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Der Radiologe Nov 2017Focal cartilage lesions are a cause of long-term disability and morbidity. After cartilage repair, it is crucial to evaluate long-term progression or failure in... (Review)
Review
Focal cartilage lesions are a cause of long-term disability and morbidity. After cartilage repair, it is crucial to evaluate long-term progression or failure in a reproducible, standardized manner. This article provides an overview of the different cartilage repair procedures and important characteristics to look for in cartilage repair imaging. Specifics and pitfalls are pointed out alongside general aspects. After successful cartilage repair, a complete, but not hypertrophic filling of the defect is the primary criterion of treatment success. The repair tissue should also be completely integrated to the surrounding native cartilage. After some months, the transplants signal should be isointense compared to native cartilage. Complications like osteophytes, subchondral defects, cysts, adhesion and chronic bone marrow edema or joint effusion are common and have to be observed via follow-up. Radiological evaluation and interpretation of postoperative changes should always take the repair method into account.
Topics: Cartilage, Articular; Fractures, Cartilage; Humans; Magnetic Resonance Imaging; Postoperative Complications
PubMed: 28929186
DOI: 10.1007/s00117-017-0305-0 -
Acta Biomaterialia Jul 2019Articular cartilage is a remarkable tissue whose sophisticated composition and architecture allow it to withstand complex stresses within the joint. Once injured,... (Review)
Review
Articular cartilage is a remarkable tissue whose sophisticated composition and architecture allow it to withstand complex stresses within the joint. Once injured, cartilage lacks the capacity to self-repair, and injuries often progress to joint wide osteoarthritis (OA) resulting in debilitating pain and loss of mobility. Current palliative and surgical management provides short-term symptom relief, but almost always progresses to further deterioration in the long term. A number of bioactive factors, including drugs, corticosteroids, and growth factors, have been utilized in the clinic, in clinical trials, or in emerging research studies to alleviate the inflamed joint environment or to promote new cartilage tissue formation. However, these therapies remain limited in their duration and effectiveness. For this reason, current efforts are focused on improving the localization, retention, and activity of these bioactive factors. The purpose of this review is to highlight recent advances in drug delivery for the treatment of damaged or degenerated cartilage. First, we summarize material and modification techniques to improve the delivery of these factors to damaged tissue and enhance their retention and action within the joint environment. Second, we discuss recent studies using novel methods to promote new cartilage formation via biofactor delivery, that have potential for improving future long-term clinical outcomes. Lastly, we review the emerging field of orthobiologics, using delivered and endogenous cells as drug-delivering "factories" to preserve and restore joint health. Enhancing drug delivery systems can improve both restorative and regenerative treatments for damaged cartilage. STATEMENT OF SIGNIFICANCE: Articular cartilage is a remarkable and sophisticated tissue that tolerates complex stresses within the joint. When injured, cartilage cannot self-repair, and these injuries often progress to joint-wide osteoarthritis, causing patients debilitating pain and loss of mobility. Current palliative and surgical treatments only provide short-term symptomatic relief and are limited with regards to efficiency and efficacy. Bioactive factors, such as drugs and growth factors, can improve outcomes to either stabilize the degenerated environment or regenerate replacement tissue. This review highlights recent advances and novel techniques to enhance the delivery, localization, retention, and activity of these factors, providing an overview of the cartilage drug delivery field that can guide future research in restorative and regenerative treatments for damaged cartilage.
Topics: Animals; Cartilage, Articular; Chondrogenesis; Drug Delivery Systems; Humans; Intercellular Signaling Peptides and Proteins; Osteoarthritis; Regeneration
PubMed: 30711660
DOI: 10.1016/j.actbio.2019.01.061 -
Tissue Engineering. Part B, Reviews Feb 2022Articular cartilage defects caused by injury frequently lead to osteoarthritis, a painful and costly disease. Despite widely used surgical methods to treat articular... (Review)
Review
Articular cartilage defects caused by injury frequently lead to osteoarthritis, a painful and costly disease. Despite widely used surgical methods to treat articular cartilage defects and a plethora of research into regenerative strategies as treatments, long-term clinical outcomes are not satisfactory. Failure to integrate repair tissue with native cartilage is a recurring issue in surgical and tissue-engineered strategies, seeing eventual degradation of the regenerated or surrounding tissue. This review delves into the current understanding of why continuous and robust integration with native cartilage is so difficult to achieve. Both the intrinsic limitations of chondrocytes to remodel injured cartilage, and the significant challenges posed by a compromised biomechanical environment are described. Recent scaffold and cell-based techniques to repair cartilage are also discussed, and limitations of existing methods to evaluate integrative repair. In particular, the importance of evaluating the mechanical integrity of the interface between native and repair tissue is highlighted as a meaningful assessment of any strategy to repair this load-bearing tissue. Impact statement The failure to integrate grafts or biomaterials with native cartilage is a major barrier to cartilage repair. An in-depth understanding of the reasons cartilage integration remains a challenge is required to inform cartilage repair strategies. In particular, this review highlights that integration of cartilage repair strategies is frequently assessed in terms of the continuity of tissue, but not the mechanical integrity. Given the load-bearing nature of cartilage, evaluating integration in terms of interfacial strength is essential to assessing the potential success of cartilage repair methods.
Topics: Cartilage, Articular; Chondrocytes; Humans; Osteoarthritis; Regeneration; Tissue Engineering
PubMed: 33307976
DOI: 10.1089/ten.TEB.2020.0244 -
Ortopedia, Traumatologia, Rehabilitacja Jun 2023Early attempts at surgical management of cartilage lesions date back to the 1950s. Since then, various reconstructive techniques have been developed; unfortunately, none... (Review)
Review
Early attempts at surgical management of cartilage lesions date back to the 1950s. Since then, various reconstructive techniques have been developed; unfortunately, none of the methods used has been able to produce a regenerate formed solely of hyaline cartilage. This paper summarizes the most popular techniques for chondral and osteochondral reconstructions of knee joint tissues.The techniques differ in their indications, which depend primarily on the location of the injury, the extent of the damage and the patient's overall health. In cases of deep damage, osteochondral reconstruction is indicated, which involves both repairing the bone defect and creating favorable conditions for the formation of regenerative tissue cartilage.The use of an appropriate repair technique increases the chances of a good therapeutic effect, which is understood as a reduction in pain, resumption of previous activities and slowing down the progression of osteoarthritis.
Topics: Humans; Cartilage, Articular; Knee Joint; Transplantation, Autologous
PubMed: 38078352
DOI: 10.5604/01.3001.0053.7978 -
Journal of Orthopaedic Surgery and... Apr 2016Mesenchymal stem cells (MSCs) have emerged as a promising option to treat articular defects and early osteoarthritis (OA) stages. However, both their potential and... (Review)
Review
Mesenchymal stem cells (MSCs) have emerged as a promising option to treat articular defects and early osteoarthritis (OA) stages. However, both their potential and limitations for a clinical use remain controversial. Thus, the aim of this systematic review was to examine MSCs treatment strategies in clinical settings, in order to summarize the current evidence of their efficacy for the treatment of cartilage lesions and OA.Among the 60 selected studies, 7 were randomized, 13 comparative, 31 case series, and 9 case reports; 26 studies reported the results after injective administration, whereas 33 used surgical implantation. One study compared the two different modalities. With regard to the cell source, 20 studies concerned BMSCs, 17 ADSCs, 16 BMC, 5 PBSCs, 1 SDSCs, and 1 compared BMC versus PBSCs. Overall, despite the increasing literature on this topic, the evidence is still limited, in particular for high-level studies. On the other hand, the available studies allow to draw some indications. First, no major adverse events related to the treatment or to the cell harvest have been reported. Second, a clinical benefit of using MSCs therapies has been reported in most of the studies, regardless of cell source, indication, or administration method. This effectiveness has been reflected by clinical improvements and also positive MRI and macroscopic findings, whereas histologic features gave more controversial results among different studies. Third, young age, lower BMI, smaller lesion size for focal lesions, and earlier stages of OA joints have been shown to correlate with better outcomes, even though the available data strength does not allow to define clear cutoff values. Finally, definite trends can be observed with regard to the delivery method: currently cultured cells are mostly being administered by i.a. injection, while one-step surgical implantation is preferred for cell concentrates. In conclusion, while promising results have been shown, the potential of these treatments should be confirmed by reliable clinical data through double-blind, controlled, prospective and multicenter studies with longer follow-up, and specific studies should be designed to identify the best cell sources, manipulation, and delivery techniques, as well as pathology and disease phase indications.
Topics: Cartilage, Articular; Humans; Mesenchymal Stem Cell Transplantation; Osteoarthritis; Regeneration; Tissue and Organ Harvesting
PubMed: 27072345
DOI: 10.1186/s13018-016-0378-x -
Current Sports Medicine Reports Jun 2023
Topics: Humans; Cartilage, Articular; Cartilage Diseases; Athletes
PubMed: 37294191
DOI: 10.1249/JSR.0000000000001070 -
Current Stem Cell Research & Therapy 2018Cartilage, constituted with a relatively hypocellular structure and lacking of neural and vascular connections, is not a well self-repairing tissue. Cartilage tissue... (Review)
Review
Cartilage, constituted with a relatively hypocellular structure and lacking of neural and vascular connections, is not a well self-repairing tissue. Cartilage tissue engineering involving bulk of biomaterials has been put forward as a strategy for articular cartilage lesions. The most complicated issue for cartilage repairing is to simulate the highly hierarchical structure, extracellular matrix (ECM) composition and even mechanical features. Electrospinning can produce flexible, dense fibrous membranes with moderate mechanical properties and biological features with different constitution of polymer, orientation, diameter and morphology of fibers, or cooperation forms with other strategies. In our review, four classes are mentioned for cartilage tissue engineering and kinds of biomaterials to be utilized.
Topics: Animals; Biopolymers; Cartilage, Articular; Chitosan; Collagen; Electrochemical Techniques; Extracellular Matrix; Fibrin; Gelatin; Humans; Hydrogels; Polyesters; Tissue Engineering; Tissue Scaffolds
PubMed: 29956636
DOI: 10.2174/1574888X13666180628163515 -
Methods in Molecular Biology (Clifton,... 2018Decellularization of cartilage enables the use of cartilage allografts or xenografts as natural scaffolds for repair and regeneration of injured cartilage. The...
Decellularization of cartilage enables the use of cartilage allografts or xenografts as natural scaffolds for repair and regeneration of injured cartilage. The preservation of the extracellular matrix ultrastructure of the graft makes this a promising tool for cartilage tissue engineering. We have optimized the decellularization protocol by enzymatically digesting proteoglycans while preserving the native collagen architecture. Here we describe our methods for cartilage decellularization and cell labeling for the tracking of infiltration for recellularization in detail.
Topics: Animals; Cartilage, Articular; Cell Tracking; Extracellular Matrix; Mesenchymal Stem Cells; Swine; Tissue Engineering; Tissue Scaffolds
PubMed: 28798993
DOI: 10.1007/7651_2017_59 -
European Cells & Materials Jul 2017As a key molecule of the extracellular matrix, laminin provides a delicate microenvironment for cell functions. Recent findings suggest that laminins expressed by... (Review)
Review
As a key molecule of the extracellular matrix, laminin provides a delicate microenvironment for cell functions. Recent findings suggest that laminins expressed by cartilage-forming cells (chondrocytes, progenitor cells and stem cells) could promote chondrogenesis. However, few papers outline the effect of laminins on providing a favorable matrix microenvironment for cartilage regeneration. In this review, we delineated the expression of laminins in hyaline cartilage, fibrocartilage and cartilage-like tissue (nucleus pulposus) throughout several developmental stages. We also examined the effect of laminins on the biological activities of chondrocytes, including adhesion, migration and survival. Furthermore, we scrutinized the potential influence of various laminin isoforms on cartilage-forming cells' proliferation and chondrogenic differentiation. With this information, we hope to facilitate the understanding of the spatial and temporal interactions between cartilage-forming cells and laminin microenvironment to eventually advance cell-based cartilage engineering and regeneration.
Topics: Animals; Cartilage, Articular; Cell Proliferation; Chondrocytes; Chondrogenesis; Humans; Laminin; Regeneration
PubMed: 28731483
DOI: 10.22203/eCM.v034a03 -
Journal of Biological Regulators and... 2018Cartilage lesions still represent an unsolved problem: despite the efforts of the basic and translational research, the regeneration of this tissue is far from being... (Review)
Review
Cartilage lesions still represent an unsolved problem: despite the efforts of the basic and translational research, the regeneration of this tissue is far from being reached (1-3). Articular cartilage lesions can be divided in two main groups: superficial or partial defects and full-thickness defects (4, 5). Partial lesions are not able to self-heal because multipotent cells from the bone marrow cannot reach the area leading to a progressive degeneration of the tissue (6). Conversely, full-thickness injuries possess greater chances to heal because subchondral bone involvement allows for the migration of mesenchymal cells, which fill the damaged area (7, 8). However, healing occurs through the formation of a fibrocartilaginous tissue, which has different biomechanical and biological properties (9). Native hyaline cartilage has indeed specific biomechanical properties, which confer resistance to compressive and shear stresses; the reparative fibrocartilaginous tissue lacks these abilities, therefore, the surrounding healthy cartilage progressively degenerates. In the past years, several therapeutic strategies have been developed to restore the damaged cartilage, bone marrow stimulation (chondroabrasion, drilling, micro- or nano-fractures) and more recently, tissue engineering approaches (10-14). Some of these latter procedures have already been applied in clinical practice such as matrix-induced autologous chondrocyte implantation (MACI) (15) or osteochondral scaffold implantation (16). Generally, tissue engineering approaches are based on the combination of three main elements: cells (i.e. primary chondrocytes or multipotent mesenchymal cells), biocompatible scaffolds (i.e. polymers, composites, ceramics) and signaling molecules (i.e. growth factors). Moreover, several culture conditions (i.e. static or dynamic cultures) and biomechanical stimuli can be applied during the culture to promote tissue maturation (17-19). However, an culture is mandatory to validate a new engineered construct as the phase lacks the essential environmental stimuli and because the culture allows for the testing of the biocompatibility and safety of a new material (18, 19). Moreover, preclinical animal models are crucial to understand the molecular mechanisms of cartilage lesions favoring the development of new regenerative strategies (20, 21). studies on animal models should focus on the analysis of the cellular component, analyzing the maintenance of the cellular phenotype and the tumorigenicity; on the evaluation of the biocompatibility, toxicity and degradation of the biomaterial and on the assessment of the engineered construct. In this manuscript, we will review the most common preclinical animal models, which are used to understand cartilage biology and therefore to develop new tissue engineering strategies. We will focus on both small and large animal models highlighting their peculiarities, advantages and drawbacks.
Topics: Animals; Cartilage, Articular; Chondrocytes; Mesenchymal Stem Cells; Models, Animal; Tissue Engineering; Tissue Scaffolds
PubMed: 30644290
DOI: No ID Found