Mechanism and research progress of improving cartilage injury based on the combination of active ingredients in traditional Chinese medicine and biomaterials (Accepted)

Cartilage injuries continue to pose a significant treatment challenge, owing to the inherent limited capacity of cartilage for self-repair. Traditional methods for treating cartilage injuries, including surgical interventions, microfracture and autologous chondrocyte implantation, may alleviate symptoms but are often associated with drawbacks such as surgical trauma, uncertain efficacy, and potential side effects. The active ingredients derived from traditional Chinese medicine (TCM), possessing anti-inflammatory, anti-apoptotic, pro-proliferative, and differentiating properties, have emerged as a novel focal point in research pertaining to the treatment of cartilage damage. However, clinical application of TCM has been limited by issues such as low bioavailability, inadequate stability, and weak targeting capabilities. The combination of active ingredients in TCM and biomaterials provide new ideas for solving the above problems. This article discussed the pathological basis of cartilage injury, the mechanism of action of TCM active ingredients such as polysaccharides, flavonoids, terpenoids, aldehydes, polyphenols, and saponins in treating cartilage injury, and the application of TCM active ingredients combined with biomaterials in the treatment of cartilage injury. These biomaterial delivery systems include gels, nanomaterials, microspheres, and tissue scaffolds. This article also summarized the challenges and possible development directions of the combination of TCM active ingredients and biomaterials in the treatment of cartilage injury, providing new insights for the treatment of cartilage injury.