Current trends in surgical treatment of local cartilaginous and bone-cartilaginous defects of the knee joint

Introduction. The search for a solution to the problem of knee cartilage restoration has been going on for more than two and a half centuries. Currently known surgical treatment options do not provide a complete guarantee of restoring the anatomical and physiological integrity of the knee joint, so there is still a need to find new, more advanced methods that will achieve maximum results. This paper analyzes data published in the world literature on generally accepted methods of surgical treatment of local cartilage and osteochondage defects of the knee joint, provides epidemiological data, analyzes in detail the possibilities of these methods, and provides an analytical assessment of the advantages and disadvantages leading to a limitation of the use of traditional chondroplasty options. Materials and Methods. The literature search is based on databases PubMed, Embase, eLybrary and Cochrane Library using the keywords "hyaline cartilage", "chondroplasty", "debridement", "bone-cartilage defect", "mosaic chondroplasty", "subchondral tunneling", "microfracturing", "abrasive chondroplasty", "autogenous chondrocyte transplantation", "new combined methods of chondroplasty". The analysis included papers describing known chondroplasty methods, evaluating their advantages and disadvantages, comparing treatment options for articular cartilage defects, and searching for the relationship between the size of the defect and the preferred method of repair. Results. Organ-sparing surgery on the cartilage of the knee joint is currently a promising area, however, the range of surgical interventions used is still limited by the area and depth of the cartilaginous or bone-cartilaginous defect. When treating full-layer defects with an area of more than 5 cm2, difficulties arise due to a lack of plastic material and the restructuring of the collagen membrane in the center of a large defect. Isolated use of alloplasty in such cases is not a good alternative to monocondylar endoprosthetics. Our accumulated experience has allowed us to propose two combined techniques for chondroplasty of large-area bone and cartilage defects. Combined bone-cartilage plastic surgery due to the relative simplicity of performing and obtaining a two-layer cartilage structure expands the indications for organ-preserving operations to restore knee cartilage and helps to avoid the lack of remodeling of the collagen membrane in the center of the defect, however, it is necessary to conduct prospective and retrospective studies aimed at a detailed comparison of the new type of chondroplasty with classical ones.