In humans and other primates, the knee joins the thigh with the leg and consists of two joints: one between the femur and tibia, and one between the femur and patella. It is the largest joint in the human body. The knee is a modified hinge joint, which permits flexion and extension as well as slight internal and external rotation. The knee is vulnerable to injury and to the development of osteoarthritis.
Arthroscopy is a minimally invasive surgical procedure on a joint in which an examination and sometimes treatment of damage is performed using an arthroscope, an endoscope that is inserted into the joint through a small incision. Arthroscopic procedures can be performed during ACL reconstruction.
Osteoarthritis (OA) is a type of degenerative joint disease that results from breakdown of joint cartilage and underlying bone. It is believed to be the fourth leading cause of disability in the world, affecting 1 in 7 adults in the United States alone. The most common symptoms are joint pain and stiffness. Usually the symptoms progress slowly over years. Other symptoms may include joint swelling, decreased range of motion, and, when the back is affected, weakness or numbness of the arms and legs. The most commonly involved joints are the two near the ends of the fingers and the joint at the base of the thumbs, the knee and hip joints, and the joints of the neck and lower back. The symptoms can interfere with work and normal daily activities. Unlike some other types of arthritis, only the joints, not internal organs, are affected.
Chondromalacia patellae is an inflammation of the underside of the patella and softening of the cartilage.
A meniscus is a crescent-shaped fibrocartilaginous anatomical structure that, in contrast to an articular disc, only partly divides a joint cavity. In humans, they are present in the knee, wrist, acromioclavicular, sternoclavicular, and temporomandibular joints; in other animals they may be present in other joints.
A meniscus transplant or meniscal transplant is a transplant of the meniscus of the knee, which separates the thigh bone (femur) from the lower leg bone (tibia). The worn or damaged meniscus is removed and is replaced with a new one from a donor. The meniscus to be transplanted is taken from a cadaver, and, as such, is known as an allograft. Meniscal transplantation is technically difficult, as it must be sized accurately for each person, positioned properly and secured to the tibial plateau. Its success also depends on donor compatibility, stability of the transplant, and long-term health of the underlying articular cartilage.
Articular cartilage, most notably that which is found in the knee joint, is generally characterized by very low friction, high wear resistance, and poor regenerative qualities. It is responsible for much of the compressive resistance and load bearing qualities of the knee joint and, without it, walking is painful to impossible. Osteoarthritis is a common condition of cartilage failure that can lead to limited range of motion, bone damage and invariably, pain. Due to a combination of acute stress and chronic fatigue, osteoarthritis directly manifests itself in a wearing away of the articular surface and, in extreme cases, bone can be exposed in the joint. Some additional examples of cartilage failure mechanisms include cellular matrix linkage rupture, chondrocyte protein synthesis inhibition, and chondrocyte apoptosis. There are several different repair options available for cartilage damage or failure.
Microfracture surgery is an articular cartilage repair surgical technique that works by creating tiny fractures in the underlying bone. This causes new cartilage to develop from a so-called super-clot.
A tear of a meniscus is a rupturing of one or more of the fibrocartilage strips in the knee called menisci. When doctors and patients refer to "torn cartilage" in the knee, they actually may be referring to an injury to a meniscus at the top of one of the tibiae. Menisci can be torn during innocuous activities such as walking or squatting. They can also be torn by traumatic force encountered in sports or other forms of physical exertion. The traumatic action is most often a twisting movement at the knee while the leg is bent. In older adults, the meniscus can be damaged following prolonged 'wear and tear'. Especially acute injuries can lead to displaced tears which can cause mechanical symptoms such as clicking, catching, or locking during motion of the joint. The joint will be in pain when in use, but when there is no load, the pain goes away.
Articular cartilage repair treatment involves the repair of the surface of the articular joint's hyaline cartilage, though these solutions do not perfectly restore the articular cartilage. These treatments have been shown to have positive results for patients who have articular cartilage damage. They can provide some measure of pain relief, while slowing down the accumulation of damage, or delaying the need for joint replacement surgery.
Mesenchymal stem cells (MSCs) are multipotent cells found in multiple human adult tissues, including bone marrow, synovial tissues, and adipose tissues. Since they are derived from the mesoderm, they have been shown to differentiate into bone, cartilage, muscle, and adipose tissue. MSCs from embryonic sources have shown promise scientifically while creating significant controversy. As a result, many researchers have focused on adult stem cells, or stem cells isolated from adult humans that can be transplanted into damaged tissue.
Kevin Robert Stone is an American physician, orthopedic surgeon, clinician, researcher, and company founder of The Stone Clinic and the Stone Research Foundation in San Francisco.
The Stone Clinic is a sports medicine clinic in San Francisco, California, offering orthopaedic surgery and medical care, physical therapy and rehabilitation, and radiology imaging services. The Stone Clinic was founded by Kevin R. Stone, M.D., an orthopaedic surgeon, combining himself with a team of nurses, physical therapists, imaging specialists, and patient coordinators, in 1988 to focus on caring for injured athletes and people experiencing arthritis pain.
Cartilage repair techniques are the current focus of large amounts of research. Many different strategies have been proposed as solutions for cartilage defects. Surgical techniques currently being studied include:
The following outline is provided as an overview of and topical guide to trauma and orthopaedics:
Alberto Gobbi is an Italian surgeon and researcher in orthopedics, traumatology and sports medicine known for his contributions in the fields of arthroscopic surgery, cartilage repair and regenerative medicine.
Cyril Wayne McIlwraith is the founding director of the Orthopaedic Research Center, a University Distinguished Professor in orthopaedics and holds the Barbara Cox Anthony University Chair in Orthopaedic Research at Colorado State University. He is a New Zealander who has had most of his career in the United States and is an equine orthopaedic surgeon and orthopaedic researcher. He pioneered many of the techniques in equine arthroscopic surgery including writing the textbook “Diagnostic and surgical arthroscopy in the horse”. He is noted for significant achievements in the fields of osteoarthritis cartilage injury, regenerative therapies and contributions on understanding of joint pathology and repair, the development and validation of equine models of joint diseases, surgical technologies, intra-articular therapies, cartilage resurfacing, tissue engineering and gene therapies for osteoarthritis many of which have been or are translatable to human joint disease. He received the Marshall R. Urist Award for Excellence in Tissue Regeneration Research from the Orthopaedic Research Society in 2014 for these contributions as well as raising many generations of basic and clinical researchers in the field of orthopaedics.
Post-traumatic arthritis (PTAr) is a form of osteoarthritis following an injury to a joint.
Raju Vaishya is an Indian researcher with contributions in the field of orthopaedics. He is former President and founder member of Indian Cartilage Society (2018–19) and Founder President of Arthritis Care Foundation. He has established a center for Autologous Chondrocyte Implantation (ACI) at Indraprastha Apollo Hospitals, New Delhi, India. Instrumental (PSI) in starting the first cartilage club in Delhi, to enhance the awareness about the cartilage science and regenerative treatments used in Orthopaedics. He has the credit of doing the first preplan patient specific instruments (PSI) total knee arthroplasty, in Northern India in May 2013.
Victor Valderrabano is a Swiss orthopedic surgeon and traumatologist specializing in sports traumatology, osteoarthritis surgery and reconstructive surgery of the lower extremity.
