JPRAS open · 2026
Molecular modulation of cartilage graft survival: a systematic review and translational synthesis of local and systemic strategies.
СтатьяОбзорНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Oruc Mehmet Sefik, Gunenc Ali Can, Yılmaz Furkan, Akdemir Ovunc
Аннотация
BACKGROUND: Cartilage grafting is widely used in reconstructive and aesthetic surgery, but graft resorption, volume loss, reduced chondrocyte viability, and variable graft-host integration remain important limitations. This review evaluated preclinical evidence for technical graft-preparation strategies and local or systemic biologic approaches intended to improve cartilage graft survival.
METHODS: A systematic review of preclinical in vivo evidence was reported in accordance with PRISMA 2020. PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar were searched between April 1 and May 1, 2026, with a publication cutoff of March 31, 2026. Direct graft-specific comparative studies, including technical preparation/interface strategies and biologically active interventions, were distinguished from broader contextual publications. Because of heterogeneity in models, strategies, follow-up, and outcomes, meta-analysis and inferential comparisons were not performed. Findings were synthesized narratively, and risk of bias in direct animal studies was assessed using SYRCLE's tool.
RESULTS: Thirty-three publications informed the review: 14 direct graft-specific studies, 5 technical or clinical contextual publications, and 14 indirect mechanistic publications. Direct evidence was predominantly derived from rabbit models and included technical graft-preparation/interface comparisons and locally delivered biologic interventions such as platelet-derived products, fibrin-based materials, and perichondrial support. Several studies reported favorable graft-related findings, but benefits could not be compared reliably across strategy categories. No direct graft-specific systemic intervention study was identified; the systemic rationale was supported by indirect literature on oxidative stress, inflammation, apoptosis, extracellular matrix biology, and tissue repair. Methodological reporting was variable, with several risk-of-bias domains remaining unclear.
CONCLUSION: Several technical graft-preparation approaches and local biologic strategies have shown promising findings in preclinical cartilage graft models. However, substantial heterogeneity and methodological limitations preclude conclusions regarding comparative superiority or routine clinical efficacy. Systemic and combined strategies remain investigational, and the proposed framework is hypothesis-generating pending standardized preclinical studies and prospective clinical validation.
METHODS: A systematic review of preclinical in vivo evidence was reported in accordance with PRISMA 2020. PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar were searched between April 1 and May 1, 2026, with a publication cutoff of March 31, 2026. Direct graft-specific comparative studies, including technical preparation/interface strategies and biologically active interventions, were distinguished from broader contextual publications. Because of heterogeneity in models, strategies, follow-up, and outcomes, meta-analysis and inferential comparisons were not performed. Findings were synthesized narratively, and risk of bias in direct animal studies was assessed using SYRCLE's tool.
RESULTS: Thirty-three publications informed the review: 14 direct graft-specific studies, 5 technical or clinical contextual publications, and 14 indirect mechanistic publications. Direct evidence was predominantly derived from rabbit models and included technical graft-preparation/interface comparisons and locally delivered biologic interventions such as platelet-derived products, fibrin-based materials, and perichondrial support. Several studies reported favorable graft-related findings, but benefits could not be compared reliably across strategy categories. No direct graft-specific systemic intervention study was identified; the systemic rationale was supported by indirect literature on oxidative stress, inflammation, apoptosis, extracellular matrix biology, and tissue repair. Methodological reporting was variable, with several risk-of-bias domains remaining unclear.
CONCLUSION: Several technical graft-preparation approaches and local biologic strategies have shown promising findings in preclinical cartilage graft models. However, substantial heterogeneity and methodological limitations preclude conclusions regarding comparative superiority or routine clinical efficacy. Systemic and combined strategies remain investigational, and the proposed framework is hypothesis-generating pending standardized preclinical studies and prospective clinical validation.