Articular cartilage, especially found in knee joints, is generally characterized by extremely low friction, high wear resistance, and poor regenerative qualities. It is responsible for much of the pressure resistance and load quality of the knee joint bearings and, without it, painful walking is not possible. Osteoarthritis is a common condition of cartilage failure that can cause limited range of motion, bone damage and always, pain. Due to the combination of acute stress and chronic fatigue, osteoarthritis directly manifests itself in an eroded articular surface and, in extreme cases, bones can be exposed to joints. Some additional examples of cartilage failure mechanisms include the rupture of cellular matrix relations, inhibition of chondrocyte protein synthesis, and chondrocyte apoptosis. There are several repair options available for cartilage failure or failure.
"Maci" or autologous chondrocytes on pig collagen membranes, is a treatment for improving cartilage defects in the knee. This treatment has been approved by the Food and Drug Administration in 2016 for adult care only.
Video Knee cartilage replacement therapy
Autologous matrix-induced chondrogenesis
Autologous matrix-induced chondrogenesis, also known as AMIC , is a biological treatment option for damage to articular cartilage that impairs bone marrow stimulation techniques in combination with collagen membranes. It is based on microfracture operation with the application of membrane collagen I/III bi-layer.
The AMIC technique was developed to correct some of the deficiencies of microfracture operations such as variable repair cartilage volumes and functional damage over time. The collagen membrane protects and stabilizes the MSC released via microfracture and increases their chondrogenic differentiation.
The AMIC operation is a one step procedure. After cartilage damage is assessed there are two methods to access the joint to continue the AMIC operation. First is to do mini arthrotomy. The second is an all-arthroscopic procedure.
Maps Knee cartilage replacement therapy
Implantation of autologous chondrocytes
The cartilage of the human body itself is still the best material to coat the knee joint. It encourages efforts to develop ways of using one's own cells to grow, or to regenerate cartilage tissue to replace lost or damaged cartilage. A cell-based replacement technique is called autologous chondrocyte implantation (ACI) or autologous condylit transplantation (ACT).
A review evaluating the implantation of autologous chondrocytes was published in 2010. The conclusion is that this is an effective treatment for chondral defects of full thickness. The evidence does not indicate that ACI is superior to other treatments.
One ACI treatment, called MACI (autologous chondrocytes on pig collagen matrix), is indicated for healthy patients 18-55 with medium to large damage to the cartilage. This does not apply to osteoarthritis patients. Chondrocytes patients are excluded arthroscopically from non-load areas of either intercondylar notch or superior ridge of the medial or lateral femoral condyl. 10,000 cells are harvested and planted in vitro for about six weeks until the population reaches 10-12 million cells. Then these cells are seeded onto a film that is implanted into the area of ​​cartilage damage and is reabsorbed into the tissue to the patient. Chondrocytes are planted then split and integrate with surrounding tissue and potentially produce cartilage that resembles hyaline. Maintenance costs range from ($ USD) 20,000-35,000. and is currently manufactured by Vericel Corporation.
Other ACI techniques, using "chondospheres", use only chondrocytes and no matrix material. The cells grow in a self-regulated spheroidal matrix that is implanted through a liquid injection or an inserted tissue matrix.
Autologous mesenchymal stem cell transplant
Over the years, the concept of harvesting stem cells and reintegrating them into their own bodies to regenerate organs and tissues has been embraced and researched in animal models. Specifically, mesenchymal stem cells have been shown in animal models to regenerate cartilages. Recently, there have been several published case reports of successful cartilage growth in human knee using mesenchymal stem cells of autologous culture. In addition, safety studies showed better safety than surgical alternatives for this cell culture injection procedure at a 3-year follow-up. The advantage of this approach is that a person's stem cell is used, avoiding tissue rejection by the patient's immune system.
Microdrilling coupled with peripheral blood stem cells
A 2011 study reported a histologic confirmation of hyaline cartilage growth in the knee. Successful protocols involving microdrilling arthroscopy/microfracture surgery are followed by postoperative injections of autologous peripheral blood progenitor blood cells (PBPCs) and hyaluronic acid. This procedure creates a blood clot scaffold in which an injected PBPC can be recruited and increases chondrogenesis at the site of the contained lesion.
See also
- Meniscal cartilage replacement therapy
- Meniscus transplant
References
External links
- Appointment of Total Minimally Invasive Knee. American Academy of Orthopedic Surgeons. February 2005.
- Osteochondral Grafting of Articular Cartilage Injury in eMedicine
Source of the article : Wikipedia
0 Comments