… more bricks to the building of cartilage knowledge?

Abstract

This issue of the KSSTA journal contains a spicy basket of papers on cartilage repair and related problems. When I was asked to give an editorial about those papers, I used a nice sunny summer morning of one of my remaining vacation days to read them. It was a nice reading and I got new information useful for my practice. It is more than 20 years ago since our group in Gothenburg performed the first autologous chondrocyte implantation [1], the first generation ACI. Today, we have reached the third generation ACI with different scaffolds and cell-seeded carriers, but still we are only in the very beginning of knowing the secrets of cartilage and cartilage repair mechanisms. We need both experimental and clinical research contributing with bricks of knowledge of how and when to do our surgery, which lesions that need to be treated and traumatic versus osteoarthritis lesions and their different behaviours.William Mayo once said [2], ''reading papers is not the purpose of showing how much we know and what we are doing but it is an opportunity to learn''. I fully agree and those cartilage papers in this edition of the KSSTA journal are such good examples of a possible new learning. It does not say that what has been found is the final truth, but as always with critical reading, found information gives us the power to change our treatment habits a bit, stimulate us to new research etc.The papers in this edition can be divided into several categories, experimental studies, retrospective and prospective studies, review papers and single case stories.

Strategies for patient profiling in articular cartilage repair of the knee: a prospective cohort of patients treated by one experienced cartilage surgeon

“…The Brittberg-Peterson VAS contains 13 items to measure different parameters of pain and function, on a scale of 0–100, where a score of 100 indicates the worst outcome [39]. The SECI consisted of a question regarding post-operative improvement (completely improved/much better/slightly improved/unchanged or worse) [6]. …”

Functional articular cartilage repair: here, near, or is the best approach not yet clear?

“…In fact, the quality of life of patients with a diagnosed focal cartilage lesion is impaired to the same extent as that of patients with OA eligible for arthroplasty. 39,40 As we discuss in the following sections, cartilage cell therapy has a role in the treatment of symptomatic joint damage because natural healing is ineffective, and because current treatment options for large defects do not provide a lasting effect. ACI has been approved by the EMA and FDA for use in restoring chondral and osteochondral lesions.…”

“…After initial in vitro and in vivo experiments in the 1970s and 1980s, a pivotal moment came with the first cartilage cell implantation in a cohort of patients. 39 The hallmark publication in 1994 40 of the outcome of ACI was the first proof of cartilage cell biological principal and clinical effectiveness. Sixteen patients received femoral condylar transplants and seven had patellar transplants; after an average 39 months (range 16-66 months), clinical symptoms had declined, surface restoration was good, and histological signs of hyaline cartilage restoration could be found.…”

Barriers and strategies for the clinical translation of advanced orthopaedic tissue engineering protocols

“…Additionally, collaborative interdisciplinary groups should continue to be supported to study disease-focused work such as that support provided by the AO Foundation's Collaborative Research Programs (CRPs). (Hunziker, 2009) and has few restorative therapies available (Brittberg, 2009), there is a clear lack of animal models that accurately mimic the human condition . For example, models that study the heterotopic implantation of cartilaginous constructs in subcutaneous pockets in nude mice have only remote relevance to a clinically apparent knee cartilage defect .…”