Articular cartilage injury of the knee is a comprehensive reference that combines the basic scientific knowledge of articular cartilage as it relates to patient health and disease with patientfocused diagnosis and treatment options. Abstract in an effort to develop an effective source of clinically relevant cells and tissues for cartilage repair a directed differentiation method was used to generate articular chondrocytes and cartilage tissues from human embryonic stem cells hescs. The first efforts to address cartilage injury focused on getting the body to produce new articular cartilage as a response to injury to the subchondral bone. Articular cartilage injury can lead to pain, dysfunction and decreased athletic participation in the short term, but can. The goal is to restore full function in each patient as quickly as possible without overloading the healing articular cartilage. Once damaged, they degenerate, causing functional impairment of joints. There are several variables to consider when developing the unique rehabilitation progression for each patient. A magnetically actuated microscaffold containing mesenchymal. Defects that penetrate to the subchondral bone elicit an intrinsic repair response that yields a fibrocartilaginous repair tissue which is a poor substitute for hyaline articular cartilage. Articular cartilage serves a vital role in maintaining joint function by minimising friction and distributing load. The purpose of this paper is to overview the principles of rehabilitation following articular cartilage repair procedures. Articular cartilage repair and postoperative rehabilitation. Decellularized tissue engineered hyaline cartilage graft. Whats new in cartilage repair hospital for special surgery.
The limited ability of articular cartilage to regenerate renders joint arthroplasty an unavoidable surgical intervention. Articular cartilage is the smooth, white tissue that covers the ends of bones where they come together to form joints. Specialized cartilage cells, known as chondrocytes, are responsible for maintaining this matrix. Emerging techniques for cartilage restoration have shown. These cspcs can be expanded extensively in vitro, form the entire adult articular cartilage in vivo, and likely contribute to the physiological healing of small defects in cartilage. Articular cartilage repair an overview sciencedirect topics. Articular cartilage repair and restoration sos med. Many people develop severe disability after chondral and osteochondral traumatic injuries and there exist several options to treat such injuries in order to reduce. Traditional repair regenerative techniques are performed based on size of the lesion and activity level of the patient 3. High therapeutic potential of cspcs in connection with articular cartilage repair was indirectly supported by the recently observed superiority of autologous.
This book emphasizes the importance of bridging the divide between basic science and clinical applications in order to select the best possible treatment when injuries occur. Future studies are warranted to assess efficacy in large controlled trials and to investigate an extension of indications to. This study proposes a magnetically actuated microscaffold with the capability of targeted mesenchymal stem cell msc delivery for articular cartilage regeneration. Articular cartilage thickness at the distal radius. By the 6month time point of implantation in porcine knee joints, the fine morphology.
This is a technique that stimulates the body to make a repair tissue fibrocartilage to fill in the defect in articular cartilage. Repair of fullthickness articular cartilage defects by. Review open access considerations in hipscderived cartilage for articular cartilage repair akihiro yamashita1, yoshihiro tamamura1, miho morioka1, peter karagiannis2, nobuyuki shima1 and noriyuki tsumaki1 abstract background. Hyaline cartilage, the most abundant type of cartilage, plays a supportive role and assists in movement.
Surgery, rehabilitation, clinical outcomes second edition, 2017. This type of procedure involves the placement of viable hyaline cartilage grafts into a. Request pdf humanderived cells in chondral or osteochondral repair chondral or osteochondral oc lesions of the knee are common. Main causes are that cartilage is lacking blood vessels, nerves and lymphatic tissue 1,2. These include specifics regarding the patient, lesion, and surgery table 1. Objective human adult articular cartilage ac has little capacity for repair, and joint surface injuries often result in osteoarthritis oa, characterised by loss of matrix, hypertrophy and chondrocyte apoptosis. Cell based transplantation methods currently involve the transplantation of expanded autologous chondrocytes to the defects to form a repair tissue.
The quality of each individuals articular cartilage. Donors are sourced through appropriate organ and tissue procurement organizations otpos hayes, 2018. Allogeneic cartilage transplantation has been performed for func tional recovery of articular cartilage. In this pathology, the entire joint is involved and the regeneration of articular cartilage still remains one of the main challenges, particularly in an. Histology of articular cartilage repair springerlink. Osteochondral autografting is a surgical procedure used in an attempt to repair damaged articular cartilage. Humanderived cells in chondral or osteochondral repair. Hyaline cartilage provides a smooth articular surface and the ability to withstand good amount of pressure. Decellularized tissue engineered hyaline cartilage graft for. This procedure uses minced pieces of cartilage seeded over a scaffold which allows for.
Apr 22, 2020 articular cartilage is specifically the smooth, white tissue covering the ends of bones where they come together to form joints. Future studies are warranted to assess efficacy in large controlled trials and to investigate an extension of indications to early degenerative states or to other joints. Repair of fullthickness articular cartilage defects by cultured mesenchymal stem cells introduction it is well established that damaged articular cartilage has only a limited ability for selfrepair 1. Defects of articular cartilage that do not penetrate to the subchondral bone fail to heal spontaneously. It is the policy of health plans affiliated with centene corporation that meniscal allograft transplant is considered medically necessary when all of the following criteria are met. Articular cartilage lesions can lead to disability and osteoarthritis if untreated 2. Current concepts in the rehabilitation following articular. Repair refers to the healing of injured tissues or replacement of lost tissues by cell proliferation and synthesis of a new extracellular matrix. Bioactive signals that enhance cartilage repair cartilage repair is a complex cascade of events controlled by bioactive molecules that provide signals at local injury sites allowing restoration of damaged articular cartilage is one the biggest challenges in modern clinical orthopaedics figure 7. Articular cartilage repair and postoperative rehabilitation jessica graziano, pt, dpt, scs, cscs dr. With regard to its 2tissue structure chondrocytes and matrix, the regenerative potential of hyaline cartilage defects is limited. The rehabilitation programs discussed are performed based on current understanding of articular cartilage and the natural healing response observed after articular cartilage repair procedures.
Aug 11, 2018 these cspcs can be expanded extensively in vitro, form the entire adult articular cartilage in vivo, and likely contribute to the physiological healing of small defects in cartilage. Though these solutions do not perfectly restore articular cartilage, some of the latest technologies start to bring very promising results in repairing. The native extracellular matrix ecm of articular cartilage is a 3d structure composed of proteinaceous fibers and a hydrogel ground substance that together provide the physical and biological cues to instruct cell behavior. Physically active and physiologically young, under age 55. Articular cartilage repair an overview sciencedirect. Intra articular therapy with recombinant human gdf5 arrests disease progression and stimulates cartilage repair in the rat medial meniscus transection mmt model of osteoarthritis w. There is a constant wearout and replacement activity of the molecules that make up the articular cartilage matrix. Over the last decades, surgeons and researchers have been working hard to elaborate surgical cartilage repair interventions. The gelchondrocyte composite accu mulated an intense metachromatic matrix, and had. Articular cartilage repair remains a significant and growing clinical challenge with the aging population. Pdf the role of tissue engineering in articular cartilage. Articular cartilage download ebook pdf, epub, tuebl, mobi. The tegner activity scale tas was developed in 1984 and has been widely used in studies on knee populations.
Pluripotent stemcellderived cartilage for repair 215. Articular cartilage knee restoration center of indiana. Pdf articular cartilage exhibits little capacity for intrinsic repair, and thus even minor injuries or lesions may lead to progressive damage and. How to repair knee articular cartilage damage treatment. Cells isolated from five human cadaveric donors were cultured. Use of mesenchymal stem cells seeded on the scaffold in.
Intraarticular therapy with recombinant human gdf5. The articular cartilage is the thin layer of smooth, shiny, white, glistening tissue that covers the surfaces of the ends of the bones in the knee joint, making the joint surfaces very low friction, to allow smooth movements. A comparative study of articular cartilage thickness in the stifle of animal species used in human preclinical studies compared to articular cartilage thickness in the human knee. Lesions to articular cartilage can be difficult to treat and directly impact surgical outcome in hip arthroscopy. Furthermore, specific rehabilitation guidelines for debridement, abrasion chondroplasty, microfracture, osteochondral autograft trans. Articular cartilage repair rabbit experiments with a collagen gelbiomatrix and chondrocytes cultured in it sadahito kawamural, shigeyuki wakitani2, tomoatsu kimura, akira maeda, arnold i caplan3, konsei sttino and takahiro ochil to repair a fullthickness articular cartilage defect in. The wellreferenced 1743 quote from the british anatomist hunter in which he states cartilage injury is a troublesome thing and once injured is seldom repaired was the general axiom for thinking about cartilage repair for the next 200 years. In this paper we will discuss the principles of rehabilitation following articular cartilage repair procedures, as well as specific. Articular cartilage paste grafting often abbreviated as art cart or paste grafting uses your own bone, cartilage and stem cells to regenerate your damaged cartilage. While the intricate ultrastructure of articular cartilage is critical for proper function, these same properties create challenges for cartilage restoration. Articular cartilage repair articular cartilage cannot be repaired directly but we can undertake various procedures that can help it to heal and repair itself. Articular medial femoral condyle and auricular cartilage anithelix was compared as a cell source for the autologous joint repair. Partialthickness articular cartilage defects, analogous to the clefts and fissures that characterize the early stages of human osteoarthritis, do not heal. Pdf the use of the tegner activity scale for articular.
Currently, cartilage lesions are often treated by microfracture or autologous chondrocyte implantation aci. The stringent structural and biological requirements imply that any tissue capable of successful repair or replacement of damaged articular cartilage should be similarly constituted. The response of cartilage to injury differs from that of other tissues because of its avascularity, the immobility of chondrocytes, and the limited ability of. To repair a fullthickness articular cartilage defect in rabbit knees, we developed a technique of using a collagen gel hardened by cultured allogeneic chon drocytes in it. Pdf articular cartilage repair of the knee in children. Arthroscopic repair of delaminated acetabular articular. The use of the tegner activity scale for articular cartilage. Nasal chondrocytebased engineered autologous cartilage. The wellreferenced 1743 quote from the british anatomist hunter in which he states cartilage injury is a troublesome thing and once injured is seldom repaired was the general axiom for thinking about. Articular cartilage regeneration in osteoarthritis mdpi. This repair tissue develops from cells brought to the area with blood from the bone marrow underneath the cartilage. Standard imaging and special considerations nonoperative treatment options a. The field of articular cartilage tissue engineering, which aims to repair, regenerate, andor improve injured or diseased articular cartilage functionality, has evoked intense interest and holds. Articular cartilage is regarded as a troublesome tissue due to its poor ability to selfrepair posttrauma 1,2.
Repair and tissue engineering techniques for articular. Lyle cain, md5 postoperative rehabilitation programs following articular cartilage repair procedures will vary. Aci is a twostage process in which, first, the healthy cartilage cells are harvested and cultured. The rehabilitation programs discussed are performed based on current understanding of articular cartilage and. Articular cartilage repair of the knee in children and. They are present in over 60% of knees undergoing arthroscopy.
Tissue engineering represents a new alternative approach for cartilage repair 2, 3. This process is experimental and the keywords may be updated as the learning algorithm improves. Considerations in hipscderived cartilage for articular. Subchondral drilling for articular cartilage repair. A lack of cell or tissue sources hampers regenerative medicine for articular cartilage damage. Articular cartilage subchondral bone cartilage defect cartilage repair hyaline cartilage these keywords were added by machine and not by the authors. The rehabilitation process after articular cartilage repair procedures is vital to the longterm success and functional outcome of the patient.
Bioinspired nanofibers support chondrogenesis for articular. Postoperative rehabilitation programs following articular cartilage repair procedures will vary greatly among patients and need to be individualized based on the nature of the lesion, the unique characteristics of the patient, and the type and detail of each surgical procedure. Hyalinelike cartilage tissues, engineered from autologous nasal chondrocytes, can be used clinically for repair of articular cartilage defects in the knee. Advanced strategies for articular cartilage defect repair mdpi. The simplest procedures involve inspecting the cartilage arthroscopically and removing loose fragments or smoothing down rough surfaces.
Story y y depuy synthes mitek sports medicine, raynham, ma, usa. The procedure involves the transplantation of a piece of articular cartilage from a cadaver donor to the damaged surface of the knee. When used appropriately, traditional techniques have yielded good results 4. This article describes a direct cartilage suture repair technique for a. Jun 19, 2012 articular cartilage repair remains a significant and growing clinical challenge with the aging population. Goebel1,2, patrick orth1,2, magali cucchiarini1 and henning madry1,2, abstract articular cartilage defects may initiate osteoarthritis. Intraarticular therapy with recombinant human gdf5 arrests disease progression and stimulates cartilage repair in the rat medial meniscus transection mmt model of osteoarthritis w.
When an ind or ide is required, you must comply with fdas. Abstract in an effort to develop an effective source of clinically relevant cells and tissues for cartilage repair a directed differentiation method was used to generate articular chondrocytes and. In this study, by combining the advantages of cartilage tissue engineering and decellularization technology, we developed a decellularized allogeneic hyaline cartilage graft, allo dlhcg, which achieved a superior efficacy of articular cartilage repair. It allows the bones to glide over each other with very little friction. Articular cartilage can be damaged by injury or normal wear and tear. Articular cartilage defect repairs page 3 of 8 in the united states and is characterized by the erosion of articular cartilage niams, 2001. Healthy articular cartilage allows joints to move and glide over each other with very little friction, but is subject to damage and injury, as well as normal wear and tear. Articular cartilage repair has been a longstanding challenge in orthopaedic medicine due to the limited selfregenerative capability of cartilage tissue. Clinical policy articular cartilage defect repairs page 2 of 8 g. Unfortunately, the repaired articular cartilage generally fails to replicate the structure, composition. Kristofer jones, md objectives epidemiology basic science and anatomy diagnosis and patient evaluation a. Clinically available cartilage repair middle column can be divided into two sub categories. There are two major problems that need to be addressed in repair of articular cartilage.
Recent scientific advances in tissue engineering have made significant steps towards development of constructs for articular cartilage repair. Healthy cartilage in our joints makes it easier to move. Pdf tissue engineering for articular cartilage repairthe state of. Current concepts in the rehabilitation following articular cartilage repair procedures in the knee michael m. Knee cartilage repair, regeneration, and replacementwho. April 22, 2020 cartilage is a flexible connective tissue found in multiple areas of the body, including joints, the ear and nose, and intervertebral discs. The microscaffold, as a 3d porous microbead, is divided into body and surface portions according to its materials and fabrication methods. Traditional repairregenerative techniques are performed based on size of the lesion and activity level of the patient 3.
Intraarticular therapy with recombinant human gdf5 arrests. The first is to fill the defect void with a tissue that has the same mechanical properties as articular cartilage. Considerations in hipscderived cartilage for articular cartilage repair akihiro yamashita1, yoshihiro tamamura1, miho morioka1, peter karagiannis2, nobuyuki shima1 and noriyuki tsumaki1 abstract background. Articular cartilage has a poor intrinsic capacity for repair. It is a minimallyinvasive, single arthroscopic procedure that stimulates regrowth of damaged articular cartilage surfaces. Research article subchondral drilling for articular cartilage repair. Repair and tissue engineering techniques for articular cartilage. Not currently a candidate for total or partial knee replacement. The aim of an articular cartilage repair treatment is to restore the surface of an articular joints hyaline cartilage.
762 1150 764 56 932 1127 1552 956 520 94 560 1124 1129 1513 703 210 1237 1285 1056 162 845 363 168 979 630 242 18 291 557 1306 282 158 1307 978 95