The absence of a vascular supply in articular cartilage means that the cells receive nutrients and discharge waste material by diffusion through the extracellular matrix, from and to the synovial fluid, respectively. As a result, articular cartilage has a very limited ability to self-heal and joint injuries with articular cartilage damage can lead to cartilage degeneration and subsequent osteoarthritis with significant personal and socioeconomic costs [93]. Cartilage replacement or repair can

be indicated for a number of medical conditions including: avascular necrosis/osteochondritis dissecans, traumatic injuries, epiphyseal tumors and arthritis. These conditions do not have good non-surgical or surgical options to restore joint

function selleck compound and, if left untreated, they lead to joint instability, deterioration and subsequent osteoarthritis. Arthritis is the most common cause of disability in North America and osteoarthritis is the most common form of arthritis. More than 20 million people in the US alone deal with severe limitations in function on a daily basis due to arthritis, which results in more than 1 million hospitalization cases, and costs a total of $100 billion US every year [1]. Surgical treatment options depend on the type and size of the cartilage lesion. Small lesions less than 1 cm in diameter typically can be compensated by the surrounding cartilage but not always. Persistently symptomatic smaller lesions and larger lesions often Cabozantinib nmr require surgical intervention. The most common cell-based interventions are microfracture [97] and [98], autologous chondrocyte implantation (ACI) [15] and [16], and matrix associated ACI (MACI) [11] and [66]. There are many reports of these surgical techniques providing some positive Methocarbamol results but they are unable to reproduce the complex structure of the articular cartilage matrix resulting in biomechanically inferior fibrocartilage or “hyaline-like” cartilage. It is possible that these inferior cartilage repair tissues will not function well in the long-term. Another

surgical treatment option is mosaicplasty (osteochondral autografts) which consists of taking cartilage from one area of the joint and moving it to the defect. This will restore the normal cartilage matrix structure in the injured area at the cost of removing it from a previously healthy area of the joint. All of these techniques can provide some relief in small to medium size defects but they are not able to treat large defects, including whole joints, effectively. The only biologic technique that can restore partial [102] and [103], or whole joints [9], [19] and [36] is osteochondral allografting [38] which entails transplanting bone and cartilage from a donor patient into a recipient patient. In older patients, synthetic total joint replacement is a viable option for more sedentary, low activity patients.