An educational review of cartilage repair: precepts & practice – myths & misconceptions – progress & prospects E.B. Hunziker, K. Lippuner, M.J.B. Keel,

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An educational review of cartilage repair: precepts & practice – myths & misconceptions – progress & prospects E.B. Hunziker, K. Lippuner, M.J.B. Keel, N. Shintani Osteoarthritis and Cartilage Volume 23, Issue 3, Pages 334-350 (March 2015) DOI: 10.1016/j.joca.2014.12.011 Copyright © 2014 Terms and Conditions

Fig. 1 Light micrograph of vertically-sectioned articular cartilage, derived from the femoral condyle of a 17-month-old bovine cow, illustrating its subdivision into superficial (S), transitional (T), upper-radial (UR), lower-radial (LR) and calcified-cartilage (C) zones; the latter abuts on the subchondral-bone plate (B). 1 μm-thick section, stained with Toluidine Blue. Bar: 200 μm. Osteoarthritis and Cartilage 2015 23, 334-350DOI: (10.1016/j.joca.2014.12.011) Copyright © 2014 Terms and Conditions

Fig. 2 Schematic drawing of a normal synovial joint. Osteoarthritis and Cartilage 2015 23, 334-350DOI: (10.1016/j.joca.2014.12.011) Copyright © 2014 Terms and Conditions

Fig. 3 Schematic representation of the microfracturing technique. The floor of a chondral defect is perforated in several places using either a pointed instrument or a narrow-calibre drill. By this action, the marrow space of the subchondral bone is opened. Blood percolates into the defect – bearing with it local bone-marrow-derived MSCs – and therein forms a haematoma. Osteoarthritis and Cartilage 2015 23, 334-350DOI: (10.1016/j.joca.2014.12.011) Copyright © 2014 Terms and Conditions

Fig. 4 Schematic representation of the principle of mosaicplasty. Cylindrical plugs of osteochondral tissue are drilled from a non-weight-bearing area of the knee joint (using a special surgical instrument) and then press-fitted, side-by-side, within the damaged zone. The number of plugs that are removed will depend upon the surface diameter of the acceptor site. The denuded donor sites are either filled with osteochondral tissue that is removed from the damaged acceptor site during its surgical preparation for the plugs, or left empty. When viewed from above, the fitted plugs form a mosaic of circular profiles that are interspersed with empty spaces; hence the name “mosaicplasty”. Osteoarthritis and Cartilage 2015 23, 334-350DOI: (10.1016/j.joca.2014.12.011) Copyright © 2014 Terms and Conditions

Fig. 5 Schematic representation of the ACI-technique. A fragment of articular cartilage is removed from the periphery of the joint that bears the lesion. This fragment of tissue is digested to release the chondrocytes, which are expanded in vitro for 11 to 21 days. A periosteal flap is then removed from the medial tibia and sutured over the lesion. A suspension of the expanded chondrocytes is injected beneath the flap into the lesion. Osteoarthritis and Cartilage 2015 23, 334-350DOI: (10.1016/j.joca.2014.12.011) Copyright © 2014 Terms and Conditions