International Cartilage Repair Society: New Frontiers in Cartilage 2013 Tallinn Estonia

The goal of the meeting was to introduce basic science avant-garde concepts to current practitioners of cartilage both in the clinical and business world of cartilage. The concepts ranged from whole limb regeneration to stem cells to genetic evaluation of cartilage degeneration risk factors.

Regenerating true hyaline cartilage remains the holy grail of cartilage scientists and surgeons. Current techniques achieve “hyaline-like” cartilage at best and fibrocartilage otherwise. While the clinical science validating that true hyaline cartilage is better than “hyaline-like” in the long term is lacking, both basic science and empirical sense suggest:  the closer the regenerative tissue is to the original the more the new tissue will perform as the original.

There are multiple examples that cartilage quality is genetically programed.  The science behind this easy to accept concept is complex.  Genetic mutations that cause discrete gene errors are relatively rare and lead to nonviable situations or severe impairments. Much more common are subtle variations on the production and repair processes.  Many of these may be epigenetic. Without digressing into the vast field of epigenetics, the concept is straightforward: microenviromental  factors can alter gene sensitivity to regulation factors.  That is the microenvironment can negatively influence gene regulation, and thus possibly diet, nutrition and drugs could positively influence this interplay.

Stem cells are all the rage in the popular press as they are proposed to cure everything: the adage, if it sounds too good to be true then it is, rings clear. When science rather than hype is involved, the issues are complex. Simplistically, stem cell can be categorized in two functions. The most common conception is that they can be “simply” told to become whatever tissue the patient needs—heart, brain, tendon, cartilage, etc. As is obvious, the signals and environment to affect this are complicated. Our study of stem cells to regrow a meniscus, failed to show regeneration, yet serendipitously a subset of patients has PRO improves at one year. This other category of stem cell use could be characterized as using them as small “chemical factories” is the other function.  What for a separate blog devoted to stem cells.