The buzz in cartilage injuries today rests on mesenchymal stem cells from bone marrow. adipose tissue, synovium and even the omnipresent pericytes. The techniques in harvesting and delivering it to the chondral defects are more or less evolved. The arguments with regards to the no of cells when harvested and directly implanted or should be expanded needs to be answered. The cellular cross talk in local environemnt appears to guide the chondroblast formation. The pioneers AA Shetty(UK) and Kim(Korea), A Gobi from bologna university and japan are way ahead the rest of us. I believe there is finally light at the end of the tunnel with regards to stem cells in cartilage injury.
As far as micro fracture is concerned, the use of the chondral pic is obsolete. As the pick jams the subchondral bone into the hole preventing the MSC cells from escaping the bone marrow. therefore a 2 mm drill would be ideal and a depth of 4mm is advisable. The problems of subchondral hypertrophy in both microfracture and chondrocyte implantation is real. The management of these are still evolving
As far as micro fracture is concerned, the use of the chondral pic is obsolete. As the pick jams the subchondral bone into the hole preventing the MSC cells from escaping the bone marrow. therefore a 2 mm drill would be ideal and a depth of 4mm is advisable. The problems of subchondral hypertrophy in both microfracture and chondrocyte implantation is real. The management of these are still evolving
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