OKOJ, Volume 2, No. 1

Because mature articular cartilage is avascular, it is unable to regenerate or repair itself. Thus, when healing is attempted by penetration of the subchondral bone plate to obtain a vascular response, the lesions are filled with biomechanically inferior fibrocartilage. Untreated, these cartilage lesions may progress to osteoarthritis, which is particularly problematic for young patients who wish to maintain a high level of activity and function. Articular injuries are extremely common in today's active society. Full-thickness articular cartilage lesions secondary to work or sporting activities account for 5% to 10% of all acute hemarthrosis of the knee. There are numerous treatment approaches and algorithms for the treatment of articular cartilage lesions.

This article reviews clinical considerations in articular cartilage defects and reviews management options in detail, including lavage and debridement; cartilage repair: marrow stimulation; cartilage reconstruction: transplantation of articular cartilage; autologous chondrocyte implantation; osteotomy, and arthroplasty.

If the skin is broken in the same anatomic region as the broken bone then the fracture is considered open or compound. If the skin is intact the fracture is considered closed. There are several mechanisms by which fractures become open. Forces may act from outside-in or from inside-out to create these injuries. Open fractures represent a wide array of skeletal injuries and a wide spectrum of soft tissue injury present unique challenges to the treating surgeon. The major problem with open fractures is that they may become infected. The associated soft-tissue injury may also cause delayed union, stiffness, and other problems. Treatment options for open fractures depend on two major factors: the soft tissue problem and the skeletal problem.

The pathophysiology and clinical presentation of open fractures is reviewed and considerations for surgical management are reviewed. This article reviews in detail debridement, soft-tissue, and antibiotic control.