Laser-Assisted RObot-guided CArtilage REgeneration (LAROCARE)
Research Project | 1 Project Members
In the age of robotics, with a global size of the market projected to reach 209 billion by 2025, it is crucial to consider how this
technology can improve medical care. Despite the advances in robotic surgery in many specialties, cartilage surgery is still regularly
performed as a “free hand technique”. The success of the procedure still relies on the skills of the surgeon. In particular, the first
step in cartilage repair, i.e., the refreshing of cartilage lesion is performed with standard sharp instruments thus not enabling an
accurate/standardized removal of the damaged cartilage and/or inducing an injury of the calcified cartilage layer.
We hypothesize that robotic cartilage surgery could 1) decrease the chondrocyte damage that may occur from surgical instruments,
2) prevent the formation of bony cysts by improving the fit between recipient bed and graft, thus decreasing synovial fluid
intrusion, and 3) select precisely the depth of cartilage resection, preserving the calcified layer for better outcomes [3]. Our project
called “LAROCARE” or Laser-Assisted RObot-guided CArtilage REgeneration, aims to improve the outcome of chondral and
osteochondral defects regeneration. This improvement of the outcome is facilitated by combining two approaches. First, by precise,
controlled, and standardized shaping of the chondral and osteochondral defects using a laser. This laser is precisely guided by a
minimal-invasive robot that can perform closed-loop laser ablation based on Optical Coherence Tomography (OCT). We call this
device “minimally-invasive smart robotic laser arthroscope” because we are aiming at an arthroscopic-assisted or a mini-arthrotomy
procedure. Second, by combining precise bed preparation with novel regenerative cell-based methods and biopolymer-based hydrogel.
We will combine nasal chondrocytes, i.e., cells with higher and more reproducible cartilage forming capacity as compare to
articular chondrocytes, already in use for the repair of knee cartilage lesion (i.e., the “nose to knee approach” [4]), with a hyaluronanbased
hydrogel [5]. The hydrogel allows the injection of nasal chondrocytes in the defect through a minimally invasive approach,
presenting a cell-friendly cross-linking mechanism, and outstanding capabilities to enhance chondrocyte proliferation, maturation
and integration into the host tissue. Pilot in vitro experiments performed by Rauter’s and Barbero’s groups have already demonstrated
promising results of laser treatment of human cartilage tissue in terms of matrix preservation and process sterility [6]. To verify the
advantage of our new regenerative two-step approach, we will perform studies on an in vivo sheep model, already used in former
pre-clinical studies to validate the nose-to-knee approach by Barbero’s and Pozzi’s groups [7].
In this project we aim to bring together unique robotic technology (G. Rauter), novel cell-based and biomaterial approaches (A.
Barbero and M. Zenobi-Wong) and clinical and animal experiment expertise (A. Pozzi), to find a solution for a significant and unmet
clinical need. This team uniquely synergizes key technological and biological expertise to bring new solutions to treat cartilage
degeneration.
