Osteoarthritis (OA) is the most common form of arthritis and affects more than 28 million Americans. It is a disease that is caused by premature deterioration of articular hyaline cartilage.

Hyaline cartilage is the tough gristle that caps the ends of long bones in the joint. The genesis of OA is a complicated process that is initiated when cartilage undergoes injury. Since cartilage is avascular and aneural (there are no nerves or blood vessels inside cartilage), the capacity to repair itself is minimal. Genetic factors also play a significant role.

Once the disease begins, there is a progressive loss of cartilage resiliency. A complex interplay of inflammation of the joint lining as well as abnormal metabolic behavior within the cartilage itself appear to both play important roles. There is new evidence that cartilage cells called chondrocytes may participate in a generalized inflammatory and destructive process that leads to the cartilage damage.

The underlying bone beneath the cartilage is also involved with the progressive growth of osteophytes (spurs.) Bone may contribute in other ways to the development of OA.

Since this is a generalized metabolic process, this makes OA different from conditions where there is an isolated area of cartilage injury.

There have been a number of procedures that have been performed in order to repair damaged cartilage.

For example, microfracture has been touted as a popular option for localized cartilage defects.

The theory is that by breaking through cartilage and bone by fracturing it, openings are created for mesenchymal stem cells to escape into the knee joint with subsequent repair of cartilage defects. It has been shown that mesenchymal stem cells from bone marrow have the ability to differentiate into cartilage and bone.

Autologous cartilage plugs are another option. These are plugs of cartilage and bone that are taken from non-weight-bearing areas of the knee joint such as the intercondylar notch and then "plugged" into cartilage defects.

Autologous chondrocyte implantation is another procedure where cartilage cells are removed from the patient, cultured in a laboratory, and then re-implanted back into the injured knee underneath a thin membrane in the cartilage defect. The patient then cannot weight-bear for several months.

These procedures have had mixed reviews since controlled studies are difficult to do and the actual success rate is hard to determine. One point that must be emphasized is that none of these procedures has been shown to be effective for OA. The probable reason is, as stated earlier, that OA is a metabolic failure of cartilage rather than an isolated injury.

One option that does appear to have promise is the use of mesenchymal stem cells along with growth factors and biomatrix. Further research is needed to confirm the anecdotal reports that have been produced so far. For more information about this procedure, here is a reference:

Wei N, Beard S, Delauter S, Bitner C, Gillis R, Rau L, Miller C, Clark T. Guided Mesenchymal Stem Cell Layering Technique for Treatment of Osteoarthritis of the Knee. J Applied Res. 2011; 11: 44-48

Nathan Wei, MD FACP FACR is a board-certified rheumatologist and nationally known arthritis authority and expert. For more info: Arthritis Treatment and Arthritis Treatment CenterOnce you come across Windows Error 2 Itunes problems, please try to reinstall itunes first and see if it works
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