Emerging technologies: What is the future of cartilage restoration?

Abstract

Algorithms for operative treatme-nt of symptomatic chondral lesions vary, but guidelines for choosing be-tween currently available treatmen-ts have been offered 4,5 . These includ-e evaluation and treatment of any a-ssociated joint pathologies including systemic disorders, limb malalignm-ent, meniscal deficiency and ligame-ntous instability. A thorough assess-ment of the size, thickness and locat-ion of the chondral lesion is also req-uired. Based on lesion and patient c-haracteristics, a treatment strategy is chosen. In current practice, this t-ypically includes one of the followin-g options: simple debridement, mic-rofracture, osteochondral autograft or allograft transplantation or cell-b-ased therapy such as autologous chondrocyte implantation (ACI). Each of these strategies has relati-ve merits and limitations, but no cu-rrently available technique meets all requirements for an 'ideal' treatme-nt option. As described by Gomoll a-nd Farr, an ideal cartilage repair tec-hnique would be (1) cost-efficient, (2) easily available or of-the-shelf, (3) implantable through a single-sta-ge, minimally invasive technique, (4) produce physiologically stratified, f-ully integrated (basilar and margin-al) hyaline repair tissue and (5) allo-w for quick return to activity 6 . While current options–with varying degre-es of efficacy–may ameliorate symp-toms, the broader goal of restoring a durable, smooth, hyaline tissue that effectively transmits shear and com-pressive loads from the cartilage to the bone remains elusive 7 . A recapit-ulation of the multilayered nature of hyaline cartilage, including