Abstract

Today, treatments of cartilage and osteochondral lesions are routine clinical procedures. Treatment of large Articular Cartilage (AC) defects is technically difficult and complex, often accompanied by failure. Articular cartilage is a highly specialized connective tissue with limited ability to repair itself after injury due to a lack of blood vessels, lymph, and nerves. Therefore, without sufficient and potent intervention, cartilage lesions can easily lead to progressive tissue degeneration, disabling joint pain, and eventually the degenerative disease, Osteoarthritis (OA). Various treatments for cartilage regeneration have shown encouraging results, but unfortunately, none of them have been the perfect solution. New minimally invasive and effective techniques are being developed. The development of tissue engineering technology has created strong promise to engineer or regenerate functional and healthy articular cartilage. In this technology, potential stem cell sources are mainly supplied with pluripotent stem cells and mesenchymal stem cells from various sources. In the meantime, some such as BioSeed®-C and NOVOCART® have been marketed. In this review, the common techniques of articular cartilage reconstruction and the clinical application of articular cartilage tissue engineering are described in detail.

Keywords: Articular cartilage; Cartilage gene therapy; Cartilage product; Regenerative medicine; Tissue engineering; Transplantation methods

Introduction

Articular cartilage is a complex organ with connective tissue that has a limited repair capacity [1]. Usually, small lesions that penetrate the subcutaneous bone layer are repaired by creating a fibrous scar, but extensive injuries require medical intervention. In recent years, a variety of surgical and non-surgical treatments have been developed to repair cartilage, but the complete treatment of lesions larger than 2-4 mm of the articular cartilage remains a therapeutic challenge [2].

Recently, tissue engineering and regenerative medicine using stem cells and biomaterials were able to revolutionize tissue and organ regeneration [3]. This method allows custom design for tissue regeneration and offers tissue replacement that mimics native tissue without adverse effects such as suppression of the immune system or contamination of the donor disease [4]. One of the major challenges in this method is designing appropriate scaffolds with the structure of native tissues [5]. Tissue-engineered cartilage must be highly compatible to prevent acute immune response after transplantation, also it must have special properties such as the ability to combine with subcutaneous bone and adjacent cartilage, mimic the mechanical properties of natural cartilage to maintain function, and withstand long-term loads [6].

In this study, new methods of repairing extensive joint cartilage injuries using different cellular sources and synthesis techniques are reviewed and a list of commercial products used in the treatment of cartilage injuries is presented.

Results and Discussion

All authors have contributed equally to the article conception, data gathering, preparation, draft writing, image drawing, and submission processes.

Conclusion

In summary, reconstruction of articular cartilage defects is a complex procedure. Despite the efforts of researchers, there is still no effective and long-term treatment for articular cartilage damage. Common treatments include surgical procedures such as debridement and arthroscopy, chondrocyte implantation, plastic mosaic, micro fracture, periosteal transplant, heart transplant, osteotomy, and bone marrow stimulation. Cartilage tissue engineering approaches by using different stem cell sources along with appropriate biological scaffolds, chondrogenic factors and physical stimuli, can be a promising way to overcome current limitations and cartilage reconstruction.

Researchers are trying to advance current cartilage therapies toward a consistently successful approach for articular cartilage regenerating. Despite many advances, tissue engineering techniques have limitations for clinical applications, the main problem being in terms of translation, modulation of the host immune system, transplant behavior in the host body, and recovery steps.

Genetic engineering, 3D bioprinting method and cell therapy are being developed alongside other technologies. In the future, combining current strategies with tissue engineering approaches could be a viable solution for the final treatment of cartilage defects.

References

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