Cartilage Journey

The human bones join with each other in various ways to serve the functional requirements of the musculoskeletal system. The most critical function of all needs is purposeful motion. The effective interaction of all muscles, tendons, ligaments and articular cartilage defines the movement required from kicking a ball in a professional athlete to running and swimming and even walking.  With a continuous repetitive movement, articular cartilage between bones helps the musculoskeletal system to move in the most efficient way.  Without it, friction would consume the energy of this system and would put it incapable of making simple required actions.  

The knee joint is incongruent, and it is the biggest incongruent joint in the human body.  To accommodate incongruency, the joint itself has the highest thickness of articular cartilage among all joints.  This indicates the importance of the articular cartilage in promoting the function of the joint.

Knee cartilage injury is a ravaging injury that can affect all people in all age groups.  It is an irreversible injury that can progress with time to osteoarthritis, which is devastating to our patients.

Science and Orthopaedics are evolving in this particular disease process.  Our knowledge in basic science of cartilage cells allowed us to explore the option of stem cells in this disease.  Arthroscopic advancement of knee surgery allowed us to have more sophisticated surgeries to this injury ranging from simple microfracture to Osteochondral allograft implantation depending on the size of the lesion.  We started to understand the implication of mal-alignment and loss of the protection of the meniscus, and this lead us to correct these issues around the knee before tackling the cartilage injury.

Members of Aspetar surgical department, experienced in cartilage surgery, together with international experts are focusing on the current concepts of the treatment, in this Targeted Topic of the Aspetar Sports Medicine Journal.

An overview of the treatment algorithm is presented by Dr Papakostas. Dr Zikria gives us his advice and expertise on what skills a sports orthopaedic surgeon needs to have in order to handle such injuries.

In the next group of papers, Dr Al-Khelaifi discusses diagnosis and treatment of osteochondritis dissecans, while Meniscus Allograft as treatment option is presented by Professor Verdonk. The role of alignment and its correction to decrease the load on cartilage is highlighted by Professor Seil.

Ultimately, in the last four papers the history of cell therapies together with the new era of orthobiologics is demonstrated. Professor Brittberg, one of the pioneers in cartilage restoration, focuses on the historical timeline of cartilage repair. Adipose tissue as source of “working” cells and its role in cartilage repair is discussed by Professor Sciarretta. Dr Slynarski, alongside with Dr Papakostas, introduces the latest development in combining chondrocytes and MSCs, as one-stage cartilage repair technique. Finally, the best evidence on the role of orthobiologics in cartilage treatment, specifically in osteoarthritis, is presented by Dr Filardo and the Bologna group.

I am sure that sport medicine clinicians will find these topics interesting and will benefit from the knowledge and expertise of this section editors and authors. I hope that the information that put forth is valuable to our readers.

Enjoy it!!

Best Regards,

Khalid & Mannos

Khalid Al-Khelaifi MD, FRCSC

Orthopaedic Surgeon

Emmanuel Papakostas MD

Orthopaedic Surgeon

Aspetar Orthopedic and Sports Medicine Hospital, Qatar