Treatment of Articular Cartilage Defects: Focus on Tissue Engineering

Abstract

The treatment of articular cartilage defects seems to be one of the greatest challenges in modern orthopaedics. From a medical point of view there are 3 main goals to achieve for cartilage trauma treatment: restoration of the joints motion, pain relief and elimination/delay of the onset of osteoarthritis. Treatment can be divided into conservative (including pharmacotherapy, arthrocentesis and physiotherapy) and surgical. The last comprises reparative techniques, regenerative methods and symptomatic treatment. While both are focused on reconstruction of the damaged cartilage, the difference lies in the type of filling tissue. Reparative techniques include: drilling of the subchondral bone, spongiolisation, abrasion, mictrofracture, and autologous matrix induced chondrogenesis (AMIC). Regenerative methods contain: periosteal and perichondral grafts, mosaicplasty, autologous chondrocyte implantation and matrix-induced autologous chondrocyte implantation (MACI). Nowadays tissue engineering, including gene therapy, is emerging as one of the key approaches to cartilage treatment and holds promises for new achievements and better outcomes of many cartilage diseases and traumas.

Clinical Application of the Basic Science of Articular Cartilage Pathology and Treatment

“…18,[63][64][65][66][67] MSP is associated with a very broad range of volume and quality of tissue filling of defects, which are dependent on numerous factors including patient age and health, lesion location and characteristics, and technique. 15,18,68 Based on best current evidence, arthroscopic or open drilling techniques with removal of calcified cartilage and irrigation during drilling are preferred to effectively access marrow elements to optimize defect-tissue fill volume and quality while mitigating subchondral bone damage and potential morbidity associated 18 Filardo et al 53 Żylińska et al 49 Abbreviations: DMOAD, disease-modifying osteoarthritis drugs (like chondroprotectors and nutraceuticals); IL, interleukin; NSAID, nonsteroidal anti/inflammatory drug; SOD, superoxide dismutase.…”

“…The Journal of Knee Surgery with bone marrow lesions and subchondral advancement ("internal osteophytes"). 49,[69][70][71][72][73][74][75][76][77][78] MSP can be augmented using cells, biologics, and/or matrices in an attempt to speed and improve defect-tissue fill volume and quality and improve outcomes. 5,15,75,[79][80][81][82][83][84][85] In general, these MSPþ techniques have reported advantages over MSP alone and can be considered for use based on surgeon preference, availability, and cost-effectiveness.…”

“…15,[93][94][95][96] These strategic advances have resulted in the ability to treat contained or semicontained defects up to 10 cm 2 and improve the durability and magnitude of functional outcomes compared with MSP. 49,88 MACI was developed in an attempt to address the technical difficulties, invasiveness, and relatively high-reoperation rates associated with ACI techniques that use a periosteal patch by seeding the cultured chondrocytes onto various collagen scaffolds. 75,[97][98][99][100][101] These MACI techniques have accomplished these goals to a large extent and are the preferred cell-based technique when available, feasible, and affordable.…”

The human arthritic hip joint is a source of mesenchymal stromal cells (MSCs) with extensive multipotent differentiation potential

“…Disorders of the locomotive system, such as soft tissue defects, diseases of the skelletal systeme and loss of articular cartilage as seen in osteoarthritis, majorly contribute to the rise of chronic, degenerative diseases that can benefit from TE [8,9]. Especially the poor capacity for selfregeneration in articular cartilage has been the subject of various in vitro and in vivo research [8,10].…”

The Effects of TGF-β3 on the Proliferation and Function of Encapsulated Costal Cartilage Chondrocytes in Alginate Scaffold

“…methods, transplanted chondrocytes in combination with a special scaffold or alone can be very effective. 7,8 Chondrocyte transplant was firstly performed in 1968, but its successfulness was only 40%. The chondrocyte transplant faces problems such as the movement of the cell from the lesion site, and placing in the joint space.…”