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J Knee Surg 2012; 25(03): 179-186
DOI: 10.1055/s-0032-1322596
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Use of Scaffolds in the Treatment of Osteochondral Lesions in the Knee: Current Concepts and Future Trends

Aad A. M. Dhollander
1   Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
2   Laboratory of Connective Tissue Biology, Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
,
Victor R. Guevara Sánchez
3   Ortopediay Tramatologia, Instituto Nacional de Rehabilitación, Mexico City, Mexico
,
Karl F. Almqvist
1   Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
,
René Verdonk
1   Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
,
Gust Verbruggen
2   Laboratory of Connective Tissue Biology, Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
,
Peter C. M. Verdonk
1   Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
4   Department of Orthopaedic Surgery, Stedelijk Ziekenhuis Roeselare, Roeselare, Belgium
› Author Affiliations
Further Information

Publication History

31 October 2011

30 May 2012

Publication Date:
04 August 2012 (online)

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Abstract

Long after the first reports on human autologous chondrocyte implantation (ACI) by Brittberg in 1994, the development of a so-called optimal technology for osteochondral tissue regeneration is still one of the most challenging issues in knee surgery. Although the short- and intermediate-term results of ACI appear to be favorable, resources are being directed toward scaffold research to improve the technology. Scaffolds used for osteochondral repair may be either cell or noncell-based before its implantation in the knee. The characteristics that make scaffolds optimal for clinical use are that they be biocompatible, biodegradable, permeable, reproducible, mechanically stable, noncytotoxic, and capable of serving as a temporary support for the cells while allowing for eventual replacement by matrix components synthesized by the implanted cells. There is a growing interest in noncell and last-minute cell seeding technologies since they allow for a one-step surgery eliminating the morbidity and necessity of a previous chondral biopsy. Although clinical and histological results from many, already clinically available scaffolds seem to be promising, improvements throughout these technologies and the developments of new ones are still necessary to obtain a more efficient biological response as well as to improve the implant's stability. Moreover, as the understanding of interactions between articular cartilage and subchondral bone continues to evolve, increased attention should be directed at treatment options for the entire osteochondral unit, rather than focusing on the articular surface only.

Keywords

cartilage - scaffolds - repair - knee
 

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