First Biological Implants Used for Treatment of Cartilage Lesions and Osteoarthritis in Humans

Every year, millions of joint replacement surgeries take place, and even more patients seek alternatives to delay or avoid using prostheses. An exciting new procedure now offers a promising solution for treating localized knee cartilage lesions and degenerative osteoarthritis (OA) cases, traditionally managed with knee joint replacements that typically require replacement after 15-20 years.

At the University Hospital Basel (Basel, Switzerland), researchers are pioneering a method that uses chondrocytes, the fundamental cells for cartilage construction, to grow new cartilage. This development could offer a significant alternative for patients who need more than just pain management but are reluctant to opt for a prosthetic joint. The procedure, named Nasal Chondrocyte Tissue-Engineered Cartilage (N-TEC), leverages autologous (self-derived) cartilage cells to create new cartilage grafts. These are then surgically implanted to repair the damaged cartilage in patients' joints. The process involves taking a small cartilage sample from the patient’s nasal septum, cultivating and expanding these cells, and then using them to grow new nasal cartilage grafts up to 40 cm2 on a collagen membrane. Remarkably, this process takes only four weeks, and harvesting the cartilage does not harm the patient's nose.

A key aspect of this technique is the use of nasal cartilage, which consists of neural crest-derived cells known for their high regenerative capacity and adaptability to various environments. This makes nasal chondrocytes, particularly from older donors, ideal for engineering N-TEC cartilage patches with the structural and mechanical qualities of typical articular cartilage tissues. Beyond lab and animal trials, N-TEC has successfully moved into clinical application. The University of Basel’s team, leading a multi-center trial across Europe, has effectively treated over 100 patients with knee focal lesions since 2012. The N-TEC grafts, tailored to the specific size and shape of the cartilage defect, are implanted via open surgery, where they integrate with surrounding cartilage and subchondral bone.

Not limited to focal lesions, the technique has been applied to patients with advanced knee OA, traditionally slated for joint replacement surgery. Two patients treated with N-TEC, along with leg axis correction, have reported sustained positive outcomes and continue to engage in daily activities six years after the procedure, without needing artificial joint replacements. Building on this success, the University Hospital Basel team is now extending this approach to treat OA and cartilage defects in various joints. They are conducting clinical trials focused on Patella-Femoral OA in the knee and cartilage issues in the ankle and shoulder, with plans to start elbow joint trials in 2024.

“N-TEC has demonstrated overwhelming success in human clinical studies to date,” said Ivan Martin, PhD, Professor of Tissue Engineering at the Department of Biomedicine, University of Basel and University Hospital Basel. “Thanks to generous public funding and cooperation with other outstanding teams, we will now extend clinical trials to investigate N-TEC in more challenging conditions so that someday it can become a mainstream bed-side procedure for many patients suffering from joint pain induced by cartilage loss.”

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