Emerging technologies and fourth generation issues in cartilage repair.
The goals of successful cartilage repair include reducing pain, improving symptoms, and long-term function; preventing early osteoarthritis and subsequent total knee replacements; and rebuilding hyaline cartilage instead of fibrous tissue. Current methods such as microfracture, osteoarticular autograft transfer system, mosaicplasty, and autologous chondrocyte implantation are somewhat successful in regenerating cartilage; however, they also have significant limitations. The future of fourth generation cartilage repair focuses on gene therapy, the use of stem cells (bone marrow, adipose, or muscle derived), and tissue engineering. Emerging techniques include creating elastin-like polymers derived from native elastin sequences to serve as biocompatible scaffolds; using hydrogels to obtain a homogeneous distribution of cells within a 3-dimensional matrix; and using nonviral gene delivery via nucleofection to allow mesenchymal stem cells the ability to express osteogenic growth factors. Although many of the techniques mentioned have yet to be used in a cartilage regeneration model, we have tried to anticipate how methods used in other specialties may facilitate improved cartilage repair.
Kessler
Michael W
MW
Department of Orthopaedic Surgery, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY 11040, USA.
Ackerman
George
G
Dines
Joshua S
JS
Grande
Daniel
D
D001672:Biocompatible Materials / Q000627:therapeutic use*; D001696:Biomechanical Phenomena; D002358:Cartilage, Articular / Q000293:injuries / Q000601:surgery* / Q000637:transplantation; D019902:Chondrocytes / Q000637:transplantation*; D005260:Female; D005544:Forecasting; D015316:Genetic Therapy / Q000379:methods* / Q000639:trends; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007718:Knee Injuries / Q000601:surgery; D008297:Male; D018570:Risk Assessment; D033581:Stem Cell Transplantation / Q000379:methods / Q000639:trends; D013718:Tensile Strength; D023822:Tissue Engineering / Q000379:methods* / Q000639:trends; D054457:Tissue Scaffolds; D016378:Tissue Transplantation / Q000379:methods / Q000639:trends; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D001672:Biocompatible Materials