Department of Orthopaedic Surgery, University of Pittsburgh, PA, USA.
J Am Acad Orthop Surg. 2013 May;21(5):303-11. doi: 10.5435/JAAOS-21-05-303.
Cartilage damaged by trauma has a limited capacity to regenerate. Current methods of managing small chondral defects include palliative treatment with arthroscopic débridement and lavage, reparative treatment with marrow-stimulation techniques (eg, microfracture), and restorative treatment, including osteochondral grafting and autologous chondrocyte implantation. Larger defects are managed with osteochondral allograft or total joint arthroplasty. However, the future of managing cartilage defects lies in providing biologic solutions through cartilage regeneration. Laboratory and clinical studies have examined the management of larger lesions using tissue-engineered cartilage. Regenerated cartilage can be derived from various cell types, including chondrocytes, pluripotent stem cells, and mesenchymal stem cells. Common scaffolding materials include proteins, carbohydrates, synthetic materials, and composite polymers. Scaffolds may be woven, spun into nanofibers, or configured as hydrogels. Chondrogenesis may be enhanced with the application of chondroinductive growth factors. Bioreactors are being developed to enhance nutrient delivery and provide mechanical stimulation to tissue-engineered cartilage ex vivo. The multidisciplinary approaches currently being developed to produce cartilage promise to bring to fruition the desire for cartilage regeneration in clinical use.
创伤导致的软骨损伤再生能力有限。目前管理小范围软骨缺损的方法包括关节镜下清创和灌洗的姑息治疗、骨髓刺激技术（如微骨折）的修复治疗以及包括骨软骨移植和自体软骨细胞移植的恢复性治疗。较大的缺损则采用骨软骨同种异体移植物或全关节置换术进行治疗。然而，软骨缺损管理的未来在于通过软骨再生提供生物解决方案。实验室和临床研究已经检查了使用组织工程软骨来管理更大的病变。再生的软骨可以源自多种细胞类型，包括软骨细胞、多能干细胞和间充质干细胞。常见的支架材料包括蛋白质、碳水化合物、合成材料和复合聚合物。支架可以编织、纺成纳米纤维或设计成水凝胶。应用软骨诱导生长因子可以增强软骨生成。正在开发生物反应器以增强营养物质的输送并为组织工程软骨提供体外机械刺激。目前正在开发的多学科方法有望实现临床应用中对软骨再生的期望。
