The osteochondral dilemma: review of current management and future trends

Abstract

The management of articular cartilage defects remains challenging and controversial. Hyaline cartilage has limited capacity for self-repair and post-injury cartilage is predominantly replaced by fibrocartilage through healing from the subchondral bone. Fibrocartilage lacks the key properties that characterize hyaline cartilage such as capacity for compression, hydrodynamic permeability and smoothness of the articular surface. Many reports relate compromised function associated with repaired cartilage and loss of function of the articular surface. Novel methods have been proposed with the key aim to regenerate hyaline cartilage for repair of osteochondral defects. Over the past decade, with many exciting developments in tissue engineering and regenerative cell-based technologies, we are now able to consider new combinatorial approaches to overcome the problems associated with osteochondral injuries and damage. In this review, the currently accepted surgical approaches are reviewed and considered; debridement, marrow stimulation, whole tissue transplantation and cellular repair. More recent products, which employ tissue engineering approaches to enhance the traditional methods of repair, are discussed. Future trends must not only focus on recreating the composition of articular cartilage, but more importantly recapitulate the nano-structure of articular cartilage to improve the functional strength and integration of repair tissue.

Chondrogenesis of human bone marrow mesenchymal stem cells in 3-dimensional, photocrosslinked hydrogel constructs: Effect of cell seeding density and material stiffness

“…4 The use of an osteochondral allograft provides native tissue that can be used to fill the defect, but it has the potential for immune rejection, disease transmission, and infection. Microfracture stimulates endogenous repair by a small fracture injury to the bone, but it can result in the formation of mechanically inferior fibrocartilage instead of native hyaline cartilage, thereby requiring a second intervention.…”

Integrating three-dimensional printing and nanotechnology for musculoskeletal regeneration

“…Zhang et al investigated a biphasic scaffold design where each phase is separated by an interfacial structure with varying porosity. The study determined that structures with interfaces outperformed those without in every instance [81]. Sherwood et al also investigated a biphasic osteochondral scaffold with an interfacial region that gradually transitioned between disparate regions by varying materials and porosity in a gradient manner.…”

Human articular cartilage repair: Sources and detection of cytotoxicity and genotoxicity in photo-crosslinkable hydrogel bioscaffolds

“…Current treatments to repair chondral lesions, which include autologous chondrocyte implantation, mosaicplasty, and microfracture, are unable to reproduce hyaline cartilage capable of sustaining shear and compressive forces associated with normal joint function. The generation of a bioscaffold, using a combination of biomaterials and cells, is a possible solution for cartilage repair . Currently, this technology has generated promising results both in vitro and in in vivo as well as in preclinical studies .…”