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New methods to diagnose and treat cartilage degeneration

Nature Reviews Rheumatology volume 5, pages 599–607 (2009)Cite this article

Abstract

Lesions in articular cartilage can result in significant musculoskeletal morbidity and display unique biomechanical characteristics that make repair difficult, at best. Several surgical procedures have been devised in an attempt to relieve pain, restore function, and delay or stop the progression of cartilaginous lesions. Advanced MRI and ultrasonography protocols are currently used in the evaluation of tissue repair and to improve diagnostic capability. Other nonoperative modalities, such as injection of intra-articular hyaluronic acid or supplementary oral glucosamine and chondroitin sulfate, have shown potential efficacy as anti-inflammatory and symptom-modifying agents. The emerging field of tissue engineering, involving the use of a biocompatible, structurally and mechanically stable scaffold, has shown promising early results in cartilage tissue repair. Scaffolds incorporating specific cell sources and bioactive molecules have been the focus in this new exciting field. Further work is required to better understand the behavior of chondrocytes and the variables that influence their ability to heal articular lesions. The future of cartilage repair will probably involve a combination of treatments in an attempt to achieve a regenerative tissue that is both biomechanically stable and, ideally, identical to the surrounding native tissues.

Key Points

  • Cartilage injuries remain a major cause of morbidity in both young and elderly patient populations

  • Advanced imaging with MRI and ultrasonography has resulted in improved sensitivity and specificity in the diagnosis of cartilage injuries

  • Surgical procedures have had some success in alleviating symptoms and improving function; however, the regenerative tissue has not been found to resemble the surrounding native tissue

  • Intra-articular injections of hyaluronic acid, oral glucosamine and oral chondroitin sulfate seem to confer a therapeutic effect via anti-inflammatory-mediated mechanisms

  • Tissue engineering involving scaffolds, bioactive molecules and specific cell lines has shown promising results in the treatment of cartilage defects

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Figure 1: Intra-operative photographs illustrating various surgical techniques commonly performed in the treatment of articular cartilage lesions involving the femoral condyle.
Figure 2: Strategies for cartilage tissue engineering.
Figure 3: Microenvironment of chondrocytes: fiber reinforcement.
Figure 4: Use of gene therapy in cartilage repair.

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Authors and Affiliations

  1. Department of Orthopedics, Long Island Jewish Medical Center, New Hyde Park, NY, USA

    Robert J. Daher, Andrew S. Greenberg & Nicholas A. Sgaglione

  2.  The Feinstein Institute for Medical Research, Manhasset, NY, USA

    Nadeen O. Chahine & Daniel A. Grande

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  1. Robert J. Daher
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Correspondence to Daniel A. Grande.

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Competing interests

N.A. Sgaglione has acted as a consultant for Arthrocare, BioSyntech, ConMed Linvatec, Smith and Nephew Endoscopy and TiGenix. D.A. Grande has acted as a consultant for Arthrocare and TiGenix. The other authors declare no competing interests.

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Daher, R., Chahine, N., Greenberg, A. et al. New methods to diagnose and treat cartilage degeneration. Nat Rev Rheumatol 5, 599–607 (2009). https://doi.org/10.1038/nrrheum.2009.204

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