Treatment of Knee Cartilage Lesions in 2024: From Hyaluronic Acid to Regenerative Medicine

Overview

Journal J Exp Orthop

Publisher Wiley

Specialty Orthopedics

Date 2024 Apr 4

PMID 38572391

Authors

Mats Brittberg

Affiliations

Soon will be listed here.

Abstract

Abstract: Intact articular cartilage plays a vital role in joint homeostasis. Local cartilage repairs, where defects in the cartilage matrix are filled in and sealed to congruity, are therefore important treatments to restore a joint equilibrium. The base for all cartilage repairs is the cells; either chondrocytes or chondrogeneic cells from bone, synovia and fat tissue. The surgical options include bone marrow stimulation techniques alone or augmented with scaffolds, chondrogeneic cell implantations and osteochondral auto- or allografts. The current trend is to choose one-stage procedures being easier to use from a regulatory point of view. This narrative review provides an overview of the current nonoperative and surgical options available for the repair of various cartilage lesions.

Level Of Evidence: Level IV.

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References

Shah S, Mithoefer K . Current Applications of Growth Factors for Knee Cartilage Repair and Osteoarthritis Treatment. Curr Rev Musculoskelet Med. 2020; 13(6):641-650. PMC: 7661573. DOI: 10.1007/s12178-020-09664-6. View

Farr J, Gracitelli G, Shah N, Chang E, Gomoll A . High Failure Rate of a Decellularized Osteochondral Allograft for the Treatment of Cartilage Lesions. Am J Sports Med. 2016; 44(8):2015-22. DOI: 10.1177/0363546516645086. View

Johnson L . Arthroscopic abrasion arthroplasty: a review. Clin Orthop Relat Res. 2001; (391 Suppl):S306-17. View

Brittberg M . Treatment of knee cartilage lesions in 2024: From hyaluronic acid to regenerative medicine. J Exp Orthop. 2024; 11(2):e12016. PMC: 10985633. DOI: 10.1002/jeo2.12016. View

Gatenholm B, Brittberg M . Neuropeptides: important regulators of joint homeostasis. Knee Surg Sports Traumatol Arthrosc. 2018; 27(3):942-949. DOI: 10.1007/s00167-018-5074-4. View

Mehl J, Otto A, Baldino J, Achtnich A, Akoto R, Imhoff A . The ACL-deficient knee and the prevalence of meniscus and cartilage lesions: a systematic review and meta-analysis (CRD42017076897). Arch Orthop Trauma Surg. 2019; 139(6):819-841. DOI: 10.1007/s00402-019-03128-4. View

Olivos-Meza A, Brittberg M, Martinez-Nava G, Landa-Solis C . Suitable characteristics in the selection of human allogeneic chondrocytes donors to increase the number of viable cells for cartilage repair. Cell Tissue Bank. 2023; 24(4):725-735. PMC: 10030348. DOI: 10.1007/s10561-023-10074-4. View

Lu Y, Dhanaraj S, Wang Z, Bradley D, Bowman S, Cole B . Minced cartilage without cell culture serves as an effective intraoperative cell source for cartilage repair. J Orthop Res. 2006; 24(6):1261-70. DOI: 10.1002/jor.20135. View

Brittberg M, Winalski C . Evaluation of cartilage injuries and repair. J Bone Joint Surg Am. 2003; 85-A Suppl 2:58-69. DOI: 10.2106/00004623-200300002-00008. View

10.

Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L . Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med. 1994; 331(14):889-95. DOI: 10.1056/NEJM199410063311401. View

11.

Irwin R, Gao T, Boys A, Ortved K, Cohen I, Bonassar L . Microscale strain mapping demonstrates the importance of interface slope in the mechanics of cartilage repair. J Biomech. 2020; 114:110159. PMC: 7808171. DOI: 10.1016/j.jbiomech.2020.110159. View

12.

Li C, Fennessy P . The periosteum: a simple tissue with many faces, with special reference to the antler-lineage periostea. Biol Direct. 2021; 16(1):17. PMC: 8522104. DOI: 10.1186/s13062-021-00310-w. View

13.

Chen H, Chevrier A, Hoemann C, Sun J, Ouyang W, Buschmann M . Characterization of subchondral bone repair for marrow-stimulated chondral defects and its relationship to articular cartilage resurfacing. Am J Sports Med. 2011; 39(8):1731-40. DOI: 10.1177/0363546511403282. View

14.

Hjelle K, Solheim E, Strand T, Muri R, Brittberg M . Articular cartilage defects in 1,000 knee arthroscopies. Arthroscopy. 2002; 18(7):730-4. DOI: 10.1053/jars.2002.32839. View

15.

Lisignoli G, Cristino S, Piacentini A, Toneguzzi S, Grassi F, Cavallo C . Cellular and molecular events during chondrogenesis of human mesenchymal stromal cells grown in a three-dimensional hyaluronan based scaffold. Biomaterials. 2005; 26(28):5677-86. DOI: 10.1016/j.biomaterials.2005.02.031. View

16.

Megaloikonomos P, Becher C, VAN DER Stok J, ODonnell T . Femoral condyle resurfacing using an inlay metal implant: low revision rate of 266 patients in a 5-10 years follow-up. Arch Orthop Trauma Surg. 2021; 143(3):1243-1251. DOI: 10.1007/s00402-021-04251-x. View

17.

Courties A, Gualillo O, Berenbaum F, Sellam J . Metabolic stress-induced joint inflammation and osteoarthritis. Osteoarthritis Cartilage. 2015; 23(11):1955-65. DOI: 10.1016/j.joca.2015.05.016. View

18.

Terzidis I, Totlis T, Papathanasiou E, Sideridis A, Vlasis K, Natsis K . Gender and Side-to-Side Differences of Femoral Condyles Morphology: Osteometric Data from 360 Caucasian Dried Femori. Anat Res Int. 2012; 2012:679658. PMC: 3437276. DOI: 10.1155/2012/679658. View

19.

Efe T, Theisen C, Fuchs-Winkelmann S, Stein T, Getgood A, Rominger M . Cell-free collagen type I matrix for repair of cartilage defects-clinical and magnetic resonance imaging results. Knee Surg Sports Traumatol Arthrosc. 2011; 20(10):1915-22. DOI: 10.1007/s00167-011-1777-5. View

20.

Nguyen D, Hagg D, Forsman A, Ekholm J, Nimkingratana P, Brantsing C . Cartilage Tissue Engineering by the 3D Bioprinting of iPS Cells in a Nanocellulose/Alginate Bioink. Sci Rep. 2017; 7(1):658. PMC: 5428803. DOI: 10.1038/s41598-017-00690-y. View