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Cartilage
Figure 3: Arthroscopic View of a Debrided, Full-thickness Figure 4: Arthroscopic View of Same Lesion at Follow-up Surgery
Articular Cartilage Lesion of the Trochlea After After Transarthroscopic Matrix Autologous Chondrocyte
Index Surgery Implantation with Fibrin Glue Fixation
Several promising treatments in articular cartilage repair have emerged therapies are in development. Screening assays using specific
over the last decade, a development that has been instrumental to the molecular markers have been successfully employed in clinical trials to
growth of this speciality. Most of the investigative efforts have focused identify cell sources with high chondrogenic potential for expansion
on improving the quality and survival of vital cells and their delivery, as for tissue-engineered constructs.
29
Due to the increased demand
well as ensuring the reliable in situ fixation of cartilage restoration driven by an actively ageing population and their treating physicians,
constructs. Advances have been made in recognising and subsequently the use of allogenic tissue as scaffolds for cell-based therapies or as an
controlling chondrocyte damage during implantation of osteochondral abundant cell source from cultured cartilage after immunological and
grafts,
23
and in improving storage parameters for allograft tissue.
24,25
molecular tissue screening is also gaining in significance.
Also, matrix-supported ACI has taken steps towards addressing some
of the criticisms of the previous generation of ACI procedures by using Overall, the field of cartilage repair has undergone exponential
collagen membranes for coverage of the implanted cells
26
and/or development and growth over the last century, culminating in the past
employing relatively resilient 3D tissue-engineered biomaterial decade under the leadership and guidance of the ICRS. Many
scaffolds or matrices seeded with cultured cells at different durations bio-orthological treatment options hold great promise, and it is up to
before implantation (see Figures 3 and 4).
27,28
clinicians and scientists alike to harness and cultivate this potential
while critically examining the limitations of these novel treatment
More emerging treatments for cartilage defects involving cell-based options in order to offer the maximum benefit to the patient. ■
1. Buckwalter JA, Articular cartilage, Instr Course Lect, 1983;32: 12. McDermott AG, Langer F, Pritzker KP, Gross AE, Fresh small- Socratesweb.pdf (accessed 1 October 2007).
349–70. fragment osteochondral allografts. Long-term follow-up study on 23. Borazjani BH, Chen AC, Bae WC, et al., Effect of impact on
2. Hunter W, Of the structure and disease of articulating cartilages, first 100 cases, Clin Orthop Relat Res, 1985;(197):96–102. chondrocyte viability during insertion of human osteochondral
1743, Clin Orthop Relat Res, 1995;(3–6):317. 13. Meyers MH, Resurfacing of the femoral head with fresh grafts, J Bone Joint Surg Am, 2006;88(9):1934–43.
3. Macewen W, Osteotomy with an inquiry into the etiology and osteochondral allografts. Long-term results, Clin Orthop Relat 24. Ball ST, Amiel D, Williams SK, et al., The effects of storage on
pathology of knock-knee, bowleg and other osseous deformities Res, 1985;(197):111–14. fresh human osteochondral allografts, Clin Orthop Relat Res,
of the lower limbs, London: J and A Churchill, 1880. 14. Convery FR, Meyers MH, Akeson WH, Fresh osteochondral 2004;(418):246–52.
4. Lexer E, Substitution of Whole or Half Joints from Freshly allografting of the femoral condyle, Clin Orthop Relat Res, 25. Pennock AT, Wagner F, Robertson CM, et al., Prolonged storage
Amputated Extremities by Free-plastic Operation, Surg Gynecol 1991;(273):139–45. of osteochondral allografts: does the addition of fetal bovine
Obstet, 1908;6:601–7. 15. Garrett JC, Treatment of osteochondral defects of the distal serum improve chondrocyte viability?, J Knee Surg, 2006;19(4):
5. Eloesser L, Implantation of Joints, Ca State J Med, 1913;11(12): femur with fresh osteochondral allografts: a preliminary report, 265–72.
485–91. Arthroscopy, 1986;2(4):222–6. 26. Fu FH, Rate of improvement was not different after
6. Charnley J, Arthroplasty of the hip. A new operation, Lancet, 16. Malinin TI, Martinez OV, Brown MD, Banking of massive osteo- chondral repair with matrix-induced autologous
1961;1(7187):1129–32. osteoarticular and intercalary bone allografts – 12 years’ chondrocyte implantation or autologous chondrocyte
7. Judet J, Judet R, The use of an artificial femoral head for experience, Clin Orthop Relat Res, 1985;(197):44–57. implantation with a cover made from porcine-derived type I/type
arthroplasty of the hip joint, J Bone Joint Surg Br, 1950;32-B(2): 17. Görtz S, Bugbee WD, Allografts in articular cartilage repair, III collagen, J Bone Joint Surg Am, 2005;87(11):2593.
166–73. J Bone Joint Surg Am, 2006;88(6):1374–84. 27. Bartlett W, Skinner JA, Gooding CR, et al., Autologous
8. McKeever DC, The classic: Tibial plateau prosthesis, 1960, 18. Bobic V, Autologous osteo-chondral grafts in the management chondrocyte implantation versus matrix-induced autologous
Clin Orthop Relat Res, 2005;440:4–8, discussion 3. of articular cartilage lesions, Orthopade, 1999;28(1):19–25. chondrocyte implantation for osteochondral defects of the knee:
9. MacIntosh DL, Hunter GA, The use of the hemiarthroplasty 19. Hangody L, Kish G, Karpati Z, et al., Mosaicplasty for the a prospective, randomised study, J Bone Joint Surg Br, 2005;
prosthesis for advanced osteoarthritis and rheumatoid arthritis of treatment of articular cartilage defects: application in clinical 87(5):640–45.
the knee, J Bone Joint Surg Br, 1972;54(2):244–55. practice, Orthopedics, 1998;21(7):751–6. 28. Marlovits S, Striessnig G, Kutscha-Lissberg F, et al., Early post-
10. Johnson LL, Arthroscopic abrasion arthroplasty historical and 20. Brittberg M, Lindahl A, Nilsson A, et al., Treatment of deep operative adherence of matrix-induced autologous chondrocyte
pathologic perspective: present status, Arthroscopy, 1986;2(1): cartilage defects in the knee with autologous chondrocyte implantation for the treatment of full-thickness cartilage defects
54–69. transplantation, N Engl J Med, 1994;331(14):889–95. of the femoral condyle, Knee Surg Sports Traumatol Arthrosc,
11. Steadman JR, Rodkey WG, Briggs KK, Rodrigo JJ, The 21. http://www.cartilage.org/_files/contentmanagement/ICRS 2005;13(6):451–7.
microfracture technique in the management of complete cartilage _evaluation.pdf (accessed 1 October 2007). 29. http://clinicaltrials.gov/ct2/show/NCT00414700 (accessed 1
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82 EUROPEAN MUSCULOSKELETAL REVIEW
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