Mylène Jansen

Clinical evidence and molecular mechanisms of KJD 205 10 Table 2 : Possible future directions Future direction How this can be achieved Improved individual patient response Better patient selection pre-treatment Patient-specific treatment alterations Implementation in regular clinical care Defining official treatment protocols Arranging treatment reimbursement Further understanding of working mechanisms Use of novel imaging techniques in combination with biomarkers Evaluating additional local or systemic markers Evaluating the role of other factors (e.g. miRNA, gait, MSC origin) Using knowledge outside current treatment Translating different components of KJD treatment and the resulting joint processes to other treatments MSC: mesenchymal stem cell; miRNA: micro RNA. Conclusion and future directions Evidence is gradually accumulating that KJD results in prolonged relief of pain and that it indeed can reverse the tissue degenerative process. It remains to be elucidated whether optimizing the biomechanical conditions during distraction, can actually cure the disease instead of only providing temporarily relief. Even in the latter case it may be of societal and patient relevance as it will delay placement of a prosthesis at an early age and with that prevent revision surgery later in life. Most importantly, a better insight in the underlying mechanisms may provide new leads to more targeted treatment options. E.g., MSC enrichment under the proper joint milieu maybe even without the need for distraction treatment (and its burden) provide sufficient repair activity, although the mechanical condition (temporary absence of wear and tear, with the bone turnover) might be assumed essential. Providing the right joint milieu mechanically and biologically has the potential to repair the joint. The difference with the many trial-and-error treatment attempts is that we can learn from distraction and (just) need to unravel the mechanisms that lead to this repair.