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TRATAMIENTO ARTROSCOPICO DE LA ARTROSIS DE RODILLA

TRATAMIENTO ARTROSCOPICO DE LA ARTROSIS DE RODILLA. INTERNA KINESIOLOGIA UDLA MARA JOSE GONZALES. TRATAMIENTO ARTROSCOPICO DE LA ARTOSIS DE RODILLA. “ La Población tiende a mantenerse físicamente cada vez mas activa y a realizar actividades mas demandante a edades mas avanzadas “

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TRATAMIENTO ARTROSCOPICO DE LA ARTROSIS DE RODILLA

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  1. TRATAMIENTO ARTROSCOPICO DE LA ARTROSIS DE RODILLA INTERNA KINESIOLOGIA UDLA MARA JOSE GONZALES

  2. TRATAMIENTO ARTROSCOPICO DE LA ARTOSIS DE RODILLA “La Población tiende a mantenerse físicamente 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 patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3

  3. ¿Cuáles 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 patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3

  4. 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

  5. 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 patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3

  6. 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

  7. El tratamiento de la artrosis de rodilla: • Debe ser etapificado • Existir relación con síntomas y signos • Se debe comenzar con medidas simples: Bajar de peso Modificación 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 patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3

  8. 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 años 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

  9. Tratamiento Quirúrgico 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

  10. Selección de paciente ycriterio 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 patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3

  11. 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 patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3

  12. El procedimiento básicamente incluye: • El aseo articular para dilución de la concentración de enzimas degradativas y remoción de productos irritantes de la degeneración condral, meniscal o sinovial • Remoción 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 patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3

  13. Meniscectomia • El proceso patológico de la artrosis en etapas tardías no solo genera la destrucción del cartílago articular, sino que afecta también la integridad de meniscos y ligamentos • Cualquier procedimiento sobre el menisco debe ir orientado a mejorar la sintomatología 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 patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3

  14. Un desgarro en un menisco con cambios degenerativos esta asociado a cambios estructurales preexistentes en el cartílago articular que pueden representar una etapa temprana de artrosis • Dependiendo de cuanta funcionalidad meniscal se pierda con un desgarro o una resección quirúrgica, la artrosis se puede acelerar a medida que aumenta la carga biomecánica en el cartílago 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 patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3

  15. 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 patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3

  16. La extrusión meniscal es otro hallazgo común en pacientes mayores y es a menudo otro signo de una degeneración meniscal y artrosis preexistente • Una extrusión 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 patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3

  17. Condroplastia • La radiofrecuencia ha ganado popularidad como herramienta artroscopica • Sus ventajas son: - Fácil de aplicar -Bajo costo - Retracción del colágeno 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

  18. 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 través 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

  19. Sinovectomia y remoción de osteofitos • En el casos que la artrosis avanzada se acompañe de sinovitis significa que provocara derrames recurrentes, y la Sinovectomia puede estar indicada • La resección 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

  20. 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

  21. Resultados 50% a 75% de los paciente con Artroscopia refieren una mejoría inicial 15% progresa a una artroplastia total de rodilla a un año 44% presenta una disminución clínica significativa del dolor a dos años 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 patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3

  22. 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 patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3

  23. Sugirio que los factores asociados a mal pronosticos son: • Tiempo de evolución 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 patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3

  24. 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 patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3

  25. Estudios Clinicos • En el estudio de Framingham sobre indicaciones de Meniscectomia en rodilla artrosica describió: “El 56% de los hombres entre 70 y 90 años sin sintomatología presenta desgarros meniscales y en pacientes con artrosis radiográfica este porcentaje aumenta a 82%. Sin embargo , la relación entre daño 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 patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3

  26. Una lesión meniscal en una rodilla sana, puede , eventualmente , llevar al desarrollo de la artrosis por perdida de la función meniscal • Una rodilla artrosica puede presentar un desgarro meniscal que acelera el proceso degenerativo • Esto sugiere que el daño meniscal visible en resonancia magnética antecede a los cambios visibles del cartílago 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

  27. Tecnica preferida por el autor • Como regla general se debe ser conservador y juicioso en las resecciones para preservar al máximo las estructuras noble de la función articular: Cartílago 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 patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3

  28. Contraindicamos formalmente cualquier tipo de procedimiento que base su éxito en respuesta reparativas del paciente, fundamentalmente por los factores de edad y por la severa alteración 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 patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3

  29. Normalmente por edad y presencia de factores de riesgo utilizamos tratamiento anticoagulante profiláctico con HBPM en el postoperatorio • Uso de kinesiología precoz , con énfasis en la movilización, limitación de la respuesta inflamatorias, drenaje venoso y linfático, mantención 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

  30. Conclusión • La evidencia es categórica 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 , sintomatología crónica, cirugías 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

  31. LESIONES CONDRALES

  32. HISTOLOGIA • Cartílago 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 células se nutren mediantes difusión a través de la fase acuosa de la matriz y a partir de los capilares de los tejidos que rodean el cartílago Alford jw, colebj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. BrittbergM,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.n°4; july/agust,1994, pag, 192-201.1994. BuckwalterJ.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, alexvaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenousosteochondralmosaicplasty for the treatment of focal chondral and osteochondraldefects.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, capitoRm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, mdVagsness, 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. O´Driscoll 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 articularcartilage.Clinorthoprelatres 2001;391:s379-s396 (suppl). ShelbourneKd, 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 OrthopaedicSurgeeons Instructional course lectures. Vol. 47, pag. 406-75. 1998.

  33. Esto le confiere una dureza y flexibilidad poco habituales Alford jw, colebj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. BrittbergM,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.n°4; july/agust,1994, pag, 192-201.1994. BuckwalterJ.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, alexvaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenousosteochondralmosaicplasty for the treatment of focal chondral and osteochondraldefects.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, capitoRm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, mdVagsness, 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. O´Driscoll 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 articularcartilage.Clinorthoprelatres 2001;391:s379-s396 (suppl). ShelbourneKd, 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 OrthopaedicSurgeeons Instructional course lectures. Vol. 47, pag. 406-75. 1998.

  34. Sus Diferencias están dadas por: • - Matriz celular • -Fibras de Colágenos • - Fibras de Elastina

  35. Cartilago Hialino • Se presenta en anillos traqueal, la nariz, laringe, superficies articulares • Condrocitos se encuentran por debajo del pericondrio • Zona mas profunda del cartílago , las lagunas tienen una configuración hemisférica o angular • Citoplasma presenta una baja densidad, contienen gotas de lípido y cantidades variables de glucógeno Alford jw, colebj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. BrittbergM,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.n°4; july/agust,1994, pag, 192-201.1994. BuckwalterJ.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, alexvaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenousosteochondralmosaicplasty for the treatment of focal chondral and osteochondraldefects.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, capitoRm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, mdVagsness, 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. O´Driscoll 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 articularcartilage.Clinorthoprelatres 2001;391:s379-s396 (suppl). ShelbourneKd, 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 OrthopaedicSurgeeons Instructional course lectures. Vol. 47, pag. 406-75. 1998.

  36. Matriz Cartilaginosa • Es de color azul grisáceo y parcialmente traslucida • Colágeno que predomina es tipo II, que forma fibras débiles con estriación transversal • Las fibras de la zona superficial están orientadas paralelamente y la mas profundas hacia adentro en forma de columnas verticales • La orientación de las fibras son adaptadas para resistir la tensión a la que están sujetas normalmente Alford jw, colebj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. BrittbergM,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.n°4; july/agust,1994, pag, 192-201.1994. BuckwalterJ.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, alexvaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenousosteochondralmosaicplasty for the treatment of focal chondral and osteochondraldefects.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, capitoRm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, mdVagsness, 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. O´Driscoll 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 articularcartilage.Clinorthoprelatres 2001;391:s379-s396 (suppl). ShelbourneKd, 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 OrthopaedicSurgeeons Instructional course lectures. Vol. 47, pag. 406-75. 1998.

  37. Dentro de la matriz existen una capsula pericelular, que rodea a las lagunas • Esta formada por fibras muy finas de características similares a la lamina basal • Desempeña un papel importante en la protección de los condrocitos de aquellos cartílagos sometidos a compresión o tensión mecánica • La matriz posee mayor concentración de proteoglicanos Alford jw, colebj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. BrittbergM,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.n°4; july/agust,1994, pag, 192-201.1994. BuckwalterJ.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, alexvaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenousosteochondralmosaicplasty for the treatment of focal chondral and osteochondraldefects.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, capitoRm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, mdVagsness, 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. O´Driscoll 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 articularcartilage.Clinorthoprelatres 2001;391:s379-s396 (suppl). ShelbourneKd, 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 OrthopaedicSurgeeons Instructional course lectures. Vol. 47, pag. 406-75. 1998.

  38. Cartilago Articular • Es un tipo de cartílago hialino, que cubre terminaciones Oseas de la articulaciones sinoviales • Es avascular y denervado, el 70%-80% de su peso es agua • Constituido por colágeno tipo II, posee poca elastina y un componente menor de glicoproteínas y lípidos Alford jw, colebj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. BrittbergM,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.n°4; july/agust,1994, pag, 192-201.1994. BuckwalterJ.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, alexvaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenousosteochondralmosaicplasty for the treatment of focal chondral and osteochondraldefects.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, capitoRm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, mdVagsness, 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. O´Driscoll 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 articularcartilage.Clinorthoprelatres 2001;391:s379-s396 (suppl). ShelbourneKd, 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 OrthopaedicSurgeeons Instructional course lectures. Vol. 47, pag. 406-75. 1998.

  39. Se organiza en cuatro capas : 1- Superficial (S) 2- Transicion (T) 3- Medial (M) 4- Calcificada (C) Alford jw, colebj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. BrittbergM,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.n°4; july/agust,1994, pag, 192-201.1994. BuckwalterJ.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, alexvaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenousosteochondralmosaicplasty for the treatment of focal chondral and osteochondraldefects.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, capitoRm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, mdVagsness, 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. O´Driscoll 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 articularcartilage.Clinorthoprelatres 2001;391:s379-s396 (suppl). ShelbourneKd, 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 OrthopaedicSurgeeons Instructional course lectures. Vol. 47, pag. 406-75. 1998.

  40. Capa Superficial Alford jw, colebj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. BrittbergM,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.n°4; july/agust,1994, pag, 192-201.1994. BuckwalterJ.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, alexvaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenousosteochondralmosaicplasty for the treatment of focal chondral and osteochondraldefects.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, capitoRm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, mdVagsness, 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. O´Driscoll 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 articularcartilage.Clinorthoprelatres 2001;391:s379-s396 (suppl). ShelbourneKd, 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 OrthopaedicSurgeeons Instructional course lectures. Vol. 47, pag. 406-75. 1998.

  41. 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, colebj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. BrittbergM,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.n°4; july/agust,1994, pag, 192-201.1994. BuckwalterJ.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, alexvaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenousosteochondralmosaicplasty for the treatment of focal chondral and osteochondraldefects.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, capitoRm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, mdVagsness, 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. O´Driscoll 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 articularcartilage.Clinorthoprelatres 2001;391:s379-s396 (suppl). ShelbourneKd, 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 OrthopaedicSurgeeons Instructional course lectures. Vol. 47, pag. 406-75. 1998.

  42. Capa Transicion • Posee mayor grosor que la capa superficial • Los condrocitos adoptan una morfología espiroidal • Sus células poseen mayor densidad de organelos, recitáculo endoplasmatico y aparato de Golgi • Sintetizan matriz con fibras colágenos de mayor diámetro con alta concentración de proteoglicano y menor de concentración de agua y colágeno Alford jw, colebj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. BrittbergM,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.n°4; july/agust,1994, pag, 192-201.1994. BuckwalterJ.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, alexvaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenousosteochondralmosaicplasty for the treatment of focal chondral and osteochondraldefects.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, capitoRm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, mdVagsness, 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. O´Driscoll 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 articularcartilage.Clinorthoprelatres 2001;391:s379-s396 (suppl). ShelbourneKd, 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 OrthopaedicSurgeeons Instructional course lectures. Vol. 47, pag. 406-75. 1998.

  43. 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, colebj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. BrittbergM,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.n°4; july/agust,1994, pag, 192-201.1994. BuckwalterJ.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, alexvaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenousosteochondralmosaicplasty for the treatment of focal chondral and osteochondraldefects.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, capitoRm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, mdVagsness, 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. O´Driscoll 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 articularcartilage.Clinorthoprelatres 2001;391:s379-s396 (suppl). ShelbourneKd, 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 OrthopaedicSurgeeons Instructional course lectures. Vol. 47, pag. 406-75. 1998.

  44. Capa Calcificado • Es una zona de cartílago calcificado que separa la zona radial del hueso subcondral • Contienen muy poco retículo endoplasmatico y aparato de Golgi • Las células aparecen completamente rodeando el cartílago calcificado, lo que sugiere una baja actividad metabólica • Estudios sugieren que podría jugar un rol en el desarrollo y progresión de la osteoartritis Alford jw, colebj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. BrittbergM,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.n°4; july/agust,1994, pag, 192-201.1994. BuckwalterJ.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, alexvaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenousosteochondralmosaicplasty for the treatment of focal chondral and osteochondraldefects.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, capitoRm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, mdVagsness, 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. O´Driscoll 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 articularcartilage.Clinorthoprelatres 2001;391:s379-s396 (suppl). ShelbourneKd, 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 OrthopaedicSurgeeons Instructional course lectures. Vol. 47, pag. 406-75. 1998.

  45. Cartilago Articular Normal • La función de este cartílago es : • Minimizar el estrés sobre el hueso subcondral • Distribución de cargas en la articulación • Disminuye el coeficiente de fricción de las superficies articulares • La interacción con el liquido sinovial proporciona un excelente mecanismo de lubricación Alford jw, colebj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. BrittbergM,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.n°4; july/agust,1994, pag, 192-201.1994. BuckwalterJ.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, alexvaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenousosteochondralmosaicplasty for the treatment of focal chondral and osteochondraldefects.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, capitoRm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, mdVagsness, 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. O´Driscoll 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 articularcartilage.Clinorthoprelatres 2001;391:s379-s396 (suppl). ShelbourneKd, 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 OrthopaedicSurgeeons Instructional course lectures. Vol. 47, pag. 406-75. 1998.

  46. Existen dos mecanismos de lubricacion : 1- Fluid Film : capa de fluido sinovial menor a 25 um , de gran viscosidad 2- Lubricacion Frontera: HAP, proteína de acido hialuronico de alta afinidad por la superficie articular, que funciona como un importante lubricante limítrofe con la superficie articular Alford jw, colebj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. BrittbergM,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.n°4; july/agust,1994, pag, 192-201.1994. BuckwalterJ.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, alexvaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenousosteochondralmosaicplasty for the treatment of focal chondral and osteochondraldefects.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, capitoRm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, mdVagsness, 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. O´Driscoll 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 articularcartilage.Clinorthoprelatres 2001;391:s379-s396 (suppl). ShelbourneKd, 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 OrthopaedicSurgeeons Instructional course lectures. Vol. 47, pag. 406-75. 1998.

  47. Los filamentos de colágeno mantienen la configuración del tejido y la resistencia a las fuerzas tensiles • Los proteoglicanos proporcionan un gel hidratado y firme que absorbe las fuerzas de compresión y además pueden atrapar e inmovilizar un gran volumen de agua Alford jw, colebj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. BrittbergM,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.n°4; july/agust,1994, pag, 192-201.1994. BuckwalterJ.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, alexvaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenousosteochondralmosaicplasty for the treatment of focal chondral and osteochondraldefects.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, capitoRm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, mdVagsness, 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. O´Driscoll 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 articularcartilage.Clinorthoprelatres 2001;391:s379-s396 (suppl). ShelbourneKd, 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 OrthopaedicSurgeeons Instructional course lectures. Vol. 47, pag. 406-75. 1998.

  48. ¿Cómo se resisten las fuerzas compresivas? cuando se ejerce una fuerza compresiva, el agua se aleja de las regiones con carga eléctrica de los proteoglicanos. Entonces , la cargas negativas de los grupos carboxilo y sulfato se aproximan y la fuerza de repulsión de las mismas permiten resistir la compresión Alford jw, colebj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. BrittbergM,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.n°4; july/agust,1994, pag, 192-201.1994. BuckwalterJ.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, alexvaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenousosteochondralmosaicplasty for the treatment of focal chondral and osteochondraldefects.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, capitoRm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, mdVagsness, 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. O´Driscoll 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 articularcartilage.Clinorthoprelatres 2001;391:s379-s396 (suppl). ShelbourneKd, 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 OrthopaedicSurgeeons Instructional course lectures. Vol. 47, pag. 406-75. 1998.

  49. Mecanismo de disipación de energía • El liquido intersticial fluye lentamente por la existencia de pequeños poros en el espacio intermolecular , con ello baja la permeabilidad de la matriz tisular y gracias a esto no existe una excesiva deformación del tejido y se crea la interacción de fricción entre fluidos y la matriz Alford jw, colebj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. BrittbergM,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.n°4; july/agust,1994, pag, 192-201.1994. BuckwalterJ.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, alexvaisman, m.d, Hangody , G.Kish, z karpati. Ostechondral plugs: autogenousosteochondralmosaicplasty for the treatment of focal chondral and osteochondraldefects.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, capitoRm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche , David s, mdVagsness, 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. O´Driscoll 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 articularcartilage.Clinorthoprelatres 2001;391:s379-s396 (suppl). ShelbourneKd, 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 OrthopaedicSurgeeons Instructional course lectures. Vol. 47, pag. 406-75. 1998.

  50. ¿los proteoglicanos influyen en el envejecimiento?

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