Hunziker E B, Lippuner K, Keel M J B, Shintani N
Departments of Osteoporosis, Orthopaedic Surgery and Clinical Research, Inselspital, University of Bern, Bern, Switzerland.
Osteoarthritis Cartilage. 2015 Mar;23(3):334-50. doi: 10.1016/j.joca.2014.12.011. Epub 2014 Dec 19.
The repair of cartilaginous lesions within synovial joints is still an unresolved and weighty clinical problem. Although research activity in this area has been indefatigably sustained, no significant progress has been made during the past decade. The aim of this educational review is to heighten the awareness amongst students and scientists of the basic issues that must be tackled and resolved before we can hope to escape from the whirlpool of stagnation into which we have fallen: cartilage repair redivivus!
Articular-cartilage lesions may be induced traumatically (e.g., by sports injuries and occupational accidents) or pathologically during the course of a degenerative disease (e.g., osteoarthritis). This review addresses the biological basis of cartilage repair and surveys current trends in treatment strategies, focussing on those that are most widely adopted by orthopaedic surgeons [viz., abrasive chondroplasty, microfracturing/microdrilling, osteochondral grafting and autologous-chondrocyte implantation (ACI)]. Also described are current research activities in the field of cartilage-tissue engineering, which, as a therapeutic principle, holds more promise for success than any other experimental approach.
Tissue engineering aims to reconstitute a tissue both structurally and functionally. This process can be conducted entirely in vitro, initially in vitro and then in vivo (in situ), or entirely in vivo. Three key constituents usually form the building blocks of such an approach: a matrix scaffold, cells, and signalling molecules. Of the proposed approaches, none have yet advanced beyond the phase of experimental development to the level of clinical induction. The hurdles that need to be surmounted for ultimate success are discussed.
滑膜关节内软骨损伤的修复仍是一个尚未解决的重大临床问题。尽管该领域的研究活动一直坚持不懈地持续进行，但在过去十年中仍未取得显著进展。本教育综述的目的是提高学生和科学家对一些基本问题的认识，在我们有望摆脱陷入的停滞漩涡（即软骨修复复兴）之前，必须解决这些问题。
关节软骨损伤可能由创伤性因素（如运动损伤和职业事故）引起，或在退行性疾病（如骨关节炎）过程中病理性产生。本综述阐述了软骨修复的生物学基础，并概述了治疗策略的当前趋势，重点关注骨科医生最广泛采用的那些策略[即磨削软骨成形术、微骨折/微钻孔、骨软骨移植和自体软骨细胞植入（ACI）]。还介绍了软骨组织工程领域的当前研究活动，作为一种治疗原则，该领域比任何其他实验方法都更有成功的希望。
组织工程旨在在结构和功能上重建组织。这个过程可以完全在体外进行，最初在体外然后在体内（原位）进行，或者完全在体内进行。三种关键成分通常构成这种方法的构建要素：基质支架、细胞和信号分子。在所提出的方法中，尚无一种方法超越实验开发阶段进入临床应用阶段。文中讨论了最终成功需要克服的障碍。
