The treatment of knee cartilage lesions: state of the art
Keywords:
cartilaginous injuries, cartilage lesions, rigenerative medicine, staminal cells, cartilaginous repairAbstract
The management and repair of knee cartilage lesions currently represents a challenge for the orthopaedic surgeon. Identifiable causes are the characteristics of the involved tissues themselves and the presence of poor vascularization, which is responsible for overall reduced repair capacity.
The literature reports three types of cartilage lesions’ treatment modalities: chondroprotection, chondroreparation and chondrogeneration. The preference for one or the other therapeutic option depends on the pattern of the lesion and the clinical conditions of the patient.
Each treatment technique is distinguished by the quality of the restorative tissue that is generated. In particular, the chondrorigeneration represents the last frontier of regenerative medicine, as it aims at the complete restoration of natural cartilage. However, the most recent literature documents good results only in the short and medium terms.
In recent years the optimization of chondroregeneration outcomes is based on the modification of the scaffolds and the search for new chondrocyte sources, in order to guarantee satisfactory long-term results.
References
Sophia Fox AJ, Bedi A, Rodeo SA. The basic science of articular cartilage: structure, composition, and function. Sports Health. 2009;1(6):461-468. doi: 10.1177/1941738109350438.
Orth P, Cucchiarini M, Kohn D, Madry H. Alterations of the subchondral bone in osteochondral repair--translational data and clinical evidence. European Cells & Materials. 2013 Jun; 25:299-316; discussion 314-6. DOI: 10.22203/ecm.v025a21. PMID: 23813020.
Murray IR, Benke MT, Mandelbaum BR. Management of knee articular cartilage injuries in athletes: chondroprotection, chondrofacilitation, and resurfacing. Knee Surg Sports Traumatol Arthrosc. 2016 May;24(5):1617-26.
Dall'Oca C1, Cengarle M, Costanzo A, Giannini N, Vacchiano A, Magnan B. 2017. Current concepts in treatment of early knee osteoarthritis and osteochondral lesions; the role of biological augmentations. Acta Biomed. Oct 18;88(4S):5-10.
Hochberg, M.C.; Altman, R.D.; April, K.T.; Benkhalti, M.; Guyatt, G.; McGowan, J.; Towheed, T.; Welch, V.; Wells, G.; Tugwell, P. 2012. American College of Rheumatology American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res. 64, 465–474.
Wernecke, C.; Braun, H.J.; Dragoo, J.L. 2015. The Effect of Intra-articular Corticosteroids on Articular Cartilage: A Systematic Review. Orthop. J. Sports Med. 3, 2325967115581163.
Bhandari M, Bannuru RR, Babins EM, Martel-Pelletier J, Khan M, Raynauld JP, Frankovich R, Mcleod D, Devji T, Phillips M, Schemitsch EH, Pelletier JP. 2017. Intra-articular hyaluronic acid in the treatment of knee osteoarthritis: a Canadian evidence-based perspective. Ther Adv Musculoskelet Dis. Sep;9(9):231-246. Epub 2017 Sep 12. Erratum in: Ther Adv Musculoskelet Dis. 2017 Nov;9(11):295.
Wright, K.E.; Maurer, S.G.; Di Cesare, P.E. 2000. Viscosupplementation for osteoarthritis. Am. J. Orthop. 29, 80–88; discussion 88–89.
Laver L, Marom N, Dnyanesh L, Mei-Dan O, Espregueira-Mendes J, Gobbi A. 2017. PRP for Degenerative Cartilage Disease: A Systematic Review of Clinical Studies. Cartilage. 8(4):341-364.
Ozmeriç A, Alemdaroğlu KB, Aydoğan NH. Treatment for cartilage injuries of the knee with a new treatment algorithm. World J Orthop. 2014 Nov 18;5(5):677-84.
Medvedeva EV, Grebenik EA, Gornostaeva SN, Telpuhov VI, Lychagin AV, Timashev PS, Chagin AS. 2017. Int J Mol Sci. Aug 11;19(8). Repair of Damaged Articular Cartilage: Current Approaches and Future Directions.
Dall'Oca C, Cengarle M, Costanzo A, Giannini N, Vacchiano A, Magnan B.Acta Biomed. 2017. Current concepts in treatment of early knee osteoarthritis and osteochondral lesions; the role of biological augmentations. Oct 18;88(4S):5-10.
Ozmeriç A, Alemdaroğlu KB, Aydoğan NH. Treatment for cartilage injuries of the knee with a new treatment algorithm. World J Orthop. 2014 Nov 18; 5 (5):677-84.
Richter DL, Schenck RC Jr, Wascher DC, Treme G. 2016. Knee Articular Cartilage Repair and Restoration Techniques: A Review of the Literature. Sports Health. Mar-Apr; 8 (2):153-60.
Gill T. J., Steadman J. R. (2004) Bone Marrow Stimulation Techniques: Microfractures, Drilling, and Abrasion. In: Articular Cartilage Lesions. Springer, New York, NY.
Gao, Liang et al. “Subchondral drilling for articular cartilage repair: a systematic review of translational research.” Disease models & mechanisms vol. 11,6 dmm034280. 19 Jun. 2018, doi: 10.1242/dmm.034280.
Benthien JP, Behrens P. Reviewing subchondral cartilage surgery: considerations for standardized and outcome predictable cartilage remodeling: a technical note. Int Orthop. 2013; 37(11):2139-2145. doi: 10.1007/s00264-013-2025-z.
Zedde, Pietro et al. “Subchondral bone remodeling: comparing nanofractures with microfracture. An ovine in vivo study.” Joints vol. 4,2 87-93. 18 Aug. 2016, doi:10.11138/jts/2016.4.2.087.
Chahla J Stone J, Mandelbaum BR. 2019. How to Manage Cartilage Injuries? Arthroscopy 2019 Oct; 35 (10):2771-2773.
Eirik Solheim. 2019. Osteochondral Autograft Transplant (Mosaicplasty) for Knee Articular Cartilage Defects. JBJS Essent Surg Tech. Oct-Dec; 9(4): e34.1-2.
Rebecca L. Davies, Nicola J Kuiper. 2019. Regenerative Medicine: A Review of the Evolution of Autologous Chondrocyte Implantation (ACI) Therapy. Bioengineering (Basel). Mar; 6(1): 22.
Linghui Dai, Zhenming He, Yanfang Jiang, Xin Zhang, Shuang Ren, Jingxian Zhu, Zhenxing Shao, Hongjie Huang, Jiying Zhang, Xin Fu, Xiaoning Duan, Xiaoqing Hu, and Yingfang Ao. 2019. One-step strategy for cartilage repair using acellular bone matrix scaffold based in situ tissue engineering technique in a preclinical minipig model. Am J Transl Res. 11 (10): 6650–6659.
Medvedeva EV, Grebenik EA, Gornostaeva SN, Telpuhov VI, Lychagin AV, Timashev PS, Chagin AS. 2018. Repair of Damaged Articular Cartilage: Current Approaches and Future DirectionsMol Sci. Aug 11; 19 (8).
Zhao Z, Zhou X, Guan J, Wu M, Zhou J. 2018. Co-implantation of bone marrow mesenchymal stem cells and chondrocytes increase the viability of chondrocytes in rat osteo-chondral defects. Oncol Lett. May; 15 (5):7021-7027.
Samad AM. 2017. Adipose stem cells. Adipocyte. Jul 3;6(3):175.
Dulak J, Szade K, Szade A, Nowak W, Józkowicz A. 2015. Adult stem cells: hopes and hypes of regenerative medicine. Acta Biochim Pol. 62(3):329-37.
Hockemeyer D, Jaenisch R. 2016Induced Pluripotent Stem Cells Meet Genome Editing. Cell Stem Cell. May 5; 18 (5):573-86.
Chen W, Li C, Peng M, Xie B, Zhang L, Tang X. 2018. Autologous nasal chondrocytes delivered by injectable hydrogel for in vivo articular cartilage regeneration. Cell Tissue Bank. Mar;19(1):35-46.
Fu N, Dong T, Meng A, Meng Z, Zhu B, Lin Y. 2018. Research Progress of the Types and Preparation Techniques of Scaffold Materials in Cartilage Tissue Engineering. Curr Stem Cell Res Ther. 13(7):583-590.
Zak L, Albrecht C, Wondrasch B, Widhalm H, Vekszler G, Trattnig S, Marlovits S, Aldrian S. 2014. Results 2 Years After Matrix-Associated Autologous Chondrocyte Transplantation Using the Novocart 3D Scaffold: An Analysis of Clinical and Radiological Data. Am J Sports Med. Jul; 42(7):1618-27.
Wu Y, Kennedy P, Bonazza N, Yu Y, Dhawan A, Ozbolat I. 2018. Three- Dimensional Bioprinting of Articular Cartilage: A Systematic Review. Cartilage. Oct 29:1947603518809410.
Jonson LL. Arthroscopic abrasion arthroplasty: a review. Clin Orthop 2001; 391 Suppl: S306-S317.
Gao, Liang et al. “Subchondral drilling for articular cartilage repair: a systematic review of translational research.” Disease models & mechanisms vol. 11,6 dmm034280. 19 Jun. 2018, doi: 10.1242/dmm.03428.
Solheim E, Hegna J, Strand T, Harlem T, Inderhaug E. 2018. Randomized Study of Long-term (15-17 Years) Outcome After Microfracture Versus Mosaicplasty in Knee Articular Cartilage Defects. Am J Sports Med. Mar; 46(4):826-831.
Enea D, Cecconi S, Calcagno S, Busilacchi A, Manzotti S, Gigante A. 2015. One- step cartilage repair in the knee: collagen-covered microfracture and autologous bone marrow concentrate. A pilot studies. Knee. Jan; 22(1):30-5.
Peñalver JM, Villalba J, Yela-Verdú CP, Sánchez J, Balaguer-Castro M. All- Arthroscopic Nanofractured Autologous Matrix-Induced Chondrogenesis (A- NAMIC) Technique for the Treatment of Focal Chondral Lesions of the Knee. Arthrosc Tech. 2020;9(6): e755-e759. Published 2020 May 14. doi: 10.1016/j.eats.2020.02.007.
Hangody L, Fules P. 2003. Autologous osteochondral mosaicplasty for the treatment of full-thickness defects of the weight-bearing joints: ten years of experimental and clinic experience. J Bone Joint Surg Am. 85-A (suppl 2):25-32.
D'Ambrosi R, Valli F, De Luca P, Ursino N, Usuelli FG, MaioRegen 2009. Osteochondral Substitute for the Treatment of Knee Defects: A Systematic Review of the Literature.J Clin Med. Jun 1;8(6).
Bentley G, et al. 2012. Minimum ten-year results of a prospective randomised study of autologous chondrocyte implantation versus mosaicplasty for symptomatic articular cartilage lesions of the knee. J Bone Joint Surg Br. Apr;94(4):504-9.
Kraeutler MJ, Belk JW, Purcell JM, McCarty EC. 2018. Microfracture Versus Autologous Chondrocyte Implantation for Articular Cartilage Lesions in the Knee: A Systematic Review of 5-Year Outcomes. Am J Sports Med. Mar; 46 (4):995-999.
Na Y, Shi Y, Liu W, Jia Y, Kong L, Zhang T, Han C, Ren Y. 2019. Is implantation of autologous chondrocytes superior to microfracture for articular-cartilage defects of the knee? A systematic review of 5-year follow-up data. Int J Surg. Aug; 68:56- 62.
G Placella, M Bartoli, M Peruzzi, A Speziali, V Pace, G Cerulli. 2016. Return to sport activity after anterior cruciate ligament reconstruction in skeletally immature athletes with manual drilling original all inside reconstruction at 8 years follow-up. Acta orthopaedica et traumatologica turcica 50 (6), 635-638.
P. Antinolfi, M. Bartoli, G. Placella, A, Speziali, V. Pace, M. Delcogliano, C. Mazzola. 2016. Acute patellofemoral instability in children and adolescents. Joints 4 (1), 47.
G Placella, V Pace, P Foster. 2016. Reconstruction of the medial patellofemoral ligament reconstruction for patients with recurrent patellar dislocation: review of surgical techniques and tips to achieve successful reconstruction. Annals of translational medicine 4 (24).
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