Table Of ContentArticular Cartilage
Tissue Engineering
Synthesis Lectures on
Tissue Engineering
Editor
Kyriacos A. Athanasiou, University of California, Davis
Articular Cartilage Tissue Engineering
Kyriacos A. Athanasiou, Eric M. Darling, and Jerry C. Hu
2009
Tissue Engineering of Temporomandibular Joint Cartilage
Kyriacos A. Athanasiou, Alejandro A. Almarza, Michael S. Detamore, and Kerem N. Kalpakci
2009
Engineering the Knee Meniscus
Kyriacos A. Athanasiou and Johannah Sanchez-Adams
2009
Copyright © 2010 by Morgan & Claypool
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in
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printed reviews, without the prior permission of the publisher.
Articular Cartilage Tissue Engineering
Kyriacos A. Athanasiou, Eric M. Darling, and Jerry C. Hu
www.morganclaypool.com
ISBN: 9781598298758
paperback
ISBN: 9781598298765
ebook
DOI 10.2200/S00212ED1V01Y200910TIS003
A Publication in the Morgan & Claypool Publishers series
SYNTHESIS LECTURES ON TISSUE ENGINEERING
Lecture #3
Series Editor: Kyriacos A. Athanasiou, University of California, Davis
Series ISSN
Synthesis Lectures on Tissue Engineering
Print 1944-0316
Electronic 1944-0308
Articular Cartilage
Tissue Engineering
Kyriacos A. Athanasiou
University of California, Davis
Eric M. Darling
Brown University
Jerry C. Hu
University of California, Davis
SYNTHESIS LECTURES ON TISSUE ENGINEERING #3
C
M
&
cLaypool
Morgan
publishers
&
ABSTRACT
Cartilage injuries in children and adolescents are increasingly observed, with roughly 20% of knee
injuries in adolescents requiring surgery. In the US alone, costs of osteoarthritis are in excess of $65
billion per year (both medical costs and lost wages). Comorbidities are common with OA and are
also costly to manage.Articular cartilage’s low friction and high capacity to bear load makes it critical
in the movement of one bone against another, and its lack of a sustained natural healing response has
necessitated a plethora of therapies.Tissue engineering is an emerging technology at the threshold of
translation to clinical use. Replacement cartilage can be constructed in the laboratory to recapitulate
the functional requirements of native tissues.This book outlines the biomechanical and biochemical
characteristics of articular cartilage in both normal and pathological states,through development and
aging. It also provides a historical perspective of past and current cartilage treatments and previous
tissue engineering efforts. Methods and standards for evaluating the function of engineered tissues
are discussed, and current cartilage products are presented with an analysis on the United States
Food and Drug Administration regulatory pathways that products must follow to market. This
book was written to serve as a reference for researchers seeking to learn about articular cartilage,
for undergraduate and graduate level courses, and as a compendium of articular cartilage tissue
engineering design criteria.
KEYWORDS
knee, hip, shoulder, articular cartilage, tissue engineering, chondrocyte, osteoarthritis,
biomechanics, cartilage products, cartilage transplant, cartilage diseases/surgery, chon-
drocyte transplantation, autologous/adverse effects, United States Food and Drug Ad-
ministration,device approval,orthopedic equipment/classification,cartilage epidemiol-
ogy/physiopathology, incidence, athletic injuries/epidemiology, stem cells, bioreactors,
direct compression, hydrostatic pressure, shear, micropatterning, single cell mechanics
To Thasos and Aristos. Always excelling is unavoidable.
Αφιερωμένο στους Θάσο και Άριστο. Αίεν αριστεύειν είναι
αναπόφευκτο. –KA
2
To my parents, John and Marilynn, who provided a
childhood of unconditional love, support, and
encouragement, and to my wife, Louise, who has
provided an adulthood of that and more. –EMD
To my family, our past and current students, and my
friends back in Houston; I think of everyone on my
treks, and wish that you can see what I see. –JH
ix
Contents
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
1
Hyaline Articular Cartilage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1
Composition, Structure and Function of Hyaline Cartilage . . . . . . . . . . . . . . . . . . . . . 1
1.1.1 Biochemical Composition
1
1.1.2 Structure
6
1.1.3 Function
8
1.2
Articular Chondrocytes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
1.3
Chapter Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
2
Cartilage Aging and Pathology: The Impetus for Tissue Engineering . . . . . . . . . . . . . . . . . 15
2.1
Cartilage Formation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
2.1.1 Chondrocyte Condensation and Differentiation
15
2.1.2 Hypertrophy and Ossification
17
2.2
Aging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
2.3
Cartilage Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
1.4
Osteochondral, Chondral Defects, and Microfractures . . . . . . . . . . . . . . . . . . . . . . . . 19
2.3.2 Causes of Cartilage Injuries
20
2.3.3 Repair Responses to Cartilage Injury
22
2.3.4 Costs of Articular Cartilage Injuries
22
2.4
Osteoarthritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
2.4.1 Osteoarthritic Changes in the Matrix
24
2.4.2 Proliferation, Catabolism, and Cell Death
25
2.4.3 Costs of Arthritis
26
2.5
Motivation for Tissue Engineering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
2.6
Chapter Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
