Articular Cartilage Regeneration with Stem Cells

Abstract

Cartilage defects continue to be a clinical challenge as regards to articular cartilage regeneration. The structure and function of articular cartilage leads to non-healing lesions after injury occurs. Well-established arthroscopic methods utilize controlled healing with marrow stimulation or transferring of non-injured cartilage to areas of injury. These include: microfracture, chondral drilling, osteochondral autograft transfer system, ostechondral allograft transplant, and autologous chondrocyte implantation. However, more often than not the treatments result in the formation of fibrocartilage and similar results within all methods with no clear superior modality (Jakobsen et al, 2005; Lubowitz et al, 2007; Magnussen et al, 2008; Nakamura et al, 2009). Recent study has investigated synthetic and biologic adjuncts to current methodology, including the use of: hyaluronic acid (HA), platelet rich plasma, mesenchymal stem cells (MSC) and peripheral blood progenitor cells (PBPC). Cell therapy has produced exciting results in animal models and has been shown to regenerate hyaline cartilage clinically in the knee joint. Our current method utilizes arthroscopic subchondral drilling of cartilage lesions in combination with a postoperative adjunct treatment involving: stimulation of the release of PBPC with filgrastim, harvest of PBPC with apheresis, and postoperative intraarticular injection of PBPC in combination with HA. Our early results lead us to the conclusion that cell therapy will have an integral part in the future treatment of cartilage damage as well as other potential orthopedic, surgical, and medical applications.