Orthopedic Disorders

Cartilage Defect   Bone Defects    

Cartilage Defect

Cartlage is a flexible connective tissue not hard as bones and less flexible than muscle. It presents in the joints between bones. A cartilage damage can result from a variety of causes, such as a bad fall or traumatic sport-accident, previous knee injuries or wear and tear over time. Cartilage defects are most commonly seen in the knee joint. The most common cause of a cartilage defect in the knee is trauma, and commonly seen as association with ligament injuries, such as ACL tears.

Cartilage defects of the knee joint may require surgical treatment to relieve pain and swelling. Treatment options for a cartilage defect include microfracture, cartilage transfer and cartilage implantation. Total knee replacement is most commonly performed in people over 60 years of age. Treatment of younger patients is more troublesome, as prostheses have a limited lifetime.

Current techniques in biological resurfacing of cartilage defects require an open arthrotomy or arthroscopy and involve the direct transplantation of isolated cells and/or scaffolds or whole tissue grafts with chondrogenic potential onto the cartilage defect. Autologous Chondrocyte Implantation (ACI) is a technique that aims to repair damaged cartilage in a joint. The goal of ACI is to allow people suffering from articular cartilage damage to return to their old lifestyle; regaining mobility, going back to work and even practicing sports again.

Autologus Chondrocyte implantation is suitable for small damage area which restricts movement of patient and causes pain. ACI is not advisable for wide range of damage area like arthritis and any damage associated with ligament and also for obese patients.

Autologous Chondrocyte Implantation (ACI) has been demonstrated as a reproducible treatment option for symptomatic chondral injuries of the knee. ACI provides pain relief while at the same time slowing down the progression or considerably delaying partial or total joint replacement (knee replacement) surgery. Cultured autologous chondrocytes fills the defect with cells of a committed pathway to develop hyaline-like cartilage. This hyaline-like cartilage more closely recreates the wear characteristics and durability of normal hyaline cartilage than the fibrous or fibrocartilage repair tissue formed by pluripotential stem cells.

Stem Cure is the pioneer in India for the development of Chondrocyte from biopsy of cartilage for Autologus Chondrocyte Implantation. At StemCure we isolate and culture Condrocytes from cartilage biopsy by following GMP standards and maintaining aseptic conditions. A small biopsy of cartilage cells is collected with arthroscopic surgery by the surgeon and area of damage is determined at the same time. The sample is send to StemCure for expansion of the cells, where the cells are expanded as per established protocol following GMP guideline. These expansion may take 4 to 6 weeks. The expanded Chondrocytes are then transferred to surgeon where the cells are implanted. The patient has to undergo another surgery in which the damaged area is open and Autologus Chondrocytes are injected.


Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L. N Engl J Med. 1994 Oct 6;331(14):889-95.

Treatment of Articular Cartilage Defects of the Knee With Autologous Chondrocyte Implantation, Scott D. Gillogly, Michael Voigbt, Tab Blackburn, JOSPT Volume 28 Number 4 October 1998


Bone Defects

Bone is living tissue that provides shape and support for the body, as well as protection for some organs. It also create and store blood cells. Any defect in bone may cause pain, tenderness, swelling, fracture etc which keep a person in miserable condition.

Avascular necrosis
(also osteonecrosis, bone infarction, aseptic necrosis, ischemic bone necrosis, and AVN) is a disease where there is cellular death (necrosis) of bone components due to interruption of the blood supply. Without blood, the bone tissue dies and the bone collapses. The blood flow to a section of bone can be interrupted if the bone is fractured or the joint becomes dislocated. A vascular necrosis is also associated with long-term use of high-dose steroid medications and excessive alcohol intake.
The incidence and prevalence of AVN are unknown. It is estimated that 2500-3300 cases of AVN of the hip occur each year; of these, 34.7% were due to corticosteroid use, 21.8% to alcohol abuse, and 37.1% to idiopathic mechanisms. AVN is a disease of middle age that most often occurs during the fourth or fifth decade of life and is bilateral in 55% of cases.

Nonunion of a fracture
refers to the absence of healing in a fracture. Nonunion is generally deemed to have occurred when the fracture moves too much, has a poor blood supply or gets infected and the normal process of bone healing is interrupted or stalled. More commonly the tissue between the ununited fragments is scar tissue.
A bone cyst is a fluid-filled hole that develops inside a bone. A bone cyst or geode is a type of cyst that can present itself in the jaw or on other locations in the body. They mostly occur in children and young adults. Types for bone cysts include Simple bone cyst, Aneurysmal bone cyst and Traumatic bone cyst.

Specific treatment for a bone disorder will be determined by the physician based on age, overall health, medical history and extent of the disease. Stem cells have the potential of multi-directional differentiations, and they can differentiate into specialized cells to repair injured tissues under certain conditions. Bone marrow stromal cells (also known as Mesenchymal Stem Cells) have the ability to differentiate into Osteoblast, eChondroblasts, Fibroblasts, Adipocytes, etc. depending on the environmental condition of adjacent tissues. Stem cells can avoid the progression of avascular necrosis to the stage of the subchondral fracture and reduced the need for total hip replacement. Bone marrow stem cells can remove vascular lesions and promote angiogenesis in necrotic femoral heads, accompanied by significant improvement of blood circulation in the necrotic femoral head and surrounding tissues.

Preliminary clinical data show successful healing of local bone defects by bone marrow derived MSC. Experiments on rabbits showed both, platelet-rich plasma and MSC are potent to heal critical-size long-bone defects. The Osteogenic potency of platelet rich plasma was also confirmed for the treatment of delayed unions. Several studies reported about successful bone healing via MSC derived from the periosteum in an atrophic femoral non-union. Experiments for a vascular necrosis demonstrate the implanted MSCs can not only survive but proliferate in the necrotic femoral head after transplantation, promoting the repair of injured femoral head. References:



Bone Marrow Concentrate: A Novel Strategy for Bone Defect Treatment, Marcus Jäger*,Eva M. Jelinek, Kai M. Wess, Axel Scharfstädt, May Jacobson, Sherwin V. Kevy and Rüdiger Krauspe, Current Stem Cell Research & Therapy, 2009, 4, 34-43

Autologous stem cells (adipose) and fibrin glue used to treat widespread traumatic calvarial defects: case report, Stefan LENDECKEL1, Andreas JO¨ DICKE2, Petros CHRISTOPHIS2, Kathrin HEIDINGER3,Jan WOLFF4, John K. FRASER5, Marc H. HEDRICK5, Lars ERTHOLD6, Hans-Peter HOWALDT1

Application of Mesenchymal Stem Cells in the Regeneration of Musculoskeletal Tissues Edward J. Caterson, BS, Leon J. Nesti, PhD, Todd Albert, MD, Keith Danielson, PhD, Rocky Tuan, PhD, Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania