Advances in the Surgical Management of Articular Cartilage Defects

Abstract

Objective:The purpose of this review is to gain insight into the latest methods of articular cartilage implantation (ACI) and to detail where they are in the Food and Drug Administration approval and regulatory process.Design:A PubMed search was performed using the phrase “Autologous Chondrocyte Implantation” alone and with the words second generation and third generation. Additionally, clinicaltrials.gov was searched for the names of the seven specific procedures and the parent company websites were referenced.Results:Two-Stage Techniques: BioCart II uses a FGF2v1 culture and a fibrinogen, thrombin matrix, whereas Hyalograft-C uses a Hyaff 11 matrix. MACI uses a collagen I/III matrix. Cartipatch consists of an agarose-alginate hydrogel. Neocart uses a high-pressure bioreactor for culturing with a type I collagen matrix. ChondroCelect makes use of a gene expression analysis to predict chondrocyte proliferation and has demonstrated significant clinical improvement, but failed to show superiority to microfracture in a phase III trial. One Step Technique: CAIS is an ACI procedure where harvested cartilage is minced and implanted into a matrix for defect filling.Conclusion:As full thickness defects in articular cartilage continue to pose a challenge to treat, new methods of repair are being researched. Later generation ACI has been developed to address the prevalence of fibrocartilage with microfracture and the complications associated with the periosteal flap of first generation ACI such as periosteal hypertrophy. The procedures and products reviewed here represent advances in tissue engineering, scaffolds and autologous chondrocyte culturing that may hold promise in our quest to alter the natural history of symptomatic chondral disease.

Nondestructive Assessment of Engineered Cartilage Composition by Near Infrared Spectroscopy

“…For these procedures, patient cartilage is harvested, cells isolated, proliferated and seeded with growth factors and/or on a scaffold, typically for a predetermined amount of time prior to implantation. 58 The optimal repair technique has not yet been established, and it is likely that in addition to finding the optimal material, identification of the ideal time for growth and implantation of an individual construct is a key factor in augmenting tissue repair. This motivates development of non-destructive analytical techniques, such as NIR spectroscopy, for in situ evaluation of construct properties during growth.…”

Silk Fiber-Reinforced Hyaluronic Acid-Based Hydrogel for Cartilage Tissue Engineering

“…Since its introduction by Mats Brittberg in 1994, ACI has evolved towards techniques that are based on different biomaterials being used as cell-carrier systems [ 4 ]. Third-generation ACI products provide a three-dimensional (3D) cell-carrier matrix, which is either composed of a hydrogel made of natural biopolymers such as agarose–alginate, hyaluronic acid (HA), type 1 collagen, or macroporous scaffolds made of natural materials such as type 1/3 collagen, HA, HA/fibrin or synthetic polymers (e.g., polyglycolic acid and poly(lactic-co-glycolic)acid) [ 5 , 6 , 7 ]. Although each biomaterial can provide individual advantages for cell viability and differentiation, biomaterials composed of a sole biomaterial are often limited in their overall function.…”

Emerging Gene-Editing Modalities for Osteoarthritis

“…Despite nonsurgical and surgical interventions, there is currently neither a cure for this disease nor a means to halt its inevitable progression [ 22 , 29 ]. Autologous chondrocyte transplantation has shown promise in clinical treatment, however, the process involves the harvest, culture, and transplant of cells grown in a monolayer (2D culture) [ 30 , 31 , 32 , 33 ]. Under these culture conditions, the risk of dedifferentiation of the chondrocytes and an altered phenotype is a major concern of tissue engineering [ 34 ].…”