Patient-specific cartilage implants: development and surgical implantation

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Damage to articular cartilage by arthritis or injury causes significant morbidity as the tissue has little potential for repair. One approach to resurface the damaged area with engineered cartilage. However, as only a limited number of cells can be extracted from a patient, the approach is restricted to the repair of small, localized defects. To extend potential treatment to a larger, more clinically relevant patient population, large-size constructs need to be developed. However, the confounding problem with large-sized implants is that the patient's anatomy at the lesion site needs to be taken into account as inadequate graft matching and imperfect restoration of the joint surface can lead to premature implant failure. The objective of this proposed study is to develop patient-specific engineered cartilage implants suitable for the repair of large, clinically-sized defects. Recently, we have developed an approach to create large-sized cartilage constructs (> 3 sq. cm) from a small population of cells (< 20,000) without a separate cell expansion phase or scaffold. The cells are cultivated in a bioreactor which elicits the extensive growth of cartilaginous tissue that can be matched to the shape, curvature and thickness of the defect site. To deliver the patient-specific implants at the desired location and orientation, we will use our computer-assisted surgical strategies developed for cartilage repair. This project translates the results from our previous work to develop and surgically implant, patient-specific engineered cartilage constructs to offer the prospect of treating large defects associated with osteoarthritis (OA) or trauma that cannot be addressed with currently available techniques. Ultimately, with these new technologies, patients will benefit from better clinical outcomes through proper implant matching resulting in a lower risk of implant failure. We expect that our methods will repair degenerative changes due to OA, and potentially delay or eliminate the need for joint replacement surgery