Disability worldwide is caused by articular knee cartilage injury, which can be related to pathological conditions or trauma. This leads to an economic burden as the patient numbers suffering from these conditions which are joint related is increasing. This is a review article which focuses on the strategies used to replace and repair the cartilage of the knee joint.
Disabilities related to knees are more prevalent compared to any other joints. Approaches which are widely used have inadequacies associated with them, thus biological strategies are being used in an increasing tendency by the orthopaedic community. These include allogeneic osteochondral grafts, tissue engineered substitutes of the cartilage, autologous transplantation, and autologous transplantation.
Denovo NT: Highly Promising for Focal Articular Knee Cartilage Defects
A highly promising type of treatment, the Denovo NT, is presented by the tissue engineered cartilage constructed for the knee injuries. This cartilage has the property to mimic the native cartilage biomechanical environment, and their capabilities are of the superior integration type. The establishment and investigation are the clinically used strategies for the tissue engineering based type as an alternative to the normal techniques used routinely for instance autologous chondrocyte transplantation and knee replacement.
Focal articular knee cartilage defects can be treated by Denovo NT Naturaltissue grafting. Implantation from autograft or from allograft donor junior is involved in these methods. The animal and laboratory models have demonstrated that both DeNovo NT and CAIS will be able to multiply migrate and integrate with the host tissue surrounding them to form a cartilage matrix of tissue, which is new and resembles hyaline. The surgery produces a positive effect on the cartilage repair.
The Denovo NT procedure has been demonstrated to be feasible, effective, and sound. It will produce improvement in subjective scores of patients, and there is improvement of the defect as shown by the magnetic resonance imaging. While options of treatment with this method are promising, more randomized studies and prospective controlled type trials are needed to refine the contraindications and the indications for both DeNovo NT and CAIS.
Tissue Engineering Strategies
Strategies based on tissue engineering are the minced cartilage implantation with copolymers of polyglycolic acid together with polycaprolactone and fibrin glue, which is also DeNovo NT graft. The strategies also include the autologous chondrocytes implantation with collagen I, HYAFF II and fibrin glue Tissucol. Better clinical outcomes are showed by tissue engineered cartilage replacements in the short term. Orthopaedics advances can ensure that they can be introduced in a fashion that is minimally invasive arthroscopically. The restoration of function thus shows this innovative approach a bright future.
In a recent controlled study, researchers analysed cartilage repair using autologous chondrocyte implantation, which is due to limited numbers of cells, age-related decline in the chondrogenic activity, morbidity at donor site, and ex vivo expansion loss of phenotype. An alternative to autologous cells is represented by chondrocytes obtained from juvenile cadaveric donors.
The method used was the obtaining of cartilage samples from both adults who were more than 13 years old and juveniles who were less than 13 year old donors. Gene expression analysis, history, and proteoglycan were used to measure the activity of the chondrocyte of the articular chondrocytes that were isolated and of the expanded cells, as well after the monolayer culture. The results of this study showed that there was a dramatic decline, which was age related in the articular chondrocytes.
The clinical relevance of this study relates to concluding that juvenile human chondrocytes possess a greater potential and ability to restore articular cartilage compared to the adult cells. Transplantation could be done with no fear of them getting rejected. This suggests a new allogeneic approach which restores articular cartilage in individuals who are older.
Conclusions
Isolated cartilage knee lesions treatment is based on underlying principles. Some of these include:
· Progressive damage prevention
· Patient’s symptoms
· Predictable reduction
· Joint and function congruence improvements
With the Denovo NT procedure Cartilage restoration surgical options are described as reparative, such as techniques of marrow stimulation, debridement, and lavage, which are like autologous chondrocyte implantation and osteochondral grafting. History of prior treatment, evaluation of the knee systematically to consider alignment ligament integrity, meniscal status and comorbidities, level of physical demand, lesion size and location all influence the appropriate treatment choice, which is made on an individual basis.
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Resources
Cole BJ, Sherman S, Karas V., Farr J
http://www.ncbi.nlm.nih.gov/pubmed /22624244
Cole BJ1, Grumet RC, Pascual-Garrido C,
http://www.ncbi.nlm.nih.gov/pubmed /20415379
http://www.ncbi.nlm.nih.gov/pubmed /20025455
Adkisson HD 4th1, Amendola RL, Milliman C, et al.
http://www.ncbi.nlm.nih.gov/pubmed /20423988
