Current surgical options for articular cartilage repair

The articular cartilage lesions represent one of the major unsolved problems in the orthopaedic surgery. This is because articular cartilage has a limited capacity of self-repair following trauma. The aim of this study is to review the different surgical options for articular cartilage repair. They can be divided into three groups: techniques without transplant of cells or tissues; techniques based on the transplantation of tissues; the tissue engineering techniques. The first group includes the joint debridement and the techniques based on the bone marrow-stimulation principle. The second group includes the transplantation of periosteum and the transplantation of autologous or allogeneic osteochondral plugs. The tissue engineering techniques could be further divided as follows: methods based on the transplantation of cells either in solution, or in the form of microspheres, or carried on a biocompatible scaffold; the transplant of cartilage fragments; the cell-free techniques, based on the use of an acellular scaffold, able to entrap the reparative cells recruited from the host tissue and to guide their differentiation toward a chondral phenotype. In this work we present various options for the treatment of chondral or osteochondral lesions. Today, however, due to the lack of comparative studies, it is not always possible to define the best treatment choice for the different cartilage pathologies.