Table 1.

Historical comparison of existing treatments for cartilage repair, including their respective advantages, limitations, and implications for tissue integration.

Treatment Method	Advantages	Limitations	Integration Mechanisms	Implications and Factors Contributing to Weak Integration in Early Phases	References
Bone Marrow Stimulation	- Minimally invasive procedure - Cost-effective - Suitable for small defects	- Fibrocartilage rather than hyaline cartilage - Limited durability and long-term efficacy - Not suitable for large defects	- Clot formation and recruitment of mesenchymal stem cells	- Immature tissue formation and limited matrix deposition - Fibrocartilage formation may compromise mechanical properties and long-term function	[3,23,24]
Osteochondral Autograft Transfer (OATS) and Mosaicplasty	- Utilizes patient’s own osteochondral tissue - Structural support and immediate stability	- Limited availability of donor tissue - Risk of donor site morbidity - Not suitable for larger defects	- Integration through precise graft matching - Promotion of chondrocyte migration and matrix production - Bone-to-bone fusion	- Challenges in achieving seamless integration between graft and host tissue - Insufficient graft-host tissue congruency - Inadequate cell migration and matrix production	[25,26,27]
Osteochondral Allograft Transplantation	- Provides mature, hyaline-like cartilage - Suitable for larger defects - Eliminates risk of donor site morbidity compared to autografts	- Limited availability of matching grafts - High cost - Requires matching of graft size and contour - Requirement to implant the graft within 28 days	- Integration through precise graft matching - Promotion of chondrocyte migration and matrix production - Bone-to-bone fusion	- Requires adequate host tissue preparation for successful integration - Insufficient graft-host tissue matching - Inadequate cell migration and matrix production	[28,29,30]
First- and second-generation ACI	- Potential for hyaline-like cartilage formation	- Limited availability of healthy chondrocytes for implantation - Risk of cell leakage - Further tissue damage by suturing the membrane	- Chondrocyte proliferation and matrix production - Gradual infiltration of native cells and matrix from surrounding tissue	- Limited cell retention and survival in the defect area - Inadequate cell migration and matrix production - Challenges in achieving uniform integration with surrounding tissue	[25,26]
Third-generation ACI	- Improved cell retention and distribution within cell carriers - Early cell differentiation using pre-seeded scaffolds	- Limited availability of healthy chondrocytes for implantation - Higher cost compared to traditional ACI	- Chondrocyte proliferation and matrix production within the scaffold - Gradual infiltration of native cells and matrix from surrounding tissues	- Inadequate cell migration and matrix production - Scaffold degradation may affect tissue integration - Suboptimal extracellular matrix production	[25,26,31]