Future of the cartilage repair


The recently used techniques for cartilage repair are fairly complicated, require sophisticated laboratory work and often more than one surgery. In many basic research facilities research is focused on the novel, stem cell and gene therapeutical methods, but it will be quite a long time before the human applications appear.


The research in cartilage repair is tending toward the treatments using stem cells (mesenchymal stem cell, MSC). These cell have great reproducibility potential and are able to differentiate into many distinct types of tissue according to the cytokines present in the culture media. These cells are present all over the human body thus the harvest of the cells is easier than collecting hyaline cartilage cells. The orientation of the cells toward cartilage, especially hyaline cartilage cells are quite difficult and the results are similar to what we see in first and second generation ACI. The field is progressing very rapidly, and has great potentials in tissue engineering.



            A novel method is aiming on the reduction of number of surgeries needed. The rationale is that cartilage specimen is harvested form the affected joint, from the non weight bearing area, and the small pieces of tissue are minced into very small fractions. These fractions contain cells, and are seeded on a matrix in a one step manner, thus the seeded scaffold is reimplanted during the same surgery. Animal studies were only performed and further assessment is necessary to elucidate the effectiveness of this technique.



            The real breakthrough would be the introduction of gene therapy for osteoarthritis or any cartilage defect. The basic principle of gene therapy is that certain genes are incorporated into viral vectors/messengers. These genes get into the target cells, inducing increased reproduction of the cells and greater production of proteins of the extracellular matrix. All studies of gene therapy in cartilage repair are only in the very early stages and no human application is expected in the near future.  


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