| Object:Probe the clinic character of knee cartilage injury with arthroscopy, research and assess the cartilage transplant to treat the knee cartilage injury . Material and Methods:From Dec. 2004 to Mar. 2006, I collect 12 patients of the knee cartilage injury including 10 males, 2 females, age from 16-48 years old, average age is 35 years old. They have been suffered by knee pains, popping, knee locking,quadriceps femon's atrophy. After diagnosis of the arthroscopy, using cartilage inlay, transplanting from non-weight bear surface of the knee to the weight bear surface of the knee's injury.Conclusion:After operation, patientis knee function have been improved the pain disappear, no-locking and don't find the fracture of the provide origin. Evaluation of knee postoperation with the Brittbery-Peterson standard, 10 patients evaluation is zero at the third month; 2 patients with little pain, one's evaluation is 13, the other evaluation is 6. With the statistic analysis, differentiation between the pro-operation and the postoperation is remarkable(p<0.001). The operative region's cartilage is smooth, location is good, no other finding in MRI .Discussion:Knee cartilage injury after trauma, osteochondritis bone necrosis in clinic practice. The patient has notable trauma, the clinic finding include the pain, swelling, locking and so on. The joint stability keep the same as before. The surgeon should think whether there is osteochondral injury or not. Osteochondral doesn't have the direct blood supply, lymphogenous circulation, nerve distribution. Metabolism of osteochondral is very slow. Degress of osteochondral'injury and deteriation is different. The osteochondral repair is limited after injury. Before two centuries, Hunter had found that the osteochondral repair after injury is very difficult. With documentary, most osteochondral fracture dosen't been found in clinic practice while the cartilage fracture diagnosis is rather difficult. It often is diagnosed wrong meniscus injury, Arthroscopy have become main diagnose method for this kind of patient. Evaluation to articular cartilage injury, arthroscopy can directly inspeet the surface of joint so it is better than other methods including the x-ray, CT, MRI. Single cartilage injury is not diagnosed very well. The arthroscopy can diagnose the cartilage injury type, area and other finding in directive observation.Development of adult's articular cartilage mainly non-mitosis so it doesn't regenerate. It has two growing pattern. One pattern is intrachondral development. Chondrocyte in matrix grow by the non-mitosis and this kind of pattern is limited. Superficial injury which doesn't reach osteochondral in the joint cartilage show the limited healing and regeneration. The other patter originate from subchondral bone when the total articular cartilage to the chondral tissue. The original cell mainly is the bone marrow matrix cell, including fibroplast, chondrocyte, osteoblast in the joint. Some researcher consider that the matrix cell originating from synovium join in this procedure excluding chondrocyte. The circumstance and construct composited with bone marrow, synovium, normal chondral may be control the procedure repair.Treatment methods to the articular cartilage injury include eliminating and burring the joint, microfracture and articular plasty. These methods induce the fibrochondral repair while the fibrochondral is not wear-resistant. Biomechanical behavior and mechanism of the fibrochondral is inferior to the transparent chondral. The fibrochondral doesn't prevent the joint deterioration and the prognosis is very poor. Auto-periosteum transplant has some defects including limited origin of periosteum, difficult suture and so on. The regenerate tissue's dynamic capacity is not definite. Auto-periosteum transplant doesn't fit with big chondral repair. Allo-osteochondral transplant can be used to treat the big chondral injury, but it has some complication such as immunity exclusion, disease propagation subchondral, bone concave, joint instability, transplant absorption. Prognosis is poor. Auto-chondrocyte transplant was account the first time 1987 by a Swiss. In the 1994, it become feasible in clinic practice. Procedure of transplant:⑴Get the articular cartilage from the non-weight bear surface of joint.⑵Enzyme digest and culture propagation.⑶Cut the joint and eliminate the articular cartilage to the healthy bone.⑷Transplant the periosteum allograft to injury surface.⑸Inject the culturing chondrocyte beneath the periosteum autograft. Prognosis is good in the clinic practice. But ACT also has some defects. Such as:①The chondrocyte maybe seep from the transplant area.②Chondrocyte doesn't well-distribute and the transplant surface is concave or convex.③Before the transplant, difficult differentiation of chondrocyte and periosteum hypertrophy maybe occur during the chondrocyte culting. Chondrocyte transplant is very expensive significant procedure and the joint must be cut. Tissue engineering repair to the articular cartilage is delayed in the animal test. The tissue project repair means the cartilage by the engineering cartilage or complicated chondrocyte.Auto-osteochondral transplant the no-weight bear surface or not important joint's osteochondral to the injury area. It can keep the cartilage biochemistry and biomechanical behavior. Small area injury can be repaired by the arthroscopy while the big area injury mest cut the joint. Inlay osteochondral transplant is commonly main surgery by far. It get the cartilage from the autograft was transplanted to the receive area. The transplant autograft include the chondral spongiosa bone and the chondral and subchondral joint must firmly and integrately. The spongiosa bone of the transplant will healing with receive areas only and establish good blood circulation with subchondral..Conclusion: Arthroscopy is gold standard to diagnose the knee cartilage injury. Auto-osteochondral transplant have the advantagement.①Blood supplyment of bone tissue is adundant and easily healing, benefiting chondrocyte's nourishment.②The origin of osteochondral transplant is simple the autografe has good stability. And subchondral bone was strong enough to maintain the articular cartilage integratedly. It doesn't need intrafixation and avaid the second surgery.③Avoiding the disease spread and immunity exclusion from allo-chondral transplant.④The injury area can be repaired by the chondrocyte. The prognosis is notable and it is o good method to repair cartilage injury.
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