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Wang AS, Nagelli CV, Lamba A, Saris DBF, Krych AJ, Hevesi M. Minimum 10-Year Outcomes of Matrix-Induced Autologous Chondrocyte Implantation in the Knee: A Systematic Review. Am J Sports Med 2024; 52:2407-2414. [PMID: 38312085 DOI: 10.1177/03635465231205309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
BACKGROUND Matrix-induced autologous chondrocyte implantation (MACI) is an established cell-based therapy for the treatment of chondral defects of the knee. As long-term outcomes are now being reported in the literature, it is important to systematically review available evidence to better inform clinical practice. PURPOSE To report (1) subjective patient-reported outcomes (PROs) and (2) the rate of graft failure, reoperation, and progression to total knee arthroplasty (TKA) after undergoing MACI of the knee at a minimum 10-year follow-up. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A comprehensive search of Ovid MEDLINE and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily; Ovid Embase; Ovid Cochrane Central Register of Controlled Trials; Ovid Cochrane Database of Systematic Reviews; and Scopus from 2008 to September 15, 2022, was conducted in the English language. Study eligibility criteria included (1) full-text articles in the English language, (2) patients undergoing a MACI within the knee, (3) clinical outcomes reported, and (4) a minimum 10-year follow-up. RESULTS In total, 168 patients (99 male, 69 female; mean age, 37 years [range, 15-63 years]; mean body mass index, 26.2 [range, 18.6-39.4]) representing 188 treated chondral defects at a minimum 10-year follow-up after MACI were included in this review. Significant and durable long-term improvements were observed across multiple PRO measures. Follow-up magnetic resonance imaging (MRI), when performed, also demonstrated satisfactory defect fill and an intact graft in the majority of patients. The all-cause reoperation rate was 9.0%, with an overall 7.4% rate of progression to TKA at 10 to 17 years of follow-up. CONCLUSION At a minimum 10-year follow-up, patients undergoing MACI for knee chondral defects demonstrated significant and durable improvements in PROs, satisfactory defect fill on MRI-based assessment, and low rates of reoperation and TKA. These data support the use of MACI as a long-term treatment of focal cartilage defects of the knee.
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Affiliation(s)
- Allen S Wang
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Abhinav Lamba
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniël B F Saris
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mario Hevesi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Chen CP, Weng PW, Lee KT, Chiang LY, Liao WJ, Shaw L. Biphasic Scaffold Loaded With Autologous Cartilage Yields Better Clinical Outcome and Magnetic Resonance Imaging Filling Compared With Marrow Stimulation for Focal Osteochondral Lesions in the Knee. Arthroscopy 2024:S0749-8063(24)00302-5. [PMID: 38719177 DOI: 10.1016/j.arthro.2024.04.016] [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: 11/10/2023] [Revised: 03/31/2024] [Accepted: 04/09/2024] [Indexed: 06/04/2024]
Abstract
PURPOSE To evaluate the effectiveness of marrow stimulation (MS) versus biphasic scaffold loaded with autologous cartilage (scaffold) in treating focal osteochondral lesions of the knee. METHODS In total, 54 patients with symptomatic focal chondral or osteochondral lesion in the knee were randomized to either the scaffold group or the MS group. International Knee Documentation Committee subjective score, the Knee Injury Osteoarthritis Outcome Score, and magnetic resonance imaging (MRI) were assessed preoperatively and at 1 and 2 years after operation to compare treatment outcomes. Biopsy and second-look arthroscopy were performed at 1 year postoperatively for consenting patients. RESULTS There were 27 patients (mean age 31.33 ± 10.95 years) in the scaffold group, and 27 patients (31.74 ± 11.44) in the MS group. The scaffold group and the MS group both included 23 patients with lesions ≤12.5 × 12.5 mm2 mm in size. In addition, each group had 4 patients with lesions between than 12.5 × 12.5 mm2 and ≤12.5 × 25 mm2. Both interventions achieved significant improvement in clinical outcome scores at 2 years. The scaffold group had greater International Knee Documentation Committee score than the MS group at 2 years (93.85 ± 9.55 vs 92.11 ± 9.84) and in the Symptoms/Stiffness and Sport/Recreation subscales of Knee Injury Osteoarthritis Outcome Score at 2 years (96.57 ± 5.97 vs 93.57 ± 6.52, P < .05) and (90.2 ± 17.76 vs 82.8 ± 16.08, P < .05). CONCLUSIONS The use of biphasic scaffold loaded with autologous cartilage in treating focal osteochondral lesions demonstrates superior clinical outcomes and better cartilage refill on magnetic resonance imaging at the 2-year follow-up compared to marrow stimulation. LEVEL OF EVIDENCE Level I, Randomized controlled trial.
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Affiliation(s)
- Chao-Ping Chen
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Health Services Administration, China Medical University, Taichung, Taiwan; Department of Acupressure Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Pei-Wei Weng
- International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kun-Tsan Lee
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Post-Baccalaureate Medicine, National Chung-Hsing University, Taichung, Taiwan
| | - Liang-Yu Chiang
- Department of Orthopedic Surgery, Taichung Armed Forces General Hospital, Taichung, Taiwan; School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Jen Liao
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Leo Shaw
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan.
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Retzky JS, Fletcher C, Rizy M, Burge A, Strickland SM. Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) Scores > 55 at 6 Months Postoperative Predict Ability to Achieve Patient Acceptable Symptomatic State at Minimum 1 Year Postoperative Following Autologous Chondrocyte Implantation for Grade IV Chondral Defects About the Patellofemoral Joint. Cartilage 2024:19476035241244491. [PMID: 38613220 DOI: 10.1177/19476035241244491] [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] [Indexed: 04/14/2024] Open
Abstract
PURPOSE The primary aim is to evaluate the relationship between MOCART scores and patient satisfaction, as evaluated by achievement of (1) the Patient Acceptable Symptomatic State (PASS) and (2) the minimal clinically important difference (MCID) for Knee Injury and Osteoarthritis Score Quality of Life (KOOS QoL), for patients undergoing autologous chondrocyte implantation (ACI) for focal Grade IV patellofemoral chondral defects. The secondary aim is to determine the threshold MOCART score which predicts the ability to meet the PASS and the MCID for KOOS QoL. METHODS Patients undergoing ACI for grade IV patellofemoral chondral defects by a single surgeon from 2017 to 2020 were identified by search of the EMR. To determine PASS status, patients were asked, "Do you consider your current level of symptoms to be acceptable?" KOOS QoL scores were also collected. Patients with 6-month postoperative knee MRI, PASS scores, and minimum 2-year follow-up data were included. Paired t tests and Wilcoxon Rank-Sum tests were used to evaluate the relationship between MOCART scores and (1) PASS achievement and (2) achievement of the MCID for KOOS QoL (12.8). RESULTS Thirty-four patients were included, with a median age of 35.1 years [IQR: 24.6, 37.1], and BMI of 24.0 kg/m2 [IQR: 21.5, 28.1]. The median time to postoperative MRI was 6.7 months [IQR: 5.8, 7.9], and average follow-up time was 3.7 ± 1.2 years. Twenty-five patients (74%) achieved PASS, and 18 patients (out of 27 who had postop KOOS QoL Scores, 67%) achieved the MCID for KOOS QoL. Patients who achieved PASS had higher average MOCART scores (61.8 ± 16.0) than those who did not achieve PASS (45.0 ± 12.8, p=0.011), whereas patients who achieved the MCID for KOOS QoL did not have higher MOCART scores than those who did not achieve the MCID (61.9 ± 18.3 versus 53.3 ± 17.1, P = 0.25). There was no relationship between age, sex, lesion size, and lesion location and ability to achieve PASS or MCID for KOOS QoL (p>0.05). A threshold MOCART value of 55 was associated with the highest AUC on ROC analysis for likelihood of achieving PASS (0.778) and MCID for KOOS QoL (0.667). CONCLUSION Higher MOCART scores are associated with an increased likelihood of achieving PASS following patellofemoral ACI. Moreover, MOCART scores > 55 predict the ability to achieve PASS and the MCID for KOOS QoL following patellofemoral ACI. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Julia S Retzky
- Hospital for Special Surgery, Sports Medicine Institute, New York, NY, USA
| | - Connor Fletcher
- Hospital for Special Surgery, Sports Medicine Institute, New York, NY, USA
| | - Morgan Rizy
- Hospital for Special Surgery, Sports Medicine Institute, New York, NY, USA
| | - Alissa Burge
- Hospital for Special Surgery, Sports Medicine Institute, New York, NY, USA
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Eichinger M, Henninger B, Petry B, Schuster P, Herbst E, Wagner M, Rosenberger R, Mayr R. Treatment of cartilage defects in the patellofemoral joint with matrix-associated autologous chondrocyte implantation effectively improves pain, function, and radiological outcomes after 5-7 years. Arch Orthop Trauma Surg 2024; 144:1655-1665. [PMID: 38206448 PMCID: PMC10965587 DOI: 10.1007/s00402-023-05179-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 12/07/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION The aim of the present study was to evaluate midterm outcomes 5-7 years after matrix-associated autologous chondrocyte implantation (MACI) in the patellofemoral joint. MATERIALS AND METHODS Twenty-six patients who had undergone MACI using the Novocart® 3D scaffold were prospectively evaluated. Clinical outcomes were determined by measuring the 36-Item Short-Form Health Survey (SF-36) and International Knee Documentation Committee (IKDC) scores and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) values preoperatively and 3, 6, and 12 months, and a mean of 6 years postoperatively. At the final follow-up, the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was evaluated. RESULTS Twenty-two patients with 23 focal cartilage defects (19 patella and four trochlea) were available for the final follow-up. The mean defect size was 4.0 ± 1.9 cm2 (range 2.4-9.4 cm2). All clinical outcome scores improved significantly until 5-7 years after MACI (SF-36 score, 61.2 ± 19.6 to 83.2 ± 11.6; P = 0.001; IKDC score, 47.5 ± 20.6 to 74.7 ± 15.5; P < 0.001; and WOMAC, 29.8 ± 15.7 to 8.2 ± 10.3; P < 0.001). The mean MOCART score was 76.0 ± 11.0 at the final follow-up. Nineteen of the 22 patients (86.4%) were satisfied with the outcomes after 5-7 years and responded that they would undergo the procedure again. CONCLUSION MACI in the patellofemoral joint demonstrated good midterm clinical results with a significant reduction in pain, improvement in function, and high patient satisfaction. These clinical findings are supported by radiological evidence from MOCART scores. LEVEL OF EVIDENCE IV-case series.
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Affiliation(s)
- Martin Eichinger
- Department of Orthopaedics and Traumatology, a.ö. Bezirkskrankenhaus St. Johann in Tirol, Bahnhofstraße 14, 6380, St. Johann in Tirol, Austria.
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria.
| | - Benjamin Henninger
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Benjamin Petry
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Philipp Schuster
- Department of Sports Orthopaedics and Special Joint Surgery, RKH Orthopaedic Hospital, Markgröningen, Germany
- Department of Orthopaedics and Traumatology, Paracelsus Medical University, Clinic Nuremberg, Nuremberg, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery, University of Münster, Münster, Germany
| | - Moritz Wagner
- Department of Orthopaedics and Traumatology, a.ö. Bezirkskrankenhaus St. Johann in Tirol, Bahnhofstraße 14, 6380, St. Johann in Tirol, Austria
| | - Ralf Rosenberger
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
- Privatklinik Hochrum, Sanatorium Der Kreuzschwestern, Rum, Austria
| | - Raul Mayr
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
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Steinwerth P, Bertrand J, Sandt V, Marchal S, Sahana J, Bollmann M, Schulz H, Kopp S, Grimm D, Wehland M. Structural and Molecular Changes of Human Chondrocytes Exposed to the Rotating Wall Vessel Bioreactor. Biomolecules 2023; 14:25. [PMID: 38254625 PMCID: PMC10813504 DOI: 10.3390/biom14010025] [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: 11/27/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024] Open
Abstract
Over the last 30 years, the prevalence of osteoarthritis (OA), a disease characterized by a loss of articular cartilage, has more than doubled worldwide. Patients suffer from pain and progressive loss of joint function. Cartilage is an avascular tissue mostly consisting of extracellular matrix with embedded chondrocytes. As such, it does not regenerate naturally, which makes an early onset of OA prevention and treatment a necessity to sustain the patients' quality of life. In recent years, tissue engineering strategies for the regeneration of cartilage lesions have gained more and more momentum. In this study, we aimed to investigate the scaffold-free 3D cartilage tissue formation under simulated microgravity in the NASA-developed rotating wall vessel (RWV) bioreactor. For this purpose, we cultured both primary human chondrocytes as well as cells from the immortalized line C28/I2 for up to 14 days on the RWV and analyzed tissue morphology, development of apoptosis, and expression of cartilage-specific proteins and genes by histological staining, TUNEL-assays, immunohistochemical detection of collagen species, and quantitative real-time PCR, respectively. We observed spheroid formation in both cell types starting on day 3. After 14 days, constructs from C28/I2 cells had diameters of up to 5 mm, while primary chondrocyte spheroids were slightly smaller with 3 mm. Further inspection of the 14-day-old C28/I2 spheroids revealed a characteristic cartilage morphology with collagen-type 1, -type 2, and -type 10 positivity. Interestingly, these tissues were less susceptible to RWV-induced differential gene expression than those formed from primary chondrocytes, which showed significant changes in the regulation of IL6, ACTB, TUBB, VIM, COL1A1, COL10A1, MMP1, MMP3, MMP13, ITGB1, LAMA1, RUNX3, SOX9, and CASP3 gene expression. These diverging findings might reflect the differences between primary and immortalized cells. Taken together, this study shows that simulated microgravity using the RWV bioreactor is suitable to engineer dense 3D cartilage-like tissue without addition of scaffolds or any other artificial materials. Both primary articular cells and the stable chondrocyte cell line C28/I2 formed 3D neocartilage when exposed for 14 days to an RWV.
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Affiliation(s)
- Paul Steinwerth
- Department of Microgravity and Translational Regenerative Medicine, University Clinic for Plastic, Aesthetic and Hand Surgery, Otto von Guericke University, 39106 Magdeburg, Germany; (P.S.); (V.S.); (S.M.); (H.S.); (M.W.)
| | - Jessica Bertrand
- Department of Orthopaedic Surgery, Otto-von-Guericke-University Magdeburg, 39120 Magdeburg, Germany; (J.B.); (M.B.)
- Research Group “Magdeburger Arbeitsgemeinschaft für Forschung unter Raumfahrt-und Schwerelosigkeitsbedingungen” (MARS), Otto von Guericke University, 39106 Magdeburg, Germany;
| | - Viviann Sandt
- Department of Microgravity and Translational Regenerative Medicine, University Clinic for Plastic, Aesthetic and Hand Surgery, Otto von Guericke University, 39106 Magdeburg, Germany; (P.S.); (V.S.); (S.M.); (H.S.); (M.W.)
| | - Shannon Marchal
- Department of Microgravity and Translational Regenerative Medicine, University Clinic for Plastic, Aesthetic and Hand Surgery, Otto von Guericke University, 39106 Magdeburg, Germany; (P.S.); (V.S.); (S.M.); (H.S.); (M.W.)
| | - Jayashree Sahana
- Department of Biomedicine, Aarhus University, Ole Worms Allé 4, 8000 Aarhus, Denmark;
| | - Miriam Bollmann
- Department of Orthopaedic Surgery, Otto-von-Guericke-University Magdeburg, 39120 Magdeburg, Germany; (J.B.); (M.B.)
| | - Herbert Schulz
- Department of Microgravity and Translational Regenerative Medicine, University Clinic for Plastic, Aesthetic and Hand Surgery, Otto von Guericke University, 39106 Magdeburg, Germany; (P.S.); (V.S.); (S.M.); (H.S.); (M.W.)
- Research Group “Magdeburger Arbeitsgemeinschaft für Forschung unter Raumfahrt-und Schwerelosigkeitsbedingungen” (MARS), Otto von Guericke University, 39106 Magdeburg, Germany;
| | - Sascha Kopp
- Research Group “Magdeburger Arbeitsgemeinschaft für Forschung unter Raumfahrt-und Schwerelosigkeitsbedingungen” (MARS), Otto von Guericke University, 39106 Magdeburg, Germany;
- Core Facility Tissue Engineering, Otto von Guericke University, 39106 Magdeburg, Germany
| | - Daniela Grimm
- Department of Microgravity and Translational Regenerative Medicine, University Clinic for Plastic, Aesthetic and Hand Surgery, Otto von Guericke University, 39106 Magdeburg, Germany; (P.S.); (V.S.); (S.M.); (H.S.); (M.W.)
- Research Group “Magdeburger Arbeitsgemeinschaft für Forschung unter Raumfahrt-und Schwerelosigkeitsbedingungen” (MARS), Otto von Guericke University, 39106 Magdeburg, Germany;
- Department of Biomedicine, Aarhus University, Ole Worms Allé 4, 8000 Aarhus, Denmark;
| | - Markus Wehland
- Department of Microgravity and Translational Regenerative Medicine, University Clinic for Plastic, Aesthetic and Hand Surgery, Otto von Guericke University, 39106 Magdeburg, Germany; (P.S.); (V.S.); (S.M.); (H.S.); (M.W.)
- Research Group “Magdeburger Arbeitsgemeinschaft für Forschung unter Raumfahrt-und Schwerelosigkeitsbedingungen” (MARS), Otto von Guericke University, 39106 Magdeburg, Germany;
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Lyu J, Geng H, Zhu W, Li D, Chen K, Ye H, Xia J. Correlation between the quality of cartilage repair tissue and patellofemoral osteoarthritis after matrix-induced autologous chondrocyte implantation at three-year follow-up: a cross-sectional study. INTERNATIONAL ORTHOPAEDICS 2023; 47:2383-2390. [PMID: 36197459 DOI: 10.1007/s00264-022-05581-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 09/08/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE To investigate whether the quality of cartilage repair tissue is associated with patellofemoral osteoarthritis (PFOA) at a three year follow-up after matrix-induced autologous chondrocyte implantation (MACI). METHODS This retrospective study included 32 patients who underwent MACI between October 2014 and May 2018 at our institute. The Lysholm score and Visual Analog Scale (VAS) score were assessed. The magnetic resonance observation of cartilage repair tissue (MOCART) 2.0 score and T2* relaxation time of repair tissue were used to evaluate cartilage repair tissue quality. A modified MRI Osteoarthritis Knee Score (mMOAKS) was used to evaluate PFOA. RESULTS Compared with pre-operative scores, the final Lysholm score (50.71 ± 2.22 vs 89.70 ± 1.18; t = 15.5, P < 0.0001) and VAS score (4.67 ± 0.47 vs 0.92 ± 0.64; t = 22.62, P < 0.0001) were improved at 3 years after MACI. At the three year follow-up, the mean MOCART 2.0 score was 61.56 ± 18.11, and the T2* relaxation time of the repair tissue was significantly lower than that in the healthy control region (24.11 ± 6.38 vs 34.39 ± 1.33, t = - 8.635, P < 0.0001). The mean mMOAKS score was 9.16 ± 4.51. On univariate analysis, the MOCART 2.0 score and T2* relaxation time were negatively associated with the mMOAKS score. CONCLUSION MACI can lead to significant pain relief and restoration of knee joint function, and good quality cartilage repair tissue was a protective factor against PFOA at the three year follow-up.
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Affiliation(s)
- Jialing Lyu
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Sungang Road West, Futian District, Shenzhen, Guangdong Province, China
| | - Hongli Geng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Weimin Zhu
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Dingfu Li
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Sungang Road West, Futian District, Shenzhen, Guangdong Province, China
| | - Kang Chen
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Hui Ye
- Department of PET-CT Centre, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China.
| | - Jun Xia
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Sungang Road West, Futian District, Shenzhen, Guangdong Province, China.
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Zhang Z, Mu Y, Zhou H, Yao H, Wang DA. Cartilage Tissue Engineering in Practice: Preclinical Trials, Clinical Applications, and Prospects. TISSUE ENGINEERING. PART B, REVIEWS 2023; 29:473-490. [PMID: 36964757 DOI: 10.1089/ten.teb.2022.0190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
Articular cartilage defects significantly compromise the quality of life in the global population. Although many strategies are needed to repair articular cartilage, including microfracture, autologous osteochondral transplantation, and osteochondral allograft, the therapeutic effects remain suboptimal. In recent years, with the development of cartilage tissue engineering, scientists have continuously improved the formulations of therapeutic cells, biomaterial-based scaffolds, and biological factors, which have opened new avenues for better therapeutics of cartilage lesions. This review focuses on advances in cartilage tissue engineering, particularly in preclinical trials and clinical applications, prospects, and challenges.
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Affiliation(s)
- Zhen Zhang
- Department of Biomedical Engineering, City University of Hong Kong, Kowloon, Hong Kong SAR
| | - Yulei Mu
- Department of Biomedical Engineering, City University of Hong Kong, Kowloon, Hong Kong SAR
| | - Huiqun Zhou
- Department of Biomedical Engineering, City University of Hong Kong, Kowloon, Hong Kong SAR
| | - Hang Yao
- School of Chemistry and Chemical Engineering, Yangzhou University, Yangzhou, P.R. China
| | - Dong-An Wang
- Department of Biomedical Engineering, City University of Hong Kong, Kowloon, Hong Kong SAR
- Karolinska Institutet Ming Wai Lau Centre for Reparative Medicine, HKSTP, Sha Tin, Hong Kong SAR
- Shenzhen Research Institute, City University of Hong Kong, Shenzhen, P.R. China
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Fani N, Peshkova M, Bikmulina P, Golroo R, Timashev P, Vosough M. Fabricating the cartilage: recent achievements. Cytotechnology 2023; 75:269-292. [PMID: 37389132 PMCID: PMC10299965 DOI: 10.1007/s10616-023-00582-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 05/09/2023] [Indexed: 07/01/2023] Open
Abstract
This review aims to describe the most recent achievements and provide an insight into cartilage engineering and strategies to restore the cartilage defects. Here, we discuss cell types, biomaterials, and biochemical factors applied to form cartilage tissue equivalents and update the status of fabrication techniques, which are used at all stages of engineering the cartilage. The actualized concept to improve the cartilage tissue restoration is based on applying personalized products fabricated using a full cycle platform: a bioprinter, a bioink consisted of ECM-embedded autologous cell aggregates, and a bioreactor. Moreover, in situ platforms can help to skip some steps and enable adjusting the newly formed tissue in the place during the operation. Only some achievements described have passed first stages of clinical translation; nevertheless, the number of their preclinical and clinical trials is expected to grow in the nearest future.
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Affiliation(s)
- Nesa Fani
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Maria Peshkova
- Institute for Regenerative Medicine, Sechenov University, Moscow, Russia
| | - Polina Bikmulina
- Institute for Regenerative Medicine, Sechenov University, Moscow, Russia
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, Sechenov University, Moscow, Russia
| | - Reihaneh Golroo
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Peter Timashev
- Institute for Regenerative Medicine, Sechenov University, Moscow, Russia
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, Sechenov University, Moscow, Russia
| | - Massoud Vosough
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
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Horng A. [Knee cartilage injuries in athletes]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:241-248. [PMID: 36877296 DOI: 10.1007/s00117-023-01128-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Acute and chronic cartilage injuries are often encountered in professional and recreational athletes. They can compromise the athlete's performance and career and are considered a potential risk factor for early joint degeneration. OBJECTIVES Incidence of cartilage injury in athletes, understanding of cartilage composition, injury mechanism and suitable diagnostic imaging are summarized and established therapeutic procedures, postoperative imaging including detection of relevant complications and assessment of reasonable indications for follow-up examinations are described. METHODS Original research and review articles were analyzed. RESULTS Cartilage injury can mimic meniscal or ligamentous injury and cannot be ruled out by clinical examination alone. Magnetic resonance imaging (MRI) is the method of choice to (1) detect (sensitivity 87-93%, specificity 94-99%) and grade cartilage lesions to facilitate choice of therapy and (2) to exclude concomitant injuries that require treatment to improve the prognosis of the chosen cartilage therapy. Postoperatively MRI allows noninvasive assessment of the repaired cartilage tissue and is an appropriate method to detect therapeutically relevant complications. CONCLUSIONS Knowledge of mechanisms and appearance of cartilage injuries, current cartilage repair techniques and their imaging is crucial for the medical care of athletes.
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Affiliation(s)
- Annie Horng
- RZM - Radiologisches Zentrum München, Pippinger Straße 25, 81245, München, Deutschland.
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Postoperative MRI of the Ankle and Foot. Magn Reson Imaging Clin N Am 2022; 30:733-755. [DOI: 10.1016/j.mric.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Zorzi AR, Antonioli E, Kaleka CC, Cohen M, Godoy JAPD, Kondo AT, Kutner JM, Lenza M, Ferretti M. Matrix-assisted autologous chondrocyte transplantation for treatment of focal chondral lesions in the knee: the Hospital Israelita Albert Einstein experience. EINSTEIN-SAO PAULO 2022; 20:eAO6819. [PMID: 35544896 PMCID: PMC9070989 DOI: 10.31744/einstein_journal/2022ao6819] [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: 06/09/2021] [Accepted: 09/30/2021] [Indexed: 12/04/2022] Open
Abstract
Objective Phase 1 clinical trial to determine feasibility, safety, and efficacy of a new advanced cell therapy product for treatment of knee articular cartilage injuries. Methods Three participants with knee focal chondral lesions were included, with no signs of osteoarthritis. Chondrocytes were obtained through knee arthroscopy, cultured in collagen membrane for 3 weeks at the laboratory, subjected to tests to release the cell therapy product, and implanted. All patients underwent a specific 3-month rehabilitation protocol, followed by assessments using functional and imaging scales. The main outcome was the incidence of severe adverse events. Results Three participants were included and completed the 2-year follow-up. There was one severe adverse event, venous thrombosis of distal leg veins, which was no associated with therapy, was treated and left no sequelae. The clinical and radiological scales showed improvement in the three cases. Conclusion The preliminary results, obtained with the described methodology, allow concluding that this product of advanced cell therapy is safe and feasible. ReBEC platform registration number: RBR-6fgy76
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Kusanagi A, Blahut EB, Ogura T, Tsuchiya A, Mizuno S. Repairing Cartilage with Processed Chondrocyte Constructs: A 6-Month Study Using a Porcine Model. Cartilage 2021; 13:1088S-1101S. [PMID: 34763541 PMCID: PMC8804739 DOI: 10.1177/19476035211053837] [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] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Autologous chondrocyte implantation was the first cell-based therapy that used a tissue engineering process to repair cartilage defects. Recently improved approaches and tissue-engineered cell constructs have been developed for growing patient populations. We developed a chondrocyte construct using a collagen gel and sponge scaffold and physicochemical stimuli, implanted with a surgical adhesive. We conducted a proof-of-concept study of these improvements using a cartilage defect model in miniature swine. DESIGN We implanted the autologous chondrocyte constructs into full-thickness chondral defects in the femoral condyle, compared those results with empty and acellular scaffold controls, and compared implantation techniques with adhesive alone and with partial adhesive with suture. Two weeks after the creation of the defects and implantation of the cellular or acellular constructs, we arthroscopically confirmed that the implanted constructs remained at the chondral defects. We evaluated the regenerated tissue macro- and microscopically 6 months after the cell constructs were implanted. The tissues were stained with Safranin-O and evaluated using Sellers' histology grading system. RESULTS The defects implanted with processed cell constructs and acellular scaffolds were filled with chondrocyte-like round cells and with nearly normal tissue architecture that were significantly greater degree compared to empty defect control. Even with the adhesive alone and with suture alone, the cell construct was composed of the dense cartilaginous matrix that was found in the implantation using both the sutures and the adhesive. CONCLUSION Implantation of cell constructs promoted regeneration and integration of articular cartilage at chondral defects in swine by 6 months.
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Affiliation(s)
| | | | - Takahiro Ogura
- Sports Medicine Center, Funabashi
Orthopaedic Hospital, Chiba, Japan
| | - Akihiro Tsuchiya
- Sports Medicine Center, Funabashi
Orthopaedic Hospital, Chiba, Japan
| | - Shuichi Mizuno
- Department of Orthopaedic Surgery,
Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA,Shuichi Mizuno, Department of Orthopedic
Surgery, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis
Street, Boston, MA 02115, USA.
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