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Understanding Cartilage Injuries

Jun 25, 2015

ISTO’s Revaflex, in clinical trials, is designed to regenerate cartilage.

Cartilage damage is responsible for a growing burden of pain and disability in the U.S. Though cartilage injuries have traditionally been resistant to treatment, new insight into regenerating this tissue has led to more options for patients.

Diagnosing cartilage injury
The clinician may be able to diagnose cartilage damage in the knee from a clinical examination, looking for signs and symptoms such as swelling, poor range of motion and pain. MRI imaging may be necessary to assess damage within the joint, as may arthroscopy.1

The pathophysiology of cartilage damage
Articular cartilage, which is a type of hyaline cartilage, consists of an extracellular matrix of collagen and proteoglycans that hold water and a sparsely distributed supply of chondrocytes. These cells arise from mesenchymal stem cells and comprise about 2 percent of the volume of articular cartilage. They play a variety of crucial roles in maintaining the cartilage’s function, such as producing lubrication, acting as shock absorbers and maintaining the extracellular matrix.2,3

Juvenile chondrocytes may offer approach to cartilage damage
Once damaged, cartilage has a limited ability to repair itself. It has no blood supply, and in some areas of the tissue, the matrix and the chondrocytes turn over very slowly.2,4 A number of approaches have been used to address cartilage damage, such as microfracturing the bone beneath the cartilage or performing mosaicplasty, in which pieces of hyaline cartilage and underlying bone are transferred from elsewhere in the patient’s joint to the site of the defect. Though these have shown some benefits, they tend to lead to the undesirable outcomes of “formation of fibrous tissue, chondrocyte death, and further cartilage degeneration.”5

Additionally, using autologous transplants can result in damage to the donor site, and in older patients, chondrocytes may have age-related decreases in their chondrogenic potential.2,6

Another approach that is currently under investigation for treating cartilage damage in the knee is to use implants containing juvenile-derived allogenic chondrocytes, which are inserted into a small incision in the knee and attached to the cartilage defect using fibrin.6

Such cells have been shown to have better regenerative potential than adult cells, and in animal models they didn’t stimulate an immunologic response.6

ISTO currently has a product in clinical trials that is designed to regenerate healthy, durable cartilage to reduce pain and restore knee function. The company has already achieved a prominent role in the field of orthopedics with its InQu Bone Graft Extender & Substitute and Influx Trabecular Bone Graft.

1 American Orthopaedic Society for Sports Medicine, https://www.sportsmed.org/uploadedFiles/Content/Patient/Sports_Tips/ST%20Articular%20Cartilage%2008.pdf
2 Annals of The Royal College of Surgeons of England, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3954317/
3 Sports Health, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445147/
4 Therapeutic Advances in Musculoskeletal Disease, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4426098/
5 Cellular and Molecular Life Sciences, http://m-learning.zju.edu.cn/G2S/eWebEditor/uploadfile/20111121101150_928704760518.pdf
6 American Journal of Sports Medicine, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3774103/

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