The Treatment of Large Degenerative Defects

In the management of large cartilage lesions the treatment algorithm, usually used for small-medium defects, can not be easily applied. Most of the numerous methods successfully proposed to restore the chondral surface offer good results especially in case of medium lesions in the young active population, whereas large degenerative pathology is still plagued by lower clinical outcome and a higher failure rate. Several improvements are soon expected, as the result of the rapidly growing knowledge on bioengineering and the development of new osteochondral scaffolds or cytokine-matrix metalloproteinase inhibitors. Studies on some new biomaterials are in progress, aiming to introduce "in situ" regeneration after direct transplantation onto the defect site. The improvement in tissue engineering with development of new scaffolds as an integrated biological and biomechanical surgical approach may offer an interesting therapeutic option even for difficult cases with large cartilage defects as joint degeneration, otherwise doomed to poor results, leading to a more reliable and biological procedure and possibly better clinical outcome.