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Thacher RR, Pascual-Leone N, Rodeo SA. Treatment of Knee Chondral Defects in Athletes. Sports Med Arthrosc Rev 2024; 32:75-86. [PMID: 38978201 DOI: 10.1097/jsa.0000000000000405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Cartilage lesions of the knee are a challenging problem, especially for active individuals and athletes who desire a return to high-load activities. They occur both through chronic repetitive loading of the knee joint or through acute traumatic injury and represent a major cause of pain and time lost from sport. They can arise as isolated lesions or in association with concomitant knee pathology. Management of these defects ultimately requires a sound understanding of their pathophysiologic underpinnings to help guide treatment. Team physicians should maintain a high index of suspicion for underlying cartilage lesions in any patient presenting with a knee effusion, whether painful or not. A thorough workup should include a complete history and physical examination. MRI is the most sensitive and specific imaging modality to assess these lesions and can provide intricate detail not only of the structure and composition of cartilage, but also of the surrounding physiological environment in the joint. Treatment of these lesions consists of both conservative or supportive measures, as well as surgical interventions designed to restore or regenerate healthy cartilage. Because of the poor inherent capacity for healing associated with hyaline cartilage, the vast majority of symptomatic lesions will ultimately require surgery. Surgical treatment options range from simple arthroscopic debridement to large osteochondral reconstructions. Operative decision-making is based on numerous patient- and defect-related factors and requires open lines of communication between the athlete, the surgeon, and the rest of the treatment team. Ultimately, a positive outcome is based on the creation of a durable, resistant repair that allows the athlete to return to pain-free sporting activities.
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Affiliation(s)
- Ryan R Thacher
- Department of Orthopaedic Surgery, Sports Medicine Institute, Hospital for Special Surgery, New York, NY
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Moore M, Vargas L, Hanidu I, Zverev S, Bi A, Triana J, Gonzalez Lomas G, Jazrawi L, Strauss E, Campbell KA. Immune Hypersensitivity Is Associated With Higher Graft Failure Rate After Osteochondral Allograft Transplantation of the Knee. Arthrosc Sports Med Rehabil 2024; 6:100933. [PMID: 39006793 PMCID: PMC11240029 DOI: 10.1016/j.asmr.2024.100933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/24/2024] [Indexed: 07/16/2024] Open
Abstract
Purpose To analyze the effects of 1 or more patient-reported allergies on clinical outcomes, in particular graft failure rate, and patient-reported outcomes (PROs) following osteochondral allograft transplantation (OCA) of the knee. Methods Retrospective review of patients who underwent knee OCA from August 2010 to May 2021 with a minimum of 2-year follow-up. Patients were initially divided into 2 cohorts: those with at least 1 allergy and those without any allergies. Clinical outcomes assessed included graft failure, reoperation rates, deep vein thrombosis/pulmonary embolism, and manipulation under anesthesia/lysis of adhesions (MUA/LOA). PROs assessed, including the visual analog scale (VAS) for pain and satisfaction, the Knee injury and Osteoarthritis Outcome Score (KOOS), and return to sport rates, were compared. Results In total, 285 patients were included with a mean clinical follow-up of 4.8 ± 2.0 years. The allergy cohort had a significantly higher rate of graft failure (P = .008). In a regression analysis controlling for confounding variables, graft failure remained significantly associated with the presence of medication allergies (odds ratio [OR], 3.631; 95% CI, 1.139-11.577; P = .029). Furthermore, an increasing number of allergies were associated with an increased rate of graft failure (OR, 1.644; 95% CI, 1.074-2.515; P = .022). There was no difference in rate of reoperation, complications, infection, and MUA/LOA. Of the 100 patients who completed PROs, there was no difference in VAS satisfaction, pain, and any of the KOOS outcome scores or return to sport. Conclusions The presence of 1 or more patient-reported allergies was shown to be significantly associated with OCA graft failure. Furthermore, an increasing number of patient-reported allergies were associated with a higher rate of graft failure. However, there were no significant differences in VAS satisfaction or pain, KOOS symptom, quality of life, pain, or return to sport in patients with at least 1 patient-reported allergy and those without allergies. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Michael Moore
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Luilly Vargas
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Idris Hanidu
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Samuel Zverev
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Andrew Bi
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Jairo Triana
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Guillem Gonzalez Lomas
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Laith Jazrawi
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Eric Strauss
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Kirk A. Campbell
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, New York, U.S.A
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Suderman RP, Hurtig MB, Grynpas MD, Kuzyk PRT, Changoor A. Effect of Press-Fit Size on Insertion Mechanics and Cartilage Viability in Human and Ovine Osteochondral Grafts. Cartilage 2024:19476035241247297. [PMID: 38651510 DOI: 10.1177/19476035241247297] [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: 04/25/2024] Open
Abstract
OBJECTIVE The osteochondral allograft procedure uses grafts constructed larger than the recipient site to stabilize the graft, in what is known as the press-fit technique. This research aims to characterize the relationships between press-fit size, insertion forces, and cell viability in ovine and human osteochondral tissue. DESIGN Human (4 donors) and ovine (5 animals) articular joints were used to harvest osteochondral grafts (4.55 mm diameter, N = 33 Human, N = 35 Ovine) and create recipient sites with grafts constructed to achieve varying degrees of press fit (0.025-0.240 mm). Donor grafts were inserted into recipient sites while insertion forces were measured followed by quantification of chondrocyte viability and histological staining to evaluate the extracellular matrix. RESULTS Both human and ovine tissues exhibited similar mechanical and cellular responses to changes in press-fit. Insertion forces (Human: 3-169 MPa, Ovine: 36-314 MPa) and cell viability (Human: 16%-89% live, Ovine: 2%-76% live) were correlated to press-fit size for both human (force: r = 0.539, viability: r = -0.729) and ovine (force: r = 0.655, viability: r = -0.714) tissues. In both species, a press-fit above 0.14 mm resulted in reduced cell viability below a level acceptable for transplantation, increased insertion forces, and reduced linear correlation to press-fit size compared to samples with a press-fit below 0.14 mm. CONCLUSIONS Increasing press-fit size required increased insertion forces and resulted in reduced cell viability. Ovine and human osteochondral tissues responded similarly to impact insertion and varying press-fit size, providing evidence for the use of the ovine model in allograft-related research.
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Affiliation(s)
- R P Suderman
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Kierans Janigan Biomechanics Research Program, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | - M B Hurtig
- Comparative Orthopaedic Research Laboratory, Department of Clinical Studies, University of Guelph, Guelph, ON, Canada
| | - M D Grynpas
- Kierans Janigan Biomechanics Research Program, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Material Science & Engineering, University of Toronto, Toronto, ON, Canada
| | - P R T Kuzyk
- Kierans Janigan Biomechanics Research Program, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - A Changoor
- Kierans Janigan Biomechanics Research Program, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Material Science & Engineering, University of Toronto, Toronto, ON, Canada
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Lee JH, Kim PY, Pyun YC, Park J, Kang TW, Seo JS, Lee DH, Khang G. Cartilage regeneration using transforming growth factor-beta 3-loaded injectable crosslinked hyaluronic acid hydrogel. Biomater Sci 2024; 12:479-494. [PMID: 38090986 DOI: 10.1039/d3bm01008b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Cartilage defects can be difficult to heal, potentially leading to complications such as osteoarthritis. Recently, a tissue engineering approach that uses scaffolds and growth factors has been proposed to regenerate new cartilage tissues. Herein, we investigated the application of hyaluronic acid (HA) gel loaded with transforming growth factor-beta 3 (TGF-β3) for enhanced cartilage regeneration. We assessed the clinical conditions required to efficiently enhance the ability of the modified HA gel to repair defective cartilage. Based on our findings, the prepared HA gel exhibited good physicochemical and mechanical properties and was non-toxic and non-inflammatory. Moreover, HA gel-loaded TGF-β3 (HAT) had improved biocompatibility and promoted the synthesis of cartilage-specific matrix and collagen, further improving its ability to repair defects. The application of HAT resulted in an initial burst release of HA, which degraded slowly in vivo. Finally, HAT combined with microfracture-inducing bone marrow stem cells could significantly improve the cartilage microenvironment and regeneration of cartilage defects. Our results indicate that HA is a suitable material for developing growth factor carriers, whereas HAT is a promising candidate for cartilage regeneration. Furthermore, this differentiated strategy provides a rapid and effective clinical approach for next-generation cartilage regeneration.
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Affiliation(s)
- Ju Hwa Lee
- Department of Bionanotechnology and Bio-Convergence Engineering, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeonbuk 54896, Republic of Korea.
| | - Pil Yun Kim
- Department of PolymerNano Science & Technology and Polymer Materials Fusion Research Center, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeonbuk 54896, Republic of Korea
- CGBio Co., Ltd, Soeul, Republic of Korea
| | - Yun Chang Pyun
- Department of Bionanotechnology and Bio-Convergence Engineering, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeonbuk 54896, Republic of Korea.
| | - Jonggyu Park
- Department of Bionanotechnology and Bio-Convergence Engineering, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeonbuk 54896, Republic of Korea.
| | - Tae Woong Kang
- Department of Bionanotechnology and Bio-Convergence Engineering, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeonbuk 54896, Republic of Korea.
| | - Jin Sol Seo
- Department of Bionanotechnology and Bio-Convergence Engineering, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeonbuk 54896, Republic of Korea.
| | - Dae Hoon Lee
- Department of Bionanotechnology and Bio-Convergence Engineering, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeonbuk 54896, Republic of Korea.
| | - Gilson Khang
- Department of Bionanotechnology and Bio-Convergence Engineering, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeonbuk 54896, Republic of Korea.
- Department of PolymerNano Science & Technology and Polymer Materials Fusion Research Center, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeonbuk 54896, Republic of Korea
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5
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Atwal A, Dale TP, Snow M, Forsyth NR, Davoodi P. Injectable hydrogels: An emerging therapeutic strategy for cartilage regeneration. Adv Colloid Interface Sci 2023; 321:103030. [PMID: 37907031 DOI: 10.1016/j.cis.2023.103030] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 11/02/2023]
Abstract
The impairment of articular cartilage due to traumatic incidents or osteoarthritis has posed significant challenges for healthcare practitioners, researchers, and individuals suffering from these conditions. Due to the absence of an approved treatment strategy for the complete restoration of cartilage defects to their native state, the tissue condition often deteriorates over time, leading to osteoarthritic (OA). However, recent advancements in the field of regenerative medicine have unveiled promising prospects through the utilization of injectable hydrogels. This versatile class of biomaterials, characterized by their ability to emulate the characteristics of native articular cartilage, offers the distinct advantage of minimally invasive administration directly to the site of damage. These hydrogels can also serve as ideal delivery vehicles for a diverse range of bioactive agents, including growth factors, anti-inflammatory drugs, steroids, and cells. The controlled release of such biologically active molecules from hydrogel scaffolds can accelerate cartilage healing, stimulate chondrogenesis, and modulate the inflammatory microenvironment to halt osteoarthritic progression. The present review aims to describe the methods used to design injectable hydrogels, expound upon their applications as delivery vehicles of biologically active molecules, and provide an update on recent advances in leveraging these delivery systems to foster articular cartilage regeneration.
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Affiliation(s)
- Arjan Atwal
- School of Pharmacy and Bioengineering, Hornbeam building, Keele University, Staffordshire ST5 5BG, United Kingdom; Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University, Staffordshire ST4 7QB, United Kingdom
| | - Tina P Dale
- School of Pharmacy and Bioengineering, Hornbeam building, Keele University, Staffordshire ST5 5BG, United Kingdom; Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University, Staffordshire ST4 7QB, United Kingdom
| | - Martyn Snow
- Department of Arthroscopy, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham B31 2AP, United Kingdom; The Robert Jones and Agnes Hunt Hospital, Oswestry, Shropshire SY10 7AG, United Kingdom
| | - Nicholas R Forsyth
- School of Pharmacy and Bioengineering, Hornbeam building, Keele University, Staffordshire ST5 5BG, United Kingdom; Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University, Staffordshire ST4 7QB, United Kingdom; Vice Principals' Office, University of Aberdeen, Kings College, Aberdeen AB24 3FX, United Kingdom
| | - Pooya Davoodi
- School of Pharmacy and Bioengineering, Hornbeam building, Keele University, Staffordshire ST5 5BG, United Kingdom; Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University, Staffordshire ST4 7QB, United Kingdom.
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6
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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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7
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Thampi P, Samulski RJ, Grieger JC, Phillips JN, McIlwraith CW, Goodrich LR. Gene therapy approaches for equine osteoarthritis. Front Vet Sci 2022; 9:962898. [PMID: 36246316 PMCID: PMC9558289 DOI: 10.3389/fvets.2022.962898] [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: 06/06/2022] [Accepted: 08/08/2022] [Indexed: 01/24/2023] Open
Abstract
With an intrinsically low ability for self-repair, articular cartilage injuries often progress to cartilage loss and joint degeneration resulting in osteoarthritis (OA). Osteoarthritis and the associated articular cartilage changes can be debilitating, resulting in lameness and functional disability both in human and equine patients. While articular cartilage damage plays a central role in the pathogenesis of OA, the contribution of other joint tissues to the pathogenesis of OA has increasingly been recognized thus prompting a whole organ approach for therapeutic strategies. Gene therapy methods have generated significant interest in OA therapy in recent years. These utilize viral or non-viral vectors to deliver therapeutic molecules directly into the joint space with the goal of reprogramming the cells' machinery to secrete high levels of the target protein at the site of injection. Several viral vector-based approaches have demonstrated successful gene transfer with persistent therapeutic levels of transgene expression in the equine joint. As an experimental model, horses represent the pathology of human OA more accurately compared to other animal models. The anatomical and biomechanical similarities between equine and human joints also allow for the use of similar imaging and diagnostic methods as used in humans. In addition, horses experience naturally occurring OA and undergo similar therapies as human patients and, therefore, are a clinically relevant patient population. Thus, further studies utilizing this equine model would not only help advance the field of human OA therapy but also benefit the clinical equine patients with naturally occurring joint disease. In this review, we discuss the advancements in gene therapeutic approaches for the treatment of OA with the horse as a relevant patient population as well as an effective and commonly utilized species as a translational model.
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Affiliation(s)
- Parvathy Thampi
- Orthopaedic Research Center, C. Wayne McIlwraith Translational Research Institute, College of Veterinary Medicine, Colorado State University, Fort Collins, CO, United States
| | - R. Jude Samulski
- Gene Therapy Center, University of North Carolina, Chapel Hill, NC, United States
| | - Joshua C. Grieger
- Gene Therapy Center, University of North Carolina, Chapel Hill, NC, United States
| | - Jennifer N. Phillips
- Orthopaedic Research Center, C. Wayne McIlwraith Translational Research Institute, College of Veterinary Medicine, Colorado State University, Fort Collins, CO, United States
| | - C. Wayne McIlwraith
- Orthopaedic Research Center, C. Wayne McIlwraith Translational Research Institute, College of Veterinary Medicine, Colorado State University, Fort Collins, CO, United States
| | - Laurie R. Goodrich
- Orthopaedic Research Center, C. Wayne McIlwraith Translational Research Institute, College of Veterinary Medicine, Colorado State University, Fort Collins, CO, United States,*Correspondence: Laurie R. Goodrich
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Xie M, Zhang Y, Xiong Z, Hines S, Shangjiang Y, Clark KL, Tan S, Alexander PG, Lin H. Generation of hyaline-like cartilage tissue from human mesenchymal stromal cells within the self-generated extracellular matrix. Acta Biomater 2022; 149:150-166. [PMID: 35779770 DOI: 10.1016/j.actbio.2022.06.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 12/20/2022]
Abstract
Chondrocytic hypertrophy, a phenotype not observed in healthy hyaline cartilage, is often concomitant with the chondrogenesis of human mesenchymal stromal cells (hMSCs). This undesired feature represents one of the major obstacles in applying hMSCs for hyaline cartilage repair. Previously, we developed a method to induce hMSC chondrogenesis within self-generated extracellular matrix (mECM), which formed a cartilage tissue with a lower hypertrophy level than conventional hMSC pellets. In this study, we aimed to test the utility of hypoxia and insulin-like growth factor-1 (IGF1) on further reducing hypertrophy. MSC-mECM constructs were first subjected to chondrogenic culture in normoxic or hypoxic (5%) conditions. The results indicated that hMSC-derived cartilage formed in hypoxic culture displayed a significantly reduced hypertrophy level than normoxic culture. However, hMSC chondrogenesis was also suppressed under hypoxic culture, partially due to the reduced activity of the IGF1 pathway. IGF1 was then supplemented in the chondrogenic medium, which promoted remarkable hMSC chondrogenesis under hypoxic culture. Interestingly, the IGF1-enhanced hMSC chondrogenesis, under hypoxic culture, was not at the expense of promoting significantly increased hypertrophy. Lastly, the cartilage tissues created by hMSCs with different conditions were implanted into osteochondral defect in rats. The results indicated that the tissue formed under hypoxic condition and induced with IGF1-supplemented chondrogenic medium displayed the best reparative results with minimal hypertrophy level. Our results demonstrate a new method to generate hyaline cartilage-like tissue from hMSCs without using exogenous scaffolds, which further pave the road for the clinical application of hMSC-based cartilage tissue engineering. STATEMENT OF SIGNIFICANCE: In this study, hyaline cartilage-like tissues were generated from human mesenchymal stromal cells (hMSCs), which displayed robust capacity in repairing the osteochondral defect in rats. In particular, the extracellular matrix created by hMSCs was used, so no exogenous scaffold was needed. Through a series of optimization, we defined that hypoxic culture and supplementation of insulin-like growth factor-1 (IGF-1) in chondrogenic medium resulted in robust cartilage formation with minimal hypertrophy. We also demonstrated that hypoxic culture suppressed chondrogenesis and hypertrophy through modulating the Wnt/β-catenin and IGF1 pathways, respectively. Our results demonstrate a new method to generate hyaline cartilage-like tissue from hMSCs without using exogenous scaffolds, which will further pave the road for the clinical application of hMSCs-based cartilage tissue engineering.
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Affiliation(s)
- Mingsheng Xie
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 450 Technology Drive, Room 217, Pittsburgh, PA 15217, USA; Department of Orthopaedic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Yiqian Zhang
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 450 Technology Drive, Room 217, Pittsburgh, PA 15217, USA; Department of Orthopaedic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Zixuan Xiong
- Xiangya School of Medicine, Central South University, Changsha, Hunan, 410008, China
| | - Sophie Hines
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 450 Technology Drive, Room 217, Pittsburgh, PA 15217, USA
| | - Yingzi Shangjiang
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 450 Technology Drive, Room 217, Pittsburgh, PA 15217, USA
| | - Karen L Clark
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 450 Technology Drive, Room 217, Pittsburgh, PA 15217, USA
| | - Susheng Tan
- Department of Electrical and Computer Engineering, Swanson School of Engineering, and Petersen Institute of NanoScience and Engineering, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Peter G Alexander
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 450 Technology Drive, Room 217, Pittsburgh, PA 15217, USA; McGowan Institute for Regenerative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA
| | - Hang Lin
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 450 Technology Drive, Room 217, Pittsburgh, PA 15217, USA; McGowan Institute for Regenerative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA; Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA 15219, USA.
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9
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Photo-Crosslinkable Hydrogels for 3D Bioprinting in the Repair of Osteochondral Defects: A Review of Present Applications and Future Perspectives. MICROMACHINES 2022; 13:mi13071038. [PMID: 35888855 PMCID: PMC9318225 DOI: 10.3390/mi13071038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/08/2022] [Accepted: 06/22/2022] [Indexed: 11/23/2022]
Abstract
An osteochondral defect is a common and frequent disease in orthopedics and treatment effects are not good, which can be harmful to patients. Hydrogels have been applied in the repair of cartilage defects. Many studies have reported that hydrogels can effectively repair osteochondral defects through loaded cells or non-loaded cells. As a new type of hydrogel, photo-crosslinked hydrogel has been widely applied in more and more fields. Meanwhile, 3D bioprinting serves as an attractive platform to fabricate customized tissue-engineered substitutes from biomaterials and cells for the repair or replacement of injured tissues and organs. Although photo-crosslinkable hydrogel-based 3D bioprinting has some advantages for repairing bone cartilage defects, it also has some disadvantages. Our aim of this paper is to review the current status and prospect of photo-crosslinkable hydrogel-based 3D bioprinting for repairing osteochondral defects.
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10
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Matthews JR, Brutico J, Heard J, Chauhan K, Tucker B, Freedman KB. Comparison of clinical outcomes following osteochondral allograft transplantation for osteochondral versus chondral defects in the knee. Knee Surg Relat Res 2022; 34:23. [PMID: 35509057 PMCID: PMC9066852 DOI: 10.1186/s43019-022-00149-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 04/03/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose Osteochondral allograft (OCA) transplantation is a restorative technique for addressing articular cartilage defects by transferring mature viable chondrocytes with subchondral bone into size-matched lesions. The purpose of this study was to compare differences in clinical and functional outcomes in patients treated with OCA for osteochondral defects compared with isolated chondral pathology.
Methods A retrospective review identified patients who underwent OCA transplantation and grouped them into osteochondral or isolated chondral pathology. Demographic data, surgical history, lesion characteristics, complications, and rate of subsequent surgery were reviewed. The review included 86 patients (24 osteochondral, 62 chondral) with a mean follow-up of 5.4 ± 1.4 years. Outcome measures included the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR.), International Knee Documentation Committee (IKDC), and Short Form Health Survey (SF-12) physical scores. Failure was defined to include revision OCA, graft removal, conversion to ACI, or conversion to arthroplasty.
Results The average age at surgery was 32.3 and 37.3 years for the osteochondral and chondral groups, respectively (P = 0.056). The medial femoral condyle was the most common defect location in both groups. P < 0.05 was considered statistically significant. Patients with osteochondral pathology had significantly greater KOOS JR., IKDC, and SF-12 scores (P < 0.05), and fewer failures were reported in the osteochondral group (8.3% versus 32.3%, P = 0.045). When controlling for age, sex, laterality, BMI, and presence of a concomitant procedure, patients with osteochondral pathology were found to have better KOOS and IKDC scores, but there was no difference in SF12 scores or rates of failure between groups.
Conclusion The findings of this study indicate that patients undergoing OCA for osteochondral defects may have greater functional outcomes and similar failure rates compared with OCA transplantation for isolated chondral pathology.
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Affiliation(s)
- John Reza Matthews
- Department of Orthopedic Surgery, Thomas Jefferson Rothman Institute Sports Fellow, 925 Chestnut St., Philadelphia, PA, 19107, USA.
| | - Joseph Brutico
- Department of Orthopedic Surgery, Rothman Institute Research Fellow, Philadelphia, USA
| | - Jeremy Heard
- Internal Medicine Resident, Thomas Jefferson University, Philadelphia, USA
| | - Kashyap Chauhan
- Internal Medicine Resident, Thomas Jefferson University, Philadelphia, USA
| | - Bradford Tucker
- Cartilage Restoration Center, Orthopaedic Surgery, Thomas Jefferson Rothman Institute, Philadelphia, USA
| | - Kevin Blake Freedman
- Cartilage Restoration Center, Orthopaedic Surgery, Thomas Jefferson Rothman Institute, Philadelphia, USA
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11
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Criswell T, Swart C, Stoudemire J, Brockbank K, Floren M, Eaker S, Hunsberger J. OUP accepted manuscript. Stem Cells Transl Med 2022; 11:107-113. [PMID: 36239619 PMCID: PMC9562819 DOI: 10.1093/stcltm/szab025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/07/2021] [Indexed: 11/20/2022] Open
Abstract
Advances in regenerative medicine manufacturing continue to be a priority for achieving the full commercial potential of important breakthrough therapies. Equally important will be the establishment of distribution chains that support the transport of live cells and engineered tissues and organs resulting from these advanced biomanufacturing processes. The importance of a well-managed distribution chain for products requiring specialized handling procedures was highlighted during the COVID-19 pandemic and serves as a reminder of the critical role of logistics and distribution in the success of breakthrough therapies. This perspective article will provide insight into current practices and future considerations for creating global distribution chains that facilitate the successful deployment of regenerative medicine therapies to the vast number of patients that would benefit from them worldwide.
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Affiliation(s)
- Tracy Criswell
- Wake Forest Institute for Regenerative Medicine, Winston-Salem, NC, USA
- Corresponding author: Tracy Criswell, PhD, Wake Forest School of Medicine, Wake Forest Institute for Regenerative Medicine, 391 Technology Way, Winston-Salem, NC 27101, USA. Tel: 336-713-1615;
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12
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Owusu-Akyaw KA, Bido J, Warner T, Rodeo SA, Williams RJ. SF-36 Physical Component Score Is Predictive of Achieving a Clinically Meaningful Improvement after Osteochondral Allograft Transplantation of the Femur. Cartilage 2021; 13:853S-859S. [PMID: 32940050 PMCID: PMC8808818 DOI: 10.1177/1947603520958132] [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: 11/16/2022] Open
Abstract
BACKGROUND Osteochondral allograft (OCA) transplantation is an increasingly common treatment for patients with symptomatic focal chondral lesions of the knee. There has been increasing interest in determining predictive factors to maximize patient benefit after this operation. The aim of the present study is to evaluate the predictive association of the physical component (PCS) and mental component (MCS) scores of the Short Form 36 (SF-36) questionnaire for achievement of the minimal clinically important difference (MCID) after OCA transplantation. METHODS This retrospective study of a longitudinally maintained institutional registry included 91 patients who had undergone OCA transplantation for symptomatic focal osteochondral lesions of the femoral condyle. Included patients were those with complete preoperative questionnaires for the SF-36 and IKDC and completed postoperative IKDC at 2-year follow-up. Multivariate analysis was performed evaluating predictive association of the preoperative MCS and PCS with achievement of the MCID for the IKDC questionnaire. RESULTS Logistic multivariate modeling demonstrated a statistically significant association between lower preoperative PCS and achievement of the MCID (P = 0.022). A defect diameter >2 cm was also associated with achievement of MCID (P = 0.049). Preoperative MCS did not demonstrate a significant association (P = 0.09) with achievement of the MCID. CONCLUSIONS For this cohort of 91 patients, the preoperative SF-36 PCS and lesion size were predictive of achievement of the MCID at 2-year follow-up after femoral OCA transplantation. These findings support an important role of baseline physical health scores for predicting which patients will obtain a meaningful clinical benefit from this surgery.
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Affiliation(s)
- Kwadwo A. Owusu-Akyaw
- Hospital for Special Surgery, New York,
NY, USA,Kwadwo A. Owusu-Akyaw, Hospital for Special
Surgery, 535 E 70th St, New York, NY 10021, USA.
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13
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Doyle SE, Snow F, Duchi S, O’Connell CD, Onofrillo C, Di Bella C, Pirogova E. 3D Printed Multiphasic Scaffolds for Osteochondral Repair: Challenges and Opportunities. Int J Mol Sci 2021; 22:12420. [PMID: 34830302 PMCID: PMC8622524 DOI: 10.3390/ijms222212420] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 12/19/2022] Open
Abstract
Osteochondral (OC) defects are debilitating joint injuries characterized by the loss of full thickness articular cartilage along with the underlying calcified cartilage through to the subchondral bone. While current surgical treatments can provide some relief from pain, none can fully repair all the components of the OC unit and restore its native function. Engineering OC tissue is challenging due to the presence of the three distinct tissue regions. Recent advances in additive manufacturing provide unprecedented control over the internal microstructure of bioscaffolds, the patterning of growth factors and the encapsulation of potentially regenerative cells. These developments are ushering in a new paradigm of 'multiphasic' scaffold designs in which the optimal micro-environment for each tissue region is individually crafted. Although the adoption of these techniques provides new opportunities in OC research, it also introduces challenges, such as creating tissue interfaces, integrating multiple fabrication techniques and co-culturing different cells within the same construct. This review captures the considerations and capabilities in developing 3D printed OC scaffolds, including materials, fabrication techniques, mechanical function, biological components and design.
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Affiliation(s)
- Stephanie E. Doyle
- Electrical and Biomedical Engineering, School of Engineering, RMIT University, Melbourne, VIC 3000, Australia; (F.S.)
- ACMD, St Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (S.D.); (C.O.); (C.D.B.)
| | - Finn Snow
- Electrical and Biomedical Engineering, School of Engineering, RMIT University, Melbourne, VIC 3000, Australia; (F.S.)
| | - Serena Duchi
- ACMD, St Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (S.D.); (C.O.); (C.D.B.)
- Department of Surgery, The University of Melbourne, St Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia
- ARC Centre of Excellence for Electromaterials Science, Intelligent Polymer Research Institute, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Cathal D. O’Connell
- Electrical and Biomedical Engineering, School of Engineering, RMIT University, Melbourne, VIC 3000, Australia; (F.S.)
- ACMD, St Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (S.D.); (C.O.); (C.D.B.)
| | - Carmine Onofrillo
- ACMD, St Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (S.D.); (C.O.); (C.D.B.)
- Department of Surgery, The University of Melbourne, St Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia
- ARC Centre of Excellence for Electromaterials Science, Intelligent Polymer Research Institute, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Claudia Di Bella
- ACMD, St Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (S.D.); (C.O.); (C.D.B.)
- Department of Surgery, The University of Melbourne, St Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia
- Department of Orthopaedics, St Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia
| | - Elena Pirogova
- Electrical and Biomedical Engineering, School of Engineering, RMIT University, Melbourne, VIC 3000, Australia; (F.S.)
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14
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Guzman AJ, Dela Rueda T, Rayos Del Sol SM, Bryant SA, Jenkins S, Gardner B, McGahan PJ, Chen JL. Arthroscopic Osteochondral Autograft Transfer System Procedure of the Lateral Femoral Condyle with Donor-Site Backfill Using Osteochondral Allograft Plug. Arthrosc Tech 2021; 10:e2683-e2689. [PMID: 35004149 PMCID: PMC8719136 DOI: 10.1016/j.eats.2021.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/06/2021] [Indexed: 02/03/2023] Open
Abstract
The osteochondral autograft transfer system (OATS) procedure is at the forefront of cartilage restoration surgeries of the knee, offering superior return to sport rates and long-term functionality. This technique reports an arthroscopic OATS procedure of the lateral femoral condyle with donor-site backfill using an osteochondral allograft plug. Potential complications from unfilled donor site sockets are eliminated through donor site backfill with an allograft plug.
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Affiliation(s)
- Alvarho J. Guzman
- Address correspondence to Alvarho J. Guzman, B.A., Advanced Orthopaedics and Sports Medicine, 450 Sutter St, Ste 400, San Francisco, CA 94108, U.S.A.
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15
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Acetabular Coverage May Affect Radiographic and Clinical Outcomes of Osteochondral Allograft Transplantation of Focal Femoral Head Lesions: A Case Series From a Single Institution. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202110000-00008. [PMID: 34637410 DOI: 10.5435/jaaosglobal-d-20-00219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 08/22/2021] [Indexed: 11/18/2022]
Abstract
Osteochondral lesions of the femoral head in young people are rare and present unique management challenges. Optimal treatment for these lesions is unclear. From 2009 to 2016, clinical and radiographic outcomes were prospectively collected within a series of symptomatic focal osteochondral lesions of the femoral head with a minimum follow-up of 2 years. A surgical hip dislocation followed by implantation of a size-matched fresh osteochondral femoral head allograft was performed. Nine hips in eight patients (6 female patients) underwent surgery at an average of 17 years (11 to 21 years). Individual allograft sizes ranged from 10 to 35 mm in diameter; with 2 of 9 hips receiving two allografts in a stacked or mosaicplasty technique at the time of treatment. The average graft implantation was 3536.5 mm2. Modified Harris hip scores improved by 13.4 (P = 0.018) from preoperative to final follow-up for all patients. Significant improvements in internal rotation (12° versus 23°, P = 0.011), external rotation (32° versus 50°, P = 0.041), and abduction (28° versus 40°, P = 0.042) were also achieved. Three patients (four hips) demonstrated poor radiographic healing (<50% incorporation at 2 years), which correlated with worse clinical outcomes and was associated with a lower preoperative lateral center edge angle (21.5° versus 30.4°, P = 0.049). Fresh osteochondral allograft treatment is a good option for focal osteochondral lesions of the femoral head with improved outcomes and motion; however, higher failure rates may be seen in those with a lower center edge angle.
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16
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Rana MM, De la Hoz Siegler H. Tuning the Properties of PNIPAm-Based Hydrogel Scaffolds for Cartilage Tissue Engineering. Polymers (Basel) 2021; 13:3154. [PMID: 34578055 PMCID: PMC8467289 DOI: 10.3390/polym13183154] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 01/15/2023] Open
Abstract
Poly(N-isopropylacrylamide) (PNIPAm) is a three-dimensional (3D) crosslinked polymer that can interact with human cells and play an important role in the development of tissue morphogenesis in both in vitro and in vivo conditions. PNIPAm-based scaffolds possess many desirable structural and physical properties required for tissue regeneration, but insufficient mechanical strength, biocompatibility, and biomimicry for tissue development remain obstacles for their application in tissue engineering. The structural integrity and physical properties of the hydrogels depend on the crosslinks formed between polymer chains during synthesis. A variety of design variables including crosslinker content, the combination of natural and synthetic polymers, and solvent type have been explored over the past decade to develop PNIPAm-based scaffolds with optimized properties suitable for tissue engineering applications. These design parameters have been implemented to provide hydrogel scaffolds with dynamic and spatially patterned cues that mimic the biological environment and guide the required cellular functions for cartilage tissue regeneration. The current advances on tuning the properties of PNIPAm-based scaffolds were searched for on Google Scholar, PubMed, and Web of Science. This review provides a comprehensive overview of the scaffolding properties of PNIPAm-based hydrogels and the effects of synthesis-solvent and crosslinking density on tuning these properties. Finally, the challenges and perspectives of considering these two design variables for developing PNIPAm-based scaffolds are outlined.
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Affiliation(s)
- Md Mohosin Rana
- Biomedical Engineering Graduate Program, Schulich School of Engineering, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Hector De la Hoz Siegler
- Biomedical Engineering Graduate Program, Schulich School of Engineering, University of Calgary, Calgary, AB T2N 1N4, Canada;
- Department of Chemical and Petroleum Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB T2N 1N4, Canada
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17
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Nelson BB, Mäkelä JTA, Lawson TB, Patwa AN, Snyder BD, McIlwraith CW, Grinstaff MW, Goodrich LR, Kawcak CE. Cationic contrast-enhanced computed tomography distinguishes between reparative, degenerative, and healthy equine articular cartilage. J Orthop Res 2021; 39:1647-1657. [PMID: 33104251 DOI: 10.1002/jor.24894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/21/2020] [Accepted: 10/21/2020] [Indexed: 02/04/2023]
Abstract
Cationic contrast-enhanced computed tomography (CECT) is a quantitative imaging technique that characterizes articular cartilage, though its efficacy in differentiating repair tissue from other disease states is undetermined. We hypothesized that cationic CECT attenuation will distinguish between reparative, degenerative, and healthy equine articular cartilage and will reflect biochemical, mechanical, and histologic properties. Chondral defects were created in vivo on equine femoropatellar joint surfaces. Within defects, calcified cartilage was retained (Repair 1) or removed (Repair 2). At sacrifice, plugs were collected from within defects, and at locations bordering (adjacent site) and remote to defects along with site-matched controls. Articular cartilage was analyzed via CECT using CA4+ to assess glycosaminoglycan (GAG) content, compressive modulus (E eq ), and International Cartilage Repair Society (ICRS) II histologic score. Comparisons of variables were made between sites using mixed model analysis and between variables with correlations. Cationic CECT attenuation was significantly lower in Repair 1 (1478 ± 333 Hounsfield units [HUs]), Repair 2 (1229 ± 191 HUs), and adjacent (2139 ± 336 HUs) sites when compared with site-matched controls (2587 ± 298, 2505 ± 184, and 2563 ± 538 HUs, respectively; all p < .0001). Cationic CECT attenuation was significantly higher at remote sites (2928 ± 420 HUs) compared with Repair 1, Repair 2, and adjacent sites (all p < .0001). Cationic CECT attenuation correlated with ICRS II score (r = .79), GAG (r = .76), and E eq (r = .71; all p < .0001). Cationic CECT distinguishes between reparative, degenerative, and healthy articular cartilage and highly correlates with biochemical, mechanical, and histological tissue properties.
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Affiliation(s)
- Brad B Nelson
- Orthopaedic Research Center, C. Wayne McIlwraith Translational Medicine Institute, Colorado State University, Fort Collins, Colorado, USA
| | - Janne T A Mäkelä
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Departments of Chemistry, Boston University, Boston, Massachusetts, USA.,Department Biomedical Engineering, Boston University, Boston, Massachusetts, USA
| | - Taylor B Lawson
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.,Departments of Chemistry, Boston University, Boston, Massachusetts, USA.,Department Biomedical Engineering, Boston University, Boston, Massachusetts, USA
| | - Amit N Patwa
- Departments of Chemistry, Boston University, Boston, Massachusetts, USA.,Department Biomedical Engineering, Boston University, Boston, Massachusetts, USA.,Deparment of Chemistry, School of Science, Navrachana University, Vadodara, Gujarat, India
| | - Brian D Snyder
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - C Wayne McIlwraith
- Orthopaedic Research Center, C. Wayne McIlwraith Translational Medicine Institute, Colorado State University, Fort Collins, Colorado, USA
| | - Mark W Grinstaff
- Departments of Chemistry, Boston University, Boston, Massachusetts, USA.,Department Biomedical Engineering, Boston University, Boston, Massachusetts, USA
| | - Laurie R Goodrich
- Orthopaedic Research Center, C. Wayne McIlwraith Translational Medicine Institute, Colorado State University, Fort Collins, Colorado, USA
| | - Chris E Kawcak
- Orthopaedic Research Center, C. Wayne McIlwraith Translational Medicine Institute, Colorado State University, Fort Collins, Colorado, USA
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18
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Borges Petros RS, Prinz RAD, Pinho Rodarte RR, Aguiar DP, Branco de Sousa E. Harvest, Transport, and Storage of Fresh Humeral Head Osteochondral Allograft: Step-by-Step Protocol. Arthrosc Tech 2021; 10:e1805-e1813. [PMID: 34336579 PMCID: PMC8322626 DOI: 10.1016/j.eats.2021.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/19/2021] [Indexed: 02/03/2023] Open
Abstract
Articular cartilage defects are not common in the glenohumeral joint and are mostly found in patients after shoulder trauma, in patients with recurrent instability, or in patients who underwent previous surgical treatment. Articular cartilage defects lead to pain and loss of motion, consequently causing shoulder function impairment and reducing quality of life. In young patients, the use of osteochondral allografts for the treatment of humeral head defects may avoid well-known complications of shoulder arthroplasty. The goal of this Technical Note is to describe a step-by-step protocol for the harvesting, transport, and preservation of fresh humeral head osteochondral tissue for use in allograft transplantation.
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Affiliation(s)
- Rodrigo Souto Borges Petros
- Divisão de Ensino e Pesquisa, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, São Cristóvão, Brazil.,Divisão de Banco Multitecidos, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, São Cristóvão, Brazil
| | - Rafael Augusto Dantas Prinz
- Divisão de Banco Multitecidos, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, São Cristóvão, Brazil
| | | | - Diego Pinheiro Aguiar
- Divisão de Ensino e Pesquisa, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, São Cristóvão, Brazil.,Centro Universitário Estadual da Zona Oeste, Campo Grande, Brazil
| | - Eduardo Branco de Sousa
- Divisão de Ensino e Pesquisa, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, São Cristóvão, Brazil
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19
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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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20
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Espinosa MG, Otarola GA, Hu JC, Athanasiou KA. Cartilage Assessment Requires a Surface Characterization Protocol: Roughness, Friction, and Function. Tissue Eng Part C Methods 2021; 27:276-286. [PMID: 33678002 DOI: 10.1089/ten.tec.2020.0367] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The surface of articular cartilage is integral to smooth, low-friction joint articulation. However, the majority of cartilage literature rarely includes measurements of surface characteristics and function. This may, in part, be due to a shortage of or unfamiliarity with fast, nondestructive, and, preferably, noncontact methods that can be applied to large cartilage surfaces for evaluating cartilage surface characteristics. A comprehensive methodology for characterizing cartilage surfaces is useful in determining changes in tissue function, as for example, in cases where the quality of cartilage grafts needs to be assessed. With cartilage storage conditions being an area of ongoing and active research, this study used interferometry and tribology methods as efficient and nondestructive ways of evaluating changes in cartilage surface topography, roughness, and coefficient of friction (CoF) resulting from various storage temperatures and durations. Standard, destructive testing for bulk mechanical and biochemical properties, as well as immunohistochemistry, were also performed. For the first time, interferometry was used to show cartilage topographical anisotropy through an anterior-posterior striated pattern in the same direction as joint articulation. Another novel observation enabled by tribology was frictional anisotropy, illustrated by a 53% increase in CoF in the medial-lateral direction compared to the anterior-posterior direction. Of the storage conditions examined, 37°C, 4°C, -20°C, and -80°C for 1 day, 1 week, and 1 month, a 49% decrease in CoF was observed at 1 week in -80°C. Interestingly, prolonged storage at 37°C resulted in up to an 83% increase in the compressive aggregate modulus by 1 month, with a corresponding increase in the glycosaminoglycan (GAG) bulk content. This study illustrates the differential effects of storage conditions on cartilage: freezing tends to target surface properties, while nonfreezing storage impacts the tissue bulk. These data show that a bulk-only analysis of cartilage function is not sufficient or representative. The nondestructive surface characterization assays described here enable improvement in cartilage functionality assessment by considering both surface and bulk cartilage properties; this methodology may thus provide a new angle to explore in future cartilage research and tissue engineering endeavors.
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Affiliation(s)
- M Gabriela Espinosa
- Department of Biomedical Engineering, University of California, Irvine, Irvine, California, USA
| | - Gaston A Otarola
- Department of Biomedical Engineering, University of California, Irvine, Irvine, California, USA
| | - Jerry C Hu
- Department of Biomedical Engineering, University of California, Irvine, Irvine, California, USA
| | - Kyriacos A Athanasiou
- Department of Biomedical Engineering, University of California, Irvine, Irvine, California, USA
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21
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Abstract
BACKGROUND Back pain is a common chief complaint within the United States and is caused by a multitude of etiologies. There are many different treatment modalities for back pain, with a frequent option being spinal fusion procedures. The success of spinal fusion greatly depends on instrumentation, construct design, and bone grafts used in surgery. Bone allografts are important for both structural integrity and providing a scaffold for bone fusion to occur. METHOD Searches were performed using terms "allografts" and "bone" as well as product names in peer reviewed literature Pubmed, Google Scholar, FDA-510k approvals, and clinicaltrials.gov. RESULTS This study is a review of allografts and focuses on currently available products and their success in both animal and clinical studies. CONCLUSION Bone grafts used in surgery are generally categorized into 3 main types: autogenous (from patient's own body), allograft (from cadaveric or living donor), and synthetic. This paper focuses on allografts and provides an overview on the different subtypes with an emphasis on recent product development and uses in spinal fusion surgery.
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Affiliation(s)
- Justin D. Cohen
- Department of
Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Linda E. Kanim
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Andrew J. Tronits
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Hyun W. Bae
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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22
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Messaoudi O, Henrionnet C, Bourge K, Loeuille D, Gillet P, Pinzano A. Stem Cells and Extrusion 3D Printing for Hyaline Cartilage Engineering. Cells 2020; 10:cells10010002. [PMID: 33374921 PMCID: PMC7821921 DOI: 10.3390/cells10010002] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/16/2020] [Accepted: 12/19/2020] [Indexed: 02/07/2023] Open
Abstract
Hyaline cartilage is deficient in self-healing properties. The early treatment of focal cartilage lesions is a public health challenge to prevent long-term degradation and the occurrence of osteoarthritis. Cartilage tissue engineering represents a promising alternative to the current insufficient surgical solutions. 3D printing is a thriving technology and offers new possibilities for personalized regenerative medicine. Extrusion-based processes permit the deposition of cell-seeded bioinks, in a layer-by-layer manner, allowing mimicry of the native zonal organization of hyaline cartilage. Mesenchymal stem cells (MSCs) are a promising cell source for cartilage tissue engineering. Originally isolated from bone marrow, they can now be derived from many different cell sources (e.g., synovium, dental pulp, Wharton’s jelly). Their proliferation and differentiation potential are well characterized, and they possess good chondrogenic potential, making them appropriate candidates for cartilage reconstruction. This review summarizes the different sources, origins, and densities of MSCs used in extrusion-based bioprinting (EBB) processes, as alternatives to chondrocytes. The different bioink constituents and their advantages for producing substitutes mimicking healthy hyaline cartilage is also discussed.
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Affiliation(s)
- Océane Messaoudi
- UMR 7365 CNRS-UL, IMoPA (Ingénierie Moléculaire et Physiopathologie Articulaire), Biopôle de l’Université de Lorraine, Campus Brabois-Santé, 9, Avenue de la Forêt de Haye, BP20199, 54505 Vandœuvre-Lès-Nancy, France; (O.M.); (C.H.); (K.B.); (D.L.); (P.G.)
| | - Christel Henrionnet
- UMR 7365 CNRS-UL, IMoPA (Ingénierie Moléculaire et Physiopathologie Articulaire), Biopôle de l’Université de Lorraine, Campus Brabois-Santé, 9, Avenue de la Forêt de Haye, BP20199, 54505 Vandœuvre-Lès-Nancy, France; (O.M.); (C.H.); (K.B.); (D.L.); (P.G.)
| | - Kevin Bourge
- UMR 7365 CNRS-UL, IMoPA (Ingénierie Moléculaire et Physiopathologie Articulaire), Biopôle de l’Université de Lorraine, Campus Brabois-Santé, 9, Avenue de la Forêt de Haye, BP20199, 54505 Vandœuvre-Lès-Nancy, France; (O.M.); (C.H.); (K.B.); (D.L.); (P.G.)
| | - Damien Loeuille
- UMR 7365 CNRS-UL, IMoPA (Ingénierie Moléculaire et Physiopathologie Articulaire), Biopôle de l’Université de Lorraine, Campus Brabois-Santé, 9, Avenue de la Forêt de Haye, BP20199, 54505 Vandœuvre-Lès-Nancy, France; (O.M.); (C.H.); (K.B.); (D.L.); (P.G.)
- Service de Rhumatologie, CHRU de Nancy, Hôpitaux de Brabois, Bâtiment des Spécialités Médicales, 5 rue du Morvan, F54511 Vandœuvre-Lès-Nancy, France
| | - Pierre Gillet
- UMR 7365 CNRS-UL, IMoPA (Ingénierie Moléculaire et Physiopathologie Articulaire), Biopôle de l’Université de Lorraine, Campus Brabois-Santé, 9, Avenue de la Forêt de Haye, BP20199, 54505 Vandœuvre-Lès-Nancy, France; (O.M.); (C.H.); (K.B.); (D.L.); (P.G.)
- Laboratoire de Pharmacologie, Toxicologie et Pharmacovigilance, Bâtiment de Biologie Médicale et de Biopathologie, CHRU de Nancy-Brabois, 5 Rue du Morvan, F54511 Vandœuvre-Lès-Nancy, France
| | - Astrid Pinzano
- UMR 7365 CNRS-UL, IMoPA (Ingénierie Moléculaire et Physiopathologie Articulaire), Biopôle de l’Université de Lorraine, Campus Brabois-Santé, 9, Avenue de la Forêt de Haye, BP20199, 54505 Vandœuvre-Lès-Nancy, France; (O.M.); (C.H.); (K.B.); (D.L.); (P.G.)
- Contrat d’Interface, Service de Rhumatologie, Hôpital de Brabois, Bâtiment Spécialités Médicales, F54511 Vandœuvre Lès Nancy, France
- Correspondence: ; Tel.: +33-(0)372-746-565
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Rogers MJ, Kondo M, Kim K, Okano T, Maak TG. Femoral Head Chondrocyte Viability at the Cam Deformity in Patients With Femoroacetabular Impingement Syndrome. Am J Sports Med 2020; 48:3586-3593. [PMID: 33108221 DOI: 10.1177/0363546520962788] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with hip pathology, such as femoroacetabular impingement (FAI) or hip dysplasia, are known to sustain chondral delamination injuries identifiable during hip arthroscopy, with an incidence of 44% to 75%. There are studies focused on understanding acetabular chondral flap viability, but there is a dearth of research regarding the viability of femoral head cartilage overlying the cam deformity in FAI. PURPOSE To describe the viability and immunohistochemistry staining patterns of femoral head cartilage in the setting of FAI. STUDY DESIGN Descriptive laboratory study. METHODS Between September 2018 and August 2019, a single surgeon prospectively collected full-thickness femoral cartilage from cam deformities in 14 patients with FAI undergoing osteoplasty. Samples were assessed for viability and underwent immunohistochemistry staining for collagen type I, collagen type II, and aggrecan. RESULTS The data set included 14 patients. Twelve samples were assessed for viability and 14 for immunohistochemistry straining. The mean patient age was 34.1 years, and the mean body mass index was 24.69. Mean ± SD chondrocyte viability per patient was 52% ± 11%. At the time of cell isolation, 8 of the 12 patients had viability >50%, with a maximum of 68.2%. This viability increased after a primary culture period, varying from 9 to 13 days, with 10 of 12 samples having viability >90%. The viability mean after the culture period was 94.54% ± 4.89%. Harvested cartilage showed expressions of type I cartilage, type II collagen, and aggrecan in a pattern that is predictable for native cartilage. CONCLUSION These data reveal that the cartilage in femoral head cartilage overlying cam deformity-much like that from acetabular chondral flaps-not only has baseline viability >50% (51.99% ± 10.83%) but the ability to increase in viability >90% after a culture period. There may be a role for use of femoral head cartilage as autograft to repair full-thickness cartilage defects of the acetabulum and femoral head, either at the time of osteochondroplasty or after a period of cell culture to improve cell viability. CLINICAL RELEVANCE A dearth of information is available regarding the viability of femoral head cartilage. This study provides insight into the cartilage viability and response to culture.
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Affiliation(s)
- Miranda J Rogers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Makoto Kondo
- Cell Sheet Tissue Engineering Center, Department of Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
| | - Kyungsook Kim
- Cell Sheet Tissue Engineering Center, Department of Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
| | - Teruo Okano
- Cell Sheet Tissue Engineering Center, Department of Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Travis G Maak
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA
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Mickevicius T, Pockevicius A, Kucinskas A, Gudas R, Maciulaitis J, Usas A. Nondestructive Assessment of Articular Cartilage Electromechanical Properties after Osteochondral Autologous and Allogeneic Transplantation in a Goat Model. Cartilage 2020; 11:348-357. [PMID: 29998744 PMCID: PMC7298600 DOI: 10.1177/1947603518786543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To determine the applicability of a minimally invasive diagnostic device to evaluate the quality of articular cartilage following autologous (OAT) and allogeneic (OCA) osteochondral graft transplantation in goat model. DESIGN OAT grafts were harvested from lateral femoral condyles (LFCs) and transplanted into osteochondral defects created in medial femoral condyles (MFCs) of contralateral knees. OCA grafts were transplanted into MFC condyles after in vitro storage. Autologous platelet-rich plasma (PRP) was administered intraarticularly after the surgery and at 1 and 2 months postoperatively. OAT and OCA grafts were evaluated macroscopically (Oswestry arthroscopy score [OAS]), electromechanically (quantitative parameter, QP), and histologically (O'Driscoll score, safranin O staining intensity) at 3 and 6 months after transplantation. Results were compared with preoperative graft evaluation. RESULTS Transplanted cartilage deteriorated within 6 months in all groups. Cartilage quality was better retained in OAT group compared with a decline in OCA group. QP and OAS scores were comparable in OAT and OCA groups at 3 months, but superior in OAT group at 6 months, according to all the methods applied. PRP injections significantly improved QP and OAS score at 6 months compared with 3 months in OAT group. QP moderately correlated with OAS, O'Driscoll score, and safranin O staining intensity. CONCLUSIONS Grafts did not retain preoperative quality parameters at 6 months follow-up; however, OAT were superior to OCA grafts. PRP may have a beneficial effect on macroscopic and electromechanical properties of cartilage; however, histological improvement is yet to be proved. Electromechanical diagnostic device enables reliable assessment of transplanted cartilage.
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Affiliation(s)
- Tomas Mickevicius
- Department of Orthopaedics and
Traumatology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics,
Kaunas, Lithuania
| | - Alius Pockevicius
- Pathology Center, Department of
Veterinary Pathobiology, Veterinary Academy, Lithuanian University of Health
Sciences, Kaunas, Lithuania
| | - Audrius Kucinskas
- Biological Research Center Lithuanian
University of Health Sciences, Kaunas, Lithuania
| | - Rimtautas Gudas
- Department of Orthopaedics and
Traumatology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics,
Kaunas, Lithuania,Institute of Sports, Lithuanian
University of Health Sciences, Kaunas, Lithuania
| | - Justinas Maciulaitis
- Department of Orthopaedics and
Traumatology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics,
Kaunas, Lithuania,Institute of Sports, Lithuanian
University of Health Sciences, Kaunas, Lithuania
| | - Arvydas Usas
- Institute of Physiology and
Pharmacology, Lithuanian University of Health Sciences, Kaunas, Lithuania,Arvydas Usas, Institute of Physiology and
Pharmacology, Lithuanian University of Health Sciences, Mickeviciaus 9, Kaunas,
LT-44307, Lithuania.
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Mancini IAD, Schmidt S, Brommer H, Pouran B, Schäfer S, Tessmar J, Mensinga A, van Rijen MHP, Groll J, Blunk T, Levato R, Malda J, van Weeren PR. A composite hydrogel-3D printed thermoplast osteochondral anchor as example for a zonal approach to cartilage repair: in vivo performance in a long-term equine model. Biofabrication 2020; 12:035028. [PMID: 32434160 DOI: 10.1088/1758-5090/ab94ce] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Recent research has been focusing on the generation of living personalized osteochondral constructs for joint repair. Native articular cartilage has a zonal structure, which is not reflected in current constructs and which may be a cause of the frequent failure of these repair attempts. Therefore, we investigated the performance of a composite implant that further reflects the zonal distribution of cellular component both in vitro and in vivo in a long-term equine model. Constructs constituted of a 3D-printed poly(ϵ-caprolactone) (PCL) bone anchor from which reinforcing fibers protruded into the chondral part of the construct over which two layers of a thiol-ene cross-linkable hyaluronic acid/poly(glycidol) hybrid hydrogel (HA-SH/P(AGE-co-G)) were fabricated. The top layer contained Articular Cartilage Progenitor Cells (ACPCs) derived from the superficial layer of native cartilage tissue, the bottom layer contained mesenchymal stromal cells (MSCs). The chondral part of control constructs were homogeneously filled with MSCs. After six months in vivo, microtomography revealed significant bone growth into the anchor. Histologically, there was only limited production of cartilage-like tissue (despite persistency of hydrogel) both in zonal and non-zonal constructs. There were no differences in histological scoring; however, the repair tissue was significantly stiffer in defects repaired with zonal constructs. The sub-optimal quality of the repair tissue may be related to several factors, including early loss of implanted cells, or inappropriate degradation rate of the hydrogel. Nonetheless, this approach may be promising and research into further tailoring of biomaterials and of construct characteristics seems warranted.
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Affiliation(s)
- I A D Mancini
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 112, 3584CM, Utrecht, The Netherlands. Regenerative Medicine Utrecht, Utrecht University, Utrecht, The Netherlands. Author to whom any correspondence should be addressed
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Is There a Scientific Rationale for the Refixation of Delaminated Chondral Flaps in Femoroacetabular Impingement? A Laboratory Study. Clin Orthop Relat Res 2020; 478:854-867. [PMID: 32011382 PMCID: PMC7282577 DOI: 10.1097/corr.0000000000001135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Debonding of the acetabular cartilage is a characteristic type of hip damage found in cam-type femoroacetabular impingement (FAI), which remains a treatment challenge. In addition to resection, refixation of these flaps using fibrin sealants has been recently suggested. However, there is only limited evidence available that the proposed refixation method results in sufficient viable cartilage formation to ensure long-term flap grafting and restored tissue function. QUESTIONS/PURPOSES To determine the flap tissue characteristics that would justify refixation of delaminated chondral flaps with a fibrin sealant, we characterized (1) the extracellular matrix (ECM) of chondral flaps in terms of chondrocyte viability and distribution of ECM components and (2) the chondrogenic potential of resident cells to migrate into fibrin and produce a cartilaginous matrix. METHODS Ten acetabular chondral flaps and three non-delaminated control cartilage samples were resected during surgery. Chondrocyte viability was quantified using a live-dead assay. To assess the ECM, histological staining of glycosaminoglycans, collagen II, and collagen I allowed the qualitative study of their distribution. The ability of chondrocytes to migrate out of the ECM was tested by encapsulating minced flap cartilage in fibrin gels and semi-quantitatively assessing the projected area of the gel covered with migrating cells. The potential of chondrocytes to produce a cartilaginous matrix was studied with a pellet assay, a standard three-dimensional culture system to test chondrogenesis. Positive controls were pellets of knee chondrocytes of age-matched donors, which we found in a previous study to have a good capacity to produce cartilage matrix. Statistical significance of controlled quantitative assays was determined by the Student's t-test with Welch's correction. RESULTS The proportion of viable chondrocytes in flaps was lower than in nondelaminated cartilage (50% ± 19% versus 76 ± 6%; p = 0.02). Histology showed a disrupted ECM in flaps compared with nondelaminated controls, with the presence of fibrillation, a loss of glycosaminoglycan at the delaminated edge, collagen II throughout the whole thickness of the flap, and some collagen I-positive area in two samples. The resident chondrocytes migrated out of this disrupted ECM in all tested samples. However in pellet culture, cells isolated from the flaps showed a qualitatively lower chondrogenic potential compared with positive controls, with a clearly inhomogeneous cell and matrix distribution and an overall smaller projected area (0.4 versus 0.7 mm; p = 0.038). CONCLUSION Despite the presence of viable chondrocytes with migration potential, the cells resided in a structurally altered ECM and had limited capacity to deposit ECM, leading us to question their capacity to produce sufficient ECM within the fibrin sealant for stable long-term attachment of such flaps. CLINICAL RELEVANCE The characterization of delaminated cartilage in cam FAI patients suggests that the refixation strategy might be adversely influenced by the low level of ECM produced by the residing cells.
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Ackermann J, Cole BJ, Gomoll AH. Cartilage Restoration in the Patellofemoral Joint: Techniques and Outcomes. OPER TECHN SPORT MED 2019. [DOI: 10.1016/j.otsm.2019.150692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abstract
PURPOSE OF REVIEW The purpose of this systematic review was to assess the outcomes and complications of described cartilage restoration techniques for cartilage defects (grades I to IV) in the adolescent knee. RECENT FINDINGS Eleven studies satisfied the inclusion criteria comprising 307 patients with a mean follow-up of 4.6 years (range 1-18.9 years). Study patients were treated with autologous chondrocyte implantation (ACI) (n = 98, mean age 16.0), microfracture (MFx) (n = 36, mean age 15.4), internal fixation (n = 71, mean age 13.1), osteochondral allograft (OCA) transplantation (n = 78, mean age 16.4), and cartillage and excision (n = 24; mean age 14.2). ACI, MFx, OCA transplantation, and internal fixation showed significant improvement in knee functionality scores. The overall complication rate was 10.6% (n = 31). OCA transplantation had the highest complication rate (26.9%; n = 21/78). In summary, our review shows that ACI was the most commonly used technique. Furthermore, ACI, MFx, OCA transplantation, and internal fixation show the most promise in treating the adolescent population due to positive postoperative functional outcomes and low complication rates. However, future studies with large sample sizes, standardized outcome documentation, and long-term follow-up are required to confirm these preliminary results.
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Lepage SIM, Robson N, Gilmore H, Davis O, Hooper A, St John S, Kamesan V, Gelis P, Carvajal D, Hurtig M, Koch TG. Beyond Cartilage Repair: The Role of the Osteochondral Unit in Joint Health and Disease. TISSUE ENGINEERING PART B-REVIEWS 2019; 25:114-125. [PMID: 30638141 PMCID: PMC6486663 DOI: 10.1089/ten.teb.2018.0122] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Once believed to be limited to articular cartilage, osteoarthritis is now considered to be an organ disease of the “whole joint.” Damage to the articular surface can lead to, be caused by, or occur in parallel with, damage to other tissues in the joint. The relationship between cartilage and the underlying subchondral bone has particular importance when assessing joint health and determining treatment strategies. The articular cartilage is anchored to the subchondral bone through an interface of calcified cartilage, which as a whole makes up the osteochondral unit. This unit functions primarily by transferring load-bearing weight over the joint to allow for normal joint articulation and movement. Unfortunately, irreversible damage and degeneration of the osteochondral unit can severely limit joint function. Our understanding of joint pain, the primary complaint of patients, is poorly understood and past efforts toward structural cartilage restoration have often not been associated with a reduction in pain. Continued research focusing on the contribution of subchondral bone and restoration of the entire osteochondral unit are therefore needed, with the hope that this will lead to curative, and not merely palliative, treatment options. The purpose of this narrative review is to investigate the role of the osteochondral unit in joint health and disease. Topics of discussion include the crosstalk between cartilage and bone, the efficacy of diagnostic procedures, the origins of joint pain, current and emerging treatment paradigms, and suitable preclinical animal models for safety and efficacy assessment of novel osteochondral therapies. The goal of the review is to facilitate an appreciation of the important role played by the subchondral bone in joint pain and why the osteochondral unit as a whole should be considered in many cases of joint restoration strategies.
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Affiliation(s)
- Sarah I M Lepage
- 1 Department of Biomedical Sciences, University of Guelph, Guelph, Canada
| | - Naomi Robson
- 1 Department of Biomedical Sciences, University of Guelph, Guelph, Canada
| | - Hillary Gilmore
- 1 Department of Biomedical Sciences, University of Guelph, Guelph, Canada
| | - Ola Davis
- 1 Department of Biomedical Sciences, University of Guelph, Guelph, Canada
| | - Allyssa Hooper
- 1 Department of Biomedical Sciences, University of Guelph, Guelph, Canada
| | - Stephanie St John
- 1 Department of Biomedical Sciences, University of Guelph, Guelph, Canada
| | - Vashine Kamesan
- 1 Department of Biomedical Sciences, University of Guelph, Guelph, Canada
| | - Paul Gelis
- 1 Department of Biomedical Sciences, University of Guelph, Guelph, Canada
| | - Diana Carvajal
- 1 Department of Biomedical Sciences, University of Guelph, Guelph, Canada
| | - Mark Hurtig
- 2 Department of Clinical Studies, University of Guelph, Guelph, Canada
| | - Thomas G Koch
- 1 Department of Biomedical Sciences, University of Guelph, Guelph, Canada
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Filardo G, Andriolo L, Soler F, Berruto M, Ferrua P, Verdonk P, Rongieras F, Crawford DC. Treatment of unstable knee osteochondritis dissecans in the young adult: results and limitations of surgical strategies-The advantages of allografts to address an osteochondral challenge. Knee Surg Sports Traumatol Arthrosc 2019; 27:1726-1738. [PMID: 30523367 DOI: 10.1007/s00167-018-5316-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/04/2018] [Indexed: 12/24/2022]
Abstract
Joint surface incongruence resulting from osteochondritis dissecans (OCD) alters the articular physiologic congruence, increasing the contact stress on adjacent joint surfaces and accelerating wear and the cascade of joint degeneration. Accordingly, the restoration of articular surface integrity is of major importance, especially in young adults where, in lesions left untreated or following simple fragment excision, early osteoarthritis can be anticipated. Therefore, the treatment algorithm in unstable knee OCD of the young adult foresees surgical options to restore the articular surface. Several procedures have been proposed, including refixation of the detached fragment bone marrow stimulation, osteochondral autograft implantation, fresh osteochondral allograft transplantation, and cell-based or cell-free regenerative techniques. The aim of this review was to summarize the evidence for these surgical strategies, reporting their results and limitations. The overall evidence documents positive results for each of the assorted surgical procedures applied to treat unstable OCD, thus indicating support for their selected use to treat osteochondral defects paying particular attention to their specific indications for the lesion characteristics. The fixation of a good quality fragment should be pursued as a first option, while unfixable small lesions may benefit from autografts. For large lesions, available cell-based or cell-free osteochondral scaffold are a feasible solution but with limitation in terms of regenerated tissue quality. In this light, fresh allografts may offer articular surface restoration with viable physiologic osteochondral tissue providing a predictably successful outcome, and therefore they may currently represent the most suitable option to treat unstable irreparable OCD lesion in young adults. LEVEL OF EVIDENCE: V.
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Affiliation(s)
| | - Luca Andriolo
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Di Barbiano,1/10, 40136, Bologna, Italy.
| | - Francesc Soler
- Traumadvance Orthopaedic Group, Terrassa, Barcelona, Spain
| | | | - Paolo Ferrua
- Dept. of Knee Surgery, ASST Pini-CTO, Milan, Italy
| | - Peter Verdonk
- Department of Orthopaedic Surgery, Department of Orthopaedic Surgery, Monica Hospitals, Monica Research Foundation, University Hospital, Antwerp, Belgium
| | - Frederic Rongieras
- Service de chirurgie orthopédique et traumatologique, Hôpital d'instruction des armées Desgenettes, Univ Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Dennis C Crawford
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon, USA
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Crawford ZT, Schumaier AP, Glogovac G, Grawe BM. Return to Sport and Sports-Specific Outcomes After Osteochondral Allograft Transplantation in the Knee: A Systematic Review of Studies With at Least 2 Years' Mean Follow-Up. Arthroscopy 2019; 35:1880-1889. [PMID: 31053460 DOI: 10.1016/j.arthro.2018.11.064] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 11/16/2018] [Accepted: 11/21/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To report current data on return-to-sport rates and sports-specific patient-reported outcomes after osteochondral allograft (OCA) transplantation for cartilage defects of the knee. METHODS We performed a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines that included studies from 1975 to 2018 with a minimum 2-year mean follow-up that reported return-to-sport rates or sports-specific patient-reported outcomes. Outcomes, reoperations, and complications were provided in table format, and a subjective analysis was performed. RESULTS This review included 13 studies with 772 patients who underwent OCA transplantation at a mean of 24 to 91 months' follow-up. The return-to-sport rate ranged from 75% to 82%. For patient-reported outcomes, the Knee Injury and Osteoarthritis Score Sport increased in 4 studies, the Tegner activity scale score increased in 3 studies but decreased in 1, and the Marx activity scale score increased in 1 study but decreased in 2. Studies reporting improvements in the Cincinnati Knee Score and Knee Injury and Osteoarthritis Score Sport reached the minimal clinically important difference. The reoperation rate was high (ranging from 34% to 53% in more than half of studies), with reoperations primarily performed for loose body removal or debridement. CONCLUSIONS This systematic review of 13 studies suggests that OCA transplantation for cartilage defects allows most athletes to return to sport (range, 75%-82%). Most studies reported improvements in sports-specific patient-reported outcomes at follow-up and reached the minimal clinically important difference. However, the reoperation rate was high in several studies, with a large percentage of patients requiring loose body removal or debridement. The long-term survival of the allografts is largely unknown, but this study suggests OCA transplantation consistently improves function in athletes with chondral injuries. LEVEL OF EVIDENCE Level IV, systematic review of Level III and IV studies.
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Affiliation(s)
- Zachary T Crawford
- Department of Orthopaedics and Sports Medicine, University of Cincinnati, Cincinnati, Ohio, U.S.A..
| | - Adam P Schumaier
- Department of Orthopaedics and Sports Medicine, University of Cincinnati, Cincinnati, Ohio, U.S.A
| | - Georgina Glogovac
- Department of Orthopaedics and Sports Medicine, University of Cincinnati, Cincinnati, Ohio, U.S.A
| | - Brian M Grawe
- Department of Orthopaedics and Sports Medicine, University of Cincinnati, Cincinnati, Ohio, U.S.A
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Cavendish PA, Everhart JS, Peters NJ, Sommerfeldt MF, Flanigan DC. Osteochondral Allograft Transplantation for Knee Cartilage and Osteochondral Defects. JBJS Rev 2019; 7:e7. [DOI: 10.2106/jbjs.rvw.18.00123] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Concentration of Chondrogenic Soluble Factors in Freshly Harvested Lipoaspirate. Ann Plast Surg 2019; 83:344-351. [PMID: 30994491 DOI: 10.1097/sap.0000000000001936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cartilage tissue has a limited capacity for healing with the consequence that patients are often treated symptomatically until they become candidates for osteotomy or total joint replacement. Alternative biological therapies, for example, application of platelet-rich plasma and implantation of chondrocytes and mesenchymal stem cells, have emerged as a new treatment modality to repair articular cartilage. In addition, autologous fat transfer is performed for treatment of cartilage defects, example given, in osteoarthrosis, but several questions regarding basic biochemical properties of the transplant remain unanswered. Bone morphogenetic protein 4 (BMP4), matrix metalloproteinase (MMP)-8, cartilage oligomeric matrix protein (COMP), and chitinase-3-like protein 1 (CHI3L1) have been shown to be involved in chondrogenic regeneration and represent potential therapeutic agents for cartilage repair. However, no study regarding naturally occurring levels of these soluble factors in transplanted adipose tissue has yet been performed. METHODS To investigate the influence of age, body mass index, donor site, and sex on the concentration of BMP4, MMP-8, COMP, and CHI3L1 in freshly aspirated adipose tissue, their content was measured by means of enzyme-linked immunosorbent assay readings. RESULTS There were significant quantities of BMP4, MMP-8, COMP, and CHI3L1 (23.6, 249.9, 298.0, and 540.6 pg/mg, respectively) in the lipoaspirate harvested for transplantation. There was no correlation between the content of soluble factors and the patients' age or body mass index. Furthermore, the sex did not affect the amount of the investigated factors. However, there were significantly lower contents of BMP4, COMP, and CHI3L1 found in lipoaspirates harvested from the abdomen compared with nonabdominal donor sites. CONCLUSIONS Naturally occurring differences in the concentrations of the investigated soluble factors will favor certain donor sites for autologous fat transfer in the field of cartilage repair. Thus, increasing knowledge will enable researchers and clinicians to make autologous fat transfer procedures more reliable and efficient for treatment of articular cartilage defects.
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Ackermann J, Ogura T, Duerr RA, Mestriner AB, Gomoll AH. Mental Health Has No Predictive Association With Self-Assessed Knee Outcome Scores in Patients After Osteochondral Allograft Transplantation of the Knee. Orthop J Sports Med 2018; 6:2325967118812363. [PMID: 30560141 PMCID: PMC6293379 DOI: 10.1177/2325967118812363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Patient-reported outcome (PRO) measures are progressively utilized as
evaluation tools in preoperative and postoperative assessments in
orthopaedic practice. Identifying the potential utility of psychosocial
factors to predict patient-reported pain and functional outcomes is of
increasing interest to determine which patients will derive the greatest
benefit from surgical treatment. Purpose/Hypothesis: The purpose of this study was to determine potential predictive associations
between the preoperative 12-Item Short Form Health Survey Mental Component
Summary (SF-12 MCS) score, patient characteristics or osteochondral
allograft (OCA) morphology, and PROs in patients who underwent OCA
transplantation. We hypothesized that poor preoperative mental health is
associated with diminished PROs at final follow-up. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 67 patients with a mean follow-up of 2.7 ± 1.0 years (range, 2-6
years) with complete preoperative and at least 24-month postoperative SF-12
MCS, Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner, Lysholm,
and International Knee Documentation Committee (IKDC) scores were included
in this study. Pearson correlation coefficients and linear regression models
were used to distinguish associations between age, sex, smoking status, body
mass index, workers’ compensation, previous surgery, concomitant surgery,
number of grafts, defect location, total graft size, SF-12 MCS score, and
postoperative PRO scores as well as their improvement from baseline
(delta). Results: The SF-12 MCS showed significant correlation with the KOOS Activities of
Daily Living subscale (P = .015), KOOS Sport/Recreation
subscale (P = .024), and IKDC (P = .039).
In the multivariable linear regression models, the SF-12 MCS had no
predictive association with any PRO measure. Patient sex contributed
significantly to the final regression models of the KOOS Sport/Recreation
(P = .042), Tegner score (P = .024),
and Lysholm score (P = .031). The SF-12 MCS showed no
bivariate correlation with changes in any PRO score (delta)
(P > .05). Conclusion: Preoperative mental health status did not predict perceived functional
outcomes as assessed by PRO measures at final follow-up. Female sex was
negatively correlated with KOOS Sport/Recreation, Tegner, and Lysholm
scores.
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Affiliation(s)
- Jakob Ackermann
- Sports Medicine Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Takahiro Ogura
- Sports Medicine Center, Funabashi Orthopaedic Hospital, Funabashi, Japan
| | - Robert A Duerr
- Cartilage Repair Center and Center for Regenerative Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Alexandre Barbieri Mestriner
- Cartilage Repair Center and Center for Regenerative Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts, USA.,Universidade Federal de São Paulo, São Paulo, Brazil
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Van de Walle A, Faissal W, Wilhelm C, Luciani N. Role of growth factors and oxygen to limit hypertrophy and impact of high magnetic nanoparticles dose during stem cell chondrogenesis. Comput Struct Biotechnol J 2018; 16:532-542. [PMID: 30524668 PMCID: PMC6260287 DOI: 10.1016/j.csbj.2018.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/25/2018] [Accepted: 10/26/2018] [Indexed: 12/26/2022] Open
Abstract
Due to an unmet clinical need of curative treatments for osteoarthritic patients, tissue engineering strategies that propose the development of cartilage tissue replacements from stem cells have emerged. Some of these strategies are based on the internalization of magnetic nanoparticles into stem cells to then initiate the chondrogenesis via magnetic compaction. A major difficulty is to drive the chondrogenic differentiation of the cells such as they produce an extracellular matrix free of hypertrophic collagen. An additional difficulty has to be overcome when nanoparticles are used, knowing that a high dose of nanoparticles can limit the chondrogenesis. We here propose a gene-based analysis of the effects of chemical factors (growth factors, hypoxia) on the chondrogenic differentiation of human mesenchymal stem cells both with and without nanoparticles. We focus on the synthesis of two of the most important constituents present in the cartilaginous extracellular matrix (Collagen II and Aggrecan) and on the expression of collagen X, the signature of hypertrophic cartilage, in order to provide a quantitative index of the type of cartilage produced (i.e. hyaline, hypertrophic). We demonstrate that by applying specific environmental conditions, gene expression can be directed toward the production of hyaline cartilage, with limited hypertrophy. Besides, a combination of the growth factors IGF-1, TGF-β3, with a hypoxic conditioning remarkably reduced the impact of high nanoparticles concentration.
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Affiliation(s)
| | | | - Claire Wilhelm
- Corresponding authors at: Laboratoire MSC, UMR 7057 CNRS, University Paris Diderot, France.
| | - Nathalie Luciani
- Corresponding authors at: Laboratoire MSC, UMR 7057 CNRS, University Paris Diderot, France.
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36
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Repair of Damaged Articular Cartilage: Current Approaches and Future Directions. Int J Mol Sci 2018; 19:ijms19082366. [PMID: 30103493 PMCID: PMC6122081 DOI: 10.3390/ijms19082366] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/07/2018] [Accepted: 08/07/2018] [Indexed: 12/28/2022] Open
Abstract
Articular hyaline cartilage is extensively hydrated, but it is neither innervated nor vascularized, and its low cell density allows only extremely limited self-renewal. Most clinical and research efforts currently focus on the restoration of cartilage damaged in connection with osteoarthritis or trauma. Here, we discuss current clinical approaches for repairing cartilage, as well as research approaches which are currently developing, and those under translation into clinical practice. We also describe potential future directions in this area, including tissue engineering based on scaffolding and/or stem cells as well as a combination of gene and cell therapy. Particular focus is placed on cell-based approaches and the potential of recently characterized chondro-progenitors; progress with induced pluripotent stem cells is also discussed. In this context, we also consider the ability of different types of stem cell to restore hyaline cartilage and the importance of mimicking the environment in vivo during cell expansion and differentiation into mature chondrocytes.
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37
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Cao F, Qi J, Song H, Xie D, Zhou L, Han Y, Li H, Wu Q, Dong J, Zhang Y. Tsmu solution improves rabbit osteochondral allograft preservation and transplantation outcome. Cell Tissue Bank 2018; 19:549-558. [PMID: 29876883 DOI: 10.1007/s10561-018-9703-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 05/25/2018] [Indexed: 12/20/2022]
Abstract
To compare the effects of Tsmu solution with vitrification on chondrocyte viability and examine histological and biomechanical properties of osteochondral allografts (OCAs) after storage, OCAs from femoral condyles of New Zealand rabbits were harvested, stored for 35 days in Tsmu solution or by in vitro vitrification, and subjected to in vivo and in vitro assays. Stored OCAs were transplanted into knee femoral condyle cartilage defects in recipient rabbits. Chondrocyte viability and histological changes of cartilage grafts were assessed in vitro. Gross assessment, chondrocyte viability, histological assessment, OCA biomechanics, and immunological markers were evaluated in vivo 6 months after transplantation. Fresh OCAs served as in vitro and in vivo controls. Chondrocyte viability and scores for cartilage surface and histological quantitative assessment were superior for Tsmu solution compared with vitrification, but inferior compared with fresh OCAs in vitro and in vivo. With the exception of interleukin 6 content, biomechanical features of samples stored in Tsmu solution were superior to vitrification, and inferior to fresh OCAs in vivo. Thus, Tsmu solution provided suitable storage that improved chondrocyte viability, intact OCA cartilage matrix architecture, and transplantation outcomes.
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Affiliation(s)
- Famin Cao
- Institute of Sports Medicine, Taishan Medical University, 619 Great Wall Road, Tai'an, 271016, Shandong, China
| | - Jianhong Qi
- Institute of Sports Medicine, Taishan Medical University, 619 Great Wall Road, Tai'an, 271016, Shandong, China. .,Institute of Sports Medicine, Taishan Medical University, 619 Changcheng Road, Tai'an, 271016, Shandong, China.
| | - Hongqiang Song
- Institute of Sports Medicine, Taishan Medical University, 619 Great Wall Road, Tai'an, 271016, Shandong, China
| | - Di Xie
- Institute of Sports Medicine, Taishan Medical University, 619 Great Wall Road, Tai'an, 271016, Shandong, China
| | - Lu Zhou
- Institute of Sports Medicine, Taishan Medical University, 619 Great Wall Road, Tai'an, 271016, Shandong, China
| | - Yunning Han
- Institute of Sports Medicine, Taishan Medical University, 619 Great Wall Road, Tai'an, 271016, Shandong, China
| | - Hao Li
- Institute of Sports Medicine, Taishan Medical University, 619 Great Wall Road, Tai'an, 271016, Shandong, China
| | - Qi Wu
- Institute of Sports Medicine, Taishan Medical University, 619 Great Wall Road, Tai'an, 271016, Shandong, China
| | - Jun Dong
- Institute of Sports Medicine, Taishan Medical University, 619 Great Wall Road, Tai'an, 271016, Shandong, China
| | - Yanming Zhang
- Institute of Sports Medicine, Taishan Medical University, 619 Great Wall Road, Tai'an, 271016, Shandong, China
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Abstract
Purpose of Review This review provides an overview of well-established and newly developed cartilage repair techniques for cartilage defects in the patellofemoral joint (PFJ). An algorithm will be presented for approaching cartilage defects considering the distinct anatomy of both the patellar and trochlear articular surfaces. Recent Findings Recent studies on cartilage repair in the PFJ have demonstrated improved outcomes in an attempt to delay or obviate the need for arthroplasty, and improve symptoms in young patients. While autologous chondrocyte implantation shows good and excellent outcomes for chondral lesions, osteochondral defects are adequately addressed with osteochondral allograft transplantation. In case of patellar malalignment, concomitant tibial tubercle osteotomy can significantly improve outcomes. Particulated cartilage and bone marrow aspirate concentrate are potential new alternative treatments for cartilage repair, currently in early clinical studies. Summary Due to the frequency of concomitant anatomic abnormalities in the PFJ, a thorough clinical examination combined with careful indication for each procedure in each individual patient combined with meticulous surgical technique is central to achieve satisfying outcomes. Additional comparative studies of cartilage repair procedures, as well as investigation of newer techniques, are needed.
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Ondrésik M, Oliveira JM, Reis RL. Advances for Treatment of Knee OC Defects. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1059:3-24. [PMID: 29736567 DOI: 10.1007/978-3-319-76735-2_1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Osteochondral (OC) defects are prevalent among young adults and are notorious for being unable to heal. Although they are traumatic in nature, they often develop silently. Detection of many OC defects is challenging, despite the criticality of early care. Current repair approaches face limitations and cannot provide regenerative or long-standing solution. Clinicians and researchers are working together in order to develop approaches that can regenerate the damaged tissues and protect the joint from developing osteoarthritis. The current concepts of tissue engineering and regenerative medicine, which have brought many promising applications to OC management, are overviewed herein. We will also review the types of stem cells that aim to provide sustainable cell sources overcoming the limitation of autologous chondrocyte-based applications. The various scaffolding materials that can be used as extracellular matrix mimetic and having functional properties similar to the OC unit are also discussed.
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Affiliation(s)
- Marta Ondrésik
- 3B's Research Group - Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Barco, Guimarães, Portugal.
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
| | - J Miguel Oliveira
- 3B's Research Group - Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Barco, Guimarães, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
- The Discoveries Centre for Regenerative and Precision Medicine, Headquarters at University of Minho, Barco, Guimarães, Portugal
| | - Rui L Reis
- 3B's Research Group - Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Barco, Guimarães, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
- The Discoveries Centre for Regenerative and Precision Medicine, Headquarters at University of Minho, Barco, Guimarães, Portugal
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40
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Oladeji LO, Stannard JP, Cook CR, Kfuri M, Crist BD, Smith MJ, Cook JL. Effects of Autogenous Bone Marrow Aspirate Concentrate on Radiographic Integration of Femoral Condylar Osteochondral Allografts. Am J Sports Med 2017; 45:2797-2803. [PMID: 28737949 DOI: 10.1177/0363546517715725] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Transplantation of fresh osteochondral allografts (OCAs) is an attractive treatment option for symptomatic articular cartilage lesions in young, healthy patients. Because the lack of OCA bone integration can be a cause of treatment failure, methods for speeding and enhancing OCA bone integration to mitigate this potential complication are highly desirable. PURPOSE To determine if autogenous bone marrow aspirate concentrate (BMC) treatment of large femoral condylar OCAs would be associated with superior radiographic OCA bone integration compared with nontreated allografts during the critical first 6 months after surgery. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A review of patients enrolled in a prospective registry who were treated with transplantation of large OCAs to one or both femoral condyles at our institution from March 12, 2013 to March 14, 2016 was performed. Patients were stratified into 2 groups based on BMC treatment versus no BMC treatment; the treatment was nonrandomized and was rooted in a shift in practice and a continuing effort to optimize OCA transplantation at our institution. Patients were excluded if they did not have orthogonal view radiographs performed at 6 weeks, 3 months, and 6 months postoperatively. Each condyle undergoing OCA transplantation was assessed individually by an independent musculoskeletal radiologist, who was blinded to the treatment group and time point. OCAs were assessed with respect to graft integration (0%-100%; 0 = no integration, 100 = complete integration) and degree of sclerosis (0-3; 0 = normal, 1 = mild sclerosis, 2 = moderate sclerosis, and 3 = severe sclerosis) of the graft at each time point. RESULTS This study identified 17 condyles in 15 patients who underwent OCA transplantation without BMC and 29 condyles in 22 patients who underwent OCA transplantation with BMC. The BMC group had significantly ( P = .033) higher graft integration scores at 6 weeks, 3 months, and 6 months after surgery. Graft sclerosis was significantly ( P = .017) less in the BMC group at 6 weeks and 3 months, with no significant difference at 6 months after surgery. When combining the groups to examine the influence of smoking on graft integration, nonsmokers had significantly ( P = .007) higher graft integration scores at 6 months. CONCLUSION Large femoral condylar OCAs treated with autogenous BMC before implantation showed superior radiographic integration to bone and less sclerosis during the initial 6-month postoperative period. BMC treatment of OCAs may mitigate the failure of OCA bone healing.
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Affiliation(s)
- Lasun O Oladeji
- Department of Orthopaedic Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - James P Stannard
- Department of Orthopaedic Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA.,Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri, USA
| | - Cristi R Cook
- Department of Orthopaedic Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA.,Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri, USA
| | - Mauricio Kfuri
- Department of Orthopaedic Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Brett D Crist
- Department of Orthopaedic Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Matthew J Smith
- Department of Orthopaedic Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA.,Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri, USA
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Datta P, Dhawan A, Yu Y, Hayes D, Gudapati H, Ozbolat IT. Bioprinting of osteochondral tissues: A perspective on current gaps and future trends. Int J Bioprint 2017; 3:007. [PMID: 33094191 PMCID: PMC7575632 DOI: 10.18063/ijb.2017.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 06/07/2017] [Indexed: 01/06/2023] Open
Abstract
Osteochondral tissue regeneration has remained a critical challenge in orthopaedic surgery, especially due to complications of arthritic degeneration arising out of mechanical dislocations of joints. The common gold standard of autografting has several limitations in presenting tissue engineering strategies to solve the unmet clinical need. However, due to the complexity of joint anatomy, and tissue heterogeneity at the interface, the conventional tissue engineering strategies have certain limitations. The advent of bioprinting has now provided new opportunities for osteochondral tissue engineering. Bioprinting can uniquely mimic the heterogeneous cellular composition and anisotropic extra-cellular matrix (ECM) organization, while allowing for targeted gene delivery to achieve heterotypic differentiation. In this perspective, we discuss the current advances made towards bioprinting of composite osteochondral tissues and present an account of challenges-in terms of tissue integration, long-term survival, and mechanical strength at the time of implantation-required to be addressed for effective clinical translation of bioprinted tissues. Finally, we highlight some of the future trends related to osteochondral bioprinting with the hope of in-clinical translation.
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Affiliation(s)
- Pallab Datta
- Centre for Healthcare Science and Technology, Indian Institute of Engineering Science and Technology Shibpur, Howrah, West Bengal 711103, India
| | - Aman Dhawan
- Orthopedics and Rehabilitation, Penn State University, Hershey, PA 17033, USA
| | - Yin Yu
- Department of Surgery, Harvard Medical School, Harvard University, Cambridge, MA 02138, USA.,The Center for Engineering in Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Dan Hayes
- The Huck Institutes of the Life Sciences, Penn State University, University Park, PA 16802, USA.,Biomedical Engineering, Penn State University, University Park, PA 16802, USA
| | - Hemanth Gudapati
- The Huck Institutes of the Life Sciences, Penn State University, University Park, PA 16802, USA.,Engineering Science and Mechanics Department, Penn State University, University Park, PA 16802, USA
| | - Ibrahim T Ozbolat
- The Huck Institutes of the Life Sciences, Penn State University, University Park, PA 16802, USA.,Biomedical Engineering, Penn State University, University Park, PA 16802, USA.,Engineering Science and Mechanics Department, Penn State University, University Park, PA 16802, USA.,Materials Research Institute, Penn State University, University Park, PA 16802, USA
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42
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Okeagu CN, Baker EA, Barreras NA, Vaupel ZM, Fortin PT, Baker KC. Review of Mechanical, Processing, and Immunologic Factors Associated With Outcomes of Fresh Osteochondral Allograft Transplantation of the Talus. Foot Ankle Int 2017; 38:808-819. [PMID: 28385038 DOI: 10.1177/1071100717697649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
UNLABELLED Osteochondral lesions of the talus (OLTs) are an increasingly implicated cause of ankle pain and instability. Several treatment methods exist with varying clinical outcomes. Due in part to successful osteochondral allografting (OCA) in other joints, such as the knee and shoulder, OCA has gained popularity as a treatment option, especially in the setting of large lesions. The clinical outcomes of talar OCA have been inconsistent relative to the positive results observed in other joints. Current literature regarding OCA failure focuses mainly on 3 factors: the effect of graft storage conditions on chondrocyte viability, graft/lesion size, and operative technique. Several preclinical studies have demonstrated the ability for bone and cartilage tissue to invoke an immune response, and a limited number of clinical studies have suggested that this response may have the potential to influence outcomes after transplantation. Further research is warranted to investigate the role of immunological mechanisms as an etiology of OCA failure. LEVEL OF EVIDENCE Level V, expert opinion.
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Affiliation(s)
- Chikezie N Okeagu
- 1 Beaumont Health System, Department of Orthopaedic Research, Royal Oak, MI, USA
| | - Erin A Baker
- 1 Beaumont Health System, Department of Orthopaedic Research, Royal Oak, MI, USA
| | - Nicholas A Barreras
- 1 Beaumont Health System, Department of Orthopaedic Research, Royal Oak, MI, USA
| | - Zachary M Vaupel
- 2 Beaumont Health System, Department of Orthopaedic Surgery, Royal Oak, MI, USA
| | - Paul T Fortin
- 2 Beaumont Health System, Department of Orthopaedic Surgery, Royal Oak, MI, USA
| | - Kevin C Baker
- 1 Beaumont Health System, Department of Orthopaedic Research, Royal Oak, MI, USA
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43
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Abstract
There is an increasing need for articular cartilage restoration procedures. Hyaline cartilage lacks intrinsic healing capacity. Persistent osteochondral defects can lead to early and rapid degenerative changes. Microfracture and autologous chondrocyte implantation provide reasonable outcomes for smaller defects without bone loss. However, these techniques have limited effectiveness for lesions greater than 4 cm2 or with significant bony involvement. Ostochondral allografts provide an option for these lesions. This article reviews osteochondral allografts for articular defects. Emerging options provide different approaches to difficult cartilage defects. We discuss current screening, procurement, and storage methods, surgical techniques, outcomes, and bacterial/viral transmission.
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Affiliation(s)
- Frank B Wydra
- Department of Orthopedics, University of Colorado School of Medicine, 12631 East 17th Avenue, Room 4501 B202, Aurora, CO 80045, USA
| | - Philip J York
- Department of Orthopedics, University of Colorado School of Medicine, 12631 East 17th Avenue, Room 4501 B202, Aurora, CO 80045, USA
| | - Armando F Vidal
- Department of Orthopedics, University of Colorado School of Medicine, 12631 East 17th Avenue, Room 4501 B202, Aurora, CO 80045, USA.
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44
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Abstract
The management of patellofemoral cartilage lesions is controversial and should begin with a comprehensive nonsurgical treatment plan. Patients with patellofemoral cartilage lesions in whom nonsurgical treatment fails may be candidates for surgical treatment. Surgical treatment strategies for the management of patellofemoral cartilage lesions are guided by the size, quality, and location of the defect. Recent advancements in cartilage restoration and arthroplasty techniques as well as appropriate patient selection and meticulous surgical technique have resulted in promising outcomes in patients with patellofemoral cartilage lesions who undergo surgical treatment.
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