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The Journal of Bone and Joint Surgery (American) 79:600-11 (1997)
© 1997 The Journal of Bone and Joint Surgery, Inc.

Instructional Course Lecture

Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Articular Cartilage. Part I: Tissue Design and Chondrocyte-Matrix Interactions*{dagger}

J. A. BUCKWALTER, M.D.{ddagger}, IOWA CITY, IOWA and H. J. MANKIN, M.D.§, BOSTON, MASSACHUSETTS

An Instructional Course Lecture, The American Academy of Orthopaedic Surgeons

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   Introduction
 
In 1892, Walt Whitman observed that "the narrowest hinge in my hand puts to scorn all machinery."78 Despite the remarkable advances in joint replacement, Whitman's observation stands unchallenged; no current prostheses come close to duplicating the function and durability of synovial joints. These complex structures, developed and progressively refined over hundreds of millions of years1, are formed by an arrangement of multiple distinct tissues, including joint capsule, ligament, meniscus, subchondral bone, synovial tissue, and hyaline articular cartilage. These tissues are self-renewing, respond to alterations in use, and provide stable movement with a level of friction less than that achieved by any prosthetic joint. The tissue that contributes the most to these extraordinary functional capacities is the hyaline articular cartilage15,19. It varies in thickness, cell density, matrix composition, and mechanical properties within the same joint, among joints, and among species2; however, in all synovial joints it consists of . . . [Full Text of this Article]


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