Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine最新文献

This Classic discusses the original publication by Brittberg and colleagues "Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation" [1], published in 1994 in the New England Journal of Medicine. At that time, this paper provided fresh, clinically relevant data on autologous chondrocyte transplantation (ACT) or, as it is commonly known today, autologous chondrocyte implantation (ACI) in the treatment of 23 patients with a symptomatic full-thickness articular cartilage defect of a femoral condyle or of a patellar facet. This was the first description of ACI being used in humans to heal articular cartilage defects. The clinical outcomes were good-to-excellent for 14 of the 16 patients with a femoral condylar defect and for two of the seven patients with a patellar defect, and these findings have largely been confirmed by subsequent research work. Nowadays, ACI has become a worldwide well-established surgical technique that has revolutionized the management of articular cartilage injuries. This is particularly relevant for young, high-demand patients, for whom reparative techniques like microfractures do not usually provide sufficient durability of treatment nor highly functional outcomes [2-3], leading to the development of early knee osteoarthritis (OA). Since this publication, which was more than 30 years ago, there has been a remarkable increase in the number of basic science and of clinical papers released on the topic. Thus, the present review starts by providing a detailed synopsis of this Classic and by highlighting its main take-home messages. Next, it discusses the historical perspectives, the scientific and the societal impact, the current evidence, and the lessons that we have learned so far. Lastly, it presents the state of ACI in 2025 and makes recommendations on its application for selected cases of full-thickness articular cartilage lesions in the knee based on the latest data that are available in the literature.

Recurrent shoulder instability after failed surgical stabilization is a disabling and complex condition. Over time, clinical research has reshaped traditional approaches, emphasizing the importance of understanding patient-specific factors, accurate diagnosis, and anatomical reconstruction. A comprehensive evaluation is essential to identify failure causes, which typically include patient-related factors (such as young age, male sex, multiple dislocations, and delayed surgery), missed diagnoses (including glenoid bone loss, engaging Hill-Sachs lesions, and capsular laxity), and technical errors (such as malpositioned anchors or insufficient fixation). High-quality imaging with computed tomography (CT) and magnetic resonance imaging (MRI) arthrograms is critical for assessing glenoid and humeral bone defects, soft tissue integrity, and associated lesions. While the Latarjet procedure remains the most widely used technique for glenoid bone reconstruction, free bone grafts from the iliac crest or allografts like distal tibia are increasingly utilized. Arthroscopic revision capsulolabral repair with or without the remplissage procedure has shown promising outcomes in selected patients with subcritical bone loss and preserved soft tissue quality. However, the definition of subcritical bone loss varies widely, complicating treatment algorithms. Special populations, such as elderly patients, those with epilepsy, or high-demand athletes, pose additional challenges and require individualized strategies. Reverse shoulder arthroplasty has emerged as a salvage option in older patients with combined instability and cuff deficiency. In athletes, bone block procedures often provide more reliable outcomes than soft tissue repairs alone. Despite advances in surgical techniques, implants, and imaging, several issues remain unresolved. There is a lack of consensus on optimal treatment for subcritical bone loss, limited high-level evidence comparing techniques, and variability in outcome definitions. Future research should aim to standardize shoulder instability treatment to create a more reproducible series supported by long-term data.