Articular cartilage regeneration with microfracture and hyaluronic acid

Abstract

Microfracture used to treat articular cartilage injuries can facilitate access to stem cells in the bone marrow and stimulate cartilage regeneration. However, the regenerated cartilage is fibrocartilage as opposed to hyaline articular cartilage and is thinner than native cartilage. Following microfracture in rabbit knee cartilage defects, application of hyaluronic acid gel resulted in regeneration of a thicker, more hyaline-like cartilage. The addition of transforming growth factor-beta3, an inducer of chondrogenic differentiation in mesenchymal stem cells, to the treatment with microfracture and hyaluronic acid did not significantly benefit cartilage regeneration.

Formation of cartilage repair tissue in articular cartilage defects pretreated with microfracture and covered with cell‐free polymer‐based implants

“…36 In microfracture, the application of a HA gel resulted in improved cartilage regeneration with thicker cartilage and more hyaline-like cartilage repair tissue in a rabbit model. 37 In addition, HA has been shown to support the chondrogenic development as shown by the induction of type II collagen and repression of type I collagen of human mesenchymal stromal cells stimulated with transforming growth factor (TGF) in a HA scaffold. 38 These reports suggest that hyaluronic acid may induce or, at least, support the chondrogenic development of mesenchymal progenitors in microfracture.…”

Fibrous Scaffolds with Varied Fiber Chemistry and Growth Factor Delivery Promote Repair in a Porcine Cartilage Defect Model

“…13 Recently, a 12-week study in rabbits using a nanofibrous selfassembling material based on peptide amphiphiles showed improved type 2 collagen deposition and higher histological scoring with the inclusion of a transforming growth factor b (TGFb)-binding domain. 14 Other materials investigated in cartilage defects with microfracture include HA, 15 alginate, 16 and poly(lactide-co-glycolide) (PLGA) sponges embedded with a fibrin gel. 17 Similarly, electrospun poly(vinyl alcohol) (PVA) and chondroitin sulfate (CS) fibers have been investigated in rat osteochondral defects, with CS fibers increasing glycosaminoglycan (GAG) and type 2 collagen deposition.…”

Articular Cartilage Regeneration with Stem Cells

“…The matrix also showed a predominance of collagen type II deposits, whereas collagen type I was minimal and located mostly over the superficial regions of the articular surface. These compositional results are features of hyaline as opposed to fibrocartilage (Kang et al, 2008;Saw et al, 2009& Lee et al, 2007. …”

“…Recent literature has illustrated that postoperative additions of HA to arthroscopic cartilage procedures yield better results (Johnson 1986;Kujawa & Caplan 1986;Gill, 2000;Freedman et al, 2004;Jakobsen et al, 2005;Gooding et al, 2006;Lee et al, 2007;Kang et al, 2008;Horvai et al, 2011;Fortier et al, 2011). High molecular weight hyaluronic acid is a component found in synovial fluid that has been investigated as adjunct for full thickness cartilage injury, microfracture, mesenchymal stem cells, and osteochondral allografting.…”