الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
In 1743, Hunter stated that “articular cartilage once destroyed, never repaired”. For more than 2 centuries, this statement remained somehow true until Pridie first developed the concept of bone marrow stimulation technique in 1974. Later on, Hangody developed the concept of mosaicplasty in 1992. In 1994, Brittberg developed the concept of autologous chondrocyte implantation for management of articular cartilage defect. Many studies had been conducted to compare all the treatment methods. However, till now no consensus could be reached about the most effective method for treatment of the chondral injuries. Several randomized controlled trials have shown different results whether superiority of one technique over the other or no statistically significant difference between the study groups. Our study is the first to compare 3rd generation ACI, mosaicplasty and microfracture for management of a large chondral defect ≥3 cm2. We recruited 56 patients of which 18 were managed by 3rd generation ACI, 18 were managed by mosaicplasty and 20 were treated by microfracture. Unlike our hypothesis, both TECI and mosaicplasty groups showed excellent functional results on Lysholm score one year postoperatively. Microfracture group has shown inferior results which were graded just good. On differential assessment of the functional results, mosaicplasty is the only group that showed statistical significant improvement of most of the components of Lysholm score. Given the fact that mosaicplasty is away cheaper than TECI, we can say that although both TECI and mosaicplcasty are effective methods for management of large chondral defect 3-4.5 cm2, mosaicplasty is a more cost effective method for management of large chondral defect 3-4.5 cm2. Conclusions: For chondral defects 3-4.5cm2; microfracture, mosaicplasty and TECI had proved satisfactory clinical improvement. The clinical improvement with the reconstructive techniques was higher than that of the reparative techniques. Within the reconstructive techniques, both TECI and mosaicplasty have shown excellent postoperative clinical score. However the clinical score of the mosaicplasty technique was statistically significant higher than that of the TECI group 1 year postoperatively. Considering the higher cost of TECI compared to mosaicplasty technique, we conclude that mosaicplasty is the best choice for large chondral defect 3-4.5cm2. TECI should be saved for larger defects where the limited capacity of the donor site represents a hurdle against mosaicplasty.