Welcome to the ICRS Patient & Public Education Site

If you suffer from joint pain, you’re not alone. Each year, more than 50 million people visit their doctors because of joint pain — half of them with a damage of the articular cartilage.

On this website, you can find useful, updated information on specific cartilage-related conditions and possible treatments options, written by world-renowned experts in this field, helpful patient information to read and download, and other useful resources

The choice of procedures depends on the size and location of cartilage defect. Larger defects are typically treated with autologous chondrocyte transplantation, osteochondral allograft transplantation, or newer synthetic or natural scaffolds which may require open incisions. Smaller defects in specific locations may be treated with enhanced bone marrow stimulating techniques, autologous chondrocyte implantation (ACI), or osteochondral autograft transfer which may be completed through the arthroscope. There is also a chapter for conservative treatments options and rehabilitation after cartilage repair.

Intended Audience for this Website

People of all ages can suffer from cartilage complications, whether due to ‘wear and tear’ or injury. While the former is much more common in middle-aged patients, and even more so in women, injuries to the joints, such as trauma or accidents during active sports, can affect any age group or gender. Careers requiring repetitive or intense motion can increase the risk of developing cartilage problems, but there are several other risk factors, including age, weight and genetic predisposition.

What is Cartilage Repair?

On this website, we focus only on articular cartilage repair treatments, which means the restoration of damaged hyaline cartilage in the joints. Cartilage repair and regeneration is a treatment for joints that have damaged cartilage but are otherwise healthy. Typically, these procedures are recommended for cartilage damage or deterioration caused by:

Injury or trauma, including sports injuries or repetitive use of the joint Congenital abnormalities – abnormalities a person is born with (for instance misalignment) – that affect normal joint structure Hormonal or idiopathic disorders that affect bone and joint development, such as osteochondritis dissecans (OCD). There are several types of new and modern procedures for cartilage repair and regeneration techniques that are designed to heal the cartilage by filling the cartilage defect (pothole) with repair tissue.

What is not covered in this Website?

There are several types of bone and joint pain, each with many potential sources or etiologies. This site is not intended for people who suffers from rheumatoid arthritis (RA), gout, avascular necrosis (AVN), and cancer within bones, osteoporosis and other inflammatory or autoimmune diseases.

Acknowledgements

To the Mäxi Foundation: 
This website project would not have been possible without the substantial support of the Swiss “Mäxi Foundation”. The ICRS would like to express a deep gratitude for this very generous contribution to the International Cartilage Repair Society and the respective patient community, making it possible to provide updated information about cartilage damage and cartilage repair technologies free of charge to all interested persons.

To the Authors & Contributors:
The following world-renowned experts in cartilage repair & cartilage research have contributed to the extensive content of this website: Stephen Abelow (USA), William Bugbee (USA), Susan Chubinskaya (USA), Brian Cole (USA), Stefano Della Villa (IT), Chris Erggelet (CH), Jack Farr (USA), Ralph Gambardella (USA), Michael Gerhardt (USA), Wayne Gersoff (USA), Alan Getgood (CA), Alberto Gobbi (IT), Laszlo Hangody (HU), Oliver Kessler (CH), Elizaveta Kon (IT), Jos Malda (NL), Bert Mandelbaum (USA), Tom Minas (USA), Kai Mithoefer (USA), Stefan Nehrer (AT), Lars Peterson (SE), Scott Gillogly (USA), Holly Silvers (USA), Jason Theodosakis (USA) and Kenneth Zaslav (USA)

To anyone else who contributed to this important project
ICRS Office Staff, Medical Writers, Committees, Illustrators and Web Developers, etc.

Terms of Use

These terms of use, together with our Privacy Policy collectively, these “Terms of Use”, governs access to and any use of the website cartilage.org and any sub-sites (the “Website“), including any content, functionality and services offered on or through the Website. By using the Website or by clicking to accept or agree to the Terms of Use when that option is made available, visitors of the Website accept and agree to bound and abide by the Terms of Use on behalf of all users of the respective computer. Visitors who do not agree with these Terms of Use must not access or use the Website.

International Cartilage Repair Society (“ICRS”) (“we” or “us”) may revise and update these Terms of Use from time to time in our sole discretion. All changes are effective immediately when we post them. Your continued use of the Website following the posting of revised Terms of Use means that you accept and agree to the changes. You are expected to check this page from time to time so that you are aware of any changes, as they are binding on you.

The information on the Website is not intended to treat, diagnose, cure or prevent any cartilage related issues. Always seek the advice of a physician or other qualified health care provider with any questions you have regarding your medical condition.

Privacy Policy

This privacy policy (“Privacy Policy”), together with the Terms of Use for the patient website section, applies to any use of the website cartilage.org and any sub-sites (the “Website”), including any content, functionality and services offered on or through the Website. By using the Website or by clicking to accept or agree to the Terms of Use when that option is made available, visitors of the Website accept and agree on behalf of all users of the respective computer to be bound and abide by the Terms of Use and this Privacy Policy. Visitors who do not agree with the Terms of Use and this Privacy Policy must not access or use the Website.

International Cartilage Repair Society (“ICRS”) (“we” or “us”) is committed to protecting your privacy and ensuring that your personal information is protected. This Privacy Policy explains the types of personal information we collect and how we use, disclose and protect that information.

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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.
Keywords

biologic arthroplasty, cartilage repair, Microfracture, stem cells, transplantation

Medicine never stands still…
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