Current strategies for integrative cartilage repair.
Osteoarthritis (OA) is a degenerative joint condition characterized by painful cartilage lesions that impair joint mobility. Current treatments such as lavage, microfracture, and osteochondral implantation fail to integrate newly formed tissue with host tissues and establish a stable transition to subchondral bone. Similarly, tissue-engineered grafts that facilitate cartilage and bone regeneration are challenged by how to integrate the graft seamlessly with surrounding host cartilage and/or bone. This review centers on current approaches to promote cartilage graft integration. It begins with an overview of articular cartilage structure and function, as well as degenerative changes to this relationship attributed to aging, disease, and trauma. A discussion of the current progress in integrative cartilage repair follows, focusing on graft or scaffold design strategies targeting cartilage-cartilage and/or cartilage-bone integration. It is emphasized that integrative repair is required to ensure long-term success of the cartilage graft and preserve the integrity of the newly engineered articular cartilage. Studies involving the use of enzymes, choice of cell source, biomaterial selection, growth factor incorporation, and stratified versus gradient scaffolds are therefore highlighted. Moreover, models that accurately evaluate the ability of cartilage grafts to enhance tissue integrity and prevent ectopic calcification are also discussed. A summary and future directions section concludes the review.
a Biomaterials and Interface Tissue Engineering Laboratory, Department of Biomedical Engineering , Columbia University , New York , NY , USA.
Margaret K
MK
Boushell
b Cellular Engineering Laboratory , Department of Biomedical Engineering Columbia University , New York , NY , USA.
Clark T
CT
Hung
c Department of Orthopaedic Surgery & Department of Clinical Research, Center of Regenerative Medicine for Skeletal Tissues , University of Bern , Bern , Switzerland.
Ernst B
EB
Hunziker
d Department of Orthopaedic Surgery, Langone Medical Center , New York University , New York , NY , USA.
Eric J
EJ
Strauss
a Biomaterials and Interface Tissue Engineering Laboratory, Department of Biomedical Engineering , Columbia University , New York , NY , USA.
Helen H
HH
Lu
D000375:Aging / Q000378:metabolism / Q000473:pathology; D000818:Animals; D002358:Cartilage, Articular / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D006801:Humans; D010003:Osteoarthritis / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D023822:Tissue Engineering; D014947:Wounds and Injuries / Q000378:metabolism / Q000473:pathology / Q000601:surgery
Bone; cartilage; integration; interface; scaffolds