Advances in research on joint distraction for repairing degenerative articular cartilage

Abstract

Degenerative osteoarthritis is a kind of chronic progressive joint disease with articular cartilage degeneration, subchondral bone abnormality as the main pathological feature, pain and joint dysfunction as the main clinical manifestations, which seriously affect the quality of life of patients. The surgical treatment strategy can be mainly attributed to arthroplasty and articular cartilage repair, but arthroplasty comes at the cost of articular cartilage resection. The advantage of articular cartilage repair is to save articular cartilage, delay or even avoid joint formation, including intra-articular treatment represented by microfracture, autologous osteochondral transplantation and extra-articular treatment represented by wedge osteotomy. Intra-articular treatment is mainly limited by the area of cartilage defects; although the extra-articular wedge osteotomy indirectly protects the diseased cartilage by force line adjustment, the cartilage degeneration of the metastatic side is accelerated. Joint distraction (JD) is a surgical technique that gradually separates both sides of the joint to a certain extent and maintains it for a period of time to promote articular cartilage damage repair. The cartilage repair mobilized by joint distraction can significantly delay the natural degeneration process of articular cartilage, and increase the structural and functional parameters of articular cartilage, indirectly providing evidence that the articular cartilage may repair itself. In the early stage of JD, the increase of joint space effectively reduced the HP in the joint, it provided the necessary conditions for the intermittent fluctuation of HP, which was beneficial to the recruitment of MSCs and the dilution of inflammatory mediators, and improved the biomechanical and biochemical environment of articular cartilage and subchondral bone; In the middle and late stages of JD, good mechanical signals may activate chemical signaling pathways including Wnts pathways and hypoxia-inducible factor-1α/vascular endothelial growth factor pathway and promote functional transformation of chondrocytes, express effective cartilage matrix components (Col Ⅱ, proteoglycan), and achieve the transformation of stretch gap to structural gap. \n \n \nKey words: \nJoint distraction;\xa0Articular cartilage;\xa0Osteoarthritis;\xa0Degenerative;\xa0Repair mechanism