Cell Culture Approaches for Articular Cartilage: Repair and Regeneration

There are several published methods for culturing human cells including chondrocytes, osteocytes, and tenocytes to study musculoskeletal development, disorders, and for tissue engineering [1–8]. In this chapter we will focus on cell culture approaches used for articular cartilage repair. Articular cartilage defects are found in nearly 60% of knee arthroscopies [9, 10]. Many times these defects are painful and may result in loss of function. Articular cartilage lacks a blood supply and innervation and therefore has a limited capacity to heal itself. Untreated chondral defects may lead to a cycle of cartilage degradation and eventual osteoarthritis. The goals of cartilage repair are to restore smooth articular cartilage surface, relieve patient symptoms, and improve function. Nonsurgical options available for treating cartilage defects include debridement and lavage. First-line surgical treatment options include bone marrow stimulation techniques such as microfracture, abrasion arthroplasty, and subchondral drilling. Other treatment options include osteochondral autografts and allografts or autologous chondrocyte implantation (ACI). ACI uses autologous cell culture-expanded chondrocytes for the repair of cartilage defects. ACI is the only cell therapy approved for cartilage repair in the USA. The technique was first described by Peterson, Lindahl, and Brittberg in 1987 [11]. It is a two-step procedure involving the harvest of cartilage from a non-weight-bearing location, in vitro expansion of chondrocytes, and reimplantation into the cartilage defect covered by a periosteal graft or off the shelf membrane. Mesenchymal stem cells (MSCs) are multipotent cells with enhanced proliferative capabilities that provide an attractive alternative source of cells for cartilage repair and other orthopedic applications. Cultured MSCs have been successfully used to treat cartilage defects. As an emerging technology, MSCs do not have as extensive a body of evidence as ACI, but clinical reports showing positive outcomes and ongoing clinical trials are advancing the field.