Articular Cartilage: Injury Pathways and Treatment Options

Articular cartilage injury and degeneration is a frequent occurrence in synovial joints. Treatment of these articular cartilage lesions are a challenge because this tissue is incapable of quality repair and/or regeneration to its native state. Nonoperative treatments endeavor to control symptoms, and include anti-inflammatory medication, viscosupplementation, bracing, orthotics, and activity modification. Techniques to stimulate the intrinsic repair (fibrocartilage) process include drilling, abrasion, and microfracture of the subchondral bone. Currently, the clinical biologic approaches to treat cartilage defects include autologous chondrocyte implantation, periosteal transfer, and osteochondral autograft or allograft transplantation. Newer strategies employing tissue engineering being studied involve the use of combinations of progenitor cells, bioactive factors, and matrices, and the use of focal synthetic devices. Many new and innovative treatments are being explored in this exciting field. However, there is a paucity of prospective, randomized controlled clinical trials that have compared the various techniques, treatment options, indications and efficacy.

[1]  Bert R. Mandelbaum,et al.  Articular Cartilage Lesions of the Knee , 1998, The American journal of sports medicine.

[2]  J. Slauterbeck,et al.  An analysis of the quality of cartilage repair studies. , 2005, The Journal of bone and joint surgery. American volume.

[3]  D. W. Jackson,et al.  Spontaneous Repair of Full-Thickness Defects of Articular Cartilage in a Goat Model: A Preliminary Study , 2001, The Journal of bone and joint surgery. American volume.

[4]  G. Stein,et al.  Quantitative analysis of pyridinium crosslinks of collagen in the synovial fluid of patients with rheumatoid arthritis using high-performance liquid chromatography , 2005, Rheumatology International.

[5]  J. D. Frost,et al.  Articular cartilage lesions of the knee. , 1989, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[6]  G. Kolarz,et al.  Intra-articular hyaluronic acid: duration of effect and results of repeated treatment cycles. , 1999, American journal of orthopedics.

[7]  A. Gross,et al.  The viability of articular cartilage in fresh osteochondral allografts after clinical transplantation. , 1990, The Journal of bone and joint surgery. American volume.

[8]  T. Schnitzer,et al.  Recommendations for the Medical Management of Osteoarthrits of the Hip and Knee , 2002 .

[9]  W. Puhl,et al.  Intra-articular sodium hyaluronate in osteoarthritis of the knee: a multicenter, double-blind study. , 1993, Osteoarthritis and cartilage.

[10]  N. Caplan,et al.  Two- to 9-Year Outcome After Autologous Chondrocyte Transplantation of the Knee , 2014 .

[11]  S. Santavirta,et al.  Chondrocyte-mediated collagenolysis correlates with cartilage destruction grades in osteoarthritis. , 2005, Clinical and experimental rheumatology.

[12]  B. P. Smith,et al.  Cartilage injuries: a review of 31,516 knee arthroscopies. , 1997, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[13]  E. Arner.  Aggrecanase-mediated cartilage degradation. , 2002, Current opinion in pharmacology.

[14]  D. Stamatiou,et al.  First comprehensive mapping of cartilage transcripts to the human genome. , 2004, Genomics.

[15]  H. Hashidate,et al.  Urinary excretion of type I collagen cross-linked N-telopeptide and serum bone-specific alkaline phosphatase analysis to determine the correlation of age and back-pain related changes in elderly women , 2005, Journal of Bone and Mineral Metabolism.

[16]  P. Noble,et al.  Topographic Matching of Selected Donor and Recipient Sites for Osteochondral Autografting of the Articular Surface of the Femoral Condyles * , 2001, The American journal of sports medicine.

[17]  H J Mankin,et al.  Articular cartilage: tissue design and chondrocyte-matrix interactions. , 1998, Instructional course lectures.

[18]  K. Siminovitch,et al.  The role of viscosupplementation with hylan G-F 20 (Synvisc) in the treatment of osteoarthritis of the knee: a Canadian multicenter trial comparing hylan G-F 20 alone, hylan G-F 20 with non-steroidal anti-inflammatory drugs (NSAIDs) and NSAIDs alone. , 1995, Osteoarthritis and cartilage.

[19]  V. Goldberg,et al.  Repair of osteochondral defects with hyaluronan- and polyester-based scaffolds. , 2005, Osteoarthritis and cartilage.

[20]  S. O’Driscoll,et al.  Articular cartilage regeneration using periosteum. , 1999, Clinical orthopaedics and related research.

[21]  David C. Johnson Patricia A. McGee Darlene D. Rumph - Pe Wilbanks,et al.  Arthritis prevalence and activity limitations--United States, 1990. , 1994, MMWR. Morbidity and mortality weekly report.

[22]  C. Sledge,et al.  Effect of Cultured Autologous Chondrocytes on Repair of Chondral Defects in a Canine Model* , 1997, The Journal of bone and joint surgery. American volume.

[23]  J A Skinner,et al.  Autologous chondrocyte implantation versus matrix-induced autologous chondrocyte implantation for osteochondral defects of the knee: a prospective, randomised study. , 2005, The Journal of bone and joint surgery. British volume.

[24]  Michael A. Slivka,et al.  Evaluation of multiphase implants for repair of focal osteochondral defects in goats. , 2000, Biomaterials.

[25]  E. Vignon,et al.  Cross sectional evaluation of biochemical markers of bone, cartilage, and synovial tissue metabolism in patients with knee osteoarthritis: relations with disease activity and joint damage , 2001, Annals of the rheumatic diseases.

[26]  P. Torzilli,et al.  Increased stromelysin-1 (MMP-3), proteoglycan degradation (3B3- and 7D4) and collagen damage in cyclically load-injured articular cartilage. , 2004, Osteoarthritis and cartilage.

[27]  L. Knodel.  Gastrointestinal toxicity of nonsteroidal antiinflammatory drugs , 1994 .

[28]  S W O'Driscoll,et al.  The role of periosteum in cartilage repair. , 2001, Clinical orthopaedics and related research.

[29]  L. Peterson,et al.  The repair of experimentally produced defects in rabbit articular cartilage by autologous chondrocyte transplantation , 1989, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[30]  L. Ryd,et al.  Intra-articular hyaluronan injections in the treatment of osteoarthritis of the knee: a randomised, double blind, placebo controlled multicentre trial. Hyaluronan Multicentre Trial Group. , 1996, Annals of the rheumatic diseases.

[31]  C. Ohlsson,et al.  Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. , 1994, The New England journal of medicine.

[32]  T. Branch,et al.  Surgical Alternatives for Treatment of Articular Cartilage Lesions , 2000, The Journal of the American Academy of Orthopaedic Surgeons.

[33]  J. Insall.  Intra-articular surgery for degenerative arthritis of the knee. A report of the work of the late K. H. Pridie. , 1967, The Journal of bone and joint surgery. British volume.

[34]  D. V. Van Sickle,et al.  Assessment of donor cell and matrix survival in fresh articular cartilage allografts in a goat model , 1996, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[35]  E. Rodriguez-Merchan.  Articular Cartilage Defects of the Knee , 2012 .

[36]  L. Hangody,et al.  Osteochondral plugs: Autogenousosteochondral mosaicplasty for the treatment of focal chondral and osteochondral articular defects , 1997 .

[37]  K. Kristen,et al.  Spontaneous osteonecrosis of the knee: biochemical markers of bone turnover and pathohistology. , 2005, Osteoarthritis and cartilage.

[38]  L. Hangody,et al.  Mosaicplasty for the treatment of articular cartilage defects: application in clinical practice. , 1998, Orthopedics.

[39]  A. Price,et al.  Management of osteoarthritis of the knee. , 2010, Annals of the Royal College of Surgeons of England.

[40]  M. Wolfe,et al.  Gastrointestinal toxicity of nonsteroidal antiinflammatory drugs. , 1999, The New England journal of medicine.

[41]  Darren L. Johnson.  Master Techniques in Orthopaedic Surgery: Reconstructive Knee Surgery , 2017 .

[42]  D. Heinegård,et al.  Differential Adherence of Osteoarthritis and Rheumatoid Arthritis Synovial Fibroblasts to Cartilage and Bone Matrix Proteins and its Implication for Osteoarthritis Pathogenesis , 2004, Scandinavian journal of immunology.

[43]  D. W. Jackson,et al.  Symptomatic articular cartilage degeneration: the impact in the new millennium. , 2001, Clinical orthopaedics and related research.

[44]  N. Sgaglione,et al.  Biologic approaches to articular cartilage surgery: future trends. , 2005, The Orthopedic clinics of North America.

[45]  G. Jay,et al.  Association of articular cartilage degradation and loss of boundary-lubricating ability of synovial fluid following injury and inflammatory arthritis. , 2005, Arthritis and rheumatism.

[46]  V. Mow,et al.  Biomechanical and Topographic Considerations for Autologous Osteochondral Grafting in the Knee , 2001, The American journal of sports medicine.

[47]  K. Kuettner,et al.  Articular cartilage superficial zone protein (SZP) is homologous to megakaryocyte stimulating factor precursor and Is a multifunctional proteoglycan with potential growth-promoting, cytoprotective, and lubricating properties in cartilage metabolism. , 1999, Biochemical and biophysical research communications.

[48]  D. W. Jackson,et al.  Chondrocyte transplantation. , 1996, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[49]  J. Borrelli,et al.  Acute effects of cartilage impact. , 2004, Clinical orthopaedics and related research.

[50]  J. Buckwalter.  Articular cartilage injuries. , 2002, Clinical orthopaedics and related research.

[51]  M. Dougados,et al.  High molecular weight sodium hyaluronate (hyalectin) in osteoarthritis of the knee: a 1 year placebo-controlled trial. , 1993, Osteoarthritis and cartilage.

[52]  D. W. Jackson,et al.  MRI and Histologic Evaluation of Two Cases of Osteochondral Autograft Transplantation Procedures , 2010, The journal of knee surgery.

[53]  D. Blake,et al.  Intra-articular injections of 750 kD hyaluronan in the treatment of osteoarthritis: a randomised single centre double-blind placebo-controlled trial of 91 patients demonstrating lack of efficacy. , 1994, Annals of the rheumatic diseases.

[54]  J C Garrett,et al.  Osteochondral allografts for reconstruction of articular defects of the knee. , 1998, Instructional course lectures.

[55]  M. Kocher,et al.  Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. , 2003, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[56]  P. Dieppe,et al.  Changes in cartilage metabolism in arthritis are reflected by altered serum and synovial fluid levels of the cartilage proteoglycan aggrecan. Implications for pathogenesis. , 1994, The Journal of clinical investigation.

[57]  W. Hunter.  VI. Of the structure and diseases of articulating cartilages , 1743, Philosophical Transactions of the Royal Society of London.

[58]  U. Irlenbusch,et al.  Investigations in generalized osteoarthritis. Part 1: genetic study of Heberden's nodes. , 2006, Osteoarthritis and cartilage.

[59]  K. Messner,et al.  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. , 1996, Acta orthopaedica Scandinavica.

[60]  Ilyas M. Khan,et al.  The surface of articular cartilage contains a progenitor cell population , 2004, Journal of Cell Science.

[61]  L. Brunnberg,et al.  Biomarkers of joint tissue metabolism in canine osteoarthritic and arthritic joint disorders. , 2002, Osteoarthritis and cartilage.