Cartilage repair

Abstract

Cartilage lesions, caused by trauma or as a result of knee instability or abnormal loading, are a common cause of disability, often associated with pain, reduction of joint mobility and loss of function. Given the limitations of traditional surgical techniques, such as lavage and debridement, bone marrow stimulation techniques and mosaicplasty newer surgical approaches have been developed focused at obtaining the regeneration of hyaline cartilage into the defect site and its complete functional integration with the surrounding tissues, to restore the normal knee function and provide durable outcomes. Autologous chondrocyte transplantation (ACT) is an advanced cell-based orthobiologic technology used for the treatment of chondral defects of the knee that has been in clinical use since 1987 and has been performed on 12,000 patients internationally. This technique involves two surgical procedures: an arthroscopic harvesting of a small cartilage biopsy from a non-weight-bearing area of the knee and the subsequent transplantation of in vitro expanded autologous chondrocytes to the defect site. A large amount of evidence is currently available concerning the clinical results obtained with ACT, indicating that the treatment is associated with significant pain reduction and improved joint functionality, resulting in improved health and economic. Further improvements in tissue engineering have contributed to the next generation of ACT techniques, where cells are combined with resorbable biomaterials, as in matrix-associated autologous chondrocyte transplantation (MACT). This composite “all-in-one” tissue-engineered approach combines cultured chondrocytes with three-dimensional biocompatible scaffolds for the purpose of generating new functional articular tissue. A variety of outcome measures are in clinical use, but studies commonly use a combination of the following: arthroscopy, MRI, clinical assessment and histology. MR imaging is becoming an increasingly effective, non-invasive method of assessing articular cartilage defects and repairs. Advanced MR imaging has been developed using additional articular cartilage and subchondral protocols. In this issue of the European Journal of Radiology, we are presenting an overview of the current available techniques of chondrocyte transplantation and the description of the clinical and radiological outcome.View Large Image Figure ViewerDownload (PPT)