Abstract
Articular cartilage possesses low intrinsic healing property due to its lack of vascularity and progenitor cells. Thus, damage to the hyaline cartilage may lead to a progressive degeneration of the joint and eventually to osteoarthritis (OA). In the last years, different surgical techniques have been introduced in the clinical practice to overcome this issue. Bone marrow stimulation, for example, is a widely known method to allow cell invasion from the bloodstream to the site of damage. However, the reparative tissue has different morphological and biomechanical properties when compared to the native cartilage. In particular, the newly formed fibrocartilage has a low amount of proteoglycans and a higher concentration of type I collagen. This different matrix composition leads to a decrease in the mechanical strength and to a poor integration of the reparative tissue with the native cartilage.
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References
Bekkers JE, Tsuchida AI, van Rijen MH, Vonk LA, Dhert WJ, Creemers LB, Saris DB. Single-stage cell-based cartilage regeneration using a combination of chondrons and mesenchymal stromal cells: comparison with microfracture. Am J Sports Med. 2013;41(9):2158–66.
Berruto M, Delcogliano M, de Caro F, Carimati G, Uboldi F, Ferrua P, Ziveri G, De Biase CF. Treatment of large knee osteochondral lesions with a biomimetic scaffold: results of a multicenter study of 49 patients at 2-year follow-up. Am J Sports Med. 2014;42(7):1607–17.
Carmont MR, Carey-Smith R, Saithna A, Dhillon M, Thompson P, Spalding T. Delayed incorporation of a TruFit plug: perseverance is recommended. Arthroscopy. 2009;25(7):810–4.
Delcogliano M, de Caro F, Scaravella E, Ziveri G, De Biase CF, Marotta D, Marenghi P, Delcogliano A. Use of innovative biomimetic scaffold in the treatment for large osteochondral lesions of the knee. Knee Surg Sports Traumatol Arthrosc. 2014;22(6):1260–9.
Dhollander AA, Liekens K, Almqvist KF, Verdonk R, Lambrecht S, Elewaut D, Verbruggen G, Verdonk PC. A pilot study of the use of an osteochondral scaffold plug for cartilage repair in the knee and how to deal with early clinical failures. Arthroscopy. 2012;28(2):225–33.
Drobnic M, Radosavljevic D, Cor A, Brittberg M, Strazar K. Debridement of cartilage lesions before autologous chondrocyte implantation by open or transarthroscopic techniques: a comparative study using post-mortem materials. J Bone Joint Surg Br. 2010;92(4):602–8.
Eldracher M, Orth P, Cucchiarini M, Pape D, Madry H. Small subchondral drill holes improve marrow stimulation of articular cartilage defects. Am J Sports Med. 2014;42(11):2741–50.
Filardo G, Kon E, Berruto M, Di Martino A, Patella S, Marcheggiani Muccioli GM, Zaffagnini S, Marcacci M. Arthroscopic second generation autologous chondrocytes implantation associated with bone grafting for the treatment of knee osteochondritis dissecans: results at 6 years. Knee. 2012;19(5):658–63.
Filardo G, Kon E, Di Martino A, Busacca M, Altadonna G, Marcacci M. Treatment of knee osteochondritis dissecans with a cell-free biomimetic osteochondral scaffold: clinical and imaging evaluation at 2-year follow-up. Am J Sports Med. 2013;41(8):1786–93.
Filardo G, Kon E, Perdisa F, Di Matteo B, Di Martino A, Iacono F, Zaffagnini S, Balboni F, Vaccari V, Marcacci M. Osteochondral scaffold reconstruction for complex knee lesions: a comparative evaluation. Knee. 2013;20(6):570–6.
Filardo G, Kon E, Di Matteo B, Di Martino A, Marcacci M. Single-plug autologous osteochondral transplantation: results at minimum 16 years’ follow-up. Orthopedics. 2014;37(9):e761–7.
Filardo G, Kon E, Perdisa F, Balboni F, Marcacci M. Autologous osteochondral transplantation for the treatment of knee lesions: results and limitations at two years’ follow-up. Int Orthop. 2014;38(9):1905–12.
Filardo G, Di Matteo B, Di Martino A, Merli ML, Cenacchi A, Fornasari P, Marcacci M, Kon E. Platelet-rich plasma intra-articular knee injections show no superiority versus viscosupplementation: a randomized controlled trial. Am J Sports Med. 2015;43(7):1575–82.
Filardo G, Kon E, Roffi A, Di Matteo B, Merli ML, Marcacci M. Platelet-rich plasma: why intra-articular? A systematic review of preclinical studies and clinical evidence on PRP for joint degeneration. Knee Surg Sports Traumatol Arthrosc. 2015;23(9):2459–74.
Gomoll AH, Madry H, Knutsen G, van Dijk N, Seil R, Brittberg M, Kon E. The subchondral bone in articular cartilage repair: current problems in the surgical management. Knee Surg Sports Traumatol Arthrosc. 2010;18(4):434–47.
Gomoll AH, Farr J, Gillogly SD, Kercher JS, Minas T. Surgical management of articular cartilage defects of the knee. Instr Course Lect. 2011;60:461–83.
Görmeli G, Görmeli CA, Ataoglu B, Çolak C, Aslantürk O, Ertem K. Multiple PRP injections are more effective than single injections and hyaluronic acid in knees with early osteoarthritis: a randomized, double-blind, placebo-controlled trial. Knee Surg Sports Traumatol Arthrosc. 2015;2:1–8.
Ha C-W, Park Y-B, Chung J-Y, Park Y-G. Cartilage repair using composites of human umbilical cord blood-derived mesenchymal stem cells and hyaluronic acid hydrogel in a minipig model. Stem Cells Transl Med. 2015;4:1044–51.
Hangody L, Dobos J, Baló E, Pánics G, Hangody LR, Berkes I. Clinical experiences with autologous osteochondral mosaicplasty in an athletic population: a 17-year prospective multicenter study. Am J Sports Med. 2010;38(6):1125–33.
Hindle P, Hendry JL, Keating JF, Biant LC. Autologous osteochondral mosaicplasty or TruFit plugs for cartilage repair. Knee Surg Sports Traumatol Arthrosc. 2014;22(6):1235–40.
Hui AY, McCarty WJ, Masuda K, Firestein GS, Sah RL. A systems biology approach to synovial joint lubrication in health, injury, and disease. Wiley Interdiscip Rev Syst Biol Med. 2012;4(1):15–37.
Johnson LL. Arthroscopic abrasion arthroplasty historical and pathologic perspective: present status. Arthroscopy. 1986;2(1):54–69.
Joshi N, Reverte-Vinaixa M, Díaz-Ferreiro EW, Domínguez-Oronoz R. Synthetic resorbable scaffolds for the treatment of isolated patellofemoral cartilage defects in young patients: magnetic resonance imaging and clinical evaluation. Am J Sports Med. 2012;40(6):1289–95.
Kim YS, Park EH, Lee HJ, Koh YG, Lee JW. Clinical comparison of the osteochondral autograft transfer system and subchondral drilling in osteochondral defects of the first metatarsal head. Am J Sports Med. 2012;40(8):1824–33.
Kon E, Delcogliano M, Filardo G, Fini M, Giavaresi G, Francioli S, Martin I, Pressato D, Arcangeli E, Quarto R, Sandri M, Marcacci M. Orderly osteochondral regeneration in a sheep model using a novel nano-composite multilayered biomaterial. J Orthop Res. 2010;28(1):116–24.
Kon E, Drobnic M, Davidson PA, Levy A, Zaslav KR, Robinson D. Chronic post-traumatic cartilage lesion of the knee treated with an acellular osteochondral regenerating implant – case history with rehabilitation guidelines. J Sport Rehabil. 2013;23(3):270–5.
Kon E, Filardo G, Di Matteo B, Marcacci M. PRP for the treatment of cartilage pathology. Open Orthop J. 2013;7:120–8.
Kon E, Filardo G, Di Martino A, Busacca M, Moio A, Perdisa F, Marcacci M. Clinical results and MRI evolution of a nano-composite multilayered biomaterial for osteochondral regeneration at 5 years. Am J Sports Med. 2014;42(1):158–65.
Kon E, Filardo G, Perdisa F, Di Martino A, Busacca M, Balboni F, Sessa A, Marcacci M. A one-step treatment for chondral and osteochondral knee defects: clinical results of a biomimetic scaffold implantation at 2 years of follow-up. J Mater Sci Mater Med. 2014;25(10):2437–44.
Kon E, Filardo G, Perdisa F, Venieri G, Marcacci M. Clinical results of multilayered biomaterials for osteochondral regeneration. J Exp Orthop. 2014;1:10.
Kon E, Filardo G, Robinson D, Eisman JA, Levy A, Zaslav K, Shani J, Altschuler N. Osteochondral regeneration using a novel aragonite-hyaluronate bi-phasic scaffold in a goat model. Knee Surg Sports Traumatol Arthrosc. 2014;22(6):1452–64.
Kon E, Filardo G, Venieri G, Perdisa F, Marcacci M. Tibial plateau lesions. Surface reconstruction with a biomimetic osteochondral scaffold: results at 2 years of follow-up. Injury. 2014;45 Suppl 6:S121–5.
Könst YE, Benink RJ, Veldstra R, van der Krieke TJ, Helder MN, van Royen BJ. Treatment of severe osteochondral defects of the knee by combined autologous bone grafting and autologous chondrocyte implantation using fibrin gel. Knee Surg Sports Traumatol Arthrosc. 2012;20(11):2263–9.
Liu TM, Martina M, Hutmacher DW, Hui JH, Lee EH, Lim B. Identification of a common pathways mediating differentiation of bone marrow and adipose tissue derived human mesenchymal stem cells into mesenchymal lineages. Stem Cells. 2007;25:750.
Lv F, Lu M, Cheung KMC, Leung VYL, Zhou G. Intrinsic properties of mesenchymal stem cells from human bone marrow, umbilical cord and umbilical cord blood comparing the different sources of MSC. Curr Stem Cell Res Ther. 2012;7:389–99.
Marcacci M, Zaffagnini S, Kon E, Marcheggiani Muccioli GM, Di Martino A, Di Matteo B, Bonanzinga T, Iacono F, Filardo G. Unicompartmental osteoarthritis: an integrated biomechanical and biological approach as alternative to metal resurfacing. Knee Surg Sports Traumatol Arthrosc. 2013;21(11):2509–17.
Marchand C, Chen G, Tran-Khanh N, Sun J, Chen H, Buschmann MD, Hoemann CD. Microdrilled cartilage defects treated with thrombin-solidified chitosan/blood implant regenerate a more hyaline, stable, and structurally integrated osteochondral unit compared to drilled controls. Tissue Eng Part A. 2011;18(5–6):508–19.
Marmotti A, et al. e-Poster P133 ICRS 2013 Minced umbilical cord fragments as an effective cell source for cartilage and bone tissue engineering. An in vitro tridimensional study. http://www.cartilage.org/.
Menche DS, Frenkel SR, Blair B, Watnik NF, Toolan BC, Yaghoubian RS, Pitman MI. A comparison of abrasion burr arthroplasty and subchondral drilling in the treatment of full-thickness cartilage lesions in the rabbit. Arthroscopy. 1996;12(3):280–6.
Mithoefer K, Williams 3rd RJ, Warren RF, Potter HG, Spock CR, Jones EC, Wickiewicz TL, Marx RG. The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospective cohort study. J Bone Joint Surg Am. 2005;87(9):1911–20.
Mithoefer K, Williams RJ, Warren RF, Potter HG, Spock CR, Jones EC, Wickiewicz TL, Marx RG. Chondral resurfacing of articular cartilage defects in the knee with the microfracture technique. Surgical technique. J Bone Joint Surg Am. 2006;88(Suppl 1 Pt 2):294–304.
Mithoefer K, Williams 3rd RJ, Warren RF, Wickiewicz TL, Marx RG. High-impact athletics after knee articular cartilage repair: a prospective evaluation of the microfracture technique. Am J Sports Med. 2006;34(9):1413–8.
Mithoefer K, Hambly K, Logerstedt D, Ricci M, Silvers H, Della Villa S. Current concepts for rehabilitation and return to sport after knee articular cartilage repair in the athlete. J Orthop Sports Phys Ther. 2012;42(3):254–73.
Ochs BG, Müller-Horvat C, Albrecht D, Schewe B, Weise K, Aicher WK, Rolauffs B. Remodeling of articular cartilage and subchondral bone after bone grafting and matrix-associated autologous chondrocyte implantation for osteochondritis dissecans of the knee. Am J Sports Med. 2011;39(4):764–73.
Orozco L, Munar A, Soler R, Alberca M, Soler F. Treatment of knee osteoarthritis with autologous mesenchymal stem cells: a pilot study. Transplantation. 2013;95:1535.
Orth P, Duffner J, Zurakowski D, Cucchiarini M, Madry H. Small diameter awls improve articular cartilage repair following microfracture treatment in a translational animal model. Am J Sports Med. 2016;44(1):209–19.
Pape D, Filardo G, Kon E, van Dijk CN, Madry H. Disease-specific clinical problems associated with the subchondral bone. Knee Surg Sports Traumatol Arthrosc. 2010;18(4):448–62.
Patel S, Dhillon MS, Aggarwal S, Marwaha N, Jain A. Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double-blind, randomized trial. Am J Sports Med. 2013;41(2):356–64.
Peeters CM, Leijs MJ, Reijman M, van Osch GJ, Bos PK. Safety of intra-articular cell-therapy with culture-expanded stem cells in humans: a systematic literature review. Osteoarthritis Cartilage. 2013;21:1465.
Pridie KH. A method of resurfacing osteoarthritic knee joints. Proc Br Orthop Assoc J Bone Joint Surg (Br). 1959;41:618–9.
Raeissadat SA, Rayegani SM, Hassanabadi H, Fathi M, Ghorbani E, Babaee M, Azma K. Knee osteoarthritis injection choices: platelet- rich plasma (PRP) versus hyaluronic acid (a one-year randomized clinical trial). Clin Med Insights Arthritis Musculoskelet Disord. 2015;8:1–8.
Shapiro F, Koide S, Glimcher MJ. Cell origin and differentiation in the repair of full-thickness defects of articular cartilage. J Bone Joint Surg Am. 1993;75(4):532–55.
Smillie IS. Treatment of osteochondritis dissecans. J Bone Joint Surg Br. 1957;39(2):248–60.
Soler R, Munar A, Soler F, Peirau X, Huguet M, Orozco L. Treatment of knee osteoarthritis with autologous expanded bone marrow mesenchymal cells: 50 cases clinical and MRI results at one year follow-up. J Stem Cell Res Ther. 2015;5:285.
Steadman JR, Rodkey WG, Rodrigo JJ. Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop. 2001;391(Suppl):S362–9.
Steadman JR, Briggs KK, Rodrigo JJ, Kocher MS, Gill TJ, Rodkey WG. Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy. 2003;19(5):477–84.
Sansone V, de Girolamo L, Pascale W, Melato M, Pascale V. Long-term results of abrasion arthroplasty for full-thickness cartilage lesions of the medial femoral condyle. Arthroscopy. 2015;31(3):396–403.
Takahashi K, Tanabe K, Ohnuki M, Narita M, Ichisaka T, Tomoda K, Yamanaka S. Induction of pluripotent stem cells from adult human fibroblasts by defined factors. Cell. 2007;131:861–72.
Tampieri A, Sandri M, Landi E, Pressato D, Francioli S, Quarto R, Martin I. Design of graded biomimetic osteochondral composite scaffolds. Biomaterials. 2008;29(26):3539–46.
Van Assche D, Staes F, Van Caspel D, Vanlauwe J, Bellemans J, Saris DB, Luyten FP. Autologous chondrocyte implantation versus microfracture for knee cartilage injury: a prospective randomized trial, with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc. 2010;18(4):486–95.
Vasiliadis HS, Danielson B, Ljungberg M, McKeon B, Lindahl A, Peterson L. Autologous chondrocyte implantation in cartilage lesions of the knee: long-term evaluation with magnetic resonance imaging and delayed gadolinium-enhanced magnetic resonance imaging technique. Am J Sports Med. 2010;38(5):943–9.
Verhaegen J, Clockaerts S, Van Osch GJ, Somville J, Verdonk P, Mertens P. TruFit plug for repair of osteochondral defects-where is the evidence? Syst Rev Lit Cartil. 2015;6(1):12–9.
Vijayan S, Bartlett W, Bentley G, Carrington RW, Skinner JA, Pollock RC, Alorjani M, Briggs TW. Autologous chondrocyte implantation for osteochondral lesions in the knee using a bilayer collagen membrane and bone graft: a two- to eight-year follow-up study. J Bone Joint Surg Br. 2012;94(4):488–92.
Wondrasch B, Arøen A, Røtterud JH, Høysveen T, Bølstad K, Risberg MA. The feasibility of a 3-month active rehabilitation program for patients with knee full-thickness articular cartilage lesions: the Oslo Cartilage Active Rehabilitation and Education Study. J Orthop Sports Phys Ther. 2013;43(5):310–24.
Zellner J, Mueller M, Krutsch W, Baumann F, Englert C, Nerlich M, Angele P. Arthroscopic three dimensional autologous chondrocyte transplantation with navigation-guided cartilage defect size assessment. Arch Orthop Trauma Surg. 2012;132(6):855–60.
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Peretti, G.M. et al. (2016). Recent Advances in Cartilage Repair (ICL 3). In: Becker, R., Kerkhoffs, G., E. Gelber, P., Denti, M., Seil, R. (eds) ESSKA Instructional Course Lecture Book . Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-49114-0_3
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