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Koh J, Diaz RL, Tafur JC, Lin Y, Echenique DB, Amirouche F. Small Chondral Defects Affect Tibiofemoral Contact Area and Stress: Should a Lower Threshold Be Used for Intervention? Orthop J Sports Med 2022; 10:23259671221129308. [PMID: 36419474 PMCID: PMC9677309 DOI: 10.1177/23259671221129308] [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: 06/29/2022] [Accepted: 07/27/2022] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Chondral defects in the knee have biomechanical differences because of defect size and location. Prior literature only compares the maximum stress experienced with large defects. HYPOTHESIS It was hypothesized that pressure surrounding the chondral defect would increase with size and vary in location, such that a size cutoff exists that suggests surgical intervention. STUDY DESIGN Controlled laboratory study. METHODS Isolated chondral defects from 0.09 to 1.0 cm2 were created on the medial and lateral femoral condyles of 6 human cadaveric knees. The knees were fixed to a uniaxial load frame and loaded from 0 to 600 N at full extension. Another defect was created at the point of tibiofemoral contact at 30° of flexion. Tibiofemoral contact pressures were measured. Peak contact pressure was the highest value in the area delimited within a 3-mm rim around the defect. The location of the peak contact pressure was determined. RESULTS At full extension, the mean maximum pressures on the medial femoral condyle ranged from 4.30 to 6.91 MPa at 0.09 and 1.0 cm2, respectively (P < .01). The location of the peak pressure was found posteromedial in defects between 0.09 and 0.25 cm2, shifting anterolaterally at sizes 0.49 and 1.0 cm2 (P < .01). The maximum pressures on the lateral femoral condyle ranged from 3.63 to 5.81 MPa at 0.09 and 1.0 cm2, respectively (P = .02). The location of the peak contact pressure point was anterolateral in defects between 0.09 and 0.25 cm2, shifting posterolaterally at 0.49 and 1.0 cm2 (P < .01). No differences in contact pressure between full extension and 30° of flexion were found for either the lateral or medial condyles. CONCLUSION Full-thickness chondral defects bilaterally had a significant increase in contact pressure between defect sizes of 0.49 and 1.0 cm2. The location of the maximum contact pressures surrounding the lesion also varied with larger defects. Contact area redistribution and cartilage stress change may affect adjacent cartilage integrity. CLINICAL RELEVANCE Size cutoffs may exist earlier in the natural history of chondral defects than previously realized, suggesting a lower threshold for intervention.
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Affiliation(s)
- Jason Koh
- Orthopaedic and Spine Institute, NorthShore University Health
System, Evanston, Illinois, USA
| | - Roberto Leonardo Diaz
- Department of Orthopaedics, University of Illinois at Chicago,
Chicago, Illinois, USA
| | - Julio Castillo Tafur
- Department of Orthopaedics, University of Illinois at Chicago,
Chicago, Illinois, USA
| | - Ye Lin
- Department of Orthopaedics, University of Illinois at Chicago,
Chicago, Illinois, USA
| | | | - Farid Amirouche
- Orthopaedic and Spine Institute, NorthShore University Health
System, Evanston, Illinois, USA
- Department of Orthopaedics, University of Illinois at Chicago,
Chicago, Illinois, USA
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2
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Randsborg PH, Årøen A, Owesen C. The Effect of Lesion Size on Pain and Function in Patients Scheduled for Cartilage Surgery of the Knee. Cartilage 2022; 13:19476035221109242. [PMID: 35815409 PMCID: PMC9277437 DOI: 10.1177/19476035221109242] [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] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Despite an increased interest in treatment options for cartilage lesions of the knee, the relationship between lesion characteristics and the symptoms they elicit is not well understood. We evaluated the relationship between lesion characteristics and the patient-reported outcome measures (PROMs) and compared this with symptoms reported by patients scheduled for knee ligament reconstruction and knee arthroplasty. DESIGN Preoperative data, including Lysholm score and The Knee Injury and Osteoarthritis Outcome Score (KOOS), in 90 consecutive patients scheduled for surgery for symptomatic isolated cartilage lesions were prospectively collected. RESULT The patients had a mean age of 33.2 years. There were 62 (69%) males. There was no statistically significant difference in PROMs between patients with cartilage lesions smaller or larger than 2 cm2, except for the KOOS subscale symptoms, with patients with smaller lesions reporting higher scores, 62.8 (95% confidence interval [CI] 58.3-67.3) vs. 51.9 (95% CI 45.5-58.4), P = 0.005. There was a small correlation between lesion size and Lysholm score. However, when adjusted for age, sex, body mass index, and lesion localization, this effect was not statistically significant. The International Cartilage Regeneration & Joint Preservation Society grade did not affect preoperative PROMs. Cartilage patients reported worse preoperative symptoms than patients scheduled for knee ligament reconstruction, and approaching the symptoms reported by patients scheduled for knee arthroplasty. CONCLUSION The size, depth, and location of cartilage lesions have little impact on the symptoms experienced by the patients. Cartilage patients have comparable symptoms to patients scheduled for knee arthroplasty.
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Affiliation(s)
- Per-Henrik Randsborg
- Department of Orthopedic Surgery,
Akershus University Hospital, Lørenskog, Norway,Per-Henrik Randsborg, Department of
Orthopedic Surgery, Akershus University Hospital, Sykehusveien, 1478 Lørenskog,
Norway.
| | - Asbjørn Årøen
- Department of Orthopedic Surgery,
Akershus University Hospital, Lørenskog, Norway,Institute of Clinical Medicine,
University of Oslo, Lørenskog, Norway
| | - Christian Owesen
- Department of Orthopedic Surgery,
Akershus University Hospital, Lørenskog, Norway
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3
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Hossain MA, Adithan A, Alam MJ, Kopalli SR, Kim B, Kang CW, Hwang KC, Kim JH. IGF-1 Facilitates Cartilage Reconstruction by Regulating PI3K/AKT, MAPK, and NF-kB Signaling in Rabbit Osteoarthritis. J Inflamm Res 2021; 14:3555-3568. [PMID: 34335042 PMCID: PMC8318731 DOI: 10.2147/jir.s316756] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/12/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose The pathogenesis of osteoarthritis (OA) is characterized by joint degeneration. The pro-inflammatory cytokine interleukin (IL)-1β plays a vital role in the pathogenesis of OA by stimulation of specific signaling pathways like NF-κB, PI3K/Akt, and MAPKs pathways. The catabolic role of growth factors in the OA may be inhibited cytokine-activated pathogen. The purpose of this study was to investigate the potential effects of insulin-like growth factor-1 (IGF-1) on IL-1β-induced apoptosis in rabbit chondrocytes in vitro and in an in vivo rabbit knee OA model. Methods In the present study, the OA developed in chondrocyte with the treatment of IL-1β and articular cartilage ruptures by removal of cartilage from the rabbit knee femoral condyle. After IGF-1 treatment, immunohistochemistry and qRT-PCR were identified OA expression with changes in MMPs (matrix metalloproteinases). The production of ROS (intracellular reactive oxygen species) in the OA was detected by flow cytometry. Further, the disease progression was microscopically investigated and pathophysiological changes were analyzed using histology. The NF-κB, PI3K/Akt and P38 (MAPK) specific pathways that are associated with disease progression were also checked using the Western blot technique. Results The expression of MMPs and various apoptotic markers are down-regulated following administration of IGF-1 in a dose-dependent fashion while significantly up-regulation of TIMP-1. The results showed that higher levels of ROS were observed upon treatment of chondrocytes and chondral OA with IL-1β. Collectively, our results indicated that IGF-1 protected NF-κB pathway by suppression of PI3K/Akt and MAPKs specific pathways. Furthermore, the macroscopic and pathological investigation showed that it has a chondroprotective effect by the formation of hyaline cartilage. Conclusion Our results indicate a protective effect of IGF-1 against OA pathogenesis by inhibition of NF-κB signaling via regulation of the MAPK and PI3K/Akt signaling pathways and prevention of apoptosis by suppression of ROS production.
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Affiliation(s)
- Mohammad Amjad Hossain
- College of Veterinary Medicine, Biosafety Research Institute, Chonbuk National University, Iksan-city, Jeollabuk-Do, Republic of Korea
| | - Aravinthan Adithan
- College of Veterinary Medicine, Biosafety Research Institute, Chonbuk National University, Iksan-city, Jeollabuk-Do, Republic of Korea
| | - Md Jahangir Alam
- College of Veterinary Medicine, Biosafety Research Institute, Chonbuk National University, Iksan-city, Jeollabuk-Do, Republic of Korea
| | - Spandana Rajendra Kopalli
- Department of Integrative Bioscience and Biotechnology, Sejong University, Gwangjin-gu, Seoul, 05006, Republic of Korea
| | - Bumseok Kim
- College of Veterinary Medicine, Biosafety Research Institute, Chonbuk National University, Iksan-city, Jeollabuk-Do, Republic of Korea
| | - Chang-Won Kang
- College of Veterinary Medicine, Biosafety Research Institute, Chonbuk National University, Iksan-city, Jeollabuk-Do, Republic of Korea
| | - Ki-Chul Hwang
- Institute for Bio-Medical Convergence, College of Medicine, Catholic Kwandong University, Gangneung-si, Gangwon-do, Republic of Korea
| | - Jong-Hoon Kim
- College of Veterinary Medicine, Biosafety Research Institute, Chonbuk National University, Iksan-city, Jeollabuk-Do, Republic of Korea
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4
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Additive manufacturing of an elastic poly(ester)urethane for cartilage tissue engineering. Acta Biomater 2020; 102:192-204. [PMID: 31778830 DOI: 10.1016/j.actbio.2019.11.041] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 01/08/2023]
Abstract
Although a growing knowledge on the field of tissue engineering of articular cartilage exists, reconstruction or in-vitro growth of functional hyaline tissue still represents an unmet challenge. Despite the simplicity of the tissue in terms of cell population and absence of innervation and vascularization, the outstanding mechanical properties of articular cartilage, which are the result of the specificity of its extra cellular matrix (ECM), are difficult to mimic. Most importantly, controlling the differentiation state or phenotype of chondrocytes, which are responsible of the deposition of this specialized ECM, represents a milestone in the regeneration of native articular cartilage. In this study, we fabricated fused deposition modelled (FDM) scaffolds with different pore sizes and architectures from an elastic and biodegradable poly(ester)urethane (PEU) with mechanical properties that can be modulated by design, and that ranged the elasticity of articular cartilage. Cell culture in additive manufactured 3D scaffolds exceeded the chondrogenic potential of the gold-standard pellet culture. In-vitro cell culture studies demonstrated the intrinsic potential of elastic (PEU) to drive the re-differentiation of de-differentiated chondrocytes when cultured in-vitro, in differentiation or basal media, better than pellet cultures. The formation of neo-tissue was assessed as a high deposition of GAGs and fibrillar collagen II, and a high expression of typical chondrogenic markers. Moreover, the collagen II / collagen I ratio commonly used to evaluate the differentiation state of chondrocytes (ratio > 1 being chondrocytes and, ratio < 0 being de-differentiated chondrocytes) was higher than 5. STATEMENT OF SIGNIFICANCE: Tissue engineering of articular cartilage requires material scaffolds capable of driving the deposition of a coherent and specific ECM representative of articular cartilage. Materials explored so far account for low mechanical properties (hydrogels), or are too stiff to mimic the elasticity of the native tissue (traditional polyesters). Here, we fabricated 3D fibrous scaffolds via FDM with a biodegradable poly(ester)urethane. The compressive Young`s modulus and elastic limit of the scaffolds can be tuned by designed, mimicking those of the native tissue. The designed scaffolds showed an intrinsic potential to drive the formation of a GAG and collagen II rich ECM, and to drive a stable chondrogenic cell phenotype.
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5
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Sismondo RA, Werner FW, Ordway NR, Osaheni AO, Blum MM, Scuderi MG. The use of a hydrogel implant in the repair of osteochondral defects of the knee: A biomechanical evaluation of restoration of native contact pressures in cadaver knees. Clin Biomech (Bristol, Avon) 2019; 67:15-19. [PMID: 31054437 DOI: 10.1016/j.clinbiomech.2019.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 03/08/2019] [Accepted: 04/24/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Osteochondral injuries have been treated by a variety of methods, each having its own drawbacks. The purpose of this study was to determine the biomechanical feasibility of using a hydrogel implant replacement for an osteochondral core defect. The hypothesis of this study was that the contact pressure of the native knee can be recreated with the use of a hydrogel implant. METHODS Six cadaver knees were tested in a knee simulator while contact pressures were measured on the tibial plateau. Pressure data was collected in the intact knee, after coring of the condyle and after insertion of a hydrogel implant. Following 1000 gait cycles of fatigue testing, each knee was taken through axial loading indentation testing where the stiffness of the in situ implant was compared to the contralateral condyle. FINDINGS While coring significantly reduced the peak pressure at the coring site from 1.8 MPa in the intact knee to 0.0 MPa after coring, implant insertion significantly increased it to 1.2 MPa. There was no significant difference in the peak pressures or the average pressures at the hole location between the intact knee and following implant insertion. After fatigue testing, no macroscopic loosening or implant damage was observed. Based on indentation testing, the stiffness of the medial condyle, 157 N/mm, was significantly less than the lateral condyle, 696 N/mm. INTERPRETATION The insertion of the hydrogel implant was able to achieve restoration of contact pressures in the knee supporting the viability of hydrogel implants in the treatment of osteochondral lesions of the knee.
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Affiliation(s)
- Ronald A Sismondo
- SUNY Upstate Medical University, 750 E. Adams Street, Syracuse, NY 13210, USA
| | - Frederick W Werner
- SUNY Upstate Medical University, 750 E. Adams Street, Syracuse, NY 13210, USA.
| | - Nathaniel R Ordway
- SUNY Upstate Medical University, 750 E. Adams Street, Syracuse, NY 13210, USA.
| | - Allen O Osaheni
- Syracuse Biomaterials Institute, Syracuse University, Syracuse, NY 13244, USA.
| | - Michelle M Blum
- Syracuse Biomaterials Institute, Syracuse University, Syracuse, NY 13244, USA.
| | - Matthew G Scuderi
- SUNY Upstate Medical University, 750 E. Adams Street, Syracuse, NY 13210, USA.
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6
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Grant JA. Outcomes Associated with Return to Sports Following Osteochondral Allograft Transplant in the Knee: a Scoping Review. Curr Rev Musculoskelet Med 2019; 12:181-189. [PMID: 31037518 DOI: 10.1007/s12178-019-09557-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW The purposes of this review were to report the currently validated outcomes for OCA transplant patients, discuss the benefits and challenges associated with "return to sports" as an outcome measure, and summarize the currently available data on patients' ability to return to sports after OCA transplant. RECENT FINDINGS College athletes may take less time than professionals to return to basketball, but there are many factors that can influence this timeframe. Player productivity is decreased ~ 40% and future career length is only 1 to 2 years following return to play. When evaluating all OCA transplant patients, 75-88% of patients return to sport and 38-80% return to their previous level of play at approximately 8-10 months following surgery. Overall graft failure rates are low (0-9.4%) but are based on limited short- to medium-term data. Data on the return to professional and college sports after OCA transplant is limited. Surgeons should consider collecting patient outcomes across multiple domains and contributing data to aggregate databases to allow for better quality outcome data to be reported.
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Affiliation(s)
- John A Grant
- MedSport, University of Michigan, 24 Frank Lloyd Wright Dr. Suite 1000, Box 391, Ann Arbor, MI, 48106, USA.
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7
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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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8
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Jia Z, Liu Q, Liang Y, Li X, Xu X, Ouyang K, Xiong J, Wang D, Duan L. Repair of articular cartilage defects with intra-articular injection of autologous rabbit synovial fluid-derived mesenchymal stem cells. J Transl Med 2018; 16:123. [PMID: 29739472 PMCID: PMC5941664 DOI: 10.1186/s12967-018-1485-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 04/17/2018] [Indexed: 02/07/2023] Open
Abstract
Background The role of rabbit synovial fluid-derived mesenchymal stem cells (rbSF-MSCs) in cartilage defect repair remains undefined. This work evaluates the in vivo effects of rbSF-MSCs to repair knee articular cartilage defects in a rabbit model. Methods Cartilage defects were made in the patellar grooves of New Zealand white rabbits. The rbSF-MSCs were generated from the knee cavity by arthrocentesis. Passage 5 rbSF-MSCs were assayed by flow cytometry. The multipotency of rbSF-MSCs was confirmed after 3 weeks induction in vitro and the autologous rbSF-MSCs and predifferentiated rbSF-MSCs were injected into the synovial cavity. The intra-articular injection was performed once a week for 4 weeks. The animals were euthanized and the articular surfaces were subjected to macroscopic and histological evaluations at 8 and 12 weeks after the first intra-articular injection. Results Hyaline-like cartilage was detected in the defects treated with rbSF-MSCs, while fibrocartilage tissue formed in the defects treated with chondrocytes induced from rbSF-MSCs. Conclusions Our results suggest that autologous undifferentiated rbSF-MSCs are favorable to articular cartilage regeneration in treating cartilage defects. Electronic supplementary material The online version of this article (10.1186/s12967-018-1485-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zhaofeng Jia
- Postgraduate Institution, Guangzhou Medical University, Guangzhou, 511436, Guangdong Province, China.,Shenzhen Key Laboratory of Tissue Engineering, Shenzhen Laboratory of Digital Orthopeadic Engineering, Shenzhen Second Peoples Hospital (The First Hospital Affiliated to Shenzhen University), Shenzhen, 518035, Guangdong Province, China.,Guangdong Provincial Research Center for Artificial Intelligence and Digital Orthopedic Technology, Shenzhen, 518035, People's Republic of China
| | - Qisong Liu
- Shenzhen Key Laboratory of Tissue Engineering, Shenzhen Laboratory of Digital Orthopeadic Engineering, Shenzhen Second Peoples Hospital (The First Hospital Affiliated to Shenzhen University), Shenzhen, 518035, Guangdong Province, China.,Guangdong Provincial Research Center for Artificial Intelligence and Digital Orthopedic Technology, Shenzhen, 518035, People's Republic of China
| | - Yujie Liang
- Department of Chemistry, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.,Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, 518035, Guangdong Province, People's Republic of China
| | - Xingfu Li
- Shenzhen Key Laboratory of Tissue Engineering, Shenzhen Laboratory of Digital Orthopeadic Engineering, Shenzhen Second Peoples Hospital (The First Hospital Affiliated to Shenzhen University), Shenzhen, 518035, Guangdong Province, China.,Guangdong Provincial Research Center for Artificial Intelligence and Digital Orthopedic Technology, Shenzhen, 518035, People's Republic of China
| | - Xiao Xu
- Postgraduate Institution, Guangzhou Medical University, Guangzhou, 511436, Guangdong Province, China.,Shenzhen Key Laboratory of Tissue Engineering, Shenzhen Laboratory of Digital Orthopeadic Engineering, Shenzhen Second Peoples Hospital (The First Hospital Affiliated to Shenzhen University), Shenzhen, 518035, Guangdong Province, China.,Guangdong Provincial Research Center for Artificial Intelligence and Digital Orthopedic Technology, Shenzhen, 518035, People's Republic of China
| | - Kan Ouyang
- Shenzhen Key Laboratory of Tissue Engineering, Shenzhen Laboratory of Digital Orthopeadic Engineering, Shenzhen Second Peoples Hospital (The First Hospital Affiliated to Shenzhen University), Shenzhen, 518035, Guangdong Province, China.,Guangdong Provincial Research Center for Artificial Intelligence and Digital Orthopedic Technology, Shenzhen, 518035, People's Republic of China
| | - Jianyi Xiong
- Shenzhen Key Laboratory of Tissue Engineering, Shenzhen Laboratory of Digital Orthopeadic Engineering, Shenzhen Second Peoples Hospital (The First Hospital Affiliated to Shenzhen University), Shenzhen, 518035, Guangdong Province, China.,Guangdong Provincial Research Center for Artificial Intelligence and Digital Orthopedic Technology, Shenzhen, 518035, People's Republic of China
| | - Daping Wang
- Postgraduate Institution, Guangzhou Medical University, Guangzhou, 511436, Guangdong Province, China. .,Shenzhen Key Laboratory of Tissue Engineering, Shenzhen Laboratory of Digital Orthopeadic Engineering, Shenzhen Second Peoples Hospital (The First Hospital Affiliated to Shenzhen University), Shenzhen, 518035, Guangdong Province, China. .,Guangdong Provincial Research Center for Artificial Intelligence and Digital Orthopedic Technology, Shenzhen, 518035, People's Republic of China.
| | - Li Duan
- Shenzhen Key Laboratory of Tissue Engineering, Shenzhen Laboratory of Digital Orthopeadic Engineering, Shenzhen Second Peoples Hospital (The First Hospital Affiliated to Shenzhen University), Shenzhen, 518035, Guangdong Province, China. .,Guangdong Provincial Research Center for Artificial Intelligence and Digital Orthopedic Technology, Shenzhen, 518035, People's Republic of China.
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9
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Mistry H, Connock M, Pink J, Shyangdan D, Clar C, Royle P, Court R, Biant LC, Metcalfe A, Waugh N. Autologous chondrocyte implantation in the knee: systematic review and economic evaluation. Health Technol Assess 2018; 21:1-294. [PMID: 28244303 DOI: 10.3310/hta21060] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The surfaces of the bones in the knee are covered with articular cartilage, a rubber-like substance that is very smooth, allowing frictionless movement in the joint and acting as a shock absorber. The cells that form the cartilage are called chondrocytes. Natural cartilage is called hyaline cartilage. Articular cartilage has very little capacity for self-repair, so damage may be permanent. Various methods have been used to try to repair cartilage. Autologous chondrocyte implantation (ACI) involves laboratory culture of cartilage-producing cells from the knee and then implanting them into the chondral defect. OBJECTIVE To assess the clinical effectiveness and cost-effectiveness of ACI in chondral defects in the knee, compared with microfracture (MF). DATA SOURCES A broad search was done in MEDLINE, EMBASE, The Cochrane Library, NHS Economic Evaluation Database and Web of Science, for studies published since the last Health Technology Assessment review. REVIEW METHODS Systematic review of recent reviews, trials, long-term observational studies and economic evaluations of the use of ACI and MF for repairing symptomatic articular cartilage defects of the knee. A new economic model was constructed. Submissions from two manufacturers and the ACTIVE (Autologous Chondrocyte Transplantation/Implantation Versus Existing Treatment) trial group were reviewed. Survival analysis was based on long-term observational studies. RESULTS Four randomised controlled trials (RCTs) published since the last appraisal provided evidence on the efficacy of ACI. The SUMMIT (Superiority of Matrix-induced autologous chondrocyte implant versus Microfracture for Treatment of symptomatic articular cartilage defects) trial compared matrix-applied chondrocyte implantation (MACI®) against MF. The TIG/ACT/01/2000 (TIG/ACT) trial compared ACI with characterised chondrocytes against MF. The ACTIVE trial compared several forms of ACI against standard treatments, mainly MF. In the SUMMIT trial, improvements in knee injury and osteoarthritis outcome scores (KOOSs), and the proportion of responders, were greater in the MACI group than in the MF group. In the TIG/ACT trial there was improvement in the KOOS at 60 months, but no difference between ACI and MF overall. Patients with onset of symptoms < 3 years' duration did better with ACI. Results from ACTIVE have not yet been published. Survival analysis suggests that long-term results are better with ACI than with MF. Economic modelling suggested that ACI was cost-effective compared with MF across a range of scenarios. LIMITATIONS The main limitation is the lack of RCT data beyond 5 years of follow-up. A second is that the techniques of ACI are evolving, so long-term data come from trials using forms of ACI that are now superseded. In the modelling, we therefore assumed that durability of cartilage repair as seen in studies of older forms of ACI could be applied in modelling of newer forms. A third is that the high list prices of chondrocytes are reduced by confidential discounting. The main research needs are for longer-term follow-up and for trials of the next generation of ACI. CONCLUSIONS The evidence base for ACI has improved since the last appraisal by the National Institute for Health and Care Excellence. In most analyses, the incremental cost-effectiveness ratios for ACI compared with MF appear to be within a range usually considered acceptable. Research is needed into long-term results of new forms of ACI. STUDY REGISTRATION This study is registered as PROSPERO CRD42014013083. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Hema Mistry
- Warwick Evidence, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Martin Connock
- Warwick Evidence, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Joshua Pink
- Warwick Evidence, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Deepson Shyangdan
- Warwick Evidence, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Christine Clar
- Warwick Evidence, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Pamela Royle
- Warwick Evidence, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Rachel Court
- Warwick Evidence, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Leela C Biant
- Department of Trauma and Orthopaedic Surgery, University of Manchester, Manchester, UK
| | - Andrew Metcalfe
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Norman Waugh
- Warwick Evidence, Division of Health Sciences, University of Warwick, Coventry, UK
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10
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He A, Xia H, Xiao K, Wang T, Liu Y, Xue J, Li D, Tang S, Liu F, Wang X, Zhang W, Liu W, Cao Y, Zhou G. Cell yield, chondrogenic potential, and regenerated cartilage type of chondrocytes derived from ear, nasoseptal, and costal cartilage. J Tissue Eng Regen Med 2017; 12:1123-1132. [PMID: 29139602 DOI: 10.1002/term.2613] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 08/24/2017] [Accepted: 10/28/2017] [Indexed: 11/12/2022]
Abstract
Functional reconstruction of large cartilage defects in subcutaneous sites remains clinically challenging because of limited donor cartilage. Tissue engineering is a promising and widely accepted strategy for cartilage regeneration. To date, however, this strategy has not achieved a significant breakthrough in clinical translation owing to a lack of detailed preclinical data on cell yield and functionality of clinically applicable chondrocytes. To address this issue, the current study investigated the initial cell yield, proliferative potential, chondrogenic capacity, and regenerated cartilage type of human chondrocytes derived from auricular, nasoseptal, and costal cartilage using a scaffold-free cartilage regeneration model (cartilage sheet). Chondrocytes from all sources exhibited high sensitivity to basic fibroblast growth factor within 8 passages. Nasoseptal chondrocytes presented the strongest proliferation rate, whereas auricular chondrocytes obtained the highest total cell amount using comparable cartilage sample weights. Importantly, all chondrocytes at fifth passage showed strong chondrogenic capacity both in vitro and in the subcutaneous environment of nude mice. Although some significant differences in histological structure, cartilage matrix content and cartilage type specific proteins were observed between the in vitro engineered cartilage and original tissue; the in vivo regenerated cartilage showed mature cartilage features with high similarity to their original native tissue, except for minor matrix changes influenced by the in vivo environment. The current study provides detailed preclinical data for choice of chondrocyte source and thus promotes the clinical translation of cartilage regeneration approach.
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Affiliation(s)
- Aijuan He
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, China.,National Tissue Engineering Center of China, Shanghai, China
| | - Huitang Xia
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, China.,National Tissue Engineering Center of China, Shanghai, China.,Research Institute of Plastic Surgery, Wei Fang Medical College, Wei Fang, Shandong, China
| | - Kaiyan Xiao
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, China
| | - Tingting Wang
- National Tissue Engineering Center of China, Shanghai, China.,Research Institute of Plastic Surgery, Wei Fang Medical College, Wei Fang, Shandong, China
| | - Yu Liu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, China.,National Tissue Engineering Center of China, Shanghai, China
| | - Jixin Xue
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, China.,Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Dan Li
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, China.,National Tissue Engineering Center of China, Shanghai, China
| | - Shengjian Tang
- Research Institute of Plastic Surgery, Wei Fang Medical College, Wei Fang, Shandong, China
| | - Fangjun Liu
- Research Institute of Plastic Surgery, Wei Fang Medical College, Wei Fang, Shandong, China
| | - Xiaoyun Wang
- Department of General Surgery, Wu Jing Hospital, Minhang District, Shanghai, China
| | - Wenjie Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, China.,National Tissue Engineering Center of China, Shanghai, China
| | - Wei Liu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, China.,National Tissue Engineering Center of China, Shanghai, China
| | - Yilin Cao
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, China.,National Tissue Engineering Center of China, Shanghai, China
| | - Guangdong Zhou
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, China.,National Tissue Engineering Center of China, Shanghai, China.,Research Institute of Plastic Surgery, Wei Fang Medical College, Wei Fang, Shandong, China
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11
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Heuijerjans A, Wilson W, Ito K, van Donkelaar CC. The critical size of focal articular cartilage defects is associated with strains in the collagen fibers. Clin Biomech (Bristol, Avon) 2017; 50:40-46. [PMID: 28987870 DOI: 10.1016/j.clinbiomech.2017.09.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 08/15/2017] [Accepted: 09/25/2017] [Indexed: 02/07/2023]
Abstract
The size of full-thickness focal cartilage defect is accepted to be predictive of its fate, but at which size threshold treatment is required is unclear. Clarification of the mechanism behind this threshold effect will help determining when treatment is required. The objective was to investigate the effect of defect size on strains in the collagen fibers and the non-fibrillar matrix of surrounding cartilage. These strains may indicate matrix disruption. Tissue deformation into the defect was expected, stretching adjacent superficial collagen fibers, while an osteochondral implant was expected to prevent these deformations. Finite element simulations of cartilage/cartilage contact for intact, 0.5 to 8mm wide defects and 8mm implant cases were performed. Impact, a load increase to 2MPa in 1ms, and creep loading, a constant load of 0.5MPa for 900s, scenarios were simulated. A composition-based material model for articular cartilage was employed. Impact loading caused low strain levels for all models. Creep loading increased deviatoric strains and collagen strains in the surrounding cartilage. Deviatoric strains increased gradually with defect size, but the surface area at which collagen fiber strains exceeded failure thresholds, abruptly increased for small increases of defect size. This was caused by a narrow distribution of collagen fiber strains resulting from the non-linear stiffness of the fibers. We postulate this might be the mechanism behind the existence of a critical defect size. Filling of the defect with an implant reduced deviatoric and collagen fiber strains towards values for intact cartilage.
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Affiliation(s)
- A Heuijerjans
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600MB Eindhoven, The Netherlands
| | - W Wilson
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600MB Eindhoven, The Netherlands
| | - K Ito
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600MB Eindhoven, The Netherlands
| | - C C van Donkelaar
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600MB Eindhoven, The Netherlands.
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12
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Kienast B, Mohsen H, Wendlandt R, Reimers N, Schulz AP, Heuer H, Gille J, Neumann H. Biomechanical evaluation of novel ultrasound-activated bioresorbable pins for the treatment of osteochondral fractures compared to established methods. BIOMED ENG-BIOMED TE 2017; 62:365-373. [PMID: 27626763 DOI: 10.1515/bmt-2016-0041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 07/27/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Osteochondral injuries often lead to osteoarthritis of the affected joint. All established systems for refixation of osteochondral defects show certain disadvantages. To address the problem of reduced stability in resorbable implants, ultrasound-activated pins were developed. By ultrasound-activated melting of the tip of these implants, a more secure anchoring is assumed. MATERIALS AND METHODS The aim of the study was to investigate if ultrasound-activated pins can provide secure fixation of osteochondral fragments compared to screws and conventional resorbable pins. In a biomechanical laboratory setting, osteochondral fragments of the medial femoral condyle of sheep were refixated with ultrasound-activated pins [US fused poly(L-lactide-co-D,L-lactide) (PLDLLA) pins], polydioxanone (PDA) pins and conventional titanium screws. Anchoring forces of the different fixation methods were examined, registered and compared concerning shear force and tensile force. RESULTS Concerning the pull out test, the US fused PLDLLA pins and titanium screws (~122 N and ~203 N) showed comparable good results, while the PDA pins showed significantly lower anchoring forces (~18 N). Examination of shear forces showed a significantly higher anchoring of the screws (~248 N) than the US fused PLDLLA pins (~218 N). Nevertheless, the US fused PLDLLA pins could significantly outperform the PDA pins (~68 N) concerning shear forces. CONCLUSION The US fused PLDLLA pins demonstrated a comparable anchorage to the fixation with screws, but were free from the disadvantages of metal implants, i.e. the need for implant removal. The PDA pin application showed inferior biomechanical properties.
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13
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Dwyer T, Martin CR, Kendra R, Sermer C, Chahal J, Ogilvie-Harris D, Whelan D, Murnaghan L, Nauth A, Theodoropoulos J. Reliability and Validity of the Arthroscopic International Cartilage Repair Society Classification System: Correlation With Histological Assessment of Depth. Arthroscopy 2017; 33:1219-1224. [PMID: 28162918 DOI: 10.1016/j.arthro.2016.12.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 11/27/2016] [Accepted: 12/05/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the interobserver reliability of the International Cartilage Repair Society (ICRS) grading system of chondral lesions in cadavers, to determine the intraobserver reliability of the ICRS grading system comparing arthroscopy and video assessment, and to compare the arthroscopic ICRS grading system with histological grading of lesion depth. METHODS Eighteen lesions in 5 cadaveric knee specimens were arthroscopically graded by 7 fellowship-trained arthroscopic surgeons using the ICRS classification system. The arthroscopic video of each lesion was sent to the surgeons 6 weeks later for repeat grading and determination of intraobserver reliability. Lesions were biopsied, and the depth of the cartilage lesion was assessed. Reliability was calculated using intraclass correlations. RESULTS The interobserver reliability was 0.67 (95% confidence interval, 0.5-0.89) for the arthroscopic grading, and the intraobserver reliability with the video grading was 0.8 (95% confidence interval, 0.67-0.9). A high correlation was seen between the arthroscopic grading of depth and the histological grading of depth (0.91); on average, surgeons graded lesions using arthroscopy a mean of 0.37 (range, 0-0.86) deeper than the histological grade. CONCLUSIONS The arthroscopic ICRS classification system has good interobserver and intraobserver reliability. A high correlation with histological assessment of depth provides evidence of validity for this classification system. CLINICAL RELEVANCE As cartilage lesions are treated on the basis of the arthroscopic ICRS classification, it is important to ascertain the reliability and validity of this method.
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Affiliation(s)
- Tim Dwyer
- Department of Surgery, Division of Orthopedics, University of Toronto Orthopaedic Sports Medicine, Toronto, Ontario, Canada; Women's College Hospital, Toronto, Ontario, Canada; Mt Sinai Hospital, Toronto, Ontario, Canada.
| | - C Ryan Martin
- Department of Surgery, Division of Orthopedics, University of Toronto Orthopaedic Sports Medicine, Toronto, Ontario, Canada
| | | | | | - Jaskarndip Chahal
- Department of Surgery, Division of Orthopedics, University of Toronto Orthopaedic Sports Medicine, Toronto, Ontario, Canada; Women's College Hospital, Toronto, Ontario, Canada
| | - Darrell Ogilvie-Harris
- Department of Surgery, Division of Orthopedics, University of Toronto Orthopaedic Sports Medicine, Toronto, Ontario, Canada; Women's College Hospital, Toronto, Ontario, Canada
| | - Daniel Whelan
- Department of Surgery, Division of Orthopedics, University of Toronto Orthopaedic Sports Medicine, Toronto, Ontario, Canada; Women's College Hospital, Toronto, Ontario, Canada
| | - Lucas Murnaghan
- Department of Surgery, Division of Orthopedics, University of Toronto Orthopaedic Sports Medicine, Toronto, Ontario, Canada; Women's College Hospital, Toronto, Ontario, Canada
| | - Aaron Nauth
- Department of Surgery, Division of Orthopedics, University of Toronto Orthopaedic Sports Medicine, Toronto, Ontario, Canada
| | - John Theodoropoulos
- Department of Surgery, Division of Orthopedics, University of Toronto Orthopaedic Sports Medicine, Toronto, Ontario, Canada; Women's College Hospital, Toronto, Ontario, Canada; Mt Sinai Hospital, Toronto, Ontario, Canada
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14
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Camarero-Espinosa S, Cooper-White J. Tailoring biomaterial scaffolds for osteochondral repair. Int J Pharm 2017; 523:476-489. [DOI: 10.1016/j.ijpharm.2016.10.035] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/11/2016] [Accepted: 10/17/2016] [Indexed: 12/11/2022]
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15
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Tosun HB, Gürger M, Gümüştaş SA, Uludag A, Üçer Ö, Serbest S, Çelik S. The effect of sodium hyaluronate-chondroitin sulfate combined solution on cartilage formation in osteochondral defects of the rabbit knee: an experimental study. Ther Clin Risk Manag 2017; 13:523-532. [PMID: 28458555 PMCID: PMC5403121 DOI: 10.2147/tcrm.s133635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective In focal cartilage lesions, multipotent mesenchymal stem cells in bone marrow are aimed to be moved into the defect area using subchondral drilling or microfracture method. However, repaired tissue insufficiently fills the defect area or cannot meet natural hyaline tissue functions, due to fibrous structure. We investigated the effect of a combined solution of sodium hyaluronate + chondroitin sulfate (HA+CS) administered intra-articularly after subchondral drilling on newly formed cartilage in rabbits with focal osteochondral defects. Materials and methods A total of 32 New Zealand White mature rabbits, whose weights ranged from 2.5 to 3 kg, were randomly divided into four groups. Full-thickness osteochondral defect was formed in the left-knee medial femur condyles of all rabbits. Subchondral drilling was then performed. The following treatment protocol was administered intra-articularly on knee joints on days 7, 14, and 21 after surgery: group 1, 0.3 mL combined solution of HA+CS (20 mg CS combined with 16 mg HA/mL); group 2, 0.3 mL HA (16 mg/mL); group 3, 0.3 mL CS (20 mg/mL); and group 4 (control group), 0.3 mL saline solution. In the sixth week, all animals were killed and then evaluated histopathologically and biochemically. Results There was significant articular cartilage formation in the HA+CS group compared to the HA, CS, and control groups. Hyaline cartilage formation was observed only in the HA+CS group. Cartilage-surface continuity and smoothness were significantly higher in the HA+CS and HA groups compared to the other groups. Normal cartilage mineralization was found to be significantly higher in the HA+CS group compared to the other groups. Increased levels of VEGFA and IL-1β in synovial fluid were observed in the HA+CS group. Conclusion After subchondral drilling, intra-articular HA-CS combination therapy is a good choice to promote better quality new cartilage-tissue formation in the treatment of focal osteochondral defects.
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Affiliation(s)
- Haci Bayram Tosun
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adıyaman University, Adıyaman
| | | | - Seyit Ali Gümüştaş
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adıyaman University, Adıyaman
| | - Abuzer Uludag
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adıyaman University, Adıyaman
| | - Özlem Üçer
- Department of Pathology, Faculty of Medicine, Firat University, Elazığ
| | - Sancar Serbest
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Suat Çelik
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adıyaman University, Adıyaman
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Abstract
Chondral defects of the knee are quite common, affecting an estimated 10% to 12% of the population. Symptomatic chondral defects are thought to be persistent and possibly progressive. Less is known about the natural history of asymptomatic chondral lesions. Traditional treatment of chondral lesions has involved arthroscopic debridement with a mechanical shaver. Radiofrequency chondroplasty has been explored as a possible alternative or adjuvant to mechanical chondroplasty. The role of chondroplasty in the setting of knee osteoarthritis is more controversial. Early studies demonstrated promising results of arthroscopic debridement in the context of knee arthritis. However, publications in the last 10 to 15 years have brought into question the role of arthroscopic debridement in the setting of knee osteoarthritis. The purpose of this chapter is to explore the role of arthroscopic debridement in the treatment of chondral defects.
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17
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Horkay F, Basser PJ. Osmotic Properties of Cartilage. BIOPHYSICS AND BIOCHEMISTRY OF CARTILAGE BY NMR AND MRI 2016. [DOI: 10.1039/9781782623663-00044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Understanding the interactions and organization of various molecular constituents of cartilage is an essential prerequisite to designing and developing effective nuclear magnetic resonance and magnetic resonance imaging (MRI) strategies to characterize the state of this tissue in normal and abnormal development, aging, health and disease, and trauma. In this chapter the osmotic properties of cartilage are discussed. An attempt is made to relate the tissue’s macroscopic behavior to its hierarchical organization and the physical–chemical interactions among its main macromolecular constituents. It is shown how to separate the osmotic contribution of the proteoglycan assemblies from that of the collagen network. The interactions between the main macromolecular components of cartilage extracellular matrix (ECM) are determined using an array of complementary experimental techniques (osmotic pressure measurements, small-angle X-ray scattering, small-angle neutron scattering, dynamic light scattering, and atomic force microscopy) probing the ECM structure and dynamics over a broad range of length and timescales. This knowledge is also important to construct magnetic resonance phantoms for quantitative MRI that exhibit osmotic, mechanical, and relaxation properties similar to that of cartilage. Such biomimetic phantoms with well-characterized physical and imaging properties are critically important to validate MRI characteristics.
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Affiliation(s)
- Ferenc Horkay
- Section on Quantitative Imaging and Tissue Sciences, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health Bethesda MD 20892 USA
| | - Peter J. Basser
- Section on Quantitative Imaging and Tissue Sciences, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health Bethesda MD 20892 USA
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18
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Aae TF, Randsborg PH, Breen AB, Visnes H, Vindfeld S, Sivertsen EA, Løken S, Brinchmann J, Hanvold HA, Årøen A. Norwegican Cartilage Project - a study protocol for a double-blinded randomized controlled trial comparing arthroscopic microfracture with arthroscopic debridement in focal cartilage defects in the knee. BMC Musculoskelet Disord 2016; 17:292. [PMID: 27422025 PMCID: PMC4947343 DOI: 10.1186/s12891-016-1156-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 07/02/2016] [Indexed: 01/30/2023] Open
Abstract
Background Focal lesions to the articular cartilage in the knee might have demolishing consequences to the knee. There exists a wide range of possible surgical procedures targeting these injuries, however no significant differences have been found between these procedures. This may support that the improvement is a result of rehabilitation, and not the surgery itself. Arthroscopic microfracture (MF) treatment has gained popularity, and has become the treatment of choice in patients with knee cartilage defects globally. In this study we want to increase knowledge, both clinical and economic, about arthroscopic microfracture (AF) compared to arthroscopic debridement (AD) and physical rehabilitation both in the short run, and in the long run. Methods/Design To compare arthroscopic microfracture with arthroscopic debridement and physiotherapy for the treatment of focal cartilage lesions in the knee, a long-term, double-blinded, randomized controlled multicenter trial will be conducted. A total of 114 men and non-pregnant women with a symptomatic focal full thickness cartilage lesion in the knee less than 2 cm2 will be included in the study. The two treatment allocations will receive identical rehabilitation, which is made up of 3 phases: accommodation, rehabilitation and return to activity. Follow up is 24 months, where all will be invited to participate in late follow ups after 5 and 10 years. The Knee Injury and Osteoarthritis Outcome Score (KOOS) knee-related quality of life (QoL) subscore is the primary endpoint. Clinical parameters, questionnaires and radiologic modalities (Magnetic Resonance Imaging (MRI) and x-ray) will be used as secondary endpoints. Discussion This is an ongoing multicenter study with a high level of evidence to compare arthroscopic microfracture with arthroscopic debridement and physiotherapy for the treatment of isolated symptomatic full thickness cartilage lesions in the knee joint. Trial registration ClinicalTrials.gov ID: NCT02637505 (December 15, 2015).
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Affiliation(s)
- Tommy Frøseth Aae
- Department of Orthopedic Surgery, Kristiansund Hospital, Kristiansund, Norway.
| | - Per-Henrik Randsborg
- Department of Orthopedic Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Anne Berg Breen
- Department of Orthopedic Surgery, Ålesund Hospital, Ålesund, Norway
| | - Håvard Visnes
- Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Søren Vindfeld
- Department of Orthopedic Surgery, Haraldsplass Deaconess Hospital, Deaconess, Norway
| | | | - Sverre Løken
- Department of Orthopedics, Oslo University Hospital, Oslo, Norway
| | - Jan Brinchmann
- Department of Immunology and Norwegian Center for Stem Cell Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | - Asbjørn Årøen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Oslo Sports Trauma Research Centre, Norwegian School of Sport Sciences, Oslo, Norway
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Hirakata E, Tomita N, Tamada Y, Suguro T, Nakajima M, Kambe Y, Yamada K, Yamamoto K, Kawakami M, Otaka A, Okumura H, Suzuki S. Early tissue formation on whole-area osteochondral defect of rabbit patella by covering with fibroin sponge. J Biomed Mater Res B Appl Biomater 2016; 104:1474-82. [DOI: 10.1002/jbm.b.33656] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 02/07/2016] [Accepted: 02/28/2016] [Indexed: 01/22/2023]
Affiliation(s)
- Eiichi Hirakata
- Field of Medical Engineering; Division of Mechanical Engineering and Science Graduate School of Engineering; Kyoto University; Kyoto Japan
- Department of Plastic Surgery; Kyoto University Postgraduate School of Medicine; Kyoto Japan
| | - Naohide Tomita
- Field of Medical Engineering; Division of Mechanical Engineering and Science Graduate School of Engineering; Kyoto University; Kyoto Japan
| | - Yasushi Tamada
- National Institute of Agrobiological Sciences; Ibaraki Japan
| | - Toru Suguro
- Institute of Medical Science; Tokyo Medical University; Tokyo Japan
| | - Masaaki Nakajima
- Department of Physical Therapy; School of Health Science and Social Welfare, Kibi International University; Okayama Japan
| | - Yusuke Kambe
- Field of Medical Engineering; Division of Mechanical Engineering and Science Graduate School of Engineering; Kyoto University; Kyoto Japan
| | - Keisuke Yamada
- Field of Medical Engineering; Division of Mechanical Engineering and Science Graduate School of Engineering; Kyoto University; Kyoto Japan
| | - Koji Yamamoto
- Field of Medical Engineering; Division of Mechanical Engineering and Science Graduate School of Engineering; Kyoto University; Kyoto Japan
| | - Masahiro Kawakami
- Field of Medical Engineering; Division of Mechanical Engineering and Science Graduate School of Engineering; Kyoto University; Kyoto Japan
| | - Akihisa Otaka
- Field of Medical Engineering; Division of Mechanical Engineering and Science Graduate School of Engineering; Kyoto University; Kyoto Japan
| | - Hideo Okumura
- Department of Orthopaedic Surgery; Rakuyo Hospital; Kyoto Japan
| | - Shigehiko Suzuki
- Department of Plastic Surgery; Kyoto University Postgraduate School of Medicine; Kyoto Japan
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20
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Focal cartilage defects in the knee - a randomized controlled trial comparing autologous chondrocyte implantation with arthroscopic debridement. BMC Musculoskelet Disord 2016; 17:117. [PMID: 26956476 PMCID: PMC4784272 DOI: 10.1186/s12891-016-0969-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 03/01/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Focal cartilage injuries in the knee might have devastating effect due to the predisposition of early onset osteoarthritis. Various surgical treatment options are available, however no statistically significant differences have been found between the different surgical treatments. This supports the suggestion that the improvement might be a result of the post-operative rehabilitation rather than the surgery itself. Autologous chondrocyte implantation (ACI) has become a recognized treatment option for larger cartilage lesions in the knee. Although ACI has been compared to other surgical treatment such as microfracture and mosaicplasty, it has never been directly compared to simple arthroscopic debridement and rehabilitation alone. In this study we want to increase clinical and economic knowledge about autologous chondrocyte implantation compared to arthroscopic debridement and physical rehabilitation in the short and long run. METHODS/DESIGN We will conduct a randomized controlled trial to compare ACI with simple arthroscopic debridement (AD) and physiotherapy for the treatment of cartilage lesions in the knee. The study will include a total of 82 patients, both men and non-pregnant women, with a full thickness cartilage defect in the weight bearing area of the femoral condyles or trochlea larger than 2 cm2. The lesion must be symptomatic, with a Lysholm score less than 75. The two treatment groups will receive identical rehabilitation protocol according to a modification of Wondrasch et al., which is an active rehabilitation and education program divided into 3 phases: accommodation, rehabilitation and return to activity. The patients will be followed for 24 months, with additional late follow-ups at 5 and 10 years to monitor the potential onset of osteoarthtitis. The primary outcome measure will be the difference in the KOOS knee-related quality of life (QoL) subscore in the ACI group compared to the AD group at 2 years. A combination of self-explanatory questionnaires, clinical parameters, clinical hop tests and radiographs and Magnetic Resonance Imaging (MRI) will be used as secondary endpoints. DISCUSSION This is the first study with a high level of evidence to compare ACI with simple debridement and physiotherapy for the treatment of isolated symptomatic full thickness lesions of the knee. TRIAL REGISTRATION ClinicalTrial NCT02636881 (21 December 2015).
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21
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Camarero-Espinosa S, Rothen-Rutishauser B, Foster EJ, Weder C. Articular cartilage: from formation to tissue engineering. Biomater Sci 2016; 4:734-67. [PMID: 26923076 DOI: 10.1039/c6bm00068a] [Citation(s) in RCA: 175] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Hyaline cartilage is the nonlinear, inhomogeneous, anisotropic, poro-viscoelastic connective tissue that serves as friction-reducing and load-bearing cushion in synovial joints and is vital for mammalian skeletal movements. Due to its avascular nature, low cell density, low proliferative activity and the tendency of chondrocytes to de-differentiate, cartilage cannot regenerate after injury, wear and tear, or degeneration through common diseases such as osteoarthritis. Therefore severe damage usually requires surgical intervention. Current clinical strategies to generate new tissue include debridement, microfracture, autologous chondrocyte transplantation, and mosaicplasty. While articular cartilage was predicted to be one of the first tissues to be successfully engineered, it proved to be challenging to reproduce the complex architecture and biomechanical properties of the native tissue. Despite significant research efforts, only a limited number of studies have evolved up to the clinical trial stage. This review article summarizes the current state of cartilage tissue engineering in the context of relevant biological aspects, such as the formation and growth of hyaline cartilage, its composition, structure and biomechanical properties. Special attention is given to materials development, scaffold designs, fabrication methods, and template-cell interactions, which are of great importance to the structure and functionality of the engineered tissue.
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Affiliation(s)
- Sandra Camarero-Espinosa
- Adolphe Merkle Institute, University of Fribourg, Chemin des Verdiers 4, 1700 Fribourg, Switzerland.
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22
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Dua R, Comella K, Butler R, Castellanos G, Brazille B, Claude A, Agarwal A, Liao J, Ramaswamy S. Integration of Stem Cell to Chondrocyte-Derived Cartilage Matrix in Healthy and Osteoarthritic States in the Presence of Hydroxyapatite Nanoparticles. PLoS One 2016; 11:e0149121. [PMID: 26871903 PMCID: PMC4752260 DOI: 10.1371/journal.pone.0149121] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 01/27/2016] [Indexed: 12/03/2022] Open
Abstract
We investigated the effectiveness of integrating tissue engineered cartilage derived from human bone marrow derived stem cells (HBMSCs) to healthy as well as osteoarthritic cartilage mimics using hydroxyapatite (HA) nanoparticles immersed within a hydrogel substrate. Healthy and diseased engineered cartilage from human chondrocytes (cultured in agar gels) were integrated with human bone marrow stem cell (HBMSC)-derived cartilaginous engineered matrix with and without HA, and evaluated after 28 days of growth. HBMSCs were seeded within photopolymerizable poly (ethylene glycol) diacrylate (PEGDA) hydrogels. In addition, we also conducted a preliminary in vivo evaluation of cartilage repair in rabbit knee chondral defects treated with subchondral bone microfracture and cell-free PEGDA with and without HA. Under in vitro conditions, the interfacial shear strength between tissue engineered cartilage derived from HBMSCs and osteoarthritic chondrocytes was significantly higher (p < 0.05) when HA nanoparticles were incorporated within the HBMSC culture system. Histological evidence confirmed a distinct spatial transition zone, rich in calcium phosphate deposits. Assessment of explanted rabbit knees by histology demonstrated that cellularity within the repair tissues that had filled the defects were of significantly higher number (p < 0.05) when HA was used. HA nanoparticles play an important role in treating chondral defects when osteoarthritis is a co-morbidity. We speculate that the calcified layer formation at the interface in the osteoarthritic environment in the presence of HA is likely to have attributed to higher interfacial strength found in vitro. From an in vivo standpoint, the presence of HA promoted cellularity in the tissues that subsequently filled the chondral defects. This higher presence of cells can be considered important in the context of accelerating long-term cartilage remodeling. We conclude that HA nanoparticles play an important role in engineered to native cartilage integration and cellular processes.
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Affiliation(s)
- Rupak Dua
- Tissue Engineered Mechanics, Imaging and Materials Laboratory (TEMIM Lab), Department of Biomedical Engineering, Florida International University, Miami, Florida, 33174, United States of America
| | - Kristin Comella
- Tissue Engineered Mechanics, Imaging and Materials Laboratory (TEMIM Lab), Department of Biomedical Engineering, Florida International University, Miami, Florida, 33174, United States of America
| | - Ryan Butler
- College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi, 39762, United States of America
| | - Glenda Castellanos
- Tissue Engineered Mechanics, Imaging and Materials Laboratory (TEMIM Lab), Department of Biomedical Engineering, Florida International University, Miami, Florida, 33174, United States of America
| | - Bryn Brazille
- Tissue Bioengineering Laboratory, Department of Agricultural & Biological Engineering, Mississippi State University, Starkville, Mississippi, 39762, United States of America
| | - Andrew Claude
- College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi, 39762, United States of America
| | - Arvind Agarwal
- Advanced Materials Engineering Research Institute (AMERI), Department of Mechanical and Materials Engineering, Florida International University, Miami, Florida, 33174, United States of America
| | - Jun Liao
- Tissue Bioengineering Laboratory, Department of Agricultural & Biological Engineering, Mississippi State University, Starkville, Mississippi, 39762, United States of America
| | - Sharan Ramaswamy
- Tissue Engineered Mechanics, Imaging and Materials Laboratory (TEMIM Lab), Department of Biomedical Engineering, Florida International University, Miami, Florida, 33174, United States of America
- * E-mail:
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Camarero-Espinosa S, Rothen-Rutishauser B, Weder C, Foster EJ. Directed cell growth in multi-zonal scaffolds for cartilage tissue engineering. Biomaterials 2016; 74:42-52. [DOI: 10.1016/j.biomaterials.2015.09.033] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 09/22/2015] [Accepted: 09/23/2015] [Indexed: 10/23/2022]
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Effect of the direct injection of bone marrow mesenchymal stem cells in hyaluronic acid and bone marrow stimulation to treat chondral defects in the canine model. Regen Ther 2015; 2:42-48. [PMID: 31245458 PMCID: PMC6581783 DOI: 10.1016/j.reth.2015.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 09/19/2015] [Accepted: 10/29/2015] [Indexed: 01/22/2023] Open
Abstract
Introduction The purpose of this study was to assess the direct injection of bone marrow-derived mesenchymal stem cells (BMSCs) suspended in hyaluronic acid (HA) combined with drilling as a treatment for chondral defects in a canine model. Methods Tibial bone marrow was aspirated, and BMSCs were isolated and cultured. One 8.0-mm diameter chondral defect was created in the femoral groove, and nine 0.9-mm diameter holes were drilled into the defect. BMSCs (2.14 × 107 cells) suspended in HA were injected into the defect. HA alone was injected into a similar defect on the contralateral knee as a control. Animals were sacrificed at 3 and 6 months. Results Although the percentage of coverage assessed macroscopically was significantly better at 6 months than at 3 months in both the BMSC (p = 0.02) and control (p = 0.001) groups, there were no significant differences in the International Cartilage Repair Society grades. The Wakitani histological score was significantly better at 6 months than at 3 months in the BMSC and control groups. While the control defects were mostly filled with fibrocartilage, several of the defects in the BMSC group contained hyaline-like cartilage. The mean Wakitani scores of the BMSC group improved from 7.0 ± 1.0 at 3 months to 4.6 ± 0.9 at 6 months, and those of the control group improved from 9.4 ± 1.2 to 6.0 ± 0.6. The BMSC group showed significantly better regeneration than the control group at 3 months (p = 0.04), but the difference at 6 months was not significant (p = 0.06). Conclusions The direct injection of BMSCs in HA combined with drilling enhanced cartilage regeneration.
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Krych AJ, Sousa PL, King AH, Morgan JA, May JH, Dahm DL. The Effect of Cartilage Injury After Arthroscopic Stabilization for Shoulder Instability. Orthopedics 2015; 38:e965-9. [PMID: 26558675 DOI: 10.3928/01477447-20151020-03] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 02/23/2015] [Indexed: 02/03/2023]
Abstract
This study was undertaken to (1) determine the incidence of articular cartilage injuries in patients with instability of the glenohumeral joint, (2) determine whether recurrent dislocations increased the risk of articular damage, and (3) correlate these injuries with postoperative clinical outcomes. A cohort was identified of consecutive patients who underwent diagnostic magnetic resonance imaging and shoulder arthroscopy for glenohumeral instability with documented dislocation or subluxation between 1997 and 2006 at a single institution. Patients with moderate or severe osteoarthritis were excluded. Arthroscopic findings were recorded, including lesion location and Outerbridge grade. The American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) was used to assess outcome in 61 patients who were available for follow-up. Outcomes were compared between shoulders with and without articular lesions. A total of 87 shoulders (83 patients) met the inclusion criteria, with 69 (83%) men and 14 (17%) women. Mean age was 26.1 years (range, 18-64 years), and mean follow-up was 36 months (range, 33-39 months). Cartilage injuries were found in 56 shoulders (64%). Previously documented shoulder dislocation requiring closed reduction (P=.046) and the number of discrete dislocations (P=.032) were significant for glenoid injury. A greater number of dislocations was associated with higher-grade lesions of the glenohumeral joint (P<.001). Overall, mean ASES score was 89.6 (range, 37-100). In patients with an articular cartilage lesion, mean ASES score was 90.4 (range, 58-100) compared with 88.1 (range, 37-100) in those without this injury (P=.75). Although clinical outcomes were not significantly affected, further investigation is warranted to establish a relationship between these injuries and longer-term outcomes.
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Hunziker EB, Lippuner K, Keel MJB, Shintani N. An educational review of cartilage repair: precepts & practice--myths & misconceptions--progress & prospects. Osteoarthritis Cartilage 2015; 23:334-50. [PMID: 25534362 DOI: 10.1016/j.joca.2014.12.011] [Citation(s) in RCA: 167] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 10/29/2014] [Accepted: 12/12/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The repair of cartilaginous lesions within synovial joints is still an unresolved and weighty clinical problem. Although research activity in this area has been indefatigably sustained, no significant progress has been made during the past decade. The aim of this educational review is to heighten the awareness amongst students and scientists of the basic issues that must be tackled and resolved before we can hope to escape from the whirlpool of stagnation into which we have fallen: cartilage repair redivivus! DESIGN Articular-cartilage lesions may be induced traumatically (e.g., by sports injuries and occupational accidents) or pathologically during the course of a degenerative disease (e.g., osteoarthritis). This review addresses the biological basis of cartilage repair and surveys current trends in treatment strategies, focussing on those that are most widely adopted by orthopaedic surgeons [viz., abrasive chondroplasty, microfracturing/microdrilling, osteochondral grafting and autologous-chondrocyte implantation (ACI)]. Also described are current research activities in the field of cartilage-tissue engineering, which, as a therapeutic principle, holds more promise for success than any other experimental approach. RESULTS AND CONCLUSIONS Tissue engineering aims to reconstitute a tissue both structurally and functionally. This process can be conducted entirely in vitro, initially in vitro and then in vivo (in situ), or entirely in vivo. Three key constituents usually form the building blocks of such an approach: a matrix scaffold, cells, and signalling molecules. Of the proposed approaches, none have yet advanced beyond the phase of experimental development to the level of clinical induction. The hurdles that need to be surmounted for ultimate success are discussed.
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Affiliation(s)
- E B Hunziker
- Departments of Osteoporosis, Orthopaedic Surgery and Clinical Research, Inselspital, University of Bern, Bern, Switzerland.
| | - K Lippuner
- Departments of Osteoporosis, Orthopaedic Surgery and Clinical Research, Inselspital, University of Bern, Bern, Switzerland.
| | - M J B Keel
- Departments of Osteoporosis, Orthopaedic Surgery and Clinical Research, Inselspital, University of Bern, Bern, Switzerland.
| | - N Shintani
- Departments of Osteoporosis, Orthopaedic Surgery and Clinical Research, Inselspital, University of Bern, Bern, Switzerland.
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Yamasaki S, Mera H, Itokazu M, Hashimoto Y, Wakitani S. Cartilage Repair With Autologous Bone Marrow Mesenchymal Stem Cell Transplantation: Review of Preclinical and Clinical Studies. Cartilage 2014; 5:196-202. [PMID: 26069698 PMCID: PMC4335770 DOI: 10.1177/1947603514534681] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Clinical trials of various procedures, including bone marrow stimulation, mosaicplasty, and autologous chondrocyte implantation, have been explored to treat articular cartilage defects. However, all of them have some demerits. We focused on autologous culture-expanded bone marrow mesenchymal stem cells (BMSC), which can proliferate without losing their capacity for differentiation. First, we transplanted BMSC into the defective articular cartilage of rabbit and succeeded in regenerating osteochondral tissue. We then applied this transplantation in humans. Our previous reports showed that treatment with BMSC relieves the clinical symptoms of chondral defects in the knee and elbow joint. We investigated the efficacy of BMSC for osteoarthritic knee treated with high tibial osteotomy, by comparing 12 BMSC-transplanted patients with 12 cell-free patients. At 16-month follow-up, although the difference in clinical improvement between both groups was not significant, the arthroscopic and histological grading score was better in the cell-transplanted group. At the over 10-year follow-up, Hospital for Special Surgery knee scores improved to 76 and 73 in the BMSC-transplanted and cell-free groups, respectively, which were better than preoperative scores. Additionally, neither tumors nor infections were observed in all patients, and in the clinical study, we have never observed hypertrophy of repaired tissue, thereby guaranteeing the clinical safety of this therapy. Although we have never observed calcification above the tidemark in rabbit model and human histologically, the repair cartilage was not completely hyaline cartilage. To elucidate the optimum conditions for cell therapy, other stem cells, culture conditions, growth factors, and gene transfection methods should be explored.
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Affiliation(s)
- Shinya Yamasaki
- Department of Orthopaedics Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hisashi Mera
- Department of Health and Sports Sciences, Mukogawa Women’s University, Hyogo, Japan
| | - Maki Itokazu
- Department of Orthopaedics Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan,Department of Health and Sports Sciences, Mukogawa Women’s University, Hyogo, Japan
| | - Yusuke Hashimoto
- Department of Orthopaedics Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shigeyuki Wakitani
- Department of Health and Sports Sciences, Mukogawa Women’s University, Hyogo, Japan,Department of Artificial Joint and Biomaterials, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
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Nawaz SZ, Bentley G, Briggs TWR, Carrington RWJ, Skinner JA, Gallagher KR, Dhinsa BS. Autologous chondrocyte implantation in the knee: mid-term to long-term results. J Bone Joint Surg Am 2014; 96:824-30. [PMID: 24875023 DOI: 10.2106/jbjs.l.01695] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND From 1998 to 2008, 1000 skeletally mature patients underwent autologous chondrocyte implantation for an osteochondral defect of the knee. We evaluated the functional outcomes in 827 of 869 patients who had undergone autologous chondrocyte implantation with Chondron or periosteum (ACI-C/ACI-P) or matrix-assisted chondrocyte implantation (MACI) and attempted to identify factors that influenced outcome. METHODS The age of the patient, the size and site of the osteochondral lesion, previous surgery, and the presence of early osteoarthritis were assessed for their influence on outcomes. Each factor was evaluated in a separate Cox proportional hazards model with use of hazard ratios (HRs), with 95% confidence intervals (CIs), describing the likelihood of failure for that particular factor. Outcomes were assessed with use of the modified Cincinnati score, visual analog scale pain score, and Stanmore functional score. RESULTS The mean duration of follow-up was 6.2 years (range, two to twelve years). The mean age was thirty-four years (range, fourteen to fifty-six years), with 493 males and 334 females. The average size of the defect was 409 mm2 (range, 64 to 2075 mm2). Four hundred and twenty-one procedures (51%) were performed on the medial femoral condyle; 109 (13%), on the lateral femoral condyle; 200 (24%), on the patella; and fifty (6%), on the trochlea. Kaplan-Meier survival analysis revealed that the unadjusted graft survival rate was 78.2% at five years and 50.7% and ten years for the entire cohort. No difference was found between the survival rates of the ACI-C/ACI-P and MACI techniques (HR = 0.948, 95% CI = 0.738 to 1.219, p = 0.678). There was a significant postoperative improvement in the function and pain scores of all three outcome measures (p < 0.002). Survivorship in the group with a previous cartilage regenerative procedure was inferior to that in patients with a previously untreated lesion, with failure five times more likely in the former group (HR = 4.718, standard error [SE] = 0.742, 95% CI = 3.466 to 6.420, p < 0.001). Degenerative change in any compartment had a significant detrimental effect on survivorship, with survivorship worsening as the osteoarthritis grade increased (Grade 1: HR = 2.077, 95% CI = 1.299 to 3.322, p = 0.002; Grade 2: HR = 3.450, 95% CI = 2.646 to 4.498, p < 0.001; and Grade 3: HR = 3.820, 95% CI = 2.185 to 6.677, p < 0.001). CONCLUSIONS Our study demonstrated an overall graft survival of 78% at five years and 51% beyond ten years following both autologous chondrocyte implantation techniques. Despite study limitations, our results demonstrate that autologous chondrocyte implantation for the treatment of osteochondral defects of the knee can achieve good results. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Syed Z Nawaz
- Joint Reconstruction Unit-Institute of Orthopaedics, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom. E-mail address for S.Z. Nawaz:
| | - George Bentley
- Joint Reconstruction Unit-Institute of Orthopaedics, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom. E-mail address for S.Z. Nawaz:
| | - Timothy W R Briggs
- Joint Reconstruction Unit-Institute of Orthopaedics, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom. E-mail address for S.Z. Nawaz:
| | - Richard W J Carrington
- Joint Reconstruction Unit-Institute of Orthopaedics, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom. E-mail address for S.Z. Nawaz:
| | - John A Skinner
- Joint Reconstruction Unit-Institute of Orthopaedics, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom. E-mail address for S.Z. Nawaz:
| | - Kieran R Gallagher
- Joint Reconstruction Unit-Institute of Orthopaedics, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom. E-mail address for S.Z. Nawaz:
| | - Baljinder S Dhinsa
- Joint Reconstruction Unit-Institute of Orthopaedics, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom. E-mail address for S.Z. Nawaz:
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Tiwary R, Amarpal, Aithal HP, Kinjavdekar P, Pawde AM, Singh R. Effect of IGF-1 and Uncultured Autologous Bone-Marrow-Derived Mononuclear Cells on Repair of Osteochondral Defect in Rabbits. Cartilage 2014; 5:43-54. [PMID: 26069684 PMCID: PMC4297094 DOI: 10.1177/1947603513499366] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the utility of bone-marrow-derived mononuclear cells (BMNCs) and insulin like growth factor-1 (IGF-1) in articular cartilage repair. DESIGN An osteochondral defect of 3 mm diameter and 5 mm depth was created in patellar groove of the left knee joint in each of 36 New Zealand White rabbits. The defect was filled with RPMI-1640 medium in group A (control), autologous BMNCs in group B, and autologous BMNCs plus IGF-1 in group C (n = 12). Healing of the defect was assessed by gross, scanning electron microscopic, radiographic, and histological examinations up to 90 days. RESULTS Gross and scanning electron microscopic examination of the healing site revealed superior gross morphology and surface architecture of the healing tissue in the animals of group C as compared to other groups. Radiographically on day 90, the defect area was not distinguishable from the surrounding area in group C, but a small circular defect area was still evident in groups A and B. The regenerated tissue was mostly hyaline in group C and fibrocartilage in groups A and B. The cells were well organized and showed better deposition of proteoglycans in groups C and B than in group A. CONCLUSIONS It was concluded that implantation of bone-marrow-derived nucleated cells may facilitate the healing of osteochondral defects; however, the combination of BMNCs and IGF-1 induces faster and histologically better healing than the BMNCs alone.
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Affiliation(s)
- Ramesh Tiwary
- Department of Clinics, Bihar Veterinary College, Patna, Bihar, India
| | - Amarpal
- Division of Surgery, Indian Veterinary Research Institute, Izatnagar, Uttar Pradesh, India
| | - Hari Prasad Aithal
- Division of Surgery, Indian Veterinary Research Institute, Izatnagar, Uttar Pradesh, India
| | - Prakash Kinjavdekar
- Division of Surgery, Indian Veterinary Research Institute, Izatnagar, Uttar Pradesh, India
| | - Abhijit M. Pawde
- Division of Surgery, Indian Veterinary Research Institute, Izatnagar, Uttar Pradesh, India
| | - Rajendra Singh
- Division of Pathology, Indian Veterinary Research Institute, Izatnagar, Uttar Pradesh, India
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Nam HY, Karunanithi P, Loo WC, Naveen S, Chen H, Hussin P, Chan L, Kamarul T. The effects of staged intra-articular injection of cultured autologous mesenchymal stromal cells on the repair of damaged cartilage: a pilot study in caprine model. Arthritis Res Ther 2013; 15:R129. [PMID: 24286235 PMCID: PMC3979160 DOI: 10.1186/ar4309] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 08/30/2013] [Indexed: 12/14/2022] Open
Abstract
Introduction Treatment of chondral injuries remains a major issue despite the many advances made in cartilage repair techniques. Although it has been postulated that the use of marrow stimulation in combination with cell-based therapy may provide superior outcome, this has yet to be demonstrated. A pilot study was thus conducted to determine if bone marrow derived mesenchymal stromal cells (BM-MSCs) have modulatory effects on the repair outcomes of bone marrow stimulation (BMS) techniques. Methods Two full-thickness chondral 5 mm diameter defects were created in tandem on the medial condyle of left stifle joints of 18 Boer caprine (N = 18). Goats were then divided equally into three groups. Simultaneously, bone marrow aspirates were taken from the iliac crests from the goats in Group 1 and were sent for BM-MSC isolation and expansion in vitro. Six weeks later, BMS surgery, which involves subchondral drilling at the defect sites, was performed. After two weeks, the knees in Group 1 were given autologous intra-articular BM-MSCs (N = 6). In Group 2, although BMS was performed there were no supplementations provided. In Group 3, no intervention was administered. The caprines were sacrificed after six months. Repairs were evaluated using macroscopic assessment through the International Cartilage Repair Society (ICRS) scoring, histologic grading by O’Driscoll score, biochemical assays for glycosaminoglycans (GAGs) and gene expressions for aggrecan, collagen II and Sox9. Results Histological and immunohistochemical analyses demonstrated hyaline-like cartilage regeneration in the transplanted sites particularly in Group 1. In contrast, tissues in Groups 2 and 3 demonstrated mainly fibrocartilage. The highest ICRS and O’Driscoll scorings was also observed in Group 1, while the lowest score was seen in Group 3. Similarly, the total GAG/total protein as well as chondrogenic gene levels were expressed in the same order, that is highest in Group 1 while the lowest in Group three. Significant differences between these 3 groups were observed (P <0.05). Conclusions This study suggests that supplementing intra-articular injections of BM-MSCs following BMS knee surgery provides superior cartilage repair outcomes.
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Spitters TWGM, Leijten JCH, Deus FD, Costa IBF, van Apeldoorn AA, van Blitterswijk CA, Karperien M. A dual flow bioreactor with controlled mechanical stimulation for cartilage tissue engineering. Tissue Eng Part C Methods 2013; 19:774-83. [PMID: 23410098 DOI: 10.1089/ten.tec.2012.0435] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
In cartilage, tissue engineering bioreactors can create a controlled environment to study chondrocyte behavior under mechanical stimulation or produce chondrogenic grafts of clinically relevant size. Here we present a novel bioreactor that combines mechanical stimulation with a two compartment system through which nutrients can be supplied solely by diffusion from opposite sides of a tissue-engineered construct. This design is based on the hypothesis that creating gradients of nutrients, growth factors, and growth factor antagonists can aid in the generation of zonal tissue-engineered cartilage. Computational modeling predicted that the design facilitates the creation of a biologically relevant glucose gradient. This was confirmed by quantitative glucose measurements in cartilage explants. In this system, it is not only possible to create gradients of nutrients, but also of anabolic or catabolic factors. Therefore, the bioreactor design allows control over nutrient supply and mechanical stimulation useful for in vitro generation of cartilage constructs that can be used for the resurfacing of articulated joints or as a model for studying osteoarthritis disease progression.
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Affiliation(s)
- Tim W G M Spitters
- Department of Developmental BioEngineering, University of Twente, MIRA Institute for Biomedical Technologyand Technical Medicine, Enschede, The Netherlands
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Horkay F. Interactions of Cartilage Extracellular Matrix Macromolecules. ACTA ACUST UNITED AC 2012; 50:1699-1705. [PMID: 23997426 DOI: 10.1002/polb.23191] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Articular cartilage is a low-friction, load-bearing tissue located at joint surfaces. The extracellular matrix (ECM) of cartilage consists of a fibrous collagen network, which is pre-stressed by the osmotic swelling pressure exerted by negatively charged proteoglycan aggregates embedded in the collagen network. The major proteoglycan is the bottlebrush shaped aggrecan, which forms complexes with linear hyaluronic acid chains. We quantify microscopic and macroscopic changes resulting from self-assembly between aggrecan and hyaluronic acid using a complementary set of physical measurements to determine structure and interactions by combining scattering techniques, including small-angle X-ray scattering, small-angle neutron scattering, and dynamic light scattering with macroscopic osmotic pressure measurements. It is demonstrated that the osmotic pressure that defines the load bearing ability of cartilage is primarily governed by the main macromolecular components (aggrecan and collagen) of the ECM. Knowledge of the interactions between the macromolecular components of cartilage ECM is essential to understand biological function and to develop successful tissue engineering strategies for cartilage repair.
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Affiliation(s)
- Ferenc Horkay
- Section on Tissue Biophysics and Biomimetics, Program in Pediatric Imaging and Tissue Sciences, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 13 South Drive, Bethesda, MD 20892, USA
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Suwannaloet W, Laupattarakasem W, Sukon P, Ong-Chai S, Laupattarakasem P. Combined effect of subchondral drilling and hyaluronic acid with/without diacerein in full-thickness articular cartilage lesion in rabbits. ScientificWorldJournal 2012; 2012:310745. [PMID: 22666105 PMCID: PMC3361165 DOI: 10.1100/2012/310745] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 12/21/2011] [Indexed: 12/19/2022] Open
Abstract
The osteochondral healing potential of hyaluronic acid (HA) plus diacerein was evaluated in subchondral-drilling- (SCD-) induced fibrocartilage generation in rabbits. A full-thickness chondral defect was created along the patellar groove of both knees and then SCD was subsequently performed only in the left knee. A week later, the rabbits were allocated into 3 groups to receive weekly intra-articular (IA) injection for 5 weeks with normal saline solution (NSS) (group 1) or with HA (group 2 and group 3). Starting at the first IA injection, rabbits were also gavaged daily for 9 weeks with NSS (group 1 and group 2) or with diacerein (group 3). The animals were then sacrificed for evaluation. The newly formed tissue in SCD lesions showed significantly better histological grading scale and had higher content of type II collagen in HA-treated group compared to NSS control. In addition, adding oral diacerein to HA injection enhanced healing potential of HA.
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Affiliation(s)
- Wanwisa Suwannaloet
- Department of Pharmacology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
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Heir S, Årøen A, Løken S, Holme I, Engebretsen L, Reinholt FP. Cartilage repair in the rabbit knee: mosaic plasty resulted in higher degree of tissue filling but affected subchondral bone more than microfracture technique: a blinded, randomized, controlled, long-term follow-up trial in 88 knees. Knee Surg Sports Traumatol Arthrosc 2012; 20:197-209. [PMID: 21892626 DOI: 10.1007/s00167-011-1596-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 06/27/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE Discrepancies and variances in outcome following different surgical techniques for cartilage repair are poorly understood. Successful repair relies on proper tissue filling without initiating degenerative processes in the cartilage-bone unit. Consequently, the objective of the current study was to compare two available techniques for cartilage repair, i.e., microfracture technique and mosaic plasty, regarding tissue filling and subchondral bone changes in an experimental model. METHODS A 4-mm pure chondral defect was created in the medial femoral condyle of both knees in New Zealand rabbits, aged 22 weeks. A stereomicroscope was used to optimize the preparation of the defects. In one knee (randomized), the defect was treated with microfracture technique whereas in the other with mosaic plasty. The animals were killed at 12, 24 and 36 weeks after surgery. Defect filling, new bone formation above the level of the tidemark and the density of subchondral mineralized tissue were estimated by histomorphometry. RESULTS Mosaic plasty resulted in a significantly 34% higher degree of tissue filling than microfracture technique at 36 weeks, SD of mean difference being 34%. Mosaic plasty resulted in significantly more new bone formation and reduced subchondral mineralized tissue density compared to microfracture technique. The differences between the two techniques were apparent mainly at the long-term follow-up. CONCLUSION Tissue filling is a limiting factor regarding microfracture technique when compared to mosaic plasty, whereas mosaic plasty resulted in more bone changes than microfracture technique-the implications of the latter remain to be settled. This study underlines the difficulty in predicting outcome in the single case with any of these two techniques, particularly in a long-term perspective.
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Affiliation(s)
- Stig Heir
- Martina Hansens Hospital, Box 23, 1306 Bærum, Norway.
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Takahashi I, Hoso M, Matsuzaki T. Histopathological Effects of Loading on Cartilage Repair in a Rat Full-thickness Articular Cartilage Defect Model. J Phys Ther Sci 2012. [DOI: 10.1589/jpts.24.1187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ikufumi Takahashi
- Department of Rehabilitation, Houju Memorial Hospital
- Division of Health Sciences, Graduate School of Medical Science, Kanazawa University
| | - Masahiro Hoso
- Division of Health Sciences, Graduate School of Medical Science, Kanazawa University
| | - Taro Matsuzaki
- Division of Health Sciences, Graduate School of Medical Science, Kanazawa University
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Sung MS, Jeong CH, Lim YS, Yoo WJ, Chung SK, Jung NY. Periosteal autograft for articular cartilage defects in dogs: MR imaging and ultrasonography of the repair process. Acta Radiol 2011; 52:181-90. [PMID: 21498347 DOI: 10.1258/ar.2010.100087] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Autologous periosteal grafting is used as treatment for cartilage defects. PURPOSE To assess the role of MR imaging and ultrasonography in the evaluation of the post-graft repair process with imaging and histologic correlation. MATERIAL AND METHODS Periosteal grafts obtained from the tibia of eight dogs were transplanted to the experimental cartilage defects in the femoral condyles (15 knees). The control group was comprised of three dogs (five knees). MR imaging using 4.7T and ultrasonography of the grafted specimens was performed at one, two, four, eight, and 16 weeks after transplantation. The animals were sacrificed at the time of imaging at the previously specified intervals. Histologic analysis with imaging correlation was subsequently performed. RESULTS All specimens taken from one to 16 weeks demonstrated periosteal proliferation in the graft. At one week, experimental cartilage defects were no longer present on MR imaging. Area of high signal intensity (SI) in the defect was present which corresponded to hemorrhage, edema, and fibrosis on histology. At two, four, and eight weeks, all but two graft demonstrated heterogeneous high SI on T2-weighted image, consistent with immature cartilage. At 16 weeks, all grafts showed heterogeneous isointense to adjacent cartilage on all sequences, which corresponded to dominant mature cartilage. The repair tissue near the exposed subchondral bone revealed heterogeneous high SI on T2-weighted images. This corresponded to the fibrosis with vascular penetration and edema. In the control group, no cartilage repair was noted within cartilage defects. The serial MR features of the grafted area correlated well with the histologic findings. Serial sonographic findings were not sufficient to provide the regenerated cartilage maturity. CONCLUSION MR imaging is capable of depicting the repair characteristics following periosteal grafting for articular cartilage defects. MR imaging may provide useful information in the assessment of the graft appearance with definite implications regarding the degree and success of incorporation.
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Affiliation(s)
| | - Chang Hoon Jeong
- Department of Orthopedic Surgery, The Catholic University of Korea, College of Medicine, Bucheon St Mary's Hospital, Sosa-dong, Bucheon, Kyunggi-do, 420-717, Korea
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Takahashi I, Hoso M, Matsuzaki T. Analysis of a Low-Invasive Method to Create Full-Thickness Articular Cartilage Defects in a Rat Model. J Phys Ther Sci 2011. [DOI: 10.1589/jpts.23.879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ikufumi Takahashi
- Department of Rehabilitation, Houju Memorial Hospital
- Division of Health Sciences, Graduate School of Medical Science, Kanazawa University
| | - Masahiro Hoso
- Division of Health Sciences, Graduate School of Medical Science, Kanazawa University
| | - Taro Matsuzaki
- Division of Health Sciences, Graduate School of Medical Science, Kanazawa University
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Hayes ML, Collins MS, Morgan JA, Wenger DE, Dahm DL. Efficacy of diagnostic magnetic resonance imaging for articular cartilage lesions of the glenohumeral joint in patients with instability. Skeletal Radiol 2010; 39:1199-204. [PMID: 20411385 DOI: 10.1007/s00256-010-0922-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 03/04/2010] [Accepted: 03/15/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was primarily to assess the diagnostic performance of magnetic resonance imaging (MRI) in detecting articular cartilage injuries in patients with glenohumeral instability. A secondary purpose was to assess the diagnostic performance of MRI for detection of Hill-Sachs and Bankart lesions. MATERIALS AND METHODS A cohort of 87 consecutive patients who underwent diagnostic MRI and shoulder arthroscopy for instability from 1997 to 2006 were identified. Fifty-five patients (63.2%) underwent MRI with intra-articular contrast medium and 32 patients (36.8%) underwent MRI without contrast medium. MR images were reviewed by two radiologists and interpreted by consensus for the presence of articular cartilage lesions (including Hill-Sachs and Bankart lesions), which were then confirmed by reviewing the operative report and images recorded at arthroscopy. RESULTS Mean patient age was 27.0 ± 10.2 years with a mean clinical and radiographic follow-up of 29 (range 3-72) months. Cartilage injuries were detected arthroscopically in 55 patients (63%). Bankart and Hill-Sachs lesions were identified arthroscopically in 66 patients (75.9%) and 55 patients (63.2%) respectively. The overall sensitivity and specificity for detection of glenohumeral articular cartilage lesions by MRI were 87.2% and 80.6% respectively. The sensitivity and specificity of MRI in detecting Bankart lesions was 98.4% (95% CI 91.9, 99.7) and 95.2% (95% CI 77.3, 99.2) respectively. The sensitivity and specificity of MRI in detecting Hill-Sachs lesions was 96.3% (95% CI 87.6, 98.9%) and 90.6% (95% CI 75.7, 96.9) respectively. No statistically significant difference was found between MRI examinations with and without intra-articular gadolinium (p = 0.89). CONCLUSION Magnetic resonance imaging demonstrates high sensitivity and specificity for the diagnosis of articular cartilage injuries in patients with glenohumeral instability. MRI with or without intra-articular contrast medium in this study were equally reliable as a non-invasive method for assessment of articular cartilage damage of the glenohumeral joint prior to diagnostic arthroscopy.
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Sayed KE, Haisch A, John T, Marzahn U, Lohan A, Müller RD, Kohl B, Ertel W, Stoelzel K, Schulze-Tanzil G. Heterotopic Autologous Chondrocyte Transplantation—A Realistic Approach to Support Articular Cartilage Repair? TISSUE ENGINEERING PART B-REVIEWS 2010; 16:603-16. [DOI: 10.1089/ten.teb.2010.0167] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Karym El Sayed
- Department of Trauma and Reconstructive Surgery, Charité-Universitätsmedizin, Berlin, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - Andreas Haisch
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - Thilo John
- Department of Trauma and Reconstructive Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - Ulrike Marzahn
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - Anke Lohan
- Department of Trauma and Reconstructive Surgery, Charité-Universitätsmedizin, Berlin, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - Riccarda D. Müller
- Department of Trauma and Reconstructive Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - Benjamin Kohl
- Department of Trauma and Reconstructive Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - Wolfgang Ertel
- Department of Trauma and Reconstructive Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - Katharina Stoelzel
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - Gundula Schulze-Tanzil
- Department of Trauma and Reconstructive Surgery, Charité-Universitätsmedizin, Berlin, Germany
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Matsumoto T, Okabe T, Ikawa T, Iida T, Yasuda H, Nakamura H, Wakitani S. Articular cartilage repair with autologous bone marrow mesenchymal cells. J Cell Physiol 2010; 225:291-5. [PMID: 20458744 DOI: 10.1002/jcp.22223] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Articular cartilage defects that do not repair spontaneously induce osteoarthritic changes in joints over a long period of observation. In this study, we examined the usefulness of transplanting culture-expanded bone marrow mesenchymal cells into osteochondral defects of joints with cartilage defects. First, we performed experiments on rabbits and up on obtaining good results proceeded to perform the experiments on humans. Macroscopic and histological repair with this method was good, and good clinical results were obtained although there was no significant difference with the control group. Recent reports have indicated that this procedure is comparable to autologous chondrocyte implantation, and concluded that it was a good procedure because it required one step less than that required by surgery, reduced costs for patients, and minimized donor site morbidity. Although some reports have previously shown that progenitor cells formed a tumor when implanted into immune-deficient mice after long term in vitro culture, the safety of the cell transplantation was confirmed by our clinical experience. Thus, this procedure is useful, effective, and safe, but the repaired tissues were not always hyaline cartilage. To obtain better repair with this procedure, treatment approaches using some growth factors during in vitro culture or gene transfection are being explored.
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Affiliation(s)
- Tomiya Matsumoto
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka, Japan
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Heir S, Årøen A, Løken S, Sulheim S, Engebretsen L, Reinholt FP. Intraarticular location predicts cartilage filling and subchondral bone changes in a chondral defect. Acta Orthop 2010; 81:619-27. [PMID: 20919808 PMCID: PMC3214753 DOI: 10.3109/17453674.2010.524593] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE The natural history of, and predictive factors for outcome of cartilage restoration in chondral defects are poorly understood. We investigated the natural history of cartilage filling subchondral bone changes, comparing defects at two locations in the rabbit knee. ANIMALS AND METHODS In New Zealand rabbits aged 22 weeks, a 4-mm pure chondral defect (ICRS grade 3b) was created in the patella of one knee and in the medial femoral condyle of the other. A stereo microscope was used to optimize the preparation of the defects. The animals were killed 12, 24, and 36 weeks after surgery. Defect filling and the density of subchondral mineralized tissue was estimated using Analysis Pro software on micrographed histological sections. RESULTS The mean filling of the patellar defects was more than twice that of the medial femoral condylar defects at 24 and 36 weeks of follow-up. There was a statistically significant increase in filling from 24 to 36 weeks after surgery at both locations. The density of subchondral mineralized tissue beneath the defects subsided with time in the patellas, in contrast to the density in the medial femoral condyles, which remained unchanged. INTERPRETATION The intraarticular location is a predictive factor for spontaneous filling and subchondral bone changes of chondral defects corresponding to ICRS grade 3b. Disregarding location, the spontaneous filling increased with long-term follow-up. This should be considered when evaluating aspects of cartilage restoration.
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Affiliation(s)
| | | | | | | | | | - Finn P Reinholt
- Division of Pathology, University of Oslo, and Oslo University Hospital Rikshospitalet, Oslo, Norway
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Lim SM, Oh SH, Lee HH, Yuk SH, Im GI, Lee JH. Dual growth factor-releasing nanoparticle/hydrogel system for cartilage tissue engineering. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2010; 21:2593-2600. [PMID: 20577785 DOI: 10.1007/s10856-010-4118-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 06/11/2010] [Indexed: 05/26/2023]
Abstract
In order to induce the chondrogenesis of mesenchymal stem cells (MSCs) in tissue engineering, a variety of growth factors have been adapted and encouraging results have been demonstrated. In this study, we developed a delivery system for dual growth factors using a gelation rate controllable alginate solution (containing BMP-7) and polyion complex nanoparticles (containing TGF-beta(2)) to be applied for the chondrogenesis of MSCs. The dual growth factors (BMP-7/TGF-beta(2))-loaded nanoparticle/hydrogel system showed a controlled release of both growth factors: a faster release of BMP-7 and a slower release of TGF-beta(2), ca., approximately 80 and 30% release at the end of an incubation period (21 days), respectively, which may be highly desirable for chondrogenic differentiation of MSCs. On the contrary, the release of each growth factor from the dual growth factors-loaded hydrogel (without the nanoparticles) was much slower than that of the nanoparticle/hydrogel system, approximately 36% (BMP-7) and 16% (TGF-beta(2)) for 21 days, and this is more than likely attributed to the aggregation between growth factors during the hydrogel fabrication step. The nanoparticle/hydrogel system with separate growth factor loading may provide desirable growth factor delivery kinetics for cartilage regeneration, as well as the chondrogenesis of MSCs.
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Affiliation(s)
- Sung Mook Lim
- Department of Advanced Materials, Hannam University, 461-6 Jeonmin Dong, Yuseong Gu, Daejeon, 305-811, Republic of Korea
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Heir S, Nerhus TK, Røtterud JH, Løken S, Ekeland A, Engebretsen L, Arøen A. Focal cartilage defects in the knee impair quality of life as much as severe osteoarthritis: a comparison of knee injury and osteoarthritis outcome score in 4 patient categories scheduled for knee surgery. Am J Sports Med 2010; 38:231-7. [PMID: 20042546 DOI: 10.1177/0363546509352157] [Citation(s) in RCA: 273] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with focal cartilage defects in the knee may suffer from both pain and functional impairment. Treatment options are often insufficient. It is not known, however, to what extent their complaints affect quality of life, compared with other knee disorders. Knee Injury and Osteoarthritis Outcome Score (KOOS) is a validated global knee score suitable for comparison of patients with knee complaints attributable to different causes. Hypothesis Complaints because of localized cartilage defects in the knee reduce quality of life measured by KOOS to a different extent than those due to anterior cruciate ligament deficiency and osteoarthritis, when comparing patients within the working population scheduled for surgery. STUDY DESIGN Cross-sectional study; Level of evidence, 3. Methods Previously registered KOOS baseline data on patients enrolled in different knee treatment studies were included in the present study; the patients were 18 to 67 years of age (working population) at data registration. The different patient categories were (1) patients with knee osteoarthritis enrolled for knee arthroplasty, (2) patients with knee osteoarthritis enrolled for osteotomies around the knee, (3) patients with focal cartilage lesions enrolled for cartilage repair, and (4) patients with anterior cruciate ligament-deficient knees enrolled for anterior cruciate ligament reconstruction. The KOOS subscale quality of life was the main parameter for comparison of complaints. RESULTS At preoperative baseline, patients with focal cartilage defects in the knee scored 27.5 on the KOOS subscale quality of life, not significantly different from the 28.8 and 27.2 in the patients with osteoarthritis enrolled for knee osteotomies and arthroplasties, respectively. For all the subscales of KOOS, the cartilage patients scored significantly lower than the patients with anterior cruciate ligament deficiency. CONCLUSION Patients with focal cartilage lesions have major problems with pain and functional impairment. Their complaints are worse than those of patients with anterior cruciate ligament-deficient knees, and quality of life is affected to the same extent as in patients scheduled for knee replacement.
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Affiliation(s)
- Stig Heir
- Department of Orthopaedic Surgery, Martina Hansens Hospital, Baerum, Norway.
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Papaioannou G, Demetropoulos CK, King YH. Predicting the effects of knee focal articular surface injury with a patient-specific finite element model. Knee 2010; 17:61-8. [PMID: 19477131 DOI: 10.1016/j.knee.2009.05.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Revised: 04/23/2009] [Accepted: 05/04/2009] [Indexed: 02/02/2023]
Abstract
Successful focal articular surface injury (FAI) repair depends on appropriate matching of the geometrical/material properties of the repaired site, and on the overall dynamic response of the knee to in-vivo loading. There is evidence linking the pathogenesis of lesion progression (e.g. osteoarthritis) to weightbearing site and defect size. The paper investigates further this link by studying the effects of osteochondral defect size on the load distribution at the human knee. Experimental data from cadaver knees (n=8) loaded at 30 degrees of flexion was used as input to a validated finite element (FE) model. Contact pressure was assessed for the intact knees and over a range of circular osteochondral defects (5 mm to 20 mm) at 30 degrees of flexion with 700 N axial load. Patient specific FE models and the specific boundary conditions of the experimental set-up were used to analyze the osteochondral defects. Stress concentration around the rims of defects 8 mm and smaller was not significant and pressure distribution was dominated by the menisci. Experimental data was confirmed by the model. For defects 10 mm and greater, distribution of peak pressures followed the rim of the defect with a mean distance from the rim of 2.64 mm on the medial condyle and 2.90 mm on the lateral condyle (model predictions were 2.63 and 2.87 mm respectively). Statistical significance was reported when comparing defects that differed by 4 mm or greater (except for the 5 mm case). Peak rim pressure did not significantly increase as defects were enlarged from 10 mm to 20 mm. Peak values were always significantly higher over the medial femoral condyle. Although the decision to treat osteochondral lesions is multifactorial, the results of this finite element analysis indicate that a size threshold of 10 mm, may be a useful early adjunct to guide clinical decision-making. This modified FE method can be employed for in-vivo studies.
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Affiliation(s)
- George Papaioannou
- MOVE Center, Wisconsin Institute for Biomedical Health Technology, University of Wisconsin, Milwaukee, WI 53201-0413, USA.
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45
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Frisbie DD, Lu Y, Kawcak CE, DiCarlo EF, Binette F, McIlwraith CW. In vivo evaluation of autologous cartilage fragment-loaded scaffolds implanted into equine articular defects and compared with autologous chondrocyte implantation. Am J Sports Med 2009; 37 Suppl 1:71S-80S. [PMID: 19934439 DOI: 10.1177/0363546509348478] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Current autologous chondrocyte implantation (ACI) techniques require 2 surgical procedures: 1 for cell harvest and 1 for reimplantation of cultured cells. A 1-step procedure is more desirable. PURPOSE A 1-step surgical procedure using autologous cartilage fragments on a polydioxanone scaffold, or CAIS (cartilage autograft implantation system), in a clinically relevant defect (15-mm diameter) within equine femoral trochlea was compared with a 2-step ACI technique as well as with empty defects and defects with polydioxanone foam scaffolds alone. STUDY DESIGN Controlled laboratory study. METHODS Ten skeletally mature horses were used. Articular cartilage from the lateral trochlea of the femur was harvested arthroscopically (n = 5), and chondrocytes were cultured on small intestinal submucosa to produce ACI constructs. The CAIS procedure had cartilage harvested during defect creation to prepare minced cartilage on polydioxanone-reinforced foam. The ACI and CAIS constructs were placed in defects using polydioxanone/polyglycolic acid staples. Defects were examined arthroscopically at 4, 8, and 12 months and with gross, histological, and immunohistochemical examination at 12 months. RESULTS Arthroscopic, histologic, and immunohistochemistry results show superiority of both implantation techniques (ACI and CAIS) compared with empty defects and defects with polydioxanone foam alone, with CAIS having the highest score. CONCLUSION This is the first demonstration of long-term healing with strenuous exercise using ACI and CAIS in a critically sized defect. CLINICAL RELEVANCE Given these results with the CAIS procedure, testing in human patients is the next logical step (a phase 1 human clinical study has proceeded from this work).
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Affiliation(s)
- David D Frisbie
- Orthopaedic Research Center, Colorado State University, 300 West Drake, Fort Collins, CO 80523, USA
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Jin RL, Park SR, Choi BH, Min BH. Scaffold-Free Cartilage Fabrication System Using Passaged Porcine Chondrocytes and Basic Fibroblast Growth Factor. Tissue Eng Part A 2009; 15:1887-95. [DOI: 10.1089/ten.tea.2008.0349] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ri Long Jin
- Department of Orthopaedic Surgery, School of Medicine, Ajou University, Suwon, Republic of Korea
| | - So Ra Park
- Department of Physiology, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Byung Hyune Choi
- Division of Biomedical and Bioengineering Sciences, Inha University College of Medicine, Incheon, Republic of Korea
| | - Byoung-Hyun Min
- Department of Orthopaedic Surgery, School of Medicine, Ajou University, Suwon, Republic of Korea
- Departmant of Molecular Science and Technology, Ajou University, Suwon, Republic of Korea
- Cell Theraphy Center, Ajou University, Suwon, Republic of Korea
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47
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Ozsoy MH, Aydogdu S, Taskiran D, Sezak M, Hayran M, Oztop F, Ozsoy A. The effects of early or late treatment of osteochondral defects on joint homoeostasis: an experimental study in rabbits. Knee Surg Sports Traumatol Arthrosc 2009; 17:578-89. [PMID: 19083207 DOI: 10.1007/s00167-008-0675-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 11/07/2008] [Indexed: 10/21/2022]
Abstract
A 3.5 x 4 mm tubular osteochondral defect was created on the right medial femoral condyles of 51 adult rabbits. In the control group (CG), defects were left untreated. In the early-(ETG) and late-(LTG) treatment groups, defects were treated by an osteoperiosteal graft 1 and 12 weeks, respectively, after the index procedure. Synovial fluid (SF) samples were collected regularly and proteoglycan fragments (PF), total collagen (TC) and collagenase (MMP-1) levels were measured. Rabbits were killed at 4 (early period), 12 (intermediate period), or 24 (late period) weeks postoperatively. Histological examination indicated a more successful healing in both grafting groups than in the CG, but without any difference at any time period between the grafting groups. In the CG, PF, and TC levels in SF increased continuously until the late period, indicating an ongoing degenerative activity in the joints. In contrast, SF marker levels in both grafting groups indicated that normalization in joint metabolism could be achieved-at least partially-after treatment. However, PF levels in the SF showed that the treatment of defects in earlier stages might result in better outcomes since the negative effects were more prominent in chronic stages, presumably due to the more prolonged period of disturbed homeostasis. Thus, histological values and SF marker levels indicated that treatment of osteochondral defects at any time of the disease had a positive effect on healing when compared to no treatment. Early treatment might better assist the recovery of joint homeostasis than late treatment.
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Affiliation(s)
- Mehmet Hakan Ozsoy
- 1st Clinic of Orthopedics and Traumatology, Ankara Training and Research Hospital, Ankara, Turkey.
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48
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Poly(vinyl alcohol)–acrylamide hydrogels as load-bearing cartilage substitute. Biomaterials 2009; 30:589-96. [DOI: 10.1016/j.biomaterials.2008.10.010] [Citation(s) in RCA: 172] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Accepted: 10/12/2008] [Indexed: 11/19/2022]
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Novel porous matrix of hyaluronic acid for the three-dimensional culture of chondrocytes. Int J Pharm 2008; 369:114-20. [PMID: 19059468 DOI: 10.1016/j.ijpharm.2008.11.008] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 10/06/2008] [Accepted: 11/07/2008] [Indexed: 11/20/2022]
Abstract
A novel three-dimensional (3D) scaffold of chemically unmodified hyaluronic acid (HA) with minimum cross-linkage was developed for the culture of chondrocytes, thereby to promote cartilage repair. The porous structure of the scaffold was observed by scanning electron microscopy (SEM), and the pore size was controlled by fabrication conditions including swelling time and composition of the HA matrix. Rabbit primary chondrocytes and human chondrocytic cell lines (C-20/A4) were cultured in the HA matrix to investigate whether they can be applied to construct the cartilage tissue in vitro. The chondrocytes retained chondrocytic spherical morphology in this HA matrix. Moreover, results from the MTT assay showed good cellular viability within the HA matrix; optical density increased for up to 28 days, demonstrating that the cells continued to proliferate inside the HA matrix. Phenotypic analysis (RT-PCR, Alcian blue staining and quantification of s-GAG) showed that chondrocytes, when three-dimensionally cultured within the HA matrix, expressed transcripts encoding collagen type II and aggrecan, and produced sulfated glycosaminoglycans (s-GAG), indicating chondrogenic differentiation. The new HA matrix therefore appears as a potentially promising scaffold for the three-dimensional culture of chondrocytes for cartilage tissue engineering.
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50
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Baumbach K, Petersen JP, Ueblacker P, Schröder J, Göpfert C, Stork A, Rueger JM, Amling M, Meenen NM. The fate of osteochondral grafts after autologous osteochondral transplantation: a one-year follow-up study in a minipig model. Arch Orthop Trauma Surg 2008; 128:1255-63. [PMID: 18064477 DOI: 10.1007/s00402-007-0532-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Because articular cartilage shows little intrinsic capacity of spontaneous regeneration, a variety of treatment options are currently at use to repair cartilage damage. One of these is the autologous osteochondral transplantation (AOT). The aim of the present work was to study the histological changes during the progress of 1 year after AOT in the knee joint. MATERIALS AND METHODS Twelve Minipigs underwent an AOT on the medial femoral condyles of both knees using cooled diamond studded trephines with a diameter of the grafts of 4.6 mm. Three animals were sacrificed at each 2, 8, 26 and 52 weeks after the operation. The condyles were analyzed histologically and immunohistologically for collagen types I and II. RESULTS A successful bony incorporation was observed in all specimens. The transplant demonstrated an increasingly stable integration of the chondral matrix into the cartilage of the surrounding femoral condyle. At 52 weeks after the operations 5 of 6 condyles showed a chondral integration at least at one side of the graft. Immunohistologically all specimens showed physiological staining characteristics up to 52 weeks after operation. The quality of the chondral part of the graft showed a wide range of variations, ranging from vital tissue resembling native cartilage after 52 weeks, to severe degenerative signs beginning 2 weeks after operation and ending at 52 weeks with deep fissures fragmenting the cartilage and the complete loss of vital cells. CONCLUSION The press-fit technique allows a stable bony incorporation. A chondral integration of the graft seems to occur, provided that a close contact between the interfaces can be achieved. Present results demonstrate a vital cartilagenous transplant for up to 52 weeks. However, some specimens showed in part severe degenerative signs. A possible explanation is an insufficient cooling of the trephines in relation to the small diameter of the grafts used in the minipig model. The collagen network seems not to be affected for up to 52 weeks.
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Affiliation(s)
- Klaus Baumbach
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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