Cartilage

Cartilage is a tough, connective tissue that covers the surface of joints and is composed of water (65-80%) and a gel-like matrix made up of proteins such as collagens, proteoglycans, and non-collagenous proteins that are responsible for the cartilage structure and function. The human body has three different types of Cartilage – Hyaline (articular Cartilage in joints), Elastic (flexible form), and Fibrous Cartilage (present in the meniscus that helps to avoid friction in knee joints due to body weight). The cartilage tissue is devoid of nerves, blood vessels, and lymph vessels.

Cartilage damage

Cartilage damage is a common injury that involves the joints of the knees, hips, ankles, and elbows. It may be due to acute sports injury, gradual wear, and tear, degenerative disorders such as osteoarthritis, hereditary abnormalities in joint structures, or hormonal disorders. The symptoms of such cartilage damage are joint pain, swelling, stiffness, and a grinding sensation.

Cartilage (osteochondral /chondral) repair

Cartilage regeneration on its own is not possible, unlike any other tissue regeneration, due to the absence of blood vessels. Cartilage repair is a treatment of joints that have damaged Cartilage by restoring the cartilage surface of the affected joint. However, cartilage repair to fill the cartilage defect with repair tissue is possible through a few procedures, which are as follows –

1) Platelet-rich plasma cells (PRP)

2) Mosaicplasty

3) Autologous chondrocyte implantation (ACI)

4) Matrix-assisted autologous chondrocyte transplantation (MACT)

5) Allograft or Osteo Chondral Allograft transplantation (OCA)

The choice of the procedure depends on the size and location of the defect, the nature of the defect (self-contained or spread out), any prior history of joint surgery, the patient’s age & fitness, and dependent on any concomitant illnesses or injuries.

Let’s see some of the details of each of these procedures –

Plate-rich plasma cells (PRP)

A concentrated solution of platelets is taken from the patient’s blood and injected to treat cartilage defects, ligament problems, and osteoarthritis. The answer may be WBC (White Blood cell) enriched or WBC depleted. This is a costly treatment procedure with limited clinical data but still a promising approach by surgeons, especially for sports injuries in athletes. PRP (especially WBC-enriched) injections in ligaments, as in the case of patella tendonitis, may cause inflammatory reactions. Hence, it is not advisable to use in such indications due to its negative effect on the healing process.

Mosaicplasty

This is a technique in which Cartilage lesions are repaired by harvesting cylindrical plugs of hyaline Cartilage from healthy tissue of the patient, especially from less weight-bearing areas, and filling the drilled section of defective Cartilage with these multiple plugs. The limitations of the procedure are –

1) Helpful only in small areas of defective Cartilage

2) Only be performed in patients of age below 50 years

3) Not recommended in degenerative disorders such as osteoarthritis or rheumatoid arthritis

Autologous Chondrocyte Implantation (ACI)

ACI involves harvesting the patient’s own articular cartilage cells and implantation into damaged Cartilage. Unlike mosaicplasty, which is helpful for small lesions, ACI is useful to repair cartilage damage with large lesions. A 10-year comparison study between ACI and mosaicplasty revealed that ACI has more benefits than mosaicplasty. Further, there was no incidence of degenerative joint disorders.

Matrix-assisted autologous chondrocyte transplantation (MACT)

MACT is an ACI extension that combines the combination of scaffolds (biodegradable structures made up of carbohydrates, proteins, or synthetic polymers) with the harvested ccartilage multiplied in the laboratory. The scaffold cartilage is transplanted into the defect area.

Allograft

Allograft from donors is transplanted in large lesions found in post-traumatic reconstruction, revision cartilage surgeries, osteochondritis (type III or IV), or osteonecrosis (bone death). Despite so many procedures available for cartilage repair, it is always better to prevent cartilage injuries. Adequate care is necessary to avoid further damage post-repair by taking care of healthy body weight and appropriate physical activity.

Cartigrow® Cell Therapy

CARTIGROW® Cartilage Cell Therapy, offered by Regrow Biosciences, is a cell therapy that is focused on regenerating the damaged cartilage naturally. In cartilage damage, cartilage-forming cells- chondrocytes are damaged due to reasons such as wear and tear or injury. During CARTIGROW® cell therapy, new chondrocytes are implanted by a skilled surgeon into the damaged area to form new cartilage. This restores the normal functions of your joint. The newly formed 3-dimensional cartilage will be useful in arresting the progression of cartilage damage and enable the joints to move freely.