Current Strategies of Tissue Engineering in Talus Chondral Defects

Abstract

Due to the nature of articular cartilage of being poorly vascularized the capabilities of self repair are limited. Mesenchymal stem cells transplantation is a modern technique which has been developed after the high success rates obtained by microfracturing and drilling techniques which promote the release of growth factors and the infiltration of bone marrow derived cells in the lesion. In order to increase the concentration of bone marrow derived cells appropriate devices, the scaffolds, are necessary. These three dimensional constructs mimic the physiological ambient of chondrogenesis.The race for new scaffold materials, which will show high biocompatibility to prevent inflammatory response, high cellular adhesion properties with three dimensional architecture, high bioactivity to deliver growth factor appropriately and possibly high biodegrability has just begun. New studies will concentrate on the role, on the interaction and on the temporal sequence of growth factors to improve ostheocondral differentiation, but the necessity to increase the number of clinical studies with more patients and longer follow ups seems mandatory. The aim of this review is to update and summarise the evidence-based knowledge of treatment of talus chondral defect with new tissue engineering techniques.

Topographic Variations in Biomechanical and Biochemical Properties in the Ankle Joint: An In Vitro Bovine Study Evaluating Native and Engineered Cartilage

“…2,16,17 Tissue engineering opens a new field in the management of ankle lesions by developing tissues that can replace the damaged cartilage. 18,19 A technique for the development of engineered scaffold-free neocartilage has been described. 20 The self-assembling approach for neocartilage development is considered a representative model of native tissue morphogenesis, maturation, and maintenance.…”

Cell-Free Scaffolds as a Monotherapy for Focal Chondral Knee Defects

“…The use of a scaffold-based approach is emerging as an innovative solution to the problem [17]. Its 3D structure can provide mechanical stability, and once inserted at the site of the chondral defect it acts as a platform for chondrocyte proliferation and matrix production [18]. Chondrocytes are usually cultured and implanted in the scaffold before it is inserted into the site of chondral defect.…”

The Use of Biological Adjuncts

“…Such an approach utilizing tissue engineering technologies for the treatment of talar osteochondral lesions stands to increase as research into this arena expands. 3 Adult derived stem cells were traditionally believed to be housed solely within hematopoietic system. Current evidence has expanded this definition to include "undifferentiated" cells found even in differentiated tissue: progenitor cells.…”

“…Current evidence has expanded this definition to include "undifferentiated" cells found even in differentiated tissue: progenitor cells. In vitro studies have identified promising stem cells for potential therapeutic application in patients in the near future [3]. Thus efforts aimed at restoring or regenerating articular cartilage in order to relieve pain, increase mobility, and delay or prevent the onset of arthritis are increasingly under i investigation.…”