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Williams J, Rucinski K, Stannard JP, Pridemore J, Stoker AM, Crecelius C, Nuelle CW, Cook JL. Donor-recipient age- or sex-mismatched osteochondral allografts do not adversely affect cumulative graft survival rates after transplantation in the knee. Knee 2024; 51:35-43. [PMID: 39236636 DOI: 10.1016/j.knee.2024.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 07/15/2024] [Accepted: 08/09/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND Osteochondral allograft transplantation (OCAT) can be performed without the need for blood-type matching or anti-rejection medications. However, other donor-recipient mismatch variables could influence outcomes. Therefore, it is critical to examine the impacts of sex and age mismatching on functional OCA survival. METHODS Prospectively collected data for patients undergoing primary knee OCAT enrolled in a lifelong outcomes registry were analyzed for functional OCA survival based on sex- and age-matched and -mismatched cohorts. Treatment failure was defined as the need for OCAT revision surgery or knee arthroplasty. RESULTS 162 donor-recipient pairs were analyzed; 57 (35.2%) were sex-mismatched and 89 (54.9%) were age-mismatched. Sex-mismatched OCATs were not associated with a significantly different cumulative graft survival rate when compared to sex-matched OCATs (78.9% vs 75.2% p = 0.324). Age-mismatched OCATs were not associated with a significantly different cumulative graft survival rate when compared to age-matched OCATs (71.6% vs 81.5% p = 0.398). When adjusting for sex, BMI, concomitant procedures, and surgery type, age-mismatched and sex-mismatched OCATs were not significantly associated with higher likelihood for treatment failure. CONCLUSION By analyzing functional graft survival rates for donor-recipient sex- or age-mismatched OCAs following primary OCAT, the results of the present study support current donor-recipient matching protocols for OCA transplantation in the knee. Based on current evidence, donor-recipient blood-type, sex-, and age-matching are not required for safe and effective primary OCAT in the knee. However, further studies are imperative for defining modifiable variables that further optimize safety and outcomes while maximizing donor tissue quality, availability, access, and use.
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Affiliation(s)
- Jonathan Williams
- Thompson Laboratory for Regenerative Orthopaedics and MU Joint Preservation Center, Missouri Orthopaedic Institute, Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, United States
| | - Kylee Rucinski
- Thompson Laboratory for Regenerative Orthopaedics and MU Joint Preservation Center, Missouri Orthopaedic Institute, Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, United States
| | - James P Stannard
- Thompson Laboratory for Regenerative Orthopaedics and MU Joint Preservation Center, Missouri Orthopaedic Institute, Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, United States
| | - Josh Pridemore
- University of Missouri School of Medicine, Columbia, MO, United States
| | - Aaron M Stoker
- Thompson Laboratory for Regenerative Orthopaedics and MU Joint Preservation Center, Missouri Orthopaedic Institute, Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, United States
| | - Cory Crecelius
- Thompson Laboratory for Regenerative Orthopaedics and MU Joint Preservation Center, Missouri Orthopaedic Institute, Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, United States
| | - Clayton W Nuelle
- Thompson Laboratory for Regenerative Orthopaedics and MU Joint Preservation Center, Missouri Orthopaedic Institute, Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, United States
| | - James L Cook
- Thompson Laboratory for Regenerative Orthopaedics and MU Joint Preservation Center, Missouri Orthopaedic Institute, Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, United States.
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Santos F, Marto-Costa C, Branco AC, Oliveira AS, Galhano Dos Santos R, Salema-Oom M, Diaz RL, Williams S, Colaço R, Figueiredo-Pina C, Serro AP. Tribomechanical Properties of PVA/Nomex ® Composite Hydrogels for Articular Cartilage Repair. Gels 2024; 10:514. [PMID: 39195043 DOI: 10.3390/gels10080514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 07/18/2024] [Accepted: 07/30/2024] [Indexed: 08/29/2024] Open
Abstract
Due to the increasing prevalence of articular cartilage diseases and limitations faced by current therapeutic methodologies, there is an unmet need for new materials to replace damaged cartilage. In this work, poly(vinyl alcohol) (PVA) hydrogels were reinforced with different amounts of Nomex® (known for its high mechanical toughness, flexibility, and resilience) and sterilized by gamma irradiation. Samples were studied concerning morphology, chemical structure, thermal behavior, water content, wettability, mechanical properties, and rheological and tribological behavior. Overall, it was found that the incorporation of aramid nanostructures improved the hydrogel's mechanical performance, likely due to the reinforcement's intrinsic strength and hydrogen bonding to PVA chains. Additionally, the sterilization of the materials also led to superior mechanical properties, possibly related to the increased crosslinking density through the hydrogen bonding caused by the irradiation. The water content, wettability, and tribological performance of PVA hydrogels were not compromised by either the reinforcement or the sterilization process. The best-performing composite, containing 1.5% wt. of Nomex®, did not induce cytotoxicity in human chondrocytes. Plugs of this hydrogel were inserted in porcine femoral heads and tested in an anatomical hip simulator. No significant changes were observed in the hydrogel or cartilage, demonstrating the material's potential to be used in cartilage replacement.
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Affiliation(s)
- Francisco Santos
- Centro de Química Estrutural (CQE), Institute of Molecular Sciences, Department of Chemical Engineering, Instituto Superior Técnico, University of Lisbon, Av. Rovisco Pais 1, 1049-001 Lisbon, Portugal
| | - Carolina Marto-Costa
- Centro de Química Estrutural (CQE), Institute of Molecular Sciences, Department of Chemical Engineering, Instituto Superior Técnico, University of Lisbon, Av. Rovisco Pais 1, 1049-001 Lisbon, Portugal
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Monte da Caparica, 2829-511 Almada, Portugal
| | - Ana Catarina Branco
- Centro de Química Estrutural (CQE), Institute of Molecular Sciences, Department of Chemical Engineering, Instituto Superior Técnico, University of Lisbon, Av. Rovisco Pais 1, 1049-001 Lisbon, Portugal
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Monte da Caparica, 2829-511 Almada, Portugal
- Escola Superior de Tecnologia de Setúbal, Instituto Politécnico de Setúbal, 2910-761 Setúbal, Portugal
| | - Andreia Sofia Oliveira
- Centro de Química Estrutural (CQE), Institute of Molecular Sciences, Department of Chemical Engineering, Instituto Superior Técnico, University of Lisbon, Av. Rovisco Pais 1, 1049-001 Lisbon, Portugal
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Monte da Caparica, 2829-511 Almada, Portugal
- Instituto de Engenharia Mecânica (IDMEC), Department of Mechanical Engineering, Instituto Superior Técnico, University of Lisbon, Av. Rovisco Pais 1, 1049-001 Lisbon, Portugal
| | - Rui Galhano Dos Santos
- CERENA-Centre for Natural Resources and the Environment, Instituto Superior Técnico, University of Lisbon, Av. Rovisco Pais, 1049-001 Lisboa, Portugal
| | - Madalena Salema-Oom
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Monte da Caparica, 2829-511 Almada, Portugal
| | - Roberto Leonardo Diaz
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Woodhouse, Leeds LS2 9JT, UK
| | - Sophie Williams
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Woodhouse, Leeds LS2 9JT, UK
| | - Rogério Colaço
- Instituto de Engenharia Mecânica (IDMEC), Department of Mechanical Engineering, Instituto Superior Técnico, University of Lisbon, Av. Rovisco Pais 1, 1049-001 Lisbon, Portugal
| | - Célio Figueiredo-Pina
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Monte da Caparica, 2829-511 Almada, Portugal
- Escola Superior de Tecnologia de Setúbal, Instituto Politécnico de Setúbal, 2910-761 Setúbal, Portugal
- CeFEMA-Center of Physiscs and Engineering of Advanced Materials, Instituto Superior Técnico, University of Lisbon, Av. Rovisco Pais 1, 1049-001 Lisbon, Portugal
| | - Ana Paula Serro
- Centro de Química Estrutural (CQE), Institute of Molecular Sciences, Department of Chemical Engineering, Instituto Superior Técnico, University of Lisbon, Av. Rovisco Pais 1, 1049-001 Lisbon, Portugal
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Monte da Caparica, 2829-511 Almada, Portugal
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Cognetti DJ, Defoor MT, Yuan TT, Sheean AJ. Knee Joint Preservation in Tactical Athletes: A Comprehensive Approach Based upon Lesion Location and Restoration of the Osteochondral Unit. Bioengineering (Basel) 2024; 11:246. [PMID: 38534520 DOI: 10.3390/bioengineering11030246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/18/2024] [Accepted: 02/28/2024] [Indexed: 03/28/2024] Open
Abstract
The unique physical demands of tactical athletes put immense stress on the knee joint, making these individuals susceptible to injury. In order to ensure operational readiness, management options must restore and preserve the native architecture and minimize downtime, while optimizing functionality. Osteochondral lesions (OCL) of the knee have long been acknowledged as significant sources of knee pain and functional deficits. The management of OCL is predicated on certain injury characteristics, including lesion location and the extent of subchondral disease. Techniques such as marrow stimulation, allograft and autologous chondrocyte implantation are examined in detail, with a focus on their application and suitability in tactical athlete populations. Moreover, the restoration of the osteochondral unit (OCU) is highlighted as a central aspect of knee joint preservation. The discussion encompasses the biomechanical considerations and outcomes associated with various cartilage restoration techniques. Factors influencing procedure selection, including lesion size, location, and patient-specific variables, are thoroughly examined. Additionally, the review underscores the critical role of post-operative rehabilitation and conditioning programs in optimizing outcomes. Strengthening the surrounding musculature, enhancing joint stability, and refining movement patterns are paramount in facilitating the successful integration of preservation procedures. This narrative review aims to provide a comprehensive resource for surgeons, engineers, and sports medicine practitioners engaged in the care of tactical athletes and the field of cartilage restoration. The integration of advanced preservation techniques and tailored rehabilitation protocols offers a promising avenue for sustaining knee joint health and function in this demanding population.
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Affiliation(s)
- Daniel J Cognetti
- Department of Orthopedic Surgery, Brooke Army Medical Center, 3551 Roger Brooke Drive, San Antonio, TX 78234, USA
| | - Mikalyn T Defoor
- Department of Orthopedic Surgery, Brooke Army Medical Center, 3551 Roger Brooke Drive, San Antonio, TX 78234, USA
| | - Tony T Yuan
- Advanced Exposures Diagnostics, Interventions and Biosecurity Group, 59 Medical Wing, Lackland Air Force Base, San Antonio, TX 78236, USA
- Center for Biotechnology (4D Bio3), Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Andrew J Sheean
- Department of Orthopedic Surgery, Brooke Army Medical Center, 3551 Roger Brooke Drive, San Antonio, TX 78234, USA
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Bumberger A, Seiferth NL, Angele P, Faber SO, Zellner J, Niemeyer P. Bipolar Lesions of the Knee Are Associated With Inferior Clinical Outcome Following Articular Cartilage Regeneration. A Propensity Score-Matched Analysis Including 238 Patients of the German Cartilage Registry (KnorpelRegister DGOU). Arthroscopy 2023; 39:2167-2173. [PMID: 36931479 DOI: 10.1016/j.arthro.2023.02.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/22/2023] [Accepted: 02/26/2023] [Indexed: 03/19/2023]
Abstract
PURPOSE To determine whether bipolar lesions (BL) are associated with inferior clinical outcome following articular cartilage regeneration (CR) compared to unipolar lesions (UL). METHODS A registry-based study, including patients undergoing isolated CR for focal knee cartilage lesions was performed. Lesions were considered UL or BL depending on the opposing cartilage. Propensity score matching was applied to eliminate potential confounders. Two groups comprising 119 patients with similar baseline characteristics were matched. The Knee Injury and Osteoarthritis Outcome Score (KOOS) at baseline, 6, 12, 24, and 36 months following CR served as primary outcome measure. KOOS improvement, reaching the minimal clinically important difference (MCID), KOOS subcomponents, and failure rates were calculated. RESULTS Autologous chondrocyte implantation (ACI) was the most frequently performed procedure in both groups with 63.0% (BL) and 46.6% (UL). There was a significant difference regarding KOOS at 24 months between UL (76.39 ± 14.96) and BL (69.83 ± 18.83; P = .028), which did not exceed the threshold of MCID. No significant difference was detected at any other follow-up. KOOS improvement from baseline was lower in the BL group at all follow-ups and peaked at 36 months in both groups (UL [26.00 ± 16.12] vs. BL [16.63 ± 17.29]; P = .024). The failure rate in the BL group was higher at 8.2% (9/110) compared to the UL group at 3.9% (4/98) (P = .256). CONCLUSIONS BL were associated with worse clinical outcome 2 years following CR compared to UL. However, both groups showed an ongoing clinical improvement up to 3 years postoperatively and a low failure rate. While inferior clinical improvement and a lower clinical response rate may be expected in BL patients, the observed differences do not justify excluding these patients from CR. LEVEL OF EVIDENCE Level III, retrospective comparative prognostic trial.
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Affiliation(s)
- Alexander Bumberger
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria; Orthopädische Chirurgie München, Munich, Germany.
| | - Nick Luca Seiferth
- Department of Orthopedics and Trauma Surgery, University Medical Center Freiburg, Albert-Ludwig University of Freiburg, Freiburg, Germany
| | - Peter Angele
- University Medical Center Regensburg, Regensburg, Germany; Sporthopaedicum Regensburg/Straubing, Regensburg, Germany
| | - Svea Olivia Faber
- Muskuloskelettales Universitätszentrum München, LMU Klinikum, Ludwig-Maximilian-University, Munich, Germany
| | | | - Philipp Niemeyer
- Orthopädische Chirurgie München, Munich, Germany; Department of Orthopedics and Trauma Surgery, University Medical Center Freiburg, Albert-Ludwig University of Freiburg, Freiburg, Germany
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Swan ER, Lynch TB, Sheean AJ. Treatment of Cartilage Defects of the Knee in Military Tactical Athletes: An Overview of Management and Clinical Outcomes. J Knee Surg 2022; 35:1165-1174. [PMID: 35488175 DOI: 10.1055/s-0042-1744190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cartilage defects of the knee are a common problem that can be caused by trauma or chronic repetitive overload and result in debilitating functional limitations. These consequences are of particular significance to military service members, who, by in large, are a group of young, active individuals with professional duties requiring full, unrestricted activity and function. The burden of knee chondral-related disease among military tactical athletes is well established, and systematic approach to the evaluation of a military member with suspected knee chondral pathology facilitates the execution of a surgical procedure that maximizes the likelihood of a return to duty. Despite advances in cartilage restoration surgery, chondral pathology of the knee remains a vexing problem and an omnipresent threat to military medical readiness and warfighter lethality.
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Affiliation(s)
- Erin R Swan
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, Texas
| | - Thomas B Lynch
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, Texas
| | - Andrew J Sheean
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, Texas
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