Table 1.
Scaffolds in clinical and preclinical use for cartilage regeneration.
| Application | Material | Problem-result | Ref. |
|---|---|---|---|
| Nose (dorsal augmentation material in rhinoplasty) | Tissue-engineered chondrocyte PCS (Porcine Cartilage-derived Substance) scaffold construct. | Preliminary animal study: Excellent biocompatibility, neocartilage formation starts. However, it was not confirmed that the constructs contributed to the formation of neocartilage. | [36] |
| Knee (subchondral bone) | Osteochondral biomimetic nanostructured scaffold Maioregen® | Better results in healing complex lesions in comparison with the implantation of a purely chondral scaffold. | [37] |
| Cell-free biphasic scaffold: collagen-hydroxyapatite osteochondral scaffold | Statistically significant improvement in clinical scores. At 5 years, between 60.9% and 78.3% of the cases showed complete filling of the cartilage, complete integration of the graft, intact repaired tissue surface and homogeneous repaired tissue. | [38] | |
| Nanostructured biomimetic three-phasic collagen-hydroxiapatite construct | The implantations to treat chondral and osteochondral knee defects were effective in terms of clinical outcome, although MRI detected abnormal findings. | [39] | |
| Knee (chondral defects) | Autologous ovine MNC Cell-seeded and cell-free dl-poly-lactide–co–glycolide (PLGA) scaffolds | The engineered tissue had not local or systemic adverse effects. However, only a poor integration of the tissue engineering product into adjacent tissue was reached and the formed ECM was not mature enough for long-lasting weight-loading resistance. | [40] |
| Type I collagen-hydroxyapatite (Maioregen®) nanostructural biomimetic osteochondral scaffold | The use of the Maioregen® scaffold is a good procedure for the treatment of large osteochondral defects; however, the lesion site seems to influence the results. Patient affected in the medial femoral condyle showed better results. | [41] | |
| DeNovo (RevaFlex) engineered tissue graft | Preliminary evidence suggests that DeNovo ET implant is capable of spontaneous matrix formation with no immune response, improving function and recreating hyaline-like cartilage. | [42] | |
| Knee (femoral condyles) | Biphasic cylindrical osteochondral composite construct of dl-poly-lactide–co–glycolide (PLGA). Its lower body is impregnated with β-tricalcium phosphate (TCP) | The regenerated osteochondral tissue was evaluated as a tissue of acceptable quality. Regenerated cartilage was defined as being hyaline when the ground substance was homogeneous without fibrous texture. |
[43] |
| Tibial plateau (osteochondral scaffold) | Osteochondral biomimetic collagen-hydroxiapatite scaffold (Maioregen®, Fin-ceramica, Faenza, Italy) | MRI abnormalities. Clinical outcome with stable results up to a mid-term follow-up. | [44] |
| Microfractured defect (for filling microfractures) | BioCartilageTM, product containing dehydrated, micronized allogeneic cartilage, implanted with the addition of platelet rich plasma | No human clinical outcomes data available. Data regarding results are limited to expert opinion. | [45] |
| Chondroitin sulfate adhesive-Poly(ethylene glycol) diacrylate (PEGDA) hydrogel system combined with standard microfracture surgery | Significant increase in tissue fillers with defects in a short-term follow-up. | [46] | |
| Knee (for donor site filling) | Artificial TruFit cylinders made of fully synthetic material called PolyGraft®-Material: 50% copolymer (PDLG), composed of 85% poly(d,l-lactide) and 15% glycolide; 40% calcium sulfphae, 10% PGA fibers | No clinical improvement could be found. The regeneration of the filled defects took more than 2 years, even though TruFit Plugs are supposed to stimulate cartilage and bone cell migration from the surrounding tissue to the synthetic cylinders. | [47] |
| Porous poly(ethylene oxide)terephthalate/butylene terephthalate) (PEOT/PBT) implants | Treated defects did not cause postoperative bleeding. Well integration. Surface stiffness was minimally improved compared to controls. Considerable biodegradation after 9 months. Congruent fibrocartilaginous surface repair with interspersed fibrous tissue formation in implanted sites. Donor site: fibrocartilaginous surface repair. |
[48] | |
| Shoulder | Engineered hyaluronic acid membrane, Hyalograft® | Using the hyaluronic membrane had no effect on the final outcome. No difference was observed between the fibrocartilage tissue formed after implementing microfractures and the fibrocartilage tissue grown on the hyaluronic acid membrane scaffold. | [49] |