Autologous costal chondral transplantation and costa-derived chondrocyte implantation: emerging surgical techniques

Abstract

It is a great challenge to cure symptomatic lesions and considerable defects of hyaline cartilage due to its complex structure and poor self-repair capacity. If left untreated, unmatured degeneration will cause significant complications. Surgical intervention to repair cartilage may prevent progressive joint degeneration. A series of surgical techniques, including biological augmentation, microfracture and bone marrow stimulation, autologous chondrocyte implantation (ACI), and allogenic and autogenic chondral/osteochondral transplantation, have been used for various indications. However, the limited repairing capacity and the potential pitfalls of these techniques cannot be ignored. Increasing evidence has shown promising outcomes from ACI and cartilage transplantation. Nevertheless, the morbidity of autologous donor sites and limited resource of allogeneic bone have considerably restricted the wide application of these surgical techniques. Costal cartilage, which preserves permanent chondrocytes and the natural osteochondral junction, is an ideal candidate for the restoration of cartilage defects. Several in vitro and in vivo studies have shown good performance of costal cartilage transplantation. Although costal cartilage is a classic donor in plastic and cosmetic surgery, it is rarely used in skeletal cartilage restoration. In this review, we introduce the fundamental properties of costal cartilage and summarize costa-derived chondrocyte implantation and costal chondral/osteochondral transplantation. We will also discuss the pitfalls and pearls of costal cartilage transplantation. Costal chondral/osteochondral transplantation and costa-based chondrocytotherapy might be up-and-coming surgical techniques for recalcitrant cartilage lesions.

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“…31 The graft's growth seen more in the growing rabbits than the adults, indicating there might be a strong influence on the growth process of growing rabbits due to hormonal and growth factors. 10,29,32 In case of a few growing rabbits the graft grew mostly in width than in length and there were no sign of graft resorption. This observantion can be explained according to Timo Peltomaki et al 29 by local factors such as possible postoperative asymmetric jaw functions, and particularly uneven loading of the grafts due to changed food habbit, this might influence the structure of the graft and eventually on its growth.…”

“…This bone remodeling or osteogenesis process might be because of osseous metaplasia 31 or previously calcified graft was used. Calcification of rib is a natural progression that should be carefully evaluated preoperatively using ultrasonography or dual-energy CT imaging 32 . Due to the lack of availability of these investigations this study depended on the visual difference in the color of the costochondral junction.…”

“…Though we always kept the intact perichondrium covering the cartilage and the periosteum covering the part of the rib; which might contribute to the regeneration of the graft. 32 Nevertheless, we determined the viability of C C G, its biological response, and the state of growth potentiality. It was also evident that longtime follow-up had a visible role in the graft's growth.…”

Proteomic, mechanical, and biochemical development of tissue-engineered neocartilage

“…Self-assembled neocartilage implants made with costal chondrocytes have also been used to treat cartilage defects in Yucatan minipig models [ 19 ]. Transplantation and autologous chondrocyte implantation procedures in the clinic have also been performed [ 20 ]. For example, recent first-in-human efforts include using costal chondrocytes in a pellet-type autologous chondrocyte implantation to treat full-thickness lesions in knee articular cartilage [ 21 ].…”

Management of cardiorespiratory function of rabbits by a customized chest drain: An experimental study

“…It protects the cartilage against fibroblastic invasion, which is responsible for chondrocyte destruction [ 8 ]. Again the perichondrium is a dense connective tissue and is the precursor of chondrogenic cells [ 9 ], especially the proliferating chondrocytes, which play an essential role in mandibular growth [ 3 ]. Experimental studies on animals also showed that costochondral regeneration comes from the perichondrium [ 10 ].…”