毛髪治療と移植
オープンアクセス

概要

Articular Cartilage Injury Treatment: History and Basic Science Review

Dumnoensun Pruksakorn, Peraphan Pothachareoun, Kassisin Klunklin, Puwapon Nimkingratana, Sattaya Rojanastein, Sompan Padongkiert, Olarn Arpornchayanon and Prachya Kongtawelert

Cartilage injury has been a troublesome problem for a long time; nevertheless the concepts of treatment have dramatically changed over the last two decades. Currently, three surgical principles have been used for cartilage resurfacing including marrow stimulating, osteochondral transplantation, and autologous chondrocyte implantation. Microfracture based on the traditional marrow stimulating technique is recommended in small (2-4 cm2) and well containable lesions in order to retain the marrow clot. The smaller and closer subchondral portals are necessary to concentrate the growth factors for controlling a good quality of new cartilage formation. Autologous osteochondral transplantation provides initial graft durability, and is recommended for very small lesions (< 2 cm2) because of the donor site morbidity concern. Osteochondral allograft transplantation allows an unlimited size of reparation; however chondrocyte apoptosis and extracellular matrix breakdown secondary to the long term preservation lead to graft degradation overtime. Autologous chondrocyte implantation repairs the cartilage defect based on two potential factors; chodrocytes and periosteum-derived progenitor cells. The interaction between cells balances the growth factors at the repairing site. The suitable mechanical stimuli and cell-matrix interactions also play a crucial role in cell proliferation, differentiation, cartilage tissue formation and integration to the surrounding host tissue.