Articular Cartilage Tissue Engineering: Cells, Bioinstructive Scaffolds, Immunological Microenvironment, and Emerging Technologies.

Evidence from laboratory and animal studies provides groundwork for understanding mechanisms and potential before human studies continue.

• Level A · Stronger Clinical Evidence
• Level B · Emerging clinical evidence with positive signals
• Level C · Early human research exploring benefits
• Level D · Scientific groundwork from lab and animal studies
• Emerging · Emerging topic under active research

Abstract (original English)

Focal articular cartilage defects retain limited intrinsic repair capacity owing to the avascular, alymphatic and aneural nature of hyaline cartilage. Marrow-stimulation procedures often generate mechanically inferior fibrocartilage with declining benefit within 2-5 years in larger or high-demand lesions, while matrix-induced autologous chondrocyte implantation (MACI) achieves durable 10-year benefit but remains constrained by two-stage logistics, in vitro dedifferentiation and cost. This review integrates the cellular, biomaterial, biochemical and immunological dimensions of articular cartilage tissue engineering with quantitative benchmarks and a critical reading of failure modes, scalability and regulatory standing. We benchmark MACI against single-stage chondron- and progenitor-based therapies; examine mesenchymal stromal cells (MSCs) from bone marrow, adipose, synovium and the infrapatellar fat pad with a mechanistic dissection of the Wnt/β-catenin, IHH-PTHrP, RUNX2/MEF2C and HIF-1α inputs driving hypertrophic drift; reframe scaffolds as bioinstructive environments delivering mechanical, biochemical and tribological cues, including stimuli-responsive and 4D-printed systems and low-intensity pulsed ultrasound (LIPUS) as a non-invasive adjunct; develop the immunological dialogue between altered native cartilage, the infrapatellar fat pad-synovium unit and engineered construc

Evidence level

Evidence from laboratory and animal studies provides groundwork for understanding mechanisms and potential before human studies continue.

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