Articular Cartilage Pathology: What to do?

A syringe delivering PRP:
A silver bullet for osteoarthritis?

My fall was so busy, I’m finally getting back to doing a sequel of a post I wrote in early October:  Osteoarthritis Part I.

I’m finally writing “Part II.”

The proximal impetus for finally attending to this item on my personal ‘to do’ list?  The new, January 2014 edition of the Clinical Journal of Sports Medicine has a couple of very fine articles on the treatment of articular cartilage pathology. One of the studies, “Treatment of Cartilage Defects of the Knee: Expanding on the Existing Algorithm,” is a general review I hope to post about in the near future.  The study that is in my line of fire today explores the uses of platelet-rich plasma (PRP) in the treatment of osteoarthritis and cartilage defects: “Platelet-rich Plasma in the Management of Articular Cartilage Pathology:  A Systematic Review.”

I found this review to be incredibly helpful.  It begins with an overview of articular cartilage pathology and a reminder of the frustrations in treating a tissue that has a limited inherent healing capacity.   Rarely can articular cartilage repair itself.  And when injury penetrates subchondral bone, underlying marrow cells can be stimulated to provide some repair, but inevitably the fibrocartilage that results is a biomechanically inferior substitute for native, articular hyaline cartilage.

ocd for blog 2

OCD of the medial femoral condyle:
what will this joint look like in 2044?

The review notes the increasing incidence of chondral and osteochondral lesions, something as a pediatric sports medicine specialist I can attest to.  The 10 year old with knee OCD I am treating today:  I often wonder what their knee will be like in 30 years?

The authors note:   “Several treatment modalities are available, including microfracture, autologous chondrocyte transplatation, and autograft and allograft osteochondral transplantation.  However, the reported resulst with these procedures have been variable and are not guaranteed to prevent symptomatic degenerative disease at long-term follow up.”

In other words, the hunt is on for an effective, definitive treatment of articular cartilage injury.  Might PRP be the answer?

The brief answer:  we need to learn much, much more about PRP, and probably about articular cartilage, too.

Let’s start with the limitations.  Read more of this post

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