Skip to main content
SpringerLink
Log in

Cell-Free Biomaterials: Indications and Borders

  • Chapter
  • First Online:
ESSKA Instructional Course Lecture Book

  • 1380 Accesses

Abstract

In the last two decades, the achievements of tissue engineering provided the surgeons with a pool of new and promising options for the treatment of cartilage defects. Cell-based regenerative techniques, in combination with various biomaterials, were proposed to improve tissue quality and clinical outcomes. Despite several investigations showing satisfactory clinical results in the long-term, the need for two surgical procedures and the related costs limited their use. Thus, the possibility to avoid cell augmentation by implanting biomaterials able to exploit in situ the patient self-regenerative potential was explored. Since then, several matrices were successfully introduced in the clinical use, and their intrinsic ability to promote tissue regeneration showed positive results in terms of clinical improvement. Moreover, some biomaterials were combined to reproduce the requirements of both bone and cartilage, in order to address osteochondral defects. This chapter aims at summarizing the state of the art concerning the clinical use of acellular scaffolds for the treatment of chondral/osteochondral lesions.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Madry H, Kon E, Condello V, et al. Early osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc. 2016;24(6):1753–62.

    Article  PubMed  Google Scholar 

  2. Andrade R, Vasta S, Pereira R, et al. Knee donor-site morbidity after mosaicplasty—a systematic review. J Exp Orthop. 2016;3(1):31.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Brittberg M, Lindahl A, Nilsson A, et al. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med. 1994;331(14):889–95.

    Article  CAS  PubMed  Google Scholar 

  4. Goyal D, Goyal A, Keyhani S, et al. Evidence-based status of second- and third-generation autologous chondrocyte implantation over first generation: a systematic review of level I and II studies. Arthroscopy. 2013;29(11):1872–8.

    Article  PubMed  Google Scholar 

  5. Peterson L, Vasiliadis HS, Brittberg M, et al. Autologous chondrocyte implantation: a long-term follow-up. Am J Sports Med. 2010;38(6):1117–24.

    Article  PubMed  Google Scholar 

  6. Aldrian S, Zak L, Wondrasch B, et al. Clinical and radiological long-term outcomes after matrix-induced autologous chondrocyte transplantation: a prospective follow-up at a minimum of 10 years. Am J Sports Med. 2014;42(11):2680–8.

    Article  PubMed  Google Scholar 

  7. Gille J, Behrens P, Schulz AP, et al. Matrix-associated autologous chondrocyte implantation: a clinical follow-up at 15 years. Cartilage. 2016;7(4):309–15.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Gille J, Kunow J, Boisch L, et al. Cell-laden and cell-free matrix-induced chondrogenesis versus microfracture for the treatment of articular cartilage defects: a histological and biomechanical study in sheep. Cartilage. 2010;1(1):29–42.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Pape D, Filardo G, Kon E, et al. Disease-specific clinical problems associated with the subchondral bone. Knee Surg Sports Traumatol Arthrosc. 2010;18(4):448–62.

    Article  PubMed  Google Scholar 

  10. Kon E, Filardo G, Perdisa F, et al. 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.

    Article  CAS  PubMed  Google Scholar 

  11. Benthien JP, Behrens P. Autologous matrix-induced chondrogenesis (AMIC). A one-step procedure for retropatellar articular resurfacing. Acta Orthop Belg. 2010;76(2):260–3.

    PubMed  Google Scholar 

  12. Benthien JP, Behrens P. The treatment of chondral and osteochondral defects of the knee with autologous matrix-induced chondrogenesis (AMIC): method description and recent developments. Knee Surg Sports Traumatol Arthrosc. 2011;19(8):1316–9.

    Article  PubMed  Google Scholar 

  13. Piontek T, Ciemniewska-Gorzela K, Szulc A, et al. All-arthroscopic AMIC procedure for repair of cartilage defects of the knee. Knee Surg Sports Traumatol Arthrosc. 2012;20(5):922–5.

    Article  PubMed  Google Scholar 

  14. Schiavone Panni A, Cerciello S, Vasso M. The management of knee cartilage defects with modified AMIC technique: preliminary results. Int J Immunopathol Pharmacol. 2011;24(1 Suppl 2):149–52.

    Article  CAS  PubMed  Google Scholar 

  15. Gille J, Schuseil E, Wimmer J, et al. Mid-term results of autologous matrix-induced chondrogenesis for treatment of focal cartilage defects in the knee. Knee Surg Sports Traumatol Arthrosc. 2010;18(11):1456–64.

    Article  CAS  PubMed  Google Scholar 

  16. Gille J, Behrens P, Volpi P, et al. Outcome of autologous matrix induced chondrogenesis (AMIC) in cartilage knee surgery: data of the AMIC registry. Arch Orthop Trauma Surg. 2013;133(1):87–93.

    Article  CAS  PubMed  Google Scholar 

  17. Kusano T, Jakob RP, Gautier E, et al. Treatment of isolated chondral and osteochondral defects in the knee by autologous matrix-induced chondrogenesis (AMIC). Knee Surg Sports Traumatol Arthrosc. 2012;20(10):2109–15.

    Article  PubMed  Google Scholar 

  18. Gobbi A, Scotti C, Karnatzikos G, et al. One-step surgery with multipotent stem cells and hyaluronan-based scaffold for the treatment of full-thickness chondral defects of the knee in patients older than 45 years. Knee Surg Sports Traumatol Arthrosc. 2017;25(8):2494–501.

    Article  PubMed  Google Scholar 

  19. Gobbi A, Whyte GP. One-stage cartilage repair using a hyaluronic acid-based scaffold with activated bone marrow-derived mesenchymal stem cells compared with microfracture: five-year follow-up. Am J Sports Med. 2016;44(11):2846–54.

    Article  PubMed  Google Scholar 

  20. Rodriguez-Vazquez M, Vega-Ruiz B, Ramos-Zuniga R, et al. Chitosan and its potential use as a scaffold for tissue engineering in regenerative medicine. Biomed Res Int. 2015;2015:821279.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  21. Steinwachs MR, Waibl B, Mumme M. Arthroscopic treatment of cartilage lesions with microfracture and BST-CarGel. Arthrosc Tech. 2014;3(3):e399–402.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Stanish WD, McCormack R, Forriol F, et al. Novel scaffold-based BST-CarGel treatment results in superior cartilage repair compared with microfracture in a randomized controlled trial. J Bone Joint Surg Am. 2013;95(18):1640–50.

    Article  PubMed  Google Scholar 

  23. Methot S, Changoor A, Tran-Khanh N, et al. Osteochondral biopsy analysis demonstrates that BST-CarGel treatment improves structural and cellular characteristics of cartilage repair tissue compared with microfracture. Cartilage. 2016;7(1):16–28.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Shive MS, Stanish WD, McCormack R, et al. BST-CarGel(R) treatment maintains cartilage repair superiority over microfracture at 5 years in a multicenter randomized controlled trial. Cartilage. 2015;6(2):62–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Andriolo L, Reale D, Di Martino A, Boffa A, Zaffagnini S, Filardo G. Cell-free scaffolds in cartilage knee surgery: a systematic review and meta-analysis of clinical evidence. Cartilage. 2019;5:1947603519852406.

    Google Scholar 

  26. Niederauer GG, Slivka MA, Leatherbury NC, et al. Evaluation of multiphase implants for repair of focal osteochondral defects in goats. Biomaterials. 2000;21(24):2561–74.

    Article  CAS  PubMed  Google Scholar 

  27. Slivka MA, Leatherbury NC, Kieswetter K, et al. Porous, resorbable, fiber-reinforced scaffolds tailored for articular cartilage repair. Tissue Eng. 2001;7(6):767–80.

    Article  CAS  PubMed  Google Scholar 

  28. Bedi A, Foo LF, Williams RJ 3rd, et al. The maturation of synthetic scaffolds for osteochondral donor sites of the knee: an MRI and T2-mapping analysis. Cartilage. 2010;1(1):20–8.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Barber FA, Dockery WD. A computed tomography scan assessment of synthetic multiphase polymer scaffolds used for osteochondral defect repair. Arthroscopy. 2011;27(1):60–4.

    Article  PubMed  Google Scholar 

  30. Quarch VM, Enderle E, Lotz J, et al. Fate of large donor site defects in osteochondral transfer procedures in the knee joint with and without TruFit plugs. Arch Orthop Trauma Surg. 2014;134(5):657–66.

    Article  PubMed  Google Scholar 

  31. Carmont MR, Carey-Smith R, Saithna A, et al. Delayed incorporation of a TruFit plug: perseverance is recommended. Arthroscopy. 2009;25(7):810–4.

    Article  PubMed  Google Scholar 

  32. Bekkers JE, Bartels LW, Vincken KL, et al. Articular cartilage evaluation after TruFit plug implantation analyzed by delayed gadolinium-enhanced MRI of cartilage (dGEMRIC). Am J Sports Med. 2013;41(6):1290–5.

    Article  PubMed  Google Scholar 

  33. Gelber PE, Batista J, Millan-Billi A, et al. Magnetic resonance evaluation of TruFit(R) plugs for the treatment of osteochondral lesions of the knee shows the poor characteristics of the repair tissue. Knee. 2014;21(4):827–32.

    Article  PubMed  Google Scholar 

  34. Dhollander AA, Liekens K, Almqvist KF, et al. 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.

    Article  PubMed  Google Scholar 

  35. Joshi N, Reverte-Vinaixa M, Diaz-Ferreiro EW, et al. 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.

    Article  PubMed  Google Scholar 

  36. Hindle P, Hendry JL, Keating JF, et al. Autologous osteochondral mosaicplasty or TruFit plugs for cartilage repair. Knee Surg Sports Traumatol Arthrosc. 2014;22(6):1235–40.

    Article  PubMed  Google Scholar 

  37. Tampieri A, Sandri M, Landi E, et al. Design of graded biomimetic osteochondral composite scaffolds. Biomaterials. 2008;29(26):3539–46.

    Article  CAS  PubMed  Google Scholar 

  38. Kon E, Delcogliano M, Filardo G, et al. A novel nano-composite multi-layered biomaterial for treatment of osteochondral lesions: technique note and an early stability pilot clinical trial. Injury. 2010;41(7):693–701.

    Article  CAS  PubMed  Google Scholar 

  39. Kon E, Delcogliano M, Filardo G, et al. Novel nano-composite multilayered biomaterial for osteochondral regeneration: a pilot clinical trial. Am J Sports Med. 2011;39(6):1180–90.

    Article  PubMed  Google Scholar 

  40. Kon E, Filardo G, Di Martino A, et al. 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.

    Article  PubMed  Google Scholar 

  41. Perdisa F, Kon E, Sessa A, Andriolo L, Busacca M, Marcacci M, Filardo G. Treatment of knee osteochondritis dissecans with a cell-free biomimetic osteochondral scaffold: clinical and imaging findings at midterm follow-up. Am J Sports Med. 2018;46(2):314–21.

    Article  PubMed  Google Scholar 

  42. Perdisa F, Filardo G, Sessa A, Busacca M, Zaffagnini S, Marcacci M, Kon E. One-step treatment for patellar cartilage defects with a cell-free osteochondral scaffold: a prospective clinical and MRI evaluation. Am J Sports Med. 2017;45(7):1581–8.

    Article  PubMed  Google Scholar 

  43. Di Martino A, Kon E, Perdisa F, et al. Surgical treatment of early knee osteoarthritis with a cell-free osteochondral scaffold: results at 24 months of follow-up. Injury. 2015;46(Suppl 8):S33–8.

    Article  PubMed  Google Scholar 

  44. Marcacci M, Zaffagnini S, Kon E, et al. Unicompartmental osteoarthritis: an integrated biomechanical and biological approach as alternative to metal resurfacing. Knee Surg Sports Traumatol Arthrosc. 2013;21(11):2509–17.

    Article  CAS  PubMed  Google Scholar 

  45. Filardo G, Kon E, Perdisa F, et al. Osteochondral scaffold reconstruction for complex knee lesions: a comparative evaluation. Knee. 2013;20(6):570–6.

    Article  CAS  PubMed  Google Scholar 

  46. Delcogliano M, de Caro F, Scaravella E, et al. 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.

    PubMed  Google Scholar 

  47. Berruto M, Delcogliano M, de Caro F, et al. 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.

    Article  PubMed  Google Scholar 

  48. Berruto M, Ferrua P, Uboldi F, et al. Can a biomimetic osteochondral scaffold be a reliable alternative to prosthetic surgery in treating late-stage SPONK? Knee. 2016;23(6):936–41.

    Article  CAS  PubMed  Google Scholar 

  49. Perdisa F, Filardo G, Sessa A, et al. One-step treatment for patellar cartilage defects with a cell-free osteochondral scaffold: a prospective clinical and MRI evaluation. Am J Sports Med. 2017;45(7):1581–8.

    Article  PubMed  Google Scholar 

  50. Christensen BB, Foldager CB, Jensen J, et al. Poor osteochondral repair by a biomimetic collagen scaffold: 1- to 3-year clinical and radiological follow-up. Knee Surg Sports Traumatol Arthrosc. 2016;24(7):2380–7.

    Article  PubMed  Google Scholar 

  51. Dhollander A, Verdonk P, Almqvist KF, et al. Clinical and MRI outcome of an osteochondral scaffold plug for the treatment of cartilage lesions in the knee. Acta Orthop Belg. 2015;81(4):629–38.

    PubMed  Google Scholar 

  52. Kon E, Filardo G, Perdisa F, et al. Clinical results of multilayered biomaterials for osteochondral regeneration. J Exp Orthop. 2014;1(1):10.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Kon E, Filardo G, Shani J, et al. Osteochondral regeneration with a novel aragonite-hyaluronate biphasic scaffold: up to 12-month follow-up study in a goat model. J Orthop Surg Res. 2015;10:81.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Kon E, Drobnic M, Davidson PA, et al. Chronic posttraumatic cartilage lesion of the knee treated with an acellular osteochondral-regenerating implant: case history with rehabilitation guidelines. J Sport Rehabil. 2014;23(3):270–5.

    Article  PubMed  Google Scholar 

  55. Kon E, Robinson D, Verdonk P, et al. A novel aragonite-based scaffold for osteochondral regeneration: early experience on human implants and technical developments. Injury. 2016;47(Suppl 6):S27–32.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Rizzoli Orthopaedic Institute, Bologna, Italy

    Giuseppe Filardo

Authors
  1. Giuseppe Filardo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giuseppe Filardo .

Editor information

Editors and Affiliations

  1. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, Basel Land, Switzerland

    Michael Tobias Hirschmann

  2. Center of Functional and Biological Reconstruction of the Knee, Humanitas University, Humanitas Research Hospital, Milan, Italy

    Elizaveta Kon

  3. Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden

    Kristian Samuelsson

  4. Istituto Ortopedico Galeazzi, Milano, Italy

    Matteo Denti

  5. Department of Orthopaedics, Lyon Ortho Clinic, LYON, France

    David Dejour

Rights and permissions

Reprints and permissions

Copyright information

© 2020 ESSKA

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Filardo, G. (2020). Cell-Free Biomaterials: Indications and Borders. In: Hirschmann, M., Kon, E., Samuelsson, K., Denti, M., Dejour, D. (eds) ESSKA Instructional Course Lecture Book . Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-61264-4_22

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-61264-4_22

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-61263-7

  • Online ISBN: 978-3-662-61264-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation