TRATAMIENTO

ARTROSCOPICO DE LA
ARTROSIS DE RODILLA

INTERNA KINESIOLOGIA UDLA

MARA JOSE GONZALES

TRATAMIENTO ARTROSCOPICO
DE LA ARTOSIS DE RODILLA
La Poblacin tiende a mantenerse
fsicamente cada vez mas activa y a
realizar actividades mas demandante a
edades mas avanzadas
Artroscopia aparece como un procedimiento
mas simple en paciente que por edades o
cambios degenerativos menores no son
candidatos a una artroplastia
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al :
questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, O
malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic

Cules son los objetivos de

una Artroscopia?

Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al :
questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, O
malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic

Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al :
questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, O
malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic

Artrosis de
Rodilla

Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al :
questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, O
malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic

Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al :
questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, O
malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic

El tratamiento de la artrosis de
rodilla:
Debe ser etapificado
Existir relacin con sntomas y signos
Se debe comenzar con medidas
simples:
Bajar de peso
Modificacin de la Actividad
Calzado amortiguador
kinesioterapia

Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al :
questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, O
malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic

Los pacientes que no presente una

respuesta favorable al tratamiento
conservador, el tratamiento
quirurgico es una alternativa con
mejores resultados en pacientes
entre 40- 60 aos

Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al :
questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, O
malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic

Tratamiento
Quirrgico

Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al :
questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, O
malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic

Seleccin de paciente y
criterio para una Artroscopia

Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al :
questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, O
malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic

Tecnica quirurgica

Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al :
questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, O
malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic

El procedimiento bsicamente
incluye:
El aseo articular para dilucin de la
concentracin de enzimas degradativas y
remocin de productos irritantes de la
degeneracin condral, meniscal o sinovial
Remocin de cuerpos libres intrarticulares
Meniscectomia parcial
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al :
questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, O
malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic

Meniscectomia
El proceso patolgico de la
artrosis en etapas tardas no
solo genera la destruccin del
cartlago articular, sino que
afecta tambin la integridad
de meniscos y ligamentos

Cualquier procedimiento
sobre el menisco debe ir
orientado a mejorar la
sintomatologa del paciente

Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al :
questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, O
malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic

 Un desgarro en un menisco con cambios

degenerativos esta asociado a cambios
estructurales preexistentes en el cartlago
articular que pueden representar una
etapa temprana de artrosis
Dependiendo de cuanta funcionalidad
meniscal se pierda con un desgarro o una
reseccin quirrgica, la artrosis se puede
acelerar a medida que aumenta la carga
biomecnica en el cartlago articular
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al :
questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, O
malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic

 La reseccion de una lesion de cuerpo

posterior del meniso interno disminuye en
dos tercios la capacidad de absorcion de
carga
Se debe evitar la reseccion del menisco
hasta la periferia, ya que elima la
capacidad del menisco de soportar cargas
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al :
questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, O
malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic

 La extrusin meniscal es otro hallazgo

comn en pacientes mayores y es a
menudo otro signo de una degeneracin
meniscal y artrosis preexistente
Una extrusin meniscal puede contribuir a
aumentar la estrechez del espacio
articular

Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al :
questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, O
malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic

Condroplastia
La radiofrecuencia ha ganado popularidad
como herramienta artroscopica
Sus ventajas son:
- Fcil de aplicar
-Bajo costo
- Retraccin del
colgeno
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al :
questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, O
malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic

 Estudios han demostrado que la

condroplastia utilizando radiofrecuencia
obtiene superficies lisas que permanecen
estables por largos periodos de tiempo
Sin embargo, la radiofrecuencia funciona a
travs del calor y su desventaja esta en
que los condrocitos son extremadamente
sensibles a la temperatura
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al :
questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, O
malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3

Sinovectomia y remocin de
osteofitos
En el casos que la artrosis
avanzada se acompae de
sinovitis significa que
provocara derrames
recurrentes, y la
Sinovectomia puede estar
indicada
La reseccin de osteofitos
en general no son
recomendado, por el riesgo
de provocar hemartrosis

Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al :
questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, O
malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3

Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al :
questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, O
malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3

Resultados
50% a 75% de los paciente con
Artroscopia refieren una mejora inicial
15% progresa a una artroplastia total de
rodilla a un ao
44% presenta una disminucin clnica
significativa del dolor a dos aos de
seguimiento
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al :
questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, O
malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic

Spahn et al. Examino los resultados

de la Artroscopia en pacientes con
artrosis medial de rodilla

Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al :
questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, O
malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic

Sugirio que los factores

asociados a mal pronosticos
son:
Tiempo de evolucin de la artrosis mayor a
24 meses
Obesidad
Osteofitos mediales
Espacio articular menor a 5 mm
Tabaco
Presencia de defecto condral tibial grado
IV y necesidad de una Meniscectomia total
o subtotal

Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al :
questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, O
malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic

No se debiera considerar
una Artroscopia
Tienen pocas
posibilidades de ser
un procedimiento
exitoso

Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al :
questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, O
malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic

Estudios Clinicos
En el estudio de Framingham sobre
indicaciones de Meniscectomia en rodilla
artrosica describi:
El 56% de los hombres entre 70 y 90 aos
sin sintomatologa presenta desgarros
meniscales y en pacientes con artrosis
radiogrfica este porcentaje aumenta a
82%. Sin embargo , la relacin entre dao
meniscal y artrosis es compleja
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al :
questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, O
malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic

 Una lesin meniscal en una rodilla sana, puede ,

eventualmente , llevar al desarrollo de la artrosis
por perdida de la funcin meniscal
Una rodilla artrosica puede presentar un desgarro
meniscal que acelera el proceso degenerativo
Esto sugiere que el dao meniscal visible
en resonancia magntica antecede a
los cambios visibles del cartlago

Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al :
questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, O
malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic

Tecnica preferida por el

autor
Como regla general se debe ser
conservador y juicioso en las resecciones
para preservar al mximo las estructuras
noble de la funcin articular: Cartlago y
Menisco
Toda estructura inestable debe ser
resecada y/o remodelada en su justa
medida teniendo en cuenta que los
pacientes solo utilizaran sus rodilla en AVD
y baja demanda

Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al :
questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, O
malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic

 Contraindicamos formalmente cualquier

tipo de procedimiento que base su xito
en respuesta reparativas del paciente,
fundamentalmente por los factores de
edad y por la severa alteracin de la
homeostasis articular que limita
seriamente su respuesta regenerativa por
ejemplo: microfracturas, meniscorresis, etc

Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al :
questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, O
malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic

 Normalmente por edad y presencia de

factores de riesgo utilizamos tratamiento
anticoagulante profilctico con HBPM en el
postoperatorio
Uso de kinesiologa precoz , con nfasis en
la movilizacin, limitacin de la respuesta
inflamatorias, drenaje venoso y linftico,
mantencin trofismo muscular y el uso
transitorio de descarga en la
deambulacion
Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al :
questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, O
malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3

Conclusin
La evidencia es categrica en demostrar
que el tratamiento artroscopico no
presenta beneficios sobre el tratamiento
conservador
Siempre se debe tomar cuenta que al
momento de evaluar al paciente que los
peores resultados de una Artroscopia en
artrosis se asocia a mal alineamiento ,
inestabilidades, artrosis avanzadas ,
sintomatologa crnica, cirugas previas

Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al :
questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in
patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern
practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic
knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D
Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors
influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on
healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, O
malley k, Petersen Nj , et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic
patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3

LESIONES CONDRALES

HISTOLOGIA
Cartlago hialino es una forma
especializada de tejido conjuntivo
Constituidos por elementos celulares
denominados CONDROCITOS que disponen
en una matriz extracelular dura de tipo gel
Las clulas se nutren mediantes difusin a
travs de la fase acuosa de la matriz y a
partir de los capilares de los tejidos que
rodean el cartlago

Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am
1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne
Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md.
Cartilage and bone development.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag. 406-75. 1998.

Esto le confiere una dureza y flexibilidad poco

habituales
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

Sus Diferencias estn dadas por:

- Matriz celular
-Fibras de Colgenos
- Fibras de Elastina

Cartilago Hialino
Se presenta en anillos traqueal, la nariz,
laringe, superficies articulares
Condrocitos se encuentran por debajo del
pericondrio
Zona mas profunda del cartlago , las
lagunas tienen una configuracin
hemisfrica o angular
Citoplasma presenta una baja densidad,
contienen gotas de lpido y cantidades
variables de glucgeno

Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am
1998;80:pag.1795-1812. Recht M, bobic V , Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne
Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md.
Cartilage and bone development.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag. 406-75. 1998.

Matriz Cartilaginosa
Es de color azul grisceo y parcialmente
traslucida
Colgeno que predomina es tipo II, que forma
fibras dbiles con estriacin transversal
Las fibras de la zona superficial estn
orientadas paralelamente y la mas profundas
hacia adentro en forma de columnas
verticales
La orientacin de las fibras son adaptadas
para resistir la tensin a la que estn sujetas
normalmente

Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

 Dentro de la matriz existen una capsula

pericelular, que rodea a las lagunas
Esta formada por fibras muy finas de
caractersticas similares a la lamina basal
Desempea un papel importante en la
proteccin de los condrocitos de aquellos
cartlagos sometidos a compresin o
tensin mecnica
La matriz posee mayor concentracin de
proteoglicanos
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

Cartilago Articular
Es un tipo de cartlago hialino, que cubre
terminaciones Oseas de la articulaciones
sinoviales
Es avascular y denervado, el 70%-80% de
su peso es agua
Constituido por colgeno tipo II, posee
poca elastina y un componente menor de
glicoprotenas y lpidos
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

 Se organiza en cuatro
capas :
1234-

Superficial (S)
Transicion (T)
Medial (M)
Calcificada (C)

Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

Capa Superficial

Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

 En esta capa los condrocitos secretan una

matriz con alta concentracion de colageno
y baja concentracion de proteoglicanos
La caracteristica estructural de esta capa
es que determinan una alta fuerza tensil y
resistencia a la compresion superior a las
capas profundas

Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

Capa Transicion
Posee mayor grosor que la capa superficial
Los condrocitos adoptan una morfologa
espiroidal
Sus clulas poseen mayor densidad de
organelos, recitculo endoplasmatico y
aparato de Golgi
Sintetizan matriz con fibras colgenos de
mayor dimetro con alta concentracin de
proteoglicano y menor de concentracin
de agua y colgeno

Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

Capa Medial
los condrocitos esferoides ubicados
perpendicular a la superficie articular
posee fibras de colagenos de gran
diametro
La concentracion mas alta de
proteoglicanos y la mas baja de agua

Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

Capa Calcificado
Es una zona de cartlago calcificado que
separa la zona radial del hueso subcondral
Contienen muy poco retculo
endoplasmatico y aparato de Golgi
Las clulas aparecen completamente
rodeando el cartlago calcificado, lo que
sugiere una baja actividad metablica
Estudios sugieren que podra jugar un rol
en el desarrollo y progresin de la
osteoartritis

Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

Cartilago Articular Normal

La funcin de este cartlago es :
Minimizar el estrs sobre el hueso subcondral
Distribucin de cargas en la articulacin
Disminuye el coeficiente de friccin de las
superficies articulares
La interaccin con el liquido sinovial
proporciona un excelente mecanismo de
lubricacin
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

Existen dos mecanismos de

lubricacion :
1- Fluid Film : capa de fluido sinovial menor
a 25 um , de gran viscosidad
2- Lubricacion Frontera: HAP, protena de
acido hialuronico de alta afinidad por la
superficie articular, que funciona como un
importante lubricante limtrofe con la
superficie articular
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

 Los filamentos de colgeno mantienen la

configuracin del tejido y la resistencia a
las fuerzas tensiles
Los proteoglicanos proporcionan un gel
hidratado y firme que absorbe las fuerzas
de compresin y adems pueden atrapar e
inmovilizar un gran volumen de agua

Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

Cmo se resisten las

fuerzas compresivas?
cuando se ejerce una fuerza compresiva, el
agua se aleja de las regiones con carga
elctrica de los proteoglicanos. Entonces ,
la cargas negativas de los grupos carboxilo
y sulfato se aproximan y la fuerza de
repulsin de las mismas permiten resistir
la compresin

Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

Mecanismo de disipacin de
energa
El liquido intersticial fluye lentamente por
la existencia de pequeos poros en el
espacio intermolecular , con ello baja la
permeabilidad de la matriz tisular y
gracias a esto no existe una excesiva
deformacin del tejido y se crea la
interaccin de friccin entre fluidos y la
matriz
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

los proteoglicanos influyen

en el envejecimiento?

 Estudios compararon cultivos de

condrocitos de animales viejos y jvenes
pudiendo observar que los condrocitos
viejos secretan proteoglicanos de menor
tamao y con cadenas condroitin sulfato
mas cortas
se ha propuesto que al ser de menor
tamao el proteoglicano ,le permite
retener una cantidad menor de agua, lo
que disminuye su capacidad para resistir
fuerzas compresivas
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

 Y con ello la matriz seria mas vulnerable a

pequeas cargas de peso, produciendo
reacciones inflamatorias que seria la causa
de la sintomatologa dolorosa de la artritis,
dejando como posibilidad que la
prevalencia de la osteoartritis en ancianos
este relacionada con cambios en la matriz
cartilaginosa
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

 El cartlago hialino muestra una capacidad

muy limitada de reparacin
Sus clulas dependen de la difusin de
nutrientes y oxigeno en distancias
considerables a travs de la matriz
Cuando disminuye el flujo de sangre
alrededor del cartlago, sus clulas pueden
morir y el cartlago es invadido por vasos
sanguneos y clulas fagocitarias mientras
que la matriz es reabsorbida y sustituida
por tejido cicatrizal
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

Lesiones del cartilago

articular
El cartlago hialino posee una relacin
injuria-respuesta muy estrecha
La magnitud y el grado de lesin del
cartlago depender del mecanismo y
grado de respuesta reparativa
La respuesta reparativa que el cartlago es
capaz de dar es insuficiente y de mal
pronostico en general
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

De acuerdo con la magnitud del dao

generado en el cartilago hialino exiten 3
grupos de lesion:

Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

Lesion aguda sin disrupcion

de tejido visible
Lesin con mayor capacidad de mejora
Traumatismo contuso cerrado como un
trauma de carga repetitiva, induce
cambios significativos en la histologa,
bioqumica y caractersticas estructurales
de la matriz

Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

Una de las primeras alteraciones

observadas en este tipo de lesion
corresponde :
1- perdida de proteoglicanos o disrupcin
de su organizacin
2-disminucion en la concentracin de
proteoglicanos, alterando las propiedades
fiscas
3-peso o carga suprafisiologica sobre ya
debilitadas protenas estructurales
4-cambios del medio ambiente que rodea
al condrocito

Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

Disrupcion mecanica del

cartilago
No existe una medida exacta de la

magnitud de la fuerza que el cartlago es

capaz de soportar ante de sufrir dao
estructural macroscpico
Sin embargo el limite critico de integridad
estructural de los condrocitos es
equivalente a 20-25 Mpas
Un estrs superior a esta medida generara
muerte y fisura del condrocito
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

 Su etiologa puede estar en lesiones que

penetran la articulacin, produciendo
laceracin o abrasin del cartlago
La respuesta tisular a este dao se
encuentra caracterizado por un tejido
avascular, no existe la generacin de un
fenmeno de inflamacin clsico
Por tanto el condrocito son los responsables
de todo el proceso de reparacin.
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

Lesin Osteocondral
En este caso el traumatismo es de tal
magnitud que incluye lesin del hueso
subcondral o fractura osteocondral
Esta lesin repara dando origen a tejido
fibrocartilaginoso con propiedades muy
distintas al cartlago hialino articular
normal
La restauracin de la placa subcondral
toma forma a partir de las 6-8 semanas
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

 Al cabo de 12-14 semanas se observa

degeneracin superficial del cartlago con
aspecto fibrilar

Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

Dao Cronico
La osteoartritis puede desarrollarse como
fenmeno primario o secundario a dao en
el cartlago articular
Si la red de colgeno presenta disminucin
del efecto restrictivo; si esta se destruye
los glicosaminoglicanos atrapados en la
red, se escapan del anclaje y su perdida
derivara en la disminucin de la tolerancia
a las fuerzas compresivas de la
articulacin

Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

Estimulos reparativos
biologicos
El estado normal del cartlago articular se
encuentra mantenido por una combinacin
de procesos anablicos y catablicos de
los condrocitos
Durante el proceso degenerativo, existe
un aumento en la reabsorcin de la matriz

Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

TGF-B
Factor de crecimiento y transformacion
B
Estimula la proporcin de sntesis de
macromolculas de la matriz,
especialmente pequeos
glicosaminoglicanos.
Promueve la reparacin del cartlago
daado
Posee un potente efecto en la expresion
fenotipica del condrocito
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

IGF-1
Factor de crecimiento insulino
simil

Producido en respuesta a estmulos

sistmicos de parte de hormonas de
crecimiento
Media efectos anablicos de esta hormona
en los tejidos
Estimula la proliferacin de condrocitos,
proteoglicanos y acido hialuronico, y a su
vez puede disminuir la degradacin de
estos
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

BFGF
Factor de crecimiento fibroblastico
Es un potente mitogenico de condrocitos
Estimula la sntesis de la matriz
cartilaginosa
Posee actividades sinrgica con el factor
IGF-1

Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

BMP
Bone morphogenectic protein
Es del tipo TGF-B
En tejidos indiferenciado, estimulacin
de BMP I-II induciendo condrogenesis y
osificacin endocondral

Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

Estimulo Fisico
Fuerzas mecnicas regulan el
funcionamiento del condrocito
La inmovilizacin o disminucin de cargas
sobre la articulacin disminuye la sntesis
de proteoglicanos
El ejercicio moderado aumenta la sntesis
de proteoglicanos y estimula el
espesamiento de la matriz cartilaginosa
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

Diagnostico y tratamiento
de las lesiones
osteocondrales

Clnica :

1- existe dao en la superficie articular

2-Disfuncion articular y/o derrame articular
Esto evoluciona con degeneracin articular
progresiva aumenta en forma
considerable el riesgo de desarrollo de
osteoartritis
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

 Las lesiones condrales son asintomticas,

a no ser que se asocien a una lesin del
hueso subcondral
Tambin puede manifestarse con bloqueo
de la articulacin

Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

Imagenologia
Artroscopia

Segn Outerbridge, que describi su

clasificacin Artroscopia de lesin articular
en cuatro grados, actualmente la mas
utilizada.
GRADO
I
Reblandecimiento
GRADO II

Fibrilacin y fisura menor al 50%

del espesor del cartlago

GRADO III

Fibrilacin y fisura mayor al 50%

del espesor del cartlago

GRADO IV

Erosin sea subcondral

Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

Se debe integrar la clasifficacion de la

International Cartilage Repair Society ( ICRS)
En esta clasificacin se mantiene los
cuatro grados de lesin, pero subclasifica
de acuerdo a la profundidad de manera
distinta
Esta clasificacin podra tener ventajas
descriptivas y adems pronosticas en
relacin con el tipo de lesin
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

ICRS
GRADO O

Normal

GRADO 1a

Fibrilacin y/o leve reblandecimiento

GRADO 1 b

Fibrilaciones superficiales

GRADO 2

Defectos menores 50% del espesor del cartlago

(anormal)

GRADO 3

Defectos mayores 50% del espesor del cartlago

( severamente anormal)

Se Subdividen en :
GRADO 3a

Hasta la capa calcificada

GRADO 3b

Compromete la capa calcificada

GRADO 3c

Hasta el hueso subcondral, sin comprometerlo

GRADO 3d

Ampollas superficiales

GRADO 4a

Compromete el hueso subcondral

GRADO 4b

La lesin se extiende mas all del hueso subcondral

Resonancia magnetica (R.M)

Es la nica modalidad radiolgica que permite
visin directa con alta resolucin del cartlago
articular y el hueso esponjoso subyacente
En las lesiones osteocondral tiene gran
utilidad
La RM evala los fragmentos condrales
desplazados y es capaz de analizar la
probable zona dadora en caso de planificar
una mosaicoplastia
La sensibilidad promedio es de 71%
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

La sensibilidad diagnostica de la RM en
lesiones condrales de la rodilla alcanzo
solo el 45% de las lesiones, es decir visto,
de otra manera, en el 55% de los casos la
RM no fue suficiente para diagnosticar la
lesin condral evidenciadas por
Artroscopia.

Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

Manejo
Clinico
Con el fin de
reproducir el fenmeno

Tratamiento
fisiolgico Quirurgico
reparativo de origen osteocondral
que, al menos momentneamente, resulta
ser mas efectivo
Estudios mostraban que con el tiempo,
indeclinablemente, se llegaba a la fibrosis
del tejido.
El gran problema de este mtodo quirrgico
era la atrofia de cudriceps generada por la
inmovilizacin posterior.
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

Abrasin y desbridamiento
artroscopico
Modificacin de la debridacion abierta:
-Remueve la superficie esclertica hasta
penetrar el hueso subcondral con una
mnima lesin de la capsula articular
-Esto facilita la rehabilitacin postoperatorio
y con ello minimiza la atrofia de
cudriceps
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

 Eficacia del tratamiento depende:

-

Edad del paciente

Magnitud de la lesin
Nivel de actividad requerido
Longitud del seguimiento

Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

Perforacion Subcondral
El concepto Drilling a travs del hueso
subcondral ebrneo para estimular la
reparacin del cartlago fue descrito
originalmente por Pridie en 1959
Se basa en perforaciones puntiforme a
travs del hueso subcondral

Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

 Con esto espera preservar porciones

estructurales de hueso subcondral y
ayuda a restablecer las propiedades
mecnicas del tejido envolvente en
la regeneracin tisular

Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

Microfractura
Fractura bajo la lnea del hueso
subcondral, con el fin de abrir una brecha,
creando una superficie rugosa alrededor
del hueso
Esto produce un mejor adaptamiento del
coagulo sanguneo alrededor de la lesin
La fractura subcondral es controlada y la
principal ventaja en relacin al Drilling
seria a la menor presencia de calor y por lo
tanto necrosis local.
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

CPM
(Movimiento Continuo Pasivo)
Estimula la reparacin osteogenica y
cartilaginosa del segmento daado
Seis horas de movimiento pasivo durante
ocho semanas despus del debridamiento
artroscopico y/o microfactura

Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

Autoinjerto o Mosaicoplastia
El metodo descrito por Hangody en 1991 y aplicado a la
clinica en 1992

No existe riesgo de rechazo inmunolgico

Es limitado en tamao y genera
comorbilidad
Se utiliza la va artroscopica
Se obtiene injerto osteocondral de zona
del cartlago que no soporta carga
Se trasplanta como verdaderos tarugos
hacia el defecto previamente moldeado
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

 Histolgicamente el cartlago trasplantado

tiene caractersticas de cartlago hialino
(Hangody)
Los resultados clnicos a mediano y largo
plazo, muestran una mejora notable del
HSS score aplicado a estos pacientes.

Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

Qu tecnica debemos utilizar?

Se debe comprender que tal vez no sea el
desarrollo o la depuracin de una sola de
las tcnicas descrita la que dar la
respuesta final al problema de la
regeneracin osteocondral, sino mas bien
el uso de terapia combinada que incluirn
seguramente el uso de factores de
crecimiento, tecnologa celular y
alojamiento microquirrgico, entre otras
Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg
M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of
injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage.
Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo , m.d, alex
vaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I
operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative
technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol
2005;94:pag 91-123. Menche , David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy
of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am

En Resumen
En la busqueda de nuevas tecnologias
basadas en la potenciacion del medio
ambiente de celulas para desarrollar el
Gold-stndar en la reparacion del
cartilago, que sea costo-efectivo ,menor
tiempo de recuperacion, menos
invasivo,logrando producir un cartilago
hialino estratificado y completamente
integrado, permitiendo un reintegro rapido
a las actividades normales

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