Cartilage Defects: Epidemiology and Natural History

Autologous chondrocyte implantation (ACI) for cartilage defects of the knee: A guideline by the working group “Clinical Tissue Regeneration” of the German Society of Orthopaedics and Trauma (DGOU)

“…Furthermore, cartilage is a tissue with relatively few cells, whose chondrocytes demonstrate limited mitotic capabilities, and are also enclosed in their extracellular matrix [10]. The sum of these characteristics may explain a phenomenon which has been known for a long time: articular cartilage, especially in adults, has only a limited intrinsic ability to regenerate itself [13].…”

“…If cartilage and/or the meniscus is damaged to a larger extent, such as due to trauma, the load per surface area in the joint increases, which can lead to higher pressure loads on the remaining intact cartilage tissue [13]. Of course, this problem increases with the extent of the cartilage damage, whereby the largest loads can lead to shearing forces, especially on the defect edges, and as a consequence to the death of chondrocytes (e.g.…”

“…There are not many systematically gathered data available in relation to the natural history of untreated primary cartilage lesions, especially for the first few years after the defect has occurred. Since cartilage is aneural and avascular, its damage also in the early stages, may not necessarily be associated with pain or other accompanying symptoms [13,17]. This gives rise to the problem of identifying patients with such damage, and also the consequential difficulty of capturing these in prospective studies [13].…”

Scientific and industrial status of tissue engineering

“…Application of tissue engineered cartilage products to the site of defect causes regeneration and obviates the need for major surgical operations. Current products are obtained by in vitro proliferation of autologous chondrocytes including Carticel (Genzyme Biosurgery, USA) (Beary III et al, 1998), Hyalograft C (Fidia Advanced Biopolymers, Italy) (Marcacci et al, 2005), Matrix-induced Autologous Chondrocyte Implantation (MACI) (Verigen, Germany) (Vibe-Hansen and Aesculai, 1998), ChondroArt (Educell, Slovenia) (Drobnic et al, 2002), co.don chondrotransplant (Grifka et al, 2000) and co.don chondrosphere (the latter is marketed as ARTHROcell as well) (both by co.don, Germany) (Litzke et al, 2004), BioSeed-C (BioTissue Technologies, Germany) (Erggelet et al, 2003), NOVOCART (TETEC, Germany) (Gaissmaier et al, 2005;Gaissmaier et al, 2006), Cartilage Repair System (CaReS) (Arthro Kinetics, Germany) (Andereya et al, 2006), ArthroMatrix, which is also marketed as Chondrokin (Orthogen, Germany) (Anon., 2002a), ChondroTec (CellTec, Germany) (Anon, 2001a), and ChondroCelect (TiGenix, Belgium) (Vanlauwe, 2005).…”

Stand und Trends in der biologischen Rekonstruktion von Knorpelschäden des Kniegelenks

“…B. der Osteochondrosis dissecans (OD), ist letztlich nicht vollständig geklärt. Diskutiert werden posttraumatische Knorpelveränderungen sowie Durchblutungsstörungen der subchondralen Knochenplatte [5,6].…”