TRATAMIENTO ARTROSCOPICO
DE LA ARTROSIS DE RODILLA
INTERNA KINESIOLOGIA UDLA
MARA JOSE GONZALES
TRATAMIENTO ARTROSCOPICO DE LA
ARTOSIS DE RODILLA
“La Población tiende a mantenerse físicamente cada
vez mas activa y a realizar actividades mas
demandante a edades mas avanzadas “
“Artroscopia aparece como un procedimiento mas
simple en paciente que por edades o cambios
degenerativos menores no son candidatos a una
artroplastia”
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al
: questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB,
O´malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
¿Cuáles son los objetivos de una
Artroscopia?
Remover las partículas inflamatorias
y enzimas degradativas
Proporcionar superficies lisas de
cartílago articular
Tratar patología meniscal
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al
: questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB,
O´malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
“la evidencia se inclina
en demostrar que el
tratamiento artroscopico
no presenta beneficios
sobre el tratamiento
conservador”
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al
: questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB,
O´malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
Artrosis de Rodilla
La artrosis se
presenta en :
Todo grupo de
edades y raza
Con mayor
prevalencia en
mujeres
Se reporto que el
50% en personas
mayores de 65
años
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al
: questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB,
O´malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
La artrosis es el segundo diagnostico
primario que causa discapacidad despues
de las enfermedades cardiovasculares
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al
: questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB,
O´malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
El tratamiento de la artrosis de rodilla:
• Debe ser etapificado
• Existir relación con síntomas y signos
• Se debe comenzar con medidas simples:
Bajar de peso
Modificación de la Actividad
Calzado amortiguador
kinesioterapia
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al
: questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB,
O´malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
Los pacientes que no presente una respuesta
favorable al tratamiento conservador, el
tratamiento quirurgico es una alternativa con
mejores resultados en pacientes entre 40- 60
años
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al
: questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB,
O´malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
Tratamiento Quirúrgico
objetivos
• Disminuir el dolor
• Aliviar la funcionalidad
beneficios
• Permite remoción de osteofitos
sintomáticos
• Trata eventuales patologías
mecánicas coexistentes (lesiones
meniscales, cuerpos libres, etc.)
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al
: questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB,
O´malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
Selección de paciente y
criterio para una Artroscopia
Inicio agudo de derrame
articular, dolor localizado en
interlinea articular o
síntomas mecánicos como
bloqueo
Inicio agudo de
sintomatología después de
un traumatismo especifico
Cuerpo libre intrarticular
confirmado por imágenes
Paciente debe presentar
artrosis temprana , ausencia
de mal alineamiento
significativo, sin disminución
de espacio articular y sin
osteofitos importantes
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al
: questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB,
O´malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
Tecnica quirurgica
¿ cual es la base y finalidad del
tratamiento artroscopico de la artrosis?
Es el debridamiento o aseo articular , que tiene como
finalidad aliviar sintomatología a través de la
restauración de la biomecánica de la rodilla
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al
: questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB,
O´malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
El procedimiento básicamente incluye:
 El aseo articular para dilución de la concentración de
enzimas degradativas y remoción de productos
irritantes de la degeneración condral, meniscal o
sinovial
 Remoción de cuerpos libres intrarticulares
 Meniscectomia parcial
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al
: questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB,
O´malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
Meniscectomia
• El proceso patológico de la artrosis en
etapas tardías no solo genera la
destrucción del cartílago articular,
sino que afecta también la integridad
de meniscos y ligamentos
• Cualquier procedimiento sobre el
menisco debe ir orientado a mejorar
la sintomatología del paciente
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al
: questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB,
O´malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
• Un desgarro en un menisco con cambios
degenerativos esta asociado a cambios estructurales
preexistentes en el cartílago articular que pueden
representar una etapa temprana de artrosis
• Dependiendo de cuanta funcionalidad meniscal se
pierda con un desgarro o una resección quirúrgica, la
artrosis se puede acelerar a medida que aumenta la
carga biomecánica en el cartílago articular
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al
: questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB,
O´malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
• La reseccion de una lesion de cuerpo posterior del
meniso interno disminuye en dos tercios la
capacidad de absorcion de carga
• Se debe evitar la reseccion del menisco hasta la
periferia, ya que elima la capacidad del menisco de
soportar cargas
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al
: questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB,
O´malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
• La extrusión meniscal es otro hallazgo común en
pacientes mayores y es a menudo otro signo de una
degeneración meniscal y artrosis preexistente
• Una extrusión meniscal puede contribuir a aumentar
la estrechez del espacio articular
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al
: questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB,
O´malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
Condroplastia
• La radiofrecuencia ha ganado popularidad como
herramienta artroscopica
• Sus ventajas son:
- Fácil de aplicar
-Bajo costo
- Retracción del colágeno
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al
: questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB,
O´malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
• Estudios han demostrado que la condroplastia
utilizando radiofrecuencia obtiene superficies lisas
que permanecen estables por largos periodos de
tiempo
• Sin embargo, la radiofrecuencia funciona a través del
calor y su desventaja esta en que los condrocitos son
extremadamente sensibles a la temperatura
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al
: questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB,
O´malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3
Sinovectomia y remoción de
osteofitos
• En el casos que la artrosis
avanzada se acompañe de sinovitis
significa que provocara derrames
recurrentes, y la Sinovectomia
puede estar indicada
• La resección de osteofitos en
general no son recomendado, por
el riesgo de provocar hemartrosis
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al
: questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB,
O´malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3
La única indicación excepcional para
realizar este procedimiento es la
presencia de un osteofito anterior en
la escotadura intercondilea o
patelofemoral que bloque la extensión
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al
: questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB,
O´malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3
Resultados
50% a 75% de los paciente con Artroscopia
refieren una mejoría inicial
15% progresa a una artroplastia total de rodilla a
un año
44% presenta una disminución clínica significativa
del dolor a dos años de seguimiento
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al
: questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB,
O´malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
Spahn et al. Examino los resultados de la
Artroscopia en pacientes con artrosis medial
de rodilla
71% de los pacientes
presento pobres
resultados
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al
: questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB,
O´malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
Sugirio que los factores asociados
a mal pronosticos son:
•
•
•
•
•
•
Tiempo de evolución de la artrosis mayor a 24 meses
Obesidad
Osteofitos mediales
Espacio articular menor a 5 mm
Tabaco
Presencia de defecto condral tibial grado IV y
necesidad de una Meniscectomia total o subtotal
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al
: questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB,
O´malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
No se debiera considerar una
Artroscopia
Si existe disminución
severa del espacio
articular comprometido
( estadio 3 de Kellgren
Lawrence)
Tienen pocas posibilidades
de ser un procedimiento
exitoso
Tampoco si el eje
mecánico de la rodilla
pase por la zona de la
lesión
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al
: questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB,
O´malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
Estudios Clinicos
• En el estudio de Framingham sobre indicaciones de
Meniscectomia en rodilla artrosica describió:
“El 56% de los hombres entre 70 y 90 años sin
sintomatología presenta desgarros meniscales y en
pacientes con artrosis radiográfica este porcentaje
aumenta a 82%. Sin embargo , la relación entre daño
meniscal y artrosis es compleja”
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al
: questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB,
O´malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
• Una lesión meniscal en una rodilla sana, puede ,
eventualmente , llevar al desarrollo de la artrosis por
perdida de la función meniscal
• Una rodilla artrosica puede presentar un desgarro menisca
que acelera el proceso degenerativo
• Esto sugiere que el daño meniscal visible
en resonancia magnética antecede a
los cambios visibles del cartílago
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al
: questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB,
O´malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
Tecnica preferida por el autor
• Como regla general se debe ser conservador y
juicioso en las resecciones para preservar al máximo
las estructuras noble de la función articular: Cartílago
y Menisco
• Toda estructura inestable debe ser resecada y/o
remodelada en su justa medida teniendo en cuenta
que los pacientes solo utilizaran sus rodilla en AVD y
baja demanda
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al
: questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB,
O´malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
• Contraindicamos formalmente cualquier tipo de
procedimiento que base su éxito en respuesta
reparativas del paciente, fundamentalmente por los
factores de edad y por la severa alteración de la
homeostasis articular que limita seriamente su
respuesta regenerativa por ejemplo: microfracturas,
meniscorresis, etc
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al
: questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB,
O´malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
• Normalmente por edad y presencia de factores de
riesgo utilizamos tratamiento anticoagulante
profiláctico con HBPM en el postoperatorio
• Uso de kinesiología precoz , con énfasis en la
movilización, limitación de la respuesta inflamatorias,
drenaje venoso y linfático, mantención trofismo
muscular y el uso transitorio de descarga en la
deambulacion
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al
: questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB,
O´malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3
Conclusión
• La evidencia es categórica en demostrar que el
tratamiento artroscopico no presenta beneficios
sobre el tratamiento conservador
• Siempre se debe tomar cuenta que al momento de
evaluar al paciente que los peores resultados de una
Artroscopia en artrosis se asocia a mal alineamiento ,
inestabilidades, artrosis avanzadas , sintomatología
crónica, cirugías previas
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al
: questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB,
O´malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3
LESIONES CONDRALES
HISTOLOGIA
• Cartílago hialino es una forma especializada de tejido
conjuntivo
• Constituidos por elementos celulares denominados
CONDROCITOS que disponen en una matriz
extracelular dura de tipo gel
• Las células se nutren mediantes difusión a través de
la fase acuosa de la matriz y a partir de los capilares
de los tejidos que rodean el cartílago
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag. 406-75. 1998.
Propiedades
Elasticidad
Viscosidad
Esto le confiere una dureza y flexibilidad poco habituales
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
Fibrocartilaginoso
Tipos de
cartílago
Hialino
Elástico
Sus Diferencias están dadas por:
- Matriz celular
-Fibras de Colágenos
- Fibras de Elastina
Cartilago Hialino
• Se presenta en anillos traqueal, la nariz, laringe,
superficies articulares
• Condrocitos se encuentran por debajo del
pericondrio
• Zona mas profunda del cartílago , las lagunas tienen
una configuración hemisférica o angular
• Citoplasma presenta una baja densidad, contienen
gotas de lípido y cantidades variables de glucógeno
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
development”.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag. 406-75. 1998.
Matriz Cartilaginosa
• Es de color azul grisáceo y parcialmente traslucida
• Colágeno que predomina es tipo II, que forma fibras
débiles con estriación transversal
• Las fibras de la zona superficial están orientadas
paralelamente y la mas profundas hacia adentro en
forma de columnas verticales
• La orientación de las fibras son adaptadas para resistir
la tensión a la que están sujetas normalmente
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
• Dentro de la matriz existen una capsula pericelular,
que rodea a las lagunas
• Esta formada por fibras muy finas de características
similares a la lamina basal
• Desempeña un papel importante en la protección de
los condrocitos de aquellos cartílagos sometidos a
compresión o tensión mecánica
• La matriz posee mayor concentración de
proteoglicanos
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
Cartilago Articular
• Es un tipo de cartílago hialino, que cubre
terminaciones Oseas de la articulaciones sinoviales
• Es avascular y denervado, el 70%-80% de su peso es
agua
• Constituido por colágeno tipo II, posee poca elastina
y un componente menor de glicoproteínas y lípidos
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
• Se organiza en cuatro capas :
1- Superficial (S)
2- Transicion (T)
3- Medial (M)
4- Calcificada (C)
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
Capa Superficial
Posee dos zonas
Compuesta por un grupo
de finas fibrillas con
pequeños polisacáridos, sin
células que cubren la
articulación
Esta zona es mas profunda
y se observan condrocitos
de forma elíptica dispuesto
en un eje mas paralelo a la
superficie
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
• En esta capa los condrocitos secretan una matriz con
alta concentracion de colageno y baja concentracion
de proteoglicanos
• La caracteristica estructural de esta capa es que
determinan una alta fuerza tensil y resistencia a la
compresion superior a las capas profundas
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
Capa Transicion
• Posee mayor grosor que la capa superficial
• Los condrocitos adoptan una morfología espiroidal
• Sus células poseen mayor densidad de organelos,
recitáculo endoplasmatico y aparato de Golgi
• Sintetizan matriz con fibras colágenos de mayor
diámetro con alta concentración de proteoglicano y
menor de concentración de agua y colágeno
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
Capa Medial
• los condrocitos esferoides ubicados perpendicular a
la superficie articular
• posee fibras de colagenos de gran diametro
• La concentracion mas alta de proteoglicanos y la mas
baja de agua
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
Capa Calcificado
• Es una zona de cartílago calcificado que separa la
zona radial del hueso subcondral
• Contienen muy poco retículo endoplasmatico y
aparato de Golgi
• Las células aparecen completamente rodeando el
cartílago calcificado, lo que sugiere una baja
actividad metabólica
• Estudios sugieren que podría jugar un rol en el
desarrollo y progresión de la osteoartritis
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
Cartilago Articular Normal
• La función de este cartílago es :
 Minimizar el estrés sobre el hueso subcondral
 Distribución de cargas en la articulación
 Disminuye el coeficiente de fricción de las superficies
articulares
 La interacción con el liquido sinovial proporciona un
excelente mecanismo de lubricación
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
Existen dos mecanismos de
lubricacion :
1- Fluid Film : capa de fluido sinovial menor a 25 um ,
de gran viscosidad
2- Lubricacion Frontera: HAP, proteína de acido
hialuronico de alta afinidad por la superficie articular,
que funciona como un importante lubricante
limítrofe con la superficie articular
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
• Los filamentos de colágeno mantienen la
configuración del tejido y la resistencia a las fuerzas
tensiles
• Los proteoglicanos proporcionan un gel hidratado y
firme que absorbe las fuerzas de compresión y
además pueden atrapar e inmovilizar un gran
volumen de agua
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
¿Cómo se resisten las fuerzas
compresivas?
cuando se ejerce una fuerza compresiva, el agua se
aleja de las regiones con carga eléctrica de los
proteoglicanos. Entonces , la cargas negativas de los
grupos carboxilo y sulfato se aproximan y la fuerza de
repulsión de las mismas permiten resistir la
compresión
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
Mecanismo de disipación de
energía
• El liquido intersticial fluye lentamente por la
existencia de pequeños poros en el espacio
intermolecular , con ello baja la permeabilidad de la
matriz tisular y gracias a esto no existe una excesiva
deformación del tejido y se crea la interacción de
fricción entre fluidos y la matriz
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
¿los proteoglicanos influyen en el
envejecimiento?
• Estudios compararon cultivos de condrocitos de
animales viejos y jóvenes
• pudiendo observar que los condrocitos viejos
secretan proteoglicanos de menor tamaño y con
cadenas condroitin sulfato mas cortas
• se ha propuesto que al ser de menor tamaño el
proteoglicano ,le permite retener una cantidad
menor de agua, lo que disminuye su capacidad para
resistir fuerzas compresivas
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
• Y con ello la matriz seria mas vulnerable a pequeñas
cargas de peso, produciendo reacciones
inflamatorias que seria la causa de la sintomatología
dolorosa de la artritis, dejando como posibilidad que
la prevalencia de la osteoartritis en ancianos este
relacionada con cambios en la matriz cartilaginosa
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
• El cartílago hialino muestra una capacidad muy
limitada de reparación
• Sus células dependen de la difusión de nutrientes y
oxigeno en distancias considerables a través de la
matriz
• Cuando disminuye el flujo de sangre alrededor del
cartílago, sus células pueden morir y el cartílago es
invadido por vasos sanguíneos y células fagocitarias
mientras que la matriz es reabsorbida y sustituida
por tejido cicatrizal
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
Lesiones del cartilago articular
• El cartílago hialino posee una relación injuriarespuesta muy estrecha
• La magnitud y el grado de lesión del cartílago
dependerá del mecanismo y grado de respuesta
reparativa
• La respuesta reparativa que el cartílago es capaz de
dar es insuficiente y de mal pronostico en general
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
De acuerdo con la magnitud del daño generado en el
cartilago hialino exiten 3 grupos de lesion:
1- Perdida o daño macromolecular de
la matriz sin disrupción tisular visible
2-Daño mecánico o disrupción de
cartílago visible dentro de la matriz
3-Disrupcion del cartílago y hueso
subcondral (lesión osteocondral)
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
Lesiones
Lesión aguda sin
disrupción de
tejido visible
Disrupción
mecánica del
cartílago
Lesión
osteocondral
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
Lesion aguda sin disrupcion de
tejido visible
• Lesión con mayor capacidad de mejoría
• Traumatismo contuso cerrado como un trauma de
carga repetitiva, induce cambios significativos en la
histología, bioquímica y características estructurales
de la matriz
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
Una de las primeras alteraciones observadas en
este tipo de lesion corresponde :
• 1- perdida de proteoglicanos o disrupción de su
organización
• 2-disminucion en la concentración de proteoglicanos,
alterando las propiedades fiscas
• 3-peso o carga suprafisiologica sobre ya debilitadas
proteínas estructurales
• 4-cambios del medio ambiente que rodea al
condrocito
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
Disrupcion mecanica del cartilago
• No existe una medida exacta de la magnitud de la
fuerza que el cartílago es capaz de soportar ante de
sufrir daño estructural macroscópico
• Sin embargo el limite critico de integridad estructural
de los condrocitos es equivalente a 20-25 Mpas
• Un estrés superior a esta medida generara muerte y
fisura del condrocito
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
• Su etiología puede estar en lesiones que penetran la
articulación, produciendo laceración o abrasión del
cartílago
• La respuesta tisular a este daño se encuentra
caracterizado por un tejido avascular, no existe la
generación de un fenómeno de inflamación clásico
• Por tanto el condrocito son los responsables de todo
el proceso de reparación.
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
Lesión Osteocondral
• En este caso el traumatismo es de tal magnitud que
incluye lesión del hueso subcondral o fractura
osteocondral
• Esta lesión repara dando origen a tejido
fibrocartilaginoso con propiedades muy distintas al
cartílago hialino articular normal
• La restauración de la placa subcondral toma forma a
partir de las 6-8 semanas
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
• Al cabo de 12-14 semanas se observa degeneración
superficial del cartílago con aspecto fibrilar
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
Daño Cronico
• La osteoartritis puede desarrollarse como fenómeno
primario o secundario a daño en el cartílago articular
• Si la red de colágeno presenta disminución del efecto
restrictivo; si esta se destruye los
glicosaminoglicanos atrapados en la red, se escapan
del anclaje y su perdida derivara en la disminución de
la tolerancia a las fuerzas compresivas de la
articulación
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
Estimulos reparativos biologicos
• El estado normal del cartílago articular se encuentra
mantenido por una combinación de procesos
anabólicos y catabólicos de los condrocitos
• Durante el proceso degenerativo, existe un aumento
en la reabsorción de la matriz
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
Para la mantención de este balance existen
mediadores polipeptidicos :
TGF-B IGF-1 BFGF
BMP
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
TGF-B
Factor de crecimiento y transformacion B
• Estimula la proporción de síntesis de
macromoléculas de la matriz, especialmente
pequeños glicosaminoglicanos.
• Promueve la reparación del cartílago dañado
• Posee un potente efecto en la expresion fenotipica
del condrocito
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
IGF-1
Factor de crecimiento insulino simil
• Producido en respuesta a estímulos sistémicos de
parte de hormonas de crecimiento
• Media efectos anabólicos de esta hormona en los
tejidos
• Estimula la proliferación de condrocitos,
proteoglicanos y acido hialuronico, y a su vez puede
disminuir la degradación de estos
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
BFGF
Factor de crecimiento fibroblastico
• Es un potente mitogenico de condrocitos
• Estimula la síntesis de la matriz cartilaginosa
• Posee actividades sinérgica con el factor IGF-1
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
BMP
Bone morphogenectic protein
• Es del tipo TGF-B
• En tejidos indiferenciado, estimulación de BMP I-II
induciendo condrogenesis y osificación
endocondral
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
Estimulo Fisico
• Fuerzas mecánicas regulan el funcionamiento del
condrocito
• La inmovilización o disminución de cargas sobre la
articulación disminuye la síntesis de proteoglicanos
• El ejercicio moderado aumenta la síntesis de
proteoglicanos y estimula el espesamiento de la
matriz cartilaginosa
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
Diagnostico y tratamiento de las
lesiones osteocondrales
• Clínica :
1- existe daño en la superficie articular
2-Disfuncion articular y/o derrame articular
• Esto evoluciona con degeneración articular
progresiva aumenta en forma considerable el riesgo
de desarrollo de osteoartritis
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
• Las lesiones condrales son asintomáticas, a no ser
que se asocien a una lesión del hueso subcondral
• También puede manifestarse con bloqueo de la
articulación
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
Imagenologia
Artroscopia
• Según Outerbridge, que describió su clasificación
Artroscopia de lesión articular en cuatro grados,
actualmente la mas utilizada.
GRADO I
GRADO II
GRADO III
GRADO IV
Reblandecimiento
Fibrilación y fisura menor al 50% del
espesor del cartílago
Fibrilación y fisura mayor al 50% del
espesor del cartílago
Erosión ósea subcondral
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
Se debe integrar la clasifficacion de la International
Cartilage Repair Society ( ICRS)
• En esta clasificación se mantiene los cuatro grados de
lesión, pero subclasifica de acuerdo a la profundidad
de manera distinta
• Esta clasificación podría tener ventajas descriptivas y
además pronosticas en relación con el tipo de lesión
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
ICRS
GRADO O
Normal
GRADO 1a
Fibrilación y/o leve reblandecimiento
GRADO 1 b
Fibrilaciones superficiales
GRADO 2
Defectos menores 50% del espesor del cartílago (anormal)
GRADO 3
Defectos mayores 50% del espesor del cartílago ( severamente
anormal)
Se Subdividen en :
GRADO 3a
Hasta la capa calcificada
GRADO 3b
Compromete la capa calcificada
GRADO 3c
Hasta el hueso subcondral, sin comprometerlo
GRADO 3d
Ampollas superficiales
GRADO 4a
Compromete el hueso subcondral
GRADO 4b
La lesión se extiende mas allá del hueso subcondral
Resonancia magnetica (R.M)
• Es la única modalidad radiológica que permite visión
directa con alta resolución del cartílago articular y el
hueso esponjoso subyacente
• En las lesiones osteocondral tiene gran utilidad
• La RM evalúa los fragmentos condrales desplazados y
es capaz de analizar la probable zona dadora en caso
de planificar una mosaicoplastia
• La sensibilidad promedio es de 71%
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
La sensibilidad diagnostica de la RM en lesiones
condrales de la rodilla alcanzo solo el 45% de las
lesiones, es decir visto, de otra manera, en el 55% de
los casos la RM no fue suficiente para diagnosticar la
lesión condral evidenciadas por Artroscopia.
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
Manejo Clinico
Tratamiento Quirurgico
• Con el fin de reproducir el fenómeno fisiológico
reparativo de origen osteocondral que, al menos
momentáneamente, resulta ser mas efectivo
• Estudios mostraban que con el tiempo,
indeclinablemente, se llegaba a la fibrosis del tejido.
• El gran problema de este método quirúrgico era la
atrofia de cuádriceps generada por la inmovilización
posterior.
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
Abrasión y desbridamiento artroscopico
• Modificación de la debridacion abierta:
-Remueve la superficie esclerótica hasta penetrar el
hueso subcondral con una mínima lesión de la
capsula articular
-Esto facilita la rehabilitación postoperatorio y con ello
minimiza la atrofia de cuádriceps
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
• Eficacia del tratamiento depende:
-
Edad del paciente
Magnitud de la lesión
Nivel de actividad requerido
Longitud del seguimiento
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
Perforacion Subcondral
• El concepto Drilling a través del hueso subcondral
ebúrneo para estimular la reparación del cartílago
fue descrito originalmente por Pridie en 1959
• Se basa en perforaciones puntiforme a través del
hueso subcondral
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
• Con esto espera preservar porciones
estructurales de hueso subcondral y ayuda a
restablecer las propiedades mecánicas del
tejido envolvente en la regeneración tisular
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
Microfractura
• Fractura bajo la línea del hueso subcondral, con el fin
de abrir una brecha, creando una superficie rugosa
alrededor del hueso
• Esto produce un mejor adaptamiento del coagulo
sanguíneo alrededor de la lesión
• La fractura subcondral es controlada y la principal
ventaja en relación al Drilling seria a la menor
presencia de calor y por lo tanto necrosis local.
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
CPM
(Movimiento Continuo Pasivo)
• Estimula la reparación osteogenica y cartilaginosa del
segmento dañado
• Seis horas de movimiento pasivo durante ocho
semanas después del debridamiento artroscopico
y/o microfactura
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
Autoinjerto o Mosaicoplastia
El metodo descrito por Hangody en 1991 y aplicado a la clinica en 1992
•
•
•
•
No existe riesgo de rechazo inmunológico
Es limitado en tamaño y genera comorbilidad
Se utiliza la vía artroscopica
Se obtiene injerto osteocondral de zona del cartílago
que no soporta carga
• Se trasplanta como verdaderos tarugos hacia el
defecto previamente moldeado
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
• Histológicamente el cartílago trasplantado tiene
características de cartílago hialino (Hangody)
• Los resultados clínicos a mediano y largo plazo,
muestran una mejoría notable del HSS score aplicado
a estos pacientes.
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
¿Qué tecnica debemos utilizar?
• Se debe comprender que tal vez no sea el desarrollo
o la depuración de una sola de las técnicas descrita la
que dará la respuesta final al problema de la
regeneración osteocondral, sino mas bien el uso de
terapia combinada que incluirán seguramente el uso
de factores de crecimiento, tecnología celular y
alojamiento microquirúrgico, entre otras
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
Nuevas técnicas caen en dos
categorías
1-Tratamiento “basados
en la células” que usan
condrocitos o stem-cells
2-”célula libre”, que utiliza
elementos sintéticos para
mejorar los mecanismos
reparativos endógenos
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
En Resumen
• En la busqueda de nuevas tecnologias basadas en la
potenciacion del medio ambiente de celulas para
desarrollar el Gold-stándar en la reparacion del
cartilago, que sea costo-efectivo ,menor tiempo de
recuperacion, menos invasivo,logrando producir un
cartilago hialino estratificado y completamente
integrado, permitiendo un reintegro rapido a las
actividades normales
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries
and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.”restoration of injuried or degenerated articular cartilage”. American academy of orthopaedic
surgeons.n°4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag.
612-632. David figuroa, md, Rafael calvo , m.d, alex vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral
defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. “basic science of articular cartilage injury and repair”. Operative technique in sports medicine
vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. “The
treatment of isolated articular cartilage lesions in the young individual”. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. O´Driscoll SW. The healing and
regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl).
Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. “Cartilage and bone
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