Biomedical Engineering Reference
In-Depth Information
38.1 Introduction
38.1.1
Tissue Engineering of the Bone Cartilage Interface
Repair of the bone cartilage interface is a challenging task, one
that is necessary not only in the combat of the degenerative joint
disease osteoarthritis (OA) but also in the treatment of traumatic
injuries. Osteochondral defects often occur in young people, partic-
ularly athletes, and these injuries have a poor spontaneous regen-
eration capacity. When a lesion of the cartilage occurs there is little
self-repair potential in the tissue, making healing di
cult. Recently
it has become clear that the underlying bone must also be taken
into consideration in such injuries as changes in the cartilage cause
changes here, too, which, if untreated, can eventually lead to degen-
erativeOA.OAisamongtheleadingcausesofdisabilityintheelderly
andformsamajorburdentohealthcare.About30%ofpersonsaged
65 and over are affected by knee or hip OA.
1
OA affects 27 million
people in the United States alone and is becoming an increasingly
prevalent disease. As with many tissues of the body, repair of osteo-
chondral defects using autologous tissue is severely limited by tis-
sue availability. To add to this problem, donor site morbidity and a
di
culty matching the shape of the graft topology with the injured
sitecompoundtheissue.
2
Theabilitytotissue-engineerreplacement
grafts would greatly reduce the socioeconomic burden associated
with this type of disease/injury. Tissue engineering of the bone car-
tilage interface presents many problems. Some of these are encoun-
teredinotherfieldsoftissueengineering,andsomeareunique.This
chapterwilldiscusstheconsiderationsforthedesignofasuccessful
tissue engineered osteochondral graft, the current state of the art,
and somepotential future prospects.
38.2 Joint Homeostasis
AftertraumaorindegenerativediseasessuchasOA,jointhomeosta-
sis is disturbed. The homeostasis in the joint is determined by bio-
mechanicalandbiochemicalfactors.Althoughcartilagedamagewas
the hallmark of OA for a long time, it is becoming more and more
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