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The biological function of cartilage transplantation

Why we have to teach the cartilage to heal
The limited ability hyaline joint cartilage has to heal itself has long been known and is essentially due to its extraordinary structure and anatomy. As it has no direct nerve or vascular supply, it receives its nutrition predominantly via lengthy stretches of diffusion from the synovia in the joint interior.

The highly specialized chondrocytes are largely "interred" in the compact extracellular matrix of the cartilage and are therefore immobilized. In addition, the cell impoverished joint cartilage has no direct access to the tissue-specific regenerative cell populations after the closure of the growth plates. Because of this, following damage to the cartilage there is generally an absence of immigration and cultivation processes through specialized progenitor cells. The absence of this important and early part of an intrinsic regeneration response leads in turn, depending on the nature and extent of the damage, to a complete lack of replenishment of the defect or the formation of an inferior biomechanical replacement tissue.
The key biological task of autologous cartilage cell transplantation and procedures developed from it, is to compensate for these lacking steps in intrinsic healing to induce healing of the cartilage damage to the fullest degree possible. Transplanted cells must therefore be capable of colonizing the existing defect in a robust state, in order to subsequently build it up again with biomechanically superior basic cartilage substance through the synthesis and secretion of cartilage specific matrix proteins.