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Clinics in Sports Medicine Jul 2017The most challenging aspects in treating articular cartilage injury include identifying the cellular and molecular mechanism(s) that lead to matrix changes and the... (Review)
Review
The most challenging aspects in treating articular cartilage injury include identifying the cellular and molecular mechanism(s) that lead to matrix changes and the differentiation and dedifferentiation behavior of chondrocytes, and understanding how they affect the structural integrity of the articular cartilage and tissue remodeling. Several treatment strategies have been proposed. A better understanding of the signaling pathways and growth and transcription factors for genes responsible for chondrogenesis is an important component in the development of new therapies to prevent cartilage degeneration or promote repair to replicate the physiologic and functional properties of the original cartilage.
Topics: Cartilage, Articular; Cell Differentiation; Chondrocytes; Chondrogenesis; Cytokines; Extracellular Matrix; Humans
PubMed: 28577703
DOI: 10.1016/j.csm.2017.02.001 -
Sports Medicine and Arthroscopy Review Jun 2016
Topics: Cartilage Diseases; Cartilage, Articular; Humans
PubMed: 27135284
DOI: 10.1097/JSA.0000000000000114 -
Sports Medicine and Arthroscopy Review Mar 2018Articular cartilage injury and degeneration is a frequent occurrence in synovial joints. Treatment of these articular cartilage lesions are a challenge because this... (Review)
Review
Articular cartilage injury and degeneration is a frequent occurrence in synovial joints. Treatment of these articular cartilage lesions are a challenge because this tissue is incapable of quality repair and/or regeneration to its native state. Nonoperative treatments endeavor to control symptoms, and include anti-inflammatory medication, viscosupplementation, bracing, orthotics, and activity modification. Techniques to stimulate the intrinsic repair (fibrocartilage) process include drilling, abrasion, and microfracture of the subchondral bone. Currently, the clinical biologic approaches to treat cartilage defects include autologous chondrocyte implantation, periosteal transfer, and osteochondral autograft or allograft transplantation. Newer strategies employing tissue engineering being studied involve the use of combinations of progenitor cells, bioactive factors, and matrices, and the use of focal synthetic devices. Many new and innovative treatments are being explored in this exciting field. However, there is a paucity of prospective, randomized controlled clinical trials that have compared the various techniques, treatment options, indications and efficacy.
Topics: Cartilage Diseases; Cartilage, Articular; Humans; Orthopedic Procedures
PubMed: 29300225
DOI: 10.1097/JSA.0000000000000182 -
The American Journal of Sports Medicine 1998Articular cartilage can tolerate a tremendous amount of intensive and repetitive physical stress. However, it manifests a striking inability to heal even the most minor... (Review)
Review
Articular cartilage can tolerate a tremendous amount of intensive and repetitive physical stress. However, it manifests a striking inability to heal even the most minor injury. Both the remarkable functional characteristics and the healing limitations reflect the intricacies of its structure and biology. Cartilage is composed of chondrocytes embedded within an extracellular matrix of collagens, proteoglycans, and noncollagenous proteins. Together, these substances maintain the proper amount of water within the matrix, which confers its unique mechanical properties. The structure and composition of articular cartilage varies three-dimensionally, according to its distance from the surface and in relation to the distance from the cells. The stringent structural and biological requirements imply that any tissue capable of successful repair or replacement of damaged articular cartilage should be similarly constituted. The response of cartilage to injury differs from that of other tissues because of its avascularity, the immobility of chondrocytes, and the limited ability of mature chondrocytes to proliferate and alter their synthetic patterns. Therapeutic efforts have focused on bringing in new cells capable of chondrogenesis, and facilitating access to the vascular system. This review presents the basic science background and clinical experience with many of these methods and information on synthetic implants and biological adhesives. Although there are many exciting avenues of study that warrant enthusiasm, many questions remain. These issues need to be addressed by careful basic science investigations and both short- and long-term clinical trials using controlled, prospective, randomized study design.
Topics: Cartilage, Articular; Humans; Tissue Transplantation; Wound Healing
PubMed: 9548130
DOI: 10.1177/03635465980260022701 -
Clinical Orthopaedics and Related... Sep 2002The acute and repetitive impact and torsional joint loading that occurs during participation in sports can damage articular surfaces causing pain, joint dysfunction, and... (Review)
Review
The acute and repetitive impact and torsional joint loading that occurs during participation in sports can damage articular surfaces causing pain, joint dysfunction, and effusions. In some instances, this articular surface damage leads to progressive joint degeneration. Three classes of chondral and osteochondral injuries can be identified based on the type of tissue damage and the repair response: (1) damage to the joint surface that does not cause visible mechanical disruption of the articular surface, but does cause chondral damage and may cause subchondral bone injury; (2) mechanical disruption of the articular surface limited to articular cartilage; and (3) mechanical disruption of articular cartilage and subchondral bone. In most instances, joints can repair damage that does not disrupt the articular surface if they are protected from additional injury. Mechanical disruption of articular cartilage stimulates chondrocyte synthetic activity, but it rarely results in repair of the injury. Disruption of subchondral bone stimulates chondral and bony repair, but it rarely restores an articular surface that duplicates the biologic and mechanical properties of normal articular cartilage. In selected patients, surgeons have used operative treatments including penetrating subchondral bone, soft tissue grafts, and cell transplants and osteochondral autografts and allografts to restore articular surfaces after chondral injuries. Experimental studies indicate that use of artificial matrices and growth factors also may promote formation of a new joint surface. However, an operative treatment of an articular surface injury that will benefit patients must not just provide a new joint surface, it must produce better long-term joint function than would be expected if the injury was left untreated or treated by irrigation and debridement alone. Therefore, before selecting a treatment for a patient with an articular cartilage injury, the surgeon should define the type of injury and understand its likely natural history.
Topics: Cartilage, Articular; Chondrocytes; Humans; Transplantation, Autologous; Transplantation, Homologous; Treatment Outcome
PubMed: 12218470
DOI: 10.1097/00003086-200209000-00004 -
The Journal of the American Academy of... 2003Articular cartilage is a complex tissue maintained by chondrocytes, which undergo metabolic changes as a result of aging, disease, and injury. These changes may hinder... (Review)
Review
Articular cartilage is a complex tissue maintained by chondrocytes, which undergo metabolic changes as a result of aging, disease, and injury. These changes may hinder tissue maintenance and repair, resulting in accelerated loss of articular surface and leading to end-stage arthritis. Researchers are investigating both normal and pathologic cellular and molecular processes as well as the development of chondroprotective agents to improve the metabolic function of articular cartilage. Current research is helping to clarify the mechanisms by which a variety of agents, such as glucosamine, chondroitin sulfate, hyaluronic acid, green tea, glucocorticoids, and nonsteroidal anti-inflammatory drugs, can modify the symptoms and course of osteoarthritis. Also under investigation are methods of stimulating repair or replacing damaged cartilage, such as matrix metalloproteinase inhibitors, gene therapy, growth factors, cytokine inhibitors, and artificial cartilage substitutes. Tissue engineering, the combining of artificial matrices with cells and growth factors or genes, offers great potential for improving patient care.
Topics: Cartilage, Articular; Humans; Osteoarthritis
PubMed: 14686827
DOI: 10.5435/00124635-200311000-00006 -
Acta Biomaterialia Jan 2018Articular cartilage is commonly described as a tissue that is made of up to 80% water, is devoid of blood vessels, nerves, and lymphatics, and is populated by only one... (Review)
Review
UNLABELLED
Articular cartilage is commonly described as a tissue that is made of up to 80% water, is devoid of blood vessels, nerves, and lymphatics, and is populated by only one cell type, the chondrocyte. At first glance, an easy tissue for clinicians to repair and for scientists to reproduce in a laboratory. Yet, chondral and osteochondral defects currently remain an open challenge in orthopedics and tissue engineering of the musculoskeletal system, without considering osteoarthritis. Why do we fail in repairing and regenerating articular cartilage? Behind its simple and homogenous appearance, articular cartilage hides a heterogeneous composition, a high level of organisation and specific biomechanical properties that, taken together, make articular cartilage a unique material that we are not yet able to repair or reproduce with high fidelity. This review highlights the available therapies for cartilage repair and retraces the research on different biomaterials developed for tissue engineering strategies. Their potential to recreate the structure, including composition and organisation, as well as the function of articular cartilage, intended as cell microenvironment and mechanically competent replacement, is described. A perspective of the limitations of the current research is given in the light of the emerging technologies supporting tissue engineering of articular cartilage.
STATEMENT OF SIGNIFICANCE
The mechanical properties of articular tissue reflect its functionally organised composition and the recreation of its structure challenges the success of in vitro and in vivo reproduction of the native cartilage. Tissue engineering and biomaterials science have revolutionised the way scientists approach the challenge of articular cartilage repair and regeneration by introducing the concept of the interdisciplinary approach. The clinical translation of the current approaches are not yet fully successful, but promising results are expected from the emerging and developing new generation technologies.
Topics: Animals; Biocompatible Materials; Biomechanical Phenomena; Cartilage, Articular; Humans; Regeneration; Tissue Engineering
PubMed: 29128537
DOI: 10.1016/j.actbio.2017.11.021 -
Instructional Course Lectures 2007Articular cartilage lesions in the athletic population commonly occur and result from the significant acute and chronic joint stress associated with high-impact sports.... (Review)
Review
Articular cartilage lesions in the athletic population commonly occur and result from the significant acute and chronic joint stress associated with high-impact sports. These lesions have poor intrinsic healing capacity, and the persistent defects in the joint surfaces cause pain, swelling, and mechanical symptoms that result in functional impairment and limitation of athletic participation. If untreated, articular cartilage lesions can lead to chronic joint degeneration and disability. Several techniques for articular cartilage repair have been recently developed with promising results. However, the significant joint stresses generated in athletes require an effective and durable cartilage surface restoration that can withstand the high mechanical demands in this population over time.
Topics: Athletic Injuries; Biomechanical Phenomena; Cartilage, Articular; Chondrocytes; Humans; Knee Injuries; Orthopedic Procedures; Osteoarthritis, Knee
PubMed: 17472328
DOI: No ID Found -
Instructional Course Lectures 1983Cartilage is not simple, inert, homogeneous, bearing surface but rather a complex, living tissue. It has the capacity to provide a low friction surface, participate in...
Cartilage is not simple, inert, homogeneous, bearing surface but rather a complex, living tissue. It has the capacity to provide a low friction surface, participate in joint lubrication, and distribute loads to subchondral bone, all with a very limited capacity for repair and without evidence of abrasive wear over a lifetime of use. The macromolecules of the cartilage matrix, collagen, proteoglycans, noncollagenous proteins and glycoproteins give it its mechanical and biologic properties, and the cells produce and maintain the matrix. The interaction between the cells and matrix is critical for normal function of the tissue, as are the influences of mechanical loads and motion on the tissue, but study of these important areas is only beginning. Significant advances in the understanding and treatment of joint disease depends on further knowledge of cartilage structure and function as well as the factors that maintain and restore the cartilage matrix.
Topics: Basement Membrane; Cartilage, Articular; Collagen; Humans; Hyalin; Joint Diseases; Macromolecular Substances; Proteoglycans
PubMed: 6085932
DOI: No ID Found -
Bulletin of the NYU Hospital For Joint... 2007Articular cartilage defects are common and play a significant role in degenerative joint disease. Cartilage is unable to regenerate, secondary to an inherent lack of... (Review)
Review
Articular cartilage defects are common and play a significant role in degenerative joint disease. Cartilage is unable to regenerate, secondary to an inherent lack of vascular supply, thus, various techniques have been described in an attempt to treat and potentially restore these defects. Treatment decisions should be based on appropriate evaluation and classification of the pathology. Only then can the surgeon choose to perform a repair or a restoration of the articular surface. Current literature and techniques for the treatment of articular cartilage defects are reviewed, with an algorithm developed for the management of articular cartilage defects by orthopaedic surgeons.
Topics: Algorithms; Arthroscopy; Calcinosis; Cartilage, Articular; Chondrocytes; Debridement; Humans; Knee Injuries; Knee Joint; Suture Techniques; Transplantation, Autologous
PubMed: 17539762
DOI: No ID Found