New scaffold–based one step procedure

The use of scaffolds in combination with autologous chondrocytes is well established in clinical practice in Europe (even if not yet available in the US). The rationale for using a scaffold is to have a temporary three dimensional structure of biodegradable polymers for the growth of living cells. An ideal scaffold should mimic biology and the architectural and structural properties of the native tissue, thus facilitating cell infiltration, attachment, proliferation and differentiation. Other important properties include biocompatibility and biodegradability through safe biochemical pathways at suitable time intervals to support the first phases of tissue formation and gradual replacement by regenerating tissue. There is increasing interest in utilising various biomaterials in clinical practice, not only to deliver expanded autologous chondrocytes for tissue regeneration, but also as a new treatment approach, which involves the implant of various biomaterials for "in situ" cartilage repair exploiting bone marrow stem cell differentiation induced by the scaffold properties. In fact, some scaffolds may have a potential themselves to promote chondral or osteochondral regeneration by exploiting the self-regenerative potential of the body. An ideal graft would be an off-the-shelf product from both a surgical and commercial standpoint. The possibility to produce a cell-free implant that is "smart" enought to provide the joint with the appropriate stimuli to induce orderly and durable tissue regeneration is realy attractive, and new, different biomaterials have recently been proposed to induce "in situ" cartilage regeneration after direct transplantation onto the defect site both in research and in clinical practice.