Greffes et transferts de cartilage

The treatment of a chondral defect is still a challenging issue for the orthopedic surgeon. Before choosing an option treatment, an arthroscopic evaluation using the ICRS classification is required. Only symptomatic patients with lesions grade III and IV required a surgical treatments. Several surgical options are available for the treatments of chondral defect in young patients. The microfracture technique is an efficient technique for small lesions. There were no side effects treatments and the results were good in case of small lesions. Massive fresh allografts are available in France, but are not very used due to the insufficiency of grafts in France. The literature review showed that this technique is a good option for young active patients with severe post-traumatic chondral defects before knee prosthesis. The oats technique or mosaic plasty is the transfer of a complete unit of bone and chondral substance. The clinical results are excellent for lesions smaller than 3 cm2. This technique is now efficient safe and reproducible. The chondrocytes cells and transplantation is a regeneration process based on the biologic activation of the chondrocytes. We are now using the third generation of chondrocytes cells culture. This technique is using chondrocytes cells with scaffolds. The only technique available in France is the Cartipatch technique and this is a national research program. Few some centers in the SOO group are involved in this research process. Before selecting the good option treatment, the complete evaluation and indication is an essential step. The clinical, radiological and arthroscopic evaluation is required to define the size, the location of the chondral defect in order to select the optimal surgical option. Pre-arthrosis with mirror kissing lesions are a contra-indication to conservative surgical treatment.