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Park D, Choi YH, Kang SH, Koh HS, In Y. Bone Marrow Aspirate Concentrate versus Human Umbilical Cord Blood-Derived Mesenchymal Stem Cells for Combined Cartilage Regeneration Procedure in Patients Undergoing High Tibial Osteotomy: A Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:634. [PMID: 36984635 PMCID: PMC10059261 DOI: 10.3390/medicina59030634] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/20/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023]
Abstract
Background and objectives: Cartilage regeneration using mesenchymal stem cells (MSCs) has been attempted to improve articular cartilage regeneration in varus knee osteoarthritis (OA) patients undergoing high tibial osteotomy (HTO). Bone marrow aspirate concentrate (BMAC) and human umbilical cord blood-derived MSCs (hUCB-MSCs) have been reported to be effective. However, whether BMAC is superior to hUCB-MSCs remains unclear. This systematic review and meta-analysis aimed to determine the clinical efficacy of cartilage repair procedures with BMAC or hUCB-MSCs in patients undergoing HTO. Materials and Methods: A systematic search was conducted using three global databases, PubMed, EMBASE, and the Cochrane Library, for studies in which the clinical outcomes after BMAC or hUCB-MSCs were used in patients undergoing HTO for varus knee OA. Data extraction, quality control, and meta-analysis were performed. To compare the clinical efficacy of BMAC and hUCB-MSCs, reported clinical outcome assessments and second-look arthroscopic findings were analyzed using standardized mean differences (SMDs) with 95% confidence intervals (CIs). Results: The present review included seven studies of 499 patients who received either BMAC (BMAC group, n = 169) or hUCB-MSCs (hUCB-MSC group, n = 330). Improved clinical outcomes were found in both BMAC and hUCB-MSC groups; however, a significant difference was not observed between procedures (International Knee Documentation Committee score; p = 0.91, Western Ontario and McMaster Universities OA Index; p = 0.05, Knee Society Score (KSS) Pain; p = 0.85, KSS Function; p = 0.37). On second-look arthroscopy, the hUCB-MSC group showed better International Cartilage Repair Society Cartilage Repair Assessment grade compared with the BMAC group (p < 0.001). Conclusions: Both BMAC and hUCB-MSCs with HTO improved clinical outcomes in varus knee OA patients, and there was no difference in clinical outcomes between them. However, hUCB-MSCs were more effective in articular cartilage regeneration than BMAC augmentation.
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Affiliation(s)
- Dojoon Park
- Department of Orthopedic Surgery, St. Vincent Hospital, College of Medicine, 93, Jungbu-daero, Paldal-gu, Suwon-si 16247, Republic of Korea
| | - Youn Ho Choi
- Department of Orthopedic Surgery, St. Vincent Hospital, College of Medicine, 93, Jungbu-daero, Paldal-gu, Suwon-si 16247, Republic of Korea
| | - Se Hyun Kang
- Department of Orthopedic Surgery, St. Vincent Hospital, College of Medicine, 93, Jungbu-daero, Paldal-gu, Suwon-si 16247, Republic of Korea
| | - Hae Seok Koh
- Department of Orthopedic Surgery, St. Vincent Hospital, College of Medicine, 93, Jungbu-daero, Paldal-gu, Suwon-si 16247, Republic of Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
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Alcaide-Ruggiero L, Molina-Hernández V, Morgaz J, Fernández-Sarmiento JA, Granados MM, Navarrete-Calvo R, Pérez J, Quirós-Carmona S, Carrillo JM, Cugat R, Domínguez JM. Particulate cartilage and platelet-rich plasma treatment for knee chondral defects in sheep. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-022-07295-7. [PMID: 36598512 DOI: 10.1007/s00167-022-07295-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Articular cartilage is vulnerable to multiple types of damage and it has limited reparative and regenerative capacities due to its absence of vascularity. Although a large number of therapeutic strategies exist to treat chondral defects, they have some limitations, such as fibrocartilage formation. Therefore, the goal of the present study was to evaluate the chondrogenic regenerative properties of an autologous-made matrix of particulated cartilage and platelet-rich plasma (PACI + PRP) implantation for the treatment of full-thickness chondral defects in sheep. METHODS A full-thickness 8 mm diameter cartilage defect was created in the weight-bearing area of the medial femoral condyle in both knees of 16 sheep. The right knees of all animals were treated with particulated autograft cartilage implantation and platelet-rich plasma, while the left knees were injected with Ringer's lactate solution or hyaluronic acid. The sheep were killed 9 or 18 months after surgery. Macroscopic evaluations were performed using three different scoring systems, and histopathological evaluations were performed using a modified scoring system based on different scoring systems. RESULTS The PACI + PRP groups showed statistically significant differences in the percentage of defect repair and chondrocytes in the newly formed cartilage tissue at 18 months compared to 9 months. CONCLUSIONS The results suggest that macroscopic appearance, histological structure and chondrocyte repair were improved when using PACI + PRP treatment for chondral defects, producing an outcome similar to the surrounding healthy cartilage. PACI + PRP is a totally autologous, easy, and unexpensive treatment that can be performed in one-step procedure and is useful as a therapeutic option for knee chondral defects.
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Affiliation(s)
- Lourdes Alcaide-Ruggiero
- Departamento de Medicina y Cirugía Animal. Facultad de Veterinaria, Universidad de Córdoba, Córdoba, Spain.,Fundación García Cugat para Investigación Biomédica, Barcelona, Spain
| | - Verónica Molina-Hernández
- Departamento de Anatomía y Anatomía Patológica Comparadas y Toxicología. UIC Zoonosis y Enfermedades Emergentes ENZOEM, Universidad de Córdoba, Córdoba, Spain.
| | - Juan Morgaz
- Departamento de Medicina y Cirugía Animal. Facultad de Veterinaria, Universidad de Córdoba, Córdoba, Spain
| | | | - María M Granados
- Departamento de Medicina y Cirugía Animal. Facultad de Veterinaria, Universidad de Córdoba, Córdoba, Spain
| | - Rocío Navarrete-Calvo
- Departamento de Medicina y Cirugía Animal. Facultad de Veterinaria, Universidad de Córdoba, Córdoba, Spain
| | - José Pérez
- Departamento de Anatomía y Anatomía Patológica Comparadas y Toxicología. UIC Zoonosis y Enfermedades Emergentes ENZOEM, Universidad de Córdoba, Córdoba, Spain
| | - Setefilla Quirós-Carmona
- Departamento de Medicina y Cirugía Animal. Facultad de Veterinaria, Universidad de Córdoba, Córdoba, Spain
| | - José M Carrillo
- Fundación García Cugat para Investigación Biomédica, Barcelona, Spain.,Departamento de Medicina y Cirugía Animal, Universidad CEU Cardenal Herrera, Valencia, Spain
| | - Ramón Cugat
- Fundación García Cugat para Investigación Biomédica, Barcelona, Spain.,Instituto Cugat y Mutualidad de Futbolistas Españoles, Delegación Catalana, Barcelona, Spain
| | - Juan M Domínguez
- Departamento de Medicina y Cirugía Animal. Facultad de Veterinaria, Universidad de Córdoba, Córdoba, Spain.,Fundación García Cugat para Investigación Biomédica, Barcelona, Spain
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Wang L, Li H, Cao Y, Song C, Chen Q, Hao J, Zhang W, Tian K. Four cases report: Treatment of knee joint cartilage defects using autologous chondrocyte patch implantation. Front Surg 2022; 9:1015091. [PMID: 36425890 PMCID: PMC9679023 DOI: 10.3389/fsurg.2022.1015091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/18/2022] [Indexed: 08/30/2023] Open
Abstract
INTRODUCTION Autologous chondrocyte implantation (ACI) is a crucial method for the treatment of defects in articular cartilage. However, the extant methods for the preparation of autologous chondrocyte patch are relatively complicated and money-consuming. Therefore, an efficient, reliable, easy-to-follow, and cost-effective technique is needed to overcome constraints. This case report aims to introduce an autologous chondrocyte patch fabrication technique to repair knee joint cartilage defects and report our typical cases with a 2-year follow-up. CASE PRESENTATION We described four cases in which patients complained of knee joint pain. According to radiological examination, the patients were diagnosed as knee joint cartilage defect. Arthroscopy and autologous chondrocyte patch implantation were performed as well as a 2-year follow up of patients. The autologous chondrocyte patch for knee joint cartilage repair was fabricated using a "sandwich" technique. The preoperative and postoperative knee function was evaluated by four subjective evaluation systems. MRI was performed for all patients to achieve more intuitionistic observation of the postoperative radiological changes of defect sites. The quality of repaired tissue was evaluated by Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART). Postoperative follow-up showed improvement in clinical and MOCART scores for all patients. However, one patient complained of knee joint pain after walking for a long time or recreational activities from 12- to 18-month postoperatively. The location of pain for this patient was not in accordance with the location of cartilage defect. CONCLUSION The patients undergoing autologous chondrocyte patch implantation demonstrated clinical improvement and good quality of repaired tissue postoperatively. The procedure is an efficient and cost-effective treatment for knee joint cartilage defect in this report. In addition, patients with osteoarthritis carry the risk of a poor outcome after the procedure, and whether to have a procedure should be considered carefully.
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Affiliation(s)
- Le Wang
- Department of Joint and Sports Medicine, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Han Li
- Department of Joint and Sports Medicine, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Yiguo Cao
- Department of Joint and Sports Medicine, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Cheng Song
- Department of Nuclear Medicine, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Qi Chen
- Department of Joint and Sports Medicine, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Jun Hao
- Department of Joint and Sports Medicine, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Weiguo Zhang
- Department of Joint and Sports Medicine, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Kang Tian
- Department of Joint and Sports Medicine, First Affiliated Hospital, Dalian Medical University, Dalian, China
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Burger D, Feucht M, Muench LN, Forkel P, Imhoff AB, Mehl J. Good clinical outcomes after patellar cartilage repair with no evidence for inferior results in complex cases with the need for additional patellofemoral realignment procedures: a systematic review. Knee Surg Sports Traumatol Arthrosc 2022; 30:1752-1768. [PMID: 34510221 PMCID: PMC9033684 DOI: 10.1007/s00167-021-06728-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/30/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE Focal, patellar cartilage defects are a challenging problem as most cases have an underlying multifactorial pathogenesis. This systematic review of current literature analysed clinical results after regenerative cartilage repair of the patella with a special focus on the assessment and treatment of existing patellofemoral malalignment. METHODS A systematic review was conducted to identify articles reporting clinical results after cartilage regenerative surgeries of the patella using the PubMed and Scopus database. The extracted data included patient-reported outcome measures (PROMS) and whether cartilage repair was performed alone or in combination with concomitant surgeries of underlying patellofemoral co-pathologies. In cases of isolated cartilage repair, specific exclusion criteria regarding underlying co-pathologies were screened. In cases of concomitant surgeries, the type of surgeries and their specific indications were extracted. RESULTS A total of 35 original articles were included out of which 27 (77%) were cohort studies with level IV evidence. The most frequently used technique for cartilage restoration of the patella was autologous chondrocyte implantation (ACI). Results after isolated cartilage repair alone were reported by 15 (43%) studies. Of those studies, 9 (60%) excluded patients with underlying patellofemoral malalignment a priori and 6 (40%) did not analyse underlying co-pathologies at all. Among the studies including combined surgeries, the most frequently reported concomitant procedures were release of the lateral retinaculum, reconstruction of the medial patellofemoral ligament (MPFL), and osteotomy of the tibial tubercle. In summary, these studies showed lower preoperative PROMS but similar final PROMS in comparison with the studies reporting on isolated cartilage repair. The most frequently used PROMS were the IKDC-, Lysholm- and the Modified Cincinnati Score. CONCLUSION This comprehensive literature review demonstrated good clinical outcomes after patellar cartilage repair with no evidence of minor results even in complex cases with the need for additional patellofemoral realignment procedures. However, a meaningful statistical comparison between isolated patellar cartilage repair and combined co-procedures is not possible due to very heterogeneous patient cohorts and a lack of analysis of specific subgroups in recent literature. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Daniel Burger
- grid.6936.a0000000123222966Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Matthias Feucht
- Department of Orthopaedic Surgery, Paulinenhilfe, Diakonieklinikum, Stuttgart, Germany
| | - Lukas N. Muench
- grid.6936.a0000000123222966Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Philipp Forkel
- grid.6936.a0000000123222966Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Andreas B. Imhoff
- grid.6936.a0000000123222966Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Julian Mehl
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
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Zahn I, Braun T, Gögele C, Schulze-Tanzil G. Minispheroids as a Tool for Ligament Tissue Engineering: Do the Self-Assembly Techniques and Spheroid Dimensions Influence the Cruciate Ligamentocyte Phenotype? Int J Mol Sci 2021; 22:11011. [PMID: 34681672 PMCID: PMC8537246 DOI: 10.3390/ijms222011011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/29/2021] [Accepted: 10/05/2021] [Indexed: 12/14/2022] Open
Abstract
Spheroid culture might stabilize the ligamentocyte phenotype. Therefore, the phenotype of lapine cruciate ligamentocyte (L-CLs) minispheroids prepared either by hanging drop (HD) method or by using a novel spheroid plate (SP) and the option of methyl cellulose (MC) for tuning spheroid formation was tested. A total of 250 and 1000 L-CLs per spheroid were seeded as HDs or on an SP before performing cell viability assay, morphometry, gene expression (qRT-PCR) and protein immunolocalization after 7 (HD/SP) and 14 (SP) days. Stable and viable spheroids of both sizes could be produced with both methods, but more rapidly with SP. MC accelerated the formation of round spheroids (HD). Their circular areas decreased significantly during culturing. After 7 days, the diameters of HD-derived spheroids were significantly larger compared to those harvested from the SP, with a tendency of lower circularity suggesting an ellipsoid shape. Gene expression of decorin increased significantly after 7 days (HD, similar trend in SP), tenascin C tended to increase after 7 (HD/SP) and 14 days (SP), whereas collagen type 1 decreased (HD/SP) compared to the monolayer control. The cruciate ligament extracellular matrix components could be localized in all mini-spheroids, confirming their conserved expression profile and their suitability for ligament tissue engineering.
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Affiliation(s)
- Ingrid Zahn
- Institute of Anatomy and Cell Biology, Paracelsus Medical University, Nuremberg and Salzburg, Prof. Ernst Nathan Str.1, 90419 Nuremberg, Germany; (I.Z.); (T.B.); (C.G.)
- Institute of Functional and Clinical Anatomy, Friedrich Alexander University, Erlangen-Nuremberg, Universitätsstraße 19, 91054 Erlangen, Germany
- Department of Applied Chemistry, Nuremberg Institute of Technology Georg Simon Ohm, Keßlerplatz 12, 90489 Nuremberg, Germany
| | - Tobias Braun
- Institute of Anatomy and Cell Biology, Paracelsus Medical University, Nuremberg and Salzburg, Prof. Ernst Nathan Str.1, 90419 Nuremberg, Germany; (I.Z.); (T.B.); (C.G.)
- Department of Applied Chemistry, Nuremberg Institute of Technology Georg Simon Ohm, Keßlerplatz 12, 90489 Nuremberg, Germany
- Department of Cardiac Surgery (Cardiovascular Center), Klinikum Nürnberg Süd, Breslauer Str. 201, 90471 Nuremberg, Germany
| | - Clemens Gögele
- Institute of Anatomy and Cell Biology, Paracelsus Medical University, Nuremberg and Salzburg, Prof. Ernst Nathan Str.1, 90419 Nuremberg, Germany; (I.Z.); (T.B.); (C.G.)
- Department of Biosciences, Paris Lodron University of Salzburg, Hellbrunnerstr 34, 5020 Salzburg, Austria
| | - Gundula Schulze-Tanzil
- Institute of Anatomy and Cell Biology, Paracelsus Medical University, Nuremberg and Salzburg, Prof. Ernst Nathan Str.1, 90419 Nuremberg, Germany; (I.Z.); (T.B.); (C.G.)
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Vonk LA, Roël G, Hernigou J, Kaps C, Hernigou P. Role of Matrix-Associated Autologous Chondrocyte Implantation with Spheroids in the Treatment of Large Chondral Defects in the Knee: A Systematic Review. Int J Mol Sci 2021; 22:7149. [PMID: 34281202 PMCID: PMC8267622 DOI: 10.3390/ijms22137149] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/25/2021] [Accepted: 06/29/2021] [Indexed: 12/24/2022] Open
Abstract
Autologous chondrocyte implantation (ACI) is a cell therapy for the treatment of focal cartilage defects. The ACI product that is currently approved for use in the European Union (EU) consists of spheroids of autologous matrix-associated chondrocytes. These spheroids are spherical aggregates of ex vivo expanded human autologous chondrocytes and their self-synthesized extracellular matrix. The aim is to provide an overview of the preclinical and nonclinical studies that have been performed to ensure reproducible quality, safety, and efficacy of the cell therapy, and to evaluate the clinical data on ACI with spheroids. A systematic review was performed to include all English publications on self-aggregated spheroids of chondrocytes cultured in autologous serum without other supplements. A total of 20 publications were included, 7 pre- and nonclinical and 13 clinical research publications. The pre- and nonclinical research publications describe the development from concept to in vivo efficacy and quality- and safety-related aspects such as biodistribution, tumorigenicity, genetic stability, and potency. The evaluation of clinical research shows short- to mid-term safety and efficacy for the ACI with spheroid-based treatment of cartilage defects in both randomized clinical trials with selected patients, as well as in routine treatment providing real-world data in more complex patients.
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Affiliation(s)
- Lucienne Angela Vonk
- CO.DON AG, 14513 Teltow, Germany; (L.A.V.); (G.R.); (C.K.)
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands
| | - Giulietta Roël
- CO.DON AG, 14513 Teltow, Germany; (L.A.V.); (G.R.); (C.K.)
| | - Jacques Hernigou
- Department of Orthopedic Surgery, EpiCURA Hospital, 7331 Baudour, Belgium;
- Laboratory of Bone and Metabolic Biochemistry, Faculty of Medecine, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Christian Kaps
- CO.DON AG, 14513 Teltow, Germany; (L.A.V.); (G.R.); (C.K.)
| | - Philippe Hernigou
- Department of Orthopaedic Surgery, Faculty of Medicine, UPEC (University Paris-Est, Créteil), 94000 Créteil, France
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