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Chondroplasty

Chondroplasty means 'reshaping the joint surface' and refers to simple surgical techniques whereby fibrillated (ragged) and damaged joint surface is cut, scraped, lasered or burred away in the hope that the healthy joint surface will heal over the defect.

Joint cartilage is problematic in that it heals poorly once it is damaged. Although chondroplasty may stimulate the area to re-cover itself with new cartilage, the problem is that the new surface is not true hyaline or joint cartilage, but a rather inferior version called 'fibrocartilage'. So the technique is generally reserved for smaller defects and there are newer techniques for the larger areas that try to heal the defect with stronger, more normal joint cartilage.

Joint cartilage restoration is receiving a great deal of medical interest at the moment. Attempts to restore the damaged surface by stimulating underlying undifferentiated ('stem') cells to cover the area with fibrocartilage included shaving (chondroplasty), drilling, Pridie rods and microfracture.

More effective procedures involved taking bits of healthy joint surface from other less-important parts of the body and transplanting them into the damaged areas - osteochondral grafting (OATS procedure, mosaicplasty, paste grafting).

Attention is currently focusing on growing the patient's own cartilage cells in a laboratory and transplanting them back into the knee (Carticel procedure, Genzyme technique or ACI - autologous chondrocyte implantation). Experimental efforts are being aimed at foetal growing stem cells in laboratories and encouraging them to form cartilage sheets which can be transplanted (stem cell research).

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