Reparative Medicine in Treating Cartilage Defect and Nerve injury: From the Past to the Future

Both cartilage injury and nerve injury are challenging for hand surgeons to treat. From the surgical reconstruction to current reparative medicine, we could treat cartilage injury and nerve injury with satisfactory results.

Cartilaginous defect is a common cause for joint pain and disability. So far, there are no effective treatments capable of restoring the original structure and function of damaged articular cartilage. Stem cell therapy is one of potential treatment in treating cartilage defect. In the past, we used the cell-based therapy, autologous chondrocyte cell sheet implantation, to treat the osteoarthritis with cartilage defect successfully with a significant functional and histological improvements. In addition to the satisfaction of autologous layered chondrocyte sheet transplantation, heterogenic layered chondrocyte sheet transplantation provides a one-stage treatment strategy with higher quality of chondrocyte sheet. In the ongoing researches, we investigated the treatment based on heterogenic layered chondrocyte sheet transplantation. Furthermore, non-cell based treatment provides equivalent therapeutic effect as stem cell therapy and becomes a current trend. We proved the efficacy of induced-Pluripotent Stem Cell (iPSC) -derived Extracellular Vesicles (EVs) in repairing cartilage damage.

Brachial plexus injuries (BPI) are a devastating disease that lead significant upper limbs function loss. Through varied reconstruction procedures, such as nerve grafting, nerve transfer, free functioning muscle transfer, etc., we could restore the function successfully and increase the quality of life of patients. In addition, nerve reconstruction procedures also be used to enhance the function of patients with spinal cord injury and become more popular in recent decades. The olfactory ensheathing cells (OECs) -derived EV showed the potential therapeutic effect in treating nerve injury. The miRNA profile is further be revealed with a neuroprotective effect and neuroregenerative effect. In the future, a combinatory treatment strategy, including surgical nerve reconstruction and biological reparative therapy, may provide an optimal outcome.