Autologous mesenchymal stem cell application for cartilage defect in recurrent patellar dislocation: A case report

Articular Cartilage Damage Worsens from First-time to Recurrent Patellar Dislocation—A Longitudinal Magnetic Resonance Imaging Study

Purpose

To compare the frequency and severity of articular cartilage injury on longitudinal magnetic resonance imaging (MRI) in patients after their initial dislocation and subsequent recurrent dislocations for those undergoing patellar stabilization surgery.

Methods

Between January 2012 and December 2017, patients undergoing patellar stabilization surgery were retrospectively reviewed. Only patients with an MRI after both the initial dislocation and subsequent dislocation events were included. The MRI scans were blindly examined to assess the Outerbridge classification grade of articular cartilage injury following each dislocation. Comparison was performed of each MRI for grade of articular cartilage damage and location.

Results

Thirty-five patients undergoing patellar stabilization surgery with recurrent instability were eligible. The incidence of articular cartilage injury following initial dislocation was 45.7%. Following a second dislocation, the incidence of articular cartilage injury increased to 62.9%, a statistically significant increase of 17.2% (P = .031). Furthermore, of the 16 patients with articular cartilage injury following their initial dislocation, 56.2% of patients (9) had an increase in grade of articular cartilage injury following the second dislocation, whereas 43.8% (7) of patients had no progression in their articular cartilage injury. Six (17.1%) patients had no articular cartilage injury following their initial dislocation but did have articular cartilage injury following their second dislocation.

Conclusions

Articular cartilage injury following patellar dislocation is common, and delayed surgical treatment may lead to an increase in articular cartilage damage. The incidence of articular cartilage injury following recurrent patellar dislocation was high (62.9%), and the majority of patients experienced an increase in their articular cartilage injury grade between their initial and recurrent dislocation on MRI evaluation.

Level of Evidence

Level IV, retrospective case series.

Management of Chondral Defects Associated with Patella Instability

Cartilage defects of the patellofemoral joint are commonly found in association with patellar instability owing to abnormal biomechanics. Strategies to address chondral defects of the patellofemoral joint secondary to instability should first address causes of recurrent instability. Most patellofemoral chondral defects associated with instability are less than 2 cm2 and do not generally require intervention beyond chondroplasty. Larger defects of the patella and/or the trochlea can be repaired with osteochondral or surface cartilage repair.

Decreasing Thickness of Partial Lateral Trochlear Cartilage in Patients with Patellar Instability

Objective

To explore morphological characteristics of patellofemoral joint surface of patients with patellar instability by adopting the MRI‐based method.

Methods

A retrospective analysis was performed from March 2016 to January 2020 to assess morphological characteristics of the patellofemoral joint surface by Magnetic Resonance Imaging (MRI) scanning knees of 30 patients (24 females, six males) with patellar instability and trochlear dysplasia and knees of 30 subjects from a randomly selected control group (25 females, five males). The control group was matched as per age and sex. All participants had undergone MRI scans in the supine position and keep knees in or near full extension. Six parts were measured in total, including thickness of trochlear cartilage, thickness of patella cartilage, cartilaginous sulcus angle, cartilaginous Wiberg angle, contact range and frequency and distributions of the mean difference measurement of the femoral trochlea, to evaluate the difference of trochlear and patellar morphology between the patient group and the control group. The threshold for statistical significance was set at P < 0.05.

Results

There were significant differences in four values between the two groups (P < 0.05). The cartilage thickness two‐third along the lateral condyle in the patient group was significantly lower than that in the control group (LCT2,1.80 ± 0.37 vs 2.06 ± 0.52, 1.92 ± 0.36 vs 2.17 ± 0.50), but there was no significant difference in other sites. There was no significant difference in patella thickness between the patient group and the control group. The cartilaginous sulcus angle in the patient group was larger than that in the control group (157.90 ± 6.64 vs 142.23 ± 3.95, P < 0.001), but there was no significant difference in cartilaginous Wiberg angle. The patient group had a larger initial contact ratio (59.47 ± 6.13 vs 46.50 ± 3.67, P < 0.001), and a smaller contact range (16.55 ± 4.14 vs 27.55 ± 4.09, P < 0.001). The deepest part of the intercondylar suclus appears more often in the lateral of the deepest part of the osseous concavity of the femoral trochlea. Among the patient group, 18 cases (60%) were found with the deepest part of the intercondylar suclus lateral to the deepest point of the osseous concavity of the femoral trochlea while among the control group only 4 cases (13.33%) were found. The distribution of trochlear dysplasia of Dejour grades was type B (n = 22), type C (n = 5), and type D (n = 3).

Conclusion

Thickness of partial lateral trochlear cartilage decreases in patients with patellar instability and the trochlear cartilage develops abnormal morphological characteristics. Moreover, it also suggests that MRI can be used to further present the morphology of cartilage for the convenience of surgical planning.

MicroRNA-126 promotes proliferation, migration, invasion and endothelial differentiation while inhibits apoptosis and osteogenic differentiation of bone marrow-derived mesenchymal stem cells

Bone marrow-derived mesenchymal stem cells (BMSCs) are widely used for the treatment of inflammatory and immune diseases, and microRNA-126 (miR-126) is a critical regulator in inflammation as well as immunity. However, the mediating role of miR-126 in BMSCs is still not clear. Thus, this study aimed to preliminarily investigate the effect of miR-126 on proliferation, apoptosis, migration, invasion, differentiation, and its potential regulating pathways in BMSCs. Human BMSCs were obtained and infected with miR-126 overexpression lentivirus, control overexpression lentivirus, miR-126 knock-down lentivirus and control knock-down lentivirus, then cell functions, the PI3 K/AKT pathway and MEK1/ERK1 pathway were evaluated. Subsequently, PI3 K overexpression plasmid and MEK1 overexpression plasmid were transfected into BMSCs with miR-126 knockdown, then the cell functions were assessed as well. BMSCs with miR-126 overexpression displayed elevated proliferation, migration and invasion while decreased apoptosis; however, BMSCs with miR-126 knockdown presented with decreased proliferation, migration, invasion but increased apoptosis. As for differentiation, BMSCs with miR-126 overexpression showed higher levels of CD31, eNOS and VE-cadherin but lower expressions of ALP, OPN and RUNX2, while BMSCs with miR-126 knockdown disclosed the opposite results. Additionally, BMSCs with miR-126 overexpression showed elevated PI3 K, pAKT, MEK1 and pERK1 expressions, while BMSCs with miR-126 knockdown displayed opposite results. Furthermore, PI3 K overexpression and MEK1 overexpression both reversed the effects of miR-126 on cell functions in BMSCs. In conclusion, miR-126 is a genetic regulator in BMSCs via modulating multiple cell functions through the PI3 K/AKT and MEK1/ERK1 signaling pathways.