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Kuwasawa A, Okazaki K, Noda K, Nihei K. Clinical results of autologous protein solution injection for knee osteoarthritis with severe disease grade is inferior to mild or moderate grade. Sci Rep 2023; 13:6404. [PMID: 37076698 PMCID: PMC10115806 DOI: 10.1038/s41598-023-33659-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 04/17/2023] [Indexed: 04/21/2023] Open
Abstract
Autologous protein solution (APS) is made from platelet-rich plasma that extracts high-concentration growth factors and cytokines. Intra-articular APS injection was reported to improve knee osteoarthritis (KOA) pain and function. However, efficacy differences regarding osteoarthritis severity remained unknown. This retrospective study clinically assessed 220 knees with KOA in the Kellgren-Lawrence (KL) grades 2-4 that underwent APS injection using the Knee Injury and Osteoarthritis Outcome Score (KOOS). A telephone survey was performed for patients who dropped out to check symptom changes. The recalculated estimated responder rate included the telephone survey results. The 12-month follow-up was completed with 148 knees (67%), whereas 72 knees dropped out. The follow-up rate was significantly lower in KL4 than KL2 and 3. The KOOS significantly improved in 148 knees, whereas the KOOS was lower in KL4 than in KL2. The responder rate was 55% total, 58% in KL2, 57% in KL3, and 47% in KL4; however, the estimated responder rate, including the telephone survey, was 49% total, 55% in KL2, 54% in KL3, and 36% in KL4. This study showed improved clinical symptoms 1-year after APS injections for KOA, with a lower responder rate in KL4 than in KL2 or KL3.
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Affiliation(s)
- Ayano Kuwasawa
- Department of Orthopaedic Surgery, Saitama Cooperative Hospital, 1317 Kizoro, Kawaguchi, Saitama, 333-0831, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, 162-8666, Japan.
| | - Kuniko Noda
- Department of Orthopaedic Surgery, Saitama Cooperative Hospital, 1317 Kizoro, Kawaguchi, Saitama, 333-0831, Japan
| | - Kotaro Nihei
- Department of Orthopaedic Surgery, Saitama Cooperative Hospital, 1317 Kizoro, Kawaguchi, Saitama, 333-0831, Japan
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Niemann M, Ort M, Lauterbach L, Streitz M, Wilhelm A, Grütz G, Fleckenstein FN, Graef F, Blankenstein A, Reinke S, Stöckle U, Perka C, Duda GN, Geißler S, Winkler T, Maleitzke T. Individual immune cell and cytokine profiles determine platelet-rich plasma composition. Arthritis Res Ther 2023; 25:6. [PMID: 36627721 PMCID: PMC9830842 DOI: 10.1186/s13075-022-02969-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 12/02/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Platelet-rich plasma (PRP) therapy is increasingly popular to treat musculoskeletal diseases, including tendinopathies and osteoarthritis (OA). To date, it remains unclear to which extent PRP compositions are determined by the immune cell and cytokine profile of individuals or by the preparation method. To investigate this, we compared leukocyte and cytokine distributions of different PRP products to donor blood samples and assessed the effect of pro-inflammatory cytokines on chondrocytes. DESIGN For each of three PRP preparations (ACP®, Angel™, and nSTRIDE® APS), products were derived using whole blood samples from twelve healthy donors. The cellular composition of PRP products was analyzed by flow cytometry using DURAClone antibody panels (DURAClone IM Phenotyping Basic and DURAClone IM T Cell Subsets). The MESO QuickPlex SQ 120 system was used to assess cytokine profiles (V-PLEX Proinflammatory Panel 1 Human Kit, Meso Scale Discovery). Primary human chondrocyte 2D and 3D in vitro cultures were exposed to recombinant IFN-γ and TNF-α. Proliferation and chondrogenic differentiation were quantitatively assessed. RESULTS All three PRP products showed elevated portions of leukocytes compared to baseline levels in donor blood. Furthermore, the pro-inflammatory cytokines IFN-γ and TNF-α were significantly increased in nSTRIDE® APS samples compared to donor blood and other PRP products. The characteristics of all other cytokines and immune cells from the donor blood, including pro-inflammatory T cell subsets, were maintained in all PRP products. Chondrocyte proliferation was impaired by IFN-γ and enhanced by TNF-α treatment. Differentiation and cartilage formation were compromised upon treatment with both cytokines, resulting in altered messenger ribonucleic acid (mRNA) expression of collagen type 1A1 (COL1A1), COL2A1, and aggrecan (ACAN) as well as reduced proteoglycan content. CONCLUSIONS Individuals with elevated levels of cells with pro-inflammatory properties maintain these in the final PRP products. The concentration of pro-inflammatory cytokines strongly varies between PRP products. These observations may help to unravel the previously described heterogeneous response to PRP in OA therapy, especially as IFN-γ and TNF-α impacted primary chondrocyte proliferation and their characteristic gene expression profile. Both the individual's immune profile and the concentration method appear to impact the final PRP product. TRIAL REGISTRATION This study was prospectively registered in the Deutsches Register Klinischer Studien (DRKS) on 4 November 2021 (registration number DRKS00026175).
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Affiliation(s)
- Marcel Niemann
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany ,grid.484013.a0000 0004 6879 971XBerlin Institute of Health at Charité – Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Melanie Ort
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353, Berlin, Germany. .,Department of Biology, Chemistry and Pharmacy, Institute of Chemistry and Biochemistry, Freie Universität Berlin, 14195, Berlin, Germany.
| | - Luis Lauterbach
- grid.484013.a0000 0004 6879 971XBerlin Institute of Health at Charité – Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Mathias Streitz
- grid.417834.dDepartment of Experimental Animal Facilities and Biorisk Management, Friedrich-Loeffler-Institut, Südufer 10, 17493 Greifswald, Insel Riems Germany
| | - Andreas Wilhelm
- grid.484013.a0000 0004 6879 971XBerlin Institute of Health at Charité – Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Gerald Grütz
- grid.484013.a0000 0004 6879 971XBerlin Institute of Health at Charité – Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Florian N. Fleckenstein
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Diagnostic and Interventional Radiology, Augustenburger Platz 1, 13353 Berlin, Germany ,grid.484013.a0000 0004 6879 971XBerlin Institute of Health Center for Regenerative Therapies, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Frank Graef
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany ,grid.484013.a0000 0004 6879 971XBerlin Institute of Health at Charité – Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Antje Blankenstein
- grid.484013.a0000 0004 6879 971XBerlin Institute of Health at Charité – Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Simon Reinke
- grid.484013.a0000 0004 6879 971XBerlin Institute of Health at Charité – Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Ulrich Stöckle
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Carsten Perka
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Georg N. Duda
- grid.484013.a0000 0004 6879 971XBerlin Institute of Health at Charité – Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Sven Geißler
- grid.484013.a0000 0004 6879 971XBerlin Institute of Health at Charité – Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Tobias Winkler
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany ,grid.484013.a0000 0004 6879 971XBerlin Institute of Health at Charité – Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany ,grid.484013.a0000 0004 6879 971XBerlin Institute of Health Center for Regenerative Therapies, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Tazio Maleitzke
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany ,grid.484013.a0000 0004 6879 971XBerlin Institute of Health at Charité – Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany ,grid.484013.a0000 0004 6879 971XBerlin Institute of Health at Charité – Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
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3
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Pagani S, Veronesi F, Giavaresi G, Filardo G, Papio T, Romandini I, Fini M. Autologous Protein Solution Effect on Chondrogenic Differentiation of Mesenchymal Stem Cells from Adipose Tissue and Bone Marrow in an Osteoarthritic Environment. Cartilage 2021; 13:225S-237S. [PMID: 33583216 PMCID: PMC8804741 DOI: 10.1177/1947603521993217] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Osteoarthritis (OA) is an inflammatory and degenerative disease, and the numerous treatments currently used are not fully effective. Mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP) are proposed for OA treatment as biologic therapies. The aim of the study was to observe the role of autologous protein solution (APS), a type of PRP, on chondrogenic differentiation of 2 types of MSCs, from bone marrow (BMSCs) and adipose tissue (ADSCs), in an in vitro osteoarthritic microenvironment. DESIGN Inflammatory culture conditions, mimicking OA, were obtained by adding interleukin-1β (IL-1β) and tumor necrosis factor α (TNFα), or synovial fluid from patient osteoarthritic knees (OSF), to the culture medium. MSCs were then treated with APS. RESULTS After 1 month of culture, both cell types formed mature micromasses, partially altered in the presence of IL-1β and TNFα but quite preserved with OSF. Inflammatory conditions hindered differentiation in terms of gene expression, not counterbalanced by APS. APS triggered type I collagen deposition and above all contributed to decrease the expression of metalloproteinases in the most aggressive conditions (IL-1β and TNFα in the culture medium). ADSCs originated micromasses more mature and less prone toward osteogenic lineage than BMSCs, thus showing to better adapt in an aggressive environment than BMSC. CONCLUSIONS APS seems to act better on inflammation front and, between cell types, ADSCs respond better to the inflammatory microenvironment of OA and to the treatment with APS than BMSCs.
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Affiliation(s)
- Stefania Pagani
- Complex Structure of Surgical Sciences
and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesca Veronesi
- Complex Structure of Surgical Sciences
and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy,Francesca Veronesi, Complex Structure of
Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Via di
Barbiano 1/10, Bologna, 40136, Italy.
| | - Gianluca Giavaresi
- Complex Structure of Surgical Sciences
and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Filardo
- Applied and Translational Research
Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Tiziana Papio
- Applied and Translational Research
Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Iacopo Romandini
- 2nd Orthopaedic and Traumatologic
Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Milena Fini
- Complex Structure of Surgical Sciences
and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Abstract
Osteoarthritis (OA) is a global health issue with myriad pathophysiological factors and is one of the most common causes of chronic disability in adults due to pain and altered joint function. The end stage of OA develops from a destructive inflammatory cycle, driven by the pro-inflammatory cytokines interleukin-1β (IL-1β) and tumour necrosis factor alpha (TNFα). Owing to the less predictable results of total knee arthroplasty (TKA) in younger patients presenting with knee OA, there has been a surge in research evaluating less invasive biological treatment options, one of which is autologous protein solution (APS). APS is an autologous blood derivative obtained by using a proprietary device, made of APS separator, which isolates white blood cells (WBCs) and platelets in a small volume of plasma, and APS concentrator, which further concentrates platelets, WBCs and plasma proteins, resulting in a concentrated solution with high levels of growth factors including the anti-inflammatory mediators against IL-1β and TNFα. A single intraarticular injection of APS appears to be a promising solution for treatment of early-stage OA from current evidence, the majority of which comes from preclinical studies. More clinical studies are needed before APS can be widely accepted as a treatment modality for OA.
Cite this article: EFORT Open Rev 2021;6:716-726. DOI: 10.1302/2058-5241.6.200040
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Affiliation(s)
- Hamid Rahmatullah Bin Abd Razak
- Department of Bioengineering, Imperial College London, London, UK.,Sengkang General Hospital, Singapore.,Joint first authors
| | - Daniel Chew
- Faculty of Medicine, Imperial College London, London, UK.,Joint first authors
| | - Zepur Kazezian
- Department of Bioengineering, Imperial College London, London, UK
| | - Anthony M J Bull
- Department of Bioengineering, Imperial College London, London, UK
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King W, Cawood K, Bookmiller M. The Use of Autologous Protein Solution (Pro-Stride ®) and Leukocyte-Rich Platelet-Rich Plasma (Restigen ®) in Canine Medicine. VETERINARY MEDICINE-RESEARCH AND REPORTS 2021; 12:53-65. [PMID: 33777723 PMCID: PMC7989049 DOI: 10.2147/vmrr.s286913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 03/01/2021] [Indexed: 12/01/2022]
Abstract
The use of autologous orthobiologics is an emerging area of interest in veterinary medicine. In this retrospective study, we reviewed the clinical results achieved using two orthobiologics devices to address orthopedic injuries and tissue repair. Leukocyte (White blood cell)-rich platelet-rich plasma (L-PRP) devices produce outputs containing high concentrations of growth factors from venous blood. The Autologous Protein Solution (APS) device produces an orthobiologic containing high concentrations of growth factors and anti-inflammatory cytokines. L-PRP has commonly been used to address soft tissue injuries. APS has been injected into the joint to address osteoarthritis. In the last five years, our practice has treated 35 dogs (38 treatments) with L-PRP and 98 dogs (108 treatments) with APS. Our group has used L-PRP and APS to address orthopedic conditions including osteoarthritis, bursitis, tendinitis, tendon/ligament rupture/repair procedures, post-surgical femoral head osteotomy/tibial-plateau-leveling osteotomy tissue repair, lumbosacral stenosis, patellar luxation, joint laxity, and osteochondral dissecans. The results achieved with L-PRP and APS have been favorable (observed pain improvement and minimal adverse reactions), but sometimes have not achieved complete pain relief or tissue repair. The most common application for L-PRP was patellar luxation and the most common application for APS was injection post-ACL surgery. Canine OA has been successfully managed in several patients with repeat injections of APS over the course of several years. Future studies on specific conditions are ongoing and including efforts to further characterize these products in canine medicine.
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Affiliation(s)
| | - Kevin Cawood
- Indian Creek Veterinary Hospital, Fort Wayne, IN, USA
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6
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Woodell-May J, Steckbeck K, King W. Potential Mechanism of Action of Current Point-of-Care Autologous Therapy Treatments for Osteoarthritis of the Knee-A Narrative Review. Int J Mol Sci 2021; 22:ijms22052726. [PMID: 33800401 PMCID: PMC7962845 DOI: 10.3390/ijms22052726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/21/2021] [Accepted: 02/23/2021] [Indexed: 12/13/2022] Open
Abstract
Osteoarthritis (OA) is a progressive degenerative disease that manifests as pain and inflammation and often results in total joint replacement. There is significant interest in understanding how intra-articular injections made from autologous blood or bone marrow could alleviate symptoms and potentially intervene in the progression of the disease. There is in vitro an in vivo evidence that suggests that these therapies, including platelet-rich plasma (PRP), autologous anti-inflammatories (AAIs), and concentrated bone marrow aspirate (cBMA), can interrupt cartilage matrix degradation driven by pro-inflammatory cytokines. This review analyzes the evidence for and against inclusion of white blood cells, the potential role of platelets, and the less studied potential role of blood plasma when combining these components to create an autologous point-of-care therapy to treat OA. There has been significant focus on the differences between the various autologous therapies. However, evidence suggests that there may be more in common between groups and perhaps we should be thinking of these therapies on a spectrum of the same technology, each providing significant levels of anti-inflammatory cytokines that can be antagonists against the inflammatory cytokines driving OA symptoms and progression. While clinical data have demonstrated symptom alleviation, more studies will need to be conducted to determine whether these preclinical disease-modifying findings translate into clinical practice.
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Affiliation(s)
| | | | - William King
- Owl Manor, 720 East Winona Avenue, Warsaw, IN 46580, USA;
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Autologous protein solution as selective treatment for advanced patellofemoral osteoarthritis in the middle-aged female patient: 54% response rate at 1 year follow-up. Knee Surg Sports Traumatol Arthrosc 2021; 29:988-997. [PMID: 32451622 DOI: 10.1007/s00167-020-06064-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 05/13/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE The study wanted to investigate the benefit, durability and safety of autologous protein solution (APS) injection(s) in a middle-aged female-only cohort suffering predominantly from patellofemoral osteoarthritis. METHODS Fifty females (aged 50.4 ± 6.5) with mainly moderate-severe (86%) patellofemoral cartilage wear (PFCW) were treated with a unilateral intra-articular APS injection. The KOOS, NRS, Kujala, UCLA and EQ-5D were assessed at baseline and 1, 3, 6, and 12 months post-injection. Therapeutic response rate (TRR) was based on KOOS pain improvement > 10 points. Absolute improvement for, respectively, therapy responders and non-responders was determined. Second APS injection was administered if improvement was deemed insufficient by the patient after 3 months. RESULTS The TRR remained stable averaging to 53.7% at final follow-up with subjects improving overall from 40.3 ± 18.7 to 57.3 ± 24.8 points on KOOS pain (p = 0.0002) and from 48.4 ± 13.0 to 56.3 ± 18.1 points on Kujala (p = 0.0203) at 12 months. Significant improvement was observed for the other KOOS subscales and NRS at each follow-up. In absolute values, APS responders improved with 30.5 ± 11.4 points on KOOS pain at 12 months. In contrast, non-responders deteriorated with 5.9 ± 8.9 points relative to baseline. A second APS injection was administered in 28 subjects. Patients with definite synovitis improved more on KOOS symptoms (p = 0.017) and KOOS ADL (p = 0.037) at 12 months compared to non-synovitis subjects. Mild-moderate arthralgia (46%) and effusion (29%) were commonly observed during the first month post-injection. CONCLUSION This study evidenced a 54% response rate at 12 months to a single or second APS injection in a middle-aged female population with advanced patellofemoral cartilage wear. Moderate temporary flares can be expected without affecting clinical outcomes. Second APS injection has low efficacy in initially poor responding patients after 3 months. Major synovitis on baseline MRI appeared to be a beneficial prognosticator for pain relief and functional improvement after APS. LEVEL OF EVIDENCE IV.
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8
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Kon E, Engebretsen L, Verdonk P, Nehrer S, Filardo G. Autologous Protein Solution Injections for the Treatment of Knee Osteoarthritis: 3-Year Results. Am J Sports Med 2020; 48:2703-2710. [PMID: 32870042 DOI: 10.1177/0363546520944891] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Blood derivative injections have been recently proposed to address osteoarthritis (OA) with overall positive results, although long-term data on their efficacy are lacking. A novel blood derivative has been developed to concentrate growth factors and antagonists of inflammatory cytokines and shown promising early findings. PURPOSE To investigate if the positive effects of a single intra-articular injection of autologous protein solution (APS) in patients affected by knee OA-previously documented at 1 year in a multicenter double-blind randomized saline-controlled trial-last up to 3 years. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 46 patients with Kellgren-Lawrence 2 or 3 knee OA were randomized into 2 groups: 1 ultrasound-guided APS injection (n = 31) or 1 saline injection (n = 15). At 1 year, the saline group was allowed to cross over. Patients were re-evaluated at 24 and 36 months through the visual analog scale for pain (VAS), Western Ontario and McMaster Universities Osteoarthritis Index Likert 3.1 (WOMAC LK 3.1), Knee injury and Osteoarthritis Outcome Score (KOOS), 36-Item Short Form Health Survey (SF-36), and Outcome Measures in Rheumatology-Osteoarthritis Research Society International (OMERACT-OARSI) responder rate. Magnetic resonance imaging evaluation was performed with the MRI Osteoarthritis Knee Score (MOAKS) before and at 24 months after treatment, and radiographs were assessed per Kellgren-Lawrence before and annually after treatment. RESULTS In the APS cohort, WOMAC pain improved from 11.5 ± 2.4 (mean ± SD) to 4.3 ± 4.0 at 1 year and to 5.7 ± 5.0 at 3 years (P < .0001 vs baseline). The APS cohort also showed a statistically significant improvement in its KOOS pain score from 39.4 ± 13.1 to 70.6 ± 21.5 at 1 year and to 64.1 ± 24.6 at 3 years (P < .0001 vs baseline) and VAS pain scores from 5.5 ± 2.2 to 2.6 ± 2.5 at 1 year and to 3.4 ± 2.9 at 3 years (P = .0184 vs baseline). VAS pain score significantly worsened from 12 to 36 months (P = .0411). All patients in the saline group decided to cross over to APS, and their final scores were better than baseline, although not significantly better than at the crossover point. Overall, 7 of 26 (26.9%) APS cases and 4 of 14 (28.6%) crossover cases were considered failures as patients underwent further injective treatments or surgical procedures between the 12- and 36-month follow-up. MOAKS findings showed no statistically significant differences. Patients with better cartilage had greater WOMAC pain improvement when their baseline scores were worse, whereas the trend was reversed for patients with cartilage loss at baseline. CONCLUSION Intra-articular use of APS for mild to moderate knee OA was safe, and significant pain improvement was documented 3 years after a single injection. Patients with better cartilage status seem to respond better than patients with more cartilage loss, with more clinical improvement even when starting from more painful conditions. REGISTRATION NCT02138890 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Elizaveta Kon
- Humanitas University Department of Biomedical Sciences, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Lars Engebretsen
- Orthopaedic Clinic, University of Oslo, and Oslo Sports Trauma Research Center, Norwegian College of Sport Sciences, Oslo, Norway
| | - Peter Verdonk
- Department of Orthopaedic Surgery, Monica Hospitals-Monica Research Foundation, and Department of Orthopaedic Surgery, University Hospital, Antwerp, Belgium
| | - Stefan Nehrer
- Dekan Fakultät Gesundheit und Medizin, Leiter Department für Gesundheitswissenschaften und Biomedizin, Leiter Zentrum für Regenerative Medizin und Orthopädie, Krems, Austria
| | - Giuseppe Filardo
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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9
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Abstract
Intra-articular drug delivery has a number of advantages over systemic administration; however, for the past 20 years, intra-articular treatment options for the management of knee osteoarthritis (OA) have been limited to analgesics, glucocorticoids, hyaluronic acid (HA) and a small number of unproven alternative therapies. Although HA and glucocorticoids can provide clinically meaningful benefits to an appreciable number of patients, emerging evidence indicates that the apparent effectiveness of these treatments is largely a result of other factors, including the placebo effect. Biologic drugs that target inflammatory processes are used to manage rheumatoid arthritis, but have not translated well into use in OA. A lack of high-level evidence and methodological limitations hinder our understanding of so-called 'stem' cell therapies and, although the off-label administration of intra-articular cell therapies (such as platelet-rich plasma and bone marrow aspirate concentrate) is common, high-quality clinical data are needed before these treatments can be recommended. A number of promising intra-articular treatments are currently in clinical development in the United States, including small-molecule and biologic therapies, devices and gene therapies. Although the prospect of new, non-surgical treatments for OA is exciting, the benefits of new treatments must be carefully weighed against their costs and potential risks.
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10
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Woodell-May JE, Sommerfeld SD. Role of Inflammation and the Immune System in the Progression of Osteoarthritis. J Orthop Res 2020; 38:253-257. [PMID: 31469192 DOI: 10.1002/jor.24457] [Citation(s) in RCA: 257] [Impact Index Per Article: 64.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/13/2019] [Indexed: 02/04/2023]
Abstract
Understanding the molecular drivers and feedback loops of osteoarthritis (OA) may provide future therapeutic strategies to modulate the disease progression. The current paradigm of OA is evolving from a purely mechanical disease caused by cartilage wear toward a complex biological response connecting biomechanics, inflammation, and the immune system. The view of OA as a chronic wound highlights the role inflammation plays and also the body's attempts to repair an ongoing injury. Inflammatory signals, including cytokines such as interleukin-1 and tissue necrosis factor α, surface-expressed pattern recognition receptors such as toll-like receptors 2 and 4, complement factors such as C5, as well as pathogen-associated molecular patterns and damage-associated molecular patterns drive the enzymatic cascade that degrades cartilage matrix in OA. Considering the joint as an entire organ, interactions between the cells that reside in the synovium including macrophages and other immune cells, appear to drive enzymatic activity in cartilage, which, in turn, feeds signals back to the synovium that continues stimulating degradation in a feed-forward loop. This review will explore the potential roles of immune cells such as macrophages and T cells in the synovium in both stimulating and modulating the inflammatory response in OA. © 2019 Orthopedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:253-257, 2020.
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Affiliation(s)
| | - Sven D Sommerfeld
- Johns Hopkins School of Medicine, Translational Tissue Engineering Center, Johns Hopkins University, 400N. Broadway, Smith Building, 5th Floor, Baltimore, Maryland, 21287
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11
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Garbin LC, Olver CS. Platelet-Rich Products and Their Application to Osteoarthritis. J Equine Vet Sci 2019; 86:102820. [PMID: 32067662 DOI: 10.1016/j.jevs.2019.102820] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 08/04/2019] [Accepted: 10/22/2019] [Indexed: 12/15/2022]
Abstract
Autologous platelet-rich plasma (PRP) is a biological preparation made from the patient's own plasma that contains a platelet concentration above the whole blood baseline. Owing to the release of growth factors and other cytokines after degranulation, platelets have a central role in inflammation and in different stages of the healing process. For this reason, PRP-derived products have been used to enhance healing of musculoskeletal injuries and modulate progression of inflammatory processes, including osteoarthritis (OA). Osteoarthritis is one of the main causes of musculoskeletal disabilities in horses, and currently, there is no effective treatment for this disease. Treatments that focus on the modulation of inflammation and disease progression offer new hope for OA. Platelet-rich plasma provides a more practical and accessible option of therapy compared to other forms of biological treatment (i.e., stem cell therapies) and is believed to induce the production of functional matrix. However, several factors related to PRP production, including methods of preparation and application, and intraindividual variability, lead to an inconsistent product, precluding reliable conclusions about its efficacy for clinical use. The aim of this study was to review the benefits related to the clinical use of PRP in OA as well as factors that influence its use, the limitations of this treatment, and future directions of PRP research and therapy.
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Affiliation(s)
- Livia Camargo Garbin
- Department of Clinical Veterinary Sciences, School of Veterinary Medicine, Faculty of Medical Sciences, University of West Indies, St. Augustine, Trinidad and Tobago, West Indies.
| | - Christine S Olver
- Veterinary Diagnostic Laboratory, Clinical Pathology Section, Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO
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Muir SM, Reisbig N, Baria M, Kaeding C, Bertone AL. The Concentration of Plasma Provides Additional Bioactive Proteins in Platelet and Autologous Protein Solutions. Am J Sports Med 2019; 47:1955-1963. [PMID: 31125271 DOI: 10.1177/0363546519849671] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Currently, platelet-poor plasma (PPP) is a discarded waste product of platelet-rich plasma (PRP) and may contain valuable proteins. PURPOSE/HYPOTHESIS The study's goal was to evaluate the concentration of plasma as a potential additive biotherapy for the treatment of osteoarthritis. We hypothesized that a novel polyacrylamide concentration device would efficiently concentrate insulin-like growth factor-1 (IGF-1) from PPP and be additive to PRP or autologous protein solution (APS). STUDY DESIGN Descriptive laboratory study. METHODS A laboratory study was conducted with human and equine whole blood from healthy volunteers/donors. Fresh samples of blood and plasma were processed and characterized for platelet, white blood cell, and growth factor/cytokine content and then quantified by enzyme-linked immunosorbent assays specific for IGF-1, transforming growth factor-β, interleukin-1β, and interleukin-1 receptor antagonist as representatives of cartilage anabolic and inflammatory mediators. RESULTS A potent cartilage anabolic protein, IGF-1, was significantly concentrated by the polyacrylamide concentration device in both human and equine PPP. The polyacrylamide device also substantially increased plasma proteins over whole blood, most dramatically key proteins relevant to the treatment of osteoarthritis, including transforming growth factor-β (29-fold over blood) and interleukin-1 receptor antagonist (70-fold over plasma). CONCLUSION Concentrated PPP is a unique source for biologically relevant concentrations of IGF-1. PRP and APS can produce greater concentrations of other anabolic and anti-inflammatory proteins not found in plasma. CLINICAL RELEVANCE The polyacrylamide device efficiently concentrated PPP to create a unique source of IGF-1 that may supplement orthopaedic biologic therapies.
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Affiliation(s)
- Sean M Muir
- The Ohio State University, Columbus, Ohio, USA
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Neybecker P, Henrionnet C, Pape E, Mainard D, Galois L, Loeuille D, Gillet P, Pinzano A. In vitro and in vivo potentialities for cartilage repair from human advanced knee osteoarthritis synovial fluid-derived mesenchymal stem cells. Stem Cell Res Ther 2018; 9:329. [PMID: 30486903 PMCID: PMC6263063 DOI: 10.1186/s13287-018-1071-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/29/2018] [Accepted: 11/09/2018] [Indexed: 12/18/2022] Open
Abstract
Background Mesenchymal stem cells (MSCs) are found in synovial fluid (SF) and can easily be harvested during arthrocentesis or arthroscopy. However, SF-MSC characterization and chondrogenicity in collagen sponges have been poorly documented as well as their hypothetical in vivo chondroprotective properties with intra-articular injections during experimental osteoarthritis (OA). Methods SF-MSCs were isolated from human SF aspirates in patients suffering from advanced OA undergoing total knee joint replacements. SF-MSCs at passage 2 (P2) were characterized by flow cytometry for epitope profiling. SF-MSCs at P2 were subsequently cultured in vitro to assess their multilineage potentials. To assess their chondrogenicity, SF-MSCs at P4 were seeded in collagen sponges for 4 weeks under various oxygen tensions and growth factors combinations to estimate their gene profile and matrix production. Also, SF-MSCs were injected into the joints in a nude rat anterior cruciate ligament transection (ACLT) to macroscopically and histologically assess their possible chondroprotective properties,. Results We characterized the stemness (CD73+, CD90+, CD105+, CD34−, CD45−) and demonstrated the multilineage potency of SF-MSCs in vitro. Furthermore, the chondrogenic induction (TGF-ß1 ± BMP-2) of these SF-MSCs in collagen sponges demonstrated a good capacity of chondrogenic gene induction and extracellular matrix synthesis. Surprisingly, hypoxia did not enhance matrix synthesis, although it boosted chondrogenic gene expression (ACAN, SOX9, COL2A1). Besides, intra-articular injections of xenogenic SF-MSCs did exert neither chondroprotection nor inflammation in ACLT-induced OA in the rat knee. Conclusions Advanced OA SF-MSCs seem better candidates for cell-based constructs conceived for cartilage defects rather than intra-articular injections for diffuse OA.
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Affiliation(s)
- Paul Neybecker
- UMR 7365 CNRS-UL, IMoPA (Ingénierie Moléculaire et Physiopathologie Articulaire), Biopôle de l'Université de Lorraine, Campus Brabois-Santé, 9 Avenue de la Forêt de Haye, BP 20199, 54505, Vandœuvre-Lès-Nancy, France
| | - Christel Henrionnet
- UMR 7365 CNRS-UL, IMoPA (Ingénierie Moléculaire et Physiopathologie Articulaire), Biopôle de l'Université de Lorraine, Campus Brabois-Santé, 9 Avenue de la Forêt de Haye, BP 20199, 54505, Vandœuvre-Lès-Nancy, France
| | - Elise Pape
- UMR 7365 CNRS-UL, IMoPA (Ingénierie Moléculaire et Physiopathologie Articulaire), Biopôle de l'Université de Lorraine, Campus Brabois-Santé, 9 Avenue de la Forêt de Haye, BP 20199, 54505, Vandœuvre-Lès-Nancy, France
| | - Didier Mainard
- UMR 7365 CNRS-UL, IMoPA (Ingénierie Moléculaire et Physiopathologie Articulaire), Biopôle de l'Université de Lorraine, Campus Brabois-Santé, 9 Avenue de la Forêt de Haye, BP 20199, 54505, Vandœuvre-Lès-Nancy, France.,Service de Chirurgie Orthopédique, Traumatologique et Arthroscopique, CHRU Nancy, 29 Avenue du Maréchal de Lattre de Tassigny CO 60034, F54035, Nancy, France
| | - Laurent Galois
- UMR 7365 CNRS-UL, IMoPA (Ingénierie Moléculaire et Physiopathologie Articulaire), Biopôle de l'Université de Lorraine, Campus Brabois-Santé, 9 Avenue de la Forêt de Haye, BP 20199, 54505, Vandœuvre-Lès-Nancy, France.,Service de Chirurgie Orthopédique, Traumatologique et Arthroscopique, CHRU Nancy, 29 Avenue du Maréchal de Lattre de Tassigny CO 60034, F54035, Nancy, France
| | - Damien Loeuille
- UMR 7365 CNRS-UL, IMoPA (Ingénierie Moléculaire et Physiopathologie Articulaire), Biopôle de l'Université de Lorraine, Campus Brabois-Santé, 9 Avenue de la Forêt de Haye, BP 20199, 54505, Vandœuvre-Lès-Nancy, France.,Service de Rhumatologie, CHRU de Nancy, Hôpitaux de Brabois, Bâtiment des Spécialités Médicales, 5 rue du Morvan, F54511, Vandœuvre-lès-Nancy, France
| | - Pierre Gillet
- UMR 7365 CNRS-UL, IMoPA (Ingénierie Moléculaire et Physiopathologie Articulaire), Biopôle de l'Université de Lorraine, Campus Brabois-Santé, 9 Avenue de la Forêt de Haye, BP 20199, 54505, Vandœuvre-Lès-Nancy, France
| | - Astrid Pinzano
- UMR 7365 CNRS-UL, IMoPA (Ingénierie Moléculaire et Physiopathologie Articulaire), Biopôle de l'Université de Lorraine, Campus Brabois-Santé, 9 Avenue de la Forêt de Haye, BP 20199, 54505, Vandœuvre-Lès-Nancy, France. .,Service de Rhumatologie, CHRU de Nancy, Hôpitaux de Brabois, Bâtiment des Spécialités Médicales, 5 rue du Morvan, F54511, Vandœuvre-lès-Nancy, France.
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Autophagy Is Independent of the Chondroprotection Induced by Platelet-Rich Plasma Releasate. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9726703. [PMID: 30140705 PMCID: PMC6081522 DOI: 10.1155/2018/9726703] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 05/27/2018] [Indexed: 01/06/2023]
Abstract
Background Platelet-rich plasma (PRP) has been shown to be a promising therapeutic agent against osteoarthritis (OA), whereas its chondroprotection mechanism is not fully elucidated. Autophagy is considered an important biological process throughout the development of OA. Therefore, the objective of the present study is to investigate the role of autophagy in the chondroprotection and compare the effects of releasate between L-PRP and P-PRP. Methods PRP were prepared from rat blood. Rat chondrocytes pretreated in the presence or absence of interleukin-1 beta (IL-1β) were incubated with PRP releasate. The expressions of OA-related genes and autophagy-related genes were determined by RT-PCR and western blot, respectively. Autophagic bodies were assessed by transmission electron microscopy and the autophagy flux was monitored under the confocal microscopy. The effect of PRP on autophagy was further investigated in the milieu of autophagy activator, rapamycin, or autophagy inhibition by downregulation of Atg5. The effect of PRP on cartilage repair and autophagy was also evaluated in an OA rat model. Results In vitro, PRP releasate increased the expression of the anabolic genes, COL2 and Aggrecan, and decreased the expression of the catabolic genes, whereas the expression of autophage markers, Atg5 and Beclin-1, as well as the ratio of LC3 II/LC3 I, was not significantly altered in normal or IL-1β-treated chondrocytes. Similar expression pattern was found following the activation (rapamycin) or inhibition (Atg5 silencing) of autophagy. In vivo, PRP releasate ameliorated posttraumatic cartilage degeneration while the expression of LC3 was comparable to that in the vehicle treatment group. Conclusions PRP releasate promoted the anabolic gene expression, relieved inflammatory stress in chondrocytes, and ameliorated cartilage degeneration, but autophagy was independent of these processes.
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Hix J, Klaassen M, Foreman R, Cullen E, Toler K, King W, Woodell-May J. An Autologous Anti-Inflammatory Protein Solution Yielded a Favorable Safety Profile and Significant Pain Relief in an Open-Label Pilot Study of Patients with Osteoarthritis. Biores Open Access 2017; 6:151-158. [PMID: 29279807 PMCID: PMC5738995 DOI: 10.1089/biores.2017.0027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Osteoarthritis (OA) is a progressive and degenerative disease, which may result in significant pain and decreased quality of life. Recent updates in our understanding of OA have demonstrated that it is a whole joint disease that has many similarities to an unhealed wound containing inflammatory cytokines. The nSTRIDE Autologous Protein Solution (APS) Kit is a medical device under development for the treatment of OA. The APS Kit processes a patient's own blood at the point of care to contain high concentrations of anti-inflammatory cytokines and anabolic growth factors. This study assessed the safety and treatment effects of a single intra-articular injection of APS. Eleven patients were enrolled in this study. Sufficient blood could not be drawn from one patient who was subsequently withdrawn, leaving 10 patients treated. Minor adverse events (AEs) were experienced by seven subjects (63.6%). There was one serious AE (diverticulitis) unrelated to the device or procedure. One subject experienced AEs that were judged “likely” to be procedure related (arthralgia/musculoskeletal discomfort) and all resolved within 6 days of injection. All other AEs were unrelated to the device or procedure. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores improved significantly over time (ANOVA, p < 0.0001, 12.0 ± 1.2 preinjection, 3.3 ± 2.9 one year postinjection, and 72.5% WOMAC pain improvement). There was significant positive correlation between white blood cell concentration in APS and improvement in WOMAC pain scores.
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Affiliation(s)
- Jason Hix
- Orthopedic Sports Medicine Center, Elkhart, Indiana
| | | | - Ryan Foreman
- Orthopedic Sports Medicine Center, Elkhart, Indiana
| | - Edith Cullen
- Orthopedic Sports Medicine Center, Elkhart, Indiana
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Kean CO, Brown RJ, Chapman J. The role of biomaterials in the treatment of meniscal tears. PeerJ 2017; 5:e4076. [PMID: 29158995 PMCID: PMC5695244 DOI: 10.7717/peerj.4076] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 10/31/2017] [Indexed: 12/15/2022] Open
Abstract
Extensive investigations over the recent decades have established the anatomical, biomechanical and functional importance of the meniscus in the knee joint. As a functioning part of the joint, it serves to prevent the deterioration of articular cartilage and subsequent osteoarthritis. To this end, meniscus repair and regeneration is of particular interest from the biomaterial, bioengineering and orthopaedic research community. Even though meniscal research is previously of a considerable volume, the research community with evolving material science, biology and medical advances are all pushing toward emerging novel solutions and approaches to the successful treatment of meniscal difficulties. This review presents a tactical evaluation of the latest biomaterials, experiments to simulate meniscal tears and the state-of-the-art materials and strategies currently used to treat tears.
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Affiliation(s)
- Crystal O. Kean
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | | | - James Chapman
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
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