Joint resurfacing in humans: what is done and what are we working on

Efficacious treatment of chondral defects is a major challenge of the orthopaedic practice. In the last three decades extended research efforts were expressed to develop new cartilage repair alternatives. Both basic science and clinical research fields tried to promote hyaline cartilage or hyaline type of repair techniques. Some of these techniques are supported by extended clinical evaluations over 25 years. Autologous osteochondral mosaicplasty and autologous chondrocyte implantation are the oldest modern cartilage repair options. Both techniques have wide basic science background as well as medium and longterm clinical evaluations are also vailable to determine the proper indications. Later on biodegradable scaffolds were also introduced to the clinical practice. This type of cartilage repair technique is often fortified by bone marrow acquired autologous mesenchymal stem cell support. Scaffold based repair techniques are usually indicated for small sized defects. For extended osteochondral defects new types of osteochondral allograft transplantation are recommended. As chondrocyte survival is critically influenced by the time between graftharvest and implantation, ultra-fresh transplants may provide better long-term results. Beside unique operative techniques adjuvant regenerative therapies may improve clinical results. This lecture will introduce old standards and new alternatives in cartilage repair.