Repair of rabbit articular surfaces with allograft chondrocytes embedded in collagen gel

Development of a novel osteochondral graft for cartilage repair

This study reports the development of a novel osteochondral graft for cartilage repair. A technique of proteoglycan extraction via timed enzymatic digestion with hyaluronidase and trypsin and subsequent processing with a chloroform-methanol solution to remove cellular debris from a fresh-frozen bovine osteochondral sample is a method described to prepare a stable biological carrier of low immunogenicity. Lyophilization of the carrier followed by rehydration in a suspension of lapine chondrocytes produced a chimeric xenograft that succeeded in vivo in enhancing cartilage repair. In a pilot study, full-thickness articular cartilage defects treated with these xenografts demonstrated improved healing compared to untreated defects or defects treated with unseeded grafts at 2, 6, and 12 weeks postimplantation. The xenograft provoked a mild inflammatory response; however this did not impede the repair process. Further investigation of this novel chimeric xenograft eventually may yield a method of cartilage repair superior to current methods of treatment.

Viability of fibroblast-seeded ligament analogs after autogenous implantation

Fibroblast-seeded collagen scaffolds or ligament analogs are potentially useful for reconstruction of the anterior cruciate ligament of the knee. To provide lasting benefits, the seeded cells must survive implantation within the harsh synovial environment of the knee joint. Our objective was to determine the in vivo fate of autogenous fibroblast-seeded ligament analogs as a function of fibroblast source (anterior cruciate ligament or skin), implantation site (knee joint or subcutaneous space), and time after implantation (1, 2, 4, 6, or 8 weeks). Before implantation, fibroblasts were labeled with PKH26-GL, a fluorescent membrane dye. Immediately after retrieval of the implant, the viability of the labeled seeded cells was assessed under a fluorescent microscope. Viable seeded fibroblasts remained attached to the collagen fibers within the ligament analogs for at least 4 weeks (skin fibroblasts) or 6 weeks (anterior cruciate ligament fibroblasts) after implantation. A larger number of viable seeded cells were consistently observed in the subcutaneous space than in the knee joint. Scaffold resorption prevented observation at the 8-week time period. Fibroblast-seeded ligament analogs remained viable for prolonged periods in the knee joint and therefore have the potential to influence the formation and remodeling of neoligament tissue after reconstruction of the anterior cruciate ligament.

Chondrocytes in culture produce a mechanically functional tissue

A mechanically testable tissue was grown in vitro from rabbit chondrocytes that were initially plated at high density (approximately 80,000 cells/cm2). The DNA, collagen, and proteoglycan content, as well as the tissue thickness, tensile stiffness, and synthesis rates, were measured at 4, 6, and 8 weeks. The biochemical properties were similar to those for immature cartilage, with predominantly type-II collagen produced; this indicated that the cells retained their chondrocytic phenotype. The tissue formed a coherent mechanical layer with testable tensile stiffness as early as 4 weeks. The tensile elastic modulus reached 1.3 MPa at 8 weeks, which is in the range of values for native cartilage from the midzone. Collagen density was approximately 24 mg/ml at 8 weeks, which is about one-half the value for native cartilage, and the collagen fibril diameters were smaller. Chondrocytes in culture responded to culture conditions and were stimulated by cytokine interleukin-1beta. When culture conditions were varied to RPMI nutrient medium with lower fetal bovine serum and higher ascorbic acid concentrations, the thickness decreased and the modulus increased significantly. Interleukin-1beta, added to the 8-week culture for 2 weeks, caused a decrease of 60% in thickness, a decrease of 81% in proteoglycan content, and a decrease of 31% in collagen content; this is similar to the response of cartilage explants to interleukin-1beta. This cartilage analog may be useful as a model system to study structure-function relationships in cartilage or as cartilage-replacement tissue.

Articular cartilage repair. Rabbit experiments with a collagen gel-biomatrix and chondrocytes cultured in it

To repair a full-thickness articular cartilage defect in rabbit knees, we developed a technique of using a collagen gel hardened by cultured allogeneic chondrocytes in it. The gel-chondrocyte composite accumulated an intense metachromatic matrix, and had elasticity and stiffness enough to be shaped easily after 2 weeks' culture in vitro. It was implanted into full-thickness articular cartilage defects. Histologic evaluation was performed up to 6 months after surgery, using a histologic grading scale composed of 5 categories. In the gel-chondrocyte composite implanted group, good repair was observed from as early as 1 day up to 6 months. On the other hand, in the empty control group, no repair was observed 1 day to 2 weeks after the defects were made. At 4 weeks, some repair occurred, but even at 6 months the repair was not good.

Bonding of cartilage matrices with cultured chondrocytes: an experimental model

The capacity of isolated chondrocytes to join separate masses of cartilage matrix was investigated with composites implanted in subcutaneous pouches in nude mice. Slices of articular cartilage were harvested from lambs and were devitalized by cyclic freezing and thawing. The slices were then either co-cultured with viable allogeneic lamb chondrocytes (experimental) or cultured without such chondrocytes (control). Composites of three slices were constructed with use of fibrin glue and were implanted in nude mice for periods ranging from 7 to 42 days. Bonding of the experimental matrices with viable chondrocytes was achieved at 28 and 42 days, as assessed by direct examination, histology, thymidine uptake, and fluorescence. No bonding occurred in the control composites without viable chondrocytes. We conclude that devitalized cartilage matrix is a scaffold to which isolated chondrocytes can attach and begin to repopulate.

Composition of cartilagenous tissue with mineralized and non-mineralized zones formed in vitro

We have previously shown that cartilagenous tissue with both non-mineralized and mineralized zones can be formed by chondrocytes which have been selectively isolated from the deep zone of bovine articular cartilage. In this study, we quantitate proteoglycan and collagen content, calcification, tissue thickness and cellularity over a 10 week culture period in order to study matrix accumulation and tissue formation. The cartilagenous tissue cellularity and proteoglycan and collagen accumulation continued up to 8 weeks and this was paralleled by an increase in tissue thickness. The amount of mineral in the tissue as well as the amount of collagen, in contrast to proteoglycan, was still increasing at 10 weeks. At the end of week 10, the amount of glycosaminoglycan and collagen as a percentage of dry weight of the tissue were 11.0 +/- 0.6% and 14.8 +/- 0.1%, respectively, compared with 10.5 +/- 1.2% and 35.1 +/- 5.8% for the in vitro deep articular cartilage. The amount of calcium as a percentage of dry weight of the cartilagenous tissue was 8.1 +/- 0.7% which was similar to the in vivo cartilage (9.1 +/- 1.6%). This data suggests that 8 weeks of culture may be necessary before the cartilagenous tissue is suitable for use as a transplant.

Principles of cartilage repair and regeneration

An experimental approach and logic are presented for the regeneration of skeletal tissues that focus on the recapitulation of embryonic events starting with an uncommitted progenitor cell population that the authors refer to as mesenchymal stem cells. The repair and regeneration of articular cartilage, which itself has no repair potential, is the subject of this presentation. Full thickness cartilage defects were created in the medial condyle of the distal femur. Self repair (empty defects), articular chondrocytes (allografts), and autologous mesenchymal stem cells were used and the results are reported in selected examples from more than 800 rabbit knees. The optimal number of the appropriate cells delivered in a supportive vehicle to a defect pretreated with a dilute trypsin solution to optimize the integration of repair with normal host cartilage provides a methodology in which regeneration of articular cartilage can be observed. The principles have relevance to the clinical repair and regeneration of cartilage and other skeletal defects.

Hepatocyte growth factor facilitates cartilage repair. Full thickness articular cartilage defect studied in rabbit knees

Hepatocyte growth factor (HGF) is a multifunctional factor which promotes proliferation, motility and morphogenesis in epithelial cells. In addition, it has been found to play an important role in cartilage metabolism. To investigate articular cartilage repair using HGF in vivo, we injected HGF into rabbit knee joints, where 4 mm diameter osteochondral defects had been made, and observed the animals for 6 months. We found that HGF effectively repaired osteochondral defects. The repair process of the articular cartilage defects using HGF was shown to be much better than saline injection on all macroscopic and histologic examinations. Although the observation period in our study was short, HGF is one of the most promising candidates for repairing articular cartilage defects clinically.

The effect of recombinant human bone morphogenetic protein-2 (rhBMP-2) on the healing of full-thickness defects of articular cartilage

Articular cartilage has a limited capacity for repair. We investigated the effect of rhBMP-2 (recombinant human bone morphogenetic protein-2) on the healing of full-thickness osteochondral defects in adult New Zealand White rabbits. A single defect, three millimeters wide by three millimeters deep, was created in the trochlear groove of the right femur in eighty-nine rabbits. The defect was either left empty, filled with a plain collagen sponge, or filled with a collagen sponge impregnated with five micrograms of rhBMP-2. The animals were killed at four, eight, or twenty-four weeks, and the repair tissue was examined histologically and evaluated with use of a grading scale. The defects also were examined immunohistochemically for the presence of type-II collagen at four and eight weeks. The rate of bone repair was evaluated with fluorescent labeling of bone at two and four weeks and with use of fluorescence microscopy at eight weeks. Treatment with rhBMP-2 greatly accelerated the formation of new subchondral bone and improved the histological appearance of the overlying articular surface. At twenty-four weeks, the thickness of the repair cartilage was 70 per cent that of the normal adjacent cartilage and a new tidemark usually had formed between the repair cartilage and the underlying subchondral bone. The average total scores on the histological grading scale were significantly better (p < 0.01) for the defects treated with rhBMP-2 than for the untreated defects (those left empty or filled with a plain collagen sponge) at all time-points. Immunostaining with an antibody against type-II collagen showed the diffuse presence of this cartilage-specific collagen throughout the repair cartilage in the treated defects. The untreated defects demonstrated minimum staining with this antibody.

Osteochondral repair using perichondrial cells. A 1-year study in rabbits

Articular cartilage repair remains a clinical and scientific challenge with increasing interest focused on the transplantation of chondrogenic cells. This study evaluated the repair response during a 1-year period after implantation of allogenic perichondrium cell polylactic acid composite grafts into 3.7 x 5 mm osteochondral defects drilled into the medial femoral condyles of 82 adult New Zealand White rabbits. The repair tissue was evaluated grossly, histologically, histomorphometrically, biochemically, and biomechanically at 6 weeks, 12 weeks, 6 months, and 1 year after implantation. After gross evaluation, cartilaginous material appeared to fill the defect in 70 experimental knees, for an overall repair frequency of 85%. The histomorphometric results and the histologic appearances were variable. None of the specimens were completely normal at 1 year. Only specimens with subchondral bone reformation displayed a definable cartilage appearing surface with chondrocytes surrounded by dense matrix. Subchondral bone reformation was inconsistent, reaching 50% at 1 year. Biochemically, the repair tissue matured during a 1-year period into a hyaline Type II collagen dominant tissue, whereas glycosaminoglycan content remained low at all time periods. The measured compressive properties of the repair tissue at 1 year were not significantly different from those of the contralateral knee that was not surgically treated. The treatment of osteochondral defects in the rabbit knee with allogenic perichondrium cell polylactic acid composite grafts yielded a high percentage of grossly successful repairs that showed inconsistent subchondral bone reformation. These results suggest that healthy subchondral bone is important to articular cartilage repair. They also highlight that a cartilaginous appearing tissue at gross inspection may not represent structurally normal articular cartilage. Continued multidisciplinary studies on the arthroplastic potential of rib perichondrial cells are needed before human studies, which rarely can extend beyond gross assessment of repair tissue appearance can be undertaken.

Requirement of fibroblast growth factor signaling for regeneration of epiphyseal morphology in rabbit full-thickness defects of articular cartilage

The involvement of fibroblast growth factor-2 (FGF-2) during the repair process in rabbit full-thickness defects of articular cartilage was studied. Fibroblast growth factor-2 (50 pg/h) was administered for 2 weeks in a 5 mm defect of articular cartilage, which is large enough not to repair spontaneously. The administration of FGF-2 resulted in the regeneration of the articular cartilage and the subchondral bone within 8 weeks. In these defects, undifferentiated mesenchymal cells initiated chondrogenic differentiation coupled with replacement by subchondral bone, resulting in the resurfacing of the defects with hyaline cartilage and the recovery of subchondral bone up to the original bone-articular cartilage junction. In rabbits, full-thickness defects are capable of regenerating articular cartilage as long as the defect size is limited to < or = 3 mm in diameter. In the defects, strong immunoreactivity for FGF-2 was observed in the granulation tissue filling the defects in the early stage of repair, in association with the expression of FGF-2 mRNA shown by in situ hybridization. Once the undifferentiated mesenchymal cells had differentiated into chondrocytes, both the immunoreactivity and the in situ hybridization signal declined significantly. Upon the local administration of a monoclonal antibody against FGF-2 (bFM-1, 50 ng/h), the defects were filled with fibrous tissue and no resurfacing hyaline cartilage was formed. Compared to the non-treated defects, there were marked increases in FGF-2 immunoreactivity and the overexpression of FGF-2 mRNA in the reparative tissue in the bFM-1-treated defects. This rebound phenomenon indicates that the autocrine FGF-2 signaling is critically important for the regeneration of articular cartilage.

Immunological response against allogeneic chondrocytes transplanted into joint surface defects in rats

Rat chondrocytes isolated from the articular-epiphyseal cartilage complex were transplanted into defects prepared in articular cartilage and subchondral bone. Transplants were taken for examination after 3 and 8 wk. Cartilage formed by syngeneic chondrocytes did not evoke formation of infiltrations. Contrary to that, in the vicinity of cartilage produced by allogeneic chondrocytes numerous infiltrating cells were present and cartilage resorption could be observed. Cyclosporine-A (CsA) treatment of recipients of allogeneic chondrocytes only partially suppressed accumulation of infiltrating cells and matrix resorption. Antichondrocyte immune response of chondrocyte graft recipients was studied by evaluation of spleen mononuclear cells (SMC) stimulation in mixed splenocyte-chondrocyte cultures and by evaluation of antichondrocyte cytotoxic antibodies. No difference in stimulation of SMC from intact rats by syngeneic and allogeneic chondrocytes was observed. Stimulation by allogeneic chondrocytes was slightly but significantly higher in recipients of syngeneic grafts. SMC of allogenic chondrocyte recipients were strongly stimulated by allogeneic chondrocytes. This response was absent in recipients treated with CsA. Spontaneous antichondrocyte cytotoxic antibody activity was detected in intact rats and in recipients of syngeneic grafts. In recipients of allogeneic chondrocytes the antibody response against allogeneic chondrocytes was raised but was statistically not significant owing to the considerable variation in the level of spontaneously occurring antichondrocyte antibodies.

Evaluation of matrix scaffolds for tissue engineering of articular cartilage grafts

Injury to articular cartilage predisposes that joint to further degeneration and eventually osteoarthritis. Recent studies have demonstrated the feasibility of using chondrocytes together with different biomaterial carriers as grafts for the repair of cartilage defects. The following study was undertaken to determine the effect of a variety of these materials on chondrocyte growth and extracellular matrix synthesis. We cultured chondrocytes on several commonly used materials and compared their rates of synthesis of proteoglycan and collagen. Additionally, we evaluated them in a closed culture recirculating system on these materials and compared them with standard culture techniques. This was done to see whether such a bioreactor-type system can be used to enhance the quality of in vitro reconstructed tissues. Our results demonstrated marked variability with respect to how chondrocytes responded to culture on the various materials. Bioabsorbable polymers such as polyglycolic acid (PGA)--enhanced proteoglycan synthesis, whereas collagen matrices stimulated synthesis of collagen. The use of the closed culture system, in general, improved the rates of synthesis of collagen and proteoglycan on the different material scaffolds. Exceptions were collagen synthesis on collagen matrices: use of the closed culture system did not enhance the rate of synthesis. Rates of proteoglycan synthesis on PGA scaffold initially was higher in the closed culture system but did not sustain a difference over the entire course of the 3-week culture period. This study demonstrates the importance of carrier material for the purpose of cartilage tissue reconstruction in vitro.

Fresh osteochondral allografts at the knee joint: good functional results in a follow-up study of more than 15 years

The treatment of deep chondral defects at the knee joint poses major difficulties and challenges to the orthopaedic surgeon, particularly in young patients for whom solutions like total or hemi-joint arthroplasty are not recommended, because of their limited durability. Biological resurfacing with materials such as perichondrium, periosteal allografts, and cultured chondrocytes is still at the experimental stage and there has been limited clinical validation. Since 1978, we have successfully used fresh osteochondral ('shell') allografts for the treatment of selected patients with a chondral defect at the knee joint. These grafts, implanted mainly in young patients, have proved durable and have provided good functional results for more than 15 years, as shown by an average of 84.6 in the Hospital for Special Surgery (HSS) Knee Score. The operative technique and results of long-term follow-up of patients receiving fresh, osteochondral ('shell') allografts are presented and discussed.

Chondrocyte transplantation

The transplantation of chondrocytes as a treatment to repair defects and degeneration in hyaline articular cartilage is being tested in numerous laboratory and clinical settings. This has included transplanting chondrocytes grown in tissue culture that were procured from non-weight-bearing areas of the affected joint to transplanting allografts with living chondrocytes in their intact cartilaginous matrix. Reported success with transplanting host and donor chondrocytes has varied and widespread application of these techniques still awaits more definitive studies. The clinician needs more evidence that the transplanted chondrocytes maintain their viability and that they synthesize the appropriate extracellular matrix. This new matrix needs to reproduce the functional, mechanical, and long-term wear properties of the native articular cartilage. Chondrocyte transplantation also merits further monitoring for possible delayed immunogenicity or for any signs of neoplastic potential. This exciting technology and its potential application to damaged and degenerated articular cartilage remains a stimulus to encourage further scientific work. Duplicating the unique and complex interrelations of the chondrocytes, matrix, and various bioactive factors is still some years away from general patient care.

Recombinant human bone morphogenetic protein-2 maintains the articular chondrocyte phenotype in long-term culture

Bone morphogenetic proteins have been shown to increase matrix synthesis by articular chondrocytes in short-term cultures. Members of this family of proteins have also been shown to induce endochondral ossification in vivo. The present study was performed to determine if the addition of human recombinant bone morphogenetic protein-2 to a long-term monolayer articular chondrocyte cell culture system affected the ability of the chondrocytes to divide in vitro, whether the cytokine altered expression of the articular chondrocyte phenotype and synthesis of matrix proteoglycans, and whether the cytokine was capable of inducing differentiation to a hypertrophic chondrocyte. Human recombinant bone morphogenetic protein-2 did not alter cell proliferation. It caused 3.5-6.2 times more proteoglycan synthesis by articular chondrocytes during each of the time points tested after 4 days in culture. Total proteoglycan accumulation in the extracellular matrix after 28 days in culture was 6.7 times as great in the treated cultures as in the control. Treatment with human recombinant bone morphogenetic protein-2 maintained the articular chondrocyte phenotype of cells in culture as demonstrated by Northern blot analysis: the expression of type-I collagen genes was increased and that of type-II collagen and aggrecan mRNA was lost in untreated chondrocyte cultures after 14-21 days in culture. In contrast, exposure to 100 ng/ml human recombinant bone morphogenetic protein-2 maintained expression of type-II collagen and increased expression of aggrecan compared with controls during the 28-day culture period. Northern blot analysis of the expression of type-X collagen and osteocalcin by chondrocytes treated with human recombinant bone morphogenetic protein-2 showed a lack of expression of these genes, indicating no alteration in phenotype. These experiments demonstrated the ability of human recombinant bone morphogenetic protein-2 to promote the articular chondrocyte phenotype and matrix synthesis in long-term culture. Characteristics of cell growth were not affected, and the cytokine did not induce differentiation to a hypertrophic chondrocyte.

Effects of nitric oxide on chondrocyte migration, adhesion, and cytoskeletal assembly

OBJECTIVE

The migration of cells of chondrocyte lineage is believed to play a role in cartilage growth and repair. The present study examined 1) whether chondrocytes are capable of migration in vitro; and 2) the effects of nitric oxide (NO) on chondrocyte migration, adhesion, and cytoskeletal assembly.

METHODS

Chondrocyte migration was evaluated by 2 assays: 1) "centrifugal" migration within a 3-dimensional collagen matrix (dot culture); and 2) directed migration under agarose in response to bone morphogenetic protein. To assess the effects of NO, chondrocytes were treated with either exogenous NO (S-nitrosoglutathione [SNO-GSH]) or a mixture of cytokines known to induce endogenous NO production. The effects of NO on chondrocyte adhesion to fibronectin-coated surfaces, as well as on actin polymerization (determined by indirect immunofluorescence), were also examined.

RESULTS

The capacity of chondrocytes to migrate was demonstrated both by the dot culture and by agarose methods. Both SNO-GSH and endogenous NO induced by cytokines inhibited this migration. Exposure to NO also inhibited attachment of chondrocytes to fibronectin and disrupted assembly of actin filaments. These effects of SNO-GSH and cytokine-induced NO production were reversed in the presence of hemoglobin and the NO synthase inhibitor NG-monomethyl arginine, respectively.

CONCLUSION

NO interferes with chondrocyte migration and attachment to fibronectin, an extracellular matrix protein, probably via effects on the actin cytoskeleton. These effects of NO may result in impairment of cartilage repair, by interfering with the extracellular matrix regulation of chondrocyte function.

Effects of growth-factor-enhanced culture on a chondrocyte-collagen implant for cartilage repair

The effects of incubation and addition of growth factors to a chondrocyte-seeded collagen implant for cartilage repair were studied. Type I collagen matrices seeded with lapine articular chondrocytes and unseeded controls cultured in the presence and absence of fibroblast growth factor and insulin for 2, 6, and 9 weeks were subjected to biomechanical, biochemical, and histological analysis. Aggregate modulus of elasticity of seeded implants decreased by half at 6 weeks, then rose by a factor of 10 above initial values. Permeability of seeded implants and their controls decreased steadily. Glycosaminoglycan content peaked at 6 weeks, coinciding with the greatest number of chondrocytes and mitotic activity in seeded implants. Chondrocytes remained phenotypically stable and metabolically active; they incorporated glycosaminoglycan into the extracellular matrix, and formed an organized pericellular environment despite the predicted resorption of the collagen matrix. Adding fibroblast growth factor and insulin tripled the rate of cell turnover and doubled the glycosaminoglycan content of seeded implants, but had no effect on their material properties. In vitro incubation for 6 weeks in the presence of fibroblast growth factor and insulin creates a metabolically and mitotically active chondrocyte-collagen composite for implantation into articular cartilage defects.

Rabbit articular cartilage defects treated with autologous cultured chondrocytes

Adult New Zealand rabbits were used to transplant autologously harvested and in vitro cultured chondrocytes into patellar chondral lesions that had been made previously and were 3 mm in diameter, extending down to the calcified zone. Healing of the defects was assessed by gross examination, light microscope, and histological-histochemical scoring at 8, 12, and 52 weeks. Chondrocyte transplantation significantly increased the amount of newly formed repair tissue compared to the found in control knees in which the lesion was solely covered by a periosteal flap. In another experiment, carbon fiber pads seeded with chondrocytes were used as scaffolds, and repair significantly increased at both 12 and 52 weeks compared to knees in which scaffolds without chondrocytes were implanted. The histologic quality scores of the repair tissue were significantly better in all knees in which defects were treated with chondrocytes compared to knees treated with periosteum alone and better at 52 weeks compared to knees in which defects were treated with carbon scaffolds seeded with chondrocytes. The repair tissue, however, tended to incomplete the bonding to adjacent cartilage. This study shows that isolated autologous articular chondrocytes that have been expanded for 2 weeks in vitro can stimulate the healing phase of chondral lesions. A gradual maturation of the hyalinelike repair with a more pronounced columnarization was noted as late as 1 year after surgery.

In vivo chondrogenesis in collagen sponge sandwiched by perichondrium

In order to increase the cartilage synthesis of the perichondrium, we combined auricular perichondrium with a collagen sponge as a template (perichondrium-sandwiched collagen sponge) and implanted the assembly as an autograft into the back of rabbits. Microscopic examination revealed that cartilaginous tissue was produced in the collagen sponge and chondrosynthesis was accelerated in the collagen sponge implants in comparison with that in materials containing perichondrium alone.

Repopulation of laser-perforated chondroepiphyseal matrix with xenogeneic chondrocytes. An experimental model

Growth of chondrocytes into a xenogeneic chondroepiphyseal matrix was investigated in an in vitro experimental model by combining viable calf chondrocytes with chick epiphyseal matrix devoid of viable chondrocytes. The chondrocytes were harvested from the wrist joints of newborn calves and cultured for 2 days. The epiphyses were harvested from the distal femurs and the proximal tibias of fetal chicks after development was arrested at 17 days by freezing. The epiphyseal specimens were prepared in four ways. These included femoral and tibial epiphyses without holes and femoral and tibial epiphyses with holes made by a laser. These epiphyseal specimens were co-cultured with calf chondrocytes for various periods. After digestion of the epiphyseal matrix, viable chondrocytes were counted in suspension. Chondrocyte division in the matrix was assessed by [3H]thymidine incorporation. The growth of calf chondrocytes into the xenogeneic chick matrix was evaluated by fluorescence microscopy on fresh thick epiphyseal sections. The percentage of viable chondrocytes in the xenogeneic epiphyseal matrix increased with culture time to a maximum at day 21. The addition of laser-drilled holes was found to extend a plateau of chondrocyte viability until day 29. A decrease in cell viability was detected at later observation points. This study demonstrates that xenogeneic matrix may serve as a morphogenetic scaffold for chondrocytic growth.

Healing of chondral and osteochondral defects in a canine model: the role of cultured chondrocytes in regeneration of articular cartilage

In this study a canine model was developed to investigate the nature of early healing responses to both chondral and osteochondral defects and to evaluate the tissue regenerative capacity of cultured autologous chondrocytes in chondral defects. The healing response to surgically created chondral defects was minor, with little cellular infiltration. In contrast, osteochondral defects exhibited a rapid cellular response, resulting ultimately in the formation of fibrous tissue. The lack of significant cellular activity in chondral defects suggests that an evaluation of the capacity of cultured autologous chondrocytes to regenerate articular cartilage is best studied in chondral defects using the canine model. When dedifferentiated cultured articular chondrocytes were implanted into chondral defects, islands of type II collagen staining were demonstrated in the regenerative tissue within 6 weeks. The relatively early expression of cartilage specific markers by the implanted chondrocytes, coupled with the inability of untreated chondral defects to repair or regenerate, demonstrates the utility of the canine model in evaluating novel materials for cartilage repair and regeneration.

Regeneration of defects in articular cartilage with callus and cortical bone grafts. An experimental study

Cartilage regeneration was studied in an experiment in rats. A standardised full-thickness articular cartilage defect was created and autogenous 12-day-old callus or cortical bone graft was transplanted into it, or the defect was left empty. The follow up periods were three, six, 12, and 24 weeks, and each subgroup consisted of five animals. A total of 60 animals were operated on. From six weeks onwards hyaline-like cartilaginous tissue had started to develop at the edges of the defect in all three groups. In the middle section of the hole, however, the picture was different; at 24 weeks none of the specimens in the defect group, two of the five in the callus graft group, and all five in the bone graft group had developed full-thickness, hyaline-like cartilaginous regeneration. The hyaline-like cartilaginous tissue in the medical segment was hypocellular when analysed by histomorphometry. On scanning electron microscopy the surface of the reparative tissue looked fibrillated in all specimens from the three groups.

Culture of chondrocytes in alginate and collagen carrier gels

In this in vitro study, we compared the potential of collagen and alginate gels as carriers for chondrocyte transplantation and we studied the influence of demineralized bone matrix (DBM) on chondrocytes in the gels. Chondrocytes were assessed for cell viability, phenotype (histology), proliferation rate and sulfate incorporation. Collagen gels showed a significant increase in cell numbers, but the chondrocytes dedifferentiated into fibroblast-like cells from day 6 onwards. In alginate gels, initial cell loss was found, but the cells maintained their typical chondrocyte phenotype. Although the total quantity of proteoglycans initially synthesized per cell in collagen gel was significantly higher, expressed per cell, the quantity in alginate gel eventually surpassed collagen. No effects of culturing chondrocytes in combination with DBM could be demonstrated on cell proliferation and sulfate incorporation. The collagen and alginate gels have different advantages as carriers for chondrocyte transplantation. The high proliferation rate of chondrocytes in collagen gel may be an advantage, but the preservation of the chondrocyte phenotype and the gradually increasing proteoglycan synthesis in alginate gel is a promising method for creating a hyaline cartilage implant in vitro.

In situ assessment of cell viability within biodegradable polylactic acid polymer matrices

Efforts to expand treatment options for articular cartilage repair have increasingly focussed on the implantation of cell polymer constructs. Primary cells cultured from perichondrium, a chondrogenic tissue, were found to survive in vitro within a biodegradable porous polylactic acid matrix. The novel application of an in situ fluorescent double-stain protocol to cell polymer constructs was supported by increased 3H-thymidine uptake and the ability of cell seeded polylactic acid to form first passage explant cultures. This in situ viability staining technique allowed for rapid determination of cell viability and, in conjunction with confocal microscopy, assessment of cellular distribution within a biodegradable scaffold. Advantages of using this method over histological and electron microscopic analysis include in situ observation, absence of distortion in scaffold architecture due to polymer dissolution and disruption during processing, and obtaining a viability assessment within 30 min. Potential applications of this protocol as a screening tool for laboratory engineered tissues and in the evaluation of cellular injury in natural tissues are discussed.

Development of biomechanical properties and morphogenesis of in vitro tissue engineered cartilage

Neocartilage was engineered by culturing bovine chondrocytes on poly(glycolic acid) (PGA) fibrous nonwoven scaffolds. The biomechanical properties and morphologies of the PGA-chondrocyte constructs were studied over 12 weeks of in vitro culture. PGA scaffolds without cells lost their mechanical strength and structural integrity between week 2 and week 3 in culture. The thickness of the PGA-chondrocyte constructs decreased by 35% during the first 3 weeks, but the thickness increased from week 3 to week 9 to a thickness 42% higher than that of the starting scaffolds, which was then maintained. Safranin O staining of PGA-chondrocyte constructs revealed increasing proteoglycan formation over time. The compressive modules of PGA-chondrocyte constructs increased with in vitro culture time, and reached the same order of magnitude as that of normal bovine cartilage at week 9. The aggregate modulus of the PGA-chondrocyte constructs decreased by 57% over the first 2 weeks but then increased, reaching the same order of magnitude as normal bovine cartilage at week 12. The apparent permeability of the PGA-chondrocyte constructs, which was initially four orders of magnitude above that of normal cartilage, decreased between weeks 1 and 3 and thereafter remained the same order of magnitude as that measured for normal cartilage.

Articular cartilage repair using allogeneic perichondrocyte-seeded biodegradable porous polylactic acid (PLA): a tissue-engineering study

Efforts to expand treatment options for articular cartilage repair have increasingly focused on the implantation of cell-polymer constructs. The purpose of this study is to determine the suitability of porous D,D-L,L-polylactic acid as a carrier for delivering repair cells obtained from rib perichondrium into full-thickness articular cartilage defects. In vitro characterization of perichondrocyte-polylactic acid composite grafts was combined with in vivo assessment of the early articular cartilage repair in a clinically relevant model. Using a fluorescent double-stain protocol to visualize live and dead cells in situ, primary cells cultured from perichondrium were found to be capable of attaching to and surviving within a porous D,D-L,L-polylactic acid matrix. These perichondrocyte-polylactic acid composite grafts were then implanted within osteochondral defects drilled into the left medial femoral condyles of 16 adult New Zealand white rabbits. Experimental animals were sacrificed 6 weeks after implantation and the repair tissue was evaluated grossly, histologically, and biochemically. Grossly, 96% (15/16) of the experimental animals demonstrated repairs consisting of a smooth, firm neocartilage which appeared similar in color and texture to the surrounding articular surface. Matrix staining for cartilaginous protein was seen surrounding chondrocyte-like cells in the cartilage regions of the repair. Cellular alignment was found to be related to scaffold architecture. These results suggest that scaffolds composed of porous D,D-L,L-polylactic acid support the growth of cartilaginous repair tissue and are compatible with both in vitro and in vivo survival of chondrogenic cells.

Chondrocyte behaviour within different types of collagen gel in vitro

In cartilage repair experiments chondrocytes are transplanted into osteochondral defects. Biological substances are used as cell vehicles and are likely to play an important role in the outcome of these studies. Collagen gel is formed by polymerization of type I collagen and is used in plastic surgery and for three-dimensional culture systems. To test collagen gel as a potential vehicle for transplantation, we evaluated chondrocyte behaviour in vitro in different collagen gels. Collagen type I was extracted and purified from rat tail tendon and fetal calf skin and compared with commercially available collagen type I. After suspension of bovine chondrocytes, five different collagen gels were cultured for 14 days and evaluated by light and electron microscopy. Cells proliferated within all gels and synthesized proteoglycans as assessed by 35S incorporation; 40-90% of cells maintained a chondrocyte-like morphology after 1 week in culture depending on the type of collagen gel. Synthetic and secretory activity was confirmed by electron microscopy. Based on these results, calf skin collagen is recommended for culturing chondrocytes for implantation.

Use of a guanidine extract of demineralized bone in the treatment of osteochondral defects of articular cartilage

In order to evaluate the ability of a guanidine extract of demineralized bone to repair osteochondral defects in articular cartilage, plugs made of this extract were implanted into defects in rabbit knees. The repair tissue was examined macroscopically, histologically, and immunohistochemically at 4, 8, 12, and 30 weeks. Controls (defects that were left empty) showed no cartilage formation. Four weeks after implantation of a guanidine extract plug, histological examination showed a nonhomogeneous metachromatically stained region extending from the surface of the repair tissue down to cancellous bone. This region also was labeled by an anti-type-II collagen antibody, indicating that cartilage-like tissue had been induced. At 8 weeks, the newly formed cartilage in the subchondral and cancellous bone had been partially replaced by bone. At 12 weeks, the thickness of the newly formed cartilage layer had decreased, and most of the newly formed cartilage in the subchondral and cancellous bone had been replaced by bone. In addition, a tidemark was observed. At 30 weeks, the repair tissue was a mixture of cartilage and fibrocartilage, and there was severe degeneration of the cartilage surrounding the repaired defects. These findings indicate that osteochondral defects of articular cartilage can be partially repaired by the implantation of a guanidine extract and that the newly formed cartilage-like tissue is not permanent.

Treatment of articular defects with meniscal allografts in a rabbit knee model

Deep-frozen allogeneic meniscal grafts for the treatment of articular cartilage defects were performed experimentally. Osteochondral defects 3 mm in diameter were created bilaterally on the medial femoral condyles of 50 Japanese white rabbits. A meniscus was then grafted into the defect in the left knee, and the right knee was left untreated. At various periods from 2 to 24 weeks postoperatively, the rabbits were killed and macroscopic and histologic examinations were performed. Two weeks after operation, the grafted meniscus was bonded to the floor of the defect. After 12 weeks, chondrocytes producing matrix granules was shown by electron microscopy. After 24 weeks, a congruous articular surface was formed. With time, cellular elements infiltrated into the graft from the surrounding tissues, and gradually increased in penetration. Weight bearing in the early stage after operation did not degrade the grafted menisci, and no changes were shown in the opposing cartilage of the tibia. Deep-frozen allogeneic menisci may be useful as a biological implant to repair articular cartilage defects in this model.

Local and remote matrix responses to chondrocyte-laden collagen scaffold implantation in extensive articular cartilage defects

Chondrocyte-laden collagen scaffolds were evaluated in extensive cartilage defects in an equine model. Arthroscopic techniques were used to implant a chondrocyte-collagen culture product in 15-mm defects in the lateral trochlear ridge of the femoropatellar joint of 12 horses. Ungrafted control defects were formed in the opposite joint. Groups of six horses were terminated at 4 and 8 months after implantation and the repair sites, adjacent cartilage, and remote cartilage within each femoropatellar joint examined biochemically. Eight months following surgery the relative proportions of type II collagen in grafted and ungrafted defects, determined using the ratio of cyanogen bromide cleavage products alpha 1(II)CB10/alpha 2(I)CB3,5, were not significantly different (31.57 +/- 2.76% and 26.88 +/- 2.76%, respectively). Aggrecan content was significantly improved in grafted defects (85.61 +/- 6.51 and 74.91 +/- 10.31 micrograms/mg dry weight). Cartilage surrounding grafted defects also showed improved maintenance of cartilage glycosaminoglycan content. Thus, chondrocyte grafting in collagen scaffold vehicles improved the aggrecan content in extensive cartilage defects and surrounding normal cartilage. However, given the continued disparity between repair tissue and normal cartilage aggrecan content, and the low proportion of type II collagen in grafted defects, the utility of collagen scaffolds for chondrocyte grafting of large cartilage defects seems limited.

Chondrocyte-laden collagen scaffolds for resurfacing extensive articular cartilage defects

Chondrocyte-collagen composites were evaluated for resurfacing of large articular defects. Isolated chondrocytes were cultured in expanded collagen scaffolds for 7-10 days to provide a composite containing 3.6 x 10(4) cells/mm3. The graft was transplanted into 15 mm full thickness articular defects in the femoropatellar joint of 12 horses using arthroscopic techniques. Ungrafted defects in the opposite femoropatellar joint served as controls. Synovial fluid, clinical progress and pain responses were evaluated in groups of 6 horses over 4-month and 8-month periods. Following termination, gross, histochemical and histologic evaluations of the repair tissues and synovial membrane were performed. Arthroscopic defect debridement and chondrocyte implantation resulted in minimal post-operative effusion or pain, and synovial fluid constituents were not significantly different in grafted and ungrafted joints. Gross differences in grafted defects were not apparent. Increased chondrocyte numbers and cartilage histochemical staining were evident in the deeper layers of grafted defects, whereas ungrafted defects were almost entirely fibrous tissue. The surface layers of grafted defects were fibrous tissue. There were no synovial fluid cellular responses, synovial membrane histiocytic reaction or subchondral bone infiltrates to suggest immune-related reaction to the allograft cells. Chondrocyte-collagen grafts were arthroscopically implanted and resulted in improved cartilage healing in extensive defects. However, the structural organization of the surface layers was inadequate and suggested poor long-term durability.

Transplantation of cartilagenous tissue generated in vitro into articular joint defects

The purpose of this pilot study was to determine whether isolated rabbit chondrocytes will form cartilagenous tissue in culture and whether this tissue can be used as a cartilage transplant in order to resurface damaged joints. Chondrocytes were isolated from rabbit articular cartilage, plated as a monolayer on Millicell-CMR filters and maintained in cell culture. The cells formed cartilagenous tissue that could be removed from the filter support by two weeks in culture. The chondrocytes synthesize type II collagen indicating that they maintained their phenotype under these conditions. For the transplant studies, two types of articular surface defects, either full thickness into subchondral bone or intra-chondral, were created in rabbits. The cartilagenous tissue was placed in the defect either without fixation or with the topical application of an adhesive agent (Cell-Tak or Nexaband Avian). The joints were examined within two weeks following the surgery. No transplants remained in the defects in those animals in which tissue fixation had been attempted with Cell-Tak. Those grafts fixed into the cartilage defect with Nexaband Avian remained in place but consisted of a condensed layer of acellular tissue. However, cartilagenous tissue was present and intact in five of the six animals in which the transplant had been placed, in the absence of adhesive, into a full thickness defect. In conclusion, cartilagenous tissue generated in vitro can survive transplantation but an appropriate method to fix grafts into intra-chondral defects is required.

Allogeneic deep frozen meniscal graft for repair of osteochondral defects in the knee joint

Osteochondral defects in the knee joints of five patients caused by trauma or osteochondritis dissecans were repaired using deep-frozen allogeneic meniscal grafts. Three patients were male and two were female, with a mean age of 26.4 years. The mean follow-up period was 31 months. Postoperative magnetic resonance imaging (MRI) at all periods clearly showed a smooth and congruous articular surface, although the signal intensity of the grafted meniscus was not the same as that of the articular cartilage. Second-look arthroscopy performed approximately 1 year after surgery demonstrated that the grafted meniscus was well bonded to the grafted site, not sunken; there was no gap between the grafted meniscus and the surrounding articular cartilage, indicating that the grafted meniscus functions as a part of the articular surface. Histologic examination revealed that host cells had infiltrated into the meniscus and that cells surrounded by thin collagen fibrils were morphologically similar to fibrochondrocytes. Thus, the acellular grafted meniscus regenerated as meniscal tissue and formed an articular surface, although hyalinization did not occur. Our results suggest that deep-frozen allogeneic meniscal grafting is a useful method to repair osteochondral defects in the knee joint.

Temporomandibular joint disc replacement made by tissue-engineered growth of cartilage

OBJECTIVE

To test the effectiveness of the new technique of tissue-engineered growth of cartilage, temporomandibular joint (TMJ) disc replacements were created by seeding dissociated chondrocytes on synthetic, three-dimensional, bioresorbable polymer constructs of a predetermined anatomic shape, incubating the cell-polymer constructs in vitro, and transplanting them into test animals.

MATERIALS AND METHODS

Twelve highly porous and bioresorbable cell-transplantation devices in the shape of TMJ discs were created using biodegradable polylactid and polyglycolic acid fibers. Bovine articular cartilage was dissociated into chondrocytes and the cells were allowed to attach to the three-dimensional polymer scaffolds and multiply in vitro. After 1 week, the cell-polymer constructs were implanted subcutaneously into nude mice. The neocartilage was assessed by magnetic resonance imaging (MRI) techniques, gross inspection, histology, and biomechanical and biochemical analysis after 12 weeks.

RESULTS

All implants seeded with chondrocytes showed gross evidence of histologically organized hyaline cartilage. The scaffolds maintained their specific shape. They not only showed appropriate intrinsic stability during neomorphogenesis of cartilage in vitro and in vivo, but also seemed to guide the growth of cartilage. The presence of sulfated glycosaminoglycans was shown by aldehyde fuchsin alcian blue staining of the specimens. Type II collagen, considered to be indicative of cartilage formation, was found in the specimens tested. MRI showed signal characteristics similar to those of hyaline cartilage. Analysis of neocartilage force/displacement curves and aqueous phase compliance using a closed compression chamber suggested that the ability of the constructs to resist deformation was similar to that of native donor cartilage.

CONCLUSION

The technology of tissue-engineered growth of cartilage on individually designed scaffolds may have many applications not only in reconstructive surgery of the TMJ, but also in craniomaxillofacial, plastic, and orthopedic surgery.

Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation

BACKGROUND

Full-thickness defects of articular cartilage in the knee have a poor capacity for repair. They may progress to osteoarthritis and require total knee replacement. We performed autologous chondrocyte transplantation in 23 people with deep cartilage defects in the knee.

METHODS

The patients ranged in age from 14 to 48 years and had full-thickness cartilage defects that ranged in size from 1.6 to 6.5 cm2. Healthy chondrocytes obtained from an uninvolved area of the injured knee during arthroscopy were isolated and cultured in the laboratory for 14 to 21 days. The cultured chondrocytes were then injected into the area of the defect. The defect was covered with a sutured periosteal flap taken from the proximal medial tibia. Evaluation included clinical examination according to explicit criteria and arthroscopic examination with a biopsy of the transplantation site.

RESULTS

Patients were followed for 16 to 66 months (mean, 39). Initially, the transplants eliminated knee locking and reduced pain and swelling in all patients. After three months, arthroscopy showed that the transplants were level with the surrounding tissue and spongy when probed, with visible borders. A second arthroscopic examination showed that in many instances the transplants had the same macroscopic appearance as they had earlier but were firmer when probed and similar in appearance to the surrounding cartilage. Two years after transplantation, 14 of the 16 patients with femoral condylar transplants had good-to-excellent results. Two patients required a second operation because of severe central wear in the transplants, with locking and pain. A mean of 36 months after transplantation, the results were excellent or good in two of the seven patients with patellar transplants, fair in three, and poor in two; two patients required a second operation because of severe chondromalacia. Biopsies showed that 11 of the 15 femoral transplants and 1 of the 7 patellar transplants had the appearance of hyaline cartilage.

CONCLUSION

Cultured autologous chondrocytes can be used to repair deep cartilage defects in the femorotibial articular surface of the knee joint.

Joint resurfacing using allograft chondrocytes and synthetic biodegradable polymer scaffolds

Cartilage implants which could potentially be used to resurface damaged joints were created using rabbit articular chondrocytes and synthetic, biodegradable polymer scaffolds. Cells were serially passaged and then cultured in vitro on fibrous polyglycolic acid (PGA) scaffolds. Cell-PGA constructs were implanted in vivo as allografts to repair 3-mm diameter, full thickness defects in the knee joints of adult rabbits, and cartilage repair was assessed histologically over 6 months. In vitro, chondrocytes proliferated on PGA and regenerated cartilaginous matrix. Collagen and glycosaminoglycan (GAG) represented 20 to 8% of the implant dry weight (dw), respectively, at the time of in vivo implantation; the remainder was PGA and unspecified components. Implants based on passaged chondrocytes had 1.7-times as much GAG and 2.6-times as much collagen as those based on primary chondrocytes. In vivo, cartilaginous repair tissue was observed after implantation of PGA both with and without cultured chondrocytes. Six month repair was qualitatively better for cell-PGA allografts than for PGA alone, with respect to: 1) surface smoothness, 2) columnar alignment of chondrocytes, 3) spatially uniform GAG distribution, 4) reconstitution of the subchondral plate, and 5) bonding of the repair tissue to the underlying bone. These pilot studies demonstrate that it is feasible to use cell-polymer allografts for joint resurfacing in vivo.

Design of nasoseptal cartilage replacements synthesized from biodegradable polymers and chondrocytes

Reconstructive and aesthetic surgery of the nose is a challenging problem in facial plastic surgery. In this study, biodegradable polymers composed of polyglycolic acid (PGA) and poly-L-lactic acid (PLLA) and their co-polymers were used to produce templates to transplant cells and promote regeneration of structural cartilage. A highly porous anatomically shaped three-dimensional non-woven PGA fibre network was sprayed with a coating polymer solution. Reinforcement of the outer circumference of the 12 nasoseptal constructs using high molecular weight PLLA further stabilized the constructs during the process of neomorphogenesis of cartilage, both during in vitro incubation and in vivo implantation. These cell transplantation devices also proved to be adhesive substrates for dissociated bovine chondrocytes. When implanted subcutaneously into nude mice, the polymer templates guided the reorganization after 8 wk of the bovine chondrocytes into neocartilage in the precisely designed size and shape of the original size and shape of the polymer delivery device. All implants loaded with chondrocytes showed evidence of formation of histologically organized hyaline cartilage. The implantation of nasal scaffolds without cells did not show cartilage formation. The technique of tissue engineered growth of cartilage has potential applications in orthopaedic, plastic and reconstructive, and craniomaxillofacial surgery.

Chondrocyte-fibrin matrix transplants for resurfacing extensive articular cartilage defects

Cartilage resurfacing by chondrocyte implantation, with fibrin used as a vehicle, was examined in large (12 mm) full-thickness articular cartilage defects in horses. Articular chondrocytes, isolated from a 9-day-old foal, were mixed with fibrinogen and injected with thrombin, in a 1:1 mixture, into 12 mm circular defects on the lateral trochlea of the distal femur of eight normal horses. The contralateral femoropatellar (knee) joint served as a control in which the defect was left empty. Synovial fluid from the femoropatellar joints was sampled on days 0, 4, 7, 30, 120, and 240 postoperatively. Groups of four horses were killed at 4 or 8 months postoperatively, and the repair tissue was evaluated by gross and histologic examination with use of hematoxylin and eosin and safranin O staining and by autoradiography. Biochemical analyses included quantitation of proteoglycan, total collagen, and type-II collagen in the repair tissue. Grossly, grafted defects had improved filling of the cartilage lesions; histologically, these areas consisted of differentiated chondrocytes in the deep and middle zones. The cellular arrangement in these zones resembled that of hyaline cartilage. The control defects contained poorly attached fibrous tissue throughout. Grafted tissue at 8 months had increased proteoglycan synthesis evident by both safranin O staining and autoradiography. Glycosaminoglycan quantitation by dye-binding assay confirmed a significantly elevated glycosaminoglycan content in grafted defects (58.8 micrograms/mg of dry weight) compared with control defects (27.4 micrograms/mg; p < 0.05). Similarly, the levels of chondroitin sulfate/dermatan sulfate was significantly elevated in the grafted defects, and this was the predominant glycosaminoglycan epitope present. There was a statistically significant (p < 0.05) increase in type-II collagen in the grafted tissue at 8 months (61.2% grafted; 25.1% control). This resurfacing attempt with use of allograft chondrocytes, secured in large full-thickness articular defects with polymerized fibrin, resulted in an improved cartilage surface in comparison with the control defects, a significantly greater aggrecan level, and a significantly higher proportion of type-II collagen.

Mesenchymal cell-based repair of large, full-thickness defects of articular cartilage

Osteochondral progenitor cells were used to repair large, full-thickness defects of the articular cartilage that had been created in the knees of rabbits. Adherent cells from bone marrow, or cells from the periosteum that had been liberated from connective tissue by collagenase digestion, were grown in culture, dispersed in a type-I collagen gel, and transplanted into a large (three-by-six-millimeter), full-thickness (three-millimeter) defect in the weight-bearing surface of the medial femoral condyle. The contralateral knee served as a control: either the defect in that knee was left empty or a cell-free collagen gel was implanted. The periosteal and the bone-marrow-derived cells showed similar patterns of differentiation into articular cartilage and subchondral bone. Specimens of reparative tissue were analyzed with use of a semiquantitative histological grading system and by mechanical testing with employment of a porous indenter to measure the compliance of the tissue at intervals until twenty-four weeks after the operation. There was no apparent difference between the results obtained with the cells from the bone marrow and those from the periosteum. As early as two weeks after transplantation, the autologous osteochondral progenitor cells had uniformly differentiated into chondrocytes throughout the defects. This repair cartilage was subsequently replaced with bone in a proximal-to-distal direction, until, at twenty-four weeks after transplantation, the subchondral bone was completely repaired, without loss of overlying articular cartilage. The mechanical testing data were a useful index of the quality of the long-term repair. Twenty-four weeks after transplantation, the reparative tissue of both the bone-marrow and the periosteal cells was stiffer and less compliant than the tissue derived from the empty defects but less stiff and more compliant than normal cartilage.

CLINICAL RELEVANCE

The current modalities for the repair of defects of the articular cartilage have many disadvantages. The transplantation of progenitor cells that will form cartilage and bone offers a possible alternative to these methods. As demonstrated in this report, autologous, bone-marrow-derived, osteochondral progenitor cells can be isolated and grown in vitro without the loss of their capacity to differentiate into cartilage or bone. Sufficient autologous cells can be generated to initiate the repair of articular cartilage and the reformation of subchondral bone. The repair tissues appear to undergo the same developmental transitions that originally led to the formation of articular tissue in the embryo.(ABSTRACT TRUNCATED AT 400 WORDS)

Tissue-engineered growth of cartilage: the effect of varying the concentration of chondrocytes seeded onto synthetic polymer matrices

Ninety-six synthetic bioresorbable cell-delivery devices (10 x 10 x 0.5 mm) were seeded, varying the concentrations of living chondrocytes (2, 10, 20, 100 million cells/cc) isolated from shoulders of freshly killed calves and implanted subcutaneously on the dorsum of nude mice after 1 week of in vitro culture. This resulted in the formation of new cartilage in 95.6% of the implants. Twenty-four control implants (0 cells seeded) did not show cartilage formation. During 12 weeks of in vivo implantation, the wet weight and the thickness of the specimens (10, 20, 100 million cells/cc) increased significantly. Histologic analysis revealed cells appearing in their own lacunar structures surrounded by basophilic matrix. The increase in sulfated glycosaminoglycan content indicated the maturation of the extracellular matrix. The ability to manipulate the growth of new cartilage on biocompatible polymer scaffolds by varying the cell density before in vivo implantation will allow engineering to optimize the utilization of chondrocytes in relation to the desired shape, thickness, and quality of the new cartilage.