Presentation is loading. Please wait.

Presentation is loading. Please wait.

TRATAMIENTO ARTROSCOPICO DE LA ARTROSIS DE RODILLA INTERNA KINESIOLOGIA UDLA MARA JOSE GONZALES.

Similar presentations


Presentation on theme: "TRATAMIENTO ARTROSCOPICO DE LA ARTROSIS DE RODILLA INTERNA KINESIOLOGIA UDLA MARA JOSE GONZALES."— Presentation transcript:

1 TRATAMIENTO ARTROSCOPICO DE LA ARTROSIS DE RODILLA INTERNA KINESIOLOGIA UDLA MARA JOSE GONZALES

2 TRATAMIENTO ARTROSCOPICO DE LA ARTOSIS DE RODILLA “ La Población tiende a mantenerse físicamente cada vez mas activa y a realizar actividades mas demandante a edades mas avanzadas “ “Artroscopia aparece como un procedimiento mas simple en paciente que por edades o cambios degenerativos menores no son candidatos a una artroplastia” Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88: Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5): Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3); Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13: Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3): Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) Moseley JB, O´malley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): E 1-3

3 ¿Cuáles son los objetivos de una Artroscopia? Remover las partículas inflamatorias y enzimas degradativas Proporcionar superficies lisas de cartílago articular Tratar patología meniscal Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88: Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5): Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3); Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13: Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3): Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) Moseley JB, O´malley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): E 1-3

4 “la evidencia se inclina en demostrar que el tratamiento artroscopico no presenta beneficios sobre el tratamiento conservador” Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88: Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5): Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3); Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13: Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3): Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) Moseley JB, O´malley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): E 1-3

5 La artrosis se presenta en : Con mayor prevalencia en mujeres Todo grupo de edades y raza Se reporto que el 50% en personas mayores de 65 años Artrosis de Rodilla Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88: Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5): Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3); Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13: Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3): Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) Moseley JB, O´malley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): E 1-3

6 La artrosis es el segundo diagnostico primario que causa discapacidad despues de las enfermedades cardiovasculares Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88: Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5): Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3); Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13: Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3): Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) Moseley JB, O´malley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): E 1-3

7 El tratamiento de la artrosis de rodilla: Debe ser etapificado Existir relación con síntomas y signos Se debe comenzar con medidas simples: Bajar de peso Modificación de la Actividad Calzado amortiguador kinesioterapia Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88: Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5): Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3); Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13: Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3): Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) Moseley JB, O´malley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): E 1-3

8 Los pacientes que no presente una respuesta favorable al tratamiento conservador, el tratamiento quirurgico es una alternativa con mejores resultados en pacientes entre años Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88: Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5): Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3); Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13: Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3): Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) Moseley JB, O´malley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): E 1-3

9 Disminuir el dolor Aliviar la funcionalidad objetivos Permite remoción de osteofitos sintomáticos Trata eventuales patologías mecánicas coexistentes (lesiones meniscales, cuerpos libres, etc.) beneficios Tratamiento Quirúrgico Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88: Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5): Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3); Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13: Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3): Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) Moseley JB, O´malley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): E 1-3

10 Selección de paciente y criterio para una Artroscopia Inicio agudo de derrame articular, dolor localizado en interlinea articular o síntomas mecánicos como bloqueo Inicio agudo de sintomatología después de un traumatismo especifico Cuerpo libre intrarticular confirmado por imágenes Paciente debe presentar artrosis temprana, ausencia de mal alineamiento significativo, sin disminución de espacio articular y sin osteofitos importantes Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88: Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5): Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3); Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13: Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3): Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) Moseley JB, O´malley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): E 1-3

11 Tecnica quirurgica ¿ cual es la base y finalidad del tratamiento artroscopico de la artrosis? Es el debridamiento o aseo articular, que tiene como finalidad aliviar sintomatología a través de la restauración de la biomecánica de la rodilla Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88: Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5): Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3); Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13: Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3): Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) Moseley JB, O´malley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): E 1-3

12 El procedimiento básicamente incluye: El aseo articular para dilución de la concentración de enzimas degradativas y remoción de productos irritantes de la degeneración condral, meniscal o sinovial Remoción de cuerpos libres intrarticulares Meniscectomia parcial Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88: Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5): Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3); Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13: Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3): Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) Moseley JB, O´malley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): E 1-3

13 Meniscectomia El proceso patológico de la artrosis en etapas tardías no solo genera la destrucción del cartílago articular, sino que afecta también la integridad de meniscos y ligamentos Cualquier procedimiento sobre el menisco debe ir orientado a mejorar la sintomatología del paciente Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88: Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5): Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3); Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13: Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3): Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) Moseley JB, O´malley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): E 1-3

14 Un desgarro en un menisco con cambios degenerativos esta asociado a cambios estructurales preexistentes en el cartílago articular que pueden representar una etapa temprana de artrosis Dependiendo de cuanta funcionalidad meniscal se pierda con un desgarro o una resección quirúrgica, la artrosis se puede acelerar a medida que aumenta la carga biomecánica en el cartílago articular Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88: Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5): Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3); Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13: Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3): Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) Moseley JB, O´malley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): E 1-3

15 La reseccion de una lesion de cuerpo posterior del meniso interno disminuye en dos tercios la capacidad de absorcion de carga Se debe evitar la reseccion del menisco hasta la periferia, ya que elima la capacidad del menisco de soportar cargas Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88: Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5): Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3); Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13: Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3): Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) Moseley JB, O´malley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): E 1-3

16 La extrusión meniscal es otro hallazgo común en pacientes mayores y es a menudo otro signo de una degeneración meniscal y artrosis preexistente Una extrusión meniscal puede contribuir a aumentar la estrechez del espacio articular Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88: Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5): Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3); Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13: Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3): Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) Moseley JB, O´malley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): E 1-3

17 Condroplastia La radiofrecuencia ha ganado popularidad como herramienta artroscopica Sus ventajas son: - Fácil de aplicar -Bajo costo - Retracción del colágeno Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88: Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5): Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3); Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13: Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3): Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) Moseley JB, O´malley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): E 1-3

18 Estudios han demostrado que la condroplastia utilizando radiofrecuencia obtiene superficies lisas que permanecen estables por largos periodos de tiempo Sin embargo, la radiofrecuencia funciona a través del calor y su desventaja esta en que los condrocitos son extremadamente sensibles a la temperatura Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88: Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5): Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3); Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13: Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3): Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) Moseley JB, O´malley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): E 1-3

19 Sinovectomia y remoción de osteofitos En el casos que la artrosis avanzada se acompañe de sinovitis significa que provocara derrames recurrentes, y la Sinovectomia puede estar indicada La resección de osteofitos en general no son recomendado, por el riesgo de provocar hemartrosis Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88: Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5): Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3); Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13: Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3): Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) Moseley JB, O´malley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): E 1-3

20 La única indicación excepcional para realizar este procedimiento es la presencia de un osteofito anterior en la escotadura intercondilea o patelofemoral que bloque la extensión Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88: Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5): Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3); Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13: Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3): Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) Moseley JB, O´malley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): E 1-3

21 Resultados 50% a 75% de los paciente con Artroscopia refieren una mejoría inicial 15% progresa a una artroplastia total de rodilla a un año 44% presenta una disminución clínica significativa del dolor a dos años de seguimiento Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88: Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5): Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3); Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13: Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3): Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) Moseley JB, O´malley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): E 1-3

22 Spahn et al. Examino los resultados de la Artroscopia en pacientes con artrosis medial de rodilla 71% de los pacientes presento pobres resultados Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88: Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5): Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3); Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13: Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3): Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) Moseley JB, O´malley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): E 1-3

23 Sugirio que los factores asociados a mal pronosticos son: Tiempo de evolución de la artrosis mayor a 24 meses Obesidad Osteofitos mediales Espacio articular menor a 5 mm Tabaco Presencia de defecto condral tibial grado IV y necesidad de una Meniscectomia total o subtotal Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88: Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5): Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3); Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13: Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3): Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) Moseley JB, O´malley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): E 1-3

24 No se debiera considerar una Artroscopia Si existe disminución severa del espacio articular comprometido ( estadio 3 de Kellgren Lawrence) Tampoco si el eje mecánico de la rodilla pase por la zona de la lesión Tienen pocas posibilidades de ser un procedimiento exitoso Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88: Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5): Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3); Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13: Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3): Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) Moseley JB, O´malley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): E 1-3

25 Estudios Clinicos En el estudio de Framingham sobre indicaciones de Meniscectomia en rodilla artrosica describió: “El 56% de los hombres entre 70 y 90 años sin sintomatología presenta desgarros meniscales y en pacientes con artrosis radiográfica este porcentaje aumenta a 82%. Sin embargo, la relación entre daño meniscal y artrosis es compleja” Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88: Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5): Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3); Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13: Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3): Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) Moseley JB, O´malley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): E 1-3

26 Una lesión meniscal en una rodilla sana, puede, eventualmente, llevar al desarrollo de la artrosis por perdida de la función meniscal Una rodilla artrosica puede presentar un desgarro meniscal que acelera el proceso degenerativo Esto sugiere que el daño meniscal visible en resonancia magnética antecede a los cambios visibles del cartílago Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88: Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5): Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3); Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13: Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3): Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) Moseley JB, O´malley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): E 1-3

27 Tecnica preferida por el autor Como regla general se debe ser conservador y juicioso en las resecciones para preservar al máximo las estructuras noble de la función articular: Cartílago y Menisco Toda estructura inestable debe ser resecada y/o remodelada en su justa medida teniendo en cuenta que los pacientes solo utilizaran sus rodilla en AVD y baja demanda Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88: Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5): Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3); Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13: Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3): Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) Moseley JB, O´malley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): E 1-3

28 Contraindicamos formalmente cualquier tipo de procedimiento que base su éxito en respuesta reparativas del paciente, fundamentalmente por los factores de edad y por la severa alteración de la homeostasis articular que limita seriamente su respuesta regenerativa por ejemplo: microfracturas, meniscorresis, etc Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88: Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5): Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3); Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13: Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3): Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) Moseley JB, O´malley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): E 1-3

29 Normalmente por edad y presencia de factores de riesgo utilizamos tratamiento anticoagulante profiláctico con HBPM en el postoperatorio Uso de kinesiología precoz, con énfasis en la movilización, limitación de la respuesta inflamatorias, drenaje venoso y linfático, mantención trofismo muscular y el uso transitorio de descarga en la deambulacion Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88: Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5): Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3); Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13: Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3): Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) Moseley JB, O´malley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): E 1-3

30 Conclusión La evidencia es categórica en demostrar que el tratamiento artroscopico no presenta beneficios sobre el tratamiento conservador Siempre se debe tomar cuenta que al momento de evaluar al paciente que los peores resultados de una Artroscopia en artrosis se asocia a mal alineamiento, inestabilidades, artrosis avanzadas, sintomatología crónica, cirugías previas Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88: Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5): Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3); Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13: Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3): Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) Moseley JB, O´malley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): E 1-3

31 LESIONES CONDRALES

32 HISTOLOGIA Cartílago hialino es una forma especializada de tejido conjuntivo Constituidos por elementos celulares denominados CONDROCITOS que disponen en una matriz extracelular dura de tipo gel Las células se nutren mediantes difusión a través de la fase acuosa de la matriz y a partir de los capilares de los tejidos que rodean el cartílago Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

33 PropiedadesElasticidadViscosidad Esto le confiere una dureza y flexibilidad poco habituales Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

34 Tipos de cartílago Fibrocartilaginoso Elástico Hialino  Sus Diferencias están dadas por: - Matriz celular -Fibras de Colágenos - Fibras de Elastina

35 Cartilago Hialino Se presenta en anillos traqueal, la nariz, laringe, superficies articulares Condrocitos se encuentran por debajo del pericondrio Zona mas profunda del cartílago, las lagunas tienen una configuración hemisférica o angular Citoplasma presenta una baja densidad, contienen gotas de lípido y cantidades variables de glucógeno Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

36 Matriz Cartilaginosa Es de color azul grisáceo y parcialmente traslucida Colágeno que predomina es tipo II, que forma fibras débiles con estriación transversal Las fibras de la zona superficial están orientadas paralelamente y la mas profundas hacia adentro en forma de columnas verticales La orientación de las fibras son adaptadas para resistir la tensión a la que están sujetas normalmente Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

37 Dentro de la matriz existen una capsula pericelular, que rodea a las lagunas Esta formada por fibras muy finas de características similares a la lamina basal Desempeña un papel importante en la protección de los condrocitos de aquellos cartílagos sometidos a compresión o tensión mecánica La matriz posee mayor concentración de proteoglicanos Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

38 Cartilago Articular Es un tipo de cartílago hialino, que cubre terminaciones Oseas de la articulaciones sinoviales Es avascular y denervado, el 70%-80% de su peso es agua Constituido por colágeno tipo II, posee poca elastina y un componente menor de glicoproteínas y lípidos Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

39 Se organiza en cuatro capas : 1- Superficial (S) 2- Transicion (T) 3- Medial (M) 4- Calcificada (C) Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

40 Capa Superficial Posee dos zonas Compuesta por un grupo de finas fibrillas con pequeños polisacáridos, sin células que cubren la articulación Esta zona es mas profunda y se observan condrocitos de forma elíptica dispuesto en un eje mas paralelo a la superficie Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

41 En esta capa los condrocitos secretan una matriz con alta concentracion de colageno y baja concentracion de proteoglicanos La caracteristica estructural de esta capa es que determinan una alta fuerza tensil y resistencia a la compresion superior a las capas profundas Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

42 Capa Transicion Posee mayor grosor que la capa superficial Los condrocitos adoptan una morfología espiroidal Sus células poseen mayor densidad de organelos, recitáculo endoplasmatico y aparato de Golgi Sintetizan matriz con fibras colágenos de mayor diámetro con alta concentración de proteoglicano y menor de concentración de agua y colágeno Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

43 Capa Medial los condrocitos esferoides ubicados perpendicular a la superficie articular posee fibras de colagenos de gran diametro La concentracion mas alta de proteoglicanos y la mas baja de agua Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

44 Capa Calcificado Es una zona de cartílago calcificado que separa la zona radial del hueso subcondral Contienen muy poco retículo endoplasmatico y aparato de Golgi Las células aparecen completamente rodeando el cartílago calcificado, lo que sugiere una baja actividad metabólica Estudios sugieren que podría jugar un rol en el desarrollo y progresión de la osteoartritis Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

45 Cartilago Articular Normal La función de este cartílago es : Minimizar el estrés sobre el hueso subcondral Distribución de cargas en la articulación Disminuye el coeficiente de fricción de las superficies articulares La interacción con el liquido sinovial proporciona un excelente mecanismo de lubricación Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

46 Existen dos mecanismos de lubricacion : 1- Fluid Film : capa de fluido sinovial menor a 25 um, de gran viscosidad 2- Lubricacion Frontera: HAP, proteína de acido hialuronico de alta afinidad por la superficie articular, que funciona como un importante lubricante limítrofe con la superficie articular Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

47 Los filamentos de colágeno mantienen la configuración del tejido y la resistencia a las fuerzas tensiles Los proteoglicanos proporcionan un gel hidratado y firme que absorbe las fuerzas de compresión y además pueden atrapar e inmovilizar un gran volumen de agua Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

48 ¿Cómo se resisten las fuerzas compresivas? cuando se ejerce una fuerza compresiva, el agua se aleja de las regiones con carga eléctrica de los proteoglicanos. Entonces, la cargas negativas de los grupos carboxilo y sulfato se aproximan y la fuerza de repulsión de las mismas permiten resistir la compresión Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

49 Mecanismo de disipación de energía El liquido intersticial fluye lentamente por la existencia de pequeños poros en el espacio intermolecular, con ello baja la permeabilidad de la matriz tisular y gracias a esto no existe una excesiva deformación del tejido y se crea la interacción de fricción entre fluidos y la matriz Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

50 ¿los proteoglicanos influyen en el envejecimiento?

51 Estudios compararon cultivos de condrocitos de animales viejos y jóvenes pudiendo observar que los condrocitos viejos secretan proteoglicanos de menor tamaño y con cadenas condroitin sulfato mas cortas se ha propuesto que al ser de menor tamaño el proteoglicano,le permite retener una cantidad menor de agua, lo que disminuye su capacidad para resistir fuerzas compresivas Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

52 Y con ello la matriz seria mas vulnerable a pequeñas cargas de peso, produciendo reacciones inflamatorias que seria la causa de la sintomatología dolorosa de la artritis, dejando como posibilidad que la prevalencia de la osteoartritis en ancianos este relacionada con cambios en la matriz cartilaginosa Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

53 El cartílago hialino muestra una capacidad muy limitada de reparación Sus células dependen de la difusión de nutrientes y oxigeno en distancias considerables a través de la matriz Cuando disminuye el flujo de sangre alrededor del cartílago, sus células pueden morir y el cartílago es invadido por vasos sanguíneos y células fagocitarias mientras que la matriz es reabsorbida y sustituida por tejido cicatrizal Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

54 Lesiones del cartilago articular El cartílago hialino posee una relación injuria- respuesta muy estrecha La magnitud y el grado de lesión del cartílago dependerá del mecanismo y grado de respuesta reparativa La respuesta reparativa que el cartílago es capaz de dar es insuficiente y de mal pronostico en general Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

55 De acuerdo con la magnitud del daño generado en el cartilago hialino exiten 3 grupos de lesion: 1- Perdida o daño macromolecular de la matriz sin disrupción tisular visible 2-Daño mecánico o disrupción de cartílago visible dentro de la matriz 3-Disrupcion del cartílago y hueso subcondral (lesión osteocondral) Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

56 Lesiones Lesión aguda sin disrupción de tejido visible Disrupción mecánica del cartílago Lesión osteocondral Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

57 Lesion aguda sin disrupcion de tejido visible Lesión con mayor capacidad de mejoría Traumatismo contuso cerrado como un trauma de carga repetitiva, induce cambios significativos en la histología, bioquímica y características estructurales de la matriz Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

58 Una de las primeras alteraciones observadas en este tipo de lesion corresponde : 1- perdida de proteoglicanos o disrupción de su organización 2-disminucion en la concentración de proteoglicanos, alterando las propiedades fiscas 3-peso o carga suprafisiologica sobre ya debilitadas proteínas estructurales 4-cambios del medio ambiente que rodea al condrocito Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

59 Disrupcion mecanica del cartilago No existe una medida exacta de la magnitud de la fuerza que el cartílago es capaz de soportar ante de sufrir daño estructural macroscópico Sin embargo el limite critico de integridad estructural de los condrocitos es equivalente a Mpas Un estrés superior a esta medida generara muerte y fisura del condrocito Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

60 Su etiología puede estar en lesiones que penetran la articulación, produciendo laceración o abrasión del cartílago La respuesta tisular a este daño se encuentra caracterizado por un tejido avascular, no existe la generación de un fenómeno de inflamación clásico Por tanto el condrocito son los responsables de todo el proceso de reparación. Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

61 Lesión Osteocondral En este caso el traumatismo es de tal magnitud que incluye lesión del hueso subcondral o fractura osteocondral Esta lesión repara dando origen a tejido fibrocartilaginoso con propiedades muy distintas al cartílago hialino articular normal La restauración de la placa subcondral toma forma a partir de las 6-8 semanas Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

62 Al cabo de semanas se observa degeneración superficial del cartílago con aspecto fibrilar Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

63 Daño Cronico La osteoartritis puede desarrollarse como fenómeno primario o secundario a daño en el cartílago articular Si la red de colágeno presenta disminución del efecto restrictivo; si esta se destruye los glicosaminoglicanos atrapados en la red, se escapan del anclaje y su perdida derivara en la disminución de la tolerancia a las fuerzas compresivas de la articulación Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

64 Estimulos reparativos biologicos El estado normal del cartílago articular se encuentra mantenido por una combinación de procesos anabólicos y catabólicos de los condrocitos Durante el proceso degenerativo, existe un aumento en la reabsorción de la matriz Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

65 Para la mantención de este balance existen mediadores polipeptidicos : TGF-BIGF-1BFGFBMP Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

66 TGF-B Factor de crecimiento y transformacion B Estimula la proporción de síntesis de macromoléculas de la matriz, especialmente pequeños glicosaminoglicanos. Promueve la reparación del cartílago dañado Posee un potente efecto en la expresion fenotipica del condrocito Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

67 IGF-1 Factor de crecimiento insulino simil Producido en respuesta a estímulos sistémicos de parte de hormonas de crecimiento Media efectos anabólicos de esta hormona en los tejidos Estimula la proliferación de condrocitos, proteoglicanos y acido hialuronico, y a su vez puede disminuir la degradación de estos Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

68 BFGF Factor de crecimiento fibroblastico Es un potente mitogenico de condrocitos Estimula la síntesis de la matriz cartilaginosa Posee actividades sinérgica con el factor IGF-1 Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

69 BMP Bone morphogenectic protein Es del tipo TGF-B En tejidos indiferenciado, estimulación de BMP I-II induciendo condrogenesis y osificación endocondral Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

70 Estimulo Fisico Fuerzas mecánicas regulan el funcionamiento del condrocito La inmovilización o disminución de cargas sobre la articulación disminuye la síntesis de proteoglicanos El ejercicio moderado aumenta la síntesis de proteoglicanos y estimula el espesamiento de la matriz cartilaginosa Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

71 Diagnostico y tratamiento de las lesiones osteocondrales Clínica : 1- existe daño en la superficie articular 2-Disfuncion articular y/o derrame articular Esto evoluciona con degeneración articular progresiva aumenta en forma considerable el riesgo de desarrollo de osteoartritis Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

72 Las lesiones condrales son asintomáticas, a no ser que se asocien a una lesión del hueso subcondral También puede manifestarse con bloqueo de la articulación Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

73 Imagenologia Artroscopia Según Outerbridge, que describió su clasificación Artroscopia de lesión articular en cuatro grados, actualmente la mas utilizada. GRADO IReblandecimiento GRADO IIFibrilación y fisura menor al 50% del espesor del cartílago GRADO IIIFibrilación y fisura mayor al 50% del espesor del cartílago GRADO IVErosión ósea subcondral Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

74 Se debe integrar la clasifficacion de la International Cartilage Repair Society ( ICRS) En esta clasificación se mantiene los cuatro grados de lesión, pero subclasifica de acuerdo a la profundidad de manera distinta Esta clasificación podría tener ventajas descriptivas y además pronosticas en relación con el tipo de lesión Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

75 ICRS GRADO ONormal GRADO 1aFibrilación y/o leve reblandecimiento GRADO 1 bFibrilaciones superficiales GRADO 2Defectos menores 50% del espesor del cartílago (anormal) GRADO 3Defectos mayores 50% del espesor del cartílago ( severamente anormal) Se Subdividen en : GRADO 3aHasta la capa calcificada GRADO 3bCompromete la capa calcificada GRADO 3cHasta el hueso subcondral, sin comprometerlo GRADO 3dAmpollas superficiales GRADO 4aCompromete el hueso subcondral GRADO 4bLa lesión se extiende mas allá del hueso subcondral

76 Resonancia magnetica (R.M) Es la única modalidad radiológica que permite visión directa con alta resolución del cartílago articular y el hueso esponjoso subyacente En las lesiones osteocondral tiene gran utilidad La RM evalúa los fragmentos condrales desplazados y es capaz de analizar la probable zona dadora en caso de planificar una mosaicoplastia La sensibilidad promedio es de 71% Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

77 La sensibilidad diagnostica de la RM en lesiones condrales de la rodilla alcanzo solo el 45% de las lesiones, es decir visto, de otra manera, en el 55% de los casos la RM no fue suficiente para diagnosticar la lesión condral evidenciadas por Artroscopia. Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

78 Manejo Clinico Tratamiento Quirurgico Con el fin de reproducir el fenómeno fisiológico reparativo de origen osteocondral que, al menos momentáneamente, resulta ser mas efectivo Estudios mostraban que con el tiempo, indeclinablemente, se llegaba a la fibrosis del tejido. El gran problema de este método quirúrgico era la atrofia de cuádriceps generada por la inmovilización posterior. Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

79 Abrasión y desbridamiento artroscopico Modificación de la debridacion abierta: -Remueve la superficie esclerótica hasta penetrar el hueso subcondral con una mínima lesión de la capsula articular -Esto facilita la rehabilitación postoperatorio y con ello minimiza la atrofia de cuádriceps Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

80 Eficacia del tratamiento depende: -Edad del paciente -Magnitud de la lesión -Nivel de actividad requerido -Longitud del seguimiento Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

81 Perforacion Subcondral El concepto Drilling a través del hueso subcondral ebúrneo para estimular la reparación del cartílago fue descrito originalmente por Pridie en 1959 Se basa en perforaciones puntiforme a través del hueso subcondral Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

82 Con esto espera preservar porciones estructurales de hueso subcondral y ayuda a restablecer las propiedades mecánicas del tejido envolvente en la regeneración tisular Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

83 Microfractura Fractura bajo la línea del hueso subcondral, con el fin de abrir una brecha, creando una superficie rugosa alrededor del hueso Esto produce un mejor adaptamiento del coagulo sanguíneo alrededor de la lesión La fractura subcondral es controlada y la principal ventaja en relación al Drilling seria a la menor presencia de calor y por lo tanto necrosis local. Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

84 CPM (Movimiento Continuo Pasivo) Estimula la reparación osteogenica y cartilaginosa del segmento dañado Seis horas de movimiento pasivo durante ocho semanas después del debridamiento artroscopico y/o microfactura Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

85 Autoinjerto o Mosaicoplastia El metodo descrito por Hangody en 1991 y aplicado a la clinica en 1992 No existe riesgo de rechazo inmunológico Es limitado en tamaño y genera comorbilidad Se utiliza la vía artroscopica Se obtiene injerto osteocondral de zona del cartílago que no soporta carga Se trasplanta como verdaderos tarugos hacia el defecto previamente moldeado Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

86 Histológicamente el cartílago trasplantado tiene características de cartílago hialino (Hangody) Los resultados clínicos a mediano y largo plazo, muestran una mejoría notable del HSS score aplicado a estos pacientes. Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

87 ¿Qué tecnica debemos utilizar? Se debe comprender que tal vez no sea el desarrollo o la depuración de una sola de las técnicas descrita la que dará la respuesta final al problema de la regeneración osteocondral, sino mas bien el uso de terapia combinada que incluirán seguramente el uso de factores de crecimiento, tecnología celular y alojamiento microquirúrgico, entre otras Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

88 Nuevas técnicas caen en dos categorías 1-Tratamiento “basados en la células” que usan condrocitos o stem-cells 2-”célula libre”, que utiliza elementos sintéticos para mejorar los mecanismos reparativos endógenos Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

89 En Resumen En la busqueda de nuevas tecnologias basadas en la potenciacion del medio ambiente de celulas para desarrollar el Gold-stándar en la reparacion del cartilago, que sea costo-efectivo,menor tiempo de recuperacion, menos invasivo,logrando producir un cartilago hialino estratificado y completamente integrado, permitiendo un reintegro rapido a las actividades normales Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic surgeons.n°4; july/agust,1994, pag, Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, a, pag David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine vol.3,number 2, pag , abril Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag Menche, David s, md Vagsness, Thomas jr, md; et al. “The treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, O´Driscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag Zaleske, David j, md. “Cartilage and bone development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag

90 GRACIAS…….


Download ppt "TRATAMIENTO ARTROSCOPICO DE LA ARTROSIS DE RODILLA INTERNA KINESIOLOGIA UDLA MARA JOSE GONZALES."

Similar presentations


Ads by Google