This article is more than 5 years old. Information may no longer be current.
Emerging imaging, biologic research may spawn new treatments for cartilage injury
Decreasing load and restoring motion during repair may aid in articular cartilage surface regeneration.
Click Here to Manage Email Alerts
LAS VEGAS — Research exploring the thresholds for mechanical damage and the biologic mediators of progressive cartilage loss may lead to better care for articular cartilage injuries and surface repair.
“With new techniques, MRI and CT, we are able to measure the severity of an articular surface injury and follow that injury over time to see which patients are going to develop osteoarthritis,” Joseph A. Buckwalter, MD, said at the American Academy of Orthopaedic Surgeons annual meeting.
Free-radical scavengers
Using CT scans to calculate the amount of energy transmitted across the articular surface during an injury, researchers have identified a threshold effect in which patients who had an energy level above the threshold developed osteoarthritis (OA) within 2 years. MRI scans can also be used to measure articular surface damage and assess patients’ risk for OA, Buckwalter said. In addition, research has revealed a correlation between cumulative mechanical stress and articular cartilage loss.
Investigators have also indicated the role of matrix fragments in progressive matrix degradation, and the impact of reactive oxygen species in stimulating continued cell loss, Buckwalter said. He noted that they are investigating the use of free-radical scavengers to increase cell viability and protect the repair response after injury.
In vitro studies examining fibrillations of the articular cartilage surface that were filled with a hydrogel releasing oxygen free-radical scavengers have shown promising results.
“If we treat the injured articular surface within 2 hours of damage, we can save more than 50% of the cells,” Buckwalter said.
Distraction and motion
In cases of severe damage, distraction and motion may help restore the articular cartilage surface. In a prospective randomized study, Buckwalter and colleagues compared the results of patients with post-traumatic ankle OA who underwent joint debridement and ankle distraction with or without motion.
At 12 months postoperative, they found that the motion group had a 50% reduction in joint pain and 50% decrease in their injury severity. CT scans also showed evidence of articular cartilage regeneration, Buckwalter said.
For more information:
- Joseph A. Buckwalter, MD, is the head of orthopedic surgery at The University of Iowa; He can be reached at 319-356-2595; e-mail: joseph-buckwalter@uiowa.edu. His work has been supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Institutes of Health.
References:
- Buckwalter JA. Hyaline cartilage health: Risk factors associated with cartilage injury and progression to ‘degenerative’ osteoarthritis. Symposium I: Hyaline cartilage biological joint repair, restoration and resurfacing. Presented at the American Academy of Orthopaedic Surgeons 76th Annual Meeting. Feb. 25-27, 2009. Las Vegas.