Abstract
The meniscus plays a vital role in protecting the articular cartilage of the knee joint. The inner two-thirds of the meniscus are avascular, and injuries to this region often fail to heal without intervention. The use of tissue engineering and regenerative medicine techniques may offer novel and effective approaches to repairing meniscal injuries. Meniscal tissue engineering and regenerative medicine typically use one of two techniques, cell-based or cell-free. While numerous cell-based strategies have been applied to repair and regenerate meniscal defects, these techniques possess certain limitations including cellular contamination and an increased risk of disease transmission. Cell-free strategies attempt to repair and regenerate the injured tissues by recruiting endogenous stem/progenitor cells. Cell-free strategies avoid several of the disadvantages of cell-based techniques and, therefore, may have a wider clinical application. This review first compares cell-based to cell-free techniques. Next, it summarizes potential sources for endogenous stem/progenitor cells. Finally, it discusses important recruitment factors for meniscal repair and regeneration. In conclusion, cell-free techniques, which focus on the recruitment of endogenous stem and progenitor cells, are growing in efficacy and may play a critical role in the future of meniscal repair and regeneration.
Highlights
The meniscus is a fibrocartilaginous structure that rests in the joint space between the femoral condyle and tibial plateau cartilage [1] and ensures normal knee joint function [2]
meniscus progenitor cells (MPCs) expressed slightly higher levels of the proinflammatory IL and CXCL genes and had higher expression of the protease gene MMP, chondrogenic progenitor cells (CPCs). These results indicated that MPCs may promote inflammation and influence immune cell migration
Progenitor cell tracing at juvenile stages has shown that injury to the articular cartilage can induce a massive and rapid increase in proteoglycan 4 (PRG4)+ and CD44+/P75+ cells within the synovium and that these cells will later fill the site of injury. These results provide evidence that synovial PRG4 + progenitors may be exquisitely responsive to cartilaginous injury in the acute phase and may be at the forefront of joint tissue regeneration and repair
Summary
The meniscus is a fibrocartilaginous structure that rests in the joint space between the femoral condyle and tibial plateau cartilage [1] and ensures normal knee joint function [2]. Cell-free techniques recruit endogenous stem/progenitor cells to participate in the repair process [13, 14]. The local endogenous stem/progenitor cells can be stimulated and recruited to the injured sites, where they gradually restore tissue structure and organ function [16]. Successful cell-free strategies for meniscus repair and regeneration require application of the appropriate stimulation and recruitment factors [17, 18]. Local endogenous stem/ progenitor cells must be stimulated in a manner similar to that during tissue injury These cells must migrate to the injured site, proliferate, and differentiate. This review will summarize existing cell-free techniques for meniscus repair and regeneration, those that recruit endogenous stem/progenitor cells. We discuss important recruitment factors for meniscal repair and regeneration
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