TREATMENT STRATEGY OF OSTEOCHONDRAL DEFECTS OF KNEE JOINT_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANGYongcheng , YUANXueling ,  WANGAiyuan , PENGJiang , LUShibi

Key Laboratory of Chinese PLA, Institute of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P. R. China;

Corresponding author：

WANGAiyuan, Email: aiyuanwang301@126.com

Keywords：

Osteochondral defect; Articular cartilage; Subchondral bone; Osteochondral tissue engineering

DOI：

10.7507/1002-1892.20140025

Video：

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Objective To review the current treatment status of osteochondral defects (OCD) of the knee joint. Methods Recent literature concerning treatment of OCD of the knee joint was extensively reviewed and summarized. Results OCD affect both the articular cartilage and the underlying subchondral bone, whereas OCD caused by different etiologies require various treatments. OCD repair is available by conventional clinical methods or the advanced tissue engineering strategies. Current clinical treatment outcomes remain uncertain; tissue engineering has emerged as a potential option as it can be efficiently applied to regenerate bone, cartilage, and the bone-cartilage interface, as well as effectively restore normal function and mechanical properties of the cartilage and subchondral bone. Conclusion OCD management and repair remain a great challenge in orthopedic surgery, thus cartilage and subchondral bone should be promoted as an interdependent functional unit considering treatment strategies to provide the best solution for the treatment of osteochondral defects.

Citation： WANGYongcheng, YUANXueling, WANGAiyuan, PENGJiang, LUShibi. TREATMENT STRATEGY OF OSTEOCHONDRAL DEFECTS OF KNEE JOINT. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(1): 113-118. doi: 10.7507/1002-1892.20140025 Copy

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2.	Laupattarakasem W,Laopaiboon M,Laupattarakasem P,et al.Arthroscopic debridement for knee osteoarthritis.Cochrane Database Syst Rev,2008,(1):CD005118.
3.	Moseley JB,O'Malley K,Petersen NJ,et al.A controlled trial of arthroscopic surgery for osteoarthritis of the knee.N Engl J Med,2002,347(2):81-88.
4.	Matsunaga D,Akizuki S,Takizawa T,et al.Repair of articular cartilage and clinical outcome after osteotomy with microfracture or abrasion arthroplasty for medial gonarthrosis.Knee,2007,14(6):465-471.
5.	Kosy JD,Schranz PJ,Toms AD,et al.The use of radiofrequency energy for arthroscopic chondroplasty in the knee.Arthroscopy,2011,27(5):695-703.
6.	Harris JD,Brophy RH,Siston RA,et al.Treatment of chondral defects in the athlete's knee.Arthroscopy,2010,26(6):841-852.
7.	Spahn G,Kahl E,Mückley T,et al.Arthroscopic knee chondroplasty using a bipolar radiofrequency-based device compared to mechanical shaver:results of a prospective,randomized,controlled study.Knee Surg Sports Traumatol Arthrosc,2008,16(6):565-573.
8.	Ollat D,Lebel B,Thaunat M,et al.Mosaic osteochondral transplantations in the knee joint,midterm results of the SFA multicenter study.Orthop Traumatol Surg Res,2011,97(8 Suppl):S160-166.
9.	Haene R,Qamirani E,Story RA,et al.Intermediate outcomes of fresh talar osteochondral allografts for treatment of large osteochondral lesions of the talus.J Bone Joint Surg (Am),2012,94(12):1105-1110.
10.	Brittberg M,Lindahl A,Nilsson A,et al.Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation.N Engl J Med,1994,331(14):889-895.
11.	Gobbi A,Kon E,Berruto M,et al.Patellofemoral full-thickness chondral defects treated with second-generation autologous chondrocyte implantation:results at 5 years'follow-up.Am J Sports Med,2009,37(6):1083-1092.
12.	McNickle AG,Provencher MT,Cole BJ.Overview of existing cartilage repair technology.Sports Med Arthrosc,2008,16(4):196-201.
13.	Capito RM,Spector M.Scaffold-based articular cartilage repair.IEEE Eng Med Biol Mag,2003,22(5):42-50.
14.	Lee SH,Shin H.Matrices and scaffolds for delivery of bioactive molecules in bone and cartilage tissue engineering.Adv Drug Deliv Rev,2007,59(4-5):339-359.
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19.	Jeong CG,Zhang H,Hollister SJ.Three-dimensional polycaprolactone scaffold-conjugated bone morphogenetic protein-2 promotes cartilage regeneration from primary chondrocytes in vitro and in vivo without accelerated endochondral ossification.J Biomed Mater Res A,2012,100(8):2088-2096.
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27.	Jiang J,Tang A,Ateshian GA,et al.Bioactive stratified polymer ceramic-hydrogel scaffold for integrative osteochondral repair.Ann Biomed Eng,2010,38(6):2183-2196.
28.	Chen K,Shi P,Teh TK,et al.In vitro generation of a multilayered osteochondral construct with an osteochondral interface using rabbit bone marrow stromal cells and a silk peptide-based scaffold.J Tissue Eng Regen Med,2013.[Epub ahead of print].
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39.	Wang X,Wenk E,Zhang X,et al.Growth factor gradients via microsphere delivery in biopolymer scaffolds for osteochondral tissue engineering.J Control Release,2009,134(2):81-90.
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46.	Darling EM,Athanasiou KA.Rapid phenotypic changes in passaged articular chondrocyte subpopulations.J Orthop Res,2005,23(2):425-432.
47.	Yonenaga K,Nishizawa S,Fujihara Y,et al.The optimal conditions of chondrocyte isolation and its seeding in the preparation for cartilage tissue engineering.Tissue Eng Part C Methods,2010,16(6):1461-1469.
48.	Caplan AI.Why are MSCs therapeutic? New data:newinsight.J Pathol,2009,217(2):318-324.
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1. Upmeier H,Bruggenjurgen B,Weiler A,et al.Follow-up costs up to 5 years after conventional treatments in patients with cartilage lesions of the knee.Knee Surg Sports Traumatolo Arthrosc,2007,15(3):249-257.
2. Laupattarakasem W,Laopaiboon M,Laupattarakasem P,et al.Arthroscopic debridement for knee osteoarthritis.Cochrane Database Syst Rev,2008,(1):CD005118.
3. Moseley JB,O'Malley K,Petersen NJ,et al.A controlled trial of arthroscopic surgery for osteoarthritis of the knee.N Engl J Med,2002,347(2):81-88.
4. Matsunaga D,Akizuki S,Takizawa T,et al.Repair of articular cartilage and clinical outcome after osteotomy with microfracture or abrasion arthroplasty for medial gonarthrosis.Knee,2007,14(6):465-471.
5. Kosy JD,Schranz PJ,Toms AD,et al.The use of radiofrequency energy for arthroscopic chondroplasty in the knee.Arthroscopy,2011,27(5):695-703.
6. Harris JD,Brophy RH,Siston RA,et al.Treatment of chondral defects in the athlete's knee.Arthroscopy,2010,26(6):841-852.
7. Spahn G,Kahl E,Mückley T,et al.Arthroscopic knee chondroplasty using a bipolar radiofrequency-based device compared to mechanical shaver:results of a prospective,randomized,controlled study.Knee Surg Sports Traumatol Arthrosc,2008,16(6):565-573.
8. Ollat D,Lebel B,Thaunat M,et al.Mosaic osteochondral transplantations in the knee joint,midterm results of the SFA multicenter study.Orthop Traumatol Surg Res,2011,97(8 Suppl):S160-166.
9. Haene R,Qamirani E,Story RA,et al.Intermediate outcomes of fresh talar osteochondral allografts for treatment of large osteochondral lesions of the talus.J Bone Joint Surg (Am),2012,94(12):1105-1110.
10. Brittberg M,Lindahl A,Nilsson A,et al.Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation.N Engl J Med,1994,331(14):889-895.
11. Gobbi A,Kon E,Berruto M,et al.Patellofemoral full-thickness chondral defects treated with second-generation autologous chondrocyte implantation:results at 5 years'follow-up.Am J Sports Med,2009,37(6):1083-1092.
12. McNickle AG,Provencher MT,Cole BJ.Overview of existing cartilage repair technology.Sports Med Arthrosc,2008,16(4):196-201.
13. Capito RM,Spector M.Scaffold-based articular cartilage repair.IEEE Eng Med Biol Mag,2003,22(5):42-50.
14. Lee SH,Shin H.Matrices and scaffolds for delivery of bioactive molecules in bone and cartilage tissue engineering.Adv Drug Deliv Rev,2007,59(4-5):339-359.
15. Mano JF,Reis RL.Osteochondral defects:present situation and tissue engineering approaches.J Tissue Eng Regen Med,2007,1(4):261-273.
16. Getgood A,Brooks R,Fortier L,et al.Articular cartilage tissue engineering:today's research,tomorrow's practice? J Bone Joint Surg (Br),2009,91(5):565-576.
17. Martin I,Miot S,Barbero A,et al.Osteochondral tissue engineering.J Biomech,2007,40(4):750-765.
18. Im GI,Lee JH.Repair of osteochondral defects with adipose stem cells and a dual growth factor-releasing scaffold in rabbits.J Biomed Mater Res B Appl Biomater,2010,92(2):552-560.
19. Jeong CG,Zhang H,Hollister SJ.Three-dimensional polycaprolactone scaffold-conjugated bone morphogenetic protein-2 promotes cartilage regeneration from primary chondrocytes in vitro and in vivo without accelerated endochondral ossification.J Biomed Mater Res A,2012,100(8):2088-2096.
20. Chu CR,Coutts RD,Yoshioka M,et al.Articular cartilage repair using allogeneic perichondrocyte-seeded biodegradable porous polylactic acid (PLA):a tissue-engineering study.J Biomed Mater Res,1995,29(9):1147-1154.
21. Khanarian NT,Haney NM,Burga RA,et al.A functional agarose-hydroxyapatite scaffold for osteochondral interface regeneration.Biomaterials,2012,33(21):5247-5258.
22. Malda J,Woodfield TB,van der Vloodt F,et al.The effect of PEGT/PBT scaffold architecture on the composition of tissue engineered cartilage.Biomaterials,2005,26(1):63-72.
23. Coburn JM,Gibson M,Monagle S,et al.Bioinspired nanofibers support chondrogenesis for articular cartilage repair.Proc Natl Acad Sci U S A,2012,109(25):10012-10017.
24. Kanungo BP,Gibson LJ.Density-property relationships in mineralized collagen-glycosaminoglycan scaffolds.Acta Biomater,2009,5(4):1006-1018.
25. Zhou J,Xu C,Wu G,et al.In vitro generation of osteochondral differentiation of human marrow mesenchymal stem cells in novel collagen-hydroxyapatite layered scaffolds.Acta Biomater,2011,7(11):3999-4006.
26. Oliveira JM,Rodrigues MT,Silva SS,et al.Novel hydroxyapatite/chitosan bilayered scaffold for osteochondral tissue-engineering applications:Scaffold design and its performance when seeded with goat bone marrow stromal cells.Biomaterials,2006,27(36):6123-6137.
27. Jiang J,Tang A,Ateshian GA,et al.Bioactive stratified polymer ceramic-hydrogel scaffold for integrative osteochondral repair.Ann Biomed Eng,2010,38(6):2183-2196.
28. Chen K,Shi P,Teh TK,et al.In vitro generation of a multilayered osteochondral construct with an osteochondral interface using rabbit bone marrow stromal cells and a silk peptide-based scaffold.J Tissue Eng Regen Med,2013.[Epub ahead of print].
29. Schek RM,Taboas JM,Segvich SJ,et al.Engineered osteochondral grafts using biphasic composite solid free-form fabricated scaffolds.Tissue Eng,2004,10(9-10):1376-1385.
30. Getgood AM,Kew SJ,Brooks R,et al.Evaluation of early-stage osteochondral defect repair using a biphasic scaffold based on a collagen-glycosaminoglycan biopolymer in a caprine model.Knee,2012,19(4):422-430.
31. Chen G,Sato T,Tanaka J,et al.Preparation of a biphasic scaffold for osteochondral tissue engineering.Materials Science and Engineering:C,2006,26(1):118-123.
32. Deng T,Lv J,Pang J,et al.Construction of tissue-engineered osteochondral composites and repair of large joint defects in rabbit.J Tissue Eng Regen Med,2012.[Epub ahead of print].
33. Da H,Jia SJ,Meng GL,et al.The impact of compact layer in biphasic scaffold on osteochondral tissue engineering.PLoS One,2013,8(1):e54838.
34. Guo X,Liao J,Park H,et al.Effects of TGF-beta3 and preculture period of osteogenic cells on the chondrogenic differentiation of rabbit marrow mesenchymal stem cells encapsulated in a bilayered hydrogel composite.Acta Biomater,2010,6(8):2920-2931.
35. Holland TA,Bodde EW,Cuijpers VM,et al.Degradable hydrogel scaffolds for in vivo delivery of single and dual growth factors in cartilage repair.Osteoarthritis and Cartilage,2007,15(2):187-197.
36. Gelse K,Klinger P,Koch M,et al.Thrombospondin-1 prevents excessive ossification in cartilage repair tissue induced by osteogenic protein-1.Tissue Eng Part A,2011,17(15-16):2101-2112.
37. Marlovits S,Zeller P,Singer P,et al.Cartilage repair:generations of autologous chondrocyte transplantation.Eur J Radiol,2006,57(1):24-31.
38. Hsiong SX,Mooney DJ.Regeneration of vascularized bone.Periodontology 2000,2006,41:109-122.
39. Wang X,Wenk E,Zhang X,et al.Growth factor gradients via microsphere delivery in biopolymer scaffolds for osteochondral tissue engineering.J Control Release,2009,134(2):81-90.
40. Lu H,Lv L,Dai Y,et al.Porous chitosan scaffolds with embedded hyaluronic acid/chitosan/plasmid-DNA nanoparticles encoding TGF-beta1 induce DNA controlled release,transfected chondrocytes,and promoted cell proliferation.PLoS One,2013,8(7):e69950.
41. Reyes R,Delgado A,Sanchez E,et al.Repair of an osteochondral defect by sustained delivery of BMP-2 or TGFbeta1 from a bilayered alginate-PLGA scaffold.J Tissue Eng Regen Med,2012.[Epub ahead of print].
42. Connelly JT,Wilson CG,Levenston ME.Characterization of proteoglycan production and processing by chondrocytes and BMSCs in tissue engineered constructs.Osteoarthritis Cartilage,2008,16(9):1092-1100.
43. Mauck RL,Yuan X,Tuan RS.Chondrogenic differentiation and functional maturation of bovine mesenchymal stem cells in long-term agarose culture.Osteoarthritis Cartilage,2006,14(2):179-189.
44. Vinardell T,Thorpe SD,Buckley CT,et al.Chondrogenesis and integration of mesenchymal stem cells within an in vitro cartilage defect repair model.Ann Biomed Eng,2009,37(12):2556-2565.
45. Asawa Y,Ogasawara T,Takahashi T,et al.Aptitude of auricular and nasoseptal chondrocytes cultured under a monolayer or three-dimensional condition for cartilage tissue engineering.Tissue Eng Part A,2009,15(5):1109-1118.
46. Darling EM,Athanasiou KA.Rapid phenotypic changes in passaged articular chondrocyte subpopulations.J Orthop Res,2005,23(2):425-432.
47. Yonenaga K,Nishizawa S,Fujihara Y,et al.The optimal conditions of chondrocyte isolation and its seeding in the preparation for cartilage tissue engineering.Tissue Eng Part C Methods,2010,16(6):1461-1469.
48. Caplan AI.Why are MSCs therapeutic? New data:newinsight.J Pathol,2009,217(2):318-324.
49. Liu Y,Shu XZ,Prestwich GD.Osteochondral defect repair with autologous bone marrow-derived mesenchymal stem cells in an injectable,in situ,cross-linked synthetic extracellular matrix.Tissue Eng,2006,12(12):3405-3416.
50. De Bari C,Dell'Accio F,Tylzanowski P,et al.Multipotent mesenchymal stem cells from adult human synovial membrane.Arthritis Rheum,2001,44(8):1928-1942.
51. Sampat SR,O'Connell GD,Fong JV,et al.Growth factor priming of synovium-derived stem cells for cartilage tissue engineering.Tissue Eng Part A,2011,17(17-18):2259-2265.
52. Gimble JM,Grayson W,Guilak F,et al.Adipose tissue as a stem cell source for musculoskeletal regeneration.Front Biosci (Schol Ed),2011,3:69-81.
53. Rodriguez LV,Alfonso Z,Zhang R,et al.Clonogenic multipotent stem cells in human adipose tissue differentiate into functional smooth muscle cells.Proc Natl Acad Sci U S A,2006,103(32):12167-12172.
54. Gonzalez-Rey E,Gonzalez MA,Varela N,et al.Human adipose-derived mesenchymal stem cells reduce inflammatory and T cell responses and induce regulatory T cells in vitro in rheumatoid arthritis.Ann Rheum Dis,2010,69(1):241-248.
55. Malgieri A,Kantzari E,Patrizi MP,et al.Bone marrow and umbilical cord blood human mesenchymal stem cells:state of the art.Int J Clin Exp Med,2010,3(4):248-269.
56. Kögler G,Sensken S,Airey JA,et al.A new human somatic stem cell from placental cord blood with intrinsic pluripotent differentiation potential.J Exp Med,2004,200(2):123-135.
57. Gao J,Yao JQ,Caplan AI.Stem cells for tissue engineering of articular cartilage.Proc Inst Mech Eng H,2007,221(5):441-450.
58. Berg L,Koch T,Heerkens T,et al.Chondrogenic potential of mesenchymal stromal cells derived from equine bone marrow and umbilical cord blood.Vet Comp Orthop Traumatol,2009,22(5):363-370.
59. Elder BD,Athanasiou KA.Hydrostatic pressure in articular cartilage tissue engineering:from chondrocytes to tissue regeneration.Tissue Eng Part B Rev,2009,15(1):43-53.
60. Vunjak-Novakovic G,Meinel L,Altman G,et al.Bioreactor cultivation of osteochondral grafts.Orthod Craniofac Res,2005,8(3):209-218.
61. Lee DA,Noguchi T,Frean SP,et al.The influence of mechanical loading on isolated chondrocytes seeded in agarose constructs.Biorheology,2000,37(1-2):149-161.
62. Haasper C,Zeichen J,Meister R,et al.Tissue engineering of osteochondral constructs in vitro using bioreactors.Injury,2008,39 Suppl 1:S66-76.
63. Madry H,Kaul G,Zurakowski D,et al.Cartilage constructs engineered from chondrocytes overexpressing IGF-I improve the repair of osteochondral defects in a rabbit model.Eur Cell Mater,2013,25:229-247.
64. Wagner DR,Lindsey DP,Li KW,et al.Hydrostatic pressure enhances chondrogenic differentiation of human bone marrow stromal cells in osteochondrogenic medium.Ann Biomed Eng,2008,36(5):813-820.
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