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The Use of Scaffolds in the Management of Articular Cartilage Injury

Dr. Safran is Associate Chief of Sports Medicine, Fellowship Director for Sports Medicine, and Professor of Orthopaedic Surgery, Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA. Dr. Kim is Associate Professor in Residence and Associate Residency Program Director, Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA. Dr. Zaffagnini is Assistant Professor and Director, Biomechanics Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.

Dr. Safran or a member of his immediate family has received research or institutional support from Histogenics Inc, Malden, MA. Dr. Zaffagnini or a member of his immediate family has received nonincome support (such as equipment or services), commercially derived honoraria, or other non-research–related funding (such as paid travel) from FAB Company, Padona, Italy. Neither Dr. Kim nor a member of his immediate family has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article.

Reprint requests: Dr. Safran, Stanford University, 300 Pasteur Drive, Edwards R105, Stanford, CA 94305-5341.

Managing articular cartilage injury continues to be a difficult challenge for the clinician. Although the short- and intermediate-term results of autologous chondrocyte implantation appear to be favorable, resources are being directed toward research to improve the technology. One promising area of investigation is the combination of cultured chondrocytes with scaffolds. Clinicians desire techniques that may be implanted easily, reduce surgical morbidity, do not require harvesting of other tissues, exhibit enhanced cell proliferation and maturation, have easier phenotype maintenance, and allow for efficient and complete integration with surrounding articular cartilage. 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. Clinical experience is growing with three scaffold-based cartilage repair techniques, each using a different type of scaffold material: matrix-induced autologous chondrocyte implantation, a hyaluronic acid–based scaffold, and a composite polylactic/polyglycolic acid polymer fleece. Clinical results are encouraging. Future directions in scaffold-based cartilage repair include bioactive and spatially oriented scaffolds.

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