarthritis and osteonecrosis of the knee joint, as well as the role of the subchondral bone in the development of both these diseases and associated articular cartilage defects. The surgical instruments developed by the authors for the implementation of new methods of chondroplasty are described. The authors conclude that there is an urgent need to develop the concept of organ-preserving surgery for destructive-dystrophic joint lesions, which should be based on data on the significance of subchondral and metaphyseal bone tissue in the above pathological processes and the unconditional need for their correction during surgical reconstruction.