Knee cartilage replacement therapy

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Articular cartilage, most notably that which is found in the knee joint, is generally characterized by very low friction, high wear resistance, and poor regenerative qualities. It is responsible for much of the compressive resistance and load bearing qualities of the knee joint and, without it, walking is painful to impossible. Osteoarthritis is a common condition of cartilage failure that can lead to limited range of motion, bone damage and invariably, pain. Due to a combination of acute stress and chronic fatigue, osteoarthritis directly manifests itself in a wearing away of the articular surface and, in extreme cases, bone can be exposed in the joint. Some additional examples of cartilage failure mechanisms include cellular matrix linkage rupture, chondrocyte protein synthesis inhibition, and chondrocyte apoptosis. There are several different repair options available for cartilage damage or failure.

Maci or autologous cultured chondrocytes on porcine collagen membrane is a treatment to correct cartilage defects in the knee. This treatment has been approved by the Food and Drug Administration (FDA) for adult treatment only.

Video Knee cartilage replacement therapy

Autologous matrix-induced chondrogenesis

Autologous matrix-induced chondrogenesis, which is also known as AMIC, is a biological treatment option for articular cartilage damage bone marrow stimulating technique in combination with a collagen membrane. It is based on the microfracture surgery with the application of a bi-layer collagen I/III membrane.

The AMIC technique was developed to improve some of the shortfalls of microfracture surgery such as variable repair cartilage volume and functional deterioration over time. The collagen membrane protects and stabilizes the MSCs released through microfracture and enhances their chondrogenic differentiation.

The AMIC surgery is a single-step procedure. Once cartilage damage is assessed there are two methods to access the joint to proceed with the AMIC surgery. First is to perform a mini arthrotomy. Second is an all-arthroscopic procedure.

Maps Knee cartilage replacement therapy

Autologous chondrocyte implantation

The human body's own cartilage is still the best material for lining knee joints. This drives efforts to develop ways of using a person's own cells to grow, or re-grow cartilage tissue to replace missing or damaged cartilage. One cell-based replacement technique is called autologous chondrocyte implantation (ACI) or autologous chondrocyte transplantation (ACT).

A review evaluating autologous chondrocyte implantation was published in 2010. The conclusions are that it is an effective treatment for full thickness chondral defects. The evidence does not suggest ACI is superior to other treatments.

One ACI treatment, called Carticel, is designated for young, healthy patients with medium to large sized damage to cartilage and is not applicable to osteoarthritis patients. The patient's chondrocytes are removed arthroscopically from a non load-bearing area from either the intercondylar notch or the superior ridge of the medial or lateral femoral condyles. 10,000 cells are harvested and grown in vitro for approximately six weeks until the population reaches 10-12 million cells. Then these cells are injected into the patient. These cells are held in place by a small piece of soft tissue from the tibia, called a periosteal flap, which is sutured over the area to serve as a watertight lid. The implanted chondrocytes then divide and integrate with surrounding tissue and potentially generate hyaline-like cartilage. The cost of the treatment ranges from ($USD) 20,000-35,000. A second generation technique, called Carticel II uses a "fleece matrix" implanted with chondrocyte cells that is arthroscopically inserted into the joint. This procedure is known as matrix autologous chondrocyte implantation or (MACI) and is available in Germany, UK, and Australia.

A variation on the Carticel technique, called matrix-associated autologous chondrocyte transplantation (MACT), grows the patient's cells in a 3D matrix of resorbable tissue which is implanted via an open or arthroscopic procedure. It appears to be a simpler technique and resolves some of the issues of using Carticel under a periosteal patch.

Another ACI technique, using "chrondospheres", uses only chrondrocytes and no matrix material. The cells grow in self-organized spheroid matrices which are implanted via injected fluid or inserted tissue matrix.

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Autologous mesenchymal stem cell transplantation

For years, the concept of harvesting stem cells and re-implanting them into one's own body to regenerate organs and tissues has been embraced and researched in animal models. In particular, mesenchymal stem cells have been shown in animal models to regenerate cartilage. Recently, there have been several published case reports of successful cartilage growth in human knees using autologous cultured mesenchymal stem cells. In addition, an n=229 safety study has also been published showing safety better than surgical alternatives for this cultured cell injection procedure at a 3-year follow-up. An advantage to this approach is that a person's own stem cells are used, avoiding tissue rejection by the patient's immune system.

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Microdrilling augmented with peripheral blood stem cells

A 2011 study reports histologically confirmed hyaline cartilage regrowth in a 5 patient case-series, 2 with grade IV bipolar or kissing lesions in the knee. The successful protocol involves arthroscopic microdrilling/ microfracture surgery followed by postoperative injections of autologous peripheral blood progenitor cells(PBPC's) and hyaluronic acid(HA). PBPC's are a blood product containing mesenchymal stem cells and is obtained by mobilizing the stem cells into the peripheral blood. Dr. Khay Yong Saw and his team propose that the microdrilling surgery creates a blood clot scaffold on which injected PBPC's can be recruited and enhance chondrogenesis at the site of the contained lesion. They explain that the significance of this cartilage regeneration protocol is that it is successful in patients with historically difficult-to-treat grade IV bipolar or bone-on-bone osteochondral lesions.

Dr. Saw and his team are currently conducting a larger randomized trial and working towards beginning a multicenter study. The work of the Malaysian research team is gaining international attention.

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See also

• Meniscal cartilage replacement therapy
• Meniscus transplant

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References

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External links

• Minimally Invasive Total Knee Replacement. American Academy of Orthopaedic Surgeons. February 2005.
• Osteochondral Grafting of Articular Cartilage Injurie at eMedicine
• Total Knee Replacement. American Academy of Orthopaedic Surgeons. January 2006.

Source of the article : Wikipedia