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The Future of Cartilage Repair
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The Future of Cartilage Repair

Medicine never stands still – studies are always underway to make sure that the current treatments are as effective, safe and beneficial as we think they are. Moreover, researchers are constantly striving to improve established techniques and to devise new therapies.

The aim is to achieve better outcomes for patients and restore their full health and function as quickly as possible, while spending healthcare budgets efficiently and prudently.

As the frontiers of old age have been pushed back by medicine and culture, the field of cartilage repair is constantly growing. New techniques and concepts are being developed not only to treat damaged or diseased joint cartilage but also to find ways of achieving regeneration to normal cartilage that will give long-lasting improvements and allow patients to return to a fully active lifestyle. Currently, there are a number of new and interesting opportunities for cartilage repair.

Intended audience

This article is intended for anyone suffering from damage to their articular cartilage and their families who would like to find out about the future of cartilage repair, as well as anyone interested in cartilage problems.

What is The Future of Cartilage Repair?

As with all treatments for damaged or diseased joint cartilage, the goal of cartilage repair is to restore the structural and biomechanical integrity of the joint (articular) surface.

Collecting a great deal of data over the years has given us a much clearer understanding of the indications for each treatment. Ultimately, we can say that there is no one ‘ideal’ treatment for every lesion.

For example, bone marrow stimulation, drilling or microfracture, is a simple and fast way to treat small cartilage or chondral (bone and cartilage) defects in those with small lesions who are under 40 years of age, with no need for special instrumentation, and with reasonable results. However, the improvements with microfracture deteriorate over time. This is why new therapies are being developed to try to improve outcomes. A number of interesting studies have shown that this goal may soon be achieved .

One novel approach is to combine a technique for enhanced cartilage regeneration such as bioscaffolds with a repair technique such as marrow stimulation as part of a one-step procedure. This bioscaffold may stabilise the resulting clot, regardless of the dimensions, geometry or size of the lesion, and may regulate the repair process. The treatment may lead to an improved repair tissue volume, and tissue that is much more similar to the characteristics of normal hyaline cartilage tissue – time and research will tell.

Cartilage transplantation is a successful treatment, but the main drawback is its high cost. As the availability of cartilage repair techniques is linked to regional authorisation and regulation, not all therapies are available worldwide. For example, several therapies that are authorised in Europe are not available in Japan or in the USA.

Cost effectiveness has promoted great interest in one-step surgery; in other words, techniques that can be carried out in just one surgical procedure. One example would be to use a type of ‘stem’ cell that can build connective tissues, bone and cartilage, among others. These are called mesenchymal stem cells. After encouraging animal studies, a method of obtaining these stem cells called the Bone Marrow Aspirate Concentrated Cell (BMAC) technique has been used in humans. Cells taken from the bone marrow via a procedure called aspiration and combined with scaffolds to treat large cartilage defects.

The goal of this technology is to carry out one-step surgery, with lower costs, less time in the operating room, and no cell cultivation in a laboratory. The technique has been tested by some medical centres, using it in the knee and in the ankle, with guarded optimisim. Some studies have suggested that combining these techniques with marrow stimulation could further enhance regeneration.

A technique known as electromagnetic field stimulation has also been suggested to improve new cartilage generation.

What can be expected over the long term?

In the long term – that is to say over the next 30 years – we would ideally like to avoid surgery altogether and, instead, inject cells directly into the affected joint. These cells could potentially be extracted from the patient. Or perhaps, an off-the-shelf product made from a donor’s stem cells (allogenic stem cells) could be used.

Frequently Asked Questions (FAQs)

Am I eligible to receive stem cell therapy?

As patients with damaged or diseased cartilage would generally prefer not to have total knee replacement, one of the most common questions they ask is whether they could have cartilage repair using stem cell therapy.

There is a much confusion regarding how stem cell therapy works and what can be expected in terms of outcomes. It is therefore important to discuss all treatment options extensively with your doctor and then decide on the best approach for you and your particular cartilage defects.

Further reading

The following selected publications examine the future of cartilage repair both in general and focusing on a particular technology:

  • Gobbi A, Karnatzikos G, Kumar A. Long-term results after microfracture treatment for full-thickness knee chondral lesions in athletes. Knee Surg Sports Traumatol Arthrosc. 2013. DOI 10.1007/s00167-013-2676-8.
  • Zaslav K, McAdams T, Scopp J, Theosadakis J, Mahajan V, Gobbi A. New Frontiers for Cartilage Repair and Protection. Cartilage. 2012;3:77S-86S.
  • International Cartilage Repair Society. Special Focus: Rehabilitation. Global Concepts for Successful Joint Restoration. ICRS Newsletter. 2011;14:36-38.
  • Dominici M, Le Blanc K, Mueller I et al. Minimal criteria for defining multipotent mesenchymal stromal cells. The International Society for Cellular Therapy position statement. Cytotherapy. 2006;8(4):315-317.
  • Giannini S, Buda R, Vannini F, Cavallo M, Grigolo B. One-step bone marrow-derived cell transplantation in talar osteochondral lesions. Clin Orthop Relat Res. 2009;467(12):3307-3320.
  • Giannini S, Buda R, Battaglia M et al. One-step repair in talar osteochondral lesions: 4-year clinical results and t2-mapping capability in outcome prediction. Am J Sports Med. 2013;41(3):511-518.
  • Gobbi A, Karnatzikos G, Scotti C, Mahajan V, Mazzucco G, Grigolo B. One-Step Cartilage Repair with Bone Marrow Aspirate Concentrated Cells and Collagen Matrix in Full-Thickness Knee Cartilage Lesions : Results at 2-Year Follow-up. Cartilage. 2011;2:286.
  • Gobbi A, Karnatzikos G, Mahajan V. Biologic Arthroplasty. In: Brittberg M, Gobbi A, Imhoff A, Kon E, Madry H, editors. Cartilage Repair Clinical Guidelines. Zurich: ICRS; 2012. p. 269-279.
  • Horwitz EM, Le Blanc K, Dominici M et al. Clarification of the nomenclature for MSC: The International Society for Cellular Therapy position statement. Cytotherapy. 2005;7(5):393-395.
  • Zaslav K, McAdams T, Scopp J, Theosadakis J, Mahajan V, Gobbi A. New Frontiers for Cartilage Repair and Protection. Cartilage. 2012;3:77S.
Medicine never stands still…
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