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Liu H, Liu H, Yang Q, Fan Z. LncRNA SNHG1 enhances cartilage regeneration by modulating chondrogenic differentiation and angiogenesis potentials of JBMMSCs via mitochondrial function regulation. Stem Cell Res Ther 2024; 15:177. [PMID: 38886785 PMCID: PMC11184886 DOI: 10.1186/s13287-024-03793-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/07/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Cartilage is a kind of avascular tissue, and it is difficult to repair itself when it is damaged. In this study, we investigated the regulation of chondrogenic differentiation and vascular formation in human jaw bone marrow mesenchymal stem cells (h-JBMMSCs) by the long-chain noncoding RNA small nucleolar RNA host gene 1 (SNHG1) during cartilage tissue regeneration. METHODS JBMMSCs were isolated from the jaws via the adherent method. The effects of lncRNA SNHG1 on the chondrogenic differentiation of JBMMSCs in vitro were detected by real-time fluorescence quantitative polymerase chain reaction (RT-qPCR), Pellet experiment, Alcian blue staining, Masson's trichrome staining, and modified Sirius red staining. RT-qPCR, matrix gel tube formation, and coculture experiments were used to determine the effect of lncRNA SNHG1 on the angiogenesis in JBMMSCs in vitro. A model of knee cartilage defects in New Zealand rabbits and a model of subcutaneous matrix rubber suppositories in nude mice were constructed for in vivo experiments. Changes in mitochondrial function were detected via RT-qPCR, dihydroethidium (DHE) staining, MitoSOX staining, tetramethyl rhodamine methyl ester (TMRM) staining, and adenosine triphosphate (ATP) detection. Western blotting was used to detect the phosphorylation level of signal transducer and activator of transcription 3 (STAT3). RESULTS Alcian blue staining, Masson's trichrome staining, and modified Sirius Red staining showed that lncRNA SNHG1 promoted chondrogenic differentiation. The lncRNA SNHG1 promoted angiogenesis in vitro and the formation of microvessels in vivo. The lncRNA SNHG1 promoted the repair and regeneration of rabbit knee cartilage tissue. Western blot and alcian blue staining showed that the JAK inhibitor reduced the increase of STAT3 phosphorylation level and staining deepening caused by SNHG1. Mitochondrial correlation analysis revealed that the lncRNA SNHG1 led to a decrease in reactive oxygen species (ROS) levels, an increase in mitochondrial membrane potential and an increase in ATP levels. Alcian blue staining showed that the ROS inhibitor significantly alleviated the decrease in blue fluorescence caused by SNHG1 knockdown. CONCLUSIONS The lncRNA SNHG1 promotes chondrogenic differentiation and angiogenesis of JBMMSCs. The lncRNA SNHG1 regulates the phosphorylation of STAT3, reduces the level of ROS, regulates mitochondrial energy metabolism, and ultimately promotes cartilage regeneration.
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Affiliation(s)
- Hua Liu
- Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - Huina Liu
- Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China.
- Department of General Dentistry and Integrated Emergency Dental Care, Capital Medical University School of Stomatology, Beijing, 100050, China.
| | - Qiubo Yang
- Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China.
| | - Zhipeng Fan
- Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China.
- Beijing Laboratory of Oral Health, Capital Medical University, Beijing, China.
- Research Unit of Tooth Development and Regeneration, Chinese Academy of Medical Sciences, Beijing, China.
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Crisol M, Wu K, Congdon B, Skene-Arnold TD, Laouar L, Elliott JAW, Jomha NM. Chondrocyte Viability of Particulated Porcine Articular Cartilage Is Maintained in Tissue Storage After Cryoprotectant Exposure, Vitrification, and Tissue Warming. Cartilage 2024; 15:139-146. [PMID: 37148124 DOI: 10.1177/19476035221118656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
OBJECTIVE Vitrification of articular cartilage (AC) is a promising technique which may enable long-term tissue banking of AC allografts. We previously developed a 2-step, dual-temperature, multi-cryoprotectant agent (CPA) loading protocol to cryopreserve particulated AC (1 mm3 cubes). Furthermore, we also determined that the inclusion of ascorbic acid (AA) effectively mitigates CPA toxicity in cryopreserved AC. Prior to clinical translation, chondrocytes must remain viable after tissue re-warming and before transplantation. However, the effects of short-term hypothermic storage of particulated AC after vitrification and re-warming are not documented. This study evaluated the chondrocyte viability of post-vitrified particulated AC during a 7-day tissue storage period at 4 °C. We hypothesized that porcine particulated AC could be stored for up to 7 days after successful vitrification without significant loss of cell viability, and these results would be enhanced when cartilage is incubated in storage medium supplemented with clinical grade AA. DESIGN Three experimental groups were examined at 5 time points: a fresh control (only incubated in medium), a vitrified - AA group, and a vitrified + AA group (N = 7). RESULTS There was a mild decline in cell viability but both treatment groups maintained a viability of greater than 80% viable cells which is acceptable for clinical translation. CONCLUSION We determined that particulated AC can be stored for up to 7 days after successful vitrification without a clinically significant decline in chondrocyte viability. This information can be used to guide tissue banks regarding the implementation of AC vitrification to increase cartilage allograft availability.
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Affiliation(s)
- Mary Crisol
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Kezhou Wu
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
- Sports Medicine Centre, Department of Orthopedic Surgery, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Barry Congdon
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | | | - Leila Laouar
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Janet A W Elliott
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, AB, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Nadr M Jomha
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
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Luk J, Bozynski CC, Williams J, Stoker AM, Stannard JP, Teixeiro E, Cook JL. Cell-Mediated Immune Responses May Play Roles in Osteochondral Allograft Transplantation Osteointegration Failures. J Knee Surg 2024. [PMID: 38754436 DOI: 10.1055/s-0044-1787058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Prolonged and incomplete osteochondral allograft (OCA) osteointegration is consistently cited as a major mechanism for OCA treatment failure. Subrejection immune responses may play roles in this mode of failure. Preimplantation OCA preparation techniques, including subchondral bone drilling, thorough irrigation, and autogenous bone marrow aspirate concentrate saturation, may dampen immune responses and improve OCA osteointegration. This study sought to further characterize potential immune system contributions to OCA transplantation treatment failures by analyzing donor-recipient ABO and Rh-factor mismatches and histological and immunohistochemical assessments of transplanted OCA tissues recovered from revision surgeries. Using a dedicated registry, OCA transplant recipients with documented treatment failures who met inclusion criteria (n = 33) as well as age-, body mass index-, and joint-matched patients with successful outcomes (n = 70) were analyzed to compare matched cohorts of patients with successful versus failed OCA transplantation outcomes. Tissues recovered from 18 failed OCA transplants and portions of 7 nonimplanted OCA controls were further analyzed to provide contributing evidence for potential immune response mechanisms. For patients analyzed, no statistically significant differences in proportions for treatment success versus failure based on mismatches for ABO type, Rh factor, or both were noted. Further, no statistically significant differences in proportions for histological immune response presence or absence based on mismatches for ABO type, Rh factor, or both were noted. Twelve (67%) of the failed OCA tissues contained lymphocyte aggregations in the subchondral bone, which were comprised of combinations of CD3 + , CD4 + , CD8 + , and CD20+ lymphocytes. The mechanisms of failure for these 12 OCA transplants involved insufficient OCA osteointegration. Results of this study suggest that T- and B-cell-mediated subrejection immune responses may play roles in OCA transplant treatment failures independent of donor-recipient blood type mismatch effects.
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Affiliation(s)
- Josephine Luk
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
| | - Chantelle C Bozynski
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
| | - Jonathan Williams
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
| | - Aaron M Stoker
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
| | - James P Stannard
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
| | - Emma Teixeiro
- Department of Molecular Microbiology and Immunology, Department of Surgery, University of Missouri, Roy Blunt NextGen Precision Health, Columbia, Missouri
| | - James L Cook
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
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4
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Abusara Z, Moo EK, Haider I, Timmermann C, Miller S, Timmermann S, Herzog W. Functional Assessment of Human Articular Cartilage Using Second Harmonic Generation (SHG) Imaging: A Feasibility Study. Ann Biomed Eng 2024; 52:1009-1020. [PMID: 38240956 DOI: 10.1007/s10439-023-03437-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/26/2023] [Indexed: 03/16/2024]
Abstract
Many arthroscopic tools developed for knee joint assessment are contact-based, which is challenging for in vivo application in narrow joint spaces. Second harmonic generation (SHG) laser imaging is a non-invasive and non-contact method, thus presenting an attractive alternative. However, the association between SHG-based measures and cartilage quality has not been established systematically. Here, we investigated the feasibility of using image-based measures derived from SHG microscopy for objective evaluation of cartilage quality as assessed by mechanical testing. Human tibial plateaus harvested from nine patients were used. Cartilage mechanical properties were determined using indentation stiffness (Einst) and streaming potential-based quantitative parameters (QP). The correspondence of the cartilage electromechanical properties (Einst and QP) and the image-based measures derived from SHG imaging, tissue thickness and cell viability were evaluated using correlation and logistic regression analyses. The SHG-related parameters included the newly developed volumetric fraction of organised collagenous network (Φcol) and the coefficient of variation of the SHG intensity (CVSHG). We found that Φcol correlated strongly with Einst and QP (ρ = 0.97 and - 0.89, respectively). CVSHG also correlated, albeit weakly, with QP and Einst, (|ρ| = 0.52-0.58). Einst and Φcol were the most sensitive predictors of cartilage quality whereas CVSHG only showed moderate sensitivity. Cell viability and tissue thickness, often used as measures of cartilage health, predicted the cartilage quality poorly. We present a simple, objective, yet effective image-based approach for assessment of cartilage quality. Φcol correlated strongly with electromechanical properties of cartilage and could fuel the continuous development of SHG-based arthroscopy.
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Affiliation(s)
- Ziad Abusara
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada.
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | - Eng Kuan Moo
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Department of Mechanical and Aerospace Engineering, Faculty of Engineering and Design, Carleton University, Ottawa, Canada
| | - Ifaz Haider
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Claire Timmermann
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Sue Miller
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Canada
- Taylor Institute for Teaching and Learning, University of Calgary, Calgary, Canada
| | - Scott Timmermann
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Canada
| | - Walter Herzog
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
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5
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Gottlich CP, Fisher JC, Diab M. A Current Review in the Orthopedic Management of Osteonecrosis of the knee Secondary to Treatment of Pediatric Hematologic Malignancy. Orthop Rev (Pavia) 2024; 16:115354. [PMID: 38533522 PMCID: PMC10963255 DOI: 10.52965/001c.115354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/05/2024] [Indexed: 03/28/2024] Open
Abstract
Acute Lymphoblastic Leukemia is the most prevalent pediatric hematologic malignancy. The treatment for this illness has advanced significantly, now touting a 90% cure rate. Although these patients often become disease free, treatment can leave devastating effects that last long after their disease burden is alleviated. A commonly experienced result of treatment is osteonecrosis (ON), often occurring in weight bearing joints. Uncertainty exists in the optimal treatment of this cohort of patients. In this review, we describe the etiology and suspected pathogenesis of ON, as well as treatment options described in the literature.
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Affiliation(s)
| | - John C Fisher
- Orthopedic Surgery Texas Tech University Health Sciences Center
| | - Michel Diab
- Orthopedic Surgery Texas Tech University Health Sciences Center
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6
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de Freitas Filho LH, Neves CDCS, Silva NP, Corsi CAC, Cardoso EM, de Miranda JB, de Campos GC. Challenges of Implementing a Human Multi-Tissue Bank in a Public Hospital in the Interior of São Paulo: Under the Light of the Quality Management System. Transplant Proc 2024:S0041-1345(24)00011-3. [PMID: 38378340 DOI: 10.1016/j.transproceed.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/16/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Human multi-tissue banks (HMTB) are important health institutions specialized in the capture, processing, and distribution of human tissues for transplants and research, aiming for safety and quality in the supply of their products, intended for reconstructive surgeries and injury repair, in addition to contributing to the advancement of research developed in regenerative medicine. This study aims to report and share the experience of implementing an HMTB, as well as creating an institution's own quality management system. METHODS This is a descriptive study, an experience report type, which identifies historical aspects of an HMTB's actions in the 5 years of implementing and operating the service. RESULTS Initially, a musculoskeletal tissue bank was established in collaboration with the Department of Orthopedics at the State University of Campinas, São Paulo, Brazil, in June 2018. In 2023, through a management model and associated technologies, the banks of human musculoskeletal and ocular tissues at the institution established the HC-UNICAMP Human Multi-tissue Bank. CONCLUSIONS The implementation of the HMTB with modern and technological infrastructure, associated with the development and operation of the quality management system, allowed us to provide excellent organization of work processes, as well as obtain the necessary health license to begin activities. It is believed that this report can be an important source of information and recommendations applicable to the implementation of other human HMTBs.
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Affiliation(s)
| | | | - Nilcilene Pinheiro Silva
- Health Quality and Safety Center of Hospital das Clínicas, State University of Campinas - UNICAMP, São Paulo, Brazil
| | - Carlos Alexandre Curylofo Corsi
- Human Tissue Bank of Hospital das Clínicas, Ribeirão Preto Medical School at University of São Paulo (FMRP/USP), Ribeirão Preto, SP, Brazil
| | - Evelyn Machado Cardoso
- Human Multi-tissue Bank of Hospital das Clínicas, State University of Campinas - UNICAMP, São Paulo, Brazil
| | - João Batista de Miranda
- Department of Orthopedics and Traumatology, Medical Sciences College, Hospital das Clínicas of State University of Campinas - UNICAMP, São Paulo, Brazil
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7
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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] [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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8
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Chen R, Pye JS, Li J, Little CB, Li JJ. Multiphasic scaffolds for the repair of osteochondral defects: Outcomes of preclinical studies. Bioact Mater 2023; 27:505-545. [PMID: 37180643 PMCID: PMC10173014 DOI: 10.1016/j.bioactmat.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/18/2023] [Accepted: 04/17/2023] [Indexed: 05/16/2023] Open
Abstract
Osteochondral defects are caused by injury to both the articular cartilage and subchondral bone within skeletal joints. They can lead to irreversible joint damage and increase the risk of progression to osteoarthritis. Current treatments for osteochondral injuries are not curative and only target symptoms, highlighting the need for a tissue engineering solution. Scaffold-based approaches can be used to assist osteochondral tissue regeneration, where biomaterials tailored to the properties of cartilage and bone are used to restore the defect and minimise the risk of further joint degeneration. This review captures original research studies published since 2015, on multiphasic scaffolds used to treat osteochondral defects in animal models. These studies used an extensive range of biomaterials for scaffold fabrication, consisting mainly of natural and synthetic polymers. Different methods were used to create multiphasic scaffold designs, including by integrating or fabricating multiple layers, creating gradients, or through the addition of factors such as minerals, growth factors, and cells. The studies used a variety of animals to model osteochondral defects, where rabbits were the most commonly chosen and the vast majority of studies reported small rather than large animal models. The few available clinical studies reporting cell-free scaffolds have shown promising early-stage results in osteochondral repair, but long-term follow-up is necessary to demonstrate consistency in defect restoration. Overall, preclinical studies of multiphasic scaffolds show favourable results in simultaneously regenerating cartilage and bone in animal models of osteochondral defects, suggesting that biomaterials-based tissue engineering strategies may be a promising solution.
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Affiliation(s)
- Rouyan Chen
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, NSW, 2065, Australia
- School of Electrical and Mechanical Engineering, Faculty of Sciences, Engineering and Technology, The University of Adelaide, SA, 5005, Australia
| | - Jasmine Sarah Pye
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, NSW, 2007, Australia
| | - Jiarong Li
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, NSW, 2065, Australia
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, NSW, 2007, Australia
| | - Christopher B. Little
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, NSW, 2065, Australia
- Corresponding author. Raymond Purves Bone and Joint Research Lab, Kolling Institute, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
| | - Jiao Jiao Li
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, NSW, 2065, Australia
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, NSW, 2007, Australia
- Corresponding author. School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, NSW, 2007, Australia.
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9
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Jin YJ, Park DY, Noh S, Kwon H, Shin DI, Park JH, Min BH. Effects of glycosaminoglycan content in extracellular matrix of donor cartilage on the functional properties of osteochondral allografts evaluated by micro-CT non-destructive analysis. PLoS One 2023; 18:e0285733. [PMID: 37220126 DOI: 10.1371/journal.pone.0285733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/28/2023] [Indexed: 05/25/2023] Open
Abstract
Osteochondral allograft (OCA) is an important surgical procedure used to repair extensive articular cartilage damage. It is known that chondrocyte viability is crucial for maintaining the biochemical and biomechanical properties of OCA, which is directly related to the clinical success of the operation and is the only standard for preoperative evaluation of OCA. However, there is a lack of systematic research on the effect of the content of cellular matrix in OCA cartilage tissue on the efficacy of transplantation. Therefore, we evaluated the effect of different GAG contents on the success of OCA transplantation in a rabbit animal model. Each rabbit OCA was treated with chondroitinase to regulate glycosaminoglycan (GAG) content in the tissue. Due to the different action times of chondroitinase, they were divided into 4 experimental groups (including control group, 2h, 4h, and 8h groups). The treated OCAs of each group were used for transplantation. In this study, transplant surgery effects were assessed using micro-computed tomography (μCT) and histological analysis. Our results showed that tissue integration at the graft site was poorer in the 4h and 8h groups compared to the control group at 4 and 12 weeks in vivo, as were the compressive modulus, GAG content, and cell density reduced. In conclusion, we evaluated the biochemical composition of OCAs before and after surgery using μCT analysis and demonstrated that the GAG content of the graft decreased, it also decreased during implantation; this resulted in decreased chondrocyte viability after transplantation and ultimately affected the functional success of OCAs.
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Affiliation(s)
- Yong Jun Jin
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Republic of Korea
- Cell Therapy Center, Ajou University Medical Center, Suwon, Republic of Korea
| | - Do Young Park
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Republic of Korea
- Cell Therapy Center, Ajou University Medical Center, Suwon, Republic of Korea
| | - Sujin Noh
- Department of Biomedical Sciences, Graduate School of Ajou University, Suwon, Republic of Korea
| | - HyeonJae Kwon
- Cell Therapy Center, Ajou University Medical Center, Suwon, Republic of Korea
- Department of Molecular Science and Technology, Ajou University, Suwon, Republic of Korea
| | - Dong Il Shin
- Cell Therapy Center, Ajou University Medical Center, Suwon, Republic of Korea
- Department of Molecular Science and Technology, Ajou University, Suwon, Republic of Korea
| | - Jin Ho Park
- Cell Therapy Center, Ajou University Medical Center, Suwon, Republic of Korea
- Department of Molecular Science and Technology, Ajou University, Suwon, Republic of Korea
| | - Byoung-Hyun Min
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Republic of Korea
- Cell Therapy Center, Ajou University Medical Center, Suwon, Republic of Korea
- Department of Molecular Science and Technology, Ajou University, Suwon, Republic of Korea
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10
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Kacprzak B, Rosińska K, Siuba-Jarosz N. Hyalofast Cartilage Repair Surgery with a Full Load-Bearing Rehabilitation Program One Day after Operation Reduces the Time for Professional Athletes to Return to Play. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040804. [PMID: 37109762 PMCID: PMC10145501 DOI: 10.3390/medicina59040804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: This study evaluated the effectiveness of Hyalofast cartilage repair surgery with an early, full load-bearing rehabilitation program one day after the operation for reducing the time needed for professional athletes to return to play. Materials and Methods: This prospective study included 49 patients aged between 19 and 38 years who had undergone surgical reconstruction of cartilage using the microfracture technique combined with a Hyalofast scaffold. All patients were active professional athletes. Early rehabilitation was implemented from the first postoperative day, fully loading the operated limb. A clinical evaluation was based on the KOOS and SF-36 questionnaires used during subsequent follow-up visits. All patients underwent magnetic resonance imaging (MRI) to evaluate the effect of the surgery after one year. Results: The clinical results demonstrated a statistically significant improvement in the number of complaints about pain and in the quality of life of the patients, measured in all of the applied scales, with comparisons made between six months or one year post-surgery and pre-surgery. Importantly for athletes, the parameter related to sports and recreation improved from 14 ± 11.1 to 95 ± 7.7 6 months after surgery and to 99.8 ± 1.8 one year after surgery. The overall quality of life score improved from 30 ± 18 to 88 ± 8.8 one year after surgery. Conclusions: These results show that this approach significantly shortened the time needed for the athletes to return to sports at the same level as before the surgery (athletes returned to sports in approximately 2.5-3 months). The mean follow-up time was 19.75 months. This technique can be considered a viable option for the treatment of cartilage injuries in professional athletes, allowing them to return to play more quickly in a safe and healthy way.
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Affiliation(s)
| | - Karolina Rosińska
- Wolf Project Studio Krzysztof Król, ul. Gdańska 79/D01, 90-612 Łódź, Poland
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11
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Buyuk AF, Stannard JP, Rucinski K, Crecelius CR, Cook JL. The Missouri Osteochondral Preservation System Is Associated With Better Short-Term Outcomes Than Standard Preservation Methods When Performing Osteochondral Allograft Transplantation Using Shell Grafts for Patellofemoral Lesions. Arthroscopy 2023; 39:650-659. [PMID: 36306891 DOI: 10.1016/j.arthro.2022.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE To compare outcomes after whole-surface osteochondral allograft (OCA) transplantation using shell grafts for treatment of patellofemoral joint lesions with respect to surfaces treated and OCA preservation method. METHODS With institutional review board approval and informed consent, patients were prospectively enrolled into a registry to follow outcomes after OCA transplantation. Patients who received patellofemoral shell OCA to treat the entire articular surface of the patella, trochlea, or both, and with a minimum of 2-year follow-up data, including patient-reported outcome measures (PROMs), failures, and complications, were included. Functional graft survival was determined based on patients returning to functional activities without need for OCA revision or arthroplasty surgery and calculated using the formula: 100% - (%revision + %failure). Minimum clinically important differences were determined based on previously validated data. Outcomes were compared based on differences in graft preservation methodology (Missouri Osteochondral Preservation System [MOPS] or standard preservation [SP]) and based on surfaces treated (patella, trochlea, or both). RESULTS Fifty-eight patients met inclusion criteria. Mean age was 36.7 years (range 15-60 years) and mean body mass index was 28.9 (range 18-42). OCAs stored using SP methods were transplanted in 12 patients, mean follow-up was (66.1 months; range 54-70 months): OCAs stored using MOPS methods were transplanted in 46 patients, mean follow-up was (44.8 months; range 24-60 months). Graft survival rate at final follow-up was significantly greater (P = .025) for MOPS OCAs (98%) compared with SP OCAs (75%), whereas 2-year functional graft survival rates (MOPS 98% vs SP 83%; P = .1) were not. Reoperation rate was significantly greater (P = .0014) for SP cases compared with MOPS cases. PROMs showed statistically significant and clinically meaningful improvements through 4 years after unipolar patella, unipolar trochlea, and bipolar patellofemoral OCA transplantation using MOPS grafts. Unipolar patella OCA transplantations were associated with significantly more reduction in pain and significantly better PROMs at 1-year compared with unipolar trochlea and bipolar patellofemoral OCAs. CONCLUSIONS OCA transplantation using MOPS shell grafts for unipolar and bipolar patellofemoral resurfacing was associated with statistically significant and clinically meaningful improvements from preoperative levels of pain and function. The 2-year functional graft survival rate was 83% in the SP group and 98% in the MOPS group, such that MOPS was associated with better short-term outcomes than SP methods when performing OCA transplantation using shell grafts for patellofemoral lesions. Patients who received unipolar patella allografts reported the best outcomes in terms of pain and function. LEVEL OF EVIDENCE Level III, retrospective analysis of registry data.
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Affiliation(s)
- Abdul Fettah Buyuk
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA
| | - James P Stannard
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA
| | - Kylee Rucinski
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA
| | - Cory R Crecelius
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA
| | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA.
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12
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Kaplan DJ, Chahla J. Editorial Commentary: Shell Grafts Are Viable in "Select" Cases, and Improved Preservation Techniques May Help Us Improve Our Outcomes. Arthroscopy 2023; 39:660-661. [PMID: 36740288 DOI: 10.1016/j.arthro.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/07/2022] [Accepted: 12/16/2022] [Indexed: 02/07/2023]
Abstract
Patellofemoral joint chondral lesions can be challenging to treat with osteochondral allograft plugs because of the complex morphology and biomechanics of the patellofemoral joint Shell allografts replace the entirety of the damaged articular surface with a single osteochondral allograft piece (e.g., the entire trochlea or patella articular surface). Although technically demanding, shell grafts would allow for the treatment of bigger defects, correction of dysplasia, and for the treatment of uncontained lesions. However, shell allografts have historically shown inferior results than focal cylindrical grafts (bone plugs), with failure rates up to 38% based in the published literature. Although evidence exists demonstrating the efficacy of shell grafts in select cases, additional studies from multiple sources are required to support their continued use as well as determine the optimal graft-preservation techniques.
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13
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Paul KD, Patel RK, Arguello AM, Kwapisz A, Brabston EW, Stannard JP, Ponce BA, Momaya AM. Variability in the Processing of Fresh Osteochondral Allografts. J Knee Surg 2023; 36:450-455. [PMID: 34600436 DOI: 10.1055/s-0041-1736148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The indications for fresh osteochondral allograft continue to increase. As a result, variations in graft processing and preservation methods have emerged. An understanding of these techniques is important when evaluating the optimal protocol for processing fresh osteochondral allografts prior to surgical implantation. The aim of this study is to review the literature and understand various tissue processing protocols of four leading tissue banks in the United States. Donor procurement, serological and microbiological testing, and storage procedures were compared among companies of interest. Similarities between the major tissue banks include donor screening, aseptic processing, and testing for microorganisms. Variability exists between these companies with relation to choice of storage media, antibiotic usage, storage temperature, and graft expiration dates. Potential exists for increased chondrocyte viability and lengthened time-to-expiration of the graft through a protocol of delicate tissue handling, proper choice of storage medium, adding hormones and growth factors like insulin growth factor-1 (IGF-1) to serum-free nutrient media, and storing these grafts closer to physiologic temperatures.
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Affiliation(s)
- Kyle D Paul
- Department of Orthopaedics, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Romil K Patel
- Department of Orthopaedics, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Alexandra M Arguello
- Department of Orthopaedics, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Adam Kwapisz
- Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, Lodz, Lodzkie, Poland
| | - Eugene W Brabston
- Department of Orthopaedics, The University of Alabama at Birmingham, Birmingham, Alabama
| | - James P Stannard
- Department of Orthopaedic Surgery, University of Missouri Columbia, Missouri Orthopaedic Institute, Columbia, Missouri.,Department of Thompson Laboratory for Regenerative Orthopaedics, University of Missouri Columbia, Missouri Orthopaedic Institute, Columbia, Missouri
| | - Brent A Ponce
- Department of Orthopaedics, Hughston Clinic, Columbus, Georgia
| | - Amit M Momaya
- Department of Orthopaedics, The University of Alabama at Birmingham, Birmingham, Alabama
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14
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Yong KW, Wu K, Elliott JAW, Jomha NM. The effect of sucrose supplementation on chondrocyte viability in porcine articular cartilage following vitrification. Cryobiology 2022; 109:53-61. [PMID: 36155184 DOI: 10.1016/j.cryobiol.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/14/2022] [Accepted: 09/17/2022] [Indexed: 02/05/2023]
Abstract
Vitrification can extend the banking life of articular cartilage (AC) and improve osteochondral transplantation success. Current vitrification protocols require optimization to enable them to be implemented in clinical practice. Sucrose as a non-permeating cryoprotective agent (CPA) and clinical grade chondroitin sulfate (CS) and ascorbic acid (AA) as antioxidants were investigated for their ability to improve a current vitrification protocol for AC. The aim of this study was to assess the impact of sucrose and CS/AA supplementation on post-warming chondrocyte viability in vitrified AC. Porcine osteochondral dowels were randomly vitrified and warmed with one established protocol (Protocol 1) and seven modified protocols (Protocols 2-8) followed by chondrocyte viability assessment. Sucrose supplementation in both vitrification and warming media (Protocol 4) resulted in significantly higher (p = 0.018) post-warming chondrocyte viability compared to the protocol without sucrose (Protocol 1). There was no significant difference (p = 0.298) in terms of post-warming chondrocyte viability between sucrose-supplemented DMEM + CS solution (Protocol 4) and Unisol-CV (UCV) + CS (Protocol 6) solution. Clinical grade CS and AA contributed to similar post-warming chondrocyte viability to previous studies using research grade CS and AA, indicating their suitability for clinical use. The addition of an initial step (step 0) to reduce the initial concentration of CPAs to minimize osmotic effects did not enhance chondrocyte viability in the superficial layer of AC. In conclusion, sucrose-supplemented DMEM + clinical grade CS (Protocol 4) could be an ideal protocol to be investigated for future use in clinical applications involving vitrified AC.
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Affiliation(s)
- Kar Wey Yong
- Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, T6G 2B7, Canada
| | - Kezhou Wu
- Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, T6G 2B7, Canada
- Department of Orthopedic Surgery, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - Janet A W Elliott
- Department of Chemical and Materials Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, T6G 1H9, Canada; Department of Laboratory Medicine and Pathology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, T6G 2R7, Canada
| | - Nadr M Jomha
- Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, T6G 2B7, Canada
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15
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Tabbaa SM, Crawford DC, Provencher M, Farr J, Bugbee WD. Variability in Private Payer Medical Policies for Osteochondral Allograft Transplantation Demonstrates the Absence of Standardization in Medical Criteria Between Payers. Arthrosc Sports Med Rehabil 2022; 4:e2107-e2113. [PMID: 36579033 PMCID: PMC9791874 DOI: 10.1016/j.asmr.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 09/13/2022] [Indexed: 11/09/2022] Open
Abstract
Purpose To define the criteria for coverage for a cartilage restoration procedure and osteochondral allograft (OCA) transplantation and to investigate coverage for OCA procedures among private payer medical policies. Methods A systematic search of private payer websites was conducted to identify publicly available 2018 OCA medical policies. Medical criteria related to patient demographics, defect characteristics, and previous treatment were analyzed. Trends in coverage for treatment of talus and patella and the extent of restrictiveness of medical policies were evaluated from 2016 to 2018. The extent of restrictiveness of a policy was defined by number of medical criteria established by payer policies. Policies with >5, 3-5, and <3 specified criteria for OCAs were considered strongly, moderately, and weakly restrictive, respectively. Results In total, 49 private payer medical policies for OCA transplantation were identified. Extracted criteria varied greatly between medical policies. Ten different defect size ranges were reported across payer policies. Criteria for patient body mass index was specified in 63% of policies. Criteria for failed arthroscopic or traditional surgical procedure were identified in 20% of the policies. More than one half of policies (51%) specified knee defect location to load-bearing surfaces. Analysis of trends in positive coverage statements and restrictiveness showed an increase from 4.7% in 2016 to 39.5% for talus, 4.7% to 7.0% for patella, and a slight shift (4.7% of payers) toward weakly restrictive medical policies. Conclusions This study demonstrates wide variability and inconsistencies in published criteria among OCA medical policies. Clinical Relevance This study informs clinicians of the current state of coverage for OCA transplantation, providing insights into the variability of payer policies and potential impact.
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Affiliation(s)
- Suzanne M. Tabbaa
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Dennis C. Crawford
- Department of Orthopedics & Rehabilitation, Oregon Health Science University, Portland, Oregon, U.S.A.,Address correspondence to Dennis C. Crawford, Ph.D., M.D., OHSU Orthopaedics Clinic, South Waterfront, 3303 S. Bond Ave., Portland, OR 97239.
| | | | - Jack Farr
- Cartilage Restoration Center of Indiana, OrthoIndy Hospital & Orthopedic Surgery, Indiana University Medical Center, Greenwood, Indiana, U.S.A
| | - Willliam D. Bugbee
- Department of Orthopaedic Surgery, Scripps Clinic Medical Group, La Jolla, California, U.S.A
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16
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He J, Wine I, Wu K, Sevick J, Laouar L, Jomha NM, Westover L. Effect of vitrification on mechanical properties of porcine articular cartilage. Proc Inst Mech Eng H 2022; 236:1521-1527. [PMID: 36169308 PMCID: PMC9574425 DOI: 10.1177/09544119221122066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 08/08/2022] [Indexed: 02/05/2023]
Abstract
Articular cartilage (AC) injuries do not heal primarily and large lesions progress to degenerative osteoarthritis. Osteochondral allograft transplantation is an effective surgical treatment but is limited by the lack of donor tissue availability. Fresh allografts can be stored hypothermically up to 28-45 days after which the tissue is no longer viable for transplantation. Vitrification is a method of cryopreservation with the potential to extend the storage time of AC. A specific protocol has been demonstrated to preserve high chondrocyte viability; however, its effect on various mechanical properties of the extracellular matrix (ECM) remains unknown and is the focus of this initial study. Porcine AC was subject to a defined vitrification protocol, using fresh and frozen samples as positive and negative controls, respectively; n = 20 for all three groups. Unconfined compression testing was used to assess mechanical properties of the tissue under rapid load, stress relaxation, and equilibrium conditions. The stress relaxation time constants (modeled with a 2-term Prony series) τ1 and τ2 were significantly lower for frozen (p = 0.014, p < 0.001) and vitrified (p = 0.009, p = 0.003) tissue compared to fresh, with no differences between frozen and vitrified samples (p = 0.848 and 0.105 for τ1 and τ2, respectively). These values indicate that frozen and vitrified samples relaxed more rapidly than fresh, which may suggest altered matrix composition and permeability post-treatment. These results represent the initial study in our experimental path to evaluate differences in mechanical properties of vitrified tissues.
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Affiliation(s)
- Jenny He
- Department of Surgery, University of Alberta, Edmonton, AB,
Canada
| | - Itai Wine
- Department of Civil and Environmental Engineering, University of
Alberta, Edmonton, AB, Canada
| | - Kezhou Wu
- Department of Surgery, University of Alberta, Edmonton, AB,
Canada
- Department of Orthopedic Surgery, First Affiliated Hospital, Shantou
University Medical College, Shantou, Guangdong, China
| | - Johnathan Sevick
- Department of Surgery, University of Alberta, Edmonton, AB,
Canada
| | - Leila Laouar
- Department of Surgery, University of Alberta, Edmonton, AB,
Canada
| | - Nadr M Jomha
- Department of Surgery, University of Alberta, Edmonton, AB,
Canada
| | - Lindsey Westover
- Department of Mechanical Engineering, University of Alberta,
Edmonton, AB, Canada
- Lindsey Westover, Department of Mechanical
Engineering, University of Alberta, 9211 116 Street NW, 10-371 D-ICE Building,
Edmonton, AB T6G 1H9, Canada.
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17
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A Comparative Study Using Fluorescent Confocal Microscopy and Flow Cytometry to Evaluate Chondrocyte Viability in Human Osteochondral Allografts. Bioengineering (Basel) 2022; 9:bioengineering9100515. [DOI: 10.3390/bioengineering9100515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/13/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022] Open
Abstract
The preservation conditions of fresh osteochondral allografts for clinical applications are critical due their objective: to transplant mature hyaline cartilage containing viable chondrocytes, maintaining their metabolic activity and also preserving the structural and functional characteristics of the extracellular matrix. The aim of the present study was to compare fluorescence confocal microscopy and flow cytometry techniques to evaluate the viability of the chondrocytes present in the osteochondral tissue, in order to determine their effectiveness and thus ensure reproducibility and robustness of the analysis. To this end, osteochondral allografts from human cadaveric donors were preserved at 4 °C for 3 weeks in a preservation medium supplemented with antibiotic and antifungal agents. Cell viability of chondrocytes was determined by monitoring the cartilage for 3 weeks of preservation by confocal fluorescence microscopy and flow cytometry, obtaining cell viabilities of 83.7 ± 2.6% and 55.8 ± 7.8% for week three, respectively. The confocal fluorescence microscopy approach is more advantageous and accurate, as it correlates better with actual cell viability values for monitoring osteochondral graft preservation, detecting only the cells that died a natural death associated with the preservation method.
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18
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Walker JC, Jorgensen AM, Sarkar A, Gent SP, Messerli MA. Anionic polymers amplify electrokinetic perfusion through extracellular matrices. Front Bioeng Biotechnol 2022; 10:983317. [PMID: 36225599 PMCID: PMC9548625 DOI: 10.3389/fbioe.2022.983317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022] Open
Abstract
Electrical stimulation (ES) promotes healing of chronic epidermal wounds and delays degeneration of articular cartilage. Despite electrotherapeutic treatment of these non-excitable tissues, the mechanisms by which ES promotes repair are unknown. We hypothesize that a beneficial role of ES is dependent on electrokinetic perfusion in the extracellular space and that it mimics the effects of interstitial flow. In vivo, the extracellular space contains mixtures of extracellular proteins and negatively charged glycosaminoglycans and proteoglycans surrounding cells. While these anionic macromolecules promote water retention and increase mechanical support under compression, in the presence of ES they should also enhance electro-osmotic flow (EOF) to a greater extent than proteins alone. To test this hypothesis, we compare EOF rates between artificial matrices of gelatin (denatured collagen) with matrices of gelatin mixed with anionic polymers to mimic endogenous charged macromolecules. We report that addition of anionic polymers amplifies EOF and that a matrix comprised of 0.5% polyacrylate and 1.5% gelatin generates EOF with similar rates to those reported in cartilage. The enhanced EOF reduces mortality of cells at lower applied voltage compared to gelatin matrices alone. We also use modeling to describe the range of thermal changes that occur during these electrokinetic experiments and during electrokinetic perfusion of soft tissues. We conclude that the negative charge density of native extracellular matrices promotes electrokinetic perfusion during electrical therapies in soft tissues and may promote survival of artificial tissues and organs prior to vascularization and during transplantation.
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Affiliation(s)
- Joseph C. Walker
- Department of Biology and Microbiology, South Dakota State University, Brookings, SD, United States
| | - Ashley M. Jorgensen
- Department of Mechanical Engineering, South Dakota State University, Brookings, SD, United States
| | - Anyesha Sarkar
- Department of Biology and Microbiology, South Dakota State University, Brookings, SD, United States
| | - Stephen P. Gent
- Department of Mechanical Engineering, South Dakota State University, Brookings, SD, United States
| | - Mark A. Messerli
- Department of Biology and Microbiology, South Dakota State University, Brookings, SD, United States
- *Correspondence: Mark A. Messerli,
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19
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Hunter CW, Deer TR, Jones MR, Chang Chien GC, D'Souza RS, Davis T, Eldon ER, Esposito MF, Goree JH, Hewan-Lowe L, Maloney JA, Mazzola AJ, Michels JS, Layno-Moses A, Patel S, Tari J, Weisbein JS, Goulding KA, Chhabra A, Hassebrock J, Wie C, Beall D, Sayed D, Strand N. Consensus Guidelines on Interventional Therapies for Knee Pain (STEP Guidelines) from the American Society of Pain and Neuroscience. J Pain Res 2022; 15:2683-2745. [PMID: 36132996 PMCID: PMC9484571 DOI: 10.2147/jpr.s370469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/12/2022] [Indexed: 11/23/2022] Open
Abstract
Knee pain is second only to the back as the most commonly reported area of pain in the human body. With an overall prevalence of 46.2%, its impact on disability, lost productivity, and cost on healthcare cannot be overlooked. Due to the pervasiveness of knee pain in the general population, there are no shortages of treatment options available for addressing the symptoms. Ranging from physical therapy and pharmacologic agents to interventional pain procedures to surgical options, practitioners have a wide array of options to choose from – unfortunately, there is no consensus on which treatments are “better” and when they should be offered in comparison to others. While it is generally accepted that less invasive treatments should be offered before more invasive ones, there is a lack of agreement on the order in which the less invasive are to be presented. In an effort to standardize the treatment of this extremely prevalent pathology, the authors present an all-encompassing set of guidelines on the treatment of knee pain based on an extensive literature search and data grading for each of the available alternative that will allow practitioners the ability to compare and contrast each option.
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Affiliation(s)
- Corey W Hunter
- Ainsworth Institute of Pain Management, New York, NY, USA.,Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Timothy R Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
| | | | | | - Ryan S D'Souza
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | | | - Erica R Eldon
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Johnathan H Goree
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Lissa Hewan-Lowe
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jillian A Maloney
- Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Anthony J Mazzola
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - Jeanmarie Tari
- Ainsworth Institute of Pain Management, New York, NY, USA
| | | | | | - Anikar Chhabra
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | | | - Chris Wie
- Interventional Spine and Pain, Dallas, TX, USA
| | - Douglas Beall
- Comprehensive Specialty Care, Oklahoma City, OK, USA
| | - Dawood Sayed
- Department of Anesthesiology, Division of Pain Medicine, University of Kansas Medical Center, Kansas City, KS, USA
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20
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Crisol M, Yong KW, Wu K, Laouar L, Elliott JAW, Jomha NM. Effectiveness of Clinical-Grade Chondroitin Sulfate and Ascorbic Acid in Mitigating Cryoprotectant Toxicity in Porcine Articular Cartilage. Biopreserv Biobank 2022; 20:401-408. [PMID: 34647812 DOI: 10.1089/bio.2021.0083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
High concentrations of cryoprotective agents (CPAs) are required to achieve successful vitrification of articular cartilage; however, CPA cytotoxicity causes chondrocyte death. To reduce CPA toxicity, supplementation with research-grade additives, in particular chondroitin sulfate (CS) and ascorbic acid (AA), have previously been shown to improve chondrocyte recovery and metabolic function after exposure to CPAs at hypothermic conditions. However, it is necessary to evaluate the pharmaceutical equivalent clinical grade of these additives to facilitate the supplementation of additives into future vitrification protocols, which will be designed for vitrifying human articular cartilage in tissue banks. We sought to investigate the effectiveness of clinical-grade CS, AA, and N-acetylcysteine (NAC) in mitigating toxicity to chondrocytes during CPA exposure and removal, and determine whether a combination of two additives would further improve chondrocyte viability. We hypothesized that clinical-grade additives would exert chondroprotective effects comparable to those of research-grade additives, and that this protective effect would be enhanced if two additives were combined when compared with a single additive. The results indicated that both clinical-grade and research-grade additives significantly improved cell viability (p < 0.10) compared with the negative control (CPA with no additives). CS, AA, and NAC+AA increased cell viability significantly (p < 0.10) compared with the negative control. However, NAC, NAC+CS, and CS+AA did not improve cell viability when compared with the negative control (p > 0.10). We demonstrated that supplementation with clinical-grade CS or AA significantly improved chondrocyte viability in porcine cartilage subjected to high CPA concentrations, whereas supplementation with clinical-grade NAC did not benefit chondrocyte viability. Supplementation with clinical-grade additives in CPA solutions can mitigate CPA toxicity, which will be important in translating previously developed effective protocols for the vitrification of articular cartilage to human tissue banks.
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Affiliation(s)
- Mary Crisol
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Kar Wey Yong
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Kezhou Wu
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Orthopedic Surgery, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - Leila Laouar
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Janet A W Elliott
- Department of Chemical and Materials Engineering and University of Alberta, Edmonton, Alberta, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Nadr M Jomha
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
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21
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Dong R, Clark S, Laouar L, Heinrichs L, Wu K, Jomha NM, Elliott JAW. Evaluation of the permeation kinetics of formamide in porcine articular cartilage. Cryobiology 2022; 107:57-63. [PMID: 35636502 DOI: 10.1016/j.cryobiol.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/08/2022] [Accepted: 05/12/2022] [Indexed: 02/05/2023]
Abstract
Cryopreservation of articular cartilage will increase tissue availability for osteochondral allografting and improve clinical outcomes. However, successful cryopreservation of articular cartilage requires the precise determination of cryoprotectant permeation kinetics to develop effective vitrification protocols. To date, permeation kinetics of the cryoprotectant formamide in articular cartilage have not been sufficiently explored. The objective of this study was to determine the permeation kinetics of formamide into porcine articular cartilage for application in vitrification. The permeation of dimethyl sulfoxide was first measured to validate existing methods from our previously published literature. Osteochondral dowels from dissected porcine femoral condyles were incubated in 6.5 M dimethyl sulfoxide for a designated treatment time (1 s, 1 min, 2 min, 5 min, 10 min, 15 min, 30 min, 60 min, 120 min, 180 min, 24 h) at 22 °C (N = 3). Methods were then repeated with 6.5 M formamide at one of three temperatures: 4 °C, 22 °C, 37 °C (N = 3). Following incubation, cryoprotectant efflux into a wash solution occurred, and osmolality was measured from each equilibrated wash solution. Concentrations of effluxed cryoprotectant were calculated and diffusion coefficients were determined using an analytical solution to Fick's law for axial and radial diffusion in combination with a least squares approach. The activation energy of formamide was determined from the Arrhenius equation. The diffusion coefficient (2.7-3.3 × 10-10 m2/s depending on temperature) and activation energy (0.9±0.6 kcal/mol) for formamide permeation in porcine articular cartilage were established. The determined permeation kinetics of formamide will facilitate its precise use in future articular cartilage vitrification protocols.
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Affiliation(s)
- Rachael Dong
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Shannon Clark
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Leila Laouar
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Luke Heinrichs
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Kezhou Wu
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; Sports Medicine Centre, Department of Orthopedic Surgery, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - Nadr M Jomha
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Janet A W Elliott
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada.
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22
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Abusara Z, Haider I, Moo EK, Miller S, Timmermann S, Herzog W. Chondrocyte morphology as an indicator of collagen network integrity. Connect Tissue Res 2022; 63:319-328. [PMID: 34006162 DOI: 10.1080/03008207.2021.1922398] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Osteochondral allograft (OCA) transplantation offers an attractive treatment option as it can be used to repair large cartilage defects that otherwise would not heal. The currently accepted criterion for OCA selection for joint reconstruction is the percentage of viable chondrocytes, but this criterion alone may not be sufficient to ensure structural integrity and functional performance of allografts following transplantation. We sought to determine an additional parameter that indicates matrix integrity. We used multi-photon microscopy to quantitatively assess chondrocyte viability, chondrocyte shape, and collagen structure of articular cartilage of OCAs. Chondrocyte shape varied considerably in otherwise macroscopically healthy-looking OCAs with good (>90%) cell viability. Shape varied from the expected ellipsoidal form found in healthy cartilage, to excessively elongated and flattened cells that often contained multiple cytoplasmic processes reminiscent of those observed in fibroblasts. Chondrocytes with abnormal morphology were associated with degradation of their pericellular matrix and disruption of the collagen fiber orientation, reflected by an increase in heterogeneity of second harmonic signal intensity. Cell shape may be an important marker for collagen network integrity in articular cartilage in general and OCAs specifically. We propose that, aside from cell viability, cell shape may be used as an additional criterion measure for the selection of OCAs. OCAs selected for transplantation based on these criteria showed good graft-host integration post-operation. In view of the rapid and nondestructive nature of the current approach, it may be suitable for clinical application in the future.
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Affiliation(s)
- Ziad Abusara
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary.,Advanced Imaging and Histopathology Core, Qatar Biomedical Research Institute, Hamad Bin Khalifa University, Doha, Qatar
| | - Ifaz Haider
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary
| | - Eng Kuan Moo
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary.,Department of Applied Physics, University of Eastern Finland
| | - Sue Miller
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary.,Section of Orthopaedic Surgery, Department of Surgery, University of Calgary.,Taylor Institute for Teaching and Learning, University of Calgary
| | - Scott Timmermann
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary.,Section of Orthopaedic Surgery, Department of Surgery, University of Calgary
| | - Walter Herzog
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary
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23
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Swindell HW, Kerzner B, Obioha OA, Fortier LM, Khan ZA, Dasari SP, Mameri ES, Gelber PE, Chahla J. Osteochondral Allograft Transplantation of the Lateral Femoral Condyle and Distal Femoral Osteotomy in the Setting of Failed Osteochondritis Dissecans Fixation. Arthrosc Tech 2022; 11:e1301-e1310. [PMID: 35936851 PMCID: PMC9353333 DOI: 10.1016/j.eats.2022.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/09/2022] [Indexed: 02/03/2023] Open
Abstract
Osteochondritis dissecans (OCD) is a pathologic condition, most commonly affecting the knee joint in adolescents and young adults, although pathology can also be found at the elbow and ankle. Lesions to the medial femoral condyle are classically associated with varus alignment, while lesions to the lateral femoral condyle are seen in patients with valgus malalignment. Common risk factors for failed fixation of OCD lesions include unstable lesions to the lateral femoral condyle, screw breakage, older age, and closed physes. The purpose of this technical note is to describe the preoperative planning and step-by-step surgical approach for treatment of failed fixation of an OCD lesion of the posterior aspect of the lateral femoral condyle in young, active patients using an osteochondral allograft, a lateral opening wedge distal femoral osteotomy to correct malalignment, and a tibial tubercle osteotomy to facilitate access to the lesion.
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Affiliation(s)
- Hasani W. Swindell
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Benjamin Kerzner
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Obianuju A. Obioha
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Luc M. Fortier
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Zeeshan A. Khan
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Suhas P. Dasari
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Enzo S. Mameri
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Pablo E. Gelber
- Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Catalunya, Spain,Institut Català de Traumatologia i Medicina de l’Esport, Hospital Universitari Dexeus, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Jorge Chahla
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A,Address correspondence to Jorge Chahla, M.D., Ph.D., Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St. Suite 300, Chicago, IL 60612, U.S.A.
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24
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Novel implantable devices delivering electrical cues for tissue regeneration and functional restoration. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2022. [DOI: 10.1016/j.medntd.2022.100146] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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25
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Tabbaa SM, Guilak F, Sah RL, Bugbee WD. Fresh Osteochondral and Chondral Allograft Preservation and Storage Media: A Systematic Review of the Literature. Am J Sports Med 2022; 50:1702-1716. [PMID: 34310184 DOI: 10.1177/03635465211016832] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Storage procedures and parameters have a significant influence on the health of fresh osteochondral allograft (OCA) cartilage. To date, there is a lack of agreement on the optimal storage conditions for OCAs. PURPOSE To systematically review the literature on (1) experimental designs and reporting of key variables of ex vivo (laboratory) studies, (2) the effects of various storage solutions and conditions on cartilage health ex vivo, and (3) in vivo animal studies and human clinical studies evaluating the effect of fresh OCA storage on osteochondral repair and outcomes. STUDY DESIGN Systematic review; Level of evidence, 5. METHODS A systematic review was performed using the PubMed, Embase, and Cochrane databases. The inclusion criteria were laboratory studies (ex vivo) reporting cartilage health outcomes after prolonged storage (>3 days) of fresh osteochondral or chondral tissue explants and animal studies (in vivo) reporting outcomes of fresh OCA. The inclusion criteria for clinical studies were studies (>5 patients) that analyzed the relationship of storage time or chondrocyte viability at time of implantation to patient outcomes. Frozen, cryopreserved, decellularized, synthetic, or tissue-engineered grafts were excluded. RESULTS A total of 55 peer-reviewed articles met the inclusion criteria. Ex vivo studies reported a spectrum of tissue sources and storage solutions and conditions, although the majority of studies lacked complete reporting of key variables, including storage solution formula and environmental conditions. The effect of various conditions (eg, temperature) and storage solutions on cartilage health were inconsistent. Although 60% of animal models suggest that storage time may influence outcomes and 80% indicate inferior outcomes with frozen OCA as compared with fresh OCA, 75% of clinical studies report no correlation between storage time and outcomes. CONCLUSION Given the variability in experimental designs and lack of reporting across studies, it is still not possible to determine optimal storage conditions, although animal studies suggest that storage time and chondrocyte viability influence osteochondral repair outcomes. A list of recommendations was developed to encourage reporting of key variables, such as media formulation, environmental factors, and methodologies used. High-quality clinical data are needed to investigate the effects of storage and graft health on outcomes.
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Affiliation(s)
- Suzanne M Tabbaa
- University of California, San Francisco, San Francisco, California, USA
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26
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Strickland CD, Ho CK, Merkle AN, Vidal AF. MR Imaging of Knee Cartilage Injury and Repair Surgeries. Magn Reson Imaging Clin N Am 2022; 30:227-239. [DOI: 10.1016/j.mric.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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27
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Cook JL, Stannard JP, Stoker AM, Rucinski K, Crist BD, Cook CR, Crecelius C, Smith MJ, Stucky R. Biologic Joint Restoration: A Translational Research Success Story. MISSOURI MEDICINE 2022; 119:115-121. [PMID: 36036037 PMCID: PMC9339389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Treatment options that result in consistently successful outcomes for young and active patients with joint disorders are needed. This article summarizes two decades of rigorous research using a bedside-to-bench- to-bedside translational approach based on the One Health - One Medicine concept that culminated in successful clinical use of biologic joint restoration options for treatment of knee, hip, ankle, and shoulder problems in this growing patient population.
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Affiliation(s)
- James L Cook
- William and Kathryn Allen Distinguished Chair in Orthopaedic Surgery; Director, Thompson Laboratory for Regenerative Orthopaedics (TLRO) and Mizzou BioJoint® Center; and Vice Chair, Orthopaedic Research Division, University of Missouri - Columbia, Columbia, Missouri
| | - James P Stannard
- TLRO and Department of Orthopaedic Surgery (DOS), University of Missouri - Columbia, Columbia, Missouri
| | - Aaron M Stoker
- TLRO, University of Missouri - Columbia, Columbia, Missouri
| | - Kylee Rucinski
- TLRO, University of Missouri - Columbia, Columbia, Missouri
| | - Brett D Crist
- TLRO and DOS, University of Missouri - Columbia, Columbia, Missouri
| | - Cristi R Cook
- TLRO, University of Missouri - Columbia, Columbia, Missouri
| | - Cory Crecelius
- TLRO, University of Missouri - Columbia, Columbia, Missouri
| | | | - Renee Stucky
- TLRO, University of Missouri - Columbia, Columbia, Missouri
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28
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Stadnyk M, Sevick JL, Wu K, Elliott JAW, Jomha NM. The effect of cryoprotectant vehicle solution on cartilage cell viability following vitrification. Cell Tissue Bank 2022; 23:31-41. [PMID: 33629239 DOI: 10.1007/s10561-021-09906-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 02/01/2021] [Indexed: 02/05/2023]
Abstract
Osteochondral allografts are often used to repair large articular cartilage defects to prevent or delay the onset of osteoarthritis. This approach is limited by the timely acquisition and use of allograft tissue since standard hypothermic protocols allow for a maximum storage of 4 weeks. Vitrification is a proven technique for the long-term preservation of cells and tissues, but requires careful determination of parameters to be successful, particularly for articular cartilage. One parameter that is infrequently considered is the choice of cryoprotectant vehicle solution. The aim of this study was to evaluate the impact of a subset of vehicle solutions on an established vitrification protocol for articular cartilage. These solutions were phosphate-buffered saline (PBS), Dulbecco's Modified Eagle's Medium: Nutrient Mixture F-12 (DMEM), X-VIVO, and Unisol-CV (UCV). Both the solution pH at various points throughout vitrification and the cell viability of porcine articular cartilage slices following vitrification were measured. Using randomized block ANOVA, it was found that the normalized cell viability of articular cartilage vitrified in UCV was significantly greater than that of PBS (p < 0.05) and may be greater than those of DMEM and X-VIVO (p < 0.1). There was no correlation between pH parameters and cell viability, although significant differences between calculated pH parameters were identified. These results provide information to guide the design of effective vitrification protocols for articular cartilage.
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Affiliation(s)
- Meredith Stadnyk
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | | | - Kezhou Wu
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
- Department of Orthopedic Surgery, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - Janet A W Elliott
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, AB, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Nadr M Jomha
- Department of Surgery, University of Alberta, Edmonton, AB, Canada.
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29
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Mu P, Feng J, Hu Y, Xiong F, Ma X, Tian L. Botanical Drug Extracts Combined With Biomaterial Carriers for Osteoarthritis Cartilage Degeneration Treatment: A Review of 10 Years of Research. Front Pharmacol 2022; 12:789311. [PMID: 35173609 PMCID: PMC8841352 DOI: 10.3389/fphar.2021.789311] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/08/2021] [Indexed: 02/06/2023] Open
Abstract
Osteoarthritis (OA) is a long-term chronic arthrosis disease which is usually characterized by pain, swelling, joint stiffness, reduced range of motion, and other clinical manifestations and even results in disability in severe cases. The main pathological manifestation of OA is the degeneration of cartilage. However, due to the special physiological structure of the cartilage, once damaged, it is unable to repair itself, which is one of the challenges of treating OA clinically. Abundant studies have reported the application of cartilage tissue engineering in OA cartilage repair. Among them, cell combined with biological carrier implantation has unique advantages. However, cell senescence, death and dedifferentiation are some problems when cultured in vitro. Botanical drug remedies for OA have a long history in many countries in Asia. In fact, botanical drug extracts (BDEs) have great potential in anti-inflammatory, antioxidant, antiaging, and other properties, and many studies have confirmed their effects. BDEs combined with cartilage tissue engineering has attracted increasing attention in recent years. In this review, we will explain in detail how cartilage tissue engineering materials and BDEs play a role in cartilage repair, as well as the current research status.
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Affiliation(s)
- Panyun Mu
- Department of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jie Feng
- Department of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yimei Hu
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- *Correspondence: Yimei Hu,
| | - Feng Xiong
- Department of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xu Ma
- Department of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Linling Tian
- Department of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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30
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Liu Y, Dzidotor G, Le TT, Vinikoor T, Morgan K, Curry EJ, Das R, McClinton A, Eisenberg E, Apuzzo LN, Tran KTM, Prasad P, Flanagan TJ, Lee SW, Kan HM, Chorsi MT, Lo KWH, Laurencin CT, Nguyen TD. Exercise-induced piezoelectric stimulation for cartilage regeneration in rabbits. Sci Transl Med 2022; 14:eabi7282. [PMID: 35020409 DOI: 10.1126/scitranslmed.abi7282] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
More than 32.5 million American adults suffer from osteoarthritis, and current treatments including pain medicines and anti-inflammatory drugs only alleviate symptoms but do not cure the disease. Here, we have demonstrated that a biodegradable piezoelectric poly(L-lactic acid) (PLLA) nanofiber scaffold under applied force or joint load could act as a battery-less electrical stimulator to promote chondrogenesis and cartilage regeneration. The PLLA scaffold under applied force or joint load generated a controllable piezoelectric charge, which promoted extracellular protein adsorption, facilitated cell migration or recruitment, induced endogenous TGF-β via calcium signaling pathway, and improved chondrogenesis and cartilage regeneration both in vitro and in vivo. Rabbits with critical-sized osteochondral defects receiving the piezoelectric scaffold and exercise treatment experienced hyaline-cartilage regeneration and completely healed cartilage with abundant chondrocytes and type II collagen after 1 to 2 months of exercise (2 to 3 months after surgery including 1 month of recovery before exercise), whereas rabbits treated with nonpiezoelectric scaffold and exercise treatment had unfilled defect and limited healing. The approach of combining biodegradable piezoelectric tissue scaffolds with controlled mechanical activation (via physical exercise) may therefore be useful for the treatment of osteoarthritis and is potentially applicable to regenerating other injured tissues.
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Affiliation(s)
- Yang Liu
- Department of Mechanical Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Godwin Dzidotor
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health Center, Farmington, CT 06030, USA
- Department of Chemical and Biomolecular Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Thinh T Le
- Department of Mechanical Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Tra Vinikoor
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Kristin Morgan
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Eli J Curry
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Ritopa Das
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Aneesah McClinton
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Ellen Eisenberg
- Division of Oral and Maxillofacial Diagnostic Sciences, School of Dental Medicine, University of Connecticut, Farmington, CT 06030, USA
- Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, School of Medicine, University of Connecticut, Farmington, CT 06030, USA
| | - Lorraine N Apuzzo
- Department of Molecular and Cell Biology, University of Connecticut, Storrs, CT 06269, USA
| | - Khanh T M Tran
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Pooja Prasad
- Department of Molecular and Cell Biology, University of Connecticut, Storrs, CT 06269, USA
| | - Tyler J Flanagan
- Department of Materials Science and Engineering, University of Connecticut, Storrs, CT 06269, USA
- Institute of Materials Science, University of Connecticut, Storrs, CT 06269, USA
| | - Seok-Woo Lee
- Department of Materials Science and Engineering, University of Connecticut, Storrs, CT 06269, USA
- Institute of Materials Science, University of Connecticut, Storrs, CT 06269, USA
| | - Ho-Man Kan
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Meysam T Chorsi
- Department of Mechanical Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Kevin W H Lo
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health Center, Farmington, CT 06030, USA
- Department of Medicine, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Cato T Laurencin
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health Center, Farmington, CT 06030, USA
- Department of Chemical and Biomolecular Engineering, University of Connecticut, Storrs, CT 06269, USA
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
- Department of Materials Science and Engineering, University of Connecticut, Storrs, CT 06269, USA
- Institute of Materials Science, University of Connecticut, Storrs, CT 06269, USA
- Department of Orthopedic Surgery, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Thanh D Nguyen
- Department of Mechanical Engineering, University of Connecticut, Storrs, CT 06269, USA
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
- Institute of Materials Science, University of Connecticut, Storrs, CT 06269, USA
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31
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Franklin SP, Stoker AM, Murphy SM, Kowaleski MP, Gillick M, Kim SE, Karlin M, Cross A, Cook JL. Outcomes Associated With Osteochondral Allograft Transplantation in Dogs. Front Vet Sci 2022; 8:759610. [PMID: 35004920 PMCID: PMC8739896 DOI: 10.3389/fvets.2021.759610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/06/2021] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to retrospectively characterize outcomes and complications associated with osteochondral allograft transplantation for treating chondral and osteochondral lesions in a group of client-owned dogs with naturally-occurring disease. Records were reviewed for information on signalment, treated joint, underlying pathology (e.g., osteochondritis dissecans; OCD), and type, size, and number of grafts used. Complications were classified as “trivial” if no treatment was provided, “non-surgical” if non-surgical treatment were needed, “minor surgical” if a minor surgical procedure such as pin removal were needed but the graft survived and function was acceptable, or “major” if the graft failed and revision surgery were needed. Outcomes were classified as unacceptable, acceptable, or full function. Thirty-five joints in 33 dogs were treated including nine stifles with lateral femoral condyle (LFC) OCD and 10 stifles with medial femoral condyle (MFC) OCD treated with osteochondral cylinders or “plugs.” There were 16 “complex” procedures of the shoulder, elbow, hip, stifle, and tarsus using custom-cut grafts. In total there were eight trivial complications, one non-surgical complication, two minor surgical complications, and five major complications for a total of 16/35 cases with complications. Accordingly, there were five cases with unacceptable outcomes, all of whom had major complications while the other 30 cases had successful outcomes. Of the 30 cases with successful outcomes, 15 had full function and 15 had acceptable function. Based on these subjective outcome assessments, it appears osteochondral allograft transplantation is a viable treatment option in dogs with focal or complex cartilage defects. However, no conclusions can be made regarding the inferiority or superiority of allograft transplantation in comparison to other treatment options based upon these data.
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Affiliation(s)
- Samuel P Franklin
- Colorado Canine Orthopedics and Rehab, Colorado Springs, CO, United States
| | - Aaron M Stoker
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, United States
| | - Sean M Murphy
- WestVet Animal Emergency and Specialty Center, Garden City, ID, United States
| | - Michael P Kowaleski
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, United States
| | - Mitchell Gillick
- Toronto Veterinary Emergency and Referral Hospital, Toronto, ON, Canada
| | - Stanley E Kim
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, FL, United States
| | - Michael Karlin
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, United States
| | - Alan Cross
- BluePearl Pet Hospital, Atlanta, GA, United States
| | - James L Cook
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, United States
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32
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Hevesi M, Denbeigh JM, Paggi CA, Galeano-Garces C, Bagheri L, Larson AN, Stuart MJ, Saris DBF, van Wijnen AJ, Krych AJ. Fresh Osteochondral Allograft Transplantation in the Knee: A Viability and Histologic Analysis for Optimizing Graft Viability and Expanding Existing Standard Processed Graft Resources Using a Living Donor Cartilage Program. Cartilage 2021; 13:948S-956S. [PMID: 31617404 PMCID: PMC8808912 DOI: 10.1177/1947603519880330] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study aims to (1) determine and validate living cartilage allograft transplantation as a novel source for viable osteochondral allograft (OCA) tissues and (2) perform histologic and viability comparisons of living donor cartilage tissues to currently available clinical-grade standard processed grafts. DESIGN Using healthy cartilage from well-preserved contralateral compartments in 27 patients undergoing total knee arthroplasty (TKA) and 10 clinical-grade OCA specimens obtained immediately following operative implantation, standard and living donor OCA quality was evaluated at the time of harvest and following up to 3 weeks of storage on the basis of macroscopic International Cartilage Repair Society grade, histology, and viability. RESULTS Osteochondral samples demonstrated a consistent decrease in viability and histologic quality over the first 3 weeks of storage at 37°C, supporting the utility of an OCA paradigm shift toward early implantation, as was the clinical standard up until recent adoption of transplantation at 14 to 35 days following donor procurement. Samples from the 10 clinical-grade OCAs, implanted at an average of 23 days following graft harvest demonstrated a mean viable cell density of 45.6% at implantation, significantly lower (P < 0.01) than the 93.6% viability observed in living donor allograft tissues. CONCLUSIONS Osteochondral tissue viability and histologic quality progressively decreases with ex vivo storage, even when kept at physiologic temperatures. Currently available clinical OCAs are stored for 2 to 5 weeks prior to implantation and demonstrate inferior viability to that of fresh osteochondral tissues that can be made available through the use of a living donor cartilage program.
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Affiliation(s)
- Mario Hevesi
- Department of Orthopedic Surgery,
Mayo Clinic, Rochester, MN, USA
| | - Janet M. Denbeigh
- Department of Orthopedic Surgery,
Mayo Clinic, Rochester, MN, USA,Department of Radiation Oncology,
Mayo Clinic, Rochester, MN, USA
| | - Carlo A. Paggi
- Department of Orthopedic Surgery,
Mayo Clinic, Rochester, MN, USA,Department of Regenerative
Medicine, University of Twente, Enschede, Netherlands
| | | | - Leila Bagheri
- Department of Orthopedic Surgery,
Mayo Clinic, Rochester, MN, USA
| | - A. Noelle Larson
- Department of Orthopedic Surgery,
Mayo Clinic, Rochester, MN, USA
| | | | - Daniel B. F. Saris
- Department of Orthopedic Surgery,
Mayo Clinic, Rochester, MN, USA,Department of Regenerative
Medicine, University of Twente, Enschede, Netherlands,Department of Orthopedics,
University Medical Center Utrecht, Utrecht, Netherlands
| | - Andre J. van Wijnen
- Department of Orthopedic Surgery,
Mayo Clinic, Rochester, MN, USA,Andre J. van Wijnen, Department of
Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN
55905, USA.
| | - Aaron J. Krych
- Department of Orthopedic Surgery,
Mayo Clinic, Rochester, MN, USA
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33
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Denbeigh JM, Hevesi M, Paggi CA, Resch ZT, Bagheri L, Mara K, Arani A, Zhang C, Larson AN, Saris DB, Krych AJ, van Wijnen AJ. Modernizing Storage Conditions for Fresh Osteochondral Allografts by Optimizing Viability at Physiologic Temperatures and Conditions. Cartilage 2021; 13:280S-292S. [PMID: 31777278 PMCID: PMC8808875 DOI: 10.1177/1947603519888798] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective. Osteochondral allograft (OCA) transplantation has demonstrated good long-term outcomes in treatment of cartilage defects. Viability, a key factor in clinical success, decreases with peri-implantation storage at 4°C during pathogen testing, matching logistics, and transportation. Modern, physiologic storage conditions may improve viability and enhance outcomes. Design. Osteochondral specimens from total knee arthroplasty patients (6 males, 5 females, age 56.4 ± 2.2 years) were stored in media and incubated at normoxia (21% O2) at 22°C or 37°C, and hypoxia (2% O2) at 37°C. Histology, live-dead staining, and quantitative polymerase chain reaction (qPCR) was performed 24 hours after harvest and following 7 days of incubation. Tissue architecture, cell viability, and gene expression were analyzed. Results. No significant viability or gene expression deterioration of cartilage was observed 1-week postincubation at 37°C, with or without hypoxia. Baseline viable cell density (VCD) was 94.0% ± 2.7% at day 1. At day 7, VCD was 95.1% (37°C) with normoxic storage and 92.2% (37°C) with hypoxic storage (P ≥ 0.27). Day 7 VCD (22°C) incubation was significantly lower than both the baseline and 37°C storage values (65.6%; P < 0.01). COL1A1, COL1A2, and ACAN qPCR expression was unchanged from baseline (P < 0.05) for all storage conditions at day 7, while CD163 expression, indicative of inflammatory macrophages and monocytes, was significantly lower in the 37°C groups (P < 0.01). Conclusion. Physiologic storage at 37°C demonstrates improved chondrocyte viability and metabolism, and maintained collagen expression compared with storage at 22°C. These novel findings guide development of a method to optimize short-term fresh OCA storage, which may lead to improved clinical results.
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Affiliation(s)
| | - Mario Hevesi
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA
| | - Carlo A. Paggi
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA
| | - Zachary T. Resch
- Center for Regenerative Medicine, Mayo
Clinic, Rochester, MN, USA
| | - Leila Bagheri
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA
| | - Kristin Mara
- Department of Biomedical Statistics and
Informatics, Mayo Clinic, Rochester, MN, USA
| | - Arvin Arani
- Department of Radiology, Mayo Clinic,
Rochester, MN, USA
| | - Chenghao Zhang
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA
| | - A. Noelle Larson
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA
| | - Daniel B.F. Saris
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA,Department of Orthopedics, University
Medical Center Utrecht, Utrecht, Netherlands,Reconstructive Medicine, University of
Twente, Enschede, Netherlands
| | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA,Sports Medicine Center, Mayo Clinic,
Rochester, MN, USA
| | - Andre J. van Wijnen
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA,Andre J. van Wijnen PhD, Department of
Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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34
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Abstract
OBJECTIVE Successful preservation of articular cartilage will increase the availability of osteochondral allografts to treat articular cartilage defects. We compared the effects of 2 methods for storing cartilage tissues using 10-mm diameter osteochondral dowels or femoral condyles at -196°C: (a) storage with a surrounding vitrification solution versus (b) storage without a surrounding vitrification solution. We investigated the effects of 2 additives (chondroitin sulfate and ascorbic acid) for vitrification of articular cartilage. DESIGN Healthy porcine stifle joints (n = 11) from sexually mature pigs were collected from a slaughterhouse within 6 hours after slaughtering. Dimethyl sulfoxide, ethylene glycol, and propylene glycol were permeated into porcine articular cartilage using an optimized 7-hour 3-step cryoprotectant permeation protocol. Chondrocyte viability was assessed by a cell membrane integrity stain and chondrocyte metabolic function was assessed by alamarBlue assay. Femoral condyles after vitrification were assessed by gross morphology for cartilage fractures. RESULTS There were no differences in the chondrocyte viability (~70%) of 10-mm osteochondral dowels after vitrification with or without the surrounding vitrification solution. Chondrocyte viability in porcine femoral condyles was significantly higher after vitrification without the surrounding vitrification solution (~70%) compared to those with the surrounding vitrification solution (8% to 36%). Moreover, articular cartilage fractures were not seen in femoral condyles vitrified without surrounding vitrification solution compared to fractures seen in condyles with surrounding vitrification solution. CONCLUSIONS Vitrification of femoral condyle allografts can be achieved by our optimized approach. Removing the surrounding vitrification solution is advantageous for vitrification outcomes of large size osteochondral allografts.
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Affiliation(s)
- Kezhou Wu
- Division of Orthopedic Surgery,
Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Orthopedic Surgery, First
Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong,
China
| | - Leila Laouar
- Division of Orthopedic Surgery,
Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Janet A. W. Elliott
- Department of Chemical and Materials
Engineering, University of Alberta, Edmonton, Alberta, Canada
- Department of Laboratory Medicine and
Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Nadr M. Jomha
- Division of Orthopedic Surgery,
Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Nadr M. Jomha, 2D2.32 WMC, Division of
Orthopedic Surgery, Department of Surgery, University of Alberta Hospital,
Edmonton, Alberta, Canada T6G 2B7.
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35
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Wissman R, Cook C, Cook JL, Okoye M, Rucisnki K, Stannard JP. Initial Validation of a Modified MRI Scoring System for Assessing Outcomes after Single-Surface Osteochondral Shell Allograft Transplantation in the Knee. J Knee Surg 2021; 36:548-554. [PMID: 34781396 DOI: 10.1055/s-0041-1739202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The Osteochondral Allograft Magnetic Resonance Imaging Scoring System (OCAMRISS) provides a reproducible method for imaging-based grading for osteochondral allograft (OCA) transplants. However, the OCAMRISS does not account for larger whole-surface OCA shell grafts, and has not been validated for assessing outcomes after shell OCA transplantation. Therefore, the objective of this study was to evaluate a modified OCAMRISS for assessing single-surface shell OCAs in the knee based on strength of correlations for a modified OCAMRISS score with graft success and patient-reported outcomes for pain and function. With institutional review board approval and informed patient consent, patients who underwent large single-surface shell OCA transplantation and magnetic resonance imaging (MRI) exams at 1-year postsurgery were identified from a prospectively enrolled registry. All patients with a minimum of 2 years of clinical follow-up were included in the present study. A modified OCAMRISS, as well as assessment of the percentage of OCA bone incorporation, was used to score each knee. Two radiologists, blinded to patient demographics and outcomes, reviewed all MRIs together to determine a consensus score for each category and %-incorporation for each OCA. Thirteen patients (7 F, 6 M; mean age = 29.8 ± 9.4; mean body mass index = 27.1 ± 5.8); 8 medial femoral condyle, 4 patella, and 1 medial tibial plateau shell OCAs were evaluated. Mean modified OCAMRISS score was 5.2 ± 2.8, range (2-12) and %-integration was 72.7 ± 33.8, range (0-100). Moderate to strong correlations were noted for 1-year modified OCAMRISS total score with final follow-up (FFU) visual analog scale (VAS) pain (r = +0.58) and Single Assessment Numeric Evaluation (SANE) function (r = -0.7) scores, and for 1-year %-incorporation with FFU VAS pain (r = -0.76) and SANE function (r = +0.83) scores. The modified OCAMRISS total score and %-incorporation assessments determined at 1 year following single-surface shell OCA transplantation correlate well with initial patient outcomes and have clinical applicability for monitoring patients after large-shell OCA transplants in the knee.
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Affiliation(s)
- Robert Wissman
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
| | - Cristi Cook
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - James L Cook
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - Munachukwudi Okoye
- Department of Graduate Medical Education, School of Medicine, University of Missouri, Columbia, Missouri
| | - Kylee Rucisnki
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - James P Stannard
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
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36
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Roberti Di Sarsisa T, Fiore M, Coco V, Govoni M, Vivarelli L, Rani N, Del Piccolo N, Dallari D. Fresh Osteochondral Allograft Transplantation in Osteochondritis Dissecans in the Knee Joint. Life (Basel) 2021; 11:life11111205. [PMID: 34833081 PMCID: PMC8622509 DOI: 10.3390/life11111205] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/27/2021] [Accepted: 11/05/2021] [Indexed: 02/07/2023] Open
Abstract
Osteochondritis dissecans (OCD) is a chronic and painful joint condition that can occur from childhood through to adult life. Microtrauma, vascular insufficiency, or abnormal endochondral ossification are the most common causes of OCD. Reconstructive techniques for OCD of the knee are typically necessary when either non-operative or reparative/regenerative operative treatments fail, or when the OCD is irreversible. To analyze the clinical outcomes and failure rates of fresh osteochondral allograft transplantation (FOCA) used as a reconstructive strategy in OCD patients, an in-depth search was carried out on the PubMed, Scopus, and Web of Science databases concerning the existing evidence related to the use of FOCA for OCD patients in the knee joint. A total of 646 studies were found through the search and 2 studies were added after a cross-referenced examination of the articles within the bibliography. Six studies with a total of 303 OCD lesions treated with FOCA, with a mean follow-up of 6.3 years, were included. Although a limited number of low-level evidence studies on this topic are available in previous research, satisfactory clinical results and survival rates of the reconstruction are reported. However, to better define the real advantages of FOCA in the healing process of OCD lesions, comparative studies with different techniques are needed.
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37
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Zitsch BP, Stannard JP, Worley JR, Cook JL, Leary EV. Patient-Reported Outcomes for Large Bipolar Osteochondral Allograft Transplantation in Combination with Realignment Osteotomies for the Knee. J Knee Surg 2021; 34:1260-1266. [PMID: 32369842 DOI: 10.1055/s-0040-1710361] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Effective treatment for bipolar articular cartilage lesions in the knee remains a clinical challenge. Lower extremity malalignment is a risk factor for treatment failures, which can be addressed by tibial or femoral osteotomy. The purpose of this study was to compare outcomes among patients who underwent knee joint restoration by osteochondral allograft (OCA) transplantation with concurrent or staged realignment osteotomy. With Institutional Review Board approval, patients undergoing bipolar OCA transplantation with concurrent or staged distal femoral osteotomy (DFO) or high tibial osteotomy (HTO) were analyzed. Patients were categorized by osteotomy type (DFO and HTO) and timing (concurrent and staged). Patient-reported outcome measures (PROMs), revisions, failures, and complications were examined preoperatively (baseline), 3, 6, 12, and 24 months after OCA transplantation; change scores from preoperative values were used for analysis. A total of 23 patients met inclusion criteria (15 males); 13 (56.5%) received HTO (5 concurrent), while 10 (43.5%) received DFO (5 concurrent). There were no significant differences in complication rates between concurrent and staged osteotomies. Primary bipolar OCA transplantation with osteotomy was associated with successful outcomes in 70% of patients; four patients underwent revision (17.4%) and three (13.0%) failed and were treated by total knee arthroplasty. Further, the four patients undergoing revision met functional criteria for success at final follow-up, resulting in a 2-year functional survival rate of 87.4%. Aside from Patient-Reported Outcomes Measurement Information System (PROMIS) physical function, all PROMs for concurrent and staged osteotomies improved from baseline to 2 years postoperatively. Concurrent osteotomies of both types were associated with significantly lower pain scores at 12 months (p = 0.04), compared with staged osteotomies. Apart from Single Assessment Numerical Evaluation (SANE), more PROM improvement was observed for concurrent osteotomies at 2 years. Improvements in PROMs for patients undergoing OCA transplantation combined with osteotomy were observed at 2-year follow-up. PROMs for concurrent osteotomy were consistently greater than staged osteotomy, lending support to addressing lower extremity malalignment with bipolar OCA transplantation in the knee during a single surgery when possible.
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Affiliation(s)
| | - James P Stannard
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - John R Worley
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - Emily V Leary
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
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38
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Gonçalves AM, Moreira A, Weber A, Williams GR, Costa PF. Osteochondral Tissue Engineering: The Potential of Electrospinning and Additive Manufacturing. Pharmaceutics 2021; 13:983. [PMID: 34209671 PMCID: PMC8309012 DOI: 10.3390/pharmaceutics13070983] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/22/2021] [Accepted: 06/25/2021] [Indexed: 12/14/2022] Open
Abstract
The socioeconomic impact of osteochondral (OC) damage has been increasing steadily over time in the global population, and the promise of tissue engineering in generating biomimetic tissues replicating the physiological OC environment and architecture has been falling short of its projected potential. The most recent advances in OC tissue engineering are summarised in this work, with a focus on electrospun and 3D printed biomaterials combined with stem cells and biochemical stimuli, to identify what is causing this pitfall between the bench and the patients' bedside. Even though significant progress has been achieved in electrospinning, 3D-(bio)printing, and induced pluripotent stem cell (iPSC) technologies, it is still challenging to artificially emulate the OC interface and achieve complete regeneration of bone and cartilage tissues. Their intricate architecture and the need for tight spatiotemporal control of cellular and biochemical cues hinder the attainment of long-term functional integration of tissue-engineered constructs. Moreover, this complexity and the high variability in experimental conditions used in different studies undermine the scalability and reproducibility of prospective regenerative medicine solutions. It is clear that further development of standardised, integrative, and economically viable methods regarding scaffold production, cell selection, and additional biochemical and biomechanical stimulation is likely to be the key to accelerate the clinical translation and fill the gap in OC treatment.
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Affiliation(s)
| | - Anabela Moreira
- BIOFABICS, Rua Alfredo Allen 455, 4200-135 Porto, Portugal; (A.M.G.); (A.M.)
| | - Achim Weber
- Fraunhofer Institute for Interfacial Engineering and Biotechnology IGB, Nobelstrasse 12, 70569 Stuttgart, Germany;
| | - Gareth R. Williams
- UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK;
| | - Pedro F. Costa
- BIOFABICS, Rua Alfredo Allen 455, 4200-135 Porto, Portugal; (A.M.G.); (A.M.)
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39
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Yue L, Vuong B, Yao H, Owens BD. Doxycycline preserves chondrocyte viability and function in human and calf articular cartilage ex vivo. Physiol Rep 2021; 8:e14571. [PMID: 32918797 PMCID: PMC7507091 DOI: 10.14814/phy2.14571] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 01/08/2023] Open
Abstract
Prolonging chondrocyte survival is essential to ensure fresh osteochondral (OC) grafts for treatment of articular cartilage lesions. Doxycycline has been shown to enhance cartilage growth, disrupt terminal differentiation of chondrocytes, and inhibit cartilage matrix degradation. It is unknown whether doxycycline prolongs chondrocyte survival in OC grafts. We hypothesized that doxycycline protects against chondrocyte death and maintains function of articular cartilage. To test this hypothesis, we employed human and calf articular cartilages, and incubated chondrocytes isolated from cartilage or cartilage plugs with doxycycline (0, 1 or 10 μg/ml) at either 37°C or 4°C. Chondrocyte viability, apoptosis, glycosaminoglycan (GAG), collagen, and mechanical test in cartilage plugs were measured. We found that reduced chondrocyte viability, increased chondrocyte apoptosis, reduced GAG contents, and impaired equilibrium modulus in cartilage plugs were observed in a time-dependent manner at both 37°C and 4°C. Chondrocyte viability was further reduced when the plugs were cultured at 4°C as compared to 37°C. Doxycycline prolonged viability and reduced apoptosis of chondrocytes during culture of cartilage plugs. Functionally, doxycycline protected against reduced production of GAG and collagen II as well as impaired mechanical properties in cartilage plugs during culture. Mechanistically, doxycycline increased mitochondrial respiration in cultured chondrocytes. In conclusion, preservation at 37°C is beneficial for maintaining chondrocyte viability in cartilage plugs compared to 4°C. Incubation of doxycycline protects against chondrocyte apoptosis, reduced extracellular matrix, and impaired mechanical properties in cartilage plugs. The findings provide a potential approach using doxycycline at 37°C to preserve chondrocyte viability in fresh OC grafts for treatment of articular cartilage lesions.
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Affiliation(s)
- Li Yue
- Department of Orthopaedics, Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, USA
| | - Brian Vuong
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Hongwei Yao
- Department of Molecular Biology, Cell Biology and Biochemistry, Division of Biology and Medicine, Brown University, Providence, RI, USA
| | - Brett D Owens
- Department of Orthopaedics, Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, USA.,University Orthopedics, East Providence, RI, USA
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40
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Görtz S, Tabbaa SM, Jones DG, Polousky JD, Crawford DC, Bugbee WD, Cole BJ, Farr J, Fleischli JE, Getgood A, Gomoll AH, Gross AE, Krych AJ, Lattermann C, Mandelbaum BR, Mandt PR, Mirzayan R, Mologne TS, Provencher MT, Rodeo SA, Safir O, Strauss ED, Wahl CJ, Williams RJ, Yanke AB. Metrics of OsteoChondral Allografts (MOCA) Group Consensus Statements on the Use of Viable Osteochondral Allograft. Orthop J Sports Med 2021; 9:2325967120983604. [PMID: 34250153 PMCID: PMC8237219 DOI: 10.1177/2325967120983604] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/31/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Osteochondral allograft (OCA) transplantation has evolved into a first-line
treatment for large chondral and osteochondral defects, aided by
advancements in storage protocols and a growing body of clinical evidence
supporting successful clinical outcomes and long-term survivorship. Despite
the body of literature supporting OCAs, there still remains controversy and
debate in the surgical application of OCA, especially where high-level
evidence is lacking. Purpose: To develop consensus among an expert group with extensive clinical and
scientific experience in OCA, addressing controversies in the treatment of
chondral and osteochondral defects with OCA transplantation. Study Design: Consensus statement. Methods: A focus group of clinical experts on OCA cartilage restoration participated
in a 3-round modified Delphi process to generate a list of statements and
establish consensus. Questions and statements were initially developed on
specific topics that lack scientific evidence and lead to debate and
controversy in the clinical community. In-person discussion occurred where
statements were not agreed on after 2 rounds of voting. After final voting,
the percentage of agreement and level of consensus were characterized. A
systematic literature review was performed, and the level of evidence and
grade were established for each statement. Results: Seventeen statements spanning surgical technique, graft matching,
indications, and rehabilitation reached consensus after the final round of
voting. Of the 17 statements that reached consensus, 11 received unanimous
(100%) agreement, and 6 received strong (80%-99%) agreement. Conclusion: The outcomes of this study led to the establishment of consensus statements
that provide guidance on surgical and perioperative management of OCAs. The
findings also provided insights on topics requiring more research or
high-quality studies to further establish consensus and provide stronger
evidence.
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Affiliation(s)
- Simon Görtz
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Suzanne M Tabbaa
- University of California-San Francisco, San Francisco, California, USA
| | - Deryk G Jones
- Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA
| | - John D Polousky
- Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA
| | | | | | - William D Bugbee
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Brian J Cole
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Jack Farr
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - James E Fleischli
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Alan Getgood
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Andreas H Gomoll
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Allan E Gross
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Aaron J Krych
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Christian Lattermann
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Bert R Mandelbaum
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Peter R Mandt
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Raffy Mirzayan
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Timothy S Mologne
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Matthew T Provencher
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Scott A Rodeo
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Oleg Safir
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Eric D Strauss
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Christopher J Wahl
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Riley J Williams
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
| | - Adam B Yanke
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of California-San Francisco, San Francisco, California, USA.,Ochsner Sports Medicine Institute, Jefferson, Louisiana, USA.,Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, Texas, USA.,Oregon Health and Science University, Portland, Oregon, USA.,Investigation performed at Metrics of Osteochondral Allografts (MOCA), JRF Ortho, Centennial, Colorado, USA
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41
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Wu K, Shardt N, Laouar L, Elliott JAW, Jomha NM. Vitrification of particulated articular cartilage via calculated protocols. NPJ Regen Med 2021; 6:15. [PMID: 33741977 PMCID: PMC7979917 DOI: 10.1038/s41536-021-00123-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 02/01/2021] [Indexed: 02/05/2023] Open
Abstract
Preserving viable articular cartilage is a promising approach to address the shortage of graft tissue and enable the clinical repair of articular cartilage defects in articulating joints, such as the knee, ankle, and hip. In this study, we developed two 2-step, dual-temperature, multicryoprotectant loading protocols to cryopreserve particulated articular cartilage (cubes ~1 mm3 in size) using a mathematical approach, and we experimentally measured chondrocyte viability, metabolic activity, cell migration, and matrix productivity after implementing the designed loading protocols, vitrification, and warming. We demonstrated that porcine and human articular cartilage cubes can be successfully vitrified and rewarmed, maintaining high cell viability and excellent cellular function. The vitrified particulated articular cartilage was stored for a period of 6 months with no significant deterioration in chondrocyte viability and functionality. Our approach enables high-quality long-term storage of viable articular cartilage that can alleviate the shortage of grafts for use in clinically repairing articular cartilage defects.
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Affiliation(s)
- Kezhou Wu
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
- Department of Orthopedic Surgery, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - Nadia Shardt
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, AB, Canada
| | - Leila Laouar
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Janet A W Elliott
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, AB, Canada.
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada.
| | - Nadr M Jomha
- Department of Surgery, University of Alberta, Edmonton, AB, Canada.
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Chitosan/polycaprolactone multilayer hydrogel: A sustained Kartogenin delivery model for cartilage regeneration. Int J Biol Macromol 2021; 177:589-600. [PMID: 33610607 DOI: 10.1016/j.ijbiomac.2021.02.122] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 02/13/2021] [Accepted: 02/16/2021] [Indexed: 12/11/2022]
Abstract
Cartilage regeneration using biomaterial-guided delivery systems presents improved therapeutic efficacy of the biomolecules while minimizing side effects. Here, our hypothesis was to design a multilayer scaffold of chitosan (CS) hydrogel and polycaprolactone (PCL) mat to enhance the mechanical properties, integrity and stability of CS, especially for subsequent in vivo transplantation. After conjugation of the Kartogenin (KGN) into this structure, its gradual release can promote chondrogenesis of mesenchymal stem cells (MSCs). Initially, a thin electrospun PCL layer was sandwiched between two CS hydrogels. Subsequently, KGN was superficially immobilized onto the CS matrix. The successful conjugation was confirmed by scanning electron microscopy (SEM) and infrared spectroscopy. These novel KGN-conjugated scaffolds possessed lower swelling and higher compressive modulus and showed gradual release of KGN in longer retention times. Immunofluorescent and histological staining represented more cells located in lacunae as well as more Coll2 and Sox9 positive cells on KGN-conjugated scaffolds. Gene expression analysis also revealed that SOX9, COLL2 and ACAN expression levels were higher in the presence of KGN, while COLLX expression was down-regulated, indicating a hypertrophy phenomenon with synergistic effect of TGF-β. This multilayer structure not only facilitates the effective treatment, but also provides a proper mechanical structure for cartilage engineering.
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43
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Cook JL, Rucinski K, Crecelius CR, Ma R, Stannard JP. Return to Sport After Large Single-Surface, Multisurface, or Bipolar Osteochondral Allograft Transplantation in the Knee Using Shell Grafts. Orthop J Sports Med 2021; 9:2325967120967928. [PMID: 33553437 PMCID: PMC7841689 DOI: 10.1177/2325967120967928] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/11/2020] [Indexed: 01/21/2023] Open
Abstract
Background: Return to sport (RTS) after osteochondral allograft (OCA) transplantation for large unipolar femoral condyle defects has been consistent, but many athletes are affected by more severe lesions. Purpose: To examine outcomes for athletes who have undergone large single-surface, multisurface, or bipolar shell OCA transplantation in the knee. Study Design: Case series; Level of evidence, 4. Methods: Data from a prospective OCA transplantation registry were assessed for athletes who underwent knee transplantation for the first time (primary transplant) between June 2015 and March 2018 for injury or overuse-related articular defects. Inclusion criteria were preinjury Tegner level ≥5 and documented type and level of sport (or elite unit active military duty); in addition, patients were required to have a minimum of 1-year follow-up outcomes, including RTS data. Patient characteristics, surgery type, Tegner level, RTS, patient-reported outcome measures (PROMs), compliance with rehabilitation, revisions, and failures were assessed and compared for statistically significant differences. Results: There were 37 included athletes (mean age, 34 years; range, 15-69 years; mean body mass index, 26.2 kg/m2; range, 18-35 kg/m2) who underwent large single-surface (n = 17), multisurface (n = 4), or bipolar (n = 16) OCA transplantation. The highest preinjury median Tegner level was 9 (mean, 7.9 ± 1.7; range, 5-10). At the final follow-up, 25 patients (68%) had returned to sport; 17 (68%) returned to the same or higher level of sport compared with the highest preinjury level. The median time to RTS was 16 months (range, 7-26 months). Elite unit military, competitive collegiate, and competitive high school athletes returned at a significantly higher proportion (P < .046) than did recreational athletes. For all patients, the Tegner level at the final follow-up (median, 6; mean, 6.1 ± 2.7; range, 1-10) was significantly lower than that at the highest preinjury level (P = .007). PROMs were significantly improved at the final follow-up compared with preoperative levels and reached or exceeded clinically meaningful differences. OCA revisions were performed in 2 patients (5%), and failures requiring total knee arthroplasty occurred in 2 patients (5%), all of whom were recreational athletes. Noncompliance was documented in 4 athletes (11%) and was 15.5 times more likely (P = .049) to be associated with failure or a need for revision than for compliant patients. Conclusion: Large single-surface, multisurface, or bipolar shell OCA knee transplantations in athletes resulted in two-thirds of these patients returning to sport at 16 to 24 months after transplantation. Combined, the revision and failure rates were 10%; thus, 90% of patients were considered to have successful 2- to 4-year outcomes with significant improvements in pain and function, even when patients did not RTS.
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Affiliation(s)
- James L Cook
- Mizzou BioJoint Center, Missouri Orthopaedic Institute, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Kylee Rucinski
- Mizzou BioJoint Center, Missouri Orthopaedic Institute, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Cory R Crecelius
- Mizzou BioJoint Center, Missouri Orthopaedic Institute, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Richard Ma
- Mizzou BioJoint Center, Missouri Orthopaedic Institute, University of Missouri-Columbia, Columbia, Missouri, USA
| | - James P Stannard
- Mizzou BioJoint Center, Missouri Orthopaedic Institute, University of Missouri-Columbia, Columbia, Missouri, USA
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44
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Early S, Tírico LEP, Pulido PA, McCauley JC, Bugbee WD. Long-Term Retrospective Follow-Up of Fresh Osteochondral Allograft Transplantation for Steroid-Associated Osteonecrosis of the Femoral Condyles. Cartilage 2021; 12:24-30. [PMID: 30378446 PMCID: PMC7755967 DOI: 10.1177/1947603518809399] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE No studies currently exist with long-term follow-up of use of osteochondral allografting (OCA) for treatment of steroid-associated osteonecrosis of femoral condyles in young, active patients who wish to avoid total knee arthroplasty (TKA). We evaluate the extent to which fresh osteochondral allografts can (1) prevent or postpone need for prosthetic arthroplasty and (2) maintain long-term clinically meaningful decrease in pain and improvement in function at mean 11-year follow-up. DESIGN Twenty-five patients (33 knees) who underwent OCA transplantation for osteonecrosis of the knee between 1984 and 2013 were evaluated, including 22 females and 11 males with average age of 25 years (range, 16-48 years). Mean total allograft surface area was 10.6 cm2 (range, 4.0-19.0 cm2). Evaluation included International Knee Documentation Committee (IKDC) scores, Knee Society function (KS-F) score, and modified (for the knee) Merle d'Aubigné-Postel (18-point) score. RESULTS OCA survivorship was 90% at 5 years and 82% at 10 years. Twenty-eight of 33 knees (85%) avoided arthroplasty and 25 of 33 knees (73%) avoided other surgical intervention. Mean IKDC pain score improved (P = 0.001) from 7.2 preoperatively to 2.8 at latest follow-up, mean IKDC function score increased (P = 0.005) from 3.3 to 6.5, and mean IKDC total score improved (P = 0.001) from 31.9 to 61.1. Mean KS-F score improved (P = 0.003) from 61.7 to 87.5. Mean modified Merle d'Aubigné-Postel (18-point) score improved (P < 0.001) from 11.4 to 15.1. CONCLUSIONS Our findings suggest that OCA transplantation is a reasonable surgical treatment option for steroid-associated osteonecrosis of the femoral condyles, with durable long-term outcomes.
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Affiliation(s)
- Samuel Early
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Luís E. P. Tírico
- Shiley Center for Orthopaedic Research & Education at Scripps Clinic, La Jolla, CA, USA
| | - Pamela A. Pulido
- Shiley Center for Orthopaedic Research & Education at Scripps Clinic, La Jolla, CA, USA
| | - Julie C. McCauley
- Shiley Center for Orthopaedic Research & Education at Scripps Clinic, La Jolla, CA, USA
| | - William D. Bugbee
- Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA,William D. Bugbee, Division of Orthopaedic Surgery, Scripps Clinic, 10666 North Torrey Pines Road, MS 116, La Jolla, CA 92037, USA.
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45
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Luk J, Stoker AM, Teixeiro E, Kuroki K, Schreiner AJ, Stannard JP, Wissman R, Cook JL. Systematic Review of Osteochondral Allograft Transplant Immunology: How We Can Further Optimize Outcomes. J Knee Surg 2021; 34:30-38. [PMID: 33389738 DOI: 10.1055/s-0040-1721670] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Despite the growing success for osteochondral allograft (OCA) transplantation in treating large articular cartilage lesions in multiple joints, associated revision and failure rates are still higher than desired. While immunorejection responses have not been documented, the effects of the host's immune responses on OCA transplantation failures have not been thoroughly characterized. The objective of this study was to systematically review clinically relevant peer-reviewed evidence pertaining to the immunology of OCAs to elucidate theragnostic strategies for improving functional graft survival and outcomes for patients undergoing OCA transplantation. This systematic review of Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, MEDLINE, PubMed, and EMBASE suggests that host immune responses play key roles in incorporation and functional survival of OCA transplants. OCA rejection has not been reported; however, graft integration through creeping substitution is reliant on host immune responses. Prolonged inflammation, diminished osteogenic potential for healing and incorporation, and relative bioburden are mechanisms that may be influenced by the immune system and contribute to undesirable outcomes after OCA transplantation. Based on the safety and efficacy of OCA transplantation and its associated benefits to a large and growing patient population, basic, preclinical, and clinical osteoimmunological studies on OCA transplantation that comprehensively assess and correlate cellular, molecular, histologic, biomechanical, biomarkers, diagnostic imaging, arthroscopic, functional, and patient-reported outcome measures are of high interest and importance.
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Affiliation(s)
- Josephine Luk
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Aaron M Stoker
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Emma Teixeiro
- Department of Molecular Microbiology and Immunology, University of Missouri, Columbia, Missouri
| | - Keiichi Kuroki
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - Anna J Schreiner
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,BG Center for Trauma and Reconstructive Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - James P Stannard
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Robert Wissman
- Department of Radiology, University of Missouri, Columbia, Missouri
| | - James L Cook
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
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46
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Yong KW, Laouar L, Elliott JAW, Jomha NM. Review of non-permeating cryoprotectants as supplements for vitrification of mammalian tissues. Cryobiology 2020; 96:1-11. [PMID: 32910946 DOI: 10.1016/j.cryobiol.2020.08.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/28/2020] [Accepted: 08/28/2020] [Indexed: 12/30/2022]
Abstract
Vitrification of mammalian tissues is important in the areas of human assisted reproduction, animal reproduction, and regenerative medicine. Non-permeating cryoprotectants (CPAs), particularly sucrose, are increasingly used in conjunction with permeating CPAs for vitrification of mammalian tissues. Combining non-permeating and permeating CPAs was found to further improve post-thaw viability and functionalities of vitrified mammalian tissues, showing the potential applications of such tissues in various clinical and veterinary settings. With the rising demand for the use of non-permeating CPAs in vitrification of mammalian tissues, there is a strong need for a timely and comprehensive review on the supplemental effects of non-permeating CPAs toward vitrification outcomes of mammalian tissues. In this review, we first discuss the roles of non-permeating CPAs including sugars and high molecular weight polymers in vitrification. We then summarize the supplemental effects of non-permeating CPAs on viability and functionalities of mammalian embryos, and ovarian, testicular, articular cartilage, tracheal, and kidney tissues following vitrification. Lastly, challenges associated with the use of non-permeating CPAs in vitrification of mammalian tissues are briefly discussed.
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Affiliation(s)
- Kar Wey Yong
- Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, T6G 2B7, Canada
| | - Leila Laouar
- Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, T6G 2B7, Canada
| | - Janet A W Elliott
- Department of Chemical and Materials Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, T6G 1H9, Canada; Department of Laboratory Medicine and Pathology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, T6G 2R7, Canada
| | - Nadr M Jomha
- Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, T6G 2B7, Canada.
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47
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Takizawa D, Sato M, Okada E, Takahashi T, Maehara M, Tominaga A, Sogo Y, Toyoda E, Watanabe M. Regenerative effects of human chondrocyte sheets in a xenogeneic transplantation model using immune-deficient rats. J Tissue Eng Regen Med 2020; 14:1296-1306. [PMID: 32652894 PMCID: PMC7540669 DOI: 10.1002/term.3101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 06/05/2020] [Accepted: 07/02/2020] [Indexed: 01/10/2023]
Abstract
Although cell transplantation has attracted much attention in regenerative medicine, animal models continue to be used in translational research to evaluate safety and efficacy because cell sources and transplantation modalities are so diverse. In the present study, we investigated the regenerative effects of human chondrocyte sheets on articular cartilage in a xenogeneic transplantation model using immune‐deficient rats. Osteochondral defects were created in the knee joints of immune‐deficient rats that were treated as Group A, untreated (without transplantation); Group B, transplantation of a layered chondrocyte sheet containing 5.0 × 105 cells (layered chondrocyte sheet transplantation); Group C, transplantation of a synoviocyte sheet containing 5.0 × 105 cells (synoviocyte sheet transplantation); or Group D, transplantation of both a synoviocyte sheet plus a layered chondrocyte sheet, each containing 5.0 × 105 cells (synoviocyte sheet plus layered chondrocyte sheet transplantation). Histological evaluation demonstrated that Group B showed cartilage regeneration with hyaline cartilage and fibrocartilage. In Groups C and D, the defect was filled with fibrous tissue but no hyaline cartilage. Transplanted cells were detected at 4 and 12 weeks after transplantation, but the number of cells had decreased at 12 weeks. Our results indicate that layered chondrocyte sheet transplantation contributes to articular cartilage regeneration; this model proved useful for evaluating these regenerative effects.
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Affiliation(s)
- Daichi Takizawa
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan.,Center for Musculoskeletal innovative Research and Advancement (C-MiRA), Tokai University Graduate School, Isehara, Japan
| | - Masato Sato
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan.,Center for Musculoskeletal innovative Research and Advancement (C-MiRA), Tokai University Graduate School, Isehara, Japan
| | - Eri Okada
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan.,Center for Musculoskeletal innovative Research and Advancement (C-MiRA), Tokai University Graduate School, Isehara, Japan
| | - Takumi Takahashi
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan.,Center for Musculoskeletal innovative Research and Advancement (C-MiRA), Tokai University Graduate School, Isehara, Japan
| | - Miki Maehara
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan.,Center for Musculoskeletal innovative Research and Advancement (C-MiRA), Tokai University Graduate School, Isehara, Japan
| | - Ayako Tominaga
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, Shinjuku-ku, Japan
| | - Yasuyuki Sogo
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan.,Center for Musculoskeletal innovative Research and Advancement (C-MiRA), Tokai University Graduate School, Isehara, Japan
| | - Eriko Toyoda
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan.,Center for Musculoskeletal innovative Research and Advancement (C-MiRA), Tokai University Graduate School, Isehara, Japan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan.,Center for Musculoskeletal innovative Research and Advancement (C-MiRA), Tokai University Graduate School, Isehara, Japan
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48
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Stadler HS. Encouraging cartilage production. eLife 2020; 9:57239. [PMID: 32374717 PMCID: PMC7202892 DOI: 10.7554/elife.57239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 12/01/2022] Open
Abstract
A long non-coding RNA called GRASLND is essential to help stem cells create stable cartilage.
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Affiliation(s)
- H Scott Stadler
- Orthopaedics and Rehabilitation, Oregon Health Science University, Portland, United States.,Skeletal Biology Research Center, Shriners Hospital for Children, Portland, United States
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49
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Stannard JP, Cook JL. Prospective Assessment of Outcomes After Primary Unipolar, Multisurface, and Bipolar Osteochondral Allograft Transplantations in the Knee: A Comparison of 2 Preservation Methods. Am J Sports Med 2020; 48:1356-1364. [PMID: 32134685 DOI: 10.1177/0363546520907101] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Articular cartilage lesions in the knee remain a challenging clinical problem. HYPOTHESIS A novel graft preservation method combined with surgical technique and patient management improvements would lead to consistently successful outcomes after osteochondral allograft (OCA) transplantation. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS With institutional review board approval and informed consent, patients were prospectively enrolled into a registry to follow outcomes after OCA transplantation. Patients were included when ≥1-year follow-up data were available, including complications and reoperations, patient-reported outcome measures (PROMs), compliance with rehabilitation, revisions, and failures. RESULTS For patients meeting inclusion criteria (N = 194), mean ± SD age was 37.9 ± 12.2 years and mean BMI was 28.9 ± 5; 38% received unipolar transplants (44% multisurface) and 62% received bipolar transplants. OCAs were preserved by standard tissue bank methods (standard preservation [SP]; 29%) or the novel method (Missouri Osteochondral Preservation System [MOPS]; 71%). Initial success rates were 79% for all cases combined, 60% for SP, and 84% for MOPS. MOPS cases were significantly (P = .028) more likely to be associated with successful outcomes when compared with SP cases. PROMs improved significantly (P < .05) for all cohorts through 3 to 4 years of follow-up. Revisions were performed in 19 cases (10%). MOPS grafts were associated with a significantly (P = .0014) lower revision rate (5%) than SP grafts (21%). Failures occurred in 26 patients (13%), with all undergoing total knee arthroplasty. Bipolar cases were significantly (P = .008) more likely to be associated with failure. MOPS grafts were associated with a significantly (P = .048) lower failure rate (11%) than were SP grafts (19%). Noncompliance with the prescribed rehabilitation protocol was significantly (P = .00008) more likely to be associated with failure. CONCLUSION Prospective data for 194 cases revealed that OCA transplantation for unipolar, multisurface, and bipolar cartilage restoration can be associated with consistently successful outcomes. The 5% revision rate, 11% failure rate, 82%-94% survival probability estimates, and continually improving PROMs through postoperative 3 to 4 years underscore major advances in outcomes as compared with previous reports. These encouraging results were realized with the use of a novel graft preservation method; autogenous bone marrow concentrate pretreatment of donor bone; advancements in graft cutting, implantation, and stabilization techniques; and procedure-specific rehabilitation protocols.
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Affiliation(s)
- James P Stannard
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA
| | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA
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50
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Stefani RM, Barbosa S, Tan AR, Setti S, Stoker AM, Ateshian GA, Cadossi R, Vunjak-Novakovic G, Aaron RK, Cook JL, Bulinski JC, Hung CT. Pulsed electromagnetic fields promote repair of focal articular cartilage defects with engineered osteochondral constructs. Biotechnol Bioeng 2020; 117:1584-1596. [PMID: 31985051 PMCID: PMC8845061 DOI: 10.1002/bit.27287] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/14/2019] [Accepted: 01/24/2020] [Indexed: 12/13/2022]
Abstract
Articular cartilage injuries are a common source of joint pain and dysfunction. We hypothesized that pulsed electromagnetic fields (PEMFs) would improve growth and healing of tissue-engineered cartilage grafts in a direction-dependent manner. PEMF stimulation of engineered cartilage constructs was first evaluated in vitro using passaged adult canine chondrocytes embedded in an agarose hydrogel scaffold. PEMF coils oriented parallel to the articular surface induced superior repair stiffness compared to both perpendicular PEMF (p = .026) and control (p = .012). This was correlated with increased glycosaminoglycan deposition in both parallel and perpendicular PEMF orientations compared to control (p = .010 and .028, respectively). Following in vitro optimization, the potential clinical translation of PEMF was evaluated in a preliminary in vivo preclinical adult canine model. Engineered osteochondral constructs (∅ 6 mm × 6 mm thick, devitalized bone base) were cultured to maturity and implanted into focal defects created in the stifle (knee) joint. To assess expedited early repair, animals were assessed after a 3-month recovery period, with microfracture repairs serving as an additional clinical control. In vivo, PEMF led to a greater likelihood of normal chondrocyte (odds ratio [OR]: 2.5, p = .051) and proteoglycan (OR: 5.0, p = .013) histological scores in engineered constructs. Interestingly, engineered constructs outperformed microfracture in clinical scoring, regardless of PEMF treatment (p < .05). Overall, the studies provided evidence that PEMF stimulation enhanced engineered cartilage growth and repair, demonstrating a potential low-cost, low-risk, noninvasive treatment modality for expediting early cartilage repair.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Clark T. Hung
- Columbia University, New York, NY
- Clark T. Hung, 351 Engineering Terrace Building, Mail Code 8904, 1210 Amsterdam Avenue, New York, NY 10027, Tel: (212) 854-6542, Fax: (212) 854-8725,
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