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Singh A, Venn A, Blizzard L, March L, Eckstein F, Jones G, Wirth W, Cicuttini F, Ding C, Antony B. Association between knee magnetic resonance imaging markers and knee symptoms over 6-9 years in young adults. Rheumatology (Oxford) 2024; 63:436-445. [PMID: 37202358 PMCID: PMC10836990 DOI: 10.1093/rheumatology/kead227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/16/2023] [Accepted: 04/04/2023] [Indexed: 05/20/2023] Open
Abstract
OBJECTIVES To describe associations between MRI markers with knee symptoms in young adults. METHODS Knee symptoms were assessed using the WOMAC scale during the Childhood Determinants of Adult Health Knee Cartilage study (CDAH-knee; 2008-2010) and at the 6- to 9-year follow-up (CDAH-3; 2014-2019). Knee MRI scans obtained at baseline were assessed for morphological markers (cartilage volume, cartilage thickness, subchondral bone area) and structural abnormalities [cartilage defects and bone marrow lesions (BMLs)]. Univariable and multivariable (age, sex, BMI adjusted) zero-inflated Poisson (ZIP) regression models were used for analysis. RESULTS The participants' mean age in CDAH-knee and CDAH-3 were 34.95 (s.d. 2.72) and 43.27 (s.d. 3.28) years, with 49% and 48% females, respectively. Cross-sectionally, there was a weak but significant negative association between medial femorotibial compartment (MFTC) [ratio of the mean (RoM) 0.99971084 (95% CI 0.9995525, 0.99986921), P < 0.001], lateral femorotibial compartment (LFTC) [RoM 0.99982602 (95% CI 0.99969915, 0.9999529), P = 0.007] and patellar cartilage volume [RoM 0.99981722 (95% CI 0.99965326, 0.9999811), P = 0.029] with knee symptoms. Similarly, there was a negative association between patellar cartilage volume [RoM 0.99975523 (95% CI 0.99961427, 0.99989621), P = 0.014], MFTC cartilage thickness [RoM 0.72090775 (95% CI 0.59481806, 0.87372596), P = 0.001] and knee symptoms assessed after 6-9 years. The total bone area was negatively associated with knee symptoms at baseline [RoM 0.9210485 (95% CI 0.8939677, 0.9489496), P < 0.001] and 6-9 years [RoM 0.9588811 (95% CI 0.9313379, 0.9872388), P = 0.005]. The cartilage defects and BMLs were associated with greater knee symptoms at baseline and 6-9 years. CONCLUSION BMLs and cartilage defects were positively associated with knee symptoms, whereas cartilage volume and thickness at MFTC and total bone area were weakly and negatively associated with knee symptoms. These results suggest that the quantitative and semiquantitative MRI markers can be explored as a marker of clinical progression of OA in young adults.
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Affiliation(s)
- Ambrish Singh
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TS, Australia
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TS, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TS, Australia
| | - Lyn March
- Institute of Bone and Joint Research, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
- Florance and Cope Professorial Rheumatology Department, University of Sydney Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia
| | - Felix Eckstein
- Chondrometrics GmbH, Ainring, Germany
- Department of Imaging and Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TS, Australia
| | - Wolfgang Wirth
- Chondrometrics GmbH, Ainring, Germany
- Department of Imaging and Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Changhai Ding
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TS, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Benny Antony
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TS, Australia
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Niu H, Deng X, Zhang Q, Zhao Y, Wen J, Li W, Liu H, Guo X, Wu C. Identification and Verification of Hub Mitochondrial Dysfunction Genes in Osteoarthritis Based on Bioinformatics Analysis. J Immunol Res 2024; 2024:6822664. [PMID: 38292759 PMCID: PMC10827375 DOI: 10.1155/2024/6822664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 12/27/2023] [Accepted: 01/06/2024] [Indexed: 02/01/2024] Open
Abstract
Objective Age-related mitochondrial dysfunction and associated oxidative stress may contribute to the development of osteoarthritis. The aim of this study was to identify hub genes associated with mitochondrial dysfunction in osteoarthritis (OA) patients, helping predict the risk of OA, and revealing the mechanism of OA progression. Methods OA expression data and mitochondrial dysfunction genes were downloaded from GEO (GSE55235, GSE82107, and GSE114007) and GeneCard databases. The differentially expressed mitochondrial dysfunction genes (DEMDFGs) between OA and control samples were screened. Gene ontology (GO) and Kyoto encyclopedia of genes and genomes pathways were analyzed for DEMDFGs. The hub genes were determined by WGCNA and LASSO regression analysis. ROC curves manifested the diagnostic efficacy of each hub gene. A nomogram model was constructed and validated to predict OA risk. The expression of hub genes in OA and normal chondrocytes was verified by external datasets, qRT-PCR and western blotting. Results A total of 31 DEMDFGs were identified, with 15 genes upregulated and 16 genes downregulated. GO functional enrichment analysis revealed that DEMDFGs were enriched in biological processes related to energy metabolism and cellular respiration. By employing weighted gene coexpression network analysis, we identified four distinct coexpression modules, among which the blue module exhibited the strongest correlation with OA. The intersection between DEMDFGs and this module yielded eight candidate genes. After LASSO analysis of the data, four hub genes (ACADL, CYBA, SLC19A2, and UCP2) were identified as potential biomarkers for OA. The expression levels of these four genes were externally validated in the GSE114007 dataset. And the biologically differential expression of these four genes has been verified in OA and normal chondrocytes. Moreover, the four hub genes had good sensitivity and specificity by ROC curve analysis, and the risk model constructed with these four genes showed promising performance. In conclusion, our study may provide novel mitochondrial dysfunction hub genes with potential clinical applications for understanding the pathology, diagnosis, and treatment of OA.
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Affiliation(s)
- Hui Niu
- School of Public Health, Xi'an Jiaotong University Health Science Center, Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an 710061, Shaanxi, China
| | - Xingxing Deng
- School of Public Health, Xi'an Jiaotong University Health Science Center, Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an 710061, Shaanxi, China
| | - Qian Zhang
- School of Public Health, Xi'an Jiaotong University Health Science Center, Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an 710061, Shaanxi, China
| | - Yijun Zhao
- School of Public Health, Xi'an Jiaotong University Health Science Center, Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an 710061, Shaanxi, China
| | - Jinfeng Wen
- School of Public Health, Xi'an Jiaotong University Health Science Center, Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an 710061, Shaanxi, China
| | - Wenyu Li
- School of Public Health, Xi'an Jiaotong University Health Science Center, Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an 710061, Shaanxi, China
| | - Huan Liu
- School of Public Health, Xi'an Jiaotong University Health Science Center, Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an 710061, Shaanxi, China
| | - Xiong Guo
- School of Public Health, Xi'an Jiaotong University Health Science Center, Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an 710061, Shaanxi, China
| | - Cuiyan Wu
- School of Public Health, Xi'an Jiaotong University Health Science Center, Key Laboratory of Trace Elements and Endemic Diseases, National Health Commission of the People's Republic of China, Xi'an 710061, Shaanxi, China
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Yıldırım M, Ünsal N, Kabataş B, Eren O, Şahin F. Effect of Solanum lycopersicum and Citrus limon-Derived Exosome-Like Vesicles on Chondrogenic Differentiation of Adipose-Derived Stem Cells. Appl Biochem Biotechnol 2024; 196:203-219. [PMID: 37103740 DOI: 10.1007/s12010-023-04491-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 04/28/2023]
Abstract
Articular cartilage defect treatment is a very important problem because its therapeutic options are not successful enough. Due to the weak self-repairing capacity of the avascular cartilage, even minor damage can progress and cause joint damage leading to osteoarthritis. Although various treatment strategies have been developed to repair damaged cartilage, cell- and exosome-based therapies are promising. Plant extracts have been used for decades, and their effects on cartilage regeneration have been studied. Exosome-like vesicles, which are secreted by all living cells, are involved in cell-to-cell communication and cell homeostasis. The differentiation potential of exosome-like vesicles isolated from S. lycopersicum and C. limon, which are known to have anti-inflammatory and antioxidant properties, was investigated in the differentiation of human adipose-derived mesenchymal stem cells (hASCs) into chondrocytes. In order to obtain tomato-derived exosome-like vesicles (TELVs) and lemon-derived exosome-like vesicles (LELVs) Aquous Two- Phase system was performed. Characterisation of isolated vesicles based on size, shape were achived via Zetasizer, NTA FAME analysis, and SEM techniques. These results showed that TELVs and LELVs increased cell viability and did not show any toxic effects on stem cells. Although TELVs triggered chondrocyte formation, LELVs downregulated. The expression of ACAN, SOX9, and COMP, known as chondrocyte markers, was increased by TELV treatment. In addition, protein expression of the two most important proteins, COL2 and COLXI, found in the extracellular matrix of cartilage, increased. These findings suggest that TELVs can be used for cartilage regeneration, and may be a novel and promising treatment for osteoarthritis.
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Affiliation(s)
- Merve Yıldırım
- Department of Genetics and Bioengineering, Faculty of Engineering and Architecture, Yeditepe University, TR-34755, Istanbul, Turkey
| | - Naz Ünsal
- Department of Genetics and Bioengineering, Faculty of Engineering and Architecture, Yeditepe University, TR-34755, Istanbul, Turkey
| | - Bilge Kabataş
- Department of Genetics and Bioengineering, Faculty of Engineering and Architecture, Yeditepe University, TR-34755, Istanbul, Turkey
| | - Olcay Eren
- Department of Genetics and Bioengineering, Faculty of Engineering and Architecture, Yeditepe University, TR-34755, Istanbul, Turkey
| | - Fikrettin Şahin
- Department of Genetics and Bioengineering, Faculty of Engineering and Architecture, Yeditepe University, TR-34755, Istanbul, Turkey.
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Matthews JR, Sonnier JH, Paul RW, Avendano JP, Saucedo ST, Freedman KB, Tjoumakaris FP. A systematic review of cartilage procedures for unstable osteochondritis dissecans. PHYSICIAN SPORTSMED 2023; 51:497-505. [PMID: 35611658 DOI: 10.1080/00913847.2022.2082262] [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: 01/07/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Osteochondritis dissecans can result in significant limitations in activity, pain, and early osteoarthritis. There are various treatment modalities to address these defects. The purpose of this study was to provide a qualitative summary of the various treatment options for unstable osteochondritis dissecans in the knee. METHODS A literature search was performed on osteochondritis dissecans in the knee using PubMed (MEDLINE), Embase, and Cochrane electronic databases. The search was completed using a combination of the following terms: 'osteochondritis dissecans,' 'OCD,' 'osteochondral,' 'articular cartilage,' 'repair,' 'surgery,' 'treatment,' 'osteochondral allograft,' 'autologous chondrocyte implantation,' 'unstable,' 'knee,' 'clinical studies.' RESULTS A total of 682 studies were found, of which 24 were included in the qualitative analysis. The quality score ranged from 46 to 80, and the mean follow-up ranged from 2 to 17 years. The most common surgical procedures were internal fixation (n = 7 studies), ACI (n = 6), fragment excision (n = 3), MACI (n = 2), bone graft + ACI (n = 2), OCA (n = 2), mosaicplasty/OAT (n = 2), and scaffold (n = 2). Overall, the reported outcome measures were heterogeneous in nature. Post-operative International Knee Documentations Committee (IKDC) scores ranged from 75 to 85 and Lysholm scores ranged from 70 to 93.5. Tegner scores ranged from 4 to 5. Rates of failure, complication, and revision were highly variable across studies and surgical techniques. CONCLUSION There are a variety of surgical options for the treatment of unstable osteochondritis dissecans. In skeletally immature patients, internal fixation demonstrated acceptable rates of radiographic union and patient reported outcome measures. In skeletally mature patients with large lesions, MACI and OCA transplantation provided similar patient reported outcomes.
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Affiliation(s)
- John Reza Matthews
- Division of Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - John Hayden Sonnier
- Division of Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Ryan W Paul
- Division of Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - John P Avendano
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Kevin B Freedman
- Division of Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Fotios P Tjoumakaris
- Division of Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, PA, USA
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Varga M, Kresakova L, Danko J, Vdoviakova K, Humenik F, Rusnak P, Giretova M, Spakovska T, Andrejcakova Z, Kadasi M, Vrzgula M, Criepokova Z, Ivaskova S, Korim F, Medvecky L. Tetracalcium Phosphate Biocement Hardened with a Mixture of Phytic Acid-Phytase in the Healing Process of Osteochondral Defects in Sheep. Int J Mol Sci 2023; 24:15690. [PMID: 37958674 PMCID: PMC10647259 DOI: 10.3390/ijms242115690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/26/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
Hyaline articular cartilage has unique physiological, biological, and biomechanical properties with very limited self-healing ability, which makes the process of cartilage regeneration extremely difficult. Therefore, research is currently focused on finding new and potentially better treatment options. The main objective of this in vivo study was to evaluate a novel biocement CX consisting of tetracalcium phosphate-monetit biocement hardened with a phytic acid-phytase mixture for the regeneration of osteochondral defects in sheep. The results were compared with tetracalcium phosphate-monetit biocement with classic fast-setting cement systems and untreated defects. After 6 months, the animals were sacrificed, and the samples were evaluated using macroscopic and histologic methods as well as X-ray, CT, and MR-imaging techniques. In contrast to the formation of fibrous or fibrocartilaginous tissue on the untreated side, treatment with biocements resulted in the formation of tissue with a dominant hyaline cartilage structure, although fine fibres were present (p < 0.001). There were no signs of pathomorphological changes or inflammation. Continuous formation of subchondral bone and hyaline cartilage layers was present even though residual biocement was observed in the trabecular bone. We consider biocement CX to be highly biocompatible and suitable for the treatment of osteochondral defects.
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Affiliation(s)
- Maros Varga
- Hospital AGEL Kosice-Saca, Lucna 57, 040 15 Kosice-Saca, Slovakia; (M.V.); (P.R.); (T.S.)
| | - Lenka Kresakova
- Department of Morphological Disciplines, University of Veterinary Medicine and Pharmacy in Kosice, Komenskeho 73, 041 81 Kosice, Slovakia; (J.D.); (K.V.); (F.H.); (S.I.); (F.K.)
| | - Jan Danko
- Department of Morphological Disciplines, University of Veterinary Medicine and Pharmacy in Kosice, Komenskeho 73, 041 81 Kosice, Slovakia; (J.D.); (K.V.); (F.H.); (S.I.); (F.K.)
| | - Katarina Vdoviakova
- Department of Morphological Disciplines, University of Veterinary Medicine and Pharmacy in Kosice, Komenskeho 73, 041 81 Kosice, Slovakia; (J.D.); (K.V.); (F.H.); (S.I.); (F.K.)
| | - Filip Humenik
- Department of Morphological Disciplines, University of Veterinary Medicine and Pharmacy in Kosice, Komenskeho 73, 041 81 Kosice, Slovakia; (J.D.); (K.V.); (F.H.); (S.I.); (F.K.)
| | - Pavol Rusnak
- Hospital AGEL Kosice-Saca, Lucna 57, 040 15 Kosice-Saca, Slovakia; (M.V.); (P.R.); (T.S.)
| | - Maria Giretova
- Division of Functional and Hybrid Systems, Institute of Materials Research of SAS, Watsonova 47, 040 01 Kosice, Slovakia; (M.G.); (L.M.)
| | - Tatiana Spakovska
- Hospital AGEL Kosice-Saca, Lucna 57, 040 15 Kosice-Saca, Slovakia; (M.V.); (P.R.); (T.S.)
| | - Zuzana Andrejcakova
- Department of Biology and Physiology, University of Veterinary Medicine and Pharmacy in Kosice, Komenskeho 73, 041 81 Kosice, Slovakia;
| | - Marian Kadasi
- Clinic of Ruminants, University of Veterinary Medicine and Pharmacy in Kosice, Komenskeho 73, 041 81 Kosice, Slovakia;
| | - Marko Vrzgula
- Department of Anatomy, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, Trieda SNP 1, 040 11 Kosice, Slovakia;
| | - Zuzana Criepokova
- Clinic of Horses, University of Veterinary Medicine and Pharmacy in Kosice, Komenskeho 73, 041 81 Kosice, Slovakia;
| | - Sonja Ivaskova
- Department of Morphological Disciplines, University of Veterinary Medicine and Pharmacy in Kosice, Komenskeho 73, 041 81 Kosice, Slovakia; (J.D.); (K.V.); (F.H.); (S.I.); (F.K.)
| | - Filip Korim
- Department of Morphological Disciplines, University of Veterinary Medicine and Pharmacy in Kosice, Komenskeho 73, 041 81 Kosice, Slovakia; (J.D.); (K.V.); (F.H.); (S.I.); (F.K.)
| | - Lubomir Medvecky
- Division of Functional and Hybrid Systems, Institute of Materials Research of SAS, Watsonova 47, 040 01 Kosice, Slovakia; (M.G.); (L.M.)
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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: 0] [Impact Index Per Article: 0] [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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Lineham B, Wijayathunga H, Moran E, Shuweihdi F, Gupta H, Pandit H, Wijayathunga N. A systematic review demonstrating correlation of MRI compositional parameters with clinical outcomes following articular cartilage repair interventions in the knee. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100388. [PMID: 37560388 PMCID: PMC10407572 DOI: 10.1016/j.ocarto.2023.100388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/21/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE Compositional-MRI parameters enable the assessment of cartilage ultrastructure. Correlation of these parameters with clinical outcomes is unclear. This systematic review investigated the correlation of various compositional- MRI parameters with clinical outcome measures following cartilage repair or regeneration interventions in the knee. DESIGN This study was registered with PROSPERO and reported in accordance with PRISMA. PubMed, Institute of Science Index, Scopus, Cochrane Central Register of Controlled Trials, and Embase databases were searched. All studies, regardless of type, that presented correlation of compositional- MRI parameters with clinical outcome measures were included. Two researchers independently performed data extraction and QUADAS-2 analysis. Compositional-MRI parameter change following intervention and correlation with clinical outcome measures were evaluated. RESULTS 19 studies were included. Risk of bias was generally low. 5 different compositional parameters were observed from the included studies. However, due to the significant variability in the reporting of compositional-MRI parameters across studies, meta-analyses were possible only for T2 values and T2 index values (T2 value of repair cartilage relative to normal cartilage). Correlation of T2 values of repair cartilage with clinical outcome score was r = 0.33 [0.15, 0.52]. Correlation of T2 index with clinical outcome score was r = 0.52 [0.32, 0.77]. CONCLUSIONS Correlation between T2 values and clinical outcome scores following knee cartilage repair were found. The heterogeneity of the correlations extracted from the included studies limited the scope for the meta-analysis. Thus, standardised, high-quality studies are required for better assessment of correlation between compositional MRI parameters and clinical outcome measures after cartilage repair. REGISTRATION NUMBER PROSPERO CRD42021287364.Study protocol available on PROSPERO website.
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Affiliation(s)
- Beth Lineham
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK
| | | | - Emma Moran
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Harun Gupta
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Hemant Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK
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Ozturk T, Erpala F, Bozduman O, Gedikbas M, Eren MB, Zengin EC. Arthroscopic Treatment of Femoral Condyle Chondral Lesions: Microfracture Versus Liquid Bioscaffold. Indian J Orthop 2023; 57:975-982. [PMID: 37214380 PMCID: PMC10192492 DOI: 10.1007/s43465-023-00878-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 03/17/2023] [Indexed: 05/24/2023]
Abstract
Purpose This study aims to compare the microfracture (MF) technique with the bioscaffold solution application (BST-CarGel) in treating femoral chondral lesions. Methods Thirty-eight patients ages 18-45 with isolated single femoral condyle full-thickness (ICRS grade 3-4) chondral lesions were included in the study. Patients were divided into two groups as MF applied (Group I = 21) and bioscaffold combined with MF (Group II = 17). The visual analog scale (VAS), Western-Ontario, and McMaster Osteoarthritis Index (WOMAC) were used in clinical evaluation. The location, size, and depth of lesions were evaluated with preoperative magnetic resonance imaging (MRI). Magnetic resonance observation of cartilage repair tissue (MOCART) score was used for postoperative evaluation. Results The mean age was 32.5 (range 19-44) years. Mean follow-up was 14.9 months (range 12-24). Lesion size was 3 cm2 in group I and 2.9 cm2 in group II. There were no differences between groups regarding demographic characteristics but BMI (Body Mass Index) was lower in group II which was significant. The duration of surgery was longer in group II (p < 0.001). Postoperative statistical significant improvements were found in WOMAC and VAS scores in groups, but there was no statistical difference. Although there was no significant radiological difference in the group II according to the MOCART score, higher scores were obtained compared to group I. Conclusion No difference was found, clinical and radiological, in terms of short-term outcomes. MF is a method to be applied as a primary treatment with its cost-effective, simple and short surgery technique, and effective clinical results up to 4 cm2. Level of Evidence Level III: retrospective comparative study.
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Affiliation(s)
- Tahir Ozturk
- Tokat, Turkey Department of Orthopaedics and Traumatology, Gaziosmanpasa University School of Medicine
| | - Firat Erpala
- Department of Orthopaedics and Traumatology, Cesme Alpercizgenakat State Hospital, 35930 Cesme, Izmir Turkey
| | - Omer Bozduman
- Tokat, Turkey Department of Orthopaedics and Traumatology, Gaziosmanpasa University School of Medicine
| | - Mete Gedikbas
- Department of Orthopaedics and Traumatology, Turhal State Hospital, Tokat, Turkey
| | - Mehmet Burtac Eren
- Tokat, Turkey Department of Orthopaedics and Traumatology, Gaziosmanpasa University School of Medicine
| | - Eyup Cagatay Zengin
- Tokat, Turkey Department of Orthopaedics and Traumatology, Gaziosmanpasa University School of Medicine
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Trofa DP, Hong IS, Lopez CD, Rao AJ, Yu Z, Odum SM, Moorman CT, Piasecki DP, Fleischli JE, Saltzman BM. Isolated Osteochondral Autograft Versus Allograft Transplantation for the Treatment of Symptomatic Cartilage Lesions of the Knee: A Systematic Review and Meta-analysis. Am J Sports Med 2023; 51:812-824. [PMID: 35139311 DOI: 10.1177/03635465211053594] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Focal cartilage lesions of the knee remain a difficult entity to treat. Current treatment options include arthroscopic debridement, microfracture, autograft or allograft osteochondral transplantation, and cell-based therapies such as autologous chondrocyte transplantation. Osteochondral transplantation techniques restore the normal topography of the condyles and provide mature hyaline cartilage in a single-stage procedure. However, clinical outcomes comparing autograft versus allograft techniques are scarce. PURPOSE To perform a comprehensive systematic review and meta-analysis of high-quality studies to evaluate the results of osteochondral autograft and allograft transplantation for the treatment of symptomatic cartilage defects of the knee. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 2. METHODS A comprehensive search of the literature was conducted using various databases. Inclusion criteria were level 1 or 2 original studies, studies with patients reporting knee cartilage injuries and chondral defects, mean follow-up ≥2 years, and studies focusing on osteochondral transplant techniques. Exclusion criteria were studies with nonknee chondral defects, studies reporting clinical outcomes of osteochondral autograft or allograft combined with other procedures, animal studies, cadaveric studies, non-English language studies, case reports, and reviews or editorials. Primary outcomes included patient-reported outcomes and failure rates associated with both techniques, and factors such as lesion size, age, sex, and the number of plugs transplanted were assessed. Metaregression using a mixed-effects model was utilized for meta-analyses. RESULTS The search resulted in 20 included studies with 364 cases of osteochondral autograft and 272 cases of osteochondral allograft. Mean postoperative survival was 88.2% in the osteochondral autograft cohort as compared with 87.2% in the osteochondral allograft cohort at 5.4 and 5.2 years, respectively (P = .6605). Patient-reported outcomes improved by an average of 65.1% and 81.1% after osteochondral autograft and allograft, respectively (P = .0001). However, meta-analysis revealed no significant difference in patient-reported outcome percentage change between osteochondral autograft and allograft (P = .97) and a coefficient of 0.033 (95% CI, -1.91 to 1.98). Meta-analysis of the relative risk of graft failure after osteochondral autograft versus allograft showed no significant differences (P = .66) and a coefficient of 0.114 (95% CI, -0.46 to 0.69). Furthermore, the regression did not find other predictors (mean age, percentage of female patients, lesion size, number of plugs/grafts used, and treatment location) that may have significantly affected patient-reported outcome percentage change or postoperative failure between osteochondral autograft versus allograft. CONCLUSION Osteochondral autograft and allograft result in favorable patient-reported outcomes and graft survival rates at medium-term follow-up. While predictors for outcomes such as mean age, percentage of female patients, lesion size, number of plugs/grafts used, and treatment location did not affect the comparison of the 2 cohorts, proper patient selection for either procedure remains paramount to the success and potentially long-term viability of the graft.
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Affiliation(s)
- David P Trofa
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, New York, USA
| | - Ian S Hong
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Cesar D Lopez
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, New York, USA
| | - Allison J Rao
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
| | - Ziqing Yu
- Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Susan M Odum
- Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, USA
- OrthoCarolina Research Institute, Charlotte, North Carolina, USA
| | - Claude T Moorman
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Dana P Piasecki
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, USA
| | - James E Fleischli
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Bryan M Saltzman
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, USA
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10
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Megaloikonomos PD, Becher C, Van der Stok J, O'Donnell T. Femoral condyle resurfacing using an inlay metal implant: low revision rate of 266 patients in a 5-10 years follow-up. Arch Orthop Trauma Surg 2023; 143:1243-1251. [PMID: 34775523 DOI: 10.1007/s00402-021-04251-x] [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: 08/10/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To assess the clinical outcome and survival of an inlay resurfacing prosthesis for focal femoral condyle chondral and osteochondral defects. METHODS Two hundred sixty-six patients (mean age, 38.25 years; range 25-56 years) with symptomatic femoral condyle chondral and osteochondral defects were reviewed. The mean follow-up period was 7.3 years (range 5-10 years). The medial femoral condyle was involved in 229 and the lateral condyle in 37 patients. Previous cartilage surgery was done in 235 patients. All patients were treated with focal femoral condyle resurfacing with the HemiCAP® device. The preoperative and the last follow-up values of the Knee Injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), 36-item Short Form Survey (SF-36) and Visual Analogue Scale (VAS) were examined. Complications, reoperation rate and survival were analyzed. RESULTS At the last follow-up, all clinical score values showed significant improvement as compared with the corresponding preoperative values (p < 0.001). Age presented a negative correlation with KOOS (p = 0.03) and SF-36 improvement (p = 0.014). Kellgren-Lawrence grade influenced OKS (p = 0.036). BMI, gender, side, medial or lateral condyle and size did not affect the outcome. Patients who had previous biological cartilage procedures demonstrated better clinical improvement in comparison with those that did not have prior surgery (p < 0.05). Survival was 96.2% at 10 years, using as endpoint implant revision or/and progression of osteoarthritis. The cumulative hazard for any-reason reoperation was 12.0%. CONCLUSIONS Femoral condyle resurfacing using the HemiCAP® device is an effective treatment option to address focal chondral and osteochondral defects. It can be successfully used either as a primary procedure or after prior biological cartilage reconstruction. Subjective clinical outcomes are expected to be good to excellent in mid- to long term, while reoperation and revision rates are low. Progression of osteoarthritis is the most common mode of failure; thus, patient selection is very important. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
| | - Christoph Becher
- International Centre for Orthopedics, ATOS Clinic Heidelberg, Bismarckstr. 9-15, 69115, Heidelberg, Germany.
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11
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McCarthy HS, Tins B, Gallacher PD, Jermin P, Richardson JB, Kuiper JH, Roberts S. Histological and Radiological Assessment of Endogenously Generated Repair Tissue In Vivo Following a Chondral Harvest. Cartilage 2023; 14:48-58. [PMID: 36704827 PMCID: PMC10076898 DOI: 10.1177/19476035221149523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To examine repair tissue formed approximately 15 months after a chondral harvest in the human knee. DESIGN Sixteen individuals (12 males, 4 females, mean age 36 ± 9 years) underwent a chondral harvest in the trochlea as a pre-requisite for autologous chondrocyte implantation (ACI) treatment. The harvest site was assessed via MRI at 14.3 ± 3.2 months and arthroscopy at 15 ± 3.5 months (using the Oswestry Arthroscopy Score [O-AS] and the International Cartilage Repair Society Arthroscopy Score [ICRS-AS]). Core biopsies (1.8 mm diameter, n = 16) of repair tissue obtained at arthroscopy were assessed histologically (using the ICRS II and OsScore histology scores) and examined via immunohistochemistry for the presence of collagen types I and II. RESULTS The mean O-AS and ICRS-AS of the repaired harvest sites were 7.2 ± 3.2 and 10.1 ± 3.5, respectively, with 80.3% ± 26% repair fill depth on MRI. The histological quality of the repair tissue formed was variable, with some hyaline cartilage present in 50% of the biopsies; where this occurred, it was associated with a significantly higher ICRS-AS than those with no hyaline cartilage present (median 11 vs. 7.5, P = 0.049). Collagen types I and II were detected in 12/14 and 10/13 biopsies, respectively. CONCLUSIONS We demonstrate good-quality structural repair tissue formed following cartilage harvest in ACI, suggesting this site can be useful to study endogenous cartilage repair in humans. The trochlea is less commonly affected by osteoarthritis; therefore, location may be critical for spontaneous repair. Understanding the mechanisms and factors influencing this could improve future treatments for cartilage defects.
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Affiliation(s)
- Helen S McCarthy
- Spinal Studies & Cartilage Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust, Oswestry, UK
- Centre for Regenerative Medicine Research, School of Pharmacy and Bioengineering, Keele University, Keele, UK
| | - Bernhard Tins
- Spinal Studies & Cartilage Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust, Oswestry, UK
| | - Peter D Gallacher
- Spinal Studies & Cartilage Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust, Oswestry, UK
| | - Paul Jermin
- Spinal Studies & Cartilage Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust, Oswestry, UK
| | - James B Richardson
- Spinal Studies & Cartilage Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust, Oswestry, UK
- Centre for Regenerative Medicine Research, School of Pharmacy and Bioengineering, Keele University, Keele, UK
| | - Jan Herman Kuiper
- Spinal Studies & Cartilage Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust, Oswestry, UK
- Centre for Regenerative Medicine Research, School of Pharmacy and Bioengineering, Keele University, Keele, UK
| | - Sally Roberts
- Spinal Studies & Cartilage Research Group, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust, Oswestry, UK
- Centre for Regenerative Medicine Research, School of Pharmacy and Bioengineering, Keele University, Keele, UK
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12
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Chahla J, Williams BT, Yanke AB, Farr J. The Large Focal Isolated Chondral Lesion. J Knee Surg 2023; 36:368-381. [PMID: 34507359 DOI: 10.1055/s-0041-1735278] [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
Focal chondral defects (FCDs) of the knee can be a debilitating condition that can clinically translate into pain and dysfunction in young patients with high activity demands. Both the understanding of the etiology of FCDs and the surgical management of these chondral defects has exponentially grown in recent years. This is reflected by the number of surgical procedures performed for FCDs, which is now approximately 200,000 annually. This fact is also apparent in the wide variety of available surgical approaches to FCDs. Although simple arthroscopic debridement or microfracture are usually the first line of treatment for smaller lesions, chondral lesions that involve a larger area or depth require restorative procedures such as osteochondral allograft transplantation or other cell-based techniques. Given the prevalence of FCDs and the increased attention on treating these lesions, a comprehensive understanding of management from diagnosis to rehabilitation is imperative for the treating surgeon. This narrative review aims to describe current concepts in the treatment of large FCDs through providing an algorithmic approach to selecting interventions to address these lesions as well as the reported outcomes in the literature.
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Affiliation(s)
- Jorge Chahla
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Brady T Williams
- Department of Orthopedic Surgery, University of Colorado, Aurora, Colorado
| | - Adam B Yanke
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Jack Farr
- Knee Preservation and Cartilage Restoration Center, OrthoIndy, Indianapolis, Indiana
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13
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O'Connell CD, Duchi S, Onofrillo C, Caballero-Aguilar LM, Trengove A, Doyle SE, Zywicki WJ, Pirogova E, Di Bella C. Within or Without You? A Perspective Comparing In Situ and Ex Situ Tissue Engineering Strategies for Articular Cartilage Repair. Adv Healthc Mater 2022; 11:e2201305. [PMID: 36541723 DOI: 10.1002/adhm.202201305] [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: 05/31/2022] [Revised: 10/21/2022] [Indexed: 11/23/2022]
Abstract
Human articular cartilage has a poor ability to self-repair, meaning small injuries often lead to osteoarthritis, a painful and debilitating condition which is a major contributor to the global burden of disease. Existing clinical strategies generally do not regenerate hyaline type cartilage, motivating research toward tissue engineering solutions. Prospective cartilage tissue engineering therapies can be placed into two broad categories: i) Ex situ strategies, where cartilage tissue constructs are engineered in the lab prior to implantation and ii) in situ strategies, where cells and/or a bioscaffold are delivered to the defect site to stimulate chondral repair directly. While commonalities exist between these two approaches, the core point of distinction-whether chondrogenesis primarily occurs "within" or "without" (outside) the body-can dictate many aspects of the treatment. This difference influences decisions around cell selection, the biomaterials formulation and the surgical implantation procedure, the processes of tissue integration and maturation, as well as, the prospects for regulatory clearance and clinical translation. Here, ex situ and in situ cartilage engineering strategies are compared: Highlighting their respective challenges, opportunities, and prospects on their translational pathways toward long term human cartilage repair.
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Affiliation(s)
- Cathal D O'Connell
- Discipline of Electrical and Biomedical Engineering, RMIT University, Melbourne, Victoria, 3000, Australia.,Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia
| | - Serena Duchi
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia.,Department of Surgery, St Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, 3065, Australia
| | - Carmine Onofrillo
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia.,Department of Surgery, St Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, 3065, Australia
| | - Lilith M Caballero-Aguilar
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia.,School of Science, Computing and Engineering Technologies, Swinburne University of Technology, Melbourne, Victoria, 3122, Australia
| | - Anna Trengove
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia.,Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - Stephanie E Doyle
- Discipline of Electrical and Biomedical Engineering, RMIT University, Melbourne, Victoria, 3000, Australia.,Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia
| | - Wiktor J Zywicki
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia.,Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - Elena Pirogova
- Discipline of Electrical and Biomedical Engineering, RMIT University, Melbourne, Victoria, 3000, Australia
| | - Claudia Di Bella
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia.,Department of Surgery, St Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, 3065, Australia.,Department of Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia
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14
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Wodzig M, Peters M, Emanuel K, Van Hugten P, Wijnen W, Jutten L, Boymans T, Loeffen D, Emans P. Minced Autologous Chondral Fragments with Fibrin Glue as a Simple Promising One-Step Cartilage Repair Procedure: A Clinical and MRI Study at 12-Month Follow-Up. Cartilage 2022; 13:19-31. [PMID: 36305343 PMCID: PMC9924984 DOI: 10.1177/19476035221126343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate early radiological and clinical outcome of autologous minced cartilage treatment as a single-step treatment option in patients with a chondral or osteochondral lesion (OCL) in the knee. DESIGN Eighteen patients with an OCL in the knee were included. Cartilage from healthy-appearing loose bodies and/or the periphery of the defect were minced into small chips and sealed in the defect using fibrin glue. Preoperatively, and at 3 (n = 14) and 12 (n = 18) months follow-up, magnetic resonance imaging (MRI) was performed. The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 score was used to assess the cartilage repair tissue on MRI at 12 months. The International Knee Documentation Score, Knee Injury and Osteoarthritis Outcome Score, EuroQoL-5D, and Visual Analogue Scale pain were collected preoperatively and 12 months after surgery. RESULTS Three months postoperative, MRI showed complete defect filling in 11 out of 14 patients. Mean MOCART 2.0 score at 12 months was 65.0 ± 18.9 with higher scores for lateral femoral chondral lesions compared to medial femoral chondral lesions (75.8 ± 14.3, 52.5 ± 15.8 respectively, P = 0.02). Clinical and statistical significant improvements were observed in the patient-reported outcome measures at 12 months postoperatively compared to preoperatively. CONCLUSION Treatment of OCLs using the autologous minced cartilage procedure resulted in good cartilage repair measured by MOCART 2.0. Clinically relevant improvements were observed in the clinical scores. This study suggests autologous minced cartilage as a promising, single-step treatment for OCLs.
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Affiliation(s)
- M.H.H. Wodzig
- Department of Orthopedic Surgery,
Joint-Preserving Clinic, Maastricht University Medical Center, Maastricht, The
Netherlands,M.H.H. Wodzig, Department of Orthopedic
Surgery, Joint-Preserving Clinic, Maastricht University Medical Center,
Maastricht 6229 HX, The Netherlands.
| | | | - K.S. Emanuel
- Department of Orthopedic Surgery,
Joint-Preserving Clinic, Maastricht University Medical Center, Maastricht, The
Netherlands,Department of Orthopedic Surgery,
Amsterdam UMC, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - P.P.W. Van Hugten
- Department of Orthopedic Surgery,
Joint-Preserving Clinic, Maastricht University Medical Center, Maastricht, The
Netherlands
| | - W. Wijnen
- Department of Orthopedic Surgery,
Joint-Preserving Clinic, Maastricht University Medical Center, Maastricht, The
Netherlands
| | - L.M. Jutten
- Department of Orthopedic Surgery,
Joint-Preserving Clinic, Maastricht University Medical Center, Maastricht, The
Netherlands
| | - T.A. Boymans
- Department of Orthopedic Surgery,
Joint-Preserving Clinic, Maastricht University Medical Center, Maastricht, The
Netherlands
| | - D.V. Loeffen
- Department of Radiology, Maastricht
University Medical Center, Maastricht, The Netherlands
| | - P.J. Emans
- Department of Orthopedic Surgery,
Joint-Preserving Clinic, Maastricht University Medical Center, Maastricht, The
Netherlands
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15
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Liu W, Feng M, Xu P. From regeneration to osteoarthritis in the knee joint: The role shift of cartilage-derived progenitor cells. Front Cell Dev Biol 2022; 10:1010818. [PMID: 36340024 PMCID: PMC9630655 DOI: 10.3389/fcell.2022.1010818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/30/2022] [Indexed: 12/02/2022] Open
Abstract
A mount of growing evidence has proven that cartilage-derived progenitor cells (CPCs) harbor strong proliferation, migration, andmultiple differentiation potentials over the past 2 decades. CPCs in the stage of immature tissue play an important role in cartilage development process and injured cartilage repair in the young and active people. However, during maturation and aging, cartilage defects cannot be completely repaired by CPCs in vivo. Recently, tissue engineering has revealed that repaired cartilage defects with sufficient stem cell resources under good condition and bioactive scaffolds in vitro and in vivo. Chronic inflammation in the knee joint limit the proliferation and chondrogenesis abilities of CPCs, which further hampered cartilage healing and regeneration. Neocartilage formation was observed in the varus deformity of osteoarthritis (OA) patients treated with offloading technologies, which raises the possibility that organisms could rebuild cartilage structures spontaneously. In addition, nutritionmetabolismdysregulation, including glucose and free fatty acid dysregulation, could influence both chondrogenesis and cartilage formation. There are a few reviews about the advantages of CPCs for cartilage repair, but few focused on the reasons why CPCs could not repair the cartilage as they do in immature status. A wide spectrum of CPCs was generated by different techniques and exhibited substantial differences. We recently reported that CPCs maybe are as internal inflammation sources during cartilage inflammaging. In this review, we further streamlined the changes of CPCs from immature development to maturation and from healthy status to OA advancement. The key words including “cartilage derived stem cells”, “cartilage progenitor cells”, “chondroprogenitor cells”, “chondroprogenitors” were set for latest literature searching in PubMed and Web of Science. The articles were then screened through titles, abstracts, and the full texts in sequence. The internal environment including long-term inflammation, extendedmechanical loading, and nutritional elements intake and external deleterious factors were summarized. Taken together, these results provide a comprehensive understanding of the underlying mechanism of CPC proliferation and differentiation during development, maturation, aging, injury, and cartilage regeneration in vivo.
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Affiliation(s)
- Wenguang Liu
- Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Meng Feng
- Department of Orthopedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Peng Xu
- Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Peng Xu,
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16
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Lineham B, Altaie A, Harwood P, McGonagle D, Pandit H, Jones E. A systematic review on the potential value of synovial fluid biomarkers to predict clinical outcomes in cartilage repair treatments. Osteoarthritis Cartilage 2022; 30:1035-1049. [PMID: 35618204 DOI: 10.1016/j.joca.2022.05.007] [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: 02/23/2022] [Revised: 05/03/2022] [Accepted: 05/17/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Multiple biochemical biomarkers have been previously investigated for the diagnosis, prognosis and response to treatment of articular cartilage damage, including osteoarthritis (OA). Synovial fluid (SF) biomarker measurement is a potential method to predict treatment response and effectiveness. However, the significance of different biomarkers and their correlation to clinical outcomes remains unclear. This systematic review evaluated current SF biomarkers used in investigation of cartilage degeneration or regeneration in the knee joint and correlated these biomarkers with clinical outcomes following cartilage repair or regeneration interventions. METHOD PubMed, Institute of Science Index, Scopus, Cochrane Central Register of Controlled Trials, and Embase databases were searched. Studies evaluating SF biomarkers and clinical outcomes following cartilage repair intervention were included. Two researchers independently performed data extraction and Quality Assessment of Diagnostic Accuracy Score 2 (QUADAS-2) analysis. Biomarker inclusion, change following intervention and correlation with clinical outcome was compared. RESULTS 9 studies were included. Study heterogeneity precluded meta-analysis. There was significant variation in sampling and analysis. 33 biomarkers were evaluated in addition to microRNA and catabolic/anabolic ratios. Five studies reported on correlation of biomarkers with six biomarkers significantly correlated with clinical outcomes following intervention. However, correlation was only demonstrated in isolated studies. CONCLUSION This review demonstrates significant difficulties in drawing conclusions regarding the importance of SF biomarkers based on the available literature. Improved standardisation for collection and analysis of SF samples is required. Future publications should also focus on clinical outcome scores and seek to correlate biomarkers with progression to further understand the significance of identified markers in a clinical context. REGISTRATION NUMBER PROSPERO CRD42022304298. Study protocol available on PROSPERO website.
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Affiliation(s)
- B Lineham
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK.
| | - A Altaie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK
| | - P Harwood
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK; Trauma and Orthopaedics Department, Leeds Teaching Hospitals NHS Trust, UK
| | - D McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK
| | - H Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK; Trauma and Orthopaedics Department, Leeds Teaching Hospitals NHS Trust, UK
| | - E Jones
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK
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17
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Madry H. Surgical therapy in osteoarthritis. Osteoarthritis Cartilage 2022; 30:1019-1034. [PMID: 35183776 DOI: 10.1016/j.joca.2022.01.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 01/14/2022] [Accepted: 01/31/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To provide an evidence-based overview of the different surgical procedures in osteoarthritis (OA). DESIGN This narrative review reports on surgical therapies (1) for severe, end stage OA and (2) of surgical options aiming to possibly reduce OA development earlier in the course of the disease. RESULTS Surgical practice guidelines provide evidence-based recommendations to assist in the clinical decision-making. Total joint arthroplasty represents the only valuable, established surgical option for severe, end stage OA. For hip and knee OA, it is by far the most common surgical procedure and provides considerable pain relief, functional restoration, and improved quality of life. Surgical therapy aiming to postpone OA essentially addresses extra- or intraarticular pre-osteoarthritic deformities, defined as congenital or acquired disturbances of the joint structure that adversely affect its function. Approaches in this category include osteotomies and different cartilage repair procedures such as osteochondral autograft and allograft transfer, marrow stimulation techniques, and autologous chondrocyte implantation. However, they are not only less commonly performed than arthroplasty, but the scientific clinical evidence in favour of this type of surgery to reduce the long-term risk of developing OA is considerably reduced. CONCLUSION Total knee and hip arthroplasty are two of the most successful procedures in all of medicine. As the progression of this insidious disease is often asymptomatic and slow, it is imperative to judge reparative procedures at their potential to reduce OA development at long-term, besides their primary clinical outcomes. Evidence-based guidelines provide a valuable tool for high-quality surgical decision making in OA.
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Affiliation(s)
- H Madry
- Institute of Experimental Orthopaedics, Saarland University, Homburg, Saar, Germany; Department of Orthopaedic Surgery, Saarland University Medical Center, Homburg, Saar, Germany.
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18
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Fortier LM, Knapik DM, Dasari SP, Polce EM, Familiari F, Gursoy S, Chahla J. Clinical and Magnetic Resonance Imaging Outcomes After Microfracture Treatment With and Without Augmentation for Focal Chondral Lesions in the Knee: A Systematic Review and Meta-analysis. Am J Sports Med 2022:3635465221087365. [PMID: 35736251 DOI: 10.1177/03635465221087365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Focal cartilage lesions represent a common source of knee pain and disability, with the potential for the development and progression of osteoarthritis. Currently, microfracture (MFx) represents the most utilized first-line surgical treatment for small, focal chondral lesions. Recent investigations have examined methods of overcoming the limitations of MFx utilizing various augmentation techniques. PURPOSE To perform a systematic review and meta-analysis evaluating clinical and radiographic outcomes in patients undergoing isolated MFx versus MFx augmented with orthobiologics or scaffolds for focal chondral defects of the knee. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS A systematic review was performed to identify studies evaluating outcomes and adverse events in patients undergoing isolated MFx versus augmented MFx for focal chondral defects in the knee from 1945 to June 1, 2021. Data were extracted from each article that met the inclusion/exclusion criteria. Meta-analyses were performed for all outcomes reported in a minimum of 3 studies. RESULTS A total of 14 studies were identified, utilizing 7 different types of injectable augmentation regimens and 5 different scaffolding regimens. Across the 14 studies, a total of 744 patients were included. The mean patient age was 46.8 years (range, 34-58 years), and 58.3% (n = 434/744) of patients were women. The mean final follow-up time was 26.7 months (range, 12-60 months). The mean chondral defect size ranged from 1.3 to 4.8 cm2. A post hoc analysis comparing mean improvement in postoperative outcomes scores compared with preoperative values found no significant differences in the improvement in the visual analog scale (VAS), International Knee Documentation Committee (IKDC), or Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores between patients undergoing isolated MFx and those undergoing MFx + augmentation. Patients undergoing MFx + augmentation reported significantly greater improvements in the Lysholm score and postoperative MOCART (magnetic resonance observation of cartilage repair tissue) scores compared with the isolated MFx group. CONCLUSION Patients undergoing combined MFx + augmentation reported significant improvements in mean Lysholm and MOCART scores, without significant improvements in VAS, IKDC, or WOMAC scores when compared with patients undergoing isolated MFx.
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Affiliation(s)
- Luc M Fortier
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, Washington University Medical Center, Saint Louis, Missouri, USA
| | - Suhas P Dasari
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Evan M Polce
- University of Wisconsin School of Medicine, Madison, Wisconsin, USA
| | - Filippo Familiari
- Department of Orthopaedic Surgery, Magna Graecia University, Catanzaro, Italy
| | - Safa Gursoy
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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19
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Gelber PE, Ramírez-Bermejo E. Salvage Procedures: Last Chance Before Arthroplasty. OPER TECHN SPORT MED 2022. [DOI: 10.1016/j.otsm.2022.150937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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20
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Du Z, You X, Wu D, Huang S, Zhou Z. Rhythm disturbance in osteoarthritis. Cell Commun Signal 2022; 20:70. [PMID: 35610652 PMCID: PMC9128097 DOI: 10.1186/s12964-022-00891-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/28/2022] [Indexed: 02/08/2023] Open
Abstract
Osteoarthritis (OA) is one of the main causes of disabilities among older people. To date, multiple disease-related molecular networks in OA have been identified, including abnormal mechanical loadings and local inflammation. These pathways have not, however, properly elucidated the mechanism of OA progression. Recently, sufficient evidence has suggested that rhythmic disturbances in the central nervous system (CNS) and local joint tissues affect the homeostasis of joint and can escalate pathological changes of OA. This is accompanied with an exacerbation of joint symptoms that interfere with the rhythm of CNS in reverse. Eventually, these processes aggravate OA progression. At present, the crosstalk between joint tissues and biological rhythm remains poorly understood. As such, the mechanisms of rhythm changes in joint tissues are worth study; in particular, research on the effect of rhythmic genes on metabolism and inflammation would facilitate the understanding of the natural rhythms of joint tissues and the OA pathology resulting from rhythm disturbance. Video Abstract
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Affiliation(s)
- Ze Du
- Department of Orthopedics, West China Hospital, Sichuan University, 610041, Chengdu, China.,Department of Orthopedics and Research institute of Orthopedics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xuanhe You
- Department of Orthopedics and Research institute of Orthopedics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Diwei Wu
- Department of Orthopedics and Research institute of Orthopedics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Shishu Huang
- Department of Orthopedics and Research institute of Orthopedics, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Zongke Zhou
- Department of Orthopedics, West China Hospital, Sichuan University, 610041, Chengdu, China. .,Department of Orthopedics and Research institute of Orthopedics, West China Hospital, Sichuan University, Chengdu, 610041, China.
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21
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Matthews JR, Brutico J, Heard J, Chauhan K, Tucker B, Freedman KB. Comparison of clinical outcomes following osteochondral allograft transplantation for osteochondral versus chondral defects in the knee. Knee Surg Relat Res 2022; 34:23. [PMID: 35509057 PMCID: PMC9066852 DOI: 10.1186/s43019-022-00149-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 04/03/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose Osteochondral allograft (OCA) transplantation is a restorative technique for addressing articular cartilage defects by transferring mature viable chondrocytes with subchondral bone into size-matched lesions. The purpose of this study was to compare differences in clinical and functional outcomes in patients treated with OCA for osteochondral defects compared with isolated chondral pathology.
Methods A retrospective review identified patients who underwent OCA transplantation and grouped them into osteochondral or isolated chondral pathology. Demographic data, surgical history, lesion characteristics, complications, and rate of subsequent surgery were reviewed. The review included 86 patients (24 osteochondral, 62 chondral) with a mean follow-up of 5.4 ± 1.4 years. Outcome measures included the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR.), International Knee Documentation Committee (IKDC), and Short Form Health Survey (SF-12) physical scores. Failure was defined to include revision OCA, graft removal, conversion to ACI, or conversion to arthroplasty.
Results The average age at surgery was 32.3 and 37.3 years for the osteochondral and chondral groups, respectively (P = 0.056). The medial femoral condyle was the most common defect location in both groups. P < 0.05 was considered statistically significant. Patients with osteochondral pathology had significantly greater KOOS JR., IKDC, and SF-12 scores (P < 0.05), and fewer failures were reported in the osteochondral group (8.3% versus 32.3%, P = 0.045). When controlling for age, sex, laterality, BMI, and presence of a concomitant procedure, patients with osteochondral pathology were found to have better KOOS and IKDC scores, but there was no difference in SF12 scores or rates of failure between groups.
Conclusion The findings of this study indicate that patients undergoing OCA for osteochondral defects may have greater functional outcomes and similar failure rates compared with OCA transplantation for isolated chondral pathology.
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Affiliation(s)
- John Reza Matthews
- Department of Orthopedic Surgery, Thomas Jefferson Rothman Institute Sports Fellow, 925 Chestnut St., Philadelphia, PA, 19107, USA.
| | - Joseph Brutico
- Department of Orthopedic Surgery, Rothman Institute Research Fellow, Philadelphia, USA
| | - Jeremy Heard
- Internal Medicine Resident, Thomas Jefferson University, Philadelphia, USA
| | - Kashyap Chauhan
- Internal Medicine Resident, Thomas Jefferson University, Philadelphia, USA
| | - Bradford Tucker
- Cartilage Restoration Center, Orthopaedic Surgery, Thomas Jefferson Rothman Institute, Philadelphia, USA
| | - Kevin Blake Freedman
- Cartilage Restoration Center, Orthopaedic Surgery, Thomas Jefferson Rothman Institute, Philadelphia, USA
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22
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Gelber PE, Ramírez-Bermejo E, Grau-Blanes A, Gonzalez-Osuna A, Fariñas O. Computerized tomography scan evaluation after fresh osteochondral allograft transplantation of the knee correlates with clinical outcomes. INTERNATIONAL ORTHOPAEDICS 2022; 46:1539-1545. [PMID: 35411436 PMCID: PMC9166817 DOI: 10.1007/s00264-022-05373-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/06/2022] [Indexed: 11/17/2022]
Abstract
Purpose
To determine the correlation between the assessment computed tomography osteochondral allograft (ACTOCA) scoring system and clinical outcomes scores. The hypothesis was that the ACTOCA score would show sufficient correlation to support its use in clinical practice. Methods We prospectively collected data from all consecutive patients who underwent cartilage restitution with fresh osteochondral allograft (FOCA) transplantation for osteochondral lesions of the knee and had a minimum follow-up of two years. CT scans were performed at three, six and 24 months post-operatively. A musculoskeletal radiologist blinded to the patients’ medical history evaluated the scans using the ACTOCA scoring system. Clinical outcomes collected preoperatively and at three, six and 24 months postoperatively were evaluated using the International Knee Documentation Committee (IKDC), Kujala, the Western Ontario Meniscal Evaluation Tool (WOMET), and the Tegner Activity Scale. Results The mean total ACTOCA score showed a statistically significant correlation with the clinical outcome. The correlation was optimal at 24 months. We found a high negative correlation with the IKDC, Kujala and Tegner (− 0.737; − 0.757, and − 0.781 respectively), and a moderate negative correlation with WOMET (− 0.566) (p < 0.001). IKDC, Kujala, WOMET, and Tegner scores showed a significant continuous improvement in all scores (p < 0.001). Conclusion The mean total ACTOCA score showed a linear correlation with clinical results in IKDC, Kujala, WOMET, and Tegner scores, being the highest at 24 months post-surgery. This finding supports the use of ACTOCA to standardize CT scan reports following fresh osteochondral allograft transplantation in the knee.
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Affiliation(s)
- Pablo Eduardo Gelber
- Department of Orthopaedic Surgery, Hospital de La Santa Creu I Sant Pau, Universitat Autonoma de Barcelona, C/Sant Quintí 89, 08041, Barcelona, Catalunya, Spain.
- ICATME-Hospital Universitari Dexeus, Universitat Autonoma de Barcelona, Barcelona, Spain.
| | - Eduard Ramírez-Bermejo
- Department of Orthopaedic Surgery, Hospital de La Santa Creu I Sant Pau, Universitat Autonoma de Barcelona, C/Sant Quintí 89, 08041, Barcelona, Catalunya, Spain
| | - Alex Grau-Blanes
- Department of Orthopaedic Surgery, Hospital de La Santa Creu I Sant Pau, Universitat Autonoma de Barcelona, C/Sant Quintí 89, 08041, Barcelona, Catalunya, Spain
| | - Aránzazu Gonzalez-Osuna
- Department of Orthopaedic Surgery, Hospital de La Santa Creu I Sant Pau, Universitat Autonoma de Barcelona, C/Sant Quintí 89, 08041, Barcelona, Catalunya, Spain
| | - Oscar Fariñas
- Barcelona Tissue Bank, Banc de Sang I Teixits, Barcelona, Spain
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23
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Zhu J, Yang S, Qi Y, Gong Z, Zhang H, Liang K, Shen P, Huang YY, Zhang Z, Ye W, Yue L, Fan S, Shen S, Mikos AG, Wang X, Fang X. Stem cell-homing hydrogel-based miR-29b-5p delivery promotes cartilage regeneration by suppressing senescence in an osteoarthritis rat model. SCIENCE ADVANCES 2022; 8:eabk0011. [PMID: 35353555 PMCID: PMC8967232 DOI: 10.1126/sciadv.abk0011] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Osteoarthritis (OA) is a common joint disease characterized by progressive loss of cartilage and reduction in lubricating synovial fluid, which lacks effective treatments currently. Here, we propose a hydrogel-based miRNA delivery strategy to rejuvenate impaired cartilage by creating a regenerative microenvironment to mitigate chondrocyte senescence that mainly contributes to cartilage breakdown during OA development. An aging-related miRNA, miR-29b-5p, was first found to be markedly down-regulated in OA cartilage, and their up-regulation suppressed the expression of matrix metalloproteinases and senescence-associated genes (P16INK4a/P21) via ten-eleven-translocation enzyme 1 (TET1). An injectable bioactive self-assembling peptide nanofiber hydrogel was applied to deliver agomir-29b-5p, which was functionalized by conjugating a stem cell-homing peptide SKPPGTSS for endogenous synovial stem cell recruitment simultaneously. Sustained miR-29b-5p delivery and recruitment of synovial stem cells and their subsequent differentiation into chondrocytes led to successful cartilage repair and chondrocyte rejuvenation. This strategy enables miRNA-based therapeutic modality to become a viable alternative for surgery in OA treatment.
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Affiliation(s)
- Jinjin Zhu
- Department of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine and Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang, Hangzhou 310016, China
- State Key Laboratory of New Ceramics and Fine Processing, Key Laboratory of Advanced Materials of Ministry of Education, School of Materials Science and Engineering, Tsinghua University, Beijing 100084, China
| | - Shuhui Yang
- State Key Laboratory of New Ceramics and Fine Processing, Key Laboratory of Advanced Materials of Ministry of Education, School of Materials Science and Engineering, Tsinghua University, Beijing 100084, China
| | - Yadong Qi
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Zhe Gong
- Department of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine and Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang, Hangzhou 310016, China
| | - Haitao Zhang
- Department of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine and Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang, Hangzhou 310016, China
| | - Kaiyu Liang
- Department of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine and Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang, Hangzhou 310016, China
| | - Panyang Shen
- Department of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine and Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang, Hangzhou 310016, China
| | - Yin-Yuan Huang
- State Key Laboratory of New Ceramics and Fine Processing, Key Laboratory of Advanced Materials of Ministry of Education, School of Materials Science and Engineering, Tsinghua University, Beijing 100084, China
| | - Zhe Zhang
- State Key Laboratory of New Ceramics and Fine Processing, Key Laboratory of Advanced Materials of Ministry of Education, School of Materials Science and Engineering, Tsinghua University, Beijing 100084, China
| | - Weilong Ye
- State Key Laboratory of New Ceramics and Fine Processing, Key Laboratory of Advanced Materials of Ministry of Education, School of Materials Science and Engineering, Tsinghua University, Beijing 100084, China
| | - Lei Yue
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Shunwu Fan
- Department of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine and Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang, Hangzhou 310016, China
| | - Shuying Shen
- Department of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine and Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang, Hangzhou 310016, China
| | - Antonios G. Mikos
- Department of Bioengineering, Rice University, 6100 Main Street, Houston, TX 77005, USA
| | - Xiumei Wang
- State Key Laboratory of New Ceramics and Fine Processing, Key Laboratory of Advanced Materials of Ministry of Education, School of Materials Science and Engineering, Tsinghua University, Beijing 100084, China
- Corresponding author. (X.F.); (X.W.)
| | - Xiangqian Fang
- Department of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine and Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang, Hangzhou 310016, China
- Corresponding author. (X.F.); (X.W.)
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24
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Gwinnutt JM, Wieczorek M, Cavalli G, Balanescu A, Bischoff-Ferrari HA, Boonen A, de Souza S, de Thurah A, Dorner TE, Moe RH, Putrik P, Rodríguez-Carrio J, Silva-Fernández L, Stamm T, Walker-Bone K, Welling J, Zlatković-Švenda MI, Guillemin F, Verstappen SMM. Effects of physical exercise and body weight on disease-specific outcomes of people with rheumatic and musculoskeletal diseases (RMDs): systematic reviews and meta-analyses informing the 2021 EULAR recommendations for lifestyle improvements in people with RMDs. RMD Open 2022; 8:rmdopen-2021-002168. [PMID: 35361692 PMCID: PMC8971792 DOI: 10.1136/rmdopen-2021-002168] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A European League Against Rheumatism (EULAR) taskforce was convened to develop recommendations for lifestyle behaviours in rheumatic and musculoskeletal diseases (RMDs). This paper reviews the literature on the effects of physical exercise and body weight on disease-specific outcomes of people with RMDs. METHODS Three systematic reviews were conducted to summarise evidence related to exercise and weight in seven RMDs: osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, axial spondyloarthritis (axSpA), psoriatic arthritis, systemic sclerosis and gout. Systematic reviews and original studies were included if they assessed exercise or weight in one of the above RMDs, and reported results regarding disease-specific outcomes (eg, pain, function, joint damage). Systematic reviews were only included if published between 2013-2018. Search strategies were implemented in the Medline, Embase, Cochrane Library of systematic reviews and CENTRAL databases. RESULTS 236 articles on exercise and 181 articles on weight were included. Exercise interventions resulted in improvements in outcomes such as pain and function across all the RMDs, although the size of the effect varied by RMD and intervention. Disease activity was not influenced by exercise, other than in axSpA. Increased body weight was associated with worse outcomes for the majority of RMDs and outcomes assessed. In general, study quality was moderate for the literature on exercise and body weight in RMDs, although there was large heterogeneity between studies. CONCLUSION The current literature supports recommending exercise and the maintenance of a healthy body weight for people with RMDs.
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Affiliation(s)
- James M Gwinnutt
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Maud Wieczorek
- EA 4360 Apemac, Université de Lorraine, Nancy, France,Center on Aging and Mobility, University of Zurich, Zurich, Switzerland
| | - Giulio Cavalli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Andra Balanescu
- Department of Internal Medicine and Rheumatology, “Sf. Maria” Hospital, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Heike A Bischoff-Ferrari
- Center on Aging and Mobility, University of Zurich, Zurich, Switzerland,Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland,University Clinic for Aging Medicine, City Hospital Zurich - Waid, Zurich, Switzerland
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Savia de Souza
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Annette de Thurah
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas E Dorner
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Vienna, Austria,Social Insurance Fund for Public Service, Railway and Mining Industries, Sitzenberg-Reidling, Austria,Karl-Landsteiner Institute for Health Promotion Research, Sitzenberg-Reidling, Austria
| | - Rikke Helene Moe
- National Advisory Unit for Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Polina Putrik
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Javier Rodríguez-Carrio
- Area of Immunology, Department of Functional Biology, Universidad de Oviedo, Oviedo, Spain,Department of Metabolism, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Lucía Silva-Fernández
- Rheumatology Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Karen Walker-Bone
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - Joep Welling
- NVLE Dutch Patient Organization for Systemic Autoimmune Diseases, Utrecht, The Netherlands
| | - Mirjana I Zlatković-Švenda
- Institute of Rheumatology, University of Belgrade School of Medicine, Belgrade, Serbia,Department of Internal Medicine, University of East Sarajevo Faculty of Medicine Foča, Republika Srpska, Bosnia and Herzegovina
| | - Francis Guillemin
- EA 4360 Apemac, Université de Lorraine, Nancy, France,Inserm, CHRU Nancy, CIC-1433 Epidémiologie Clinique, Université de Lorraine, Nancy, France
| | - Suzanne M M Verstappen
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK .,MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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25
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Koh JL, Jacob KC, Kulkarni R, Vasilion Z, Amirouche FM. Consequences of Progressive Full-Thickness Focal Chondral Defects Involving the Medial and Lateral Femoral Condyles After Meniscectomy: A Biomechanical Study Using a Goat Model. Orthop J Sports Med 2022; 10:23259671221078598. [PMID: 35356308 PMCID: PMC8958688 DOI: 10.1177/23259671221078598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/30/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Full-thickness chondral defects alter tibiofemoral joint homeostasis and, if left untreated, have the potential to progress to osteoarthritis. Purpose: To assess the effects of isolated and dual full-thickness chondral defect size and location on the biomechanical properties of the lateral femoral condyle (LFC) and medial femoral condyle (MFC) during dynamic knee flexion in goat knees without menisci. Methods: In 12 goat knees, we created progressively increasing full-thickness circular chondral defects (3-, 5-, and 7.5-mm diameter) in the weightbearing contact area of flexion and extension in the MFC, the LFC, or both. Each knee was fixed into a custom steel frame and attached to a motor with sensors inserted intra-articularly. For each testing condition, the knee was loaded to 100 N and underwent a dynamic range of motion between 90° of flexion and 30° of extension. The following parameters were collected: contact area, contact pressure, contact force, peak area, and peak pressure. Study Design: Controlled laboratory study. Results: The peak pressure at the defect rim of the MFC at full extension increased by 51.51% from no defect (1.887 MPa) to a 7.5-mm defect (2.859 MPa) (P < .001), and the peak pressure at the defect rim of the LFC at full extension increased by 139.14% from no defect (1.704 MPa) to a 7.5-mm defect (4.075 MPa) (P < .001). The peak pressures for LFC defects at all 3 diameters were significantly greater when compared with dual defects consisting of increasing LFC defect diameter and constant MFC defect diameter (P < .001 for all). Conclusion: Extremely large increases in peak pressure were seen at the rim of articular cartilage defects when evaluated under dynamic loading conditions. Isolated LFC defects experienced a greater increase in defect rim stress concentrations when compared with isolated MFC defects for equivalent increases in defect size. Defect size played a significant role independent of location for peak pressures on the MFC and LFC. Clinical Relevance: Significant rim-loading effects increase with defect size under dynamic loading and may result in increasingly rapid progression of articular cartilage lesions. Within the context of this goat model, findings suggest that lateral compartment chondral lesions are more likely to progress than medial compartment lesions of equivalent size.
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Affiliation(s)
- Jason L. Koh
- Department of Orthopaedic Surgery, Orthopaedic and Spine Institute, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Kevin C. Jacob
- Department of Orthopaedic Surgery, University of Illinois, Chicago, Illinois, USA
| | - Rohan Kulkarni
- Department of Orthopaedic Surgery, University of Illinois, Chicago, Illinois, USA
| | - Zachary Vasilion
- Department of Orthopaedic Surgery, Orthopaedic and Spine Institute, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Farid M.L. Amirouche
- Department of Orthopaedic Surgery, Orthopaedic and Spine Institute, NorthShore University HealthSystem, Evanston, Illinois, USA
- Department of Orthopaedic Surgery, University of Illinois, Chicago, Illinois, USA
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26
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Cogan CJ, Friedman J, You J, Zhang AL, Feeley BT, Ma CB, Lansdown DA. Prior Bone Marrow Stimulation Surgery Influences Outcomes After Cell-Based Cartilage Restoration: A Systematic Review and Meta-analysis. Orthop J Sports Med 2022; 9:23259671211035384. [PMID: 35146031 PMCID: PMC8822078 DOI: 10.1177/23259671211035384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/30/2021] [Indexed: 01/06/2023] Open
Abstract
Background: Cell-based cartilage restoration with autologous chondrocyte implantation (ACI) is a safe and effective treatment for symptomatic cartilage lesions. Many patients undergoing ACI have a history of prior surgery, including bone marrow stimulation (BMS). There is mounting evidence that a history of prior BMS may impede healing of the ACI graft. Purpose/Hypothesis: The purpose of this study was to compare the failure rates of primary ACI with ACI after prior BMS. We hypothesized that ACI after BMS would have a significantly higher failure rate (defined as reoperation, conversion to arthroplasty, and/or imaging-based failure) compared with primary ACI. Study Design: Systematic review; Level of evidence, 4. Methods: A literature search was performed by use of PubMed and Embase databases for relevant articles published through October 2, 2020, to identify studies evaluating outcomes and failures rates of ACI after prior BMS in the knee. Results: Included were 11 studies comprising 1479 ACI procedures. The mean age at surgery ranged from 18.3 to 39.1 years, and the mean follow-up ranged from 3 to 20.6 years. All studies reported failure rates. The overall failure rate was significantly higher in the patients who underwent ACI after BMS, at 26.4% compared with 14.8% in the ACI group (P < .001). Meta-analysis demonstrated an increased risk of failure in patients with a history of prior BMS (log odds ratio = –0.90 [95% confidence interval, –1.38 to –0.42]). Conclusion: This systematic review demonstrated that failure rates were significantly higher for patients treated with ACI after BMS relative to patients undergoing ACI without prior BMS. This finding has important implications when considering the use of BMS for defects that are amenable to cell-based restoration and when determining treatment options after failed BMS. Registration: PROSPERO (CRD42020180387).
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Affiliation(s)
- Charles J Cogan
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - James Friedman
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jae You
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Drew A Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
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Matthews JR, Brutico JM, Abraham DT, Heard JC, Tucker BS, Tjoumakaris FP, Freedman KB. Differences in Clinical and Functional Outcomes Between Osteochondral Allograft Transplantation and Autologous Chondrocyte Implantation for the Treatment of Focal Articular Cartilage Defects. Orthop J Sports Med 2022; 10:23259671211058425. [PMID: 35155699 PMCID: PMC8832612 DOI: 10.1177/23259671211058425] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Articular cartilage pathology can result from a spectrum of origins, including trauma, osteochondritis dissecans, avascular necrosis, or degenerative joint disease. Purpose: To compare the differences in clinical and patient-reported outcomes after autologous chondrocyte implantation (ACI) versus osteochondral allograft transplantation (OCA) in patients with focal articular cartilage defects without underlying bone loss. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review identified patients who underwent ACI or OCA between 2008 and 2016 for isolated grades 3 and 4 articular cartilage defects without underlying bone loss. Outcome measures included the Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR), International Knee Documentation Committee (IKDC) evaluation, and 12-Item Short Form Health Survey–Physical Component (SF-12-P) scores. Defect location, size, complications, and rate of subsequent surgery were determined. Results: Overall, 148 patients were included: 82 (55%) underwent ACI and 66 (45%) underwent OCA. The mean age at the time of surgery was 31.2 years within the ACI cohort and 37.7 years within the OCA cohort (P < .001); the mean follow-up for both cohorts was 6.7 years (P = .902). Within the ACI group, 28 (34%) patients had multifocal defects, 21 (26%) had defects confined to the femoral condyles, and 33 (40%) had defects in the patellofemoral region. Within the OCA group, 23 (35%) patients had multifocal defects, 30 (46%) had confined femoral condyle lesions, and 13 (20%) had patellofemoral defects. When comparing by lesion location, there were no significant differences in KOOS JR, and IKDC scores between the ACI and OCA cohorts (P < .05). There was, however, a significant difference for SF-12-P scores for FDD trochlear lesions. In both cohorts, traumatic patellofemoral pathology demonstrated lower patient-reported outcomes and higher failure rates than degenerative lesions. The overall rate of failure, defined as graft failure with revision surgery and/or conversion to arthroplasty, was significantly greater in the OCA group (21% vs 4%; P = .002). Conclusion: Study results indicated that ACI provides similar outcomes to OCA with or without concomitant procedures for the treatment of symptomatic articular cartilage defects in all lesion locations and may have a lower revision rate for multifocal and condylar lesions.
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Affiliation(s)
- John R. Matthews
- Thomas Jefferson Rothman Orthopedic Institute, Philadelphia, Pennsylvania, USA
| | - Joseph M. Brutico
- Thomas Jefferson Rothman Orthopedic Institute, Philadelphia, Pennsylvania, USA
| | | | - Jeremy C. Heard
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Bradford S. Tucker
- Thomas Jefferson Rothman Orthopedic Institute, Philadelphia, Pennsylvania, USA
| | | | - Kevin B. Freedman
- Thomas Jefferson Rothman Orthopedic Institute, Philadelphia, Pennsylvania, USA
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Lee DH, Kim SJ, Kim SA, Ju GI. Past, present, and future of cartilage restoration: from localized defect to arthritis. Knee Surg Relat Res 2022; 34:1. [PMID: 35090574 PMCID: PMC8800252 DOI: 10.1186/s43019-022-00132-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/11/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Osteoarthritis, one of the most common joint diseases, is characterized by the loss of joint function due to articular cartilage destruction. Herein, we review current and previous research involving the clinical applications of arthritis therapy and suggest potential therapeutic options for osteoarthritis in the future. PAST, PRESENT, AND FUTURE TREATMENT The arthroscopic cartilage regeneration procedure or realignment osteotomy has been performed as a joint-conserving procedure in cases where conservative treatment for damaged articular cartilage and early osteoarthritis failed. If cartilage regeneration is ineffective or if the joint damage progresses, arthroplasty is the main treatment option. The need for biological arthritis treatment has expanded as the healthy lifespan of the global population has increased. Accordingly, minimally invasive surgical treatment has been developed for the treatment of damaged cartilage and early osteoarthritis. However, patients generally prefer to avoid all types of surgery, including minimally invasive surgery. Therefore, in the future, the treatment of osteoarthritis will likely involve injection or medication. CONCLUSION Currently, arthritis management primarily involves the surgical application of therapeutic agents to the joints. However, nonsurgical or prophylactic methods are expected to become mainstream arthritis therapies in the future.
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Affiliation(s)
- Dong Hwan Lee
- Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 271, Cheonbo-ro, Gyeonggi-do, 11765, Uijeongbu-si, Republic of Korea
| | - Seok Jung Kim
- Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 271, Cheonbo-ro, Gyeonggi-do, 11765, Uijeongbu-si, Republic of Korea.
| | - Seon Ae Kim
- Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 271, Cheonbo-ro, Gyeonggi-do, 11765, Uijeongbu-si, Republic of Korea
| | - Gang-Ik Ju
- Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 271, Cheonbo-ro, Gyeonggi-do, 11765, Uijeongbu-si, Republic of Korea
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Ibragimova SI, Medvedeva EV, Romanova IA, Istranov LP, Istranova EV, Lychagin AV, Nedorubov AA, Timashev PS, Telpukhov VI, Chagin AS. Implantation of Various Cell-Free Matrixes Does Not Contribute to the Restoration of Hyaline Cartilage within Full-Thickness Focal Defects. Int J Mol Sci 2021; 23:292. [PMID: 35008719 PMCID: PMC8745283 DOI: 10.3390/ijms23010292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/22/2021] [Accepted: 12/25/2021] [Indexed: 11/24/2022] Open
Abstract
Articular cartilage is a highly organized tissue that has a limited ability to heal. Tissue engineering is actively exploited for joint tissue reconstruction in numerous cases of articular cartilage degeneration associated with trauma, arthrosis, rheumatoid arthritis, and osteoarthritis. However, the optimal scaffolds for cartilage repair are not yet identified. Here we have directly compared five various scaffolds, namely collagen-I membrane, collagen-II membrane, decellularized cartilage, a cellulose-based implant, and commercially available Chondro-Gide® (Geistlich Pharma AG, Wolhusen, Switzerland) collagen membrane. The scaffolds were implanted in osteochondral full-thickness defects, formed on adult Wistar rats using a hand-held cutter with a diameter of 2.0 mm and a depth of up to the subchondral bone. The congruence of the articular surface was almost fully restored by decellularized cartilage and collagen type II-based scaffold. The most vivid restoration was observed 4 months after the implantation. The formation of hyaline cartilage was not detected in any of the groups. Despite cellular infiltration into scaffolds being observed in each group except cellulose, neither chondrocytes nor chondro-progenitors were detected. We concluded that for restoration of hyaline cartilage, scaffolds have to be combined either with cellular therapy or morphogens promoting chondrogenic differentiation.
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Affiliation(s)
- Shabnam I. Ibragimova
- Institute of Regenerative Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (S.I.I.); (E.V.M.); (L.P.I.); (E.V.I.); (P.S.T.)
| | - Ekaterina V. Medvedeva
- Institute of Regenerative Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (S.I.I.); (E.V.M.); (L.P.I.); (E.V.I.); (P.S.T.)
| | - Irina A. Romanova
- World-Class Research Center, Digital Biodesign and Personalized Healthcare, Sechenov University, 8-2 Trubetskaya St., 119991 Moscow, Russia;
| | - Leonid P. Istranov
- Institute of Regenerative Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (S.I.I.); (E.V.M.); (L.P.I.); (E.V.I.); (P.S.T.)
| | - Elena V. Istranova
- Institute of Regenerative Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (S.I.I.); (E.V.M.); (L.P.I.); (E.V.I.); (P.S.T.)
| | - Aleksey V. Lychagin
- Department of Traumatology, Orthopedics and Disaster Surgery, Sechenov University, 8-2 Trubetskaya St., 119991 Moscow, Russia;
| | - Andrey A. Nedorubov
- Center for Preclinical Research, Institute of Translational Medicine and Biotechnology, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia;
| | - Peter S. Timashev
- Institute of Regenerative Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (S.I.I.); (E.V.M.); (L.P.I.); (E.V.I.); (P.S.T.)
| | - Vladimir I. Telpukhov
- Department of Operative Surgery and Topographic Anatomy, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Andrei S. Chagin
- Institute of Regenerative Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (S.I.I.); (E.V.M.); (L.P.I.); (E.V.I.); (P.S.T.)
- Department of Physiology and Pharmacology, Karolinska Institutet, 17177 Stockholm, Sweden
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30
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Melugin HP, Bernard CD, Camp CL, Saris DB, Krych AJ. Bipolar Cartilage Lesions of the Knee: A Systematic Review of Techniques, Outcomes, and Complications. Cartilage 2021; 13:17S-30S. [PMID: 31204486 PMCID: PMC8808778 DOI: 10.1177/1947603519855761] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The purpose of this systematic review was to determine (1) treatment options for bipolar cartilage lesions of the knee, (2) patient-reported outcomes following various surgical treatments, and (3) complication and failure rates following surgery. DESIGN A literature search of PubMed, the Cochrane Library, and CINHAL was performed using PRISMA guidelines. Patients were included if they had bipolar cartilage lesions of the knee treated surgically. Lesion characteristics, surgical technique, patient-reported outcomes, complication rates, failure rates, and survivorship were recorded. RESULTS Fourteen studies yielded 301 knees treated surgically. Patient age ranged from 15 to 74 years. Surgical techniques included 138 autologous chondrocyte implantation (ACI), 156 osteochondral allograft transplantation (OCA), and 7 osteochondral autograft transfer system (OATS). Seven studies reported a concomitant procedure rate that ranged from 0% to 88%. Eight studies reported that both reciprocal lesions received surgical treatment, while 6 studies did not specify. Lesion size ranged from 1 to 41 cm2. All reported postoperative improvements in patient-reported outcomes, but the measures were very heterogeneous. There were no major complications and the rate of minor complications ranged from 0% to 50%. Survivorship ranged from 40% to 100% for OCA, 76% to 95% for ACI, and 100% for the 1 study evaluating OATS. CONCLUSIONS Bipolar cartilage lesions of the knee typically involve a large surface area and are most commonly treated with ACI or OCA, while OATS may be an option for smaller lesions. Improvements in mid-term patient-reported outcomes were reported for all surgical procedures and they can be performed safely with a low rate of major complications.
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Affiliation(s)
- Heath P. Melugin
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA
| | | | | | | | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA
- Aaron J. Krych, Department of Orthopedic
Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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31
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DeFroda SF, Bokshan SL, Yang DS, Daniels AH, Owens BD. Trends in the Surgical Treatment of Articular Cartilage Lesions in the United States from 2007 to 2016. J Knee Surg 2021; 34:1609-1616. [PMID: 32483798 DOI: 10.1055/s-0040-1712946] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Management of cartilage lesions of the knee can be complex, time consuming, and controversial, especially without a widely agreed upon "gold-standard" management. The PearlDiver database (www.pearldiverinc.com, Fort Wayne, IN) was queried for surgical management of cartilage lesions specified by Current Procedure Terminology (CPT) codes: 29877, chondroplasty; 29879, microfracture/drilling; 29866, arthroscopic osteochondral autograft; 29867, arthroscopic osteochondral allograft; 27412, autologous chondrocyte implantation (ACI); 27415, open osteochondral allograft; or 27416, open osteochondral autograft. Procedures were categorized as palliative (chondroplasty), microfracture/drilling, or restorative (arthroscopic osteochondral autograft; arthroscopic osteochondral allograft; ACI; open osteochondral allograft; or open osteochondral autograft). Linear regression was performed to determine the significance of yearly trend across each procedure.From 2007 to 2016, a total of 35,506 surgical procedures were performed. The average yearly incidence was 7.8 per 10,000 patients. Overall, palliative techniques (chondroplasty) were more common (1.8:1 ratio for chondroplasty to microfracture and 34:1 ratio chondroplasty to restoration procedure). There was a trend of decreasing incidence of palliative procedures seen by a significant decrease in the ratio of palliative to microfracture/restorative procedures of 0.2512 each year from 2007 to 2016 (p < 0.001). This decrease followed a linear trend (R 2 = 0.9123). In 2013, the number and incidence of the palliative procedures declined below that of microfracture procedures, with microfracture being most common from 2013 to 2016. Palliative chondroplasty was no longer the most commonly performed procedure for cartilage lesions in the United States from 2007 to 2016, as more surgeons opted for microfracture procedures instead. Restorative procedures (ACI, osteochondral autograft transfer system) remained unchanged over the study period, in accordance with the sports medicine literature; however, early functional outcomes studies do show the equivalency and in some cases superiority compared with microfracture. This is Level III study.
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Affiliation(s)
- Steven F DeFroda
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
| | - Steven L Bokshan
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
| | - Daniel S Yang
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
| | - Brett D Owens
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
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32
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Pastrama M, Spierings J, van Hugten P, Ito K, Lopata R, van Donkelaar CC. Ultrasound-Based Quantification of Cartilage Damage After In Vivo Articulation With Metal Implants. Cartilage 2021; 13:1540S-1550S. [PMID: 34894778 PMCID: PMC8721675 DOI: 10.1177/19476035211063861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study aims to evaluate the applicability of the ultrasound roughness index (URI) for quantitative assessment of cartilage quality ex vivo (post-mortem), after 6 months of in vivo articulation with a Focal Knee Resurfacing Implant (FKRI). DESIGN Goats received a metal FKRI (n = 8) or sham surgery (n = 8) in the medial femoral condyles. After 6 months animals were sacrificed, tibial plateaus were stained with Indian ink, and macroscopic scoring of the plateaus was performed based on the ink staining. The URI was calculated from high-frequency ultrasound images at several sections, covering both areas that articulated with the implant and non-articulating areas. Cartilage quality at the most damaged medial location was evaluated with a Modified Mankin Score (MMS). RESULTS The URI was significantly higher in the FKRI-articulating than in the sham plateaus at medial articulating sections, but not at sections that were not in direct contact with the implant, for example, under the meniscus. The mean macroscopic score and MMS were significantly higher in the FKRI-articulating group than in the sham group (P=0.035, P<0.001, respectively). Correlation coefficients between URI and macroscopic score were significant in medial areas that articulated with the implant. A significant correlation between URI and MMS was found at the most damaged medial location (ρ=0.72,P=0.0024). CONCLUSIONS This study demonstrates the potential of URI to evaluate cartilage roughness and altered surface morphology after in vivo articulation with a metal FKRI, rendering it a promising future tool for quantitative follow-up assessment of cartilage quality.
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Affiliation(s)
- Maria Pastrama
- Orthopaedic Biomechanics Group,
Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven,
The Netherlands,Corrinus C. van Donkelaar, Orthopaedic
Biomechanics Group, Department of Biomedical Engineering, Eindhoven University
of Technology, Groene Loper 15, 5612AP Eindhoven, The Netherlands.
| | - Janne Spierings
- Orthopaedic Biomechanics Group,
Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven,
The Netherlands
| | - Pieter van Hugten
- Department of Orthopaedics, Maastricht
UMC+, Maastricht, The Netherlands
| | - Keita Ito
- Orthopaedic Biomechanics Group,
Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven,
The Netherlands
| | - Richard Lopata
- Cardiovascular Biomechanics Group,
Photoacoustics and Ultrasound Laboratory Eindhoven, Department of Biomedical
Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Corrinus C. van Donkelaar
- Orthopaedic Biomechanics Group,
Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven,
The Netherlands
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33
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Gatenholm B, Lindahl C, Brittberg M, Simonsson S. Collagen 2A Type B Induction after 3D Bioprinting Chondrocytes In Situ into Osteoarthritic Chondral Tibial Lesion. Cartilage 2021; 13:1755S-1769S. [PMID: 32070108 PMCID: PMC8721610 DOI: 10.1177/1947603520903788] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Large cartilage defects and osteoarthritis (OA) cause cartilage loss and remain a therapeutic challenge. Three-dimensional (3D) bioprinting with autologous cells using a computer-aided design (CAD) model generated from 3D imaging has the potential to reconstruct patient-specific features that match an articular joint lesion. DESIGN To scan a human OA tibial plateau with a cartilage defect, retrieved after total knee arthroplasty, following clinical imaging techniques were used: (1) computed tomography (CT), (2) magnetic resonance imaging (MRI), and (3) a 3D scanner. From such a scan, a CAD file was obtained to generate G-code to control 3D bioprinting in situ directly into the tibial plateau lesion. RESULTS Highest resolution was obtained using the 3D scanner (2.77 times more points/mm2 than CT), and of the 3 devices tested, only the 3D scanner was able to detect the actual OA defect area. Human chondrocytes included in 3D bioprinted constructs produced extracellular matrix and formed cartilage tissue fragments after 2 weeks of differentiation and high levels of a mature splice version of collagen type II (Col IIA type B), characteristic of native articular cartilage and aggrecan (ACAN). Chondrocytes had a mean viability of 81% in prints after day 5 of differentiation toward cartilage and similar viability was detected in control 3D pellet differentiation of chondrocytes (mean viability 72%). CONCLUSION Articular cartilage can be formed in 3D bioprints. Thus, this 3D bioprinting system with chondrocytes simulating a patient-specific 3D model provides an attractive strategy for future treatments of cartilage defects or early OA.
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Affiliation(s)
- Birgitta Gatenholm
- Department of Orthopaedics, Institute of
Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg,
Gothenburg, Sweden,Sahlgrenska University Hospital,
Mölndal, Sweden
| | - Carl Lindahl
- Institute of Biomedicine, Department of
Clinical Chemistry and Transfusion Medicine, University of Gothenburg, Gothenburg,
Sweden
| | - Mats Brittberg
- Cartilage Repair Unit, University of
Gothenburg, Region Halland Orthopaedics, Kungsbacka Hospital, Kungsbacka,
Sweden
| | - Stina Simonsson
- Institute of Biomedicine, Department of
Clinical Chemistry and Transfusion Medicine, University of Gothenburg, Gothenburg,
Sweden,Stina Simonsson, Department of Clinical
Chemistry and Transfusion Medicine, Institute of Biomedicine, University of
Gothenburg, Sahlgrenska University Hospital, Bruna Straket 16, Gothenburg, 413
45, Sweden.
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Abstract
PURPOSE The aim of the study was to investigate the long-term outcomes of the Focal Femoral Condyle Resurfacing Prosthesis (HemiCAP) using clinical and radiographic assessments, and to evaluate the revision and survival rates. METHODS Clinical evaluation was performed in those not revised and was able to participate. This was a prospective single-center cohort study of HemiCAP patients with 7 to 10 years of clinical and radiographic follow-up. The clinical examination included the Knee Society Score (KSS) and visual analogue scale (VAS) score. The radiographic examination included the Kellgren-Lawrence (KL) grade. Survival was estimated by Kaplan-Meier survival analysis, and potential risk factors for revision was evaluated by a regression analysis. RESULTS Of the 62 patients with 64 HemiCAP prostheses, 37 were HemiCAP condyle, 11 HemiCAP PF, and 16 HemiCAP Wave; 27 (42%) were revised-HemiCAP condyle 17 (42%), HemiCAP PF 4 (36%), HemiCAP Wave 6 (37%), and 1 died. Examinations were performed on 31 patients (86%). When compared with the preoperative data, there were significant increases in the KSS objective (mean = 51.5, standard deviation [SD] = 5.9 vs. mean =94.2, SD = 5.0) and function (mean = 51.0, SD = 6.2 vs. mean = 93.7, SD = 4.8) scores, a decrease in the VAS score (mean = 7.1, SD = 0.7 vs. mean = 2.7, SD = 1.7) and a decrease in the KL lateral score (mean = 1.1, SD = 0.3 vs. mean = 0.6, SD = 0.6). The mean follow-up was 7.3 years (SD 1.4) with minimum 4.2 years and maximum 10.2 years. No failures occurred in the series beyond 5 years. CONCLUSIONS As hypothesized, we found good clinical and radiographic outcomes, and for those patients who did not require revisions, there were long-term improvements in disability and function. This suggests that patient selection is a key element to successfully applying these devices in clinical practice.
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Affiliation(s)
- Jens Ole Laursen
- Department of Emergency Medicine,
Hospital of Southern Jutland, Sydals, Denmark,Department of Orthopedic Surgery,
Hospital of Southern Jutland, Sydals, Denmark,Institute of Regional Health Research,
University of Southern Denmark, Odense, Denmark,Jens Ole Laursen, MD, Department of
Orthopedic Surgery and Emergency Medicine, Hospital of Southern Jutland,
Vimmelskaftet 16, Sydals, 6470, Denmark.
| | - Christian Backer Mogensen
- Department of Emergency Medicine,
Hospital of Southern Jutland, Sydals, Denmark,Institute of Regional Health Research,
University of Southern Denmark, Odense, Denmark
| | - Helene Skjøt-Arkil
- Department of Emergency Medicine,
Hospital of Southern Jutland, Sydals, Denmark,Institute of Regional Health Research,
University of Southern Denmark, Odense, Denmark
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35
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Chechik Y, Beit Ner E, Lysyy O, Tal S, Stern N, Agar G, Beer Y, Ben-Eliezer N, Lindner D. Post-Run T 2 Mapping Changes in Knees of Adolescent Basketball Players. Cartilage 2021; 13:707S-717S. [PMID: 34128410 PMCID: PMC8808782 DOI: 10.1177/19476035211021891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE While articular cartilage defects are common incidental findings among adult athletes, the effect of running on the cartilage of adolescent athletes have rarely been assessed. This study aims to assess the variations in the articular cartilage of the knees in healthy adolescent basketball players using quantitative T2 MRI (magnetic resonance imaging). DESIGN Fifteen adolescent basketball players were recruited (13.8 ± 0.5 years old). Girls were excluded to avoid potential gender-related confounding effects. Players underwent a pre-run MRI scan of both knees. All participants performed a 30-minute run on a treadmill. Within 15 minutes after completion of their run, players underwent a second, post-run MRI scan. Quantitative T2 maps were generated using the echo modulation curve (EMC) algorithm. Pre-run scans and post-run scans were compared using paired t test. RESULTS Participants finished their 30-minute run with a mean running distance of 5.77 ± 0.42 km. Pre-run scans analysis found statistically significant (P < 0.05) changes in 3 regions of the knee lateral compartment representing the cartilaginous tissue. No differences were found in the knee medial compartment. Post-run analysis showed lower T2 values in the medial compartment compared to the pre-run scans in several weight-bearing regions: femoral condyle central (pre/post mean values of 33.9/32.2 ms, P = 0.020); femoral condyle posterior (38.1/36.8 ms, P = 0.038); and tibial plateau posterior (34.1/31.0 ms, P < 0.001). The lateral regions did not show any significant changes. CONCLUSIONS Running leads to microstructural changes in the articular cartilage in several weight-bearing areas of the medial compartment, both in the femoral and the tibial cartilage.
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Affiliation(s)
- Yigal Chechik
- Department of Orthopedic Surgery,
Yitzhak Shamir Medical Center, Zerifin, Israel, affiliated to the Sackler Faculty of
Medicine, Tel Aviv University, Tel Aviv, Israel,Yigal Chechik, Department of Orthopedic
Surgery, Yitzhak Shamir Medical Center, Zerifin 70300, Israel.
| | - Eran Beit Ner
- Department of Orthopedic Surgery,
Yitzhak Shamir Medical Center, Zerifin, Israel, affiliated to the Sackler Faculty of
Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oleg Lysyy
- Department of Imaging, Yitzhak Shamir
Medical Center, Zerifin, Israel, affiliated to the Sackler Faculty of Medicine,
Tel-Aviv University, Tel Aviv, Israel
| | - Sigal Tal
- Department of Imaging, Yitzhak Shamir
Medical Center, Zerifin, Israel, affiliated to the Sackler Faculty of Medicine,
Tel-Aviv University, Tel Aviv, Israel
| | - Neta Stern
- Department of Biomedical Engineering,
Tel Aviv University, Tel Aviv, Israel
| | - Gabriel Agar
- Department of Orthopedic Surgery,
Yitzhak Shamir Medical Center, Zerifin, Israel, affiliated to the Sackler Faculty of
Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yiftach Beer
- Department of Orthopedic Surgery,
Yitzhak Shamir Medical Center, Zerifin, Israel, affiliated to the Sackler Faculty of
Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noam Ben-Eliezer
- Department of Biomedical Engineering,
Tel Aviv University, Tel Aviv, Israel,Sagol School of Neuroscience, Tel Aviv
University, Tel Aviv, Israel,Center for Advanced Imaging Innovation
and Research (CAI2R), New-York University Langone Medical Center, New York, NY,
USA
| | - Dror Lindner
- Department of Orthopedic Surgery,
Yitzhak Shamir Medical Center, Zerifin, Israel, affiliated to the Sackler Faculty of
Medicine, Tel Aviv University, Tel Aviv, Israel
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Van Genechten W, Vuylsteke K, Struijk C, Swinnen L, Verdonk P. Joint Surface Lesions in the Knee Treated with an Acellular Aragonite-Based Scaffold: A 3-Year Follow-Up Case Series. Cartilage 2021; 13:1217S-1227S. [PMID: 33448238 PMCID: PMC8808874 DOI: 10.1177/1947603520988164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The study aimed to evaluate the clinical outcome and repair capacity of a cell-free aragonite-based scaffold in patients with an isolated symptomatic joint surface lesion (JSL) of the knee. DESIGN Thirteen patients (age 33.5 ± 8.9; female 23%; body mass index 25.3 ± 3.4, K/L [Kellgren-Lawrence] 1.8) with a JSL (2.6 ± 1.7 cm2 [1.0-7.5 cm2]) of the distal femur were enrolled in a single-center prospective case series. Safety and clinical outcome was assessed by the KOOS (Knee Injury and Osteoarthritis Outcome Score), IKDC (International Knee Documentation Committee), Lysholm, and Tegner activity scale at baseline and 6, 12, 18, 24, and 36 months follow-up. The MOCART 2.0 and scaffold integration were evaluated on magnetic resonance imaging at 12, 24, and 36 months postoperatively. RESULTS Primary outcome (KOOS pain) improved with 36.5 ± 14.7 points at 12 months (P = 0.002) and 41.2 ± 14.7 points at 36 months (P = 0.002) follow-up. Similar increasing trends were observed for the other KOOS subscales, IKDC, and Lysholm score, which were significantly better at each follow-up time point relative to baseline (P < 0.05). Activity level increased from 2.75 ± 1.6 to 4.6 ± 2.2 points at final follow-up (P = 0.07). The MOCART was 61.7 ± 12.6 at 12 months and 72.9 ± 13.0 at 36 months postoperatively. Sixty-six to 100% implant integration and remodeling was observed in 73.3% cases at 36 months. No serious adverse events were reported. CONCLUSION The study demonstrated that the biphasic aragonite-based scaffold is a safe and clinically effective implant for treating small-medium sized JSLs of the distal femur in a young and active patient cohort. The implant showed satisfying osteointegration and restoration of the osteochondral unit up to 3 years postimplantation.
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Affiliation(s)
- Wouter Van Genechten
- MoRe Foundation, Antwerp, Belgium,Antwerp University, Antwerp,
Belgium,Wouter Van Genechten, MoRe Foundation,
Stevenslei 20, Antwerp 2100, Belgium.
| | | | | | - Linus Swinnen
- Department of Radiology, AZ Monica,
Antwerp-Deurne, Antwerp, Belgium
| | - Peter Verdonk
- MoRe Foundation, Antwerp, Belgium,Antwerp University, Antwerp,
Belgium,ORTHOCA, Antwerp, Belgium
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Beck A, Wood D, Vertullo CJ, Ebert J, Janes G, Sullivan M, Zheng MH. Morphological Assessment of MACI Grafts in Patients with Revision Surgery and Total Joint Arthroplasty. Cartilage 2021; 13:526S-539S. [PMID: 31793330 PMCID: PMC8808925 DOI: 10.1177/1947603519890754] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the histological and immunohistochemical characteristics of matrix-assisted chondrocyte implantation (MACI) grafts between patients with revision surgery and patients with total joint arthroplasty. METHODS Biopsies of MACI grafts from patients with revision and total joint arthroplasty. The graft tissue characteristics and subchondral bone were examined by qualitative histology, ICRS (International Cartilage Repair Society) II scoring and semiquantitative immunohistochemistry using antibodies specific to type I and type II collagen. RESULTS A total of 31 biopsies were available, 10 undergoing total knee arthroplasty (TKA) and 21 patients undergoing revision surgery. Patients in the clinically failed group were significantly older (46.3 years) than patients in the revision group (36.6 years) (P = 0.007). Histologically, the predominant tissue in both groups was of fibrocartilaginous nature, although a higher percentage of specimens in the revision group contained a hyaline-like repair tissue. The percentages of type I collagen (52.9% and 61.0%) and type II collagen (66.3% and 42.2%) were not significantly different between clinically failed and revised MACI, respectively. The talar dome contained the best and patella the worst repair tissue. Subchondral bone pathology was present in all clinically failed patients and consisted of bone marrow lesions, including edema, necrosis and fibrosis, intralesional osteophyte formation, subchondral bone plate elevation, intralesional osteophyte formation, subchondral bone cyst formation, or combinations thereof. CONCLUSIONS MACI grafts in patients with revision and total joint arthroplasty were predominantly fibrocartilage in repair type, did not differ in composition and were histologically dissimilar to healthy cartilage. Clinically failed cases showed evidence of osteochondral unit failure, rather than merely cartilage repair tissue failure. The role of the subchondral bone in relation to pain and failure and the pathogenesis warrants further investigation.
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Affiliation(s)
- Aswin Beck
- Centre for Orthopaedic Research, Faculty
of Health and Medical Sciences, The University of Western Australia, Nedlands,
Western Australia, Australia
| | - David Wood
- Centre for Orthopaedic Research, Faculty
of Health and Medical Sciences, The University of Western Australia, Nedlands,
Western Australia, Australia
| | | | - Jay Ebert
- School of Human Sciences, Faculty of
Science, The University of Western Australia, Nedlands, Western Australia,
Australia
| | - Greg Janes
- Perth Orthopaedic and Sports Medicine
Research Institute, West Perth, Western Australia, Australia
| | - Martin Sullivan
- Foot & Ankle Department, St.
Vincent’s Clinic, Sydney, New South Wales, Australia
| | - Ming-Hao Zheng
- Centre for Orthopaedic Research, Faculty
of Health and Medical Sciences, The University of Western Australia, Nedlands,
Western Australia, Australia
- Ming-Hao Zheng, Centre for Orthopaedic
Research, Faculty of Health and Medical Sciences, The University of Western
Australia, 2nd Floor M-Block QEII Medical Centre, Nedlands, Western Australia
6009, Australia.
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Markus DH, Hurley ET, Haskel JD, Manjunath AK, Campbell KA, Gonzalez-Lomas G, Strauss EJ, Alaia MJ. High Return to Sport in Patients Over 45 Years of Age Undergoing Osteochondral Allograft Transplantation for Isolated Chondral Defects in the Knee. Cartilage 2021; 13:915S-919S. [PMID: 34521255 PMCID: PMC8808893 DOI: 10.1177/19476035211046008] [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] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the efficacy of osteochondral allograft (OCA) in patients older than 45 years of age, particularly with respect to return to sport. DESIGN A retrospective review was performed to evaluate patients greater than 45 who underwent an OCA for a symptomatic osteochondral defect of the knee between June 2011 and January 2019. RESULTS Overall, there were 18 patients (76% male) that met our inclusion and exclusion criteria. Follow-up was attained in 14 of these patients (78%). The mean age of patients included was 52.6 years (48-57) with a mean of 37 months of follow-up (18-60). Visual Analogue Scale scores decreased significantly from the preoperative baseline to final follow-up (7.7 ± 1.7 vs. 2.0 ± 2.0, P < 0.01). Furthermore, the mean Visual Analogue Scale while playing sport was 3.4 ± 3.2, and the mean Knee Injury and Osteoarthritis Outcome Score was 77.5 ± 12.7 at final follow-up. Overall, 11 patients (78.6%) were able to return to their desired sport. No clinical failures were identified during the follow-up period. CONCLUSION In our series of patients 45 years and older who were treated with OCA for focal osteochondral injuries of the knee, we found a significant improvement in clinical outcome scores at a midterm follow-up of 37 months with no revision OCA procedures or conversion to any form of knee arthroplasty. In addition, a high percentage of patients were able to return to their preferred level of athletic activity.
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Affiliation(s)
- Danielle H. Markus
- Department of Orthopedic Surgery, New
York University Langone Health, New York, NY, USA,Danielle H. Markus, Department of
Orthopedic Surgery, New York University Langone Health, 333 E 38th St, New York,
NY 10012-1126, USA.
| | - Eoghan T. Hurley
- Department of Orthopedic Surgery, New
York University Langone Health, New York, NY, USA
| | - Jonathan D. Haskel
- Department of Orthopedic Surgery, New
York University Langone Health, New York, NY, USA
| | - Amit K. Manjunath
- Department of Orthopedic Surgery, New
York University Langone Health, New York, NY, USA
| | - Kirk A. Campbell
- Department of Orthopedic Surgery, New
York University Langone Health, New York, NY, USA
| | | | - Eric J. Strauss
- Department of Orthopedic Surgery, New
York University Langone Health, New York, NY, USA
| | - Michael J. Alaia
- Department of Orthopedic Surgery, New
York University Langone Health, New York, NY, USA
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Schreiner MM, Raudner M, Marlovits S, Bohndorf K, Weber M, Zalaudek M, Röhrich S, Szomolanyi P, Filardo G, Windhager R, Trattnig S. The MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) 2.0 Knee Score and Atlas. Cartilage 2021; 13:571S-587S. [PMID: 31422674 PMCID: PMC8725373 DOI: 10.1177/1947603519865308] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Since the first introduction of the MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score, significant progress has been made with regard to surgical treatment options for cartilage defects, as well as magnetic resonance imaging (MRI) of such defects. Thus, the aim of this study was to introduce the MOCART 2.0 knee score - an incremental update on the original MOCART score - that incorporates this progression. MATERIALS AND METHODS The volume of cartilage defect filling is now assessed in 25% increments, with hypertrophic filling of up to 150% receiving the same scoring as complete repair. Integration now assesses only the integration to neighboring native cartilage, and the severity of surface irregularities is assessed in reference to cartilage repair length rather than depth. The signal intensity of the repair tissue differentiates normal signal, minor abnormal, or severely abnormal signal alterations. The assessment of the variables "subchondral lamina," "adhesions," and "synovitis" was removed and the points were reallocated to the new variable "bony defect or bony overgrowth." The variable "subchondral bone" was renamed to "subchondral changes" and assesses minor and severe edema-like marrow signal, as well as subchondral cysts or osteonecrosis-like signal. Overall, a MOCART 2.0 knee score ranging from 0 to 100 points may be reached. Four independent readers (two expert readers and two radiology residents with limited experience) assessed the 3 T MRI examinations of 24 patients, who had undergone cartilage repair of a femoral cartilage defect using the new MOCART 2.0 knee score. One of the expert readers and both inexperienced readers performed two readings, separated by a four-week interval. For the inexperienced readers, the first reading was based on the evaluation sheet only. For the second reading, a newly introduced atlas was used as an additional reference. Intrarater and interrater reliability was assessed using intraclass correlation coefficients (ICCs) and weighted kappa statistics. ICCs were interpreted according to Koo and Li; weighted kappa statistics were interpreted according to the criteria of Landis and Koch. RESULTS The overall intrarater (ICC = 0.88, P < 0.001) as well as the interrater (ICC = 0.84, P < 0.001) reliability of the expert readers was almost perfect. Based on the evaluation sheet of the MOCART 2.0 knee score, the overall interrater reliability of the inexperienced readers was poor (ICC = 0.34, P < 0.019) and improved to moderate (ICC = 0.59, P = 0.001) with the use of the atlas. CONCLUSIONS The MOCART 2.0 knee score was updated to account for changes in the past decade and demonstrates almost perfect interrater and intrarater reliability in expert readers. In inexperienced readers, use of the atlas may improve interrater reliability and, thus, increase the comparability of results across studies.
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Affiliation(s)
- Markus M. Schreiner
- Department of Orthopedics and Trauma
Surgery, Medical University of Vienna, Vienna, Austria
| | - Marcus Raudner
- Department of Biomedical Imaging and
Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stefan Marlovits
- Department of Orthopedics and Trauma
Surgery, Medical University of Vienna, Vienna, Austria
| | - Klaus Bohndorf
- Department of Radiology, University
Hospital Halle, Halle, Germany
| | - Michael Weber
- Department of Biomedical Imaging and
Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Martin Zalaudek
- Department of Biomedical Imaging and
Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sebastian Röhrich
- Department of Biomedical Imaging and
Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Pavol Szomolanyi
- Department of Biomedical Imaging and
Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Giuseppe Filardo
- Applied and Translational Research
Center, IRCCS Rizzoli Orthopaedic Institute, Bologna University, Bologna,
Italy
| | - Reinhard Windhager
- Department of Orthopedics and Trauma
Surgery, Medical University of Vienna, Vienna, Austria
| | - Siegfried Trattnig
- Department of Biomedical Imaging and
Image-guided Therapy, Medical University of Vienna, Vienna, Austria,Christian Doppler Laboratory for
Clinical Molecular MR Imaging (MOLIMA), Department of Biomedical Imaging and
Image-Guided Therapy, Medical University of Vienna, Vienna, Austria,Siegfried Trattnig, Christian Doppler
Laboratory for Clinical Molecular MR Imaging (MOLIMA), High Field MR Centre,
Department for Biomedical Imaging and Image-guided Therapy, Medical University
of Vienna, Lazarettgasse 14, 1090 Vienna.
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40
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Markus DH, Blaeser AM, Hurley ET, Mannino BJ, Campbell KA, Jazrawi LM, Alaia MJ, Strauss EJ, Alaia EF. No Difference in Outcomes Following Osteochondral Allograft with Fresh Precut Cores Compared to Hemi-Condylar Allografts. Cartilage 2021; 13:886S-893S. [PMID: 34078119 PMCID: PMC8808877 DOI: 10.1177/19476035211021911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The purpose of the current study is to evaluate the clinical and radiographic outcomes at early to midterm follow-up between fresh precut cores versus hemi-condylar osteochondral allograft (OCAs) in the treatment of symptomatic osteochondral lesions. DESIGN A retrospective review of patients who underwent an OCA was performed. Patient matching between those with OCA harvested from an allograft condyle/patella or a fresh precut allograft core was performed to generate 2 comparable groups. The cartilage at the graft site was assessed with use of a modified Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system and patient-reported outcomes were collected. RESULTS Overall, 52 total patients who underwent OCA with either fresh precut OCA cores (n = 26) and hemi-condylar OCA (n = 26) were pair matched at a mean follow-up of 34.0 months (range 12 months to 99 months). The mean ages were 31.5 ± 10.7 for fresh precut cores and 30.9 ± 9.8 for hemi-condylar (P = 0.673). Males accounted for 36.4% of the overall cohort, and the mean lesion size for fresh precut OCA core was 19.6 mm2 compared to 21.2 mm2 for whole condyle (P = 0.178). There was no significant difference in patient-reported outcomes including Visual Analogue Scale, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, and Tegner (P > 0.5 for each), or in MOCART score (69.2 vs. 68.3, P = 0.93). CONCLUSIONS This study found that there was no difference in patient-reported clinical outcomes or MOCART scores following OCA implantation using fresh precut OCA cores or size matched condylar grafts at early to midterm follow-up.
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Affiliation(s)
- Danielle H. Markus
- Department of Orthopedic Surgery, New
York University Langone Health, New York, NY, USA,Danielle H. Markus, Department of
Orthopedic Surgery, NYU Langone Health, 333 E 38th Street, New York, NY
10012-1126, USA.
| | - Anna M. Blaeser
- Department of Orthopedic Surgery, New
York University Langone Health, New York, NY, USA
| | - Eoghan T. Hurley
- Department of Orthopedic Surgery, New
York University Langone Health, New York, NY, USA
| | - Brian J. Mannino
- Department of Orthopedic Surgery, New
York University Langone Health, New York, NY, USA
| | - Kirk A. Campbell
- Department of Orthopedic Surgery, New
York University Langone Health, New York, NY, USA
| | - Laith M. Jazrawi
- Department of Orthopedic Surgery, New
York University Langone Health, New York, NY, USA
| | - Michael J. Alaia
- Department of Orthopedic Surgery, New
York University Langone Health, New York, NY, USA
| | - Eric J. Strauss
- Department of Orthopedic Surgery, New
York University Langone Health, New York, NY, USA
| | - Erin F. Alaia
- Department of Radiology, New York
University Langone Health, New York, NY, USA
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41
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Turhan AU, Açıl S, Gül O, Öner K, Okutan AE, Ayas MS. Treatment of knee osteochondritis dissecans with autologous tendon transplantation: Clinical and radiological results. World J Orthop 2021; 12:867-876. [PMID: 34888147 PMCID: PMC8613687 DOI: 10.5312/wjo.v12.i11.867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/28/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Defect treatment with tendon autograft in osteochondral lesions has been published in the literature with an experimental study in dogs. To demonstrate that it is possible to treat knee osteochondral lesions with the technique of autologous tendon transplantation.
AIM To evaluate the clinical and radiological results of patients with knee osteochondral lesions who were treated with autologous tendon transplantation.
METHODS Twenty patients (22 knees) with osteochondritis dissecans (OCD) lesions involving the knee were treated with autologous tendon transplantation between 2005-2018. All lesions were International Cartilage Repair Society grade IV. All patients were evaluated clinically at final follow-up with knee injury and osteoarthritis outcome score (KOOS); and radiologically with magnetic resonance observation and cartilage repair tissue (MOCART) and Kellgren-Lawrence (KL) classification.
RESULTS A total of 20 patients (22 knees) with a mean age of 25.5± 6.8 years were included. The average defect size was 4.2 ± 2.1 cm2, and the average defect depth was 0.9 ± 0.4 cm. Total KOOS score was preoperatively 29.4 ± 5.5 and was later found to be 81.5 ± 5.9 after an average of 68.7 ± 37.7 mo follow-up. The mean MOCART score was 56.2 ± 10.7. Preoperatively, all of the patients had KL grades of 0–1; during the follow-up period, 80% of the patients showed no radiological progress of osteoarthritis. Patients with less than 4 cm2 lesion had statistically significantly better overall KOOS than patients whose more than 4 cm2 lesion, particularly in sport and quality of life subscales.
CONCLUSION The autologous tendon transplantation is a single-step, safe, simple, cost-effective method for the treatment of knee OCD with satisfactory clinical and radiological outcomes, particularly in patients with less than 4 cm2 lesion.
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Affiliation(s)
- Ahmet Uğur Turhan
- Department of Orthopedics and Traumatology, Karadeniz Technical University Faculty of Medicine, Trabzon 61080, Turkey
| | - Sezgin Açıl
- Department of Orthopedics and Traumatology, Tirebolu State Hospital, Giresun 28100, Turkey
| | - Orkun Gül
- Department of Orthopedics and Traumatology, Medical Park Trabzon Hospital, Trabzon 61080, Turkey
| | - Kerim Öner
- Department of Orthopedics and Traumatology, Karadeniz Technical University Faculty of Medicine, Trabzon 61080, Turkey
| | - Ahmet Emin Okutan
- Department of Orthopedics and Traumatology, Samsun Training and Research Hospital, Samsun 55100, Turkey
| | - Muhammet Salih Ayas
- Department of Orthopedics and Traumatology, Erzurum Regional Training and Research Hospital, Erzurum 25070, Turkey
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Gowd AK, Weimer AE, Rider DE, Beck EC, Agarwalla A, O'Brien LK, Alaia MJ, Ferguson CM, Waterman BR. Cartilage Restoration for Tibiofemoral Bipolar Lesions Results in Promising Failure Rates: A Systematic Review. Arthrosc Sports Med Rehabil 2021; 3:e1227-e1235. [PMID: 34430903 PMCID: PMC8365214 DOI: 10.1016/j.asmr.2021.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 03/31/2021] [Indexed: 02/08/2023] Open
Abstract
Purpose The purpose of the present study is to systematically review the available literature for management of bipolar lesions within the tibiofemoral joint and determine whether tibiofemoral cartilage restoration is an effective treatment modality. Methods PubMed and MEDLINE databases were queried between 2000 and 2020 using the following keywords: “osteochondral” and “knee” and “microfracture,” “autologous chondrocyte implantation (ACI),” or “transplantation." Articles were reviewed for the presence of a bipolar or “kissing” tibiofemoral lesion and reported lesion size, concomitant procedures, failure rates, and time to failure. Results After screening 1,295 articles, there were 4 articles available for analysis and a total of 152 knees involving the management of bipolar tibiofemoral lesions. Age ranged from 14 to 60 years, and mean follow-up was between 12 and 240 months. There was 1 retrospective cohort study (36 knees) and 3 case series (mean, 38.7 ± 17.5 knees). There were 58 knees treated with bipolar osteochondral allograft (OCA) transplantation, 58 knees treated with bipolar ACI, 20 knees treated with femoral OCA and tibial debridement, and 16 knees treated with femoral OCA and tibial microfracture. There were 37 failures (24.3%): 16 patients (10.5%) were converted to unicompartmental or total knee arthroplasty, 4 restorative procedures (2.6%) were revised, and 8 patients (1.6%) had unsatisfactory outcomes only. The remaining 15 failures (9.9%) had an unspecified combination of objective failure. The mean rate of failure ranged between 0% and 44.1% (I2 = 83.2%). The mean time to failure ranged between 2.7 and 4.1 years (I2 = 79.1%). Conclusions Cartilage restoration, through both ACI and OCA, had failure rates between 0% and 44% in patients with bipolar lesions of the tibiofemoral compartment. Although a higher level of evidence is required to prove efficacy, the current study demonstrates midterm survivorship rates between 55% and 100%, which may delay the need for secondary arthroplasty. Level of Evidence Level IV, systematic review of Level IV studies.
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Affiliation(s)
- Anirudh K Gowd
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, U.S.A
| | - Alexander E Weimer
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, U.S.A
| | - Danielle E Rider
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, U.S.A
| | - Edward C Beck
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, U.S.A
| | | | - Lisa K O'Brien
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, U.S.A
| | - Michael J Alaia
- New York University Langone Health, New York, New York, U.S.A
| | - Cristin M Ferguson
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, U.S.A
| | - Brian R Waterman
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, U.S.A
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Perry J, Roelofs AJ, Mennan C, McCarthy HS, Richmond A, Clark SM, Riemen AHK, Wright K, De Bari C, Roberts S. Human Mesenchymal Stromal Cells Enhance Cartilage Healing in a Murine Joint Surface Injury Model. Cells 2021; 10:1999. [PMID: 34440768 PMCID: PMC8393840 DOI: 10.3390/cells10081999] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/23/2021] [Accepted: 07/29/2021] [Indexed: 01/15/2023] Open
Abstract
Human umbilical cord (hUC)- or bone marrow (hBM)-derived mesenchymal stromal cells (MSCs) were evaluated as an allogeneic source of cells for cartilage repair. We aimed to determine if they could enhance healing of chondral defects with or without the recruitment of endogenous cells. hMSCs were applied into a focal joint surface injury in knees of adult mice expressing tdTomato fluorescent protein in cells descending from Gdf5-expressing embryonic joint interzone cells. Three experimental groups were used: (i) hUC-MSCs, (ii) hBM-MSCs and (iii) PBS (vehicle) without cells. Cartilage repair was assessed after 8 weeks and tdTomato-expressing cells were detected by immunostaining. Plasma levels of pro-inflammatory mediators and other markers were measured by electrochemiluminescence. Both hUC-MSC (n = 14, p = 0.009) and hBM-MSC (n = 13, p = 0.006) treatment groups had significantly improved cartilage repair compared to controls (n = 18). While hMSCs were not detectable in the repair tissue at 8 weeks post-implantation, increased endogenous Gdf5-lineage cells were detected in repair tissue of hUC-MSC-treated mice. This xenogeneic study indicates that hMSCs enhance intrinsic cartilage repair mechanisms in mice. Hence, hMSCs, particularly the more proliferative hUC-MSCs, could represent an attractive allogeneic cell population for treating patients with chondral defects and perhaps prevent the onset and progression of osteoarthritis.
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Affiliation(s)
- Jade Perry
- The Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, Shropshire SY10 7AG, UK; (C.M.); (H.S.M.); (K.W.); (S.R.)
- The School of Pharmacy & Bioengineering, Keele University, Staffordshire ST5 5BG, UK
- The Tissue Engineering & Regenerative Therapies Centre versus Arthritis, Cambridge CB2 2QQ, UK
| | - Anke J. Roelofs
- The Tissue Engineering & Regenerative Therapies Centre versus Arthritis, Cambridge CB2 2QQ, UK
- Arthritis and Regenerative Medicine Laboratory, Institute of Medical Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK; (A.J.R.); (A.R.); (S.M.C.); (A.H.K.R.); (C.D.B.)
| | - Claire Mennan
- The Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, Shropshire SY10 7AG, UK; (C.M.); (H.S.M.); (K.W.); (S.R.)
- The School of Pharmacy & Bioengineering, Keele University, Staffordshire ST5 5BG, UK
- The Tissue Engineering & Regenerative Therapies Centre versus Arthritis, Cambridge CB2 2QQ, UK
| | - Helen S. McCarthy
- The Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, Shropshire SY10 7AG, UK; (C.M.); (H.S.M.); (K.W.); (S.R.)
- The School of Pharmacy & Bioengineering, Keele University, Staffordshire ST5 5BG, UK
- The Tissue Engineering & Regenerative Therapies Centre versus Arthritis, Cambridge CB2 2QQ, UK
| | - Alison Richmond
- The Tissue Engineering & Regenerative Therapies Centre versus Arthritis, Cambridge CB2 2QQ, UK
- Arthritis and Regenerative Medicine Laboratory, Institute of Medical Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK; (A.J.R.); (A.R.); (S.M.C.); (A.H.K.R.); (C.D.B.)
| | - Susan M. Clark
- The Tissue Engineering & Regenerative Therapies Centre versus Arthritis, Cambridge CB2 2QQ, UK
- Arthritis and Regenerative Medicine Laboratory, Institute of Medical Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK; (A.J.R.); (A.R.); (S.M.C.); (A.H.K.R.); (C.D.B.)
| | - Anna H. K. Riemen
- The Tissue Engineering & Regenerative Therapies Centre versus Arthritis, Cambridge CB2 2QQ, UK
- Arthritis and Regenerative Medicine Laboratory, Institute of Medical Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK; (A.J.R.); (A.R.); (S.M.C.); (A.H.K.R.); (C.D.B.)
| | - Karina Wright
- The Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, Shropshire SY10 7AG, UK; (C.M.); (H.S.M.); (K.W.); (S.R.)
- The School of Pharmacy & Bioengineering, Keele University, Staffordshire ST5 5BG, UK
- The Tissue Engineering & Regenerative Therapies Centre versus Arthritis, Cambridge CB2 2QQ, UK
| | - Cosimo De Bari
- The Tissue Engineering & Regenerative Therapies Centre versus Arthritis, Cambridge CB2 2QQ, UK
- Arthritis and Regenerative Medicine Laboratory, Institute of Medical Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK; (A.J.R.); (A.R.); (S.M.C.); (A.H.K.R.); (C.D.B.)
| | - Sally Roberts
- The Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, Shropshire SY10 7AG, UK; (C.M.); (H.S.M.); (K.W.); (S.R.)
- The School of Pharmacy & Bioengineering, Keele University, Staffordshire ST5 5BG, UK
- The Tissue Engineering & Regenerative Therapies Centre versus Arthritis, Cambridge CB2 2QQ, UK
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Ibarra C, Villalobos E, Madrazo-Ibarra A, Velasquillo C, Martinez-Lopez V, Izaguirre A, Olivos-Meza A, Cortes-Gonzalez S, Perez-Jimenez FJ, Vargas-Ramirez A, Franco-Sanchez G, Ibarra-Ibarra LG, Sierra-Suarez L, Almazan A, Ortega-Sanchez C, Trueba C, Martin FB, Arredondo-Valdes R, Chavez-Arias D. Arthroscopic Matrix-Assisted Autologous Chondrocyte Transplantation Versus Microfracture: A 6-Year Follow-up of a Prospective Randomized Trial. Am J Sports Med 2021; 49:2165-2176. [PMID: 34048286 DOI: 10.1177/03635465211010487] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Few randomized controlled trials with a midterm follow-up have compared matrix-assisted autologous chondrocyte transplantation (MACT) with microfracture (MFx) for knee cartilage lesions. PURPOSE To compare the structural, clinical, and safety outcomes at midterm follow-up of MACT versus MFx for treating symptomatic knee cartilage lesions. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A total of 48 patients aged between 18 and 50 years, with 1- to 4-cm2 International Cartilage Repair Society (ICRS) grade III to IV knee chondral lesions, were randomized in a 1:1 ratio to the MACT and MFx treatment groups. A sequential prospective evaluation was performed using magnetic resonance imaging (MRI) T2 mapping, the MOCART (magnetic resonance observation of cartilage repair tissue) score, second-look arthroscopic surgery, patient-reported outcome measures, the responder rate (based on achieving the minimal clinically important difference for the Knee injury and Osteoarthritis Outcome Score [KOOS] pain and KOOS Sport/Recreation), adverse events, and treatment failure (defined as a reoperation because of symptoms caused by the primary defect and the detachment or absence of >50% of the repaired tissue during revision surgery). RESULTS Overall, 35 patients (18 MACT and 17 MFx) with a mean chondral lesion size of 1.8 ± 0.8 cm2 (range, 1-4 cm2) were followed up to a mean of 6 years postoperatively (range, 4-9 years). MACT demonstrated significantly better structural outcomes than MFx at 1 to 6 years postoperatively. At final follow-up, the MRI T2 mapping values of the repaired tissue were 37.7 ± 8.5 ms for MACT versus 46.4 ± 8.5 ms for MFx (P = .003), while the MOCART scores were 59.4 ± 17.3 and 42.4 ± 16.3, respectively (P = .006). More than 50% defect filling was seen in 95% of patients at 2 years and 82% at 6 years in the MACT group and in 67% at 2 years and 53% at 6 years in the MFx group. The second-look ICRS scores at 1 year were 10.7 ± 1.3 for MACT and 9.0 ± 1.8 for MFx (P = .001). Both groups showed significant clinical improvements at 6 years postoperatively compared with their preoperative status. Significant differences favoring the MACT group were observed at 2 years on the KOOS Activities of Daily Living (P = .043), at 4 years on all KOOS subscales (except Symptoms; P < .05) and the Tegner scale (P = .008), and at 6 years on the Tegner scale (P = .010). The responder rates at 6 years were 53% and 77% for MFx and MACT, respectively. There were no reported treatment failures after MACT; the failure rate was 8.3% in the MFx group. Neither group had serious adverse events related to treatment. CONCLUSION Patients who underwent MACT had better structural outcomes than those who underwent MFx at 1 to 6 years postoperatively. Both groups of patients showed significant clinical improvements at final follow-up compared with their preoperative status. MACT showed superiority at 4 years for the majority of the KOOS subscales and for the Tegner scale at 4 to 6 years. The MACT group also had a higher responder rate and lower failure rate at final follow-up. REGISTRATION NCT01947374 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Clemente Ibarra
- Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico.,Investigation performed at the Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Enrique Villalobos
- Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico.,Investigation performed at the Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Antonio Madrazo-Ibarra
- School of Medicine, Universidad Panamericana, Mexico City, Mexico.,Investigation performed at the Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Cristina Velasquillo
- Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico.,Investigation performed at the Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Valentin Martinez-Lopez
- Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico.,Investigation performed at the Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Aldo Izaguirre
- Facultad de Medicina de Tampico "Dr. Alberto Romo Caballero," Universidad Autonoma de Tamaulipas, Victoria, Mexico.,Investigation performed at the Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Anell Olivos-Meza
- Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico.,Investigation performed at the Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Socorro Cortes-Gonzalez
- Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico.,Investigation performed at the Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Francisco Javier Perez-Jimenez
- Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico.,Investigation performed at the Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Alberto Vargas-Ramirez
- Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico.,Investigation performed at the Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Gilberto Franco-Sanchez
- Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico.,Investigation performed at the Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Luis Guillermo Ibarra-Ibarra
- Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico.,Investigation performed at the Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Luis Sierra-Suarez
- Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico.,Investigation performed at the Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Arturo Almazan
- Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico.,Investigation performed at the Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Carmina Ortega-Sanchez
- Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico.,Investigation performed at the Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Cesareo Trueba
- Hospital Español, Mexico City, Mexico.,Investigation performed at the Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Fernando Barbosa Martin
- Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico.,Investigation performed at the Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Reynaldo Arredondo-Valdes
- Hospital Regional "1 de Octubre," Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico.,Investigation performed at the Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Daniel Chavez-Arias
- Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico.,Investigation performed at the Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
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Migliorini F, Berton A, Salvatore G, Candela V, Khan W, Longo UG, Denaro V. Autologous Chondrocyte Implantation and Mesenchymal Stem Cells for the Treatments of Chondral Defects of the Knee- A Systematic Review. Curr Stem Cell Res Ther 2021; 15:547-556. [PMID: 32081109 DOI: 10.2174/1574888x15666200221122834] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/23/2019] [Accepted: 01/09/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND There is still a lack of consensus about the best treatment of chondral defects of the knee. We conducted a systematic PRISMA review to evaluate clinical outcomes of Autologous Chondrocyte Implantation (ACI) and Mesenchymal Stem Cell (MSC) injections for the treatment of focal chondral defects of the knee. METHODS A systematic review of literature was performed according to the PRISMA guidelines. All the articles reporting data on ACI and MSC treatments for chondral defects of the knee were considered for inclusion. The main databases were accessed: PubMed, Medline, CINAHL, Cochrane, Embase and Google Scholar. The statistical analysis was performed using the Review Manager Software. RESULTS In the p-ACI group (987 knees), the Cincinnati Score improved by 18.94% (p=0.1), VAS by 38% (p=0.01), Tegner score by 19.11% (p=0.03), Lysholm score by 22.40% (p=0.01), IKCD by 27.36% (p=0.003). In the c-ACI group (444 knees), the Cincinnati Score improved by 23.80% (p=0.08), KOOS by 23.48% (p=0.03), VAS by 33.2% (p=0.005), IKDC by 33.30% (p=0.005). In the m-ACI group (599 knees), the Cincinnati Score improved by 26.80% (p=0.08), KOOS by 31.59% (p=0.1), VAS by 30.43% (p=0.4), Tegner score by 23.1% (p=0.002), Lysholm score by 31.14% (p=0.004), IKCD by 30.57% (p<0.001). In the MSCs group (291 knees), the KOOS improved by 29.7% (p=0.003), VAS by 41.89% (p<0.001), Tegner score by 25.81% (p=0.003), Lysholm score by 36.96% (p<0.001), IKCD by 30.57% (p=0.001). CONCLUSION Both ACI and MSC therapies can be considered as a concrete solution to treat focal chondral defects of the knee.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
| | - Alessandra Berton
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
| | - Giuseppe Salvatore
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
| | - Vincenzo Candela
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
| | - Wasim Khan
- Division of Trauma & Orthopaedic Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 2QQ, United Kingdom
| | - Umile G Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
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Elbardesy H, Nagle M, Simmons L, Harty J. The partial femoral condyle focal resurfacing (HemiCAP-UniCAP) for treatment of full-thickness cartilage defects, systematic review and meta-analysis. Acta Orthop Belg 2021. [DOI: 10.52628/87.1.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Knee osteochondral defects are a common problem among people, especially young and active patients. So effective joint preserving surgeries is essential to prevent or even delay the onset of osteoarthritis for these group of patients. This study aims to critically appraise and evaluate the evidence for the results and effectiveness of femoral condyle resurfacing (HemiCAP/ UniCAP) in treatment of patients with focal femoral condyle cartilage defect.
Using the search terms : HemiCAP, UniCAP, Episurf, focal, femoral, condyle, inlay and resur-facing, we reviewed the PubMed and EMBASE and the Cochrane Database of Systematic Reviews (CDSR) to find any articles published up to March 2020.
The short term follow-up of the HemiCAP shows (6.74 %) revision rate. However, 29.13 % loss of follow up let us consider these results with caution especially if the revision rate progressively increased with time to 19.3 % in 5-7 years with no enough evidence for the long term results except the data from the Australian Joint Registry 2018, where the cumulative revision rate was 40.6 % (33.5, 48.4) at ten years. The UniCAP that used for defect more than 4 cm 2 has a high revision rate (53.66 %) which is considered unacceptable revision rate in com-parison to another similar prosthesis such as Uni-Knee Arthroplasty (UKA).
The evidence from published studies and our meta- analysis suggests that partial resurfacing of the femoral condyle (HemiCAP) doesn’t support its usage as a tool to treat the focal cartilage defect in middle- aged patients.
The UniCAP as femoral condyle resurfacing has very high revision rate at 5-7 years (53.66 %) which make us recommend against its usage.
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47
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Hu H, Liu W, Sun C, Wang Q, Yang W, Zhang Z, Xia Z, Shao Z, Wang B. Endogenous Repair and Regeneration of Injured Articular Cartilage: A Challenging but Promising Therapeutic Strategy. Aging Dis 2021; 12:886-901. [PMID: 34094649 PMCID: PMC8139200 DOI: 10.14336/ad.2020.0902] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022] Open
Abstract
Articular cartilage (AC) has a very limited intrinsic repair capacity after injury or disease. Although exogenous cell-based regenerative approaches have obtained acceptable outcomes, they are usually associated with complicated procedures, donor-site morbidities and cell differentiation during ex vivo expansion. In recent years, endogenous regenerative strategy by recruiting resident mesenchymal stem/progenitor cells (MSPCs) into the injured sites, as a promising alternative, has gained considerable attention. It takes full advantage of body's own regenerative potential to repair and regenerate injured tissue while avoiding exogenous regenerative approach-associated limitations. Like most tissues, there are also multiple stem-cell niches in AC and its surrounding tissues. These MSPCs have the potential to migrate into injured sites to produce replacement cells under appropriate stimuli. Traditional microfracture procedure employs the concept of MSPCs recruitment usually fails to regenerate normal hyaline cartilage. The reasons for this failure might be attributed to an inadequate number of recruiting cells and adverse local tissue microenvironment after cartilage injury. A strategy that effectively improves local matrix microenvironment and recruits resident MSPCs may enhance the success of endogenous AC regeneration (EACR). In this review, we focused on the reasons why AC cannot regenerate itself in spite of potential self-repair capacity and summarized the latest developments of the three key components in the field of EACR. In addition, we discussed the challenges facing in the present EACR strategy. This review will provide an increasing understanding of EACR and attract more researchers to participate in this promising research arena.
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Affiliation(s)
- Hongzhi Hu
- 1Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Weijian Liu
- 1Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Caixia Sun
- 2Department of Gynecology, General Hospital of the Yangtze River Shipping, Wuhan 430022, China
| | - Qiuyuan Wang
- 3Department of Nephrology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang 441100, China
| | - Wenbo Yang
- 1Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - ZhiCai Zhang
- 1Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Zhidao Xia
- 4Centre for Nanohealth, ILS2, Swansea university Medical school, Swansea, SA2 8PP, UK
| | - Zengwu Shao
- 1Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Baichuan Wang
- 1Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,4Centre for Nanohealth, ILS2, Swansea university Medical school, Swansea, SA2 8PP, UK
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48
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Becher C, Imhoff A. [Guidelines for the treatment of unicompartmental cartilage defects of the knee-Cartilage repair, osteotomy, mini-implant or arthroplasty?]. DER ORTHOPADE 2021; 50:88-95. [PMID: 33337504 DOI: 10.1007/s00132-020-04051-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The treatment of unicompartmental cartilage defects offers a large variety of therapeutic options. With help of an algorithm, decision-making for the most suitable treatment approach is supported. Correction of malalignment is key for successful treatment. Defect size, influencing factors such as "age" and prior treatments play an important role in choosing the most appropriate operative treatment option.
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Affiliation(s)
- Christoph Becher
- IZO - Internationales Zentrum für Orthopädie, ATOS Klinik Heidelberg, Bismarckstr. 9-15, 69115, Heidelberg, Deutschland.
| | - Andreas Imhoff
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München (TUM), München, Deutschland
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49
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Synovial Joints. Tribology, Regeneration, Regenerative Rehabilitation and Arthroplasty. LUBRICANTS 2021. [DOI: 10.3390/lubricants9020015] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Synovial joints are unique biological tribosystems that allow a person to perform a wide range of movements with minimal energy consumption. In recent years, they have been increasingly called “smart friction units” due to their ability to self-repair and adapt to changing operating conditions. However, in reality, the elements of the internal structure of the joints under the influence of many factors can degrade rather quickly, leading to serious disease such as osteoarthritis. According to the World Health Organization, osteoarthritis is already one of the 10 most disabling diseases in developed countries. In this regard, at present, fundamental research on synovial joints remains highly relevant. Despite the fact that the synovial joints have already been studied fully, many issues related to their operating, prevention, development of pathology, diagnosis and treatment require more detailed consideration. In this article, we discuss the urgent problems that need to be solved for the development of new pharmacological agents, biomaterials, scaffolds, implants and rehabilitation devices for the prevention, rehabilitation and improvement of the treatment effectiveness of synovial joints at various stages of osteoarthritis.
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50
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Liao S, Meng H, Li J, Zhao J, Xu Y, Wang A, Xu W, Peng J, Lu S. Potential and recent advances of microcarriers in repairing cartilage defects. J Orthop Translat 2021; 27:101-109. [PMID: 33520655 PMCID: PMC7810913 DOI: 10.1016/j.jot.2020.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 11/11/2022] Open
Abstract
Articular cartilage regeneration is one of the challenges faced by orthopedic surgeons. Microcarrier applications have made great advances in cartilage tissue engineering in recent years and enable cost-effective cell expansion, thus providing permissive microenvironments for cells. In addition, microcarriers can be loaded with proteins, factors, and drugs for cartilage regeneration. Some microcarriers also have the advantages of injectability and targeted delivery. The application of microcarriers with these characteristics can overcome the limitations of traditional methods and provide additional advantages. In terms of the transformation potential, microcarriers have not only many advantages, such as providing sufficient and beneficial cells, factors, drugs, and microenvironments for cartilage regeneration, but also many application characteristics; for example, they can be injected to reduce invasiveness, transplanted after microtissue formation to increase efficiency, or combined with other stents to improve mechanical properties. Therefore, this technology has enormous potential for clinical transformation. In this review, we focus on recent advances in microcarriers for cartilage regeneration. We compare the characteristics of microcarriers with other methods for repairing cartilage defects, provide an overview of the advantages of microcarriers, discuss the potential of microcarrier systems, and present an outlook for future development. Translational potential of this article We reviewed the advantages and recent advances of microcarriers for cartilage regeneration. This review could give many scholars a better understanding of microcarriers, which can provide doctors with potential methods for treating patients with cartilage injure.
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Affiliation(s)
- Sida Liao
- Institute of Orthopedics/ Beijing Key Laboratory of Regenerative Medicine in Orthopedics/ Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, 100853, China
| | - Haoye Meng
- Institute of Orthopedics/ Beijing Key Laboratory of Regenerative Medicine in Orthopedics/ Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, 100853, China
| | - Junkang Li
- Institute of Orthopedics/ Beijing Key Laboratory of Regenerative Medicine in Orthopedics/ Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, 100853, China
| | - Jun Zhao
- Institute of Orthopedics/ Beijing Key Laboratory of Regenerative Medicine in Orthopedics/ Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yichi Xu
- Institute of Orthopedics/ Beijing Key Laboratory of Regenerative Medicine in Orthopedics/ Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, 100853, China
| | - Aiyuan Wang
- Institute of Orthopedics/ Beijing Key Laboratory of Regenerative Medicine in Orthopedics/ Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, 100853, China
| | - Wenjing Xu
- Institute of Orthopedics/ Beijing Key Laboratory of Regenerative Medicine in Orthopedics/ Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, 100853, China
| | - Jiang Peng
- Institute of Orthopedics/ Beijing Key Laboratory of Regenerative Medicine in Orthopedics/ Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, 100853, China
| | - Shibi Lu
- Institute of Orthopedics/ Beijing Key Laboratory of Regenerative Medicine in Orthopedics/ Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, 100853, China
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