Operative Treatment of Knee Cartilage Injuries: A Review of the Current Literature on Non-Cell-Based and Cell-Based Therapies
P. K. Jaiswal, K. Wong, W. S. Khan
Journal of Advances in Medicine and Medical Research · pp. 516–537 · Published 29 Sep 2011
10.9734/BJMMR/2011/562Abstract
Aims: Cartilage is frequently damaged through injury and disease but shows little or no capacity for repair. Injuries that extend to the subchondral level show some capacity for repair due to the release of bone marrow derived mesenchymal stem cells. Focal articular cartilage defects are challenging clinical problems that may progress to more generalised lesions. We reviewed the literature to analyse the results of available non-cell-based and cell-based strategies for the repair of articular cartilage defects in the knee. Study design: Review Article Place and Duration of Study: University College London Institute of Orthopaedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, United Kingdom Methodology: We reviewed the literature to identify studies on the use of non-cell-based and cell-based strategies for the repair of articular cartilage defects in the knee. Results: Repair techniques that do not utilise cell therapy include bone marrow stimulating techniques such as microfracture that is effective in small well-contained lesions and has the advantages of being performed arthroscopically as a single stage and cheaper costs compared to cell-based therapies. It also associated with no donor site morbidity unlike mosaicplasty, and perichondrial or periosteal grafting. The evidence suggests that none of the techniques described above consistently produce durable results. There are encouraging mid-term results with Autologous Matrix Induced Chondrogenesis (AMIC) procedures in small number of patients. Although microfracture is appropriate for smaller cartilage defects, Autologous Chondrocyte Implantation (ACI) and Matrix-carried Autologous Chondrocyte Implantation (MACI), as well as other cell carrier systems, are currently used to treat larger full thickness chondral defects in the knee. Although the results are fairly similar, MACI and procedures using other cell carrier systems are amenable to be performed arthroscopically or through a more limited approach. There are a small number of studies using mesenchymal stem cells with promising early results bur further in vitro and in vivo studies are needed before this treatment becomes more routinely available. Conclusion: Focal articular cartilage defects are challenging clinical problems that progress to more generalised lesions. Only cartilage injuries that extend to the subchondral level show some capacity for repair due to the release of bone marrow derived mesenchymal stem cells. Bone marrow stimulating techniques such as microfracture are effective in small well-contained lesions (<2cm2) and have the advantages of being performed arthroscopically as a single stage and cheaper costs compared to cell-based therapies. Mosaicplasty, and perichondrial or periosteal grafting are associated with donor site morbidity. Longer term studies on AMIC may help define the role for this procedure. The best form of non-cell-based treatment for focal articular cartilage defects in the long term is still unknown. ACI and MACI, as well as other cell carrier systems, are currently used in clinical practice to treat larger full thickness chondral defects in the knee. There are a small number of studies using mesenchymal stem cells and further in vitro and in vivo studies are needed before this treatment is optimised.
References (133)
- 1 Treatment of Deep Cartilage Defects in the Knee with Autologous Chondrocyte Transplantation [DOI]
- 2 In VitroChondrogenesis of Bone Marrow-Derived Mesenchymal Progenitor Cells [DOI]
- 3 Mesenchymal cell-based repair of large, full-thickness defects of articular cartilage. [DOI]
- 4 Comparison of human stem cells derived from various mesenchymal tissues: Superiority of synovium as a cell source [DOI]
- 5 Microfracture: Surgical Technique and Rehabilitation to Treat Chondral Defects [DOI]
- 6 The response of articular cartilage to mechanical injury. [DOI]
- 7 Outcomes of microfracture for traumatic chondral defects of the knee: Average 11‐year follow‐up [DOI]
- 8 AUTOLOGOUS OSTEOCHONDRAL MOSAICPLASTY FOR THE TREATMENT OF FULL-THICKNESS DEFECTS OF WEIGHT-BEARING JOINTS [DOI]
- 9 Human autologous culture expanded bone marrow mesenchymal cell transplantation for repair of cartilage defects in osteoarthritic knees [DOI]
- 10 A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee [DOI]
- 11 Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study [DOI]
- 12 Results after microfracture of full-thickness chondral defects in different compartments in the knee [DOI]
- 13 High tibial osteotomy for varus gonarthrosis. A long-term follow-up study. [DOI]
- 14 Microfracture technique forfull-thickness chondral defects: Technique and clinical results [DOI]
- 15 Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length.
- 16 Arthroscopic autogenous osteochondral mosaicplasty for the treatment of femoral condylar articular defects [DOI]
- 17 Current Concepts in the Treatment of Articular Cartilage Defects [DOI]
- 18 Rabbit Articular Cartilage Defects Treated With Autologous Cultured Chondrocytes [DOI]
- 19 Failure of in vitro–differentiated mesenchymal stem cells from the synovial membrane to form ectopic stable cartilage in vivo [DOI]
- 20 The microfracture technique in the treatment of full-thickness chondral lesions of the knee in National Football League players.
- 21 Treatment of Articular Cartilage Defects in Athletes: An Analysis of Functional Outcome and Lesion Appearance [DOI]
- 22 The Install Award. Survivorship of the high tibial valgus osteotomy. A 10- to -22-year followup study.
- 23 Autologous Osteochondral Grafting in the Knee: Indication, Results, and Reflections [DOI]
- 24 ADVANCED TECHNIQUES IN AUTOLOGOUS CHONDROCYTE TRANSPLANTATION [DOI]
- 25 Anti-inflammatory effects of mesenchymal stem cells: novel concept for future therapies [DOI]
- 26 Proximal tibial osteotomy [DOI]
- 27 Osteochondritis dissecans of the femoral condyles: a long-term follow-up study.
- 28 Autologous osteochondral mosaicplasty. Surgical technique.
- 29 Autologous Chondrocyte Implantation in Chondral Defects of the Knee With a Type I/III Collagen Membrane: A Prospective Study With a 3‐Year Follow‐up [DOI]
- 30 Sources of Adult Mesenchymal Stem Cells Applicable for Musculoskeletal Applications - A Systematic Review of the Literature [DOI]
- 31 Opening Wedge High Tibial Osteotomy [DOI]
- 32 Patient Satisfaction and Outcome After Microfracture of the Degenerative Knee [DOI]
- 33 Evaluation of Cartilage Repair Tissue after Matrix-Associated Autologous Chondrocyte Transplantation Using a Hyaluronic-Based or a Collagen-Based Scaffold with Morphological MOCART Scoring and Biochemical T2 Mapping [DOI]
- 34 Human infrapatellar fat pad-derived stem cells express the pericyte marker 3G5 and show enhanced chondrogenesis after expansion in fibroblast growth factor-2 [DOI]
- 35 Homotransplantation of Isolated Epiphyseal and Articular Cartilage Chondrocytes into Joint Surfaces of Rabbits [DOI]
- 36 Does arthroscopic abrasion arthroplasty promote cartilage regeneration in osteoarthritic knees with eburnation? A prospective study of high tibial osteotomy with abrasion arthroplasty versus high tibial osteotomy alone [DOI]
- 37 Treatment of Deep Cartilage Defects of the Knee Using Autologous Chondrograft Transplantation and by Abrasive Techniques — A Randomized Controlled Study [DOI]
- 38 Osteochondral autografting (mosaicplasty) in articular cartilage defects in the knee: Results at 5 to 9 years [DOI]
- 39 Bone marrow‐derived mesenchymal stem cells express the pericyte marker 3G5 in culture and show enhanced chondrogenesis in hypoxic conditions [DOI]
- 40 The Use of Growth Factors and Mesenchymal Stem Cells in Orthopaedics [DOI]
- 41 Reconstruction of the patellar articulation with periosteal grafts: 4-year follow-up of 13 cases [DOI]
- 42 Autologous Chondrocyte Transplantation [DOI]
- 43 Patient Satisfaction After Medial Opening High Tibial Osteotomy and Microfracture [DOI]
- 44 The treatment of articular cartilage defects using microfracture and debridement.
- 45 Chondrogenic induction of human mesenchymal stem cells using combined growth factors for cartilage tissue engineering [DOI]
- 46 Survival of Frozen Chondrocytes Isolated from Cartilage of Adult Mammals [DOI]
- 47 Transplantation of free tibial periosteal grafts for the repair of articular cartilage defect: An experimental study [DOI]
- 48 Role of carbon fibre implants in osteochondral defects of the knee [DOI]
- 49 Current cell-based strategies for knee cartilage injuries.
- 50 Cartilage Repair with Chondrocytes: Clinical and Cellular Aspects [DOI]
- 51 Dedifferentiated chondrocytes reexpress the differentiated collagen phenotype when cultured in agarose gels [DOI]
- 52 Articular cartilage repair: basic science and clinical progress. A review of the current status and prospects [DOI]
- 53 The Role of Knee Alignment in Disease Progression and Functional Decline in Knee Osteoarthritis [DOI]
- 54 Clinical Efficacy of the Microfracture Technique for Articular Cartilage Repair in the Knee [DOI]
- 55 Autologous Chondrocyte Implantation [DOI]
- 56 Characterized Chondrocyte Implantation Results in Better Structural Repair when Treating Symptomatic Cartilage Defects of the Knee in a Randomized Controlled Trial versus Microfracture [DOI]
- 57 The repair of experimentally produced defects in rabbit articular cartilage by autologous chondrocyte transplantation [DOI]
- 58 A Prospective Randomized Clinical Study of Mosaic Osteochondral Autologous Transplantation Versus Microfracture for the Treatment of Osteochondral Defects in the Knee Joint in Young Athletes [DOI]
- 59 Treatment of Symptomatic Cartilage Defects of the Knee [DOI]
- 60 Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Articular Cartilage. Part I [DOI]
- 61 Mesenchymal multipotency of adult human periosteal cells demonstrated by single‐cell lineage analysis [DOI]
- 62 The long-term prognosis for severe damage to weight-bearing cartilage in the knee: A 14-year clinical and radiographic follow-up in 28 young athletes [DOI]
- 63 Matrix‐induced autologous chondrocyte implantation versus microfracture in the treatment of cartilage defects of the knee: a 2‐year randomised study [DOI]
- 64 Is Microfracture of Chondral Defects in the Knee Associated With Different Results in Patients Aged 40 Years or Younger? [DOI]
- 65 A prospective, ranomised study comparing two techniques of autologous chondrocyte implantation for osteochondral defects in the knee: Periosteum covered versus type I/III collagen covered [DOI]
- 66 Enhanced early chondrogenesis in articular defects following arthroscopic mesenchymal stem cell implantation in an equine model [DOI]
- 67 Mid‐term results of Autologous Matrix‐Induced Chondrogenesis for treatment of focal cartilage defects in the knee [DOI]
- 68 Autologous Chondrocyte Implantation Using the Original Periosteum-Cover Technique versus Matrix-Associated Autologous Chondrocyte Implantation [DOI]
- 69 A Prospective Study of Autologous Chondrocyte Implantation in Patients with Failed Prior Treatment for Articular Cartilage Defect of the Knee [DOI]
- 70 Marrow stimulation techniques [DOI]
- 71 The Immunogenicity and Immunomodulatory Function of Osteogenic Cells Differentiated from Mesenchymal Stem Cells [DOI]
- 72 Autologous Cultured Chondrocytes: Adverse Events Reported to the United States Food and Drug Administration [DOI]
- 73 Autologous matrix‐induced chondrogenesis combined with platelet‐rich plasma gel: technical description and a five pilot patients report [DOI]
- 74 High Tibial Osteotomy for Unloading Osteochondral Defects in the Medial Compartment of the Knee [DOI]
- 75 Autologous Osteochondral Mosaicplasty [DOI]
- 76 Long-Term Durability of Autologous Chondrocyte Implantation [DOI]
- 77 Outcomes of Full‐Thickness Articular Cartilage Injuries of the Shoulder Treated With Microfracture [DOI]
- 78 Perichondral grafting for cartilage lesions of the knee [DOI]
- 79 Tibial Osteotomy for Varus Gonarthrosis [DOI]
- 80 The effects of high magnitude cyclic tensile load on cartilage matrix metabolism in cultured chondrocytes [DOI]
- 81 Ex vivo synthesis of articular cartilage [DOI]
- 82 Tissue-engineered growth of cartilage: the effect of varying the concentration of chondrocytes seeded onto synthetic polymer matrices [DOI]
- 83 The results of arthroscopic lavage and debridement of osteoarthritic knees based on the severity of degeneration [DOI]
- 84 Traditional vs accelerated approaches to post-operative rehabilitation following matrix-induced autologous chondrocyte implantation (MACI): comparison of clinical, biomechanical and radiographic outcomes [DOI]
- 85 Autologous Chondrocyte Implantation in the Knee Joint: Open Compared with Arthroscopic Technique [DOI]
- 86 MRI and clinical evaluation of collagen-covered autologous chondrocyte implantation (CACI) at two years [DOI]
- 87 Simultaneous arthroscopic implantation of autologous chondrocytes and high tibial osteotomy for tibial chondral defects in the varus knee [DOI]
- 88 The Role of Bioreactors in Tissue Engineering for Musculoskeletal Applications [DOI]
- 89 Mesenchymal Stem Cells and Articular Cartilage Repair: Clinical Studies and Future Direction [DOI]
- 90 Long-term results of rib perichondrial grafts for repair of cartilage defects in the human knee [DOI]
- 91 Up-Regulation of Matrix Metalloproteinase Expression and Activation Following Cyclical Compressive Loading of Articular Cartilage in Vitro [DOI]
- 92 Pretreatment of periosteum with TGF-β1 in situ enhances the quality of osteochondral tissue regenerated from transplanted periosteal grafts in adult rabbits [DOI]
- 93 Behavior of Articular Chondrocytes in Cell Culture [DOI]
- 94 Osteochondritis dissecans of the femoral condyle treated with periosteal transplantation: Poor outcome in 14 patients followed for 6–9 years [DOI]
- 95 Articular cartilage regeneration of the knee joint after proximal tibial valgus osteotomy: a prospective study of different intra‐ and extra‐articular operative techniques [DOI]
- 96 Treatment of painful articular cartilage defects of the patella by carbon-fibre implants [DOI]
- 97 Autologous chondrocyte implantation: where do we stand now? [DOI]
- 98 Treatment of deep cartilage defects of the patella with periosteal transplantation [DOI]
- 99 The repair of osteochondral defects in osteoarthritic rabbit knees by the use of carbon fibre [DOI]
- 100 Advances and Developments in the Use of Human Mesenchymal Stem Cells – A Few Considerations [DOI]
- 101 Multilineage Potential of Adult Human Mesenchymal Stem Cells [DOI]
- 102 Autologous Chondrocyte Implantation Compared with Microfracture in the Knee [DOI]
- 103 A CONTROLLED TRIAL OF ARTHROSCOPIC SURGERY FOR OSTEOARTHRITIS OF THE KNEE
- 104 The surface of articular cartilage contains a progenitor cell population [DOI]
- 105 The Chondrogenic Potential of Human Bone-Marrow-Derived Mesenchymal Progenitor Cells* [DOI]
- 106 A Randomized Trial Comparing Autologous Chondrocyte Implantation with Microfracture [DOI]
- 107 Treatment of full thickness chondral lesions of the knee with microfracture in a group of athletes [DOI]
- 108 The Clinical Use of Human Culture–Expanded Autologous Bone Marrow Mesenchymal Stem Cells Transplanted on Platelet-Rich Fibrin Glue in the Treatment of Articular Cartilage Defects [DOI]
- 109 Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. [DOI]
- 110 High-Impact Athletics after Knee Articular Cartilage Repair [DOI]
- 111 Autologous chondrocyte implantation at the knee using a bilayer collagen membrane with bone graft [DOI]
- 112 Microfracture of the Hip in Athletes [DOI]
- 113 Autologous chondrocyte implantation versus microfracture for knee cartilage injury: a prospective randomized trial, with 2‐year follow‐up [DOI]
- 114 Chondral Resurfacing and High Tibial Osteotomy in the Varus Knee [DOI]
- 115 HOMOTRANSPLANTATION OF ARTICULAR CARTILAGE AND ISOLATED CHONDROCYTES [DOI]
- 116 Results of total knee arthroplasty after failed proximal tibial osteotomy for osteoarthritis. [DOI]
- 117 ARTICULAR DEBRIDEMENT VERSUS WASHOUT FOR DEGENERATION OF THE MEDIAL FEMORAL CONDYLE [DOI]
- 118 Localization of Tritiated Thymidine in Articular Cartilage of Rabbits [DOI]
- 119 Chondral Resurfacing and High Tibial Osteotomy in the Varus Knee [DOI]
- 120 Sources of Adult Mesenchymal Stem Cells and their Applicability for Musculoskeletal Applications [DOI]
- 121 Regulation of Differentiation of Mesenchymal Stem Cells into Musculoskeletal Cells [DOI]
- 122 The induction of neochondrogenesis in free intra-articular periosteal autografts under the influence of continuous passive motion. An experimental investigation in the rabbit. [DOI]
- 123 ROLE OF ABRASION ARTHROPLASTY AND DEBRIDEMENT IN THE MANAGEMENT OF OSTEOARTHRITIS OF THE KNEE [DOI]
- 124 Carbon fiber scaffolds in the treatment of early knee osteoarthritis. A prospective 4-year followup of 37 patients.
- 125 Repair of articular surfaces by allografts of articular and growth-plate cartilage [DOI]
- 126 Localization of Tritiated Thymidine in Articular Cartilage of Rabbits [DOI]
- 127 Osteochondral Defects of the Knee [DOI]
- 128 Stem Cell Applications and Tissue Engineering Approaches in Surgical Practice [DOI]
- 129 The Potential Therapeutic Use of Stem Cells in Cartilage Repair [DOI]
- 130 Total Knee Replacement Following High Tibial Osteotomy and Unicompartmental Knee [DOI]
- 131 Histological and biochemical evaluation of perichondrial transplants in human articular cartilage defects [DOI]
- 132 Tissue Engineering in Orthopaedics and Musculoskeletal Sciences [DOI]
- 133 [Long-term clinical observation on the repair of large articular cartilage defects of the hip and the knee with free autogeneous periosteum].
Cited by 3
Peter D. Counsel, Daniel Bates, Richard Boyd · Sports Health: A Multidisciplinary Approach · 2014
Showing 1 of 3 known citations — external sources report more than can currently be individually listed.
Related research
- The Role of MSC-Derived Exosomes in Soft Tissue Remodelling via the PTEN and PI3K/AKT Pathway Following Wide Excision of Fibrosarcoma: A Review — shares topic coverage
- Mesenchymal Stem Cell-based Cancer Gene Therapy: Application and Unresolved Problems — shares topic coverage
- Advances in Cell Therapy Using Rabbit Models for Regenerative Medicine — shares topic coverage
- Enhanced Wound Healing in Diabetic Rat Limbs Using Autologous Mesenchymal Stem Cell Micrografts via the Rigenera® System — shares topic coverage
- Etiopathogenesis and Stem Cell Treatment Outcomes in Avascular Necrosis of the Femoral Head: A Review of 50 Cases — shares topic coverage
Article metrics
Real usage data collected on this platform.
20
Page views
0
PDF downloads
1
Outbound clicks
3
Citations
Views over time
Views by country
Approximate, from request IP at view time — not citizenship or institution. Countries with fewer than 5 views are grouped as "Other".
Traffic sources
Referring site, by host.
Views and downloads exclude known bots/crawlers. Citations combines this platform's own DOI-resolved index with each external source's own reported total — see Cited by above for individually listed citing works. Last refreshed 0 seconds ago.