Surgical Repair of Cartilage Defects - An Update for Practitioners

Biologic resurfacing of articular cartilage is the Holy Grail of joint surgery. While no current resurfacing treatment option consistently results in re-creation of fully integrated and functional hyaline cartilage and subchondral bone long term and the available options are more limited in veterinary medicine compared to human medicine, there are still some viable biologic treatment options that can result in very good outcomes in our patients. We will discuss marrow stimulation, osteochondral autografts, osteochondral allografts, and synthetic resurfacing as realistic clinical options, and cell-based and tissue engineering strategies as potential future modalities.

MARROW STIMULATION

Marrow stimulation is the simplest and most common method for surgical repair of cartilage defects. This is typically accomplished using specifically designed picks or awls, but can also be accomplished with drilling techniques using Kirschner wires or drill bits. These techniques are only effective for contained defects, and at best, result in formation of reparative fibrocartilage tissue in the defect.

OSTEOCHONDRAL AUTOGRAFTS

Osteochondral autograft treatment has been reported to improve outcomes in human patients when compared to other treatment modalities. Based on the human success, we adapted the concept and the OATS (Arthrex) technique to veterinary surgery for use in dogs and horses. We performed a body of research using cadavers, research dogs, and finally, clinical cases. We have reported the results of that work in the peer-reviewed literature. We have found the OATS procedure can be successfully performed in the stifle of dogs for treatment of OCD. Clinical results have been excellent with respect to graft viability and integration, and improved clinical function. Others have reported their work on the technical aspects of this technique in dogs and use of OATS in other joints including the elbow and shoulder. Further work is needed to determine appropriate indications and long-term results. […]