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Wang DY, Jiang D, Yu JK. Editorial Commentary: Meniscal Allograft Transplantation Results in Both Pain Relief and Chondroprotection. Arthroscopy 2024; 40:1575-1577. [PMID: 38219097 DOI: 10.1016/j.arthro.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 01/15/2024]
Abstract
Meniscal allograft transplantation (MAT) effectively alleviates symptoms of the meniscus deficiency. Thus, MAT is a widely accepted and recommended treatment for individuals with unicompartmental pain due to meniscus deficiency. Long-term follow-up studies have indicated that MAT yields favorable clinical outcomes, demonstrating high survivorship and low rates of serious complications. In addition, the ability of MAT to function akin to the native meniscus and shield the knee cartilage from osteoarthritis has been a subject of ongoing investigation, and recent direct magnetic resonance imaging evidence shows long-term chondroprotection following MAT. Cartilage lesions worsen during the meniscus deficiency period. Consequently, delaying MAT until patients become more symptomatic may lead to poor outcomes and low graft survivorship due to concomitant cartilage lesions. These findings prompt a reevaluation of the purpose and timing of MAT decisions for meniscectomy patients, suggesting a more proactive approach to recommending MAT, particularly for patients at high risk of postmeniscectomy syndrome and osteoarthritis progression.
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Affiliation(s)
- Ding-Yu Wang
- Peking University Third Hospital; Beijing Key Laboratory of Sports Injuries; Engineering Research Center of Sports Trauma Treatment Technology and Devices
| | - Dong Jiang
- Peking University Third Hospital; Beijing Key Laboratory of Sports Injuries; Engineering Research Center of Sports Trauma Treatment Technology and Devices
| | - Jia-Kuo Yu
- Peking University Third Hospital; Beijing Key Laboratory of Sports Injuries; Engineering Research Center of Sports Trauma Treatment Technology and Devices; Orthopaedic Sports Medicine Center, Beijing Tsinghua Changgung Hospital, Affiliated Hospital of Tsinghua University, Beijing, China
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Rucinski K, Cook JL, Schweser KM, Crist BD. Short-Term Outcomes After Bipolar Osteochondral Allograft Transplantation (OCAT) in the Ankle. J Foot Ankle Surg 2024; 63:207-213. [PMID: 37972816 DOI: 10.1053/j.jfas.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/01/2023] [Accepted: 11/04/2023] [Indexed: 11/19/2023]
Abstract
Treatment options for symptomatic cartilage loss in the ankle are not consistently effective. This study documents initial outcomes for patients undergoing bipolar OCAT in the ankle after advances in tissue preservation, transplantation techniques, and patient management strategies were implemented. Patients were prospectively enrolled into a registry designed to follow outcomes after OCAT in the ankle. Fourteen patients were included for analyses (12 primary OCAT, 2 revision OCAT). Four patients underwent Bipolar OCAT (tibia, talus) and 10 Bipolar+ OCAT (tibia, talus, fibula). Short-term (median follow-up 43, range 13-73 months) success was documented for 13 patients. Radiographic assessments indicated OCA integration and maintenance of joint space in 12 patients. Statistically significant (p < .030) and clinically meaningful improvements in AAOS and VAS pain scores were noted at 3 months, 6 months, 1 year, and 2 years following OCA transplantation when compared to preoperative measures. For patients that were nonadherent to postoperative restriction and rehabilitation protocols, all 1-year postoperative PROs were significantly lower (p < .050) than for patients who were adherent. The successful outcomes documented in 13 of 14 patients in conjunction with significant and clinically meaningful improvements in patient-reported measures of pain and function support OCA transplantation as an appropriate treatment option in indicated patients. These improvements in outcomes were associated with advances in OCA preservation, preimplantation treatment, transplantation techniques, and patient management strategies, suggesting this shift in practice be considered for OCA transplantation in the ankle.
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Affiliation(s)
- Kylee Rucinski
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO; Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO
| | - James L Cook
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO; Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO
| | - Kyle M Schweser
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO
| | - Brett D Crist
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO; Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO.
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Luk J, Troyer L, Guess TM, Teixeiro E, Stannard JP, Cook JL. Characterizing Osteochondral Allograft Biomechanics for Optimizing Transplant Success: A Systematic Review. J Knee Surg 2024; 37:227-237. [PMID: 36940706 DOI: 10.1055/s-0043-1764403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Osteochondral allograft (OCA) transplantation has been largely successful in treating symptomatic articular cartilage lesions; however, treatment failures persist. While OCA biomechanics have been consistently cited as mechanisms of treatment failure, the relationships among mechanical and biological variables that contribute to success after OCA transplantation have yet to be fully characterized. The purpose of this systematic review was to synthesize the clinically relevant peer-reviewed evidence targeting the biomechanics of OCAs and the impact on graft integration and functional survival toward developing and implementing strategies for improving patient outcomes. The Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, MEDLINE, PubMed, Cumulative Index to Nursing and Allied Health (CINAHL), Google Scholar, and EMBASE were searched to identify articles for systematic review. This review of relevant peer-reviewed literature provided evidence that the biomechanics related to OCA transplantation in the knee have direct and indirect effects on functional graft survival and patient outcomes. The evidence suggests that biomechanical variables can be optimized further to enhance benefits and mitigate detrimental effects. Each of these modifiable variables should be considered regarding indications, patient selection criteria, graft preservation methodology, graft preparation, transplantation, fixation techniques, and prescribed postoperative restriction and rehabilitation protocols. Criteria, methods, techniques, and protocols should target OCA quality (chondrocyte viability, extracellular matrix integrity, material properties), favorable patient and joint characteristics, rigid fixation with protected loading, and innovative ways to foster rapid and complete OCA cartilage and bone integration to optimize outcomes for OCA transplant patients.
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Affiliation(s)
- Josephine Luk
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
- School of Medicine, University of Missouri, Columbia, Missouri
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Luke Troyer
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
- School of Medicine, University of Missouri, Columbia, Missouri
| | - Trent M Guess
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Emma Teixeiro
- School of Medicine, University of Missouri, Columbia, Missouri
- University of Missouri, Molecular Microbiology & Immunology, Columbia, Missouri
| | - James P Stannard
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
- School of Medicine, University of Missouri, Columbia, Missouri
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - James L Cook
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
- School of Medicine, University of Missouri, Columbia, Missouri
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
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Dardanelli P, Larrague C, Molho N, Yacuzzi C, Zicaro JP, Costa-Paz M. [Use of frozen osteochondral allograft for the treatment of cartilage defects of the knee. Results at seven-year follow-up]. Medicina (B Aires) 2024; 84:261-266. [PMID: 38683511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024] Open
Abstract
INTRODUCTION Knee osteochondral lesions represent a frequent pathology within young active patients. One possible indication for severe lesions or in case of impossibility of harvesting an autograft is the use of fresh frozen allograft. The objective of this study was to retrospectively analyze functional results and failure rate after osteochondral transplants using fresh frozen allografts. METHODS We analyzed data from patients who underwent knee osteochondral transplant using mosaicplasty technique with fresh frozen allografts at our institution between 2014 and 2019. We included those patients with at least two-year follow-up. Demographic characteristics such as age at the moment of intervention and size of the defect were included. Functional results were assessed using pre and postoperative Lysholm and IKDC scores. Patients who underwent a knee replacement were considered failures. RESULTS Twenty-five patients were included. The median age was 43.5 years (IQR 29-50), 45% were female and the mean follow-up was 83 months (SD 54.6). Mean osteochondral defect size was 4 cm2. Mean pre and postoperative Lysholm scores were 39 (SD 19.3) and 82 (SD 15.4) respectively (p < 0.01). Mean pre and postoperative IKDC scores were 42 (SD 13.8) and 60 (SD 13.5) respectively (p < 0.01). Five patients (20%) underwent a knee replacement afterwards and were considered failures. DISCUSSION Our results after a mean seven-year follow-up evidenced an overall improvement in functional scores and a failure rate of 20%. Osteochondral transplant using fresh frozen allografts is a reliable and feasible treatment for patients with large osteochondral defects.
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Affiliation(s)
- Pablo Dardanelli
- Sección de Artroscopia y Prótesis de Rodilla, Instituto de Ortopedia y Traumatología, Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. E-mail:
| | - Catalina Larrague
- Sección de Artroscopia y Prótesis de Rodilla, Instituto de Ortopedia y Traumatología, Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Nicolás Molho
- Sección de Artroscopia y Prótesis de Rodilla, Instituto de Ortopedia y Traumatología, Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Carlos Yacuzzi
- Sección de Artroscopia y Prótesis de Rodilla, Instituto de Ortopedia y Traumatología, Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Juan Pablo Zicaro
- Sección de Artroscopia y Prótesis de Rodilla, Instituto de Ortopedia y Traumatología, Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Matías Costa-Paz
- Sección de Artroscopia y Prótesis de Rodilla, Instituto de Ortopedia y Traumatología, Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Abstract
OBJECTIVE The main purpose of the present study was to assess the risk for major revision surgery after perichondrium transplantation (PT) at a minimum of 22 years postoperatively and to evaluate the influence of patient characteristics. DESIGN Primary outcome was treatment success or failure. Failure of PT was defined as revision surgery in which the transplant was removed, such as (unicondylar) knee arthroplasty or patellectomy. The functioning of nonfailed patients was evaluated using the International Knee Documentation Committee (IKDC) score. In addition, the influence of patient characteristics was evaluated. RESULTS Ninety knees in 88 patients, aged 16 to 55 years with symptomatic cartilage defects, were treated by PT. Eighty knees in 78 patients were eligible for analysis and 10 patients were lost to follow-up. Twenty-eight knees in 26 patients had undergone major revision surgery. Previous surgery and a longer time of symptoms prior to PT were significantly associated with an increased risk for failure of cartilage repair. Functioning of the remaining 52 patients and influence of patient characteristics was analyzed using their IKDC score. Their median IKDC score was 39.08, but a relatively young age at transplantation was associated with a higher IKDC score. CONCLUSIONS This 22-year follow-up study of PT, with objective outcome parameters next to patient-reported outcome measurements in a unique group of patients, shows that overall 66% was without major revision surgery and patient characteristics also influence long-term outcome of cartilage repair surgery.
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Affiliation(s)
- Maarten P. F. Janssen
- Department of Orthopaedic Surgery,
CAPHRI School for Public Health and Primary Care, Maastricht University Medical
Center, Maastricht, Netherlands
| | - Esther G. M. van der Linden
- Department of Orthopaedic Surgery,
CAPHRI School for Public Health and Primary Care, Maastricht University Medical
Center, Maastricht, Netherlands
| | - Tim A. E. J. Boymans
- Department of Orthopaedic Surgery,
CAPHRI School for Public Health and Primary Care, Maastricht University Medical
Center, Maastricht, Netherlands
| | - Tim J. M. Welting
- Department of Orthopaedic Surgery,
CAPHRI School for Public Health and Primary Care, Maastricht University Medical
Center, Maastricht, Netherlands
| | - Lodewijk W. van Rhijn
- Department of Orthopaedic Surgery,
CAPHRI School for Public Health and Primary Care, Maastricht University Medical
Center, Maastricht, Netherlands
| | - Sjoerd K. Bulstra
- Department of Orthopaedics, University
of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Peter J. Emans
- Department of Orthopaedic Surgery,
CAPHRI School for Public Health and Primary Care, Maastricht University Medical
Center, Maastricht, Netherlands
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Bae DS, Ingall EM, Miller PE, Eisenberg K. Early Results of Single-plug Autologous Osteochondral Grafting for Osteochondritis Dissecans of the Capitellum in Adolescents. J Pediatr Orthop 2020; 40:78-85. [PMID: 31923167 DOI: 10.1097/bpo.0000000000001114] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Osteochondral autologous transplantation surgery (OATS) has been advocated for unstable osetochondritis dissecans (OCD) lesions of the adolescent capitellum, though limited information is available regarding clinical and radiographic results in North American patients. We hypothesize that single-plug OATS is safe and effective in alleviating pain and restoring function in unstable OCD. METHODS Twenty-eight patients with unstable OCD treated with single-plug OATS were evaluated. Mean age at surgery was 14.2 years; there were 14 males. Etiology of OCD was presumed to be sports participation, including baseball (n=5) and gymnastics (n=11). Indications for surgery included unstable, deep OCD lesions; 2 lesions were uncontained, and 3 patients (11%) had OATS after failed prior surgery. OATS was performed by an anconeus muscle-splitting approach; donor grafts were harvested from the lateral femoral condyle by small arthrotomy. Functional outcomes were quantified using the Timmerman instrument. Median clinical and radiographic follow-up was 6.3 months (range, 5.0 to 27.0 mo) and 5.7 months (range, 5.0 to 26.7 mo), respectively. Furthermore, all patients returned functional questionnaires at a median of 9 months postoperatively (range, 5 to 27 mo). RESULTS Of the 26 patients who reported preoperative tenderness, 19 (73%) patients had no tenderness at most recent clinical follow-up (P=0.02). Of 18 patients with restricted elbow motion preoperatively, 13 had achieved full range of motion (P=0.10). Both elbow flexion and extension improved significantly [flexion: median change (interquartile range)=10 degrees (0 to 10 degrees), P=0.009; extension: 0 degree (-5 to 0 degrees), P <0.001). On postoperative magnetic resonance imaging, 86% (P<0.001) of elbows had restoration of articular congruity and 93% had complete graft incorporation. Objective [median change (interquartile range)=5 degrees (0 to 15 degrees)], subjective [25 degrees (15 to 40 degrees)], and overall [35 degrees (15 to 45 degrees)] Timmerman scores improved significantly (P=0.001, <0.001, and <0.001, respectively). Of the 13 patients with >6 months follow-up, 9 patients (69%) had returned to their primary sport (P=0.27) and 100% had returned to general sports participation. There were no postoperative complications. At final follow-up, all donor knees were asymptomatic with full motion and strength. CONCLUSION Single-plug OATS is safe and effective in improving pain and elbow function in adolescents with unstable OCD, with high return to sports rates and little donor-site morbidity. LEVEL OF EVIDENCE Level IV-case series.
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Affiliation(s)
- Donald S Bae
- Department of Orthopaedics, Boston Children's Hospital, Boston, MA
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Shardt N, Chen Z, Yuan SC, Wu K, Laouar L, Jomha NM, Elliott JAW. Using engineering models to shorten cryoprotectant loading time for the vitrification of articular cartilage. Cryobiology 2020; 92:180-188. [PMID: 31952947 DOI: 10.1016/j.cryobiol.2020.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/13/2020] [Indexed: 02/05/2023]
Abstract
Osteochondral allograft transplantation can treat full thickness cartilage and bone lesions in the knee and other joints, but the lack of widespread articular cartilage banking limits the quantity of cartilage available for size and contour matching. To address the limited availability of cartilage, vitrification can be used to store harvested joint tissues indefinitely. Our group's reported vitrification protocol [Biomaterials 33 (2012) 6061-6068] takes 9.5 h to load cryoprotectants into intact articular cartilage on bone and achieves high cell viability, but further optimization is needed to shorten this protocol for clinical use. Herein, we use engineering models to calculate the spatial and temporal distributions of cryoprotectant concentration, solution vitrifiability, and freezing point for each step of the 9.5-h protocol. We then incorporate the following major design choices for developing a new shorter protocol: (i) all cryoprotectant loading solution concentrations are reduced, (ii) glycerol is removed as a cryoprotectant, and (iii) an equilibration step is introduced to flatten the final cryoprotectant concentration profiles. We also use a new criterion-the spatially and temporally resolved prediction of solution vitrifiability-to assess whether a protocol will be successful instead of requiring that each cryoprotectant individually reaches a certain concentration. A total cryoprotectant loading time of 7 h is targeted, and our new 7-h protocol is predicted to achieve a level of vitrifiability comparable to the proven 9.5-h protocol throughout the cartilage thickness.
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Affiliation(s)
- Nadia Shardt
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, T6G 1H9, Canada
| | - Zhirong Chen
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, T6G 1H9, Canada
| | - Shuying Claire Yuan
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, T6G 1H9, Canada
| | - Kezhou Wu
- Department of Surgery, University of Alberta, Edmonton, T6G 2B7, Canada; Department of Orthopedic Surgery, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - Leila Laouar
- Department of Surgery, University of Alberta, Edmonton, T6G 2B7, Canada
| | - Nadr M Jomha
- Department of Surgery, University of Alberta, Edmonton, T6G 2B7, Canada
| | - Janet A W Elliott
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, T6G 1H9, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, T6G 2R7, Canada.
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Stefani RM, Lee AJ, Tan AR, Halder SS, Hu Y, Guo XE, Stoker AM, Ateshian GA, Marra KG, Cook JL, Hung CT. Sustained low-dose dexamethasone delivery via a PLGA microsphere-embedded agarose implant for enhanced osteochondral repair. Acta Biomater 2020; 102:326-340. [PMID: 31805408 PMCID: PMC6956850 DOI: 10.1016/j.actbio.2019.11.052] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 12/16/2022]
Abstract
Articular cartilage defects are a common source of joint pain and dysfunction. We hypothesized that sustained low-dose dexamethasone (DEX) delivery via an acellular osteochondral implant would have a dual pro-anabolic and anti-catabolic effect, both supporting the functional integrity of adjacent graft and host tissue while also attenuating inflammation caused by iatrogenic injury. An acellular agarose hydrogel carrier with embedded DEX-loaded poly(lactic-co-glycolic) acid (PLGA) microspheres (DLMS) was developed to provide sustained release for at least 99 days. The DLMS implant was first evaluated in an in vitro pro-inflammatory model of cartilage degradation. The implant was chondroprotective, as indicated by maintenance of Young's modulus (EY) (p = 0.92) and GAG content (p = 1.0) in the presence of interleukin-1β insult. In a subsequent preliminary in vivo experiment, an osteochondral autograft transfer was performed using a pre-clinical canine model. DLMS implants were press-fit into the autograft donor site and compared to intra-articular DEX injection (INJ) or no DEX (CTL). Functional scores for DLMS animals returned to baseline (p = 0.39), whereas CTL and INJ remained significantly worse at 6 months (p < 0.05). DLMS knees were significantly more likely to have improved OARSI scores for proteoglycan, chondrocyte, and collagen pathology (p < 0.05). However, no significant improvements in synovial fluid cytokine content were observed. In conclusion, utilizing a targeted DLMS implant, we observed in vitro chondroprotection in the presence of IL-1-induced degradation and improved in vivo functional outcomes. These improved outcomes were correlated with superior histological scores but not necessarily a dampened inflammatory response, suggesting a primarily pro-anabolic effect. STATEMENT OF SIGNIFICANCE: Articular cartilage defects are a common source of joint pain and dysfunction. Effective treatment of these injuries may prevent the progression of osteoarthritis and reduce the need for total joint replacement. Dexamethasone, a potent glucocorticoid with concomitant anti-catabolic and pro-anabolic effects on cartilage, may serve as an adjuvant for a variety of repair strategies. Utilizing a dexamethasone-loaded osteochondral implant with controlled release characteristics, we demonstrated in vitro chondroprotection in the presence of IL-1-induced degradation and improved in vivo functional outcomes following osteochondral repair. These improved outcomes were correlated with superior histological cartilage scores and minimal-to-no comorbidity, which is a risk with high dose dexamethasone injections. Using this model of cartilage restoration, we have for the first time shown the application of targeted, low-dose dexamethasone for improved healing in a preclinical model of focal defect repair.
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Affiliation(s)
- Robert M Stefani
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York 10027, NY United States
| | - Andy J Lee
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York 10027, NY United States
| | - Andrea R Tan
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York 10027, NY United States
| | - Saiti S Halder
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York 10027, NY United States
| | - Yizhong Hu
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York 10027, NY United States
| | - X Edward Guo
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York 10027, NY United States
| | - Aaron M Stoker
- Missouri Orthopaedic Institute, University of Missouri, 1100 Virginia Avenue, Columbia 65212, MO, United States
| | - Gerard A Ateshian
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York 10027, NY United States; Department of Mechanical Engineering, Columbia University, 500 West 120th Street, 220 S.W. Mudd, New York 10027, NY, United States
| | - Kacey G Marra
- University of Pittsburgh, Biomedical Science Tower, 200 Lothrop Street, Pittsburgh 15213, PA, United States
| | - James L Cook
- Missouri Orthopaedic Institute, University of Missouri, 1100 Virginia Avenue, Columbia 65212, MO, United States
| | - Clark T Hung
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York 10027, NY United States.
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Jungmann PM, Gersing AS, Baumann F, Holwein C, Braun S, Neumann J, Zarnowski J, Hofmann FC, Imhoff AB, Rummeny EJ, Link TM. Cartilage repair surgery prevents progression of knee degeneration. Knee Surg Sports Traumatol Arthrosc 2019; 27:3001-3013. [PMID: 30542744 DOI: 10.1007/s00167-018-5321-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 12/04/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate, whether cartilage repair surgery for focal osteochondral defects at the knee results in less degenerative changes over 6 years in a MR imaging follow-up than morphologically initially identical defects in non-operated control subjects from the osteoarthritis initiative (OAI). METHODS A total of 32 individuals received baseline and follow-up MRI. In n = 16 patients with cartilage repair [osteochondral autograft transfer system (OATS), n = 12; spongiosa-augmented matrix-associated autologous chondrocyte implantation (MACI), n = 4] MRI was performed preoperatively and after 5.7 ± 2.3 year follow-up. Baseline MRIs of non-operated subjects from the OAI were screened for initially identical cartilage defects (n = 16). Morphological knee abnormalities were assessed using WORMS, AMADEUS and MOCART scores. A sagittal 2D MSME sequence was implemented for quantitative cartilage T2 relaxation time measurements in all (0, 2, 4, 6 and 8-years) follow-ups from the OAI and in the postoperative MRI protocol. RESULTS For both groups, focal osteochondral defects were located at the femoral condyle in 8/16 cases (5 medial, 3 lateral) and at the patella in 8/16 cases. At baseline, the mean cartilage defect size ± SD was 1.4 ± 1.3 cm2 for the control group and 1.3 ± 1.2 cm2 for the cartilage repair group (n.s.). WORMS scores were not significantly different between the cartilage repair group and the control group at baseline [mean difference ± SEM (95%CI); 0.5 ± 2.5 (- 4.7, 5.7), n.s.]. During identical follow-up times, the progression of total WORMS scores [19.9 ± 2.3 (15.0, 24.9), P < 0.001] and of cartilage defects scores in the affected (P < 0.001) and in the opposing (P = 0.029) compartment was significantly more severe in non-operated individuals (P < 0.05). In non-operated subjects, T2 values increased continuously from baseline to the 8-year follow-up (P = 0.001). CONCLUSIONS Patients with cartilage repair showed less progression of degenerative MRI changes at 6-year follow-up than a control cohort from the OAI with initially identical osteochondral defects. Patients with focal cartilage defects may profit from cartilage repair surgery since it may prevent progression of early osteoarthritis at the knee joint. LEVEL OF EVIDENCE Prognostic study, Level II.
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Affiliation(s)
- Pia M Jungmann
- Department of Neuroradiology, University Hospital of Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
| | - Alexandra S Gersing
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Frederic Baumann
- Clinical and Interventional Angiology, University Hospital of Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Christian Holwein
- Department of Sportsorthopedic Surgery, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- BG Unfallklinik Murnau, Prof.-Küntscher-Strasse 8, 82418, Murnau, Germany
| | - Sepp Braun
- Department of Sportsorthopedic Surgery, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- Gelenkpunkt, Sports and Joint Surgery Innsbruck, Olympiastrasse 39, 6020, Innsbruck, Austria
| | - Jan Neumann
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| | - Julia Zarnowski
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| | - Felix C Hofmann
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| | - Andreas B Imhoff
- Department of Sportsorthopedic Surgery, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Ernst J Rummeny
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Thomas M Link
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
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Goodfriend B, Essilfie AA, Jones IA, Thomas Vangsness C. Fresh osteochondral grafting in the United States: the current status of tissue banking processing. Cell Tissue Bank 2019; 20:331-337. [PMID: 31214919 DOI: 10.1007/s10561-019-09768-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 04/16/2019] [Indexed: 11/29/2022]
Abstract
The use of musculoskeletal allografts has become increasingly popular among surgeons. The purpose of this review is to highlight the procurment and delievery process of fresh osteochondral allografts in the United States. The four distributors of fresh osteochondral allografts in the United States were contacted. Surveys containing quantitative and qualitative sections concerning the procurement and processing of osteochondral allograft tissue were obtained. Our results showed an average of 13 ± 4.24 years of experience with osteochondral allografts. The average donor age ranged from 13.5 ± 3 to 37.5 ± 5 years, with an average age of 27 ± 2.83 years. All donors were between ages 12 and 45 years old. The percentage of screened donors that were accepted for allograft transplant was consistent at 70-75% for 3 out of the 4 tissue banks. The percentage of grafts that expire without implantation ranged from 20% to 29%. Maximum shipping time varied between 24 and 96 hours. Each tissue bank used its own proprietary storage medium. The time from donor death to the harvest of allograft tissue was < 24 hours. The most commonly requested osteochondral allograft tissue for all banks was the medial femoral condyle. The market share of fresh allografts is as follows: Joint Restoration Foundation (JRF) 59.9%, Muskuloskeletal Transplant Foundation (MTF) 15.3%, LifeNet Health (LN) 14.5%, and Regeneration Technology Incorporated (RTI) 10.2%, with approximately 4700 fresh allografts distributed in 2018. This compiled data from the four tissue banks that supply fresh osteochondral allograft in the United States provides important background information for patients and orthopaedic surgeons.
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Affiliation(s)
- Brett Goodfriend
- Department of Orthopedic Surgery, USC Keck School of Medicine, 1540 Alcazar Street, CHP 207, Los Angeles, CA, 90089-9007, USA
| | - Anthony A Essilfie
- Department of Orthopedic Surgery, USC Keck School of Medicine, 1540 Alcazar Street, CHP 207, Los Angeles, CA, 90089-9007, USA
| | - Ian A Jones
- School of Medicine, University of California, Irvine, 1001 Health Sciences Rd, Irvine, CA, 92617, USA
| | - C Thomas Vangsness
- Department of Orthopedic Surgery, USC Keck School of Medicine, 1540 Alcazar Street, CHP 207, Los Angeles, CA, 90089-9007, USA.
- Department of Orthopaedic Surgery, USC Keck School of Medicine, 1520 San Pablo Street, Suite 2000, Los Angeles, CA, 90089-9007, USA.
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11
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Abstract
BACKGROUND Osteochondral allograft (OCA) transplantation is a useful treatment for posttraumatic ankle arthritis in young patients, but failure rates are high and reoperations are not uncommon. The aim of this study was to evaluate the outcomes of failed ankle OCA transplantation converted to ankle arthrodesis (AA) or total ankle arthroplasty (TAA). METHODS We evaluated 24 patients who underwent salvage procedures (13 AA and 11 TAA) after primary failed ankle OCA transplantation. Reoperations were assessed. Failure of the salvage procedure was defined as an additional surgery that required a revision AA/TAA or amputation. Evaluation among nonfailing ankles included the American Academy of Orthopaedic Surgeons Foot and Ankle Module (AAOS-FAM), pain, and satisfaction. RESULTS In the salvage AA cohort, 3 patients were classified as failures (2 revision AA and 1 amputation). The 10 nonfailing patients had a mean follow-up of 7.4 years. Eighty-eight percent were satisfied with the procedure, but 63% reported continued problems with their ankle (eg, pain, swelling, stiffness). Mean pain level was 1.9 and AAOS-FAM core score was 83±13. In the salvage TAA cohort, 2 patients were classified as failures (both revision TAA). The 9 nonfailing patients had a mean follow-up of 3.8 years. Fifty percent were satisfied with the procedure, but 40% reported continued problems with their ankle. The mean pain level was 1.3, and the median AAOS-FAM core score was 82±26. CONCLUSION Revision and reoperation rates for salvage procedures following failed OCA transplantation of the ankle are higher compared to published data for primary AA and TAA procedures. However, we believe OCA transplantation can serve as an interim procedure for younger patients with advanced ankle joint disease who may not be ideal candidates for primary AA or TAA at the time of initial presentation. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Florian Gaul
- 1 Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
- 2 Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, USA
- 4 Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Germany
| | - Cameron R Barr
- 3 Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA
| | - Julie C McCauley
- 1 Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
| | - Steven N Copp
- 3 Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA
| | - William D Bugbee
- 1 Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
- 3 Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA
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12
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Lavernia L, Brown WE, Wong BJF, Hu JC, Athanasiou KA. Toward tissue-engineering of nasal cartilages. Acta Biomater 2019; 88:42-56. [PMID: 30794988 DOI: 10.1016/j.actbio.2019.02.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/15/2019] [Accepted: 02/18/2019] [Indexed: 12/25/2022]
Abstract
Nasal cartilage pathologies are common; for example, up to 80% of people are afflicted by deviated nasal septum conditions. Because cartilage provides the supportive framework of the nose, afflicted patients suffer low quality of life. To correct pathologies, graft cartilage is often required. Grafts are currently sourced from the patient's septum, ear, or rib. However, their use yields donor site morbidity and is limited by tissue quantity and quality. Additionally, rhinoplasty revision rates exceed 15%, exacerbating the shortage of graft cartilage. Alternative grafts, such as irradiated allogeneic rib cartilage, are associated with complications. Tissue-engineered neocartilage holds promise to address the limitations of current grafts. The engineering design process may be used to create suitable graft tissues. This process begins by identifying the surgeon's needs. Second, nasal cartilages' properties must be understood to define engineering design criteria. Limited investigations have examined nasal cartilage properties; numerous additional studies need to be performed to examine topographical variations, for example. Third, tissue-engineering processes must be applied to achieve the engineering design criteria. Within the recent past, strategies have frequently utilized human septal chondrocytes. As autologous and allogeneic rib graft cartilage is used, its suitability as a cell source should also be examined. Fourth, quantitative verification of engineered neocartilage is critical to check for successful achievement of the engineering design criteria. Finally, following the FDA paradigm, engineered neocartilage must be orthotopically validated in animals. Together, these steps delineate a path to engineer functional nasal neocartilages that may, ultimately, be used to treat human patients. STATEMENT OF SIGNIFICANCE: Nasal cartilage pathologies are common and lead to greatly diminished quality of life. The ability to correct pathologies is limited by cartilage graft quality and quantity, as well as donor site morbidity and surgical complications, such as infection and resorption. Despite the significance of nasal cartilage pathologies and high rhinoplasty revision rates (15%), little characterization and tissue-engineering work has been performed compared to other cartilages, such as articular cartilage. Furthermore, most work is published in clinical journals, with little in biomedical engineering. Therefore, this review discusses what nasal cartilage properties are known, summarizes the current state of nasal cartilage tissue-engineering, and makes recommendations via the engineering design process toward engineering functional nasal neocartilage to address current limitations.
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Affiliation(s)
- Laura Lavernia
- Department of Biomedical Engineering, University of California Irvine, 3120 Natural Sciences II, Irvine, CA 92697-2715, USA
| | - Wendy E Brown
- Department of Biomedical Engineering, University of California Irvine, 3120 Natural Sciences II, Irvine, CA 92697-2715, USA.
| | - Brian J F Wong
- Division of Facial Plastic Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, 1002 Health Sciences Road, Irvine, CA 92617, USA; Department of Biomedical Engineering, University of California Irvine, 1002 Health Sciences Road, Irvine, CA 92617, USA.
| | - Jerry C Hu
- Department of Biomedical Engineering, University of California Irvine, 3120 Natural Sciences II, Irvine, CA 92697-2715, USA.
| | - Kyriacos A Athanasiou
- Department of Biomedical Engineering, University of California Irvine, 3120 Natural Sciences II, Irvine, CA 92697-2715, USA.
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13
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Frank RM, Cotter EJ, Hannon CP, Harrast JJ, Cole BJ. Cartilage Restoration Surgery: Incidence Rates, Complications, and Trends as Reported by the American Board of Orthopaedic Surgery Part II Candidates. Arthroscopy 2019; 35:171-178. [PMID: 30611347 DOI: 10.1016/j.arthro.2018.08.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the current status of advanced cartilage restoration procedures among newly trained orthopaedic surgeons in the United States. METHODS The American Board of Orthopaedic Surgery database was queried to identify all advanced cartilage restoration procedure cases submitted by American Board of Orthopaedic Surgery part II board certification examination candidates from 2003 to 2015. All documented autologous chondrocyte implantation, autologous osteochondral transfer, osteochondral allograft transplantation, and marrow stimulation techniques (MSTs) procedures were analyzed. Analysis was performed to describe trends in annual incidence, types of complications, concomitant procedures, and geographical differences in incidence of advanced cartilage procedures. RESULTS From 2003 to 2015, a total of 2,827 surgeons submitted 7,522 cartilage restoration procedures, with 7,060 cases documented as MST (80.01%). The number of cartilage cases decreased significantly from 2003 to in 2015 (P <.001), with MST having the largest decline (P < .001). The incidence of open osteochondral allograft transplantation (odds ratio = 1.35; P = .023) and open autologous osteochondral transfer (odds ratio = 0.84; P = .004) increased over the study period. Overall, the majority of patients (57.0%) were male; however, female patients were on average significantly older than male patients (P < .001). Cartilage procedures were performed concomitantly with a realignment osteotomy procedure in 1.7% of cases. The incidence of surgical complications increased throughout the study period from 2.9% in 2003 to 9.5% in 2015 (P < .001). CONCLUSIONS Cartilage restoration procedures, specifically MSTs, are being decreasingly performed among recently trained orthopaedic surgeons. In contrast, complication rates have been increasing since 2003, demonstrating a possible paradigm shift toward more complex cartilage procedures, specifically osteochondral grafting procedures. CLINICAL RELEVANCE This study demonstrates a significant decline in the use of MSTs by recently trained orthopaedic surgeons. In addition, an increase in several more complex cartilage restoration procedures was found. Taken in sum, these changes may reflect a shift in residency and fellowship training away from marrow stimulation procedures that elicit a fibrocartilage reparative tissue and toward more complex procedures that provide a more hyaline-like articular cartilage surface.
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Affiliation(s)
- Rachel M Frank
- Department of Orthopedics, CU Sports Medicine, University of Colorado School of Medicine, Boulder, Colorado, U.S.A..
| | - Eric J Cotter
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Charles P Hannon
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - John J Harrast
- American Board of Orthopaedic Surgery, Chapel Hill, North Carolina, U.S.A
| | - Brian J Cole
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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14
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Abstract
Ample experimental examples have been accumulated during the last 3 decades indicating the ability of exogenous sources of cultured cells to serve as implants accelerating cartilage regeneration in defects of articular surfaces. In some cases, the repair tissues form complete spatial reconstruction of the defect. In other cases, either the spatial reconstruction is incomplete or the quality of the reparative tissue is inadequate. A delayed pace of endochondral ossification in the deep zones of the subchondral region of the defects, or ossification above the tide mark, within the superficial cartilaginous articular regions have been noted. Therefore, even in this promising approach of biological resurfacing procedure results are not certain, and further investigative research efforts are required. In the current study, a comparison of implantations of various cultured cells of four different sources were tested in an avian system. The reparative tissue outcomes are divided into three grades: full regeneration success, partial success, and failure of regeneration according to qualitative histological parameters and quantitative observation of the gross specimen. Defects that failed to regenerate a completely filled lesion were found to contain cells carrying the preskeletal–precartilaginous characteristic marker of FGFR3. The findings based on the above parameters suggest that autogeneic, chondrocytic-enriched bone marrow derived mesenchymal cells are superior to other cell sources for articular cartilage regeneration. Grafting of defects with these cells results in a 100% success rate. Allogeneic limb bud-derived mesenchymal cells and allogeneic embryonal chondrocytes have both reached a success of 75% of completely filled defects. Allogeneic chondrocytic-enriched bone marrow-derived mesenchymal cells yielded a 31% success rate. Untreated defects completely failed to heal. In successfully healed defects no cells of the reparative tissue carry the FGFR3 marker 3 months postimplantation. In partially healed defects, FGFR3 positive staining is present in fibrous cells at the invaginated surface. These latest findings may suggest some kind of proliferation failure in such cases.
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Affiliation(s)
- Z Nevo
- Department of Clinical Biochemistry, and affiliated Orthopaedic, Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
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15
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Abstract
Cartilage and osteochondral defects of the knee can in most cases be treated with total knee replacement in the elderly population. However, these lesions pose a difficult treatment problem in the younger patient. A number of surgical options are available today to address this increasingly common condition and each has its own indications and limitations. This article reviews debridement and microfracture, fixation, metallic spacing devices, autologous chondrocyte implantation, osteochondral autograft transplantation, fresh cadaveric allografts and osteotomies. In addition, possible future developments are discussed.
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Affiliation(s)
- Catherine F Kellett
- University of Toronto, Division of Orthopaedic Surgery, Mount Sinai Hospital, 600 University Avenue, Suite 476A, Toronto, Ontario M5S 1X5, Canada
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16
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Abstract
Articular cartilage has proved refractory to satisfactory cryopreservation using conventional freezing methods. Therefore, an ice-free cryopreservation method by vitrification was tested. Osteochondral plugs from New Zealand White rabbits were preserved using either a freezing method or an ice-free vitrification method of cryopreservation. Preserved and fresh control plugs were implanted in the tibial plateau of allogeneic recipients. A modified O'Driscoll grading scale, based on gross pathology, histopathology, and histochemistry, was used to evaluate the explants.The histology of fresh and vitrified explants was essentially the same, while the frozen cryopreserved explants were devoid of chondrocytes and only fibroblastlike cells were observed. The O'Driscoll grading indicated that both fresh and vitrified plugs performed significantly better than frozen plugs (p < or =.05). The results demonstrate the feasibility of vitrification as a storage method for cartilaginous tissues.
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Affiliation(s)
- Ying C Song
- Charleston Research Center, Organ Recovery Systems, Charleston, South Carolina, USA
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17
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Kuroki H, Nakagawa Y, Mori K, Kobayashi M, Nakamura S, Nishitani K, Shirai T, Nakamura T. Ultrasound properties of articular cartilage immediately after osteochondral grafting surgery: in cases of traumatic cartilage lesions and osteonecrosis. Knee Surg Sports Traumatol Arthrosc 2009; 17:11-8. [PMID: 18685829 DOI: 10.1007/s00167-008-0586-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2007] [Accepted: 07/02/2008] [Indexed: 11/26/2022]
Abstract
Although osteochondral grafting surgery is believed to replace damaged cartilage with healthy-looking normal cartilage, no study focuses on ultrasound quantification of those cartilage immediately after the surgery. It is unknown whether the ultrasound properties of damaged cartilage from trauma or osteonecrosis are same with each other. We have examined ultrasound properties of damaged cartilage, adjacent intact cartilage and plug cartilage during osteochondral grafting surgery for 15 knees of 15 patients, mean age of 43.4 (range, 14-61) years. Results showed that signal intensities of ultrasound (a measure of superficial cartilage integrity) of intact cartilage, damaged cartilage, and plug cartilage were 1.91 (arbitrary unit), 0.40, and 2.13, respectively, in 11 knees of 11 patients of traumatic cartilage lesions. Interval between signals of ultrasound (a parameter related to thickness) were 2.79 (micros), 1.90, and 2.85, respectively. The signal intensity and the interval between signals of plug cartilage were 533% (P < 0.01) and 150% (P < 0.01) of damaged cartilage, respectively. In four knees of four patients of osteonecrosis, the signal intensities of intact cartilage, damaged cartilage, and plug cartilage were 1.25, 0.30, and 1.39, respectively. The interval between signals were 2.36, 2.00, and 2.69, respectively. The signal intensity and the interval between signals of plug cartilage were 463% (P < 0.01) and 135% (P < 0.05) of damaged cartilage. We conclude that ultrasound properties of the damaged cartilage from trauma or osteonecrosis did not differ a lot especially in the late stages of osteonecrosis and that the osteochondral grafting surgery replaced the damaged cartilage with plug cartilage that had greater superficial cartilage integrity and greater thickness parameter immediately after the surgery. Long-term effect of the osteochondral grafting surgery should be verified in further study.
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Affiliation(s)
- Hiroshi Kuroki
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto 606-8507, Japan.
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18
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Kokkinakis M, Kafchitsas K, Rajeev A, Mortier J. Is MRI useful in the early follow-up after autologous osteochondral transplantation? Acta Orthop Belg 2008; 74:636-642. [PMID: 19058698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The study was carried out to evaluate MRI findings following osteochondral auto-grafting in femoral condyles and talus, and to correlate these with the clinical outcome. Thirty-three patients (20 knees, 13 ankles) were examined 1 to 4 years after operation using MRI, Lysholm Knee Score and Foot and Ankle Osteoarthritis Score. Clinical examination showed pain relief and improved function and MRI images demonstrated graft incorporation. Radiological criteria such as articular step-off, subchondral lamina irregularity, subchondral oedema and inhomogeneity of the graft interface opposed to the host tissue do not correlate statistically with the clinical outcome. MRI is a well-recognised, useful diagnostic tool to assess the articular surface but it has a limited clinical significance in the early post-operative stages after autologous osteochondral transplantation. The long-term prognostic significance of unsatisfying MRI results is unknown.
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Affiliation(s)
- Michail Kokkinakis
- Orthopaedic University Hospital Friedrichsheim, Frankfurt am Main, Germany.
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19
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Kobayashi T, Adachi N, Deie M, Ochi M. [Regeneration of articular cartilage]. Nihon Rinsho 2008; 66:966-970. [PMID: 18464518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Articular cartilage has very limited healing potential. Although there are several treatment options for cartilage defect, no treatment has been established as a gold standard procedure. Recently, a tissue-engineering technique has made great progress, and repair of cartilage has been given much attention in regenerative medicine. Since 1996, we have been performing transplantation of tissue-engineered cartilage made ex vivo for the treatment of human cartilage defect of the joint. This paper will summarize our procedure of articular cartilage repair and our novel stem cell delivery system using magnetic field.
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Affiliation(s)
- Takaaki Kobayashi
- Department of Orthopaedic Surgery, Graduate School of Biomedical Science, Hiroshima University
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20
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Nowacki W, Kruczyński J, Futyma J, Stencel P. Results of operative treatment of the pectus carinatum. Chir Narzadow Ruchu Ortop Pol 2008; 73:203-195. [PMID: 18847027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIM OF THIS STUDY Evaluation of the efficiency of the operative treatment for pectus carinatum depending on the type of deformity. MATERIAL AND METHODS 65 subjects following surgical procedures due to pectus carinatum deformity between 1997 and 2003 were analyzed. Surgical correction of the deformity depended on the localization of the sternal protrusion, grade of asymmetry and severity of the deformity. Radiological severity index of the deformity (Haller's index-HI) and patients' subjective evaluation were collected to assess the grade of deformity and the results of treatment. RESULTS Very good or good results were achieved after a mean period of 38 months of follow-up in all subjects who undergone surgical procedure. CONCLUSIONS It was proven that stabilization of the osteotomy sternum site with a non-absorbable suture sufficiently enough protects against relapses of the malformation and hypercorrection.
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Affiliation(s)
- Wiesław Nowacki
- Department of Orthopaedics and Musculoskeletal Traumatology at the Nicolaus Copernicus University in Toruń, Ludwik Rydygier's Collegium Medicum in Bydgoszcz, Poland
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21
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Abstract
Chondral damage to the young knee is common. In symptomatic patients current surgical treatment has focused on filling the defect with fibrocartilage; however, this tissue has poor resistance to shear forces, leading to failure and the onset of degenerative osteoarthritis.
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Affiliation(s)
- P D Gikas
- Bone Tumour Unit and Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, UK
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22
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Hattori K, Uematsu K, Tanikake Y, Habata T, Tanaka Y, Yajima H, Takakura Y. Spectrocolorimetric assessment of cartilage plugs after autologous osteochondral grafting: correlations between color indices and histological findings in a rabbit model. Arthritis Res Ther 2008; 9:R88. [PMID: 17825111 PMCID: PMC2212560 DOI: 10.1186/ar2287] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Revised: 08/20/2007] [Accepted: 09/10/2007] [Indexed: 11/10/2022] Open
Abstract
We investigated the use of a commercial spectrocolorimeter and the application of two color models (L* a* b* colorimetric system and spectral reflectance distribution) to describe and quantify cartilage plugs in a rabbit model of osteochondral autografting. Osteochondral plugs were removed and then replaced in their original positions in Japanese white rabbits. The rabbits were sacrificed at 4 or 12 weeks after the operation and cartilage samples were assessed using a spectrocolorimeter. The samples were retrospectively divided into two groups on the basis of the histological findings (group H: hyaline cartilage, successful; group F: fibrous tissue or fibrocartilage, failure) and investigated for possible significant differences in the spectrocolorimetric analyses between the two groups. Moreover, the relationships between the spectrocolorimetric indices and the Mankin histological score were examined. In the L* a* b* colorimetric system, the L* values were significantly lower in group H than in group F (P = 0.02), whereas the a* values were significantly higher in group H than in group F (P = 0.006). Regarding the spectral reflectance distribution, the spectral reflectance percentage 470 (SRP470) values, as a coincidence index for the spectral reflectance distribution (400 to 470 nm in wavelength) of the cartilage plugs with respect to intact cartilage, were 99.8 +/- 6.7% in group H and 119.8 +/- 10.6% in group F, and the difference between these values was significant (P = 0.005). Furthermore, the a* values were significantly correlated with the histological score (P = 0.004, r = -0.76). The SRP470 values were also significantly correlated with the histological score (P = 0.01, r = 0.67). Our findings demonstrate the ability of spectrocolorimetric measurements to predict the histological findings of cartilage plugs after autologous osteochondral grafting. In particular, the a* values and SRP470 values can be used to judge the surface condition of an osteochondral plug on the basis of objective data. Therefore, spectrocolorimetry may contribute to orthopedics, rheumatology and related research in arthritis, and arthroscopic use of this method may potentially be preferable for in vivo assessment.
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Affiliation(s)
- Koji Hattori
- Department of DAIWA HOUSE Indoor Environmental Medicine, Nara Medical University, Kashihara, Nara, Japan
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Kota Uematsu
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Yohei Tanikake
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Takashi Habata
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Hiroshi Yajima
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Yoshinori Takakura
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
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23
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Abstract
Once articular cartilage is injured, it has a very limited capacity for self repair. Although current surgical therapeutic procedures for cartilage repair are clinically useful, they cannot restore a normal articular surface. Current research offers a growing number of bioactive reagents, including proteins and nucleic acids, that may be used to augment various aspects of the repair process. As these agents are difficult to administer effectively, gene-transfer approaches are being developed to provide their sustained synthesis at sites of repair. To augment regeneration of articular cartilage, therapeutic genes can be delivered to the synovium or directly to the cartilage lesion. Gene delivery to the cells of the synovial lining is generally considered more suitable for chondroprotective approaches, based on the expression of anti-inflammatory mediators. Gene transfer targeted at cartilage defects can be achieved by either direct vector administration to cells located at or surrounding the defects, or by transplantation of genetically modified chondrogenic cells into the defect. Several studies have shown that exogenous cDNAs encoding growth factors can be delivered locally to sites of cartilage damage, where they are expressed at therapeutically relevant levels. Furthermore, data is beginning to emerge indicating that efficient delivery and expression of these genes is capable of influencing a repair response toward the synthesis of a more hyaline cartilage repair tissue in vivo. This review presents the current status of gene therapy for cartilage healing and highlights some of the remaining challenges.
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Affiliation(s)
- Andre F. Steinert
- Orthopaedic Center for Musculoskeletal Research König-Ludwig-Haus, Julius-Maximilians-University, Würzburg, Germany
| | - Ulrich Nöth
- Orthopaedic Center for Musculoskeletal Research König-Ludwig-Haus, Julius-Maximilians-University, Würzburg, Germany
| | - Rocky S. Tuan
- Cartilage Biology and Orthopaedics Branch National Institute of Arthritis, and Musculoskeletal and Skin Diseases National Institutes of Health, Department of Health and Human Services Bethesda, MD, U.S.A
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24
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Das RHJ, Jahr H, Verhaar JAN, van der Linden JC, van Osch GJVM, Weinans H. In vitro expansion affects the response of chondrocytes to mechanical stimulation. Osteoarthritis Cartilage 2008; 16:385-91. [PMID: 17920939 DOI: 10.1016/j.joca.2007.07.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Accepted: 07/29/2007] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Expansion of autologous chondrocytes is a common step in procedures for cartilage defect repair. Subsequent dedifferentiation can alter cellular response to mechanical loading, having major consequences for the cell's behavior in vivo after reimplantation. Therefore, we examined the response of primary and expanded human articular chondrocytes to mechanical loading. METHOD Primary and expanded chondrocytes were stretched at either 0.5% or 3.0% at 0.5Hz, 2h per day, for 3 days. Gene expression levels of matrix components (aggrecan (AGC1), lubricin (PRG4), collagen type I (COL1), type II (COL2) and type X (COL10)) as well as matrix enzymes (matrix metalloproteinase 1 (MMP1), MMP3, MMP13) and SOX9 were compared to unstretched controls. To evaluate the effect of a chondrogenic environment on cellular response to stretch, redifferentiation medium was used on expanded cells. RESULTS In primary chondrocytes, stretch led to mild decreases in AGC1, COL1 and COL10 gene expression (maximum of 3.8-fold) and an up-regulation of PRG4 (2.0-fold). In expanded chondrocytes, expression was down-regulated for AGC1 (up to 21-fold), PRG4 (up to 5.0-fold), COL1 (10-fold) and COL2 (2.9-fold). Also, expression was up-regulated for MMP1 (20-fold) and MMP3 (up to 4-fold), while MMP13 was down-regulated (2.8-fold). A chondrogenic environment appeared to temper effects of stretch. DISCUSSION Our results show that expansion alters the response of human chondrocytes to stretch. Expanded chondrocytes greatly decrease gene expression of matrix constituents and increase expression of MMPs, whereas primary chondrocytes hardly respond. Our data could be a reference for optimization of cell sources or expansion protocols for reimplanted chondrocytes.
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Affiliation(s)
- R H J Das
- Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, The Netherlands
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Marcacci M, Kon E, Delcogliano M, Filardo G, Busacca M, Zaffagnini S. Arthroscopic autologous osteochondral grafting for cartilage defects of the knee: prospective study results at a minimum 7-year follow-up. Am J Sports Med 2007; 35:2014-21. [PMID: 17724094 DOI: 10.1177/0363546507305455] [Citation(s) in RCA: 132] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Articular cartilage lesions, with their inherent limited healing potential, remain a challenging problem for orthopaedic surgeons. Various approaches have been proposed to treat these lesions; nevertheless, opinions on indications and clinical efficacy of these techniques are still controversial. PURPOSE To evaluate the outcome of osteochondral autografts for treatment of femoral condyle cartilage lesions at a medium-to long-term follow-up. STUDY DESIGN Case series; Level of evidence, 4. METHODS We prospectively evaluated 30 patients (mean age, 29.3 years) with full-thickness knee chondral lesions (<2.5 cm(2)) treated with arthroscopic autologous osteochondral transplantation. Thirteen patients underwent previous surgery, while 17 patients were operated on for the first time. In 19 patients, associated procedures were performed. All patients were evaluated at 2- and 7-year follow-up. The International Cartilage Repair Society form, Tegner score, and magnetic resonance imaging were used for clinical evaluation. RESULTS The International Cartilage Repair Society objective evaluation showed 76.7% of patients had good or excellent results at 7-year follow-up, and International Knee Documentation Committee subjective score significantly improved from preoperative (34.8) to 7-year follow-up (71.8). The Tegner evaluation showed a significant improvement after the surgery at 2- and 7-year follow-up (from 2.9 to 6.2 and 5.6, respectively); however, we noticed reduced sports activity from 2- to 7-year follow-up. Magnetic resonance imaging evaluation showed good integration of the graft in the host bone and complete maintenance of the grafted cartilage in more than 60% of cases. CONCLUSION The results of this technique at medium- to long-term follow-up are encouraging. This arthroscopic 1-step surgery appears to be a valid solution for treatment of small, grade III to IV cartilage defects.
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Williams SK, Amiel D, Ball ST, Allen RT, Tontz WL, Emmerson BC, Badlani NM, Emery SC, Haghighi P, Bugbee WD. Analysis of cartilage tissue on a cellular level in fresh osteochondral allograft retrievals. Am J Sports Med 2007; 35:2022-32. [PMID: 17724095 DOI: 10.1177/0363546507305017] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Fresh human osteochondral allografting is a biological cartilage replacement technique used to treat articular and osteoarticular defects in the knee. A small number of grafts fail, and we analyzed every retrieved graft during a 4-year period in order to learn more about the potential causes of failure. HYPOTHESIS A large percentage of chondrocytes still remain viable many years after fresh osteochondral allografting. STUDY DESIGN Descriptive laboratory study. METHODS Retrieval specimens were obtained at the time of revision surgery and immediately analyzed. Chondrocyte viability and viable cell density were determined using a live/dead staining technique followed by confocal microscopy. Glycosaminoglycan content was a measure of the cartilage matrix. Radiolabeled sulfate uptake served as a biochemical marker of chondrocyte metabolic activity. Cartilage and subchondral bone were examined histologically. RESULTS Fourteen patients yielded a total of 26 retrieval specimens that had been originally implanted as individual fresh osteochondral allografts. Average graft survival was 42 months. Chondrocyte viability was 82% +/- 17%, and chondrocyte viable cell density was 15 590 +/- 5900 viable cells/mm(3). Retrieved tissue demonstrated radiolabeled sulfate uptake of 437 +/- 270 counts per minute and 3.5% +/- 0.8% hexosamine per dry weight. Histologically, all specimens showed some degree of cartilage fibrillation. There was evidence of bone allograft incorporation in most specimens, as well as pannus formation in 4 specimens, but no evidence of immune rejection. CONCLUSION A small percentage of fresh osteochondral allografts fail, but the precise cause is unknown. The main theories for failure investigated here include immunologic rejection, failure of bony incorporation, and chondrocyte death causing breakdown of the cartilage matrix. We show that chondrocytes remain viable many years after transplantation, allograft bone incorporates, and immune rejection does not seem to play a primary role in failure. CLINICAL RELEVANCE Fresh osteochondral allografting is becoming more common in the treatment of articular cartilage defects in the knee. Our findings support the paradigm of fresh osteochondral allografting, the transplantation of hyaline cartilage with biological incorporation of the underlying bone scaffold. The reasons for failure of a small percentage of grafts remain unclear.
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Affiliation(s)
- Seth K Williams
- Department of Orthopaedic Surgery, University of California, San Diego, 9500 Gilman Drive, Mail Code 0630, La Jolla, CA 92093-0630, USA
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Lee J, Lee E, Kim HY, Son Y. Comparison of articular cartilage with costal cartilage in initial cell yield, degree of dedifferentiation during expansion and redifferentiation capacity. Biotechnol Appl Biochem 2007; 48:149-58. [PMID: 17492943 DOI: 10.1042/ba20060233] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Costal cartilage has been proposed as an alternative donor of chondrocytes for articular-cartilage repair. In the present study we compared the initial cell yield of chondrocytes from rabbit costal cartilage and their cell expansion rates in monolayer culture with those of articular cartilage. Costal cartilage gave an approx. 2.6-fold higher cell yield than did articular cartilage. During in vitro culture, CCs (costal chondrocytes) grew faster and displayed approx. 3-fold more cell expansion up to P4 (passage 4) than did ACs (articular chondrocytes). In order to match the degree of dedifferentiation during serial cultivation with the cells' expansion rate, type II collagen expression and the emergence of fibroblastic morphology were monitored at each cell passage. Both ACs and CCs gradually lost their chondrocytic phenotype, changed to fibroblast-like cells and displayed a reduced expression of type II collagen. We then also evaluated the redifferentiation capacity of the expanded ACs and CCs by culturing them at high density in collagen gel. Almost fully dedifferentiated CCs at P4 were successfully redifferentiated into hyaline cartilage, which showed the expression of glycosaminoglycan and type II collagen as well as the formation of lacunae and a territorial matrix. In conclusion, costal cartilage may have advantages over articular cartilage as an alternative donor tissue for autologous chondrocytes on the basis of its higher cell yield, higher cell expansion and successful reversion into hyaline cartilage without ossification in vitro. However, although this experiment with a rabbit model gave a better insight into the problem than other experiments have done, it does not answer definitively the question as to which cells are most appropriate for articular cartilage repair in humans.
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Affiliation(s)
- Jungsun Lee
- R&D Institute, Modern Cell and Tissue Technologies Inc., Seoul, Korea
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Abstract
BACKGROUND Effective treatment of osteochondral lesions in the elbow remains challenging. Arthroscopic débridement and microfracture or retrograde drilling techniques are often insufficient and provide only temporary symptomatic relief. The purpose of this study was to evaluate the treatment of these lesions with osteochondral autografts. METHODS From 1999 to 2002, seven patients with osteochondral lesions of the capitellum humeri (five patients), trochlea (one patient), or radial head (one patient) were treated with cylindrical osteochondral grafts, which were harvested from the non-weight-bearing area of the proximal aspect of the lateral femoral condyle. The patients (three female and four male patients with an average age of seventeen years) were evaluated preoperatively and postoperatively, with an average follow-up of fifty-nine months. The Broberg and Morrey score was chosen for functional evaluation of the elbow (with regard to motion, pain, strength, activities of daily living, and stability), and the American Shoulder and Elbow Surgeons score was used for the analysis of pain. All patients had imaging studies done preoperatively to evaluate the defect and postoperatively to assess the ingrowth and viability of the graft. The ipsilateral knee was examined for donor-site morbidity. RESULTS The Broberg and Morrey score improved from a mean (and standard deviation) of 76.3 +/- 13.2 preoperatively to 97.6 +/- 2.7 postoperatively, and pain scores were significantly reduced (p < 0.05). The mean elbow extension lag of 4.7 degrees +/- 5.8 degrees was reduced to 0 degrees postoperatively. Compared with the contralateral side, there was a mean preoperative flexion lag of 12.9 degrees +/- 13.8 degrees . At the time of the final follow-up, flexion was free and was equal bilaterally in all patients. None of the plain radiographs made at the time of follow-up showed any degenerative changes or signs of osteoarthritis. The postoperative magnetic resonance imaging scans showed graft viability and a congruent chondral surface in all seven patients. No donor-site morbidity was noted at one year postoperatively. CONCLUSIONS The osteochondral autograft procedure described in the present study provides the opportunity to retain viable hyaline cartilage for the repair of osteochondral lesions in the elbow while restoring joint congruity and function and perhaps reducing the risk of osteoarthritis. These medium-term results suggest that the risks of a two-joint procedure are modest and justifiable. In addition, the described technique provides an option for revision surgery after the failure of other surgical procedures.
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Affiliation(s)
- Patrick Ansah
- Department of Orthopedic Sports Medicine, Technical University Munich, Connollystrasse 32, 80809 Munich, Germany
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Giannini S, Buda R, Faldini C, Vannini F, Romagnoli M, Grandi G, Bevoni R. The treatment of severe posttraumatic arthritis of the ankle joint. J Bone Joint Surg Am 2007; 89 Suppl 3:15-28. [PMID: 17908868 DOI: 10.2106/jbjs.g.00544] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- S Giannini
- Department of Orthopaedic Surgery, University of Bologna, Italy.
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Abstract
Osteochondral allografts have demonstrated encouraging clinical and scientific success in the treatment of full-thickness articular cartilage defects in multiple anatomic locations including the knee. The use of fresh grafts has shown the greatest potential for clinical success. There has been growing interest in cryopreservation techniques and the use of cryopreserved grafts owing to the delay in obtaining grafts secondary to regulatory testing, encouraging laboratory data surrounding their use, and the potential for more effective tissue banking. This article reviews the indications, operative technique, and clinical outcomes using osteochondral allografts for full-thickness articular cartilage defects in the knee.
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Affiliation(s)
- Alex Hennig
- Department of Orthopaedics and Rehabilitation, University of Vermont College of Medicine, Burlington, VT 05405, USA
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Abstract
Musculoskeletal allografts are commonly used in orthopedic surgery and have become increasingly popular. Their indications have widened as an alternatives to autografts. A tissue processing industry has secondarily evolved. An increasing number of accredited tissue banks are providing donor screening, procurement, processing, storage, and distribution of tissue. Multiple factors play a role for a graft to be successfully implanted: sterility, reduction of antigenicity, and preservation of its biologic and biomechanical properties. A rare but catastrophic complication that has raised concern is disease transmission. Controversies exist on which is the best way to produce a strong, disease-free graft. There is no current standard, but as allograft technology evolves, surgeons need to be aware of the regulations and policies surrounding allograft tissue procurement and processing to provide the best outcomes in transplanted patients.
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Okamoto Y, Nakagawa Y, Maekawa M, Kobayashi M, Nakamura T. Osteochondral grafting for treatment of a massive chondral defect in the knee of a young adult with anterior cruciate ligament deficit. Arthroscopy 2007; 23:1024.e1-4. [PMID: 17868845 DOI: 10.1016/j.arthro.2006.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2005] [Revised: 03/03/2006] [Accepted: 07/12/2006] [Indexed: 02/02/2023]
Abstract
We report the case of a 28-year-old woman who underwent osteochondral grafting and anterior cruciate ligament (ACL) reconstruction for treatment of a massive cartilage defect in a knee joint with ACL deficit. Arthroscopy showed a full-thickness degenerative cartilage defect measuring 22 x 35 mm in the weight-bearing area of the medial femoral condyle, a totally resected lateral meniscus, and a loosened ACL. Therefore we performed osteochondral autograft transplantation and ACL reconstruction. Osteochondral plugs were harvested from a donor site in the patellofemoral joint of the contralateral knee and grafted into the recipient site in a "skipping" manner. Arthroscopic examination 1 year after surgery showed good preservation of the grafts and satisfactory bridging of the gaps between the plugs with fibrocartilage-like tissue. A recent follow-up examination, performed 36 months after surgery, has shown an excellent result, with a Lysholm score of 100, an International Knee Documentation Committee score of 95.4, and full range of knee motion with no symptoms. Plain radiographs at that time showed preservation of the medial joint space on the weighted anteroposterior view. No osteoarthritic changes were evident in the patellofemoral joint.
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Affiliation(s)
- Yukihiro Okamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Kyoto University, Kyoto, Japan
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Miniaci A, Tytherleigh-Strong G. Fixation of unstable osteochondritis dissecans lesions of the knee using arthroscopic autogenous osteochondral grafting (mosaicplasty). Arthroscopy 2007; 23:845-51. [PMID: 17681206 DOI: 10.1016/j.arthro.2007.02.017] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2005] [Revised: 02/11/2007] [Accepted: 02/14/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE A number of surgical techniques have been described for the operative fixation of an unstable osteochondritis dissecans (OCD) lesion in the knee that has failed appropriate nonoperative management. However, no one technique has been universally successful. We report the results of a new fixation technique for unstable OCD lesions using arthroscopic autogenous osteochondral grafting (mosaicplasty). METHODS Twenty patients with OCD lesions (16 International Cartilage Repair Society [ICRS] OCD type II, 3 ICRS OCD type III, and 1 ICRS OCD type IV) who had failed an appropriate course of nonoperative management underwent autogenous osteochondral grafting. The OCD lesions were assessed arthroscopically and then fixed in situ by using multiple 4.5-mm osteochondral dowel grafts harvested from the edges of the femoral trochlea. The lesion was initially fixed with an osteochondral graft passing through the center of the fragment and then stabilized by using further grafts inserted around its periphery. RESULTS Preoperative International Knee Documentation Committee scores assessed 5 patients as nearly normal, 8 as abnormal, and 7 as severely abnormal. At the 18-month follow-up, all of the knees were scored as normal. The average preoperative visual analog pain score out of 10 was 8.3, which was reduced to 0.8 at 6 months and to 0 at 1 year after surgery. Serial magnetic resonance imaging scans showed healing of the bony part of the lesion in all of the knees 6 months after surgery and continuous articular cartilage healing at 9 months. CONCLUSIONS Autogenous osteochondral grafting of unstable OCD lesions in the knee is a reliable and minimally invasive technique that provides a stable biologic fixation using autogenous bone graft and has few complications. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Anthony Miniaci
- Sports Medicine Program, Division of Surgery, University of Toronto, Toronto, Ontario, Canada
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Lubowitz JH, Poehling GG. Clinically relevant articles of high levels of evidence are required to change surgical practice. Arthroscopy 2007; 23:803. [PMID: 17681198 DOI: 10.1016/j.arthro.2007.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Accepted: 06/05/2007] [Indexed: 02/02/2023]
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Davidson PA, Rivenburgh DW, Dawson PE, Rozin R. Clinical, histologic, and radiographic outcomes of distal femoral resurfacing with hypothermically stored osteoarticular allografts. Am J Sports Med 2007; 35:1082-90. [PMID: 17351122 DOI: 10.1177/0363546507299529] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Fresh osteoarticular allograft transplantation has a long history of clinical success. These grafts have typically been implanted less than 1 week from donor asystole. HYPOTHESIS Osteoarticular allografts stored 4 to 6 weeks represent a viable alternative to treat full-thickness cartilage and osteochondral defects of the distal femur as measured by clinical, histologic, and magnetic resonance imaging (MRI) criteria. STUDY DESIGN Case series; Level of evidence, 4. METHODS Osteoarticular allografts were implanted after a mean graft storage time (at 4 degrees C) of 36 days (range, 28-43). Sixty-seven patients received massive hypothermically stored osteoarticular allografts. Ten knees in 8 of these patients underwent second-look arthroscopic evaluation and biopsy at a mean of 40 months (range, 23-60) after implantation. Clinical assessment was performed using multiple outcome measures and sequential MRI evaluations. Biopsy specimens were obtained from the graft as well as from native articular cartilage at the time of second-look arthroscopy for histologic analysis. RESULTS The mean International Knee Documentation Committee scores were as follows: preoperative, 27 (range, 9-55); postoperative, 79 (range, 56-99); P = .002. The mean Lysholm scores were as follows: preoperative, 37 (range, 12-47); postoperative, 78 (range, 55-90); P = .002. The mean Short Form-36 physical scores were as follows: preoperative, 38 (range, 24-55); postoperative, 51 (range, 39-61); P = .002. The mean Tegner scores were as follows: preoperative, 4.3 (range, 1-9); postoperative, 5.3 (range, 4-7); P = .16. The mean International Cartilage Repair Society score at follow-up was 10 (nearly normal) (range, 7-11). The mean modified Outerbridge scores were as follows: preoperative, 4.3 (range, 3-5); postoperative, 0.6 (range, 0-1); P = .002. The mean graft and native cartilage cellular density and viability were not statistically different. CONCLUSIONS Fresh-stored osteoarticular grafts for full-thickness articular surface defects of the distal femur appear to offer a viable biological method to restore knee function. Our study suggests that osteoarticular grafts stored in cell culture medium at 4 degrees C for 4 to 6 weeks provide successful short-term clinical outcomes.
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Affiliation(s)
- Philip A Davidson
- Tampa Bay Orthopaedic Specialists, 6500 66th Street North, Pinellas Park, Florida 33781, USA.
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del Piñal F, Innocenti M. Evolving concepts in the management of the bone gap in the upper limb. Long and small defects. J Plast Reconstr Aesthet Surg 2007; 60:776-92. [PMID: 17452133 DOI: 10.1016/j.bjps.2007.03.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Accepted: 03/07/2007] [Indexed: 11/18/2022]
Abstract
Vascularised bone graft is a well accepted technique when dealing with long defects. Its role in refractory nonunion, in small defects and in the growing patient is rarely discussed. In this paper the authors review the different alternatives to deal with bone defects in the upper extremity. The indications of vascularised corticoperiosteal graft for solving small defects harbouring refractory nonunion, and the use of vascularised bone phalanx and metatarsal for complex - but small - defects in the fingers is presented. The ability of the bone to grow and remodel when a living epiphysis is included, and to maintain the cartilage viability when a composite osteochondral graft is transferred are also discussed.
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Affiliation(s)
- Francisco del Piñal
- Unit of Hand-Wrist and Plastic Surgery, Hospital Mutua Montañesa, Instituto de Cirugía Plástica y de la Mano, Santander, Spain.
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Abstract
Isolated patellofemoral osteoarthritis is now recognised to be more common than previously thought. The features and management are reviewed, including the various surgical options in symptomatic patients. The evidence base for managing patellofemoral osteoarthritis is behind that for the tibiofemoral joint. All treatments are based on uncontrolled observational case series, typically retrospectively reviewed. Fortunately the majority of patients with isolated patellofemoral degenerative changes do not need surgical treatment. Those who are symptomatic can usually be successfully treated with weight loss and quadriceps strengthening exercises.
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Affiliation(s)
- Simon T Donell
- Institute of Orthopaedics, Norfolk and Norwich University Hospital, Norwich, NR4 7UY UK.
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Abstract
Chondral or osteochondral lesions are typical injuries in orthopaedics and traumatology. Since there is no regeneration of damaged articular cartilage, these lesions can lead to premature osteoarthritis. Therefore, an adequate therapy for these injuries is an important goal. Nowadays, common methods in cartilage therapy are procedures for the recruitment of mesenchymal stem cells: autologous osteochondral transplantation and autologous chondrocyte transplantation. Currently, autologous osteochondral transplantation is the only procedure that allows the replacement of the defect with hyaline cartilage. However, this procedure has the problem of donor-site morbidity and limited availability of transplants. Stem cell recruiting procedures and autologous chondrocyte transplantation normally achieve a regeneration of the defect with only fibrocartilage tissue, but both can achieve good medium-term clinical results. Each of these therapeutic principles has certain major indications. In order to select an adequate therapy, the classification of chondral or osteochondral lesion is needed. From a multiplicity of classification systems, those of the ICRS are of particular clinical relevance.
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Affiliation(s)
- S Braun
- Berufsgenossenschaftliche Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau am Staffelsee.
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Kuroki H, Nakagawa Y, Mori K, Kobayashi M, Okamoto Y, Yasura K, Nishitani K, Nakamura T. Sequential changes in implanted cartilage after autologous osteochondral transplantation: postoperative acoustic properties up to 1 year in an in vivo rabbit model. Arthroscopy 2007; 23:647-54. [PMID: 17560480 DOI: 10.1016/j.arthro.2007.01.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Revised: 01/19/2007] [Accepted: 01/19/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE For successful autologous osteochondral transplantation, it is important that the cartilage in an implanted plug provide histologic replacement of damaged cartilage with cartilage that is structurally and mechanically normal. The purpose of this study was to investigate whether the press-fit technique reconstructs the normal hyaline cartilage and provides acoustic stiffness equal to that of normal intact cartilage. METHODS In 36 rabbits an osteochondral plug, 6 mm in diameter, was removed from the right patellar groove and grafted into a recipient hole, 5 mm in diameter, in the left patellar groove. Specimens at 2, 4, 8, 12, 24, and 52 weeks postoperatively were assessed by macroscopic and histologic observation and by use of an ultrasonic system. The ultrasonic acoustic stiffness, acoustic surface irregularity, and acoustic thickness of the implanted cartilage were examined and compared with normal intact cartilage. RESULTS The gross appearance of the implanted cartilage was glossy, maintained good surface smoothness, and survived well throughout the observation period. The cartilage recovered histologic features of hyaline cartilage. The acoustic stiffness decreased up to 12 weeks and then increased at 24 and 52 weeks after surgery. The acoustic stiffness at 8 or 12 weeks was significantly lower (acoustically softer) than that of control cartilage (P < .001). The acoustic stiffness at 52 weeks was equal to that of the control. The difference in acoustic surface irregularity was not significant. The acoustic thickness at 8 weeks was higher (acoustically thicker) than that of the control (P < .01). CONCLUSIONS Although the reason acoustically soft cartilage in plugs becomes acoustically stiff and whether the histology of the implanted cartilage had recovered completely remain unclear, the acoustic stiffness recovered to normal control values by 52 weeks postoperatively. CLINICAL RELEVANCE Postoperative care for up to 12 weeks should be taken after autologous osteochondral transplantation.
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Affiliation(s)
- Hiroshi Kuroki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Lubiatowski P, Zalewski T, Gradys A, Kruczyński J, Jaroszewski J, Trzeciak T, Szcześniak E, Manikowski W. [Application of microscopic MR for evaluation of cartilage repair]. Chir Narzadow Ruchu Ortop Pol 2007; 72:193-199. [PMID: 17941582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Magnetic resonance imaging is gold standard for noninvasive evaluation of articular cartilage damage and has been also used for monitoring cartilage repair. The aim of this study was to find correlation between histological microscopy and microscopic MR in evaluation of the repair of osteochondral defects in articular cartilage. Study was based animal model (rabbit). The cartilage repair process was evaluated histology and micro MR. Most of the defects were filled with fibrocartilage and fibrous tissue formed. Both methods were equally efficient to show repair tissue thickness, subchondral bone reconstruction and disintegration. Result of observation by both histological and MR microscopy and showed good correlation. Micro MR is promising evaluation tool for cartilage repair monitoring. Results of micro MR correlate well with standard microscopy.
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Affiliation(s)
- Przemysław Lubiatowski
- Katedra i Klinika Traumatologii, Ortopedii i Chirurgii Rekla Uniwersytet Medyczny im. Karola Marcinkowskiego w Poznaniu
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Nakagawa Y, Suzuki T, Kuroki H, Kobayashi M, Okamoto Y, Nakamura T. The effect of surface incongruity of grafted plugs in osteochondral grafting: a report of five cases. Knee Surg Sports Traumatol Arthrosc 2007; 15:591-6. [PMID: 17219225 DOI: 10.1007/s00167-006-0253-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Accepted: 11/15/2006] [Indexed: 11/30/2022]
Abstract
Although grafted osteochondral plugs should ideally have a smooth surface for mosaicplasty, surface incongruity is sometimes evident at the time of surgery. There may be no problem if there is depression of the grafted plugs, but graft protuberance may have an adverse effect. We studied five knees in five patients who had incongruity (protuberance or depression) of grafted osteochondral plugs at the time of mosaicplasty. The mean age at surgery was 36.6 years (range, 15-65 years), and the mean follow-up period was 32.9 months (range, 24-49 months). All patients underwent second-look arthroscopy after a mean post-surgical period of 14.8 months (range, 3-18 months). We divided the cases so that there were two in the protuberant group (P) and three in the depressed group (D). In P, all patients had a catching sensation about 4 months after surgery, and sometimes pain in the knee joint. Second-look arthroscopy revealed fissuring of the plugs and fibrillation around the recipient site. In D, there were no symptoms due to the depressed plugs. Second-look arthroscopy showed that the depressed areas were covered with fibrocartilage-like tissue, and that the joint surface was smooth. In conclusion, our clinical results and second-look arthroscopic evaluation suggest that isolated osteochondral plug depressions of not greater than 1 mm could still promote acceptable cartilage healing leading to good clinical outcomes. However, plug protuberance at mosaicplasty should always be avoided.
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Affiliation(s)
- Yasuaki Nakagawa
- Department of Orthopaedic Surgery, Faculty of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
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Affiliation(s)
- Terry L Thompson
- Drs Thompson and Lewis are from Howard University Hospital, Washington, DC 20060, USA
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Thaunat M, Couchon S, Lunn J, Charrois O, Fallet L, Beaufils P. Cartilage thickness matching of selected donor and recipient sites for osteochondral autografting of the medial femoral condyle. Knee Surg Sports Traumatol Arthrosc 2007; 15:381-6. [PMID: 17096170 DOI: 10.1007/s00167-006-0222-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Accepted: 09/21/2006] [Indexed: 10/23/2022]
Abstract
Osteochondral transplantation requires a careful assessment of the location of donor plugs. A mismatch of cartilage thickness between the donor and recipient site may lead to abnormal stresses and poor function. The objective of this study was to characterize the recommended donor and recipient sites with respect to cartilage thickness in younger individuals. Nineteen arthro CT (13 men, 6 women), which had been carried out in a population of less than 50 years old were studied. Recommended donor sites have included the posterior femoral condyles, the medial and lateral aspect of the trochlea and central, medial and lateral sides of the intercondylar notch. Recipient sites were studied at four regions of interest on the medial femoral condyle usually involved in osteochondritis dissecans. Average cartilage thickness was calculated on the digital version of the reference cuts for each site and compared. The sensitivity of the precision of the measurements to observer variability was evaluated using intra- and inter-observer correlation coefficient tests. The femoral cartilage in the knee was thickest in the recipient sites (2.49 mm, SD 0.64) than in donor sites (1.79 mm, SD 0.43) (P<0.0001). There was no differences between the different donor sites, unless for the antero lateral intercondylar notch which was significantly thinner (1.3 mm, SD 0.29) than the other sites (P<0.05). The cartilage of the donor site was consistently thinner than the cartilage of the recipient sites. Between the different donor sites, the lateral side of the intercondylar notch was significantly thinner than the other donor sites and should not be harvested in priority.
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Affiliation(s)
- Mathieu Thaunat
- Orthopaedic Surgery Department, Hopital Andre Mignot, 177, rue de Versailles, Le Chesnay, 78157, France.
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Abstract
Severe ankle degeneration can be a devastating problem for young adults. Although ankle fusion continues to be the gold standard, inherent long-term problems are related to this treatment option. Further advances in total ankle prosthetic arthroplasty are needed before this treatment option can be considered suitable in a younger population. The use of fresh osteochondral allograft transplantation can provide an alternative treatment option without precluding future salvage procedures. Future studies may further define the role immunosuppression can play in improving fresh osteochondral allograft viability.
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Affiliation(s)
- Todd A Irwin
- Department of Orthopaedic Surgery, William Beaumont Hospital, 3535 W Thirteen Mile Road, Suite 744, Royal Oak, MI 48073, USA
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Miura K, Ishibashi Y, Tsuda E, Sato H, Toh S. Results of arthroscopic fixation of osteochondritis dissecans lesion of the knee with cylindrical autogenous osteochondral plugs. Am J Sports Med 2007; 35:216-22. [PMID: 17192319 DOI: 10.1177/0363546506294360] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In situ fixation of unstable lesions of osteochondral dissecans of the knees with cylindrical osteochondral autograft transplantation has been reported to provide excellent results with healing of the osteochondral dissecans fragment. PURPOSE To evaluate the clinical results and magnetic resonance imaging findings of the osteochondral dissecans of knees treated with in situ fixation of the osteochondral fragments with osteochondral autograft transplantation. STUDY DESIGN Case series; Level of evidence, 4. METHODS Twelve knees (12 patients; mean age, 16.0 years) with osteochondral dissecans lesions were treated with in situ fixation with autogenous osteochondral plugs. The mean lesion size was 2.4 cm(2) (range, 1.0-4.9 cm(2)). The osteochondral dissecans lesions were located on the medial femoral condyle in 10 patients and on the lateral femoral condyle in 2 patients. Seven lesions were located in the weightbearing area. The International Cartilage Repair Society classification in arthroscopic findings was grade II in 1 patient, grade III in 8 patients, and grade IV in 3 patients. All patients were evaluated with the Hughston Rating Scale form with the mean follow-up at 4.5 years (range, 2.8-5.9 years). The interface between the osteochondral fragment and subchondral bone and changes in donor site of the osteochondral graft were evaluated with T2-weighted magnetic resonance image up to 12 months postoperatively. RESULTS The Hughston Rating Scale scored 8 knees as excellent, 3 as good, and 1 as fair. The interface between the osteochondral fragment and subchondral bone had disappeared on magnetic resonance image by 3 months postoperatively in all cases. No complications arising from the donor site area were observed. Signal intensity of donor site changed from high signal preoperatively to homogeneous surrounding cancellous bone by 1 year postoperatively. CONCLUSION Biological fixation of the osteochondral dissecans lesion with cylindrical osteochondral autograft provided healing of the osteochondral fragments.
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Affiliation(s)
- Kazutomo Miura
- Department of Orthopaedic Surgery, Hirosaki University, School of Medicine, 5 Zaifucho, Hirosaki 036-8562, Japan.
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Abstract
AIM To investigate, in vitro, the effects of radial shock waves on the release of nitric oxide (NO) and synthesis of prostaglandin E2 (PGE2) and glycosaminoglycan (GAG), and liberation of GAG, from equine articular cartilage explants. METHODS Equine cartilage from normal metacarpophalangeal and metatarsophalangeal joints was exposed to radial shock waves at various impulse doses and then maintained as explants in culture for 48 h. Shock waves were delivered at 1,876 Torr pressure and a frequency of 10 Hz. Treatment groups consisted of a negative control group, or application of 500, 2,000, or 4,000 impulses by use of either a convex handpiece (Group A) or concave handpiece (Group B). Synthesis of GAG was measured using incorporation of 35S-labelled sodium sulphate. Additionally, the synthesis of NO and PGE2, and content of GAG of the explants and media were determined. RESULTS No significant effects (p>0.05) of radial shock-wave treatment were evident on the synthesis of NO or PGE2, or release of GAG by cartilage explants. However, radial shock waves decreased synthesis of GAG measured 48 h after exposure for all treatment groups other than the 500-impulse Group-A explants (p<0.05). CONCLUSIONS Radial shock waves impact the metabolism of GAG in chondrocytes in equine articular cartilage. Further studies will be required to fully investigate the impact of this effect on the health of joints, and to elucidate the clinical impact.
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Affiliation(s)
- B M Benson
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, 1008 W. Hazelwood Drive, Urbana, IL 61802, USA
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Schick B, Weidenbecher M, Miller R, Iro H. [Experience with laryngotracheal reconstruction in subglottic stenosis in a 30 years time period]. Laryngorhinootologie 2007; 86:358-64. [PMID: 17226434 DOI: 10.1055/s-2006-945002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Severe subglottic stenosis is a difficult condition to manage. It can be treated by laryngotracheal reconstruction or cricotracheal resection. PATIENTS AND METHODS In this retrospective study the experiences for treatment of isolated subglottic stenosis in 37 patients (age: 3-78 years; stenosis grading: 20 x grade II, 13 x grade III, and 4 x grade IV) by laryngotracheal reconstruction in a 30-years experience are presented. RESULTS In 33 out of 37 patients (89.2 %) a sufficient subglottic patency (postoperative endoscopic finding: stenosis less than 30 %) was achieved by laryngotracheal reconstruction. However, 5 patients of this series had required revision of laryngotracheal recontruction and in 22 patients endoscopic removal of granulation tissue had been performed. Sufficient widening of the subglottic space had been possible in all grade II stenosis (20/20), in 11 out of 13 patients with grade III stenosis, and in 3 out of 4 patients with grade IV stenosis. In one child an accidental decannulation occurred and due to asphyxia an apallic syndrome developed. CONCLUSIONS Even through laryngotracheal reconstruction is a demanding surgical technique requiring great experience it is an effective option for treatment of subglottic stenosis less than 90 %. For severe subglottic stenosis (> 90 %) treatment by laryngotracheal reconstruction is possible and should be considered if mobilisation of the trachea by scar tissue is suited to be worse or to extended cricotracheal stenosis is present, both being not good candidates for cricotracheal resection.
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Affiliation(s)
- B Schick
- Hals-Nasen-Ohrenklinik, Kopf- und Halschirurgie der Friedrich-Alexander-Universität Erlangen-Nürnberg
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Mueller-Rath R, Gavénis K, Gravius S, Andereya S, Mumme T, Schneider U. In vivo cultivation of human articular chondrocytes in a nude mouse-based contained defect organ culture model. Biomed Mater Eng 2007; 17:357-366. [PMID: 18032817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The nude mouse model is an established method to cultivate and investigate tissue engineered cartilage analogues under in vivo conditions. One limitation of this common approach is the lack of appropriate surrounding articular tissues. Thus the bonding capacity of cartilage repair tissue cannot be evaluated. Widely applied surgical techniques in cartilage repair such as conventional and three-dimensional autologous chondrocyte implantation (ACI) based on a collagen gel matrix cannot be included into nude mouse studies, since their application require a contained defect. The aim of this study is to apply an organ culture defect model for the in vivo cultivation of different cell-matrix-constructs. Cartilage defects were created on osteochondral specimens which had been harvested from 10 human knee joints during total knee replacement. Autologous chondrocytes were isolated from the cartilage samples and cultivated in monolayer until passage 2. On each osteochondral block defects were treated either by conventional ACI or a collagen gel seeded with autologous chondrocytes, including a defect left empty as a control. The samples were implanted into the subcutaneous pouches of nude mice and cultivated for six weeks. After retrieval, the specimens were examined histologically, immunohistochemically and by cell morphology quantification. In both, ACI and collagen gel based defect treatment, a repair tissue was formed, which filled the defect and bonded to the adjacent tissues. The repair tissue was immature with low production of collagen type II. In both groups redifferentiation of chondrocytes remained incomplete. Different appearances of interface zones between the repair tissue and the adjacent cartilage were found. The presented contained defect organ culture model offers the possibility to directly compare different types of clinically applied biologic cartilage repair techniques using human articular tissues in a nude mouse model.
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Affiliation(s)
- R Mueller-Rath
- Department of Orthopaedic Surgery, University of Aachen, Aachen, Germany.
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Cirpar M, Korkusuz F. [The future of treatment for chondral and osteochondral lesions]. Acta Orthop Traumatol Turc 2007; 41 Suppl 2:153-159. [PMID: 18180597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The population of patients with symptomatic focal or generalized cartilage lesions is growing due to prolongation of life expectancy and to increasing frequency of sports injuries. Cartilage tissue lesions which were defined as untreatable in the past have now become treatable thanks to advances in basic scientific research. With the development of technologies regarding biomaterial, cell and local regulators, and with the introduction of new surgical techniques, it is estimated that, in the near future, clinical applications of cartilage tissue engineering will also receive particular attention in our country. Currently, all alternatives used in the treatment of cartilage lesions have merits and demerits, including arthroscopic debridement and lavage, mesenchymal stem cell stimulation, osteochondral replacement techniques, and autologous chondrocyte transplantation. Preliminary results of experimental cartilage tissue engineering are encouraging for the replacement of disrupted tissue with that having mechanical properties of hyaline cartilage. Clinical applications of cartilage tissue engineering include bioabsorbable scaffolds as extracellular collagen, hyaluronic acid matrices, and genetically engineered bioactive materials.
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Affiliation(s)
- Meriç Cirpar
- Kirikkale Universitesi Tip Fakültesi Ortopedi ve Travmatoloji Anabilim Dali, Kirikkale, Turkey.
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