Operative Treatment of Knee Cartilage Injuries: A Review of the Current Literature on Non-Cell-Based and Cell-Based Therapies

Abstract

Aims: Cartilage is frequently damaged through injury and disease but shows little or no capacity for repair. Injuries that extend to the subchondral level show some capacity for repair due to the release of bone marrow derived mesenchymal stem cells. Focal articular cartilage defects are challenging clinical problems that may progress to more generalised lesions. We reviewed the literature to analyse the results of available noncell-based and cell-based strategies for the repair of articular cartilage defects in the knee.

Cell Therapy in Joint Disorders

“…Non-cell-based surgical treatment includes debridement, marrow stimulation by microfracture, abrasion or drilling of the subchondral bone plate, and osteochondral grafting (mosaicplasty). 55 , 63 , 83 …”

“…Non-cell-based surgical treatment includes debridement, marrow stimulation by microfracture, abrasion or drilling of the subchondral bone plate, and osteochondral grafting (mosaicplasty). 55,63,83 Abnormal cartilage in defects produces detrimental effects on adjacent and opposing cartilage, and debridement can improve symptoms and potentially minimize further chondral loss. 28,55 Activation of the innate repair mechanism by injuries involving the subchondral bone plate, as opposed to partial-thickness chondral injury, provides the rationale for marrow stimulation techniques where multiple small holes are placed in the subchondral bone of the defect.…”

“…55,63,83 Abnormal cartilage in defects produces detrimental effects on adjacent and opposing cartilage, and debridement can improve symptoms and potentially minimize further chondral loss. 28,55 Activation of the innate repair mechanism by injuries involving the subchondral bone plate, as opposed to partial-thickness chondral injury, provides the rationale for marrow stimulation techniques where multiple small holes are placed in the subchondral bone of the defect. 55 The mechanism of action is thought to be due to the influx of chondroprogenitor cells.…”

“…Broadly, these may be considered as non-cell-based and cell-based. 55 , 63 Cell-based therapies may be further subdivided into non–stem cell therapy or stem cell therapy.…”

The Potential of Stem Cells in the Treatment of Skeletal Muscle Injury and Disease

“…Stem cells are emerging as a potential source of tissue repair and regeneration in many musculoskeletal tissues [ 66 – 80 ]. Although most advances have been made with bone, cartilage, tendon, and ligaments [ 81 – 109 ], this review shows that the application of stem cells in skeletal muscle regeneration following injury and disease is slowly emerging. Although satellite cells have attracted much interest due to their commitment to the myogenic lineage, their ability to cross the endothelial junction is limited, thus meaning locallydelivered transplantations are required.…”