Spontaneous Healing of ARticular Cartilage (SHARC)
Research type
Research Study
Full title
How do cartilage injuries heal naturally? An observational studies of spontaneously healing cartilage defects.
IRAS ID
243678
Contact name
Jan Herman Kuiper
Contact email
Sponsor organisation
Keele University
Duration of Study in the UK
2 years, 9 months, 17 days
Research summary
Research Summary:
Osteoarthritis is a very common disease of the joints, for which in the United Kingdom alone almost 9 million people have sought treatment. This painful disease affects the cartilage and bone inside the joint. Many factors are known to increase the risk of getting osteoarthritis, or the rate at which it gets worse. Very important among these factors is an injury or a defect of the cartilage. It was believed for hundreds of years that cartilage, once injured, does not heal.
Research from the past 10 years is now throwing doubt on this old certainty, as researchers who took regular scans of volunteers over time noted that sometimes these defects come and then go. A Japanese group of surgeons decided to look again after a year to see what had happened to these defects, and noted that about half of them had got better! Cartilage defects in human therefore can heal, but nobody knows how this works.
For many years, our Centre has helped patients who have knee cartilage damage by using the patients' own cartilage cells to help repair areas of damaged cartilage. This cell therapy starts by taking a piece of cartilage (10 mm) from the patient's knee, and this created defect always heals after a year. Thus, our proposal is to use our cell therapy patients as a human experimental model of natural cartilage healing using a wide range of techniques including Magnetic Resonance Imaging (MRI), visual inspection of the joint itself during knee joint surgery, examining biopsies of repair tissue down the microscope and measuring various kinds of molecules researchers think are important. The information gathered from these tests will help bridge the gap in our understanding of the mechanisms involved in the cartilage tissue regeneration.
Summary of Results:
Our Centre helps patients who have knee cartilage damage by using the patients' own cartilage cells to help repair areas of damaged cartilage. This cell therapy starts by taking a cartilage "harvest" from the knee, a 10-mm sized piece of full-thickness cartilage. This artificially created defect always appears to heal after a year. This study used our cell therapy patients as a human experimental model of natural cartilage healing using a range of techniques including Magnetic Resonance Imaging (MRI) and examining biopsies of repair tissue down the microscope to measure various kinds of molecules researchers think are important.
Preliminary analyses found that these artificially created defects did heal, filling around 80% of the defect depth. In around 30% of participants the repair tissue mainly consisted of hyaline cartilage, which is the tissue covering healthy joints. In another 30% the tissue mainly consisted of fibrocartilage, a tissue that may mature further to form hyaline cartilage. In 20% of participants, the tissue was a mix of hyaline and fibrocartilage. In the final 20% of participants, the tissue consisted mainly of fibrous tissue, which is regarded as poorly adapted to the mechanical forces that act on cartilage.
In conclusion, the study provided clear evidence for human articular cartilage to produce good-quality repair tissue in response to a cartilage harvest.
REC name
North West - Liverpool Central Research Ethics Committee
REC reference
18/NW/0291
Date of REC Opinion
19 Jun 2018
REC opinion
Further Information Favourable Opinion