Strategies for Articular Cartilage Lesion Repair and Functional Restoration

Abstract

Injury of articular cartilage due to trauma or pathological conditions is the major cause of disability worldwide, especially in North America. The increasing number of patients suffering from joint-related conditions leads to a concomitant increase in the economic burden. In this review article, we focus on strategies to repair and replace knee joint cartilage, since knee-associated disabilities are more prevalent than any other joint. Because of inadequacies associated with widely used approaches, the orthopedic community has an increasing tendency to develop biological strategies, which include transplantation of autologous (i.e., mosaicplasty) or allogeneic osteochondral grafts, autologous chondrocytes (autologous chondrocyte transplantation), or tissue-engineered cartilage substitutes. Tissue-engineered cartilage constructs represent a highly promising treatment option for knee injury as they mimic the biomechanical environment of the native cartilage and have superior integration capabilities. Currently, a wide range of tissue-engineering-based strategies are established and investigated clinically as an alternative to the routinely used techniques (i.e., knee replacement and autologous chondrocyte transplantation). Tissue-engineering-based strategies include implantation of autologous chondrocytes in combination with collagen I, collagen I/III (matrix-induced autologous chondrocyte implantation), HYAFF 11 (Hyalograft C), and fibrin glue (Tissucol) or implantation of minced cartilage in combination with copolymers of polyglycolic acid along with polycaprolactone (cartilage autograft implantation system), and fibrin glue (DeNovo NT graft). Tissue-engineered cartilage replacements show better clinical outcomes in the short term, and with advances that have been made in orthopedics they can be introduced arthroscopically in a minimally invasive fashion. Thus, the future is bright for this innovative approach to restore function.

Time Evolution of in Vivo Articular Cartilage Repair Induced by Bone Marrow Stimulation and Scaffold Implantation in Rabbits

“…Different techniques are used to injury subchondral bone, such as abrasion chondroplasty, Pridie drilling, spongialization and microfracture (6)(7)(8), producing bleeding in the zone of osteoarthritic lesion and clot formation, that initiate bone marrow stem cells migration and thus the regenerative process. These techniques take the advantage of the body's own healing potential (8), representing an easy, simple, minimally invasive, low-morbidity, single-stage procedure, and it has been reported to be cost-effective, associated with few complications, with a high capacity for creation of durable repair tissue, and with best long-term results in younger active patients with isolated small lesions (13).…”

“…Scaffolds rapidly fill cartilage defects and provide a temporary substrate onto which invading cells can adhere. They also play important roles in maintaining mechanical integrity and withstanding mechanical stresses, therefore they should be designed to match mechanical properties with those of native cartilage, as well as appropriate for the loading conditions of the joint (6,15,16). Different "in vivo" studies had demonstrated the importance of the stress transmission to the cells in cartilage regeneration.…”

The Basic Science and Surgical Treatment Options for Articular Cartilage Injuries of the Knee

“…40 The DeNovo ET Engineered Tissue Graft (Zimmer, Inc) and Cartilage Autograft Implantation System (CAIS; DePuy Mitek, Inc, Raynham, MA) are alternative techniques currently under investigation. The DeNovo ET uses juvenile allogenic chondrocytes in culture to create a 3-dimensional sheet of cartilage, 2 while CAIS uses autogenic donor tissue that is procured from a non-weight-bearing region, minced, and implanted to the defect site on a scaffold placed into the defect. Both technologies are still under investigation and are about to undergo phase III clinical trial enrollment.…”

Retropatellar Accessory Portals for Improved Access to the Patella; Anatomic Description and Evaluation of Safety

“…Such orientation is essential in properly executing a number of chondral resurfacing and restorative techniques, namely microfracture, mosaicplasty, and autologous matrixinduced chondrogenesis. 3,7,11,23,26,31 Thus, the findings of the present study are valuable in providing the arthroscopist with an alternative portal option that may allow him or her to address deep, centralized chondral lesions of the patella effectively while maintaining an arthroscopic approach.…”