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Stewart HL, Gilbert D, Stefanovski D, Garman Z, Albro MB, Bais M, Grinstaff MW, Snyder BD, Schaer TP. A missed opportunity: A scoping review of the effect of sex and age on osteoarthritis using large animal models. Osteoarthritis Cartilage 2024; 32:501-513. [PMID: 38408635 DOI: 10.1016/j.joca.2024.02.009] [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: 10/27/2023] [Revised: 02/13/2024] [Accepted: 02/20/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE The objective was to critically analyze the published literature accounting for sex differences and skeletal age (open vs. closed physis) in preclinical animal models of OA, including the disaggregation of data by sex and skeletal maturity when data is generated from combined sex and/or multi-aged cohorts without proper confounding. METHOD A scoping literature review of PubMed, Web of Science, EMBASE, and SCOPUS was performed for studies evaluating the effect of sex and age in experimental studies and clinical trials utilizing preclinical large animal models of OA. RESULTS A total of 9727 papers were identified in large animal (dog, pig, sheep, goat, horse) models for preclinical OA research, of which 238 ex vivo and/or in vivo studies disclosed model type, animal species, sex, and skeletal age sufficient to analyze their effect on outcomes. Dogs, followed by pigs, sheep, and horses, were the most commonly used models. A paucity of preclinical studies evaluated the effect of sex and age in large animal models of naturally occurring or experimentally induced OA: 26 total studies reported some kind of analysis of the effects of sex or age, with 4 studies discussing the effects of sex only, 11 studies discussing the effects of age only, and 11 studies analyzing both the effects of age and sex. CONCLUSION Fundamental to translational research, OARSI is uniquely positioned to develop recommendations for conducting preclinical studies using large animal models of OA that consider biological mechanisms linked to sex chromosomes, skeletal age, castration, and gonadal hormones affecting OA pathophysiology and treatment response.
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Affiliation(s)
- Holly L Stewart
- Department of Clinical Studies New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA 19348, USA
| | - Derek Gilbert
- Department of Clinical Studies New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA 19348, USA
| | - Darko Stefanovski
- Department of Clinical Studies New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA 19348, USA
| | - Zoe Garman
- Departments of Biomedical Engineering and Chemistry, Boston University, Boston MA 02215, USA
| | - Michael B Albro
- Department of Mechanical Engineering, Boston University, Boston MA 02215, USA
| | - Manish Bais
- Boston University, Henry M. Goldman School of Dental Medicine, Boston MA 02118, USA
| | - Mark W Grinstaff
- Departments of Biomedical Engineering and Chemistry, Boston University, Boston MA 02215, USA
| | - Brian D Snyder
- Department of Orthopaedic Surgery, Boston Children's Hospital Boston, MA 02215, USA
| | - Thomas P Schaer
- Department of Clinical Studies New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA 19348, USA.
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Mikova E, Kunutsor SK, Butler M, Murray JR. Focal resurfacing of the knee - A systematic review and meta-analysis. Knee 2024; 48:63-75. [PMID: 38521014 DOI: 10.1016/j.knee.2024.02.013] [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: 10/15/2023] [Revised: 02/03/2024] [Accepted: 02/27/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE In order to assess the published validity of focal resurfacing of the knee, a systematic review and meta-analysis were conducted to (i) evaluate revision rates and implant survival of focal resurfacing of the knee; (ii) explore surgical complications; and (iii) evaluate patient reported clinical outcome measures. METHODS PubMED, Cochrane Library and Medline databases were searched by 2 independent reviewers in February 2022 for prospective and retrospective cohort studies evaluating any of the following implant types: HemiCAP®, UniCAP®, Episealer® or BioBoly®. Data on incidence of revision, complications and various patient reported outcome measures, such as Knee Society Score (KSS) or Knee Injury and Osteoarthritis Outcome Score (KOOS) was sourced. RESULTS A total of 24 published studies were identified with a total of 1465 enrolled patients. A revision rate of 12.97% over a 5.9 year weighted mean follow-up period was observed across all implant types. However, in one series a Kaplan-Meir survival as high as 92.6% at a 10-year follow-up period was noted. A statistically significant improvement was documented across multiple subjective clinical outcomes scores, for example a mean 4.56 point improvement of the VAS (0-10) pain score. The Kellgren-Lawrence score was used to evaluate the radiological progression of osteoarthritis and showed a small significant reduction in all anatomical locations, hence not supporting the hypothesis that focal femoral implants can lead to the progression of osteoarthritis in the affected compartment. There was a low reported incidence of post-operative complications such as aseptic loosening or deep wound infection. CONCLUSIONS Focal femoral resurfacing appears to be a viable treatment option for focal symptomatic chondral lesions in patients beyond biological reconstruction, with low revision rates and high patient satisfaction especially at short and medium length follow-up.
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Affiliation(s)
- Ester Mikova
- Bristol Medical School, University of Bristol, 5 Tyndall Avenue, Bristol BS8 1UD, UK.
| | - Setor K Kunutsor
- Musculoskeletal Research Unit, Bristol Medical School, Southmead Hospital, University of Bristol, Bristol, United Kingdom.
| | - Meg Butler
- Bristol Medical School, University of Bristol, 5 Tyndall Avenue, Bristol BS8 1UD, UK
| | - James R Murray
- Bristol Medical School, University of Bristol, 5 Tyndall Avenue, Bristol BS8 1UD, UK; Department of Orthopaedics, North Bristol NHS Trust, Bristol BS10 5NB, UK.
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van Hugten PPW, Jeuken RM, Asik EE, Oevering H, Welting TJM, van Donkelaar CC, Thies JC, Emans PJ, Roth AK. In vitro and in vivo evaluation of the osseointegration capacity of a polycarbonate-urethane zirconium-oxide composite material for application in a focal knee resurfacing implant. J Biomed Mater Res A 2024. [PMID: 38465895 DOI: 10.1002/jbm.a.37691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 03/12/2024]
Abstract
Currently available focal knee resurfacing implants (FKRIs) are fully or partially composed of metals, which show a large disparity in elastic modulus relative to bone and cartilage tissue. Although titanium is known for its excellent osseointegration, the application in FKRIs can lead to potential stress-shielding and metal implants can cause degeneration of the opposing articulating cartilage due to the high resulting contact stresses. Furthermore, metal implants do not allow for follow-up using magnetic resonance imaging (MRI).To overcome the drawbacks of using metal based FKRIs, a biomimetic and MRI compatible bi-layered non-resorbable thermoplastic polycarbonate-urethane (PCU)-based FKRI was developed. The objective of this preclinical study was to evaluate the mechanical properties, biocompatibility and osteoconduction of a novel Bionate® 75D - zirconium oxide (B75D-ZrO2 ) composite material in vitro and the osseointegration of a B75D-ZrO2 composite stem PCU implant in a caprine animal model. The tensile strength and elastic modulus of the B75D-ZrO2 composite were characterized through in vitro mechanical tests under ambient and physiological conditions. In vitro biocompatibility and osteoconductivity were evaluated by exposing human mesenchymal stem cells to the B75D-ZrO2 composite and culturing the cells under osteogenic conditions. Cell activity and mineralization were assessed and compared to Bionate® 75D (B75D) and titanium disks. The in vivo osseointegration of implants containing a B75D-ZrO2 stem was compared to implants with a B75D stem and titanium stem in a caprine large animal model. After a follow-up of 6 months, bone histomorphometry was performed to assess the bone-to-implant contact area (BIC). Mechanical testing showed that the B75D-ZrO2 composite material possesses an elastic modulus in the range of the elastic modulus reported for trabecular bone. The B75D-ZrO2 composite material facilitated cell mediated mineralization to a comparable extent as titanium. A significantly higher bone-to-implant contact (BIC) score was observed in the B75D-ZrO2 implants compared to the B75D implants. The BIC of B75D-ZrO2 implants was not significantly different compared to titanium implants. A biocompatible B75D-ZrO2 composite approximating the elastic modulus of trabecular bone was developed by compounding B75D with zirconium oxide. In vivo evaluation showed an significant increase of osseointegration for B75D-ZrO2 composite stem implants compared to B75D polymer stem PCU implants. The osseointegration of B75D-ZrO2 composite stem PCU implants was not significantly different in comparison to analogous titanium stem metal implants.
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Affiliation(s)
- Pieter P W van Hugten
- Department of Orthopedic Surgery, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Department of Orthopedic Surgery, Joint Preservation Clinic, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ralph M Jeuken
- Department of Orthopedic Surgery, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Department of Orthopedic Surgery, Joint Preservation Clinic, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Erkan E Asik
- Department of Biomedical Engineering, Orthopaedic Biomechanics, Eindhoven University of Technology, Eindhoven, The Netherlands
- Avalanche Medical BV, Maastricht, The Netherlands
| | | | - Tim J M Welting
- Department of Orthopedic Surgery, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Corrinus C van Donkelaar
- Department of Biomedical Engineering, Orthopaedic Biomechanics, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | - Peter J Emans
- Department of Orthopedic Surgery, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Department of Orthopedic Surgery, Joint Preservation Clinic, Maastricht University Medical Center, Maastricht, The Netherlands
- Avalanche Medical BV, Maastricht, The Netherlands
| | - Alex K Roth
- Department of Orthopedic Surgery, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Avalanche Medical BV, Maastricht, The Netherlands
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Peng L, Li H, Deng H, Gao T, Li R, Xu Z, Tian Q, Zhao T, Li J, Yang Y, Wang C, Liu S, Guo Q. Combination of a human articular cartilage-derived extracellular matrix scaffold and microfracture techniques for cartilage regeneration: A proof of concept in a sheep model. J Orthop Translat 2024; 44:72-87. [PMID: 38259590 PMCID: PMC10801125 DOI: 10.1016/j.jot.2023.09.004] [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] [Received: 07/05/2023] [Revised: 08/16/2023] [Accepted: 09/20/2023] [Indexed: 01/24/2024] Open
Abstract
Background The utilization of decellularized extracellular matrix has gained considerable attention across numerous areas in regenerative research. Of particular interest is the human articular cartilage-derived extracellular matrix (hACECM), which presents as a promising facilitator for cartilage regeneration. Concurrently, the microfracture (MF) technique, a well-established marrow stimulation method, has proven efficacious in the repair of cartilage defects. However, as of the current literature review, no investigations have explored the potential of a combined application of hACECM and the microfracture technique in the repair of cartilage defects within a sheep model. Hypothesis The combination of hACECM scaffold and microfracture will result in improved repair of full-thickness femoral condyle articular cartilage defects compared to the use of either technique alone. Study design Controlled laboratory study. Methods Full-thickness femoral condyle articular cartilage defect (diameter, 7.0 mm; debrided down to the subchondral bone plate) were created in the weight-bearing area of the femoral medial and lateral condyles (n = 24). All of defected sheep were randomly divided into four groups: control, microfracture, hACECM scaffold, and hACECM scaffold + microfracture. After 3, 6 and 12 months, the chondral repair was assessed for standardized (semi-) quantitative macroscopic, imaging, histological, immunohistochemical, mechanics, and biochemical analyses in each group. Result At 3, 6 and 12 months after implantation, the gross view and pathological staining of regenerative tissues were better in the hACECM scaffold and hACECM scaffold + microfracture groups than in the microfracture and control groups; Micro-CT result showed that the parameters about the calcified layer of cartilage and subchondral bone were better in the hACECM scaffold and hACECM scaffold + microfracture groups than the others, and excessive subchondral bone proliferation in the microfracture group. The results demonstrate that human cartilage extracellular matrix scaffold alone is an efficient, safe and simple way to repair cartilage defects. Conclusion hACECM scaffolds combined with/without microfracture facilitate chondral defect repair. The translational potential of this article Preclinical large animal models represent an important adjunct and surrogate for studies on articular cartilage repair, while the sheep stifle joint reflects many key features of the human knee and are therefore optimal experimental model for future clinical application in human. In this study, we developed a human articular cartilage-derived extracellular matrix scaffold and to verify the viability of its use in sheep animal models. Clinical studies are warranted to further quantify the effects of hACECM scaffolds in similar settings.
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Affiliation(s)
- Liqing Peng
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- Department of Orthopedics, First People's Hospital of Shuangliu District, No. 120, Chengbeishang Street, Shuangliu District, Chengdu, 610200, China
| | - Hao Li
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Haoyuan Deng
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Tianze Gao
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Runmeng Li
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Ziheng Xu
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Qinyu Tian
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Tianyuan Zhao
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Jianwei Li
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Yongkang Yang
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Chao Wang
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Shuyun Liu
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Quanyi Guo
- Institute of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, 300071, China
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Veizi E, Güven Ş, Naldöven ÖF, Çepni Ş, Çay N, Işık Ç, Bozkurt M. Low local curvature index and history of previous surgery are risk factors for revision in focal metallic inlay implants. Knee 2023; 43:42-50. [PMID: 37269796 DOI: 10.1016/j.knee.2023.05.003] [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: 12/23/2022] [Revised: 02/27/2023] [Accepted: 05/11/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Focal chondral defects are debilitating lesions with poor healing potential. Focal metallic inlay implants were developed as a salvage procedure, whose reoperation causes and risk factors for revision are still debatable. The aim of this study is to analyze the local subchondral curvature matching of focal metallic inlay implants and its effects on survival and clinical results. METHODS Patients operated with a knee focal metallic inlay resurfacing implant between 2014 and 2017 were eligible. Surgery was indicated for painful, focal, full-thickness cartilage lesions that had failed alternative treatments. Inclusion criteria were patients treated for a lesion ≤ 5 cm2 in the femoral condyle, aged 40-65 years, with complete surgical records and a knee CT scan. The curvature index (Kindex) was calculated as the ratio of the mean curvature of the implant (K1) to the mean curvature of the subchondral bone (K2). RESULTS Sixty-nine patients were included, of which 60.9% were female. Mean age was 54.8 ± 6.0. Seven patients (10.1%) underwent revision surgery. When adjusted for age and sex, lesion size was not significantly correlated to revision in a multivariate regression model, while previous surgery and smaller K index were. A positive history for previous surgery was significantly correlated with worse clinical outcomes in surviving patients. CONCLUSION A positive history of previous knee surgery and a low local curvature index are risk factors for revision after focal metallic inlay implant resurfacing. Patients with a history of knee surgery should be counseled on the advantages and disadvantages before undergoing a focal resurfacing procedure.
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Affiliation(s)
- Enejd Veizi
- Ankara City Hospital, Department of Orthopedics and Traumatology, 06000 Ankara, Turkey.
| | - Şahan Güven
- Ankara City Hospital, Department of Orthopedics and Traumatology, Ankara, Turkey
| | - Ömer Faruk Naldöven
- Ankara City Hospital, Department of Orthopedics and Traumatology, Ankara, Turkey
| | - Şahin Çepni
- Ankara City Hospital, Department of Orthopedics and Traumatology, Ankara, Turkey
| | - Nurdan Çay
- Yıldırım Beyazıt University, Faculty of Medicine, Ankara City Hospital, Department of Radiology, Ankara, Turkey
| | - Çetin Işık
- Memorial Ataşehir Hospital, Department of Orthopedics and Traumatology, Istanbul, Turkey
| | - Murat Bozkurt
- Ankara Acıbadem Hospital, Department of Orthopedics and Traumatology, Ankara, Turkey
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Cosma C, Apostu D, Vilau C, Popan A, Oltean-Dan D, Balc N, Tomoaie G, Benea H. Finite Element Analysis of Different Osseocartilaginous Reconstruction Techniques in Animal Model Knees. MATERIALS (BASEL, SWITZERLAND) 2023; 16:2546. [PMID: 37048840 PMCID: PMC10095518 DOI: 10.3390/ma16072546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 06/19/2023]
Abstract
Lesions of the articular cartilage are frequent in all age populations and lead to functional impairment. Multiple surgical techniques have failed to provide an effective method for cartilage repair. The aim of our research was to evaluate the effect of two different compression forces on three types of cartilage repair using finite element analysis (FEA). Initially, an in vivo study was performed on sheep. The in vivo study was prepared as following: Case 0-control group, without cartilage lesion; Case 1-cartilage lesion treated with macro-porous collagen implants; Case 2-cartilage lesion treated with collagen implants impregnated with bone marrow concentrate (BMC); Case 3-cartilage lesion treated with collagen implants impregnated with adipose-derived stem cells (ASC). Using the computed tomography (CT) data, virtual femur-cartilage-tibia joints were created for each Case. The study showed better results in bone changes when using porous collagen implants impregnated with BMC or ASC stem cells for the treatment of osseocartilaginous defects compared with untreated macro-porous implant. After 7 months postoperative, the presence of un-resorbed collagen influences the von Mises stress distribution, total deformation, and displacement on the Z axis. The BMC treatment was superior to ASC cells in bone tissue morphology, resembling the biomechanics of the control group in all FEA simulations.
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Affiliation(s)
- Cosmin Cosma
- Department of Manufacturing Engineering, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania; (C.C.)
| | - Dragos Apostu
- Department of Orthopedics and Traumatology, Iuliu Haţieganu University of Medicine and Pharmacy, 400132 Cluj-Napoca, Romania
| | - Cristian Vilau
- Department of Material Resistance, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania
| | - Alexandru Popan
- Department of Manufacturing Engineering, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania; (C.C.)
| | - Daniel Oltean-Dan
- Department of Orthopedics and Traumatology, Iuliu Haţieganu University of Medicine and Pharmacy, 400132 Cluj-Napoca, Romania
| | - Nicolae Balc
- Department of Manufacturing Engineering, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania; (C.C.)
| | - Gheorghe Tomoaie
- Department of Orthopedics and Traumatology, Iuliu Haţieganu University of Medicine and Pharmacy, 400132 Cluj-Napoca, Romania
- Academy of Romanian Scientists, 050044 Bucharest, Romania
| | - Horea Benea
- Department of Orthopedics and Traumatology, Iuliu Haţieganu University of Medicine and Pharmacy, 400132 Cluj-Napoca, Romania
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Pellegrini MJ, Mombello F, Cortes A, Chaparro F, Ortiz C, Carcuro G. Short-term Results of Hemiarthroplasty of the Ankle Joint for Talar-Sided Cartilage Loss. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114221148172. [PMID: 36741679 PMCID: PMC9893082 DOI: 10.1177/24730114221148172] [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] [Indexed: 01/29/2023] Open
Abstract
Background Ankle hemiarthroplasty is a 1-piece implant system replacing the talar side of the tibiotalar joint. Hemiarthroplasty offers limited bone resection and may provide easier revision options than joint-ablating procedures. Methods Prospective, multicenter, noncomparative, nonrandomized clinical study with short term follow-up on patients undergoing hemiarthroplasty of the ankle. Radiologic and functional outcomes (Foot and Ankle Outcome Score FAOS, Foot and Ankle Ability Measure [FAAM], Short Form-36 Health Survey [SF-36], Short Musculoskeletal Functional Assessment [SMFA], and visual analog scale [VAS] pain scores) were obtained at 3 and 12 months and the last follow-up (mean 31.9 months). Results Ten patients met the inclusion criteria. Three were converted to total ankle replacement at 14, 16, and 18 months. Pain VAS scores improved on average from 6.8 to 4.8 (P = .044) of the remaining 7 at a mean of 31.9 months' follow-up. For these 7 in the Survival Group, we found that SF-36 physical health component improved from 25.03 to 42.25 (P = .030), SMFA dysfunction and bother indexes improved from 46.36 to 32.28 (P = .001), and from 55.21 to 30.14 (P = .002) in the Survival Group, and FAAM sports improved from 12.5 to 34.5 (P = .023). Conclusion Patients undergoing hemiarthroplasty of the ankle joint for talar-sided lesions had a 30% failure rate by 18 months. Those who did not have an early failure exhibited modest pain reduction, functional improvements, and better quality of life in short-term follow-up. This procedure offers a possible alternative for isolated talar ankle cartilage cases. Level of Evidence Level IV, prospective case series.
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Affiliation(s)
- Manuel J. Pellegrini
- Hospital Clinico Universidad de Chile, Santiago, Chile,Clinica Universidad de Los Andes, Santiago, Chile,Manuel J. Pellegrini, MD, Facultad de Medicina, Departamento de Traumatología, Clinica Universidad de los Andes, Av. Plaza 2501, Santiago 7620157, Chile.
| | | | - Aaron Cortes
- Clinica Universidad de Los Andes, Santiago, Chile
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8
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Demott CJ, Grunlan MA. Emerging polymeric material strategies for cartilage repair. J Mater Chem B 2022; 10:9578-9589. [PMID: 36373438 DOI: 10.1039/d2tb02005j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cartilage is found throughout the body, serving an array of essential functions. Owing to the limited healing capacity of cartilage, damage or degeneration is often permanent and so requires clinical intervention. Established surgical techniques generally rely on biological grafting. However, recent advances in polymeric materials provide an encouraging alternative to overcome limits of auto- and allografts. For regenerative engineering of cartilage, a polymeric scaffold ideally supports and instructs tissue regeneration while also providing mechanical integrity. Scaffolds direct regeneration via chemical and mechanical cues, as well as delivery and support of exogenous cells and bioactive factors. Advanced polymeric scaffolds aim to direct regeneration locally, replicating the heterogeneities of native tissues. Alternatively, new cartilage-mimetic hydrogels have potential to serve as synthetic cartilage replacements. Prepared as multi-network or composite hydrogels, the most promising candidates have simultaneously realized the hydration, mechanical, and tribological properties of native cartilage. Collectively, the recent rise in polymers for cartilage regeneration and replacement proposes a changing paradigm, with a new generation of materials paving the way for improved clinical outcomes.
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Affiliation(s)
- Connor J Demott
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843-3003, USA
| | - Melissa A Grunlan
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843-3003, USA.,Department of Materials Science & Engineering, Texas A&M University, College Station, TX 77843-3003, USA.,Department of Chemistry, Texas A&M University, College Station, TX 77843-3003, USA.
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9
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Good subjective outcome and low risk of revision surgery with a novel customized metal implant for focal femoral chondral lesions at a follow-up after a minimum of 5 years. Arch Orthop Trauma Surg 2022; 142:2887-2892. [PMID: 34523047 PMCID: PMC9474357 DOI: 10.1007/s00402-021-04160-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: 04/13/2021] [Accepted: 09/01/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Patients with focal cartilage lesions experience functional impairment. Results for biological treatments in the middle-aged patient is poor. Previous studies with focal prosthetic inlay resurfacing have shown a higher risk of conversion to total knee replacement at mid-term follow-up. A novel customized implant (Episealer, Episurf, Stockholm, Sweden) has been proposed to improve implant positioning and survival. The primary objective was to assess subjective-, objective function and implant survival at a minimum of five years after surgery. MATERIALS AND METHODS The inclusion criteria were patients aged 30-65 years with symptomatic focal chondral defects in the medial femoral condyle, International Cartilage Research Society grade 3 or 4 and failed conservative or surgical treatment. Minimum follow-up of 5 years. Clinical and radiologic assessments were made. Patient-reported outcome measurements at the latest follow-up were compared with the baseline data for the Knee injury and Osteoarthritis Outcome Score (KOOS), the EuroQoL (EQ-5D), the Tegner Activity Scale and a Visual Analog Scale of pain (VAS 0-10). RESULTS Ten patients with the mean follow-up period of 75 months (60-86 months, SD 10) were included. Signs of osteoarthritis were seen in one patient (Ahlbäck 1). No cases with revision to knee replacement. VAS for pain and KOOS showed improvements that reached significance for VAS (p ≤ 0.001) and the KOOS subscores Pain (p = 0.01), ADL (p = 0.003), Sport and Recreation (p = 0.024) and Quality of Life (p = 0.003). CONCLUSION A good subjective outcome, a low risk of progression to degenerative changes and the need for subsequent surgery were seen at the mid-term follow-up with this customized focal knee-resurfacing implant. LEVEL OF EVIDENCE Prospective case series, level 4.
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10
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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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Martinez-Carranza N, Rockborn P, Roberts D, Högström M, Stålman A. Successful Treatment of Femoral Chondral Lesions with a Novel Customized Metal Implant at Midterm Follow-Up. Cartilage 2021; 13:1726S-1733S. [PMID: 33106003 PMCID: PMC8808814 DOI: 10.1177/1947603520967064] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Full-depth cartilage lesions do not heal spontaneously and may progress to osteoarthritis (OA). Treatment for these lesions is warranted when symptomatic. At younger age, biological treatment remains the gold standard, but treatment in the middle-aged patient remains a clinical challenge and focal metal implants have been proposed. We aim to present the subjective outcome at 2 years and the risk of reoperation for any reason at midterm after surgery with a novel customized implant for focal femoral chondral lesions in the knee. METHODS In a prospective cohort study, 30 patients were included between January 2013 and December 2017 at 9 different clinics in Sweden. The primary outcome was subjective outcome measurements (Visual Analogue Scale [VAS], EuroQoL [EQ5D], Knee injury and Osteoarthritis Outcome Score [KOOS]) at a minimum of 2 years. The secondary outcome was reoperations for any reason during the follow-up period until December 2019 (mean of 55 months) studied retrospectively by analyzing medical records. RESULTS The VAS, EQ5D, and all the KOOS subscales showed significant improvements from preoperatively to the 2-year follow-up. The VAS showed the greatest improvement at the early (3 months) postoperative stage (P < 0.001). Five (7%) patients underwent reoperations and one of these was revised to hemiarthroplasty due to OA progression. No implant loosening was detected in any of the cases. CONCLUSIONS This customized resurfacing metal implant showed good safety and patient satisfaction. The risk of OA progression and implant loosening is low. Subjective function and pain improved significantly.
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Affiliation(s)
- Nicolas Martinez-Carranza
- Department of Orthopaedics, Institution
of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet,
Stockholm, Sweden,Division of Orthopaedics, Karolinska
University Hospital, Stockholm, Sweden,Nicolas Martinez-Carranza, Division of
Orthopaedics, Karolinska University Hospital, Hälsovägen, SE-141 86 Stockholm,
Sweden.
| | - Peter Rockborn
- Orthopedic Clinic, Vrinnevi Hospital,
Norrköping, Sweden
| | - David Roberts
- Ortho Center Skåne and Department of
Orthopaedics, Skane University Hospital, Malmo, Sweden
| | - Magnus Högström
- Sports Medicine Umeå and Orthopedics,
Umeå, Sweden,Department of Surgical and Perioperative
Sciences, Umeå University, Umeå, Sweden
| | - Anders Stålman
- Stockholm Sports Trauma Research Center,
MMK, Karolinska Institutet, Stockholm, Sweden
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Moewis P, Kaiser R, Trepczynski A, von Tycowicz C, Krahl L, Ilg A, Holz J, Duda GN. Patient-specific resurfacing implant knee surgery in subjects with early osteoarthritis results in medial pivot and lateral femoral rollback during flexion: a retrospective pilot study. Knee Surg Sports Traumatol Arthrosc 2021; 31:1247-1266. [PMID: 34601628 PMCID: PMC10050034 DOI: 10.1007/s00167-021-06749-8] [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] [Received: 03/31/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Metallic resurfacing implants have been developed for the treatment of early, small, condylar and trochlear osteoarthritis (OA) lesions. They represent an option for patients who do not fulfill the criteria for unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA) or are too old for biological treatment. Although clinical evidence has been collected for different resurfacing types, the in vivo post-operative knee kinematics remain unknown. The present study aims to analyze the knee kinematics in subjects with patient-specific episealer implants. This study hypothesized that patient-specific resurfacing implants would lead to knee kinematics close to healthy knees, resulting in medial pivot and a high degree of femoral rollback during flexion. METHODS Retrospective study design. Fluoroscopic analysis during unloaded flexion-extension and loaded lunge was conducted at > 12 months post-surgery in ten episealer knees, and compared to ten healthy knees. Pre- and post-operative clinical data of the episealer knees were collected using a visual analog scale (VAS), the EQ 5d Health, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaires. RESULTS A consistent medial pivot was observed in both episealer and healthy knees. Non-significant differences were found in the unloaded (p = 0.15) and loaded (p = 0.51) activities. Although lateral rollback was observed in both groups, it was significantly higher for the episealer knees in both the unloaded (p = 0.02) and loaded (p = 0.01) activities. Coupled axial rotation was significantly higher in the unloaded (p = 0.001) but not in the loaded (p = 0.06) activity in the episealer knees. Improved scores were observed at 1-year post-surgery in the episealer subjects for the VAS (p = 0.001), KOOS (p = 0.001) and EQ Health (p = 0.004). CONCLUSION At 12 month follow-up, a clear physiological knee kinematics pattern of medial pivot, lateral femoral rollback and coupled axial external femoral rotation during flexion was observed in patients treated with an episealer resurfacing procedure. However, higher femoral rollback and axial external rotation in comparison to healthy knees was observed, suggesting possible post-operative muscle weakness and consequent insufficient stabilization at high flexion.
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Affiliation(s)
- Philippe Moewis
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - René Kaiser
- OrthoCentrum Hamburg, Hansastrasse 1-3, 20149, Hamburg, Germany
| | - Adam Trepczynski
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353, Berlin, Germany
| | | | - Leonie Krahl
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Ansgar Ilg
- OrthoCentrum Hamburg, Hansastrasse 1-3, 20149, Hamburg, Germany
| | - Johannes Holz
- OrthoCentrum Hamburg, Hansastrasse 1-3, 20149, Hamburg, Germany
| | - Georg N Duda
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353, Berlin, Germany
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13
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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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14
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Springer B, Boettner F. Treatment of Unicompartmental Cartilage Defects of the Knee with Unicompartmental Knee Arthroplasty, Patellofemoral Partial Knee Arthroplasty or Focal Resurfacing. Life (Basel) 2021; 11:life11050394. [PMID: 33925287 PMCID: PMC8146542 DOI: 10.3390/life11050394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 11/18/2022] Open
Abstract
Focal chondral defects are common lesions of the articular cartilage. They are predominantly found on the medial femoral condyle and often progress to osteoarthritis of the knee. Various conservative treatment options are available. The conservative treatment might reduce pain and delay the progress of degenerative processes. However, restoration of the articular cartilage cannot be accomplished. If the conservative treatment fails unicompartmental arthroplasty, patellofemoral joint replacement or focal resurfacing are reasonable options to postpone total knee arthroplasty. A careful patient selection before surgery is crucial for all three treatment options. The following overview reports indications and outcomes of medial partial knee replacement, patellofemoral partial knee replacement, and focal resurfacing treatment options for focal chondral defects.
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Affiliation(s)
- Bernhard Springer
- Department of Orthopedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria;
| | - Friedrich Boettner
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA
- Correspondence:
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15
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Meng X, Zhang W, Yuan Z, Chen J, Lyu Z, Wang Y. A partial hemi-resurfacing preliminary study of a novel magnetic resonance imaging compatible polyetheretherketone mini-prosthesis for focal osteochondral defects. J Orthop Translat 2021; 26:67-73. [PMID: 33437625 PMCID: PMC7773958 DOI: 10.1016/j.jot.2020.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/19/2020] [Accepted: 02/22/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The use of partial articular resurfacing surgery with a mini-implant has been gradually increasing; the implant is mainly made of cobalt-chromium metal material, and cartilage changes cannot be monitored after implantation. Thus, we aimed to develop a novel local articular resurfacing polyetheretherketone (PEEK) mini-implant and investigate its feasibility for postoperative magnetic resonance imaging (MRI) monitoring of implant location, bone changes, and cartilage degeneration without artefacts. METHODS Nine skeletally mature female standardised goats were used and divided into the sham, PEEK, and cobalt-chromium-molybdenum alloy (Co-Cr-Mo) groups. The animals underwent local articular resurfacing operation with Co-Cr-Mo alloy (Co-Cr-Mo group) and PEEK (PEEK group) mini-implants. X-ray, computed tomography, and MRI examinations were performed at 12 weeks postoperatively. The sham group underwent a similar surgical procedure to expose the femoral head but without implantation. Gross necropsy and surface topography measurement of the articular cartilage of the acetabulum were performed after sacrificing the animals. Imaging artefacts and opposing cartilage degeneration in the acetabulum were also examined. RESULTS Cartilage damage occurred in both the Co-Cr-Mo and PEEK groups, and the damaged cartilage area was markedly larger in the Co-Cr-Mo group than in the PEEK group, as assessed by gross necropsy and histological staining. The mean surface roughness of the opposing cartilage was approximately 65.3, 117.4, and 188.4 μm at 12 weeks in the sham, PEEK, and Co-Cr-Mo groups, respectively. The Co-Cr-Mo mini-implant was visualised on radiographs, but computed tomography and MR images were markedly affected by artefacts, whereas the opposing cartilage and surrounding tissue were clear on MR images in the PEEK group. Opposing cartilage damage and subchondral bone marrow oedema could be detected by MRI in the PEEK group. CONCLUSIONS The PEEK mini-implant can be a novel alternative to the Co-Cr-Mo mini-implant in articular resurfacing to treat focal osteochondral defects with less cartilage damage. It is feasible to postoperatively monitor the PEEK implant location, surrounding bone changes, and opposing cartilage degeneration by MRI without artefacts. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE The use of MRI to monitor changes in the opposing cartilage after prosthesis implantation has not been widely applied because MR images are generally affected by artefacts generated by the metal prosthesis. This study revealed that the PEEK mini-implant can be a novel alternative to the Co-Cr-Mo mini-implant in articular resurfacing to treat focal osteochondral defects, and it is feasible to monitor the PEEK implant location, surrounding bone changes, and opposing cartilage damage/degeneration by MRI without artefacts postoperatively.
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Affiliation(s)
- Xiangchao Meng
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Wei Zhang
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zhiguo Yuan
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jun Chen
- Department of Head and Neck Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zhuocheng Lyu
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - You Wang
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Abstract
The menisci and articular cartilage of the knee have a close embryological, anatomical and functional relationship, which explains why often a pathology of one also affects the other. Traumatic meniscus tears should be repaired, when possible, to protect the articular cartilage. Traumatic articular cartilage lesions can be treated with success using biological treatment options such as microfracture or microdrilling, autologous chondrocyte transplantation (ACT), or osteochondral transplantation (OCT) depending on the depth and area of the lesion. Degenerative cartilage and meniscus lesions often occur together, and osteoarthritis is already present or impending. Most degenerative meniscus lesions should be treated first conservatively and, after failed conservative treatment, should undergo arthroscopic partial meniscus resection. Degenerative cartilage lesions should also be treated conservatively initially and then surgically; thereby treating the cartilage defect itself and also maintaining the axis of the leg if necessary. Tears of the meniscus roots are devastating injuries to the knee and should be repaired e.g. by transtibial re-fixation. The clinical role of ‘ramp’ lesions of the meniscus is still under investigation.
Cite this article: EFORT Open Rev 2020;5:652-662. DOI: 10.1302/2058-5241.5.200016
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Affiliation(s)
- Sebastian Kopf
- Center of Orthopaedics and Traumatology, Brandenburg Medical School Theodor Fontane, Germany
| | - Manuel-Paul Sava
- Orthopedics and Traumatology 2nd Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Christian Stärke
- Department of Orthopaedic Surgery, Otto-von-Guericke University Magdeburg, Germany
| | - Roland Becker
- Center of Orthopaedics and Traumatology, Brandenburg Medical School Theodor Fontane, Germany
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Damen AHA, Nickien M, Ito K, van Donkelaar CC. The performance of resurfacing implants for focal cartilage defects depends on the degenerative condition of the opposing cartilage. Clin Biomech (Bristol, Avon) 2020; 79:105052. [PMID: 32591239 DOI: 10.1016/j.clinbiomech.2020.105052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 04/08/2020] [Accepted: 05/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Non-degradable resurfacing implants are being developed for treatment of focal cartilage defects. Performance of these implants has been investigated opposing intact cartilage. This study investigates whether implants would perform equally well when the opposing cartilage is fibrillated. METHODS Human osteochondral strips (~2x1x1 cm) with a smooth (n = 9) or fibrillated (n = 17) cartilage surface were obtained from human tibial plateaus excised during total knee arthroscopy. A custom-made pin-on-plate sliding indenter was used to apply simultaneous compression (0.75-3 MPa) and movement (4 mm/s over 6 mm). Either metal implants, polycarbonate-urethane or healthy porcine osteochondral plugs with a diameter of 6 mm were used as indenter. FINDINGS Cartilage roughness of the osteochondral strips was significantly higher for the fibrillated than the smooth group prior to sliding-indentation. Roughness of the indenters was not significantly altered by sliding indentation using either smooth or fibrillated cartilage. For all but one sample, sliding of smooth cartilage against any of the indenter surfaces did not cause damage. However, samples with fibrillated cartilage showed varied responses from seemingly unaffected to severe tissue wear as quantified by analysis of Indian ink staining and histology. INTERPRETATION This study demonstrates that the opposing cartilage quality is relevant for the clinical success of implanting an artificial implant in a focal cartilage defect. Therefore it is essential to test the efficacy of newly developed implants against arthritic joint surfaces, and care should be taken when interpreting in vivo studies in which implants are inserted in healthy joints.
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Affiliation(s)
- A H A Damen
- Orthopaedic Biomechanics, Dept. of Biomedical Engineering, Eindhoven University of Technology, the Netherlands
| | - M Nickien
- Orthopaedic Biomechanics, Dept. of Biomedical Engineering, Eindhoven University of Technology, the Netherlands
| | - K Ito
- Orthopaedic Biomechanics, Dept. of Biomedical Engineering, Eindhoven University of Technology, the Netherlands
| | - C C van Donkelaar
- Orthopaedic Biomechanics, Dept. of Biomedical Engineering, Eindhoven University of Technology, the Netherlands.
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The 3D-Printed Bilayer's Bioactive-Biomaterials Scaffold for Full-Thickness Articular Cartilage Defects Treatment. MATERIALS 2020; 13:ma13153417. [PMID: 32756370 PMCID: PMC7436011 DOI: 10.3390/ma13153417] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 11/22/2022]
Abstract
The full-thickness articular cartilage defect (FTAC) is an abnormally severe grade of articular cartilage (AC) injury. An osteochondral autograft transfer (OAT) is the recommended treatment, but the increasing morbidity rate from osteochondral plug harvesting is a limitation. Thus, the 3D-printed bilayer’s bioactive-biomaterials scaffold is of major interest. Polylactic acid (PLA) and polycaprolactone (PCL) were blended with hydroxyapatite (HA) for the 3D-printed bone layer of the bilayer’s bioactive-biomaterials scaffold (B-BBBS). Meanwhile, the blended PLA/PCL filament was 3D printed and combined with a chitosan (CS)/silk firoin (SF) using a lyophilization technique to fabricate the AC layer of the bilayer’s bioactive-biomaterials scaffold (AC-BBBS). Material characterization and mechanical and biological tests were performed. The fabrication process consists of combining the 3D-printed structure (AC-BBBS and B-BBBS) and a lyophilized porous AC-BBBS. The morphology and printing abilities were investigated, and biological tests were performed. Finite element analysis (FEA) was performed to predict the maximum load that the bilayer’s bioactive-biomaterials scaffold (BBBS) could carry. The presence of HA and CS/SF in the PLA/PCL structure increased cell proliferation. The FEA predicted the load carrying capacity to be up to 663.2 N. All tests indicated that it is possible for BBBS to be used in tissue engineering for AC and bone regeneration in FTAC treatment.
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Jeuken RM, Roth AK, Peters MJM, Welting TJM, van Rhijn LW, Koenen J, Peters RJRW, Thies JC, Emans PJ. In vitro and in vivo study on the osseointegration of BCP-coated versus uncoated nondegradable thermoplastic polyurethane focal knee resurfacing implants. J Biomed Mater Res B Appl Biomater 2020; 108:3370-3382. [PMID: 32614486 PMCID: PMC7586808 DOI: 10.1002/jbm.b.34672] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 04/18/2020] [Accepted: 06/03/2020] [Indexed: 11/10/2022]
Abstract
Focal knee resurfacing implants (FKRIs) are intended to treat cartilage defects in middle-aged patients. Most FKRIs are metal-based, which hampers follow-up of the joint using magnetic resonance imaging and potentially leads to damage of the opposing cartilage. The purpose of this study was to develop a nondegradable thermoplastic polyurethane (TPU) FKRI and investigate its osseointegration. Different surface roughness modifications and biphasic calcium phosphate (BCP) coating densities were first tested in vitro on TPU discs. The in vivo osseointegration of BCP-coated TPU implants was subsequently compared to uncoated TPU implants and the titanium bottom layer of metal control implants in a caprine model. Implants were implanted bilaterally in stifle joints and animals were followed for 12 weeks, after which the bone-to-implant contact area (BIC) was assessed. Additionally, 18F-sodium-fluoride (18F-NaF) positron emission tomography PET/CT-scans were obtained at 3 and 12 weeks to visualize the bone metabolism over time. The BIC was significantly higher for the BCP-coated TPU implants compared to the uncoated TPU implants (p = .03), and did not significantly differ from titanium (p = .68). Similar 18F-NaF tracer uptake patterns were observed between 3 and 12 weeks for the BCP-coated TPU and titanium implants, but not for the uncoated implants. TPU FKRIs with surface modifications could provide the answer to the drawbacks of metal FKRIs.
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Affiliation(s)
- Ralph M Jeuken
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Alex K Roth
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marloes J M Peters
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Tim J M Welting
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Lodewijk W van Rhijn
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jac Koenen
- DSM Biomedical BV, Geleen, The Netherlands
| | | | | | - Pieter J Emans
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, Maastricht, The Netherlands
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20
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Diermeier T, Venjakob A, Byrne K, Burgkart R, Foehr P, Milz S, Imhoff AB, Vogt S. Effects of focal metallic implants on opposing cartilage - an in-vitro study with an abrasion test machine. BMC Musculoskelet Disord 2020; 21:261. [PMID: 32316943 PMCID: PMC7175572 DOI: 10.1186/s12891-020-03292-4] [Citation(s) in RCA: 4] [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: 11/11/2019] [Accepted: 04/14/2020] [Indexed: 11/18/2022] Open
Abstract
Background For focal cartilage defects, biological repair might be ineffective in patients over 45 years. A focal metallic implant (FMI) (Hemi-CAP Arthrosurface Inc., Franklin, MA, USA) was designed to reduce symptoms. The aim of this study was to evaluate the effects of a FMI on the opposing tibial cartilage in a biomechanical set-up. It is hypothesized that a FMI would not damage the opposing cartilage under physiological loading conditions. Methods An abrasion machine was used to test the effects of cyclic loading on osteochondral plugs. The machine applied a compressive load of 33 N and sheared the samples 10 mm in the anteroposterior direction by 1 Hz. Tibial osteochondral plugs from porcine knees were placed in opposition to a FMI and cycled for 1 or 6 h. After testing each plug was fixed, stained and evaluated for cartilage damage. Results After 1 h of loading (n = 6), none of the osteochondral plugs showed histologic signs of degradation. After 6 h of loading (n = 6) three samples had histologic signs of injury in the tangential zone (grade 1) and one had signs of injury in the transitional and deep zones (grade 2). Exploration for 6 h resulted in significant more cartilage damage compared to the shorter exploration time (p = 0.06). However, no significant difference between saline and hyaluronic acid was evident (p = 0.55). Conclusion Under physiologic loading conditions, contact with a FMI leads to cartilage damage in the opposing articular cartilage in six hours. In clinical practice, a thorough analysis of pre-existing defects on the opposing cartilage is recommended when FMI is considered.
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Affiliation(s)
- Theresa Diermeier
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Arne Venjakob
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.,Department of Rheumatology and Arthroscopy, Marienkrankenhaus Düsseldorf-Kaiserswerth, Düsseldorf, Germany
| | - Kevin Byrne
- Department of Orthopaedics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rainer Burgkart
- Department for Orthopedics and Orthopedic Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Peter Foehr
- Department for Orthopedics and Orthopedic Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Stefan Milz
- Department of Anatomy Munich, Ludwig-Maximilians University Munich, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Stephan Vogt
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.,Department of Sports Orthopedics, Hessing Klinik, Augsburg, Germany
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21
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Schell H, Zimpfer E, Schmidt-Bleek K, Jung T, Duda GN, Ryd L. Treatment of osteochondral defects: chondrointegration of metal implants improves after hydroxyapatite coating. Knee Surg Sports Traumatol Arthrosc 2019; 27:3575-3582. [PMID: 30879107 DOI: 10.1007/s00167-019-05484-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 03/11/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE The treatment of osteochondral defects in joint cartilage remains challenging due to its limited repair capacity. This study presents a metallic osteochondral plug with hydroxyapatite (HA)-coated cap edges for improved implant-tissue contact. The hypothesis was that improved attachment prevents from synovial fluid-influx and thereby avoids osteolysis and resulting implant instability. METHODS In total, 24 female, adult sheep were randomized into three groups. All animals received an Episealer®-implant in the medial condyle of the right knee. The implants were coated with two different HA versions or uncoated (control group). After 12 weeks, the implant-tissue connections were analysed radiologically and histologically. RESULTS In general, the groups with the coated cap edges showed a better quality of tissue connection to the implant. The occurrence of gaps between tissue and implant was more seldom, the binding of calcified and hyaline cartilage to the cap was significantly better than in the uncoated group. A histomorphometrically measured lower amount of void space in these groups compared to the group with the uncoated edges confirmed that. CONCLUSIONS The hypothesis of a tighter cartilage bone contact was confirmed. The HA coating of the implant's cap edges resulted in better adherence of cartilage to the implant, which was not previously reported. In conclusion, this led to a better contact between implant and cartilage as well as neighbouring bone. In clinical routine, joint fluid is aggressive, penetrates through cartilage rifts, and promotes osteolysis and loosening of implants. The observed sealing effect will act to prevent joint fluid to get access to the implant-tissue interfaces. Joint fluid is aggressive, can cause osteolysis, and can, clinically cause pain. These effects are liable to decrease with these findings and will further the longevity of these osteochondral implants.
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Affiliation(s)
- Hanna Schell
- Julius Wolff Institut, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Elisabeth Zimpfer
- Julius Wolff Institut, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Schmidt-Bleek
- Julius Wolff Institut, Charité-Universitätsmedizin Berlin, Berlin, Germany. .,Berlin Brandenburg Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Tobias Jung
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Georg N Duda
- Julius Wolff Institut, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Brandenburg Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Leif Ryd
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institute, Stockholm, Sweden
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22
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Martinez-Carranza N, Hultenby K, Lagerstedt AS, Schupbach P, Berg HE. Cartilage Health in Knees Treated with Metal Resurfacing Implants or Untreated Focal Cartilage Lesions: A Preclinical Study in Sheep. Cartilage 2019; 10:120-128. [PMID: 28703030 PMCID: PMC6376557 DOI: 10.1177/1947603517720260] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Full-depth cartilage lesions do not heal and the long-term clinical outcome is uncertain. In the symptomatic middle-aged (35-60 years) patient, treatment with metal implants has been proposed. However, the cartilage health surrounding these implants has not been thoroughly studied. Our objective was to evaluate the health of cartilage opposing and adjacent to metal resurfacing implants. METHODS The medial femoral condyle was operated in 9 sheep bilaterally. A metallic resurfacing metallic implant was immediately inserted into an artificially created 7.5 mm defect while on the contralateral knee the defect was left untreated. Euthanasia was performed at 6 months. Six animals, of similar age and study duration, from a previous study were used for comparison in the evaluation of cartilage health adjacent to the implant. Cartilage damage to joint surfaces within the knee, cartilage repair of the defect, and cartilage adjacent to the implant was evaluated macroscopically and microscopically. RESULTS Six animals available for evaluation of cartilage health within the knee showed a varying degree of cartilage damage with no statistical difference between defects treated with implants or left untreated ( P = 0.51; 95% CI -3.7 to 6.5). The cartilage adjacent to the implant (score 0-14; where 14 indicates no damage) remained healthy in these 6 animals showing promising results (averaged 10.5; range 9-11.5, SD 0.95). Cartilage defects did not heal in any case. CONCLUSION Treatment of a critical size focal lesion with a metal implant is a viable alternative treatment.
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Affiliation(s)
- Nicolas Martinez-Carranza
- Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden,Institution of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden,Nicolas Martinez-Carranza, Institution of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
| | - Kjell Hultenby
- Division of Clinical Research Center, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anne Sofie Lagerstedt
- Department of Clinical Sciences, Swedish University of Agricultural Science, Uppsala, Sweden
| | - Peter Schupbach
- Schupbach Ltd, Service and Research Laboratory for Histology, Electron Microscopy and Micro CT, Horgen, Switzerland
| | - Hans E. Berg
- Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden,Institution of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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Heuijerjans A, Wilson W, Ito K, van Donkelaar CC. Osteochondral resurfacing implantation angle is more important than implant material stiffness. J Orthop Res 2018; 36:2911-2922. [PMID: 29943463 PMCID: PMC6586006 DOI: 10.1002/jor.24101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/18/2018] [Indexed: 02/04/2023]
Abstract
Osteochondral resurfacing implants are a promising treatment for focal cartilage defects. Several implant-factors may affect the clinical outcome of this treatment, such as the implant material stiffness and the accuracy of implant placement, known to be challenging. In general, softer implants are expected to be more accommodating for implant misalignment than stiffer implants, and motion is expected to increase effects from implant misalignment and stiffness. 3D finite element models of cartilage/cartilage contact were employed in which implantation angle (0°, 5°, 10°) and implant material stiffness (E = 5 MPa, 100 MPa, 2 GPa) were varied. A creep loading (0.6 MPa) was simulated, followed by a sliding motion. Creep loading resulted in low maximum collagen strains of 2.5% in the intact case compared to 11.7% with an empty defect. Implants mostly positively affected collagen strains, deviatoric strains, and hydrostatic pressures in the adjacent cartilage, but these effects were superior for correct alignment (0°). The main effect of implant misalignment was bulging of opposing cartilage tissue into the gap caused by the misalignment. This increased collagen strains and hydrostatic pressures. Deviatoric strains were increased adjacent to the gap. Subsequent sliding initially increased strains for a stiff, misaligned implant, but generally sliding decreased strains. In conclusion, implants can decrease the detrimental effect of defects, but correct implant alignment is crucial, more than implant material stiffness. Implant misalignment causes a gap, causing potentially damaging cartilage deformation during prolonged loading, for example, standing, even for soft implants. Mild motion may positively affect the cartilage. © 2018 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 36:2911-2922, 2018.
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Affiliation(s)
- Ashley Heuijerjans
- Orthopaedic BiomechanicsDepartment of Biomedical EngineeringEindhoven University of TechnologyP.O. Box 5135600MBEindhovenThe Netherlands
| | - Wouter Wilson
- Orthopaedic BiomechanicsDepartment of Biomedical EngineeringEindhoven University of TechnologyP.O. Box 5135600MBEindhovenThe Netherlands
| | - Keita Ito
- Orthopaedic BiomechanicsDepartment of Biomedical EngineeringEindhoven University of TechnologyP.O. Box 5135600MBEindhovenThe Netherlands
| | - Corrinus C. van Donkelaar
- Orthopaedic BiomechanicsDepartment of Biomedical EngineeringEindhoven University of TechnologyP.O. Box 5135600MBEindhovenThe Netherlands
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D'Ambrosi R, Usuelli FG. Osteochondral lesions of the talus: are we ready for metal? ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:S19. [PMID: 30613594 DOI: 10.21037/atm.2018.09.24] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Riccardo D'Ambrosi
- IRCCS Istituto Ortopedico Galeazzi, Unità Operativa C.A.S.C.O, Milan, Italy
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25
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Zevenbergen L, Smith CR, Van Rossom S, Thelen DG, Famaey N, Vander Sloten J, Jonkers I. Cartilage defect location and stiffness predispose the tibiofemoral joint to aberrant loading conditions during stance phase of gait. PLoS One 2018; 13:e0205842. [PMID: 30325946 PMCID: PMC6191138 DOI: 10.1371/journal.pone.0205842] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 10/02/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The current study quantified the influence of cartilage defect location on the tibiofemoral load distribution during gait. Furthermore, changes in local mechanical stiffness representative for matrix damage or bone ingrowth were investigated. This may provide insights in the mechanical factors contributing to cartilage degeneration in the presence of an articular cartilage defect. METHODS The load distribution following cartilage defects was calculated using a musculoskeletal model that included tibiofemoral and patellofemoral joints with 6 degrees-of-freedom. Circular cartilage defects of 100 mm2 were created at different locations in the tibiofemoral contact geometry. By assigning different mechanical properties to these defect locations, softening and hardening of the tissue were evaluated. RESULTS Results indicate that cartilage defects located at the load-bearing area only affect the load distribution of the involved compartment. Cartilage defects in the central part of the tibia plateau and anterior-central part of the medial femoral condyle present the largest influence on load distribution. Softening at the defect location results in overloading, i.e., increased contact pressure and compressive strains, of the surrounding tissue. In contrast, inside the defect, the contact pressure decreases and the compressive strain increases. Hardening at the defect location presents the opposite results in load distribution compared to softening. Sensitivity analysis reveals that the surrounding contact pressure, contact force and compressive strain alter significantly when the elastic modulus is below 7 MPa or above 18 MPa. CONCLUSION Alterations in local mechanical behavior within the high load bearing area resulted in aberrant loading conditions, thereby potentially affecting the homeostatic balance not only at the defect but also at the tissue surrounding and opposing the defect. Especially, cartilage softening predisposes the tissue to loads that may contribute to accelerated risk of cartilage degeneration and the initiation or progression towards osteoarthritis of the whole compartment.
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Affiliation(s)
- Lianne Zevenbergen
- Department of Movement Sciences, Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium
| | - Colin R. Smith
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Sam Van Rossom
- Department of Movement Sciences, Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium
| | - Darryl G. Thelen
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Nele Famaey
- Department of Mechanical Engineering, Biomechanics Section, KU Leuven, Leuven, Belgium
| | - Jos Vander Sloten
- Department of Mechanical Engineering, Biomechanics Section, KU Leuven, Leuven, Belgium
| | - Ilse Jonkers
- Department of Movement Sciences, Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium
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26
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Focal metallic inlay resurfacing prosthesis for the treatment of localized cartilage defects of the femoral condyles: a systematic review of clinical studies. Knee Surg Sports Traumatol Arthrosc 2018; 26:2722-2732. [PMID: 28918523 DOI: 10.1007/s00167-017-4714-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 09/08/2017] [Indexed: 01/22/2023]
Abstract
PURPOSE To systematically review the results of focal metallic inlay resurfacing prosthesis for the treatment of isolated cartilage defects of the femoral condyles. METHODS A systematic electronic search of the PubMed database and the Cochrane Library was performed in April 2017 to identify studies that reported clinical or radiographic outcome of focal metallic inlay resurfacing prosthesis for the treatment of isolated cartilage defects of the femoral condyles. Included studies were abstracted regarding study characteristics, patient demographics, prosthetic device and location, indications and contraindications, and outcome measures. Outcome of interest included functional outcome scores, radiographic measures, complications, re-operations, and conversion to arthroplasty. The methodologic quality of the included studies was assessed with the Coleman Methodology Score. RESULTS Six studies with a total of 186 patients met the inclusion criteria. Five studies were level IV evidence, and one was level III. The methodologic quality of the included studies was good, with a mean Coleman Methodology Score of 78. Two different implants were used: the HemiCAP® (five studies; 66% of study group) and UniCAP® (one study; 34%) implant. The mean age was 46-54 years, and the mean follow-up was 24 months to 7 years. Pre- and post-operative outcome scores were compared in all six studies, and five studies reported significant improvements at the final follow-up for all scores (objective und functional KSS, KOOS, WOMAC, Tegner, HSS Knee and Function score, SF-36 and SF-12 physical component score) except for the SF-36 and SF-12 mental component score. Progression of osteoarthritis was analysed using the Kellgren-Lawrence grading in three studies (30% of study group), with two studies reporting significant progression. The OARSI grading system was analysed in one study with no significant progression. The overall conversion rate to arthroplasty was 22% with considerable differences between the two implants: 9% for HemiCAP® and 47% for UniCAP®. CONCLUSIONS Focal metallic inlay resurfacing prosthesis seems to be a viable option for a carefully selected group of patients. Significant improvement in knee function and pain was observed in most patients. Uncertainty remains with regard to progression of osteoarthritis because of conflicting results and inconsistent reporting. One out of five patients has to be converted to arthroplasty after an average of 4 years. However, compared to the UniCAP® implant, considerable lower conversion rates were reported for the smaller HemiCAP® implant. LEVEL OF EVIDENCE Systematic review of level III and IV studies, Level IV.
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27
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Oláh T, Reinhard J, Gao L, Goebel LKH, Madry H. Reliable landmarks for precise topographical analyses of pathological structural changes of the ovine tibial plateau in 2-D and 3-D subspaces. Sci Rep 2018; 8:75. [PMID: 29311696 PMCID: PMC5758565 DOI: 10.1038/s41598-017-18426-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 12/06/2017] [Indexed: 11/09/2022] Open
Abstract
Selecting identical topographical locations to analyse pathological structural changes of the osteochondral unit in translational models remains difficult. The specific aim of the study was to provide objectively defined reference points on the ovine tibial plateau based on 2-D sections of micro-CT images useful for reproducible sample harvesting and as standardized landmarks for landmark-based 3-D image registration. We propose 5 reference points, 11 reference lines and 12 subregions that are detectable macroscopically and on 2-D micro-CT sections. Their value was confirmed applying landmark-based rigid and affine 3-D registration methods. Intra- and interobserver comparison showed high reliabilities, and constant positions (standard errors < 1%). Spatial patterns of the thicknesses of the articular cartilage and subchondral bone plate were revealed by measurements in 96 individual points of the tibial plateau. As a case study, pathological phenomena 6 months following OA induction in vivo such as osteophytes and areas of OA development were mapped to the individual subregions. These new reference points and subregions are directly identifiable on tibial plateau specimens or macroscopic images, enabling a precise topographical location of pathological structural changes of the osteochondral unit in both 2-D and 3-D subspaces in a region-appropriate fashion relevant for translational investigations.
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Affiliation(s)
- Tamás Oláh
- Center of Experimental Orthopaedics, Saarland University, Homburg, Germany
| | - Jan Reinhard
- Center of Experimental Orthopaedics, Saarland University, Homburg, Germany
| | - Liang Gao
- Center of Experimental Orthopaedics, Saarland University, Homburg, Germany
| | - Lars K H Goebel
- Center of Experimental Orthopaedics, Saarland University, Homburg, Germany.,Department of Orthopaedic Surgery, Saarland University Medical Center, Homburg, Germany
| | - Henning Madry
- Center of Experimental Orthopaedics, Saarland University, Homburg, Germany. .,Department of Orthopaedic Surgery, Saarland University Medical Center, Homburg, Germany.
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28
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No implant migration and good subjective outcome of a novel customized femoral resurfacing metal implant for focal chondral lesions. Knee Surg Sports Traumatol Arthrosc 2018; 26:2196-2204. [PMID: 29167954 PMCID: PMC6061440 DOI: 10.1007/s00167-017-4805-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 11/13/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE Managing focal cartilage injuries in the middle-aged patient poses a challenge. Focal prosthetic inlay resurfacing has been proposed to be a bridge between biologics and conventional joint arthroplasty. Patient selection and accurate implant positioning is crucial to avoid increased contact pressure to the opposite cartilage surface. A customized femoral condyle implant for focal cartilage injuries was designed to precisely fit each patient's individual size and location of damage. The primary objective was to assess implant safety profile, surgical usability of the implant and instruments, and implant migration with radiostereometric analysis (RSA). METHODS Ten patients 36-56 years with focal chondral defects, ICRS 3-4 of the femoral cartilage and failed earlier conservative or surgical interventions with VAS pain > 40. The patients were followed for 2 years with subjective outcome measures (VAS, EQ5D, KOOS) and RSA. The customized implant and guide instruments were manufactured by computer-aided design/computer-aided manufacturing (CAD/CAM) techniques using MRI data. RESULTS VAS, EQ5D and KOOS showed improvements that reached significance for VAS (p ≤ 0.001), Tegner (p = 0.034) and the KOOS subscores ADL (p = 0.0048), sport and recreation (p = 0.034) and quality of life (p = 0.037). VAS and KOOS scores improved gradually at 3, 6 and 12 months. The improvements in EQ5D, KOOS pain and KOOS symptoms did not reach statistical significance. No infections, deep venous thrombosis or other complications occured in the postoperative period. No radiographic signs of damage to the opposing tibial cartilage was noted. The surgical usability of implants and instruments were good. RSA did not show any implant migration. CONCLUSION This is the first clinical report of a new customized, focal knee resurfacing system. The short-term implant safety and patient-related outcome measures showed good-to-excellent results. LEVEL OF EVIDENCE Prospective case series, Level 4.
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Brzezinski A, Ghodbane SA, Patel JM, Perry BA, Gatt CJ, Dunn MG. * The Ovine Model for Meniscus Tissue Engineering: Considerations of Anatomy, Function, Implantation, and Evaluation. Tissue Eng Part C Methods 2017; 23:829-841. [PMID: 28805136 DOI: 10.1089/ten.tec.2017.0192] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Meniscus injuries represent one of the most-common intra-articular knee injuries. The current treatment options include meniscectomy and allograft transplantation, both with poor long-term outcomes. Therefore, there is a need for regenerative techniques to restore meniscal function. To preclinically test scaffolds for meniscus replacement, large animal models need to be established and standardized. This review establishes the anatomical and compositional similarities between human and sheep menisci and provides guidance for implantation and evaluation of such devices. The ovine meniscus represents a scaled-down version of the human meniscus, with only slight structural differences that can be addressed during device fabrication. Implantation protocols in sheep remain a challenge, as the meniscus cannot be visualized with the arthroscopic-assisted procedures commonly performed in human patients. Thus, we recommend the appropriate implantation protocols for meniscus visualization, ligamentous restoration, and surgical fixation of both total and partial meniscus replacement devices. Last, due to the lack of standardization in evaluation techniques, we recommend a comprehensive battery of tests to evaluate the efficacy of meniscus replacement implants. We recommend other investigators utilize these surgical and testing techniques to establish the ovine model as the gold standard for preclinical evaluation of meniscus replacement devices.
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Affiliation(s)
- Andrzej Brzezinski
- 1 Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences-Robert Wood Johnson Medical School , New Brunswick, New Jersey
| | - Salim A Ghodbane
- 1 Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences-Robert Wood Johnson Medical School , New Brunswick, New Jersey.,2 Department of Biomedical Engineering, Rutgers, The State University of New Jersey , Piscataway, New Jersey
| | - Jay M Patel
- 1 Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences-Robert Wood Johnson Medical School , New Brunswick, New Jersey.,2 Department of Biomedical Engineering, Rutgers, The State University of New Jersey , Piscataway, New Jersey
| | - Barbara A Perry
- 1 Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences-Robert Wood Johnson Medical School , New Brunswick, New Jersey
| | - Charles J Gatt
- 1 Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences-Robert Wood Johnson Medical School , New Brunswick, New Jersey.,2 Department of Biomedical Engineering, Rutgers, The State University of New Jersey , Piscataway, New Jersey
| | - Michael G Dunn
- 1 Department of Orthopaedic Surgery, Rutgers Biomedical and Health Sciences-Robert Wood Johnson Medical School , New Brunswick, New Jersey.,2 Department of Biomedical Engineering, Rutgers, The State University of New Jersey , Piscataway, New Jersey
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Focal articular prosthetic resurfacing for the treatment of full-thickness articular cartilage defects in the knee: 12-year follow-up of two cases and review of the literature. Arch Orthop Trauma Surg 2017; 137:1307-1317. [PMID: 28526923 DOI: 10.1007/s00402-017-2717-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The rationale of focal articular prosthetic resurfacing used as a primary arthroplasty procedure in the treatment of articular cartilage defects is still under debate. Conflicting reports raise concern about high rates of re-operations and continued development of osteoarthritis, while others have reported good outcomes. The goal of this paper is to present the long-term results of two patients with a 12-year follow-up and to report the results of a literature review. MATERIALS AND METHODS Two patients (male, 70 years; female 63 years) with a follow-up of 12 years were reviewed. Patients were evaluated with standard radiographs to assess the progression of osteoarthritis (OA), a clinical examination including the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Tegner activity scale. The literature review was performed using the search terms HemiCAP, focal, femoral, condyle, inlay, and resurfacing to identify articles published in the English language up until September 25, 2016. RESULTS The clinical and radiographic follow-ups of the patients were 11.9 and 11.8 years, respectively. Both patients were satisfied with their outcome and would have the operation again. Comparing the first postoperative to 12-year follow-up X-rays, the radiographic results demonstrated no signs of periprosthetic loosening, preservation of joint space, and no change in the osteoarthritic stage. KOOS Scores were 86 and 83 for pain, 89 and 93 for symptoms, 88 and 100 for activities of daily living (ADL), 75 and 65 for sports and recreation, and 75 and 81 for quality of life (QOL). The Tegner activity level was 5 and 4. The literature review comprised 6 studies with 169 focal articular prosthetic resurfacing procedures in 169 patients (84 male, 85 female) with a mean age at implantation ranging from 44.7 to 53.7 years and a follow-up range of 20 months to 7 years. Five studies were classified as level 4 and one as level 3. Clinical and radiographic results showed mainly good to excellent outcomes but were different among the studies depending on the indication. Re-operation rates ranged from 0 to 23% depending on the length of follow-up. CONCLUSIONS The results suggest that focal articular prosthetic resurfacing is an effective and safe treatment option in selected cases.
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31
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Diogo CC, Camassa JA, Pereira JE, Costa LMD, Filipe V, Couto PA, Geuna S, Maurício AC, Varejão AS. The use of sheep as a model for studying peripheral nerve regeneration following nerve injury: review of the literature. Neurol Res 2017; 39:926-939. [DOI: 10.1080/01616412.2017.1331873] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Camila Cardoso Diogo
- Department of Veterinary Sciences, University of Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal
| | - José Arthur Camassa
- Department of Veterinary Sciences, University of Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal
| | - José Eduardo Pereira
- Department of Veterinary Sciences, University of Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal
- CECAV, Centre for Animal Sciences and Veterinary Studies, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Luís Maltez da Costa
- Department of Veterinary Sciences, University of Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal
- CECAV, Centre for Animal Sciences and Veterinary Studies, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Vítor Filipe
- Department of Engineering, School of Science and Technology, University of Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal
- INESC TEC, Porto, Portugal
| | - Pedro Alexandre Couto
- Department of Engineering, School of Science and Technology, University of Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal
- CITAB, Centre for the Research and Technology of Agro-Environmental and Biological Sciences, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Stefano Geuna
- Department of Clinical and Biological Sciences, University of Turin, Torino, Italy
| | - Ana Colette Maurício
- Department of Veterinary Clinics, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto (UP), Porto, Portugal
- Animal Science and Study Centre (CECA), Food and Agrarian Sciences and Technologies Institute (ICETA), University of Porto, Porto, Portugal
| | - Artur Severo Varejão
- Department of Veterinary Sciences, University of Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal
- CECAV, Centre for Animal Sciences and Veterinary Studies, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal
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Goebel L, Kohn D, Madry H. Biological Reconstruction of the Osteochondral Unit After Failed Focal Resurfacing of a Chondral Defect in the Knee. Am J Sports Med 2016; 44:2911-2916. [PMID: 27411359 DOI: 10.1177/0363546516654910] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Lars Goebel
- Center of Experimental Orthopaedics and Osteoarthritis Research, Saarland University, Homburg/Saar, Germany.,Department of Orthopaedic Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Dieter Kohn
- Department of Orthopaedic Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Henning Madry
- Center of Experimental Orthopaedics and Osteoarthritis Research, Saarland University, Homburg/Saar, Germany .,Department of Orthopaedic Surgery, Saarland University Medical Center, Homburg/Saar, Germany
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33
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Zaino NL, Hedgeland MJ, Ciani MJ, Clark AM, Kuxhaus L, Michalek AJ. White-Tailed Deer as an Ex Vivo Knee Model: Joint Morphometry and ACL Rupture Strength. Ann Biomed Eng 2016; 45:1093-1100. [PMID: 27718092 DOI: 10.1007/s10439-016-1746-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 10/04/2016] [Indexed: 11/30/2022]
Abstract
Animal joints are valuable proxies for those of humans in biomechanical studies, however commonly used quadruped knees differ greatly from human knees in scale and morphometry. To test the suitability of the cervine stifle joint (deer knee) as a laboratory model, gross morphometry, ACL cross section, and ACL rupture strength were measured and compared to values previously reported for the knees of humans and commonly studied animals. Twelve knee joints from wild white-tailed deer were tested. Several morphometry parameters, including bicondylar width (53.5 ± 3.0 mm) and notch width (14.7 ± 2.5 mm), showed a high degree of similarity to those of the human knee, while both medial (16.7 ± 2.1°) and lateral (17.6 ± 4.7°) tibial slopes were steeper than in humans but less steep than other quadrupeds. The median ACL rupture force (2054 N, 95% CI 2017-2256 N), mean stiffness (260 ± 166 N/mm), mean length (33 ± 7 mm), and mean cross sectional area (44.8 ± 18.3 mm2) were also comparable to previously reported values for human knees. In our limited sample size, no significant sexual dimorphism in strength or morphometry was observed (p ≥ 0.05 for all parameters), though female specimens generally had steeper tibial slopes (lateral: p = 0.52, medial: p = 0.07). Our results suggest that the deer knee may be a suitable model for ex vivo studies of ACL rupture and repair.
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Affiliation(s)
- Nicole L Zaino
- Department of Mechanical & Aeronautical Engineering, Clarkson University, 8 Clarkson Ave., Box 5725, Potsdam, NY, 13699, USA
| | - Mark J Hedgeland
- Department of Mechanical & Aeronautical Engineering, Clarkson University, 8 Clarkson Ave., Box 5725, Potsdam, NY, 13699, USA
| | - Mario J Ciani
- Department of Occupational Therapy, Clarkson University, Potsdam, USA
| | | | - Laurel Kuxhaus
- Department of Mechanical & Aeronautical Engineering, Clarkson University, 8 Clarkson Ave., Box 5725, Potsdam, NY, 13699, USA
| | - Arthur J Michalek
- Department of Mechanical & Aeronautical Engineering, Clarkson University, 8 Clarkson Ave., Box 5725, Potsdam, NY, 13699, USA.
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Jeuken RM, Roth AK, Peters RJRW, Van Donkelaar CC, Thies JC, Van Rhijn LW, Emans PJ. Polymers in Cartilage Defect Repair of the Knee: Current Status and Future Prospects. Polymers (Basel) 2016; 8:E219. [PMID: 30979313 PMCID: PMC6432241 DOI: 10.3390/polym8060219] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/26/2016] [Accepted: 05/31/2016] [Indexed: 02/06/2023] Open
Abstract
Cartilage defects in the knee are often seen in young and active patients. There is a need for effective joint preserving treatments in patients suffering from cartilage defects, as untreated defects often lead to osteoarthritis. Within the last two decades, tissue engineering based techniques using a wide variety of polymers, cell sources, and signaling molecules have been evaluated. We start this review with basic background information on cartilage structure, its intrinsic repair, and an overview of the cartilage repair treatments from a historical perspective. Next, we thoroughly discuss polymer construct components and their current use in commercially available constructs. Finally, we provide an in-depth discussion about construct considerations such as degradation rates, cell sources, mechanical properties, joint homeostasis, and non-degradable/hybrid resurfacing techniques. As future prospects in cartilage repair, we foresee developments in three areas: first, further optimization of degradable scaffolds towards more biomimetic grafts and improved joint environment. Second, we predict that patient-specific non-degradable resurfacing implants will become increasingly applied and will provide a feasible treatment for older patients or failed regenerative treatments. Third, we foresee an increase of interest in hybrid construct, which combines degradable with non-degradable materials.
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Affiliation(s)
- Ralph M Jeuken
- Department of Orthopaedic Surgery, Maastricht University Medical Center, P. Debyelaan 25, Maastricht 6229 HX, The Netherlands.
| | - Alex K Roth
- Department of Orthopaedic Surgery, Maastricht University Medical Center, P. Debyelaan 25, Maastricht 6229 HX, The Netherlands.
| | | | - Corrinus C Van Donkelaar
- Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, Eindhoven 5600 MB, The Netherlands.
| | - Jens C Thies
- DSM Biomedical, Koestraat 1, Geleen 6167 RA, The Netherlands.
| | - Lodewijk W Van Rhijn
- Department of Orthopaedic Surgery, Maastricht University Medical Center, P. Debyelaan 25, Maastricht 6229 HX, The Netherlands.
| | - Pieter J Emans
- Department of Orthopaedic Surgery, Maastricht University Medical Center, P. Debyelaan 25, Maastricht 6229 HX, The Netherlands.
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