CARTILAGE

Contents Introduction Development Histogenesis Growth of cartilage Nutrition Cartilage canals Classification Hyaline cartilage Elastic cartilage Fibrocartilage Functions of cartilage Regeneration and Ageing Mineralization pattern Calcification of cartilage and replacement by bone Histophysiology of Cartilage Diseases affecting cartilage Bibliography

INTRODUCTION Cartilage is composed of specialized cells called chondroblasts that produce a large amount of extracellular matrix composed of Type II collagen (except fibrocartilage which also contains type I collagen) fibers, abundant ground substance rich in proteoglycan, and elastin fibers. Chondroblasts that get caught in the matrix are called chondrocytes. They lie in spaces, called lacunae, up to eight chondrocytes per lacunae. Cartilage is classified in three types, elastic cartilage, hyaline cartilage and fibrocartilage, which differ in the relative amounts of these three main components. Unlike other connective tissues, cartilage does not contain blood vessels. Because of this, it heals very slowly. The chondrocytes are supplied by diffusion, helped by the pumping action generated by compression of the articular cartilage or flexion of the elastic cartilage. Thus, compared to other connective tissues, cartilage grows and repairs more slowly. Cartilage found in many areas in the bodies of humans and other animals, including the joints between bones, the rib cage, the ear, the nose, the elbow, the knee, the ankle, the bronchial tubes and the intervertebral discs. It is not as hard and rigid as bone but is stiffer and less flexible than muscle.

In fetus, most long bones initially represented by cartilage models.

DEVELOPMENT The first skeleton to develop in embryo is cartilage. It develops in segmental pattern and appears throughout the body: in axial skeleton, base of cranium and appendages. Cartilage cells first appear during fourth and fifth week and thereafter cartilage matrix soon appears throughout the body. It provides skeletal strength and forms matrix where bone cells will later form bone. Later nutrient blood vessels enter cartilage. By 20th week bone replaces most of the cartilage in the body. Cartilage ultimately limited to covering of: heads of long bones, nasal septum, trachea. Specialised cartilage provide support for ears:(elastic cartilage) and spinal column(fibrous cartilage).

HISTOGENESIS

Cartilage arises from mesenchyme. Areas where cartilage develops excluding head, mesenchymal cells aggregate and form mass of rounded, closely apposed cells. In head most cartilages arise from aggregates of ectomesenchyme derived from neural crest cells. These aggregates called Blastema of precartilage and mark site of hyaline cartilage formation. Cells of blastema begin to secrete cartilage matrix and then called Chondroblasts. When become completely surrounded by matrix material , these cells called Chondrocytes. During this process mesenchymal tissue surrounding chondrogenic blastema forms perichondrium.

GROWTH OF CARTILAGE Cartilage capable of two kinds of growth: -Appositional or Exogenous: It is a process that forms new cartilage at surface of preexisting cartilage. It results from activity within perichondrium. -Interstitial or Endogenous: It is a process that forms new cartilage within the cartilage mass.

NUTRITION OF CARTILAGE Cartilage is basically an avascular tissue. Cartilage cells are usually distant from exchange vessels. Between this perichondrial capillary network and chondrocytes, nutrient substances and metabolites takes place along concentration gradient across intervening matrix.

CARTILAGE CANALS Each canal contain central small artery or arteriole which is surrounded by numerous venules, and perivascular capillaries .Chondrocytes also play role in canal formation. Cartilage canals are believed to assist in nutrition of large cartilage. Canals are involved in forming secondary centres of ossification. At around seventh month of embryo canals in laryngeal and nasal cartilage are first formed. In coastal cartilage it arises in first year and by tenth year it reaches centre of shaft.

CLASSIFICATION On the basis of characteristics of the matrix: 1) Hyaline Cartilage: Characterized by homogeneous amorphous matrix 2) Elastic Cartilage: Matrix contains elastic fibers and elastic lamellae 3) Fibrocartilage: Matrix contains large bundles of type I collagen

Hyaline Cartilage

It is distinguished by homogeneous, amorphous matrix. It is derived from Greek word HYALOS which means glassy. Throughout the cartilage matrix, empty spaces are present called lacunae. Matrix consists of two components: - Collagen fibrils - Ground substance

Cartilage matrix: Collagen component of matrix is formed by thin fibrils of approrximately 20nm in diameter. Fibrils are arranged in three dimensional pattern. Chemical analysis reveals presence of three glycosaminoglycans: Hyaluronic acid Chondroitin sulfate Keratan sulphate Cartilage matrix is highly hydrated, because 60-78% of its net weight is water. Much of this water is bound tightly to proteoglycan aggregates which is a major cause of resilience nature of cartilage. In articular cartilage both transient and regional changes in water content takes place. Two major Factors that allow cartilage matrix to respond to pressure loads arehigh degree of hydration and movement of water in matrix. These two factors also contribute to cartilages weight bearing capacity. The ring of intensely staining matrix is designated as capsule.

Territorial matrix is the area of High concentration of sulfated proteoglycans and cell clusters. Interterritorial matrix is the area of sulfated proteoglycans in their lowest concentration in matrix farthest removed from cells. Matrix of hyaline cartilage calcify.

Cartilage Chondrocytes: Chondrocytes under electron microscope contain numerous organelles such as rough endoplasmic reticulum, large golgi apparatus, secretory granules, vesicles, intermediate filaments, microtubules and actin filaments. Old cartilage cells contain numerous intermediate filaments.

Hyaline cartilage forms most of initial skeleton of the fetus: Hyaline cartilage is precursor to bones which is developed by process of Endochondral Ossification. During endochondral bone development, cartilage serves as Epiphyseal growth site. The Epiphyseal growth plate (Epiphyseal disc) remains functional as long as bone grows in length. Hyaline cartilage is present in adult as skeletal unit in trachea, bronchi, larynx, nose and ends of the ribs (costal cartilages).

Perichondrium: Hyaline cartilage is surrounded by firmly attached connective tissue known as Perichondrium. It consists of dense connective tissue whose cells are indistinguishable from fibroblasts. When actively growing it appears to be divided into inner cellular layer, which give rise to cartilage cells and outer fibrous layer. Exception to rule that hyaline cartilage is surrounded by perichondrium occur where cartilage forms free surface. As in articular surfaces of joints cartilage makes contact with bone, as in nasal and costal cartilages and in forming bones.

Elastic Cartilage It is distinguished by presence of elastin in cartilage matrix. Elastic cartilage matrix contains normal components of hyaline cartilage matrix, elastic fibers and interconnecting sheets of elastic material. Elastic material gives elastic properties, resilience and pliability. It is found in external ear, walls of external auditory canal, auditory tube, epiglottis and larynx. Matrix of elastic cartilage does not calcify.

Fibrocartilage It is dense, fasciculated, white fibrous tissue. In it also present are small interfascicular group of chondrocytes. Cells are ovoid and surrounded by matrix. It is present in intervertebral discs, symphysis pubis, articular discs of sternoclavicular and temporomandibular joints, menisci of knee joint and certain places where tendon attach to bones. Presence of fibrocartilage indicates resistance to both compression and shear forces required of the tissue.

FUNCTIONS OF CARTILAGE a) In elasticity and hardness: cartilage between fibrous tissue and bone. b) Helps to maintain shape and rigidity of structure. c) Acts as mechanical buffer as in intervertebral discs. d) Hyaline cartilage serves role in forming primary medium in which cartilagenous development of bone occurs. e) Fibrous cartilage acts as strong, flexible connecting substance between bones. f) Elastic cartilage maintains and strengthens attached organs.

Regeneration and Ageing: The ability of damaged cartilage to repair itself is limited. There are microcracks in calcified layer of ageing articular cartilage that may initiate remodelling of tissue at chondro-osseous junction. Experimentally in cultures of mesenchymal tissues that ordinarily produce bone, cartilage develops if oxygen tension is lowered.

MINERALIZATION PATTERN There are three ways: 1. In process of endochondral ossification, mineralization of growth plate in hypertrophic zone and incidence of matrix vesicles. Matrix vesicles originate from chondrocytes in proliferation zone and are evident in intercolumnar regions and appear to initiate crystal formation.

2. Mineralisation spreads along collagen fibers. 3. Also seen in pericellular regions enveloping chondrocytes.

CALCIFICATION OF CARTILAGE AND REPLACEMENT BY BONE Hyaline cartilage when calcified is generally replaced by bone. Matrix of hyaline cartilage undergoes calcification in three situations: -Portion of articular surface in contact with bone tissue. -In cartilage about to be replaced by bone. -Hyaline cartilage throughout body calcifies with time as part of ageing process. In above cases, given sufficient time, cartilage when calcified is replaced by bone. Chondrocytes derive nutrients and dispose wastes by diffusion through matrix. When matrix is heavily calcified, chondrocytes swell and die and thus there is removal of calcified matrix and replacement by bone.

HISTOPHYSIOLOGY OF CARTILAGE The growth of cartilage is mainly regulated by hypophyseal hormone somatotropin (growth hormone) which causes production of somatomedin-C by liver. It stimulates proliferation of chondrocytes and increase in the size of cartilage. As cartilage is an avascular tissue, it also restricts the entry of lymphocytes and immunoglobulin into the matrix. This property of cartilage is an advantage for cosmetic and reconstructive surgeries, as cartilage can be transplanted from one individual to other without any fear of rejection. DISEASES AFFECTING CARTILAGE

 Achondroplasia: There is reduced proliferation of chondrocytes

in epihyseal

plate of long bones. It is seen during infancy and childhood and causes Dwarfism Costochondritis: Inflammation of cartilage in ribs. Causes chest pain Spinal disc Herniation: Asymmetrical compression of intervertebral disc ruptures sac like disc causing herniation of its soft content. It causes back pain Osteoarthritis: Degeneration of cartilage which is accompanied by pain and stiffness Relapsing Polychondritis: Destruction, probably auto immune, especially of nose and ears. It causes disfiguartion. Death can also occur due to suffocation as larynx loses its rigidity and collapses

Chondroma: A benign tumor composed of hyaline cartilage with areas of

calcification. The most common sites include- anterior portion of maxilla, posterior to canine in mandible and coronoid & condylar process. Clinical features include slowly progressive swelling of jaws. The treatment is surgical excision. Chondroblastoma: A benign tumor composed of closely packed polyhedral chondroid cells in the intercellular matrix, multinucleated giant cells. Areas of calcification & necrosis can be seen. Main sites are the long bones. Clinical features include expansion of long bones. The treatment is conservative surgical excision. Chondromyxoid fibroma: A benign tumor characterized by large myxomatous and fibrous areas in the intercellular substance of the cartilage. In some cases foci of calcification can also be seen. Main sites are long bones, small bones of hands & feet. Clinical feature are pain & swelling in the affected area. The treatment is conservative surgical excision.

 Chondrosarcoma: A malignant counterpart of chondroma with same histological features, except that the size of cells in chondrosarcoma are larger and sometimes binucleate cells are also present. Main sites are maxilla, mandible and other bones in the body. Clinical features include painless swelling of the jaw. The treatment is surgical excision.

BIBLIOGRAPHY Histology A Text And Atlas: Michel H.Ross, Lynn J.Romrell, Gordon I. Kaye; 3rd Edition Oral Histology Development, Structure And Fundamental: A. R. Ten Cate, 6th Edition Concise Histology: Don W. Fawcett & Ronald P. Jensh, 2nd edition Essentials of oral histology and embryology: James K Avery; 3rd edition Grays Anatomy: Churchill Livingstone; 38th Edition Human Physiology: C C Chatterjee; 11th Edition di Fiores atlas of histology with functional correlations; 8th Edition A Textbook of Oral Pathology: Shafer; 4th Edition