Rebuilding from the ground up.

Articular Cartilage Repair

TreatmentsAnti-inflammatory Medication or Systemic

SteroidsInjections

CorticosteroidsHyaluronic Acid

Surgery (major types)Bone Marrow Stimulation (e.g. Microfracture)

MosaicplastySurgery combined with tissue engineering

(e.g. Autologous Chondrocyte Implantation (ACI))

Tissue DevelopmentGrowth Factors

The transforming growth factor beta (TGF-β) superfamily, specifically the BMPs, CDMPs, OPs, and GDFs, have a dramatic effect on the development of bone and cartilage tissue.

These growth factors help produce an extracellular matrix that can withstand extreme loading conditions in the body.

Mechanical LoadingLoad-bearing tissue, such as

articular cartilage, will atrophy in the absence of mechanical forces

Scaffolds

Design Criteria• Biocompatibility

• Limit immune reaction responses

• Induce maturation and differentiation of cellular structures that they are to support

• Biodegrade into non-harmful substances

• Structural integrity & stability

• Durability• the ability of the scaffold to

be retained at the implantation site

Types• Natural

• Fibrin• Agarose and Alginate• Collagen• Chitosan• Hyaluronan

• Synthetic • Polylactic Acid (PLA)• Polyglycolic acid (PGA)• PLA-PGA Copolymer

Advantages• deliver the repair materials to

the site of injury• remain in place long enough

to effect repair• provide an even distribution

of implanted cells• provide an instructive three

dimensional environment for seeded and colonising cells

• allow for the controlled local delivery of polypeptide or chemical molecules that stimulate repair

Cartilage Integration

1. Frenkel, S, & Di Cesare, P. (2004) ‘Scaffolds for Articular Cartilage Repair’ Annals of Biomedical Engineering, Vol. 32, No. 1, pp. 26–34.

2. Steinert, A et al. (2007) ‘Major biological obstacles for persistent cell-based regeneration of articular cartilage’, Arthritis Research & Therapy, Vol. 9, No. 3, pp. 213-228.

3. Bhosale, A, & Richardson, J. (2008) ‘Articular cartilage: structure, injuries and review of management’, British Medical Bulletin, No. 87, pp. 77-95.

4. Darling, E, & Athanasiou, K. (2003) ‘Biomechanical Strategies for Articular Cartilage Regeneration’, Annals of Biomedical Engineering, Vol. 31, No. 9, pp. 1114–1124.

5. Marcacci, M et al (2005) ‘Articular cartilage engineering with Hyalograft C: 3-year clinical results’, Clinical orthopaedics and related research, No. 435, pp. 96–105.

6. Khan, I et al (2008) ‘Cartilage integration: evaluation of the reasons for failure of integration during cartilage repair. A review’, European cells and materials, Vol. 16, pp. 26-39

7. Ma, C (2008) ‘Cartilage Injury and repair: Current treatment of cartilage injuries’, Google Knol, [Online] Accessed on September 1 2008, Available from: http://knol.google.com/k/c-benjamin-ma/cartilage-injury-and-repair/uOR7Q0inq/hpms2a#

8. Pavesio A, et al. (2003) ‘Hyaluronan-based scaffolds (Hyalograft C) in the treatment of knee cartilage defects: preliminary clinical findings.’, Novartis Found Symp, No. 249, pp. 203—17

References