Concise Review: Knee Cartilage Repair Techniques using Cellular Therapy
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 5, Issue 4
Abstract
Osteoarthritis is a degenerative disease of joints and leading cause of joint pain resulting from subchondral bone hypertrophy and inflammation. Although, many researches have been focused to overcome the articular cartilage, the latter has proven to be a very difficult tissue to repair defeating researchers, surgeons, and patients. Numerous surgical techniques have been developed to address focal cartilage defects. One area that seems encouraging is cell-based therapies based on stem cells to promote cartilage repair. Several human body tissues contain mesenchymal stem cells from where these can be harvested and cultured. This review summarises autologous chondrocytes implantation, first generation, second generation, third generation and recent clinical trials on mesenchymal stem cells implantation. Articular hyaline cartilage is a tissue whose mechanical properties allow joint movements with a low coefficient of friction and a high absorption of constraints. Degradation of hyaline cartilage causes functional impairment of the joint, pain and decreased quality of life. In the case of isolated cartilage lesion of the knee, a remedy that allows histological restoration of cartilage and therefore a functional improvement for the long-term represents a therapeutic challenge. The hyaline cartilage is organized into four distinct layers. It is a non-vascularised and non-innervated tissue [1] composed of chondrocytes, which come from the undifferentiated mesenchymal stem cells, immersed in an extracellular matrix. This matrix synthesized by chondrocytes consists mainly of water, electrolytes, collagen (type II mainly, IX and XI), proteoglycans (aggrecan) and glycoproteins. Production of the extracellular matrix is a function of various parameters such as growth factors, intra-articular mechanical stress, hormones or age. Nutrition of articular cartilage occurs by soaking in the joint fluid but also by capillary from the adjacent connective tissues. Surgery offers many other restorative procedures with the objective of restoring joint function thanks to the return of a hyaline cartilage. The procedure chosen will depend on the size of the lesion, its depth, the age of the patient, the nature of the symptoms and the treatment authorization in each country. The therapeutic tools can be separated into three major groups; those conducting subchondral stimulation (Pridie, microfractures), reconstruction techniques which transplant mature cartilage (OATS: osteochondral autologous transfer surgery, allograft) and finally cellular transplants which aim to create a favourable environment for cartilage healing. The aim of this literature review is to identify all surgical possibilities used to repair articular cartilage of the knee using cellular transplant with or without culture. The main principles of these techniques will be reviewed in the light of articles and the most recent results which will be compared and evaluated.
Authors and Affiliations
Coursier R, Mazor M, Best TM, Lespessailles E, Toumi H
Keywords
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- EP ID EP591768
- DOI 10.26717/BJSTR.2018.05.001226
- Views 178
- Downloads 0
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