Abstract
Introduction This article reviews the evolution of cartilage regeneration therapeutic approaches from two-step cell-based autologous chondrocyte implantation procedures to current one-step cell-free scaffold-assisted cartilage repair approaches for chondral cartilage repair. In particular, our research is focused on clinical data about commercially available cell-free implants used in regenerative medicine approaches for the treatment of chondral cartilage defects. Discussion Chondral cartilage lesions do not heal spontaneously and may progress to severe osteoarthritis. For cartilage repair, a variety of surgical techniques have been established over the years. Further research led to the development of current new one-step cell-free scaffold-assisted cartilage repair approaches based on the experience with scaffold materials in previous two-step autologous chondrocyte implantation procedures. Commercially available scaffold-based products for one-step chondral cartilage repair have been recently tested in first case series and showed promising clinical outcome in the short-term follow-up; however, medium- and long-term comparative studies are necessary to evaluate the regenerative potential of this new one-step cartilage repair procedure and to demonstrate its superiority over or adequacy to traditional approaches. Conclusion This critical review summarises the development from two-step cell-based autologous chondrocyte implantation procedures to new onestep cell-free cartilage repair and discusses the first clinical outcome of commercially available cell-free implants. This new approach, based on the principle of cell ingrowths and guidance towards tissue repair, showed promising first clinical results and is considered as an effective and safe treatment option for chondral cartilage repair.
Highlights
This article reviews the evolution of cartilage regeneration therapeutic approaches from two-step cell-based autologous chondrocyte implantation procedures to current one-step cell-free scaffold-assisted cartilage repair approaches for chondral cartilage repair
3 Department of Orthopaedics and Trauma Surgery, Martin-Luther-Krankenhaus Berlin, Berlin, Germany new one-step cartilage repair procedure and to demonstrate its superiority over or adequacy to traditional approaches. This critical review summarises the development from two-step cell-based autologous chondrocyte implantation procedures to new onestep cell-free cartilage repair and discusses the first clinical outcome of commercially available cell-free implants
Focal cartilage lesions of the knee occur frequently, are mostly located on the femoral condyle and display a major health problem because they may progress to severe osteoarthritis, when untreated
Summary
The authors have referenced some of their own studies in this review. These referenced studies have been conducted in accordance with the Declaration of Helsinki (1964) and the protocols of these. Different commercially available cell-free medical devices based on collagen (Chondro-GideTM, Geistlich, Switzerland; CaReS-1STM, Arthro Kinetics, Germany; MeRG®, Bioteck, Italy), different hydrogels (BSTCargelTM, Piramal Healthcare, Canada; GelrinCTM, Regentis Biomaterials, Israel) and resorbable synthetic polymers (chondrotissue®, BioTissue AG, Switzerland) have been recently tested for one-step chondral cartilage repair and showed first clinical outcomes. One of these products is a bilayer matrix of porcine type I and III collagen with one compact and one porous side (Chondro-GideTM, Geistlich, Switzerland) to cover chondral cartilage defects after microfracturing. Preliminary clinical results of a randomised, comparative multicenter clinical trial showed that the chondrotissue® treatment for cartilage repair significantly improves the patients’ situation as assessed by VAS, Knee Injury and Osteoarthritis Outcome Score (KOOS) and IKDC score, while there is no significant improvement after microfracture treatment in patients with 12–24 months follow-up[34]
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