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Wang AS, Nagelli CV, Lamba A, Saris DBF, Krych AJ, Hevesi M. Minimum 10-Year Outcomes of Matrix-Induced Autologous Chondrocyte Implantation in the Knee: A Systematic Review. Am J Sports Med 2024; 52:2407-2414. [PMID: 38312085 DOI: 10.1177/03635465231205309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
BACKGROUND Matrix-induced autologous chondrocyte implantation (MACI) is an established cell-based therapy for the treatment of chondral defects of the knee. As long-term outcomes are now being reported in the literature, it is important to systematically review available evidence to better inform clinical practice. PURPOSE To report (1) subjective patient-reported outcomes (PROs) and (2) the rate of graft failure, reoperation, and progression to total knee arthroplasty (TKA) after undergoing MACI of the knee at a minimum 10-year follow-up. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A comprehensive search of Ovid MEDLINE and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily; Ovid Embase; Ovid Cochrane Central Register of Controlled Trials; Ovid Cochrane Database of Systematic Reviews; and Scopus from 2008 to September 15, 2022, was conducted in the English language. Study eligibility criteria included (1) full-text articles in the English language, (2) patients undergoing a MACI within the knee, (3) clinical outcomes reported, and (4) a minimum 10-year follow-up. RESULTS In total, 168 patients (99 male, 69 female; mean age, 37 years [range, 15-63 years]; mean body mass index, 26.2 [range, 18.6-39.4]) representing 188 treated chondral defects at a minimum 10-year follow-up after MACI were included in this review. Significant and durable long-term improvements were observed across multiple PRO measures. Follow-up magnetic resonance imaging (MRI), when performed, also demonstrated satisfactory defect fill and an intact graft in the majority of patients. The all-cause reoperation rate was 9.0%, with an overall 7.4% rate of progression to TKA at 10 to 17 years of follow-up. CONCLUSION At a minimum 10-year follow-up, patients undergoing MACI for knee chondral defects demonstrated significant and durable improvements in PROs, satisfactory defect fill on MRI-based assessment, and low rates of reoperation and TKA. These data support the use of MACI as a long-term treatment of focal cartilage defects of the knee.
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Affiliation(s)
- Allen S Wang
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Abhinav Lamba
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniël B F Saris
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mario Hevesi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Zhang H, Wang M, Wu R, Guo J, Sun A, Li Z, Ye R, Xu G, Cheng Y. From materials to clinical use: advances in 3D-printed scaffolds for cartilage tissue engineering. Phys Chem Chem Phys 2023; 25:24244-24263. [PMID: 37698006 DOI: 10.1039/d3cp00921a] [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: 09/13/2023]
Abstract
Osteoarthritis caused by articular cartilage defects is a particularly common orthopedic disease that can involve the entire joint, causing great pain to its sufferers. A global patient population of approximately 250 million people has an increasing demand for new therapies with excellent results, and tissue engineering scaffolds have been proposed as a potential strategy for the repair and reconstruction of cartilage defects. The precise control and high flexibility of 3D printing provide a platform for subversive innovation. In this perspective, cartilage tissue engineering (CTE) scaffolds manufactured using different biomaterials are summarized from the perspective of 3D printing strategies, the bionic structure strategies and special functional designs are classified and discussed, and the advantages and limitations of these CTE scaffold preparation strategies are analyzed in detail. Finally, the application prospect and challenges of 3D printed CTE scaffolds are discussed, providing enlightening insights for their current research.
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Affiliation(s)
- Hewen Zhang
- School of the Faculty of Mechanical Engineering and Mechanic, Ningbo University, Ningbo, Zhejiang Province, 315211, China
- Center of Materials Science and Optoelectronics Engineering, University of Chinese Academy of Sciences, Beijing 100049, P. R. China
- Zhejiang Key Laboratory of Additive Manufacturing Materials, Ningbo Institute of Materials Technology & Engineering, Chinese Academy of Sciences, Ningbo 315201, P. R. China.
| | - Meng Wang
- Department of Joint Surgery, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, 315020, China.
| | - Rui Wu
- Department of Orthopedics, Ningbo First Hospital Longshan Hospital Medical and Health Group, Ningbo 315201, P. R. China
| | - Jianjun Guo
- Zhejiang Key Laboratory of Additive Manufacturing Materials, Ningbo Institute of Materials Technology & Engineering, Chinese Academy of Sciences, Ningbo 315201, P. R. China.
| | - Aihua Sun
- Zhejiang Key Laboratory of Additive Manufacturing Materials, Ningbo Institute of Materials Technology & Engineering, Chinese Academy of Sciences, Ningbo 315201, P. R. China.
| | - Zhixiang Li
- Zhejiang Key Laboratory of Additive Manufacturing Materials, Ningbo Institute of Materials Technology & Engineering, Chinese Academy of Sciences, Ningbo 315201, P. R. China.
| | - Ruqing Ye
- Department of Joint Surgery, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, 315020, China.
| | - Gaojie Xu
- Zhejiang Key Laboratory of Additive Manufacturing Materials, Ningbo Institute of Materials Technology & Engineering, Chinese Academy of Sciences, Ningbo 315201, P. R. China.
| | - Yuchuan Cheng
- Center of Materials Science and Optoelectronics Engineering, University of Chinese Academy of Sciences, Beijing 100049, P. R. China
- Zhejiang Key Laboratory of Additive Manufacturing Materials, Ningbo Institute of Materials Technology & Engineering, Chinese Academy of Sciences, Ningbo 315201, P. R. China.
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Sumii J, Nakasa T, Kato Y, Miyaki S, Adachi N. The Subchondral Bone Condition During Microfracture Affects the Repair of the Osteochondral Unit in the Cartilage Defect in the Rat Model. Am J Sports Med 2023; 51:2472-2479. [PMID: 37306063 DOI: 10.1177/03635465231177586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Microfracture (MF) is frequently performed as a first-line treatment for articular cartilage defects. Although good clinical outcomes are often obtained in the short term, poor clinical outcomes sometimes occur because of subchondral bone deterioration. The condition of the subchondral bone treated with MF may affect the repair of the osteochondral unit. PURPOSE To analyze histological findings of the osteochondral unit after performing MF on subchondral bone in different states-normal, absorption, and sclerosis-in a rat model. STUDY DESIGN Controlled laboratory study. METHODS Full-thickness cartilage defects (5.0 × 3.0 mm) were created in the weightbearing area of the medial femoral condyle in both knees of 47 Sprague-Dawley rats. Five MF holes were created within the cartilage defect using a 0.55-mm needle to a depth of 1 mm at 0 weeks (normal group), 2 weeks (absorption group), and 4 weeks (sclerosis group) after the cartilage defect was created. In the left knee, MF holes were filled with β-tricalcium phosphate (β-TCP). At 2 and 4 weeks after MF, knee joints were harvested and histologically analyzed. RESULTS MF holes were enlarged at 2 weeks and further enlarged at 4 weeks in all groups. In the absorption group, osteoclast accumulation around the MF holes and cyst formation were observed. The trabecular bone surrounding the MF holes was thickened in the sclerosis group. The diameter of the MF hole was largest in the absorption group at 2 and 4 weeks after MF compared with the other groups. No subchondral bone cysts were observed after β-TCP implantation. Pineda scores in all groups were significantly better with β-TCP implantation than without β-TCP implantation at 2 and 4 weeks. CONCLUSION MF for subchondral bone with bone absorption induced enlargement of the MF holes, cyst formation, and delay of cartilage defect coverage. Implantation of β-TCP into the MF holes enhanced remodeling of the MF holes and improved repair of the osteochondral unit compared with MF only. Therefore, the condition of the subchondral bone treated with MF affects repair of the osteochondral unit in a cartilage defect.
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Affiliation(s)
- Junichi Sumii
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomoyuki Nakasa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuichi Kato
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shigeru Miyaki
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Herausforderungen der Translation von innovativen Produkten und Technologien in die klinische Praxis. ARTHROSKOPIE 2023. [PMCID: PMC9972308 DOI: 10.1007/s00142-023-00593-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
In Zeiten der zunehmenden Technisierung und Digitalisierung hat die Bedeutung der translationalen Medizin zugenommen. Eine erfolgreiche Translation von der Grundlagenforschung bis zur klinischen Anwendung ist ein kostspieliger und zeitaufwendiger Prozess, der von vielen Faktoren abhängt. Negative Beispiele aus der Vergangenheit (Thalidomid, Metall-Metall-Paarungen bei der Hüftendoprothetik) zeigen, dass eine Translation auch Risiken für die Patienten birgt. In den letzten Jahren wurden strengere Auflagen für die Herstellung und Zulassung von Medizinprodukten eingeführt, um die Patientensicherheit gewährleisten zu können. Die autologe Chondrozytentransplantation (ACT) ist ein Beispiel für eine gelungene Translation. Auf präklinische experimentelle Tierstudien folgten klinische Patientenstudien mit einer Marktzulassung und Implementation in den klinischen Alltag. Die Wirksamkeit allein ist nicht entscheidend, ob dieses Produkt auf dem Markt zugelassen wird. Zwischen der Grundlagenwissenschaft und der Bereitschaft des Markts, in die Weiterentwicklung und Kommerzialisierung eines Produkts zu investieren, ist eine erhebliche Hürde, die auch Tal des Todes genannt wird. Nur wenn diese Hürde überwunden wird, kommt es letztendlich zur Marktzulassung und zum klinischen Einsatz. Das Minced-cartilage-Verfahren zur Behandlung von fokalen Knorpelschäden hat kürzlich diese Hürde genommen und den Translationsprozess abgeschlossen. Aktuell liegen lediglich Kurzzeitergebnisse vor; frühzeitige Anwender verwenden diese Technik bereits, obwohl noch keine randomisierten Studien und mittelfristige Ergebnisse vorliegen. Weitere Studien werden zeigen, ob sich ein klinischer Nutzen abzeichnet und das Produkt am Markt bleibt.
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Herman K, Gobbi A. Evidence-Based Approach to Orthobiologics for Osteoarthritis and Other Joint Disorders. Phys Med Rehabil Clin N Am 2023; 34:71-81. [DOI: 10.1016/j.pmr.2022.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Tee CA, Han J, Hui JHP, Lee EH, Yang Z. Perspective in Achieving Stratified Articular Cartilage Repair Using Zonal Chondrocytes. TISSUE ENGINEERING. PART B, REVIEWS 2023. [PMID: 36416231 DOI: 10.1089/ten.teb.2022.0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Articular cartilage is composed of superficial, medial, and deep zones, which endow the tissue with biphasic mechanical properties to withstand shearing force and compressional loading. The tissue has very limited self-healing capacity once it is damaged due to its avascular nature. To prevent the early onset of osteoarthritis, surgical intervention is often needed to repair the injured cartilage. Current noncell-based and cell-based treatments focus on the regeneration of homogeneous cartilage to achieve bulk compressional properties without recapitulating the zonal matrix and mechanical properties, and often oversight in aiding cartilage integration between host and repair cartilage. It is hypothesized that achieving zonal architecture in articular cartilage tissue repair could improve the structural and mechanical integrity and thus the life span of the regenerated tissue. Engineering stratified cartilage constructs using zonal chondrocytes have been hypothesized to improve the functionality and life span of the regenerated tissues. However, stratified articular cartilage repair has yet to be realized to date due to the lack of an efficient zonal chondrocyte isolation method and an expansion platform that would allow both cell propagation and phenotype maintenance. Various attempts and challenges in achieving stratified articular cartilage repair in a clinical setting are evaluated. In this review, different perspectives on achieving stratified articular cartilage repair using zonal chondrocytes are described. The effectiveness of different zonal chondrocyte isolation and zonal chondrocyte phenotype maintenance methodologies during expansion are compared, with the focus on recent advancements in zonal chondrocyte isolation and expansion that could present a possible strategy to overcome the limitation of applying zonal chondrocytes to facilitate zonal architecture development in articular cartilage regeneration. Impact Statement The zonal properties of articular cartilage contribute to the biphasic mechanical properties of the tissues. Recapitulation of the zonal architecture in regenerated articular cartilage has been hypothesized to improve the mechanical integrity and life span of the regenerated tissue. This review provides a comprehensive discussion on the current state of research relevant to achieving stratified articular cartilage repair using zonal chondrocytes from different perspectives. This review further elaborates on a zonal chondrocyte production pipeline that can potentially overcome the current clinical challenges and future work needed to realize stratified zonal chondrocyte implantation in a clinical setting.
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Affiliation(s)
- Ching Ann Tee
- Critical Analytics for Manufacturing Personalised-Medicine Interdisciplinary Research Group, Singapore-MIT Alliance in Research and Technology, Singapore, Singapore.,Department of Orthopaedic Surgery, National University of Singapore, Singapore, Singapore
| | - Jongyoon Han
- Critical Analytics for Manufacturing Personalised-Medicine Interdisciplinary Research Group, Singapore-MIT Alliance in Research and Technology, Singapore, Singapore.,Department of Electrical Engineering and Computer Science, Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - James Hoi Po Hui
- Department of Orthopaedic Surgery, National University of Singapore, Singapore, Singapore.,NUS Tissue Engineering Program, Life Sciences Institute, National University of Singapore, Singapore, Singapore
| | - Eng Hin Lee
- Critical Analytics for Manufacturing Personalised-Medicine Interdisciplinary Research Group, Singapore-MIT Alliance in Research and Technology, Singapore, Singapore.,Department of Orthopaedic Surgery, National University of Singapore, Singapore, Singapore.,NUS Tissue Engineering Program, Life Sciences Institute, National University of Singapore, Singapore, Singapore
| | - Zheng Yang
- Critical Analytics for Manufacturing Personalised-Medicine Interdisciplinary Research Group, Singapore-MIT Alliance in Research and Technology, Singapore, Singapore.,Department of Orthopaedic Surgery, National University of Singapore, Singapore, Singapore.,NUS Tissue Engineering Program, Life Sciences Institute, National University of Singapore, Singapore, Singapore
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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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Heiss DMR, Guermazi A, Janka PDMR, Uder PDMM, Li X, Hayashi D, Roemer FW. Update: Posttreatment Imaging of the Knee after Cartilage Repair. Semin Musculoskelet Radiol 2022; 26:216-229. [PMID: 35654091 DOI: 10.1055/s-0042-1743405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Focal cartilage lesions are common pathologies at the knee joint that are considered important risk factors for the premature development of osteoarthritis. A wide range of surgical options, including but not limited to marrow stimulation, osteochondral auto- and allografting, and autologous chondrocyte implantation, allows for targeted treatment of focal cartilage defects. Arthroscopy is the standard of reference for the assessment of cartilage integrity and quality before and after repair. However, deep cartilage layers, intrachondral composition, and the subchondral bone are only partially or not at all visualized with arthroscopy. In contrast, magnetic resonance imaging offers noninvasive evaluation of the cartilage repair site, the subchondral bone, and the soft tissues of the joint pre- and postsurgery. Radiologists need to be familiar with the different surgical procedures available and their characteristic postsurgical imaging appearances to assess treatment success and possible complications adequately. We provide an overview of the most commonly performed surgical procedures for cartilage repair at the knee and typical postsurgical imaging characteristics.
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Affiliation(s)
- Dr Med Rafael Heiss
- Department of Radiology, Universityhospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Ali Guermazi
- Department of Radiology, VA Healthcare System, West Roxbury, Massachusetts.,Department of Radiology, Boston University School of Medicine, Boston, Massachusetts
| | - Prof Dr Med Rolf Janka
- Department of Radiology, Universityhospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Prof Dr Med Michael Uder
- Department of Radiology, Universityhospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Xinning Li
- Department of Orthopedic Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Daichi Hayashi
- Department of Radiology, Stony Brook University Renaissance School of Medicine, Stony Brook, New York
| | - Frank W Roemer
- Department of Radiology, Universityhospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.,Department of Radiology, Boston University School of Medicine, Boston, Massachusetts
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Epanomeritakis IE, Lee E, Lu V, Khan W. The Use of Autologous Chondrocyte and Mesenchymal Stem Cell Implants for the Treatment of Focal Chondral Defects in Human Knee Joints-A Systematic Review and Meta-Analysis. Int J Mol Sci 2022; 23:ijms23074065. [PMID: 35409424 PMCID: PMC8999850 DOI: 10.3390/ijms23074065] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/02/2022] [Accepted: 04/03/2022] [Indexed: 12/16/2022] Open
Abstract
Focal chondral defects of the knee occur commonly in the young, active population due to trauma. Damage can insidiously spread and lead to osteoarthritis with significant functional and socioeconomic consequences. Implants consisting of autologous chondrocytes or mesenchymal stem cells (MSC) seeded onto scaffolds have been suggested as promising therapies to restore these defects. However, the degree of integration between the implant and native cartilage still requires optimization. A PRISMA systematic review and meta-analysis was conducted using five databases (PubMed, MEDLINE, EMBASE, Web of Science, CINAHL) to identify studies that used autologous chondrocyte implants (ACI) or MSC implant therapies to repair chondral defects of the tibiofemoral joint. Data on the integration of the implant-cartilage interface, as well as outcomes of clinical scoring systems, were extracted. Most eligible studies investigated the use of ACI only. Our meta-analysis showed that, across a total of 200 patients, 64% (95% CI (51%, 75%)) achieved complete integration with native cartilage. In addition, a pooled improvement in the mean MOCART integration score was observed during post-operative follow-up (standardized mean difference: 1.16; 95% CI (0.07, 2.24), p = 0.04). All studies showed an improvement in the clinical scores. The use of a collagen-based scaffold was associated with better integration and clinical outcomes. This review demonstrated that cell-seeded scaffolds can achieve good quality integration in most patients, which improves over time and is associated with clinical improvements. A greater number of studies comparing these techniques to traditional cartilage repair methods, with more inclusion of MSC-seeded scaffolds, should allow for a standardized approach to cartilage regeneration to develop.
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Affiliation(s)
| | - Ernest Lee
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK; (I.E.E.); (E.L.); (V.L.)
| | - Victor Lu
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK; (I.E.E.); (E.L.); (V.L.)
| | - Wasim Khan
- Department of Trauma and Orthopaedic Surgery, Addenbrooke’s Hospital, University of Cambridge, Cambridge CB2 0QQ, UK
- Correspondence: ; Tel.: +44-(0)-7791-025554
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Matsushita T, Matsumoto T, Araki D, Nagai K, Hoshino Y, Niikura T, Kawamoto A, Go MJ, Kawamata S, Fukushima M, Kuroda R. A phase I/IIa clinical trial of third-generation autologous chondrocyte implantation (IK-01) for focal cartilage injury of the knee. Asia Pac J Sports Med Arthrosc Rehabil Technol 2022; 28:6-12. [PMID: 35415075 PMCID: PMC8967970 DOI: 10.1016/j.asmart.2022.03.004] [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: 10/01/2021] [Revised: 01/13/2022] [Accepted: 03/14/2022] [Indexed: 11/22/2022] Open
Abstract
Background/objective The purpose of this study was to report the outcomes of a clinical trial conducted in Japan to assess the safety and effectiveness of third-generation autologous chondrocyte implantation (ACI) using IK-01 (CaReS™), which does not require flap coverage, in the treatment of patients with focal cartilage injury of the knee. Methods This was an open label, exploratory clinical trial. Patients were enrolled between June 2012 and September 2016. The primary endpoint of the study was the International Knee Documentation Committee (IKDC) score at 52 weeks after implantation. The IKDC, Lysholm, and visual analog scale (VAS) scores were evaluated at the time of screening and at 4, 12, 24, 36, and 52 weeks after implantation. Improvements from the baseline scores were evaluated using the equation “(postoperative score) − (preoperative score).” Magnetic resonance imaging (MRI) was performed at 2, 12, 24, and 52 weeks after implantation, and MRI measurements were evaluated using T1 rho and T2 mapping. Results Nine patients were enrolled in this study and were examined for safety. Product quality did not satisfy the specification in one patient, and bacterial joint infection occurred in one patient. As a result, seven patients were included in the outcome analyses. The mean IKDC score significantly improved from 36.4 preoperatively to 74.1% at 52 weeks after implantation (p < 0.0001). The mean Lysholm and VAS scores also significantly improved from 39.6 to 57.4 to 89.6 and 22.9, respectively, after surgery. In the MRI evaluation, the T1 rho and T2 values of the implanted area were similar to those of the surrounding cartilage at 52 weeks after implantation. Conclusions Third generation ACI (IK-01) can be an effective treatment option for focal cartilage defects of the knee; however, surgeons must pay careful attention to the risk of postoperative joint infection.
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Affiliation(s)
- Takehiko Matsushita
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
- Corresponding author. Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
| | - Tomoyuki Matsumoto
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daisuke Araki
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kanto Nagai
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuichi Hoshino
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiro Niikura
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Masahiro J. Go
- Foundation for Biomedical Research and Innovation at Kobe, Japan
| | - Shin Kawamata
- Foundation for Biomedical Research and Innovation at Kobe, Japan
| | | | - Ryosuke Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Cogan CJ, Friedman J, You J, Zhang AL, Feeley BT, Ma CB, Lansdown DA. Prior Bone Marrow Stimulation Surgery Influences Outcomes After Cell-Based Cartilage Restoration: A Systematic Review and Meta-analysis. Orthop J Sports Med 2022; 9:23259671211035384. [PMID: 35146031 PMCID: PMC8822078 DOI: 10.1177/23259671211035384] [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: 03/16/2021] [Accepted: 04/30/2021] [Indexed: 01/06/2023] Open
Abstract
Background: Cell-based cartilage restoration with autologous chondrocyte implantation (ACI) is a safe and effective treatment for symptomatic cartilage lesions. Many patients undergoing ACI have a history of prior surgery, including bone marrow stimulation (BMS). There is mounting evidence that a history of prior BMS may impede healing of the ACI graft. Purpose/Hypothesis: The purpose of this study was to compare the failure rates of primary ACI with ACI after prior BMS. We hypothesized that ACI after BMS would have a significantly higher failure rate (defined as reoperation, conversion to arthroplasty, and/or imaging-based failure) compared with primary ACI. Study Design: Systematic review; Level of evidence, 4. Methods: A literature search was performed by use of PubMed and Embase databases for relevant articles published through October 2, 2020, to identify studies evaluating outcomes and failures rates of ACI after prior BMS in the knee. Results: Included were 11 studies comprising 1479 ACI procedures. The mean age at surgery ranged from 18.3 to 39.1 years, and the mean follow-up ranged from 3 to 20.6 years. All studies reported failure rates. The overall failure rate was significantly higher in the patients who underwent ACI after BMS, at 26.4% compared with 14.8% in the ACI group (P < .001). Meta-analysis demonstrated an increased risk of failure in patients with a history of prior BMS (log odds ratio = –0.90 [95% confidence interval, –1.38 to –0.42]). Conclusion: This systematic review demonstrated that failure rates were significantly higher for patients treated with ACI after BMS relative to patients undergoing ACI without prior BMS. This finding has important implications when considering the use of BMS for defects that are amenable to cell-based restoration and when determining treatment options after failed BMS. Registration: PROSPERO (CRD42020180387).
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Affiliation(s)
- Charles J Cogan
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - James Friedman
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jae You
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Drew A Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
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12
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The Induced Pluripotent Stem Cells in Articular Cartilage Regeneration and Disease Modelling: Are We Ready for Their Clinical Use? Cells 2022; 11:cells11030529. [PMID: 35159338 PMCID: PMC8834349 DOI: 10.3390/cells11030529] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/29/2022] [Accepted: 02/01/2022] [Indexed: 02/01/2023] Open
Abstract
The development of induced pluripotent stem cells has brought unlimited possibilities to the field of regenerative medicine. This could be ideal for treating osteoarthritis and other skeletal diseases, because the current procedures tend to be short-term solutions. The usage of induced pluripotent stem cells in the cell-based regeneration of cartilage damages could replace or improve on the current techniques. The patient’s specific non-invasive collection of tissue for reprogramming purposes could also create a platform for drug screening and disease modelling for an overview of distinct skeletal abnormalities. In this review, we seek to summarise the latest achievements in the chondrogenic differentiation of pluripotent stem cells for regenerative purposes and disease modelling.
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13
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Marcarelli M, Zappia M, Rissolio L, Baroni C, Astarita C, Trovato L, Graziano A. Cartilage Micrografts as a Novel Non-Invasive and Non-Arthroscopic Autograft Procedure for Knee Chondropathy: Three-Year Follow-Up Study. J Clin Med 2021; 10:jcm10020322. [PMID: 33477260 PMCID: PMC7830188 DOI: 10.3390/jcm10020322] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 12/19/2022] Open
Abstract
(1) Background: Focal chondral defects of the knee can significantly impair patient quality of life. Although different options are available, they are still not conclusive and have several limitations. The aim of this study was to evaluate the role of autologous cartilage micrografts in the treatment of knee chondropathy. (2) Methods: Eight patients affected by knee chondropathy were evaluated before and after 6 months and 3 years following autologous cartilage micrografts by magnetic resonance imaging (MRI) for cartilage measurement and clinical assessment. (3) Results: All patients recovered daily activities, reporting pain reduction without the need for analgesic therapy; Oxford Knee Score (OKS) was 28.4 ± 6 and 40.8 ± 6.2 and visual analogue scale (VAS) was 5.5 ± 1.6 and 1.8 ± 0.7 before and after 6 months following treatment, respectively. Both scores remained stable after 3 years. Lastly, a significant improvement of the cartilage thickness was observed using MRI after 3 years. (4) Conclusions: Autologous cartilage micrografts can promote the formation of new cartilage, and could be a valid approach for the treatment of knee chondropathy.
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Affiliation(s)
- Marco Marcarelli
- Unit of Orthopedics and Traumatology of Chieri and Moncalieri, Santa Croce Hospital, 10024 Turin, Italy; (M.M.); (L.R.); (C.B.)
| | - Marcello Zappia
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy;
| | - Lorenzo Rissolio
- Unit of Orthopedics and Traumatology of Chieri and Moncalieri, Santa Croce Hospital, 10024 Turin, Italy; (M.M.); (L.R.); (C.B.)
| | - Chiara Baroni
- Unit of Orthopedics and Traumatology of Chieri and Moncalieri, Santa Croce Hospital, 10024 Turin, Italy; (M.M.); (L.R.); (C.B.)
| | - Carlo Astarita
- Human Brain Wave, Corso Galileo Ferraris, 63, 10128 Turin, Italy;
- Sbarro Institute for Cancer Research and Molecular Medicine, Department of Biology, College of Science and Technology, Temple University, Philadelphia, PA 19126, USA;
- Correspondence:
| | - Letizia Trovato
- Sbarro Institute for Cancer Research and Molecular Medicine, Department of Biology, College of Science and Technology, Temple University, Philadelphia, PA 19126, USA;
| | - Antonio Graziano
- Human Brain Wave, Corso Galileo Ferraris, 63, 10128 Turin, Italy;
- Sbarro Institute for Cancer Research and Molecular Medicine, Department of Biology, College of Science and Technology, Temple University, Philadelphia, PA 19126, USA;
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14
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Schreiner AJ, Stoker AM, Bozynski CC, Kuroki K, Stannard JP, Cook JL. Clinical Application of the Basic Science of Articular Cartilage Pathology and Treatment. J Knee Surg 2020; 33:1056-1068. [PMID: 32583400 DOI: 10.1055/s-0040-1712944] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The joint is an organ with each tissue playing critical roles in health and disease. Intact articular cartilage is an exquisite tissue that withstands incredible biologic and biomechanical demands in allowing movement and function, which is why hyaline cartilage must be maintained within a very narrow range of biochemical composition and morphologic architecture to meet demands while maintaining health and integrity. Unfortunately, insult, injury, and/or aging can initiate a cascade of events that result in erosion, degradation, and loss of articular cartilage such that joint pain and dysfunction ensue. Importantly, articular cartilage pathology affects the health of the entire joint and therefore should not be considered or addressed in isolation. Treating articular cartilage lesions is challenging because left alone, the tissue is incapable of regeneration or highly functional and durable repair. Nonoperative treatments can alleviate symptoms associated with cartilage pathology but are not curative or lasting. Current surgical treatments range from stimulation of intrinsic repair to whole-surface and whole-joint restoration. Unfortunately, there is a relative paucity of prospective, randomized controlled, or well-designed cohort-based clinical trials with respect to cartilage repair and restoration surgeries, such that there is a gap in knowledge that must be addressed to determine optimal treatment strategies for this ubiquitous problem in orthopedic health care. This review article discusses the basic science rationale and principles that influence pathology, symptoms, treatment algorithms, and outcomes associated with articular cartilage defects in the knee.
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Affiliation(s)
- Anna J Schreiner
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,BG Center for Trauma and Reconstructive Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Aaron M Stoker
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Chantelle C Bozynski
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Keiichi Kuroki
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - James P Stannard
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - James L Cook
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
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15
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McCrum CL. Editorial Commentary: Third-Generation Autologous Chondrocyte Implantation-Are Cells Seeded Onto the Scaffold Itself in It for the Long Run? Arthroscopy 2020; 36:1939-1941. [PMID: 32624127 DOI: 10.1016/j.arthro.2020.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/01/2020] [Indexed: 02/02/2023]
Abstract
Autologous chondrocyte implantation (ACI) is an increasingly performed procedure, with rapidly evolving technology. First-generation ACI used a periosteal patch, leading to the second generation, in which a type I-type III collagen membrane is used to cover the autologous chondrocytes, and ultimately the third generation, in which autologous chondrocytes are seeded onto the scaffold itself. As third-generation, scaffold-based ACI techniques are becoming more widely available, interest in the long-term clinical and radiographic outcomes continues to grow, especially given the high costs associated with these procedures. Several studies have now shown persistently improved clinical outcomes at long-term follow-up, which support the increasing utilization of third-generation ACI techniques. However, it is important to continue to develop our understanding of the limitations of and expectations with third-generation ACI, particularly regarding reoperation, as well as to continue to design high-quality long-term studies that can evaluate differences in technology.
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16
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GIGLIO PEDRONOGUEIRA, LIZIER NELSONFORESTO, LEVY DÉBORA, SOBRADO MARCELFARACO, GOBBI RICCARDOGOMES, PÉCORA JOSÉRICARDO, BYDLOWSKI SERGIOPAULO, DEMANGE MARCOKAWAMURA. AUTOLOGOUS CHONDROCYTE IMPLANTATION IN BRAZIL. ACTA ORTOPEDICA BRASILEIRA 2020; 28:131-136. [PMID: 32536794 PMCID: PMC7269135 DOI: 10.1590/1413-785220202803226503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Objective: To describe the first series of cases of autologous chondrocyte implantation
(ACI) in collagen membrane performed in Brazil. Methods: ACI was performed in 12 knees of 11 patients, aged 32.1 ± 10.9 years, with
5.3 ± 2.6 cm2 full-thickness knee cartilage lesions, with a
six-month minimum follow-up. Two surgical procedures were performed:
arthroscopic cartilage biopsy for isolation and expansion of chondrocytes,
which were seeded onto collagen membrane and implanted in the lesion site;
the characterization of cultured cells and implant was performed using
immunofluorescence for type II collagen (COL2) for cell viability and
electron microscopy of the implant. Clinical safety, KOOS and IKDC scores
and magnetic resonance imaging were evaluated. We used repeated-measures
ANOVA and post-hoc comparisons at α = 5%. Results: COL2 was identified in the cellular cytoplasm, cell viability was higher than
95% and adequate distribution and cell adhesion were found in the membrane.
The median follow-up was 10.9 months (7 to 19). We had two cases of
arthrofibrosis, one of graft hypertrophy and one of superficial infection as
complications, but none compromising clinical improvement. KOOS and IKDC
ranged from 71.2 ± 11.44 and 50.72 ± 14.10, in preoperative period, to 85.0
± 4.4 and 70.5 ± 8.0, at 6 months (p = 0.007 and 0.005). MRI showed
regenerated tissue compatible with hyaline cartilage. Conclusion: ACI in collagen membrane was feasible and safe in a short-term follow-up,
presenting regenerated formation visualized by magnetic resonance imaging
and improved clinical function. Level of evidence IV, Case
series.
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17
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Müller PE, Gallik D, Hammerschmid F, Baur-Melnyk A, Pietschmann MF, Zhang A, Niethammer TR. Third-generation autologous chondrocyte implantation after failed bone marrow stimulation leads to inferior clinical results. Knee Surg Sports Traumatol Arthrosc 2020; 28:470-477. [PMID: 31407047 DOI: 10.1007/s00167-019-05661-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 08/05/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Third-generation autologous chondrocyte implantation (ACI) is an established and frequently used method and successful method for the treatment of full-thickness cartilage defects in the knee. There are also an increasing number of patients with autologous chondrocyte implantation as a second-line therapy that is used after failed bone marrow stimulation in the patient's history. The purpose of this study is to investigate the effect of previous bone marrow stimulation on subsequent autologous chondrocyte implantation therapy. In this study, the clinical results after the matrix-based autologous chondrocyte implantation in the knee in a follow-up over 3 years postoperatively were analysed. METHODS Forty patients were included in this study. A total of 20 patients with cartilage defects of the knee were treated with third-generation autologous chondrocyte implantation (Novocart® 3D) as first-line therapy. The mean defect size was 5.4 cm2 (SD 2.6). IKDC subjective score and VAS were used for clinical evaluation after 6, 12, 24 and 36 months postoperatively. The results of these patients were compared with 20 matched patients with autologous chondrocyte implantation as second-line therapy. Matched pair analysis was performed by numbers of treated defects, defect location, defect size, gender, age and BMI. RESULTS Both the first-line (Group I) and second-line group (Group II) showed significantly better clinical results in IKDC score and VAS score in the follow-up over 3 years compared with the preoperative findings. In addition, Group I showed significantly better results in the IKDC and VAS during the whole postoperative follow-up after 6, 12, 24 and 36 months compared to Group II with second-line autologous chondrocyte implantation (IKDC 6 months p = 0.015, 1 year p = 0.001, 2 years p = 0.001, 3 years p = 0.011). Additionally, we found a lower failure rate in Group I. No revision surgery was performed in Group I. The failure rate in the second-line Group II was 30%. CONCLUSION This study showed that third-generation autologous chondrocyte implantation is a suitable method for the treatment of full-thickness cartilage defects. Both, Group I and Group II showed significant improvement in our follow-up. However, in comparing the results of the two groups, autologous chondrocyte implantation after failed bone marrow stimulation leads to worse clinical results. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Peter Ernst Müller
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - David Gallik
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Florian Hammerschmid
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Andrea Baur-Melnyk
- Department of Radiology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Matthias Frank Pietschmann
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Anja Zhang
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Thomas Richard Niethammer
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
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18
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Bozkurt M, Aşık MD, Gürsoy S, Türk M, Karahan S, Gümüşkaya B, Akkaya M, Şimşek ME, Cay N, Doğan M. Autologous stem cell-derived chondrocyte implantation with bio-targeted microspheres for the treatment of osteochondral defects. J Orthop Surg Res 2019; 14:394. [PMID: 31779662 PMCID: PMC6883666 DOI: 10.1186/s13018-019-1434-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 10/28/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Chondral injury is a common problem around the world. Currently, there are several treatment strategies for these types of injuries. The possible complications and problems associated with conventional techniques lead us to investigate a minimally invasive and biotechnological alternative treatment. Combining tissue-engineering and microencapsulation technologies provide new direction for the development of biotechnological solutions. The aim of this study is to develop a minimal invasive tissue-engineering approach, using bio-targeted microspheres including autologous cells, for the treatment of the cartilage lesions. METHOD In this study, a total of 28 sheeps of Akkaraman breed were randomly assigned to one of the following groups: control (group 1), microfracture (group 2), scaffold (group 3), and microsphere (group 4). Microspheres and scaffold group animals underwent adipose tissue collection prior to the treatment surgery. Mesenchymal cells collected from adipose tissue were differentiated into chondrocytes and encapsulated with scaffolds and microspheres. Osteochondral damage was conducted in the right knee joint of the sheep to create an animal model and all animals treated according to study groups. RESULTS Both macroscopic and radiologic examination showed that groups 3 and 4 have resulted better compared to the control and microfracture groups. Moreover, histologic assessments indicate hyaline-like cartilage formations in groups 3 and 4. CONCLUSION In conclusion, we believe that the bio-targeted microspheres can be a more effective, easier, and safer approach for cartilage tissue engineering compared to previous alternatives.
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Affiliation(s)
- Murat Bozkurt
- Department of Orthopedics and Traumatology, Ankara Yildirim Beyazit University, 06800, Ankara, Turkey.
| | - Mehmet Doğan Aşık
- Department of Medical Biology, Ankara Yildirim Beyazit University, 06800, Ankara, Turkey
| | - Safa Gürsoy
- Department of Orthopedics and Traumatology, Ankara Yildirim Beyazit University, 06800, Ankara, Turkey
| | - Mustafa Türk
- Deparment Of Bioengineering, Faculty of Engineering, Kırıkkale University, 72450, Kırıkkale, Turkey
| | - Siyami Karahan
- Deparment of Histology and Embryology, Faculty of Vetarinary Medicine, Kırıkkale University, 72450, Kırıkkale, Turkey
| | - Berrak Gümüşkaya
- Department of Pathology, Ankara Yildirim Beyazit University, 06800, Ankara, Turkey
| | - Mustafa Akkaya
- Department of Orthopedics and Traumatology, Ankara Yildirim Beyazit University, 06800, Ankara, Turkey
| | - Mehmet Emin Şimşek
- Department of Orthopedics and Traumatology, Ankara Yenimahalle Research and Training Hospital, 06800, Ankara, Turkey
| | - Nurdan Cay
- Deparment of Radiology, School of Medicine, Ankara Yildirim Beyazit University, 06800, Ankara, Turkey
| | - Metin Doğan
- Department of Orthopedics and Traumatology, Ankara Yildirim Beyazit University, 06800, Ankara, Turkey
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19
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Martinčič D, Mekač J, Drobnič M. Survival Rates of Various Autologous Chondrocyte Grafts and Concomitant Procedures. A Prospective Single-Center Study over 18 Years. Cell Transplant 2019; 28:1439-1444. [PMID: 31373214 PMCID: PMC6802147 DOI: 10.1177/0963689719861922] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Seven different autologous chondrocyte implantation (ACI) grafts were used consecutively over a period of 18 years for the treatment of cartilage lesions in the knees. The aim was to evaluate this entire ACI patient series for graft-related or unrelated serious adverse events (SAE), graft failures, and to reveal potential risk factors for these incidents. The study group comprised 151 operated patients: classical periosteum-ACI (n = 45); ACI-seeded fibrin-collagen patch, fixed by either periosteum (n = 59), collagen membrane (n = 15), or fibrin glue (n = 6); ACI seeded alginate-agarose hydrogel (n = 14); and biomimetic collagen-hydroxyapatite scaffold injected with the ACI suspension (n = 12). The covariates analyzed as possible predicting factors were: age, gender, BMI, lesion depth, lesion size, lesion location, previous surgeries, and concomitant procedures. The Kaplan-Meier method for estimating survival curves, and Cox's proportional hazards model to test for covariates, were used in the statistical analysis. The patients in this series, follow-up 10.1 (2.1-18.3) years, encountered 11% of graft-related SAE (risk factors: previous cartilage surgery, age over 40 years, BMI over 25 kg/m2, and meniscus surgery) and 10% of graft unrelated SAE (risk factors: meniscus surgery and osteotomy). None of these factors was a risk for definitive graft failure. The 10-year graft survival rate was 86%. Females had 2.8 times higher incidence of graft failures than males. There was a tendency toward higher graft failures after a previous cartilage surgery. Different ACI graft types offered safe and durable cartilage repair. Female gender, age over 40 years, increased weight, previous cartilage surgery, and meniscus loss showed increased risk for revision surgery or graft failures.
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Affiliation(s)
- David Martinčič
- Department of Orthopedic Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Jakob Mekač
- Orthopedic Hospital Valdoltra, Ankaran, Slovenia
| | - Matej Drobnič
- Department of Orthopedic Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
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20
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Wang K, Li J, Li Z, Wang B, Qin Y, Zhang N, Zhang H, Su X, Wang Y, Zhu H. Chondrogenic Progenitor Cells Exhibit Superiority Over Mesenchymal Stem Cells and Chondrocytes in Platelet-Rich Plasma Scaffold-Based Cartilage Regeneration. Am J Sports Med 2019; 47:2200-2215. [PMID: 31194571 DOI: 10.1177/0363546519854219] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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 Platelet-rich plasma (PRP) has been considered a promising tool for cartilage regeneration. However, increasing evidence has demonstrated the controversial effects of PRP on tissue regeneration, partially due to the unsatisfactory cell source. Chondrogenic progenitor cells (CPCs) have gained increasing attention as a potential cell source due to their self-renewal and multipotency, especially toward the chondrogenic lineage, and, thus, may be an appropriate alternative for cartilage engineering. PURPOSE To compare the effects of PRP on CPC, mesenchymal stem cell (MSC), and chondrocyte proliferation, chondrogenesis, and cartilage regeneration. STUDY DESIGN Controlled laboratory study. METHODS Whole blood samples were obtained from 5 human donors to create PRPs (0, 1000 × 109, and 2000 × 109 platelets per liter). The proliferation and chondrogenesis of CPCs, bone marrow-derived MSCs (BMSCs), and chondrocytes were evaluated via growth kinetic and CCK-8 assays. Immunofluorescence, cytochemical staining, and gene expression analyses were performed to assess chondrogenic differentiation and cartilaginous matrix formation. The in vivo effects of CPCs, BMSCs, and chondrocytes on cartilage regeneration after PRP treatment were measured by use of histopathological, biochemical, and biomechanical techniques in a cartilage defect model involving mature male New Zealand White rabbits (critical size, 5 mm). RESULTS The CPCs possessed migration abilities and proliferative capacities superior to those of the chondrocytes, while exhibiting a chondrogenic predisposition stronger than that of the BMSCs. The growth kinetic, CCK-8, cytochemical staining, and biochemical analyses revealed that the CPCs simultaneously displayed a higher cell density than the chondrocytes and stronger chondrogenesis than the BMSCs after PRP stimulation. In addition, the in vivo study demonstrated that the PRP+CPC construct yielded better histological (International Cartilage Repair Society [ICRS] score, mean ± SEM, 1197.2 ± 163.2) and biomechanical (tensile modulus, 1.523 ± 0.194) results than the PRP+BMSC (701.1 ± 104.9, P < .05; 0.791 ± 0.151, P < .05) and PRP+chondrocyte (541.6 ± 98.3, P < .01; 0.587 ± 0.142, P < .01) constructs at 12 weeks after implantation. CONCLUSION CPCs exhibit superiority over MSCs and chondrocytes in PRP scaffold-based cartilage regeneration, and PRP+CPC treatment may be a favorable strategy for cartilage repair. CLINICAL RELEVANCE These findings provide evidence highlighting the preferable role of CPCs as a cell source in PRP-mediated cartilage regeneration and may help researchers address the problem of unsatisfactory cell sources in cartilage engineering.
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Affiliation(s)
- Ketao Wang
- Department of Orthopedics, Center of Sport Medicine, Chinese PLA General Hospital, Haidian, Beijing, China
| | - Ji Li
- Department of Orthopedics, Center of Sport Medicine, Chinese PLA General Hospital, Haidian, Beijing, China
| | - Zhongli Li
- Department of Orthopedics, Center of Sport Medicine, Chinese PLA General Hospital, Haidian, Beijing, China
| | - Bin Wang
- Department of Orthopedics, Center of Sport Medicine, Chinese PLA General Hospital, Haidian, Beijing, China
| | - Yuanyuan Qin
- Department of Blood Transfusion, Chinese PLA General Hospital, Haidian, Beijing, China
| | - Ning Zhang
- Department of Orthopedics, Center of Sport Medicine, Chinese PLA General Hospital, Haidian, Beijing, China
| | - Hao Zhang
- Department of Orthopedics, Center of Sport Medicine, Chinese PLA General Hospital, Haidian, Beijing, China
| | - Xiangzheng Su
- Department of Orthopedics, Center of Sport Medicine, Chinese PLA General Hospital, Haidian, Beijing, China
| | - Yuxing Wang
- Department of Orthopedics, Center of Sport Medicine, Chinese PLA General Hospital, Haidian, Beijing, China
| | - Heng Zhu
- Beijing Institute of Radiation Medicine/Beijing Institute of Basic Medical Sciences, Haidian, Beijing, China
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21
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Na Y, Shi Y, Liu W, Jia Y, Kong L, Zhang T, Han C, Ren Y. Is implantation of autologous chondrocytes superior to microfracture for articular-cartilage defects of the knee? A systematic review of 5-year follow-up data. Int J Surg 2019; 68:56-62. [PMID: 31220632 DOI: 10.1016/j.ijsu.2019.06.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 06/02/2019] [Accepted: 06/12/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Autologous chondrocyte implantation (ACI) and microfracture are two of the main surgical treatment options for articular cartilage lesions of the knee. Consensus regarding the best clinical options to repair knee cartilage lesions is lacking. We undertook a systematic review to clarify the clinical efficacy of ACI and microfracture at minimum mean 5-year follow-up. METHODS A literature search was conducted using the MEDLINE, Embase and Cochrane Library databases up to August 2018. Only comparative clinical studies of ACI and microfracture for the treatment of articular cartilage lesions of the knee with level I/Ⅱ evidence were included. Clinical outcomes and the prevalence of treatment failure from each study were extracted and compared. The methodological quality of the included studies was analyzed by means of the PEDro scale. RESULTS Five comparative studies (three randomized controlled trials and two prospective cohort studies) met our eligibility criteria. ACI and microfracture elicited significant improvement in clinical outcomes after 5 years. However, better clinical results with significant differences were found with modified versions of ACI (ACI with a modified collagen membrane [ACI-C] or matrix-applied chondrocyte implantation [MACI]) than with microfracture as determined by the Knee Injury and Osteoarthritis Outcome Score, activities of daily living assessment, Tegner Activity Scale score, and the International Knee Documentation Committee objective and subjective scores. No significant difference was observed in the treatment failure rate between these two methods within a particular study. CONCLUSIONS Currently, the best-available evidence suggests that some clinical outcomes of articular cartilage lesions of the knee treated with modified versions of ACI (ACI-C or MACI) can significantly improve patient outcomes at the mid-term follow-up of 5 years compared with those obtained using microfracture.
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Affiliation(s)
- Yuyan Na
- Department of Arthroscopy and Sports Medicine, The Second Affiliated Hospital of Inner Mongolia Medical University, Huimin District, Hohhot, 010000, Inner Mongolia Autonomous Region, China.
| | - Yuting Shi
- Cardiac Function Department, Cadre Health Care Center, Inner Mongolia Autonomous Region People's Hospital, Saihan District, Hohhot, 010000, Inner Mongolia Autonomous Region, China.
| | - Wanlin Liu
- Department of Pediatric Orthopedics, The Second Affiliated Hospital of Inner Mongolia Medical University, Huimin District, Hohhot, 010000, Inner Mongolia Autonomous Region, China.
| | - Yanbo Jia
- Department of Arthroscopy and Sports Medicine, The Second Affiliated Hospital of Inner Mongolia Medical University, Huimin District, Hohhot, 010000, Inner Mongolia Autonomous Region, China.
| | - Lingyue Kong
- Department of Arthroscopy and Sports Medicine, The Second Affiliated Hospital of Inner Mongolia Medical University, Huimin District, Hohhot, 010000, Inner Mongolia Autonomous Region, China.
| | - Ting Zhang
- Department of Arthroscopy and Sports Medicine, The Second Affiliated Hospital of Inner Mongolia Medical University, Huimin District, Hohhot, 010000, Inner Mongolia Autonomous Region, China.
| | - Changxu Han
- Department of Arthroscopy and Sports Medicine, The Second Affiliated Hospital of Inner Mongolia Medical University, Huimin District, Hohhot, 010000, Inner Mongolia Autonomous Region, China.
| | - Yizhong Ren
- Department of Arthroscopy and Sports Medicine, The Second Affiliated Hospital of Inner Mongolia Medical University, Huimin District, Hohhot, 010000, Inner Mongolia Autonomous Region, China.
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Armiento AR, Alini M, Stoddart MJ. Articular fibrocartilage - Why does hyaline cartilage fail to repair? Adv Drug Deliv Rev 2019; 146:289-305. [PMID: 30605736 DOI: 10.1016/j.addr.2018.12.015] [Citation(s) in RCA: 172] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/07/2018] [Accepted: 12/27/2018] [Indexed: 12/12/2022]
Abstract
Once damaged, articular cartilage has a limited potential to repair. Clinically, a repair tissue is formed, yet, it is often mechanically inferior fibrocartilage. The use of monolayer expanded versus naïve cells may explain one of the biggest discrepancies in mesenchymal stromal/stem cell (MSC) based cartilage regeneration. Namely, studies utilizing monolayer expanded MSCs, as indicated by numerous in vitro studies, report as a main limitation the induction of type X collagen and hypertrophy, a phenotype associated with endochondral bone formation. However, marrow stimulation and transfer studies report a mechanically inferior collagen I/II fibrocartilage as the main outcome. Therefore, this review will highlight the collagen species produced during the different therapeutic approaches. New developments in scaffold design and delivery of therapeutic molecules will be described. Potential future directions towards clinical translation will be discussed. New delivery mechanisms are being developed and they offer new hope in targeted therapeutic delivery.
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Affiliation(s)
| | - Mauro Alini
- AO Research Institute Davos, 7270 Davos Platz, Switzerland.
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23
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Islam A, Fossum V, Hansen AK, Urbarova I, Knutsen G, Martinez-Zubiaurre I. In vitro chondrogenic potency of surplus chondrocytes from autologous transplantation procedures does not predict short-term clinical outcomes. BMC Musculoskelet Disord 2019; 20:19. [PMID: 30630436 PMCID: PMC6329094 DOI: 10.1186/s12891-018-2380-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 12/12/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Autologous chondrocyte implantation (ACI) has been used over the last two decades to treat focal cartilage lesions aiming to delay or prevent the onset of osteoarthritis; however, some patients do not respond adequately to the procedure. A number of biomarkers that can forecast the clinical potency of the cells have been proposed, but evidence for the relationship between in vitro chondrogenic potential and clinical outcomes is missing. In this study, we explored if the ability of cells to make cartilage in vitro correlates with ACI clinical outcomes. Additionally, we evaluated previously proposed chondrogenic biomarkers and searched for new biomarkers in the chondrocyte proteome capable of predicting clinical success or failure after ACI. METHODS The chondrogenic capacity of chondrocytes derived from 14 different donors was defined based on proteoglycans staining and visual histological grading of tissues generated using the pellet culture system. A Lysholm score of 65 two years post-ACI was used as a cut-off to categorise "success" and "failure" clinical groups. A set of predefined biomarkers were investigated in the chondrogenic and clinical outcomes groups using flow cytometry and qPCR. High-throughput proteomics of cell lysates was used to search for putative biomarkers to predict chondrogenesis and clinical outcomes. RESULTS Visual histological grading of pellets categorised donors into "high" and "low" chondrogenic groups. Direct comparison between donor-matched in vitro chondrogenic potential and clinical outcomes revealed no significant associations. Comparative analyses of selected biomarkers revealed that expression of CD106 and TGF-β-receptor-3 was enhanced in the low chondrogenic group, while expression of integrin-α1 and integrin-β1 was significantly upregulated in the high chondrogenic group. Additionally, increased surface expression of CD166 was observed in the clinical success group, while the gene expression of cartilage oligomeric matrix protein was downregulated. High throughput proteomics revealed no differentially expressed proteins from success and failure clinical groups, whereas seven proteins including prolyl-4-hydroxylase 1 were differentially expressed when comparing chondrogenic groups. CONCLUSION In our limited material, we found no correlation between in vitro cartilage-forming capacity and clinical outcomes, and argue on the limitations of using the chondrogenic potential of cells or markers for chondrogenesis as predictors of clinical outcomes.
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Affiliation(s)
- Ashraful Islam
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
| | - Vegard Fossum
- Department of Orthopaedic Surgery, University Hospital of Northern Norway, Tromsø, Norway
| | - Ann Kristin Hansen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Orthopaedic Surgery, University Hospital of Northern Norway, Tromsø, Norway
| | - Ilona Urbarova
- Department of Medical Biology, Tromsø University Proteomics Platform, UiT The Arctic University of Norway, Tromsø, Norway
| | - Gunnar Knutsen
- Department of Orthopaedic Surgery, University Hospital of Northern Norway, Tromsø, Norway
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24
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Sommerfeldt MF, Magnussen RA, Hewett TE, Kaeding CC, Flanigan DC. Microfracture of Articular Cartilage. JBJS Rev 2018; 4:01874474-201606000-00006. [PMID: 27486725 DOI: 10.2106/jbjs.rvw.15.00005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Microfracture is a treatment option for symptomatic, full-thickness cartilage defects. Microfracture is most likely to be successful when performed in nonobese patients under the age of thirty years for small (<2 to 4-cm2) femoral condylar defects that have been symptomatic for a short time (less than twelve to twenty-four months). Microfracture has acceptable short-term clinical results, but results can be expected to decline over time. Long-term studies that compare microfracture with advanced cartilage restoration techniques are required to ascertain whether these newer techniques provide longer-lasting results.
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Affiliation(s)
- Mark F Sommerfeldt
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
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25
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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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26
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Shimomura K, Yasui Y, Koizumi K, Chijimatsu R, Hart DA, Yonetani Y, Ando W, Nishii T, Kanamoto T, Horibe S, Yoshikawa H, Nakamura N, Sakaue M, Sugita N, Moriguchi Y. First-in-Human Pilot Study of Implantation of a Scaffold-Free Tissue-Engineered Construct Generated From Autologous Synovial Mesenchymal Stem Cells for Repair of Knee Chondral Lesions. Am J Sports Med 2018; 46:2384-2393. [PMID: 29969043 DOI: 10.1177/0363546518781825] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Articular cartilage has limited healing capacity, owing in part to poor vascularity and innervation. Once injured, it cannot be repaired, typically leading to high risk for developing osteoarthritis. Thus, cell-based and/or tissue-engineered approaches have been investigated; however, no approach has yet achieved safety and regenerative repair capacity via a simple implantation procedure. PURPOSE To assess the safety and efficacy of using a scaffold-free tissue-engineered construct (TEC) derived from autologous synovial membrane mesenchymal stem cells (MSCs) for effective cartilage repair. STUDY DESIGN Case series; Level of evidence, 4. METHODS Five patients with symptomatic knee chondral lesions (1.5-3.0 cm2) on the medial femoral condyle, lateral femoral condyle, or femoral groove were included. Synovial MSCs were isolated from arthroscopic biopsy specimens and cultured to develop a TEC that matched the lesion size. The TECs were then implanted into chondral defects without fixation and assessed up to 24 months postoperatively. The primary outcome was the safety of the procedure. Secondary outcomes were self-assessed clinical scores, arthroscopy, tissue biopsy, and magnetic resonance image-based estimation of morphologic and compositional quality of the repair tissue. RESULTS No adverse events were recorded, and self-assessed clinical scores for pain, symptoms, activities of daily living, sports activity, and quality of life were significantly improved at 24 months after surgery. Secure defect filling was confirmed by second-look arthroscopy and magnetic resonance imaging in all cases. Histology of biopsy specimens indicated repair tissue approaching the composition and structure of hyaline cartilage. CONCLUSION Autologous scaffold-free TEC derived from synovial MSCs may be used for regenerative cartilage repair via a sutureless and simple implantation procedure. Registration: 000008266 (UMIN Clinical Trials Registry number).
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Affiliation(s)
- Kazunori Shimomura
- Investigation performed at the Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yukihiko Yasui
- Investigation performed at the Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kota Koizumi
- Investigation performed at the Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ryota Chijimatsu
- Investigation performed at the Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - David A Hart
- Investigation performed at the Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasukazu Yonetani
- Investigation performed at the Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Wataru Ando
- Investigation performed at the Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takashi Nishii
- Investigation performed at the Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takashi Kanamoto
- Investigation performed at the Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shuji Horibe
- Investigation performed at the Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hideki Yoshikawa
- Investigation performed at the Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Norimasa Nakamura
- Investigation performed at the Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Morito Sakaue
- Investigation performed at the Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Norihiko Sugita
- Investigation performed at the Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yu Moriguchi
- Investigation performed at the Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Ruta DJ, Villarreal AD, Richardson DR. Orthopedic Surgical Options for Joint Cartilage Repair and Restoration. Phys Med Rehabil Clin N Am 2018; 27:1019-1042. [PMID: 27788899 DOI: 10.1016/j.pmr.2016.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The limited natural capacity for articular cartilage to regenerate has led to a continuously broadening array of surgical interventions. Used once patients' symptoms are not relieved by nonoperative management, these share the goals of joint preservation and restoration. Techniques include bone marrow stimulation, whole-tissue transplantation, and cell-based strategies, each with its own variations. Many of these interventions are performed arthroscopically or with extended-portal techniques. Indications, operative techniques, unique benefits, and limitations are presented.
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Affiliation(s)
- David J Ruta
- St. Luke's Department of Orthopedics & Sports Medicine, Duluth, MN, USA.
| | - Arturo D Villarreal
- Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - David R Richardson
- Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
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Vilela CA, Correia C, da Silva Morais A, Santos TC, Gertrudes AC, Moreira ES, Frias AM, Learmonth DA, Oliveira P, Oliveira JM, Sousa RA, Espregueira-Mendes JD, Reis RL. In vitro
and in vivo
performance of methacrylated gellan gum hydrogel formulations for cartilage repair*. J Biomed Mater Res A 2018; 106:1987-1996. [DOI: 10.1002/jbm.a.36406] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/26/2018] [Accepted: 03/15/2018] [Indexed: 01/01/2023]
Affiliation(s)
- Carlos A. Vilela
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho; Braga Portugal
- 3Bs Research Group - Biomaterials, Biodegradables and Biomimetics; University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine; Guimarães Portugal
- ICVS/3Bs-PT Government Associate Laboratory; Braga/Guimarães Portugal
- Orthopaedic Department; Hospital da Senhora da Oliveira Guimarães EPE; Guimarães Portugal
| | - Cristina Correia
- Stemmatters, Biotecnologia e Medicina Regenerativa SA; Guimarães Portugal
| | - Alain da Silva Morais
- 3Bs Research Group - Biomaterials, Biodegradables and Biomimetics; University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine; Guimarães Portugal
- ICVS/3Bs-PT Government Associate Laboratory; Braga/Guimarães Portugal
| | - Tírcia C. Santos
- 3Bs Research Group - Biomaterials, Biodegradables and Biomimetics; University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine; Guimarães Portugal
- ICVS/3Bs-PT Government Associate Laboratory; Braga/Guimarães Portugal
| | - Ana C. Gertrudes
- Stemmatters, Biotecnologia e Medicina Regenerativa SA; Guimarães Portugal
| | - Elsa S. Moreira
- Stemmatters, Biotecnologia e Medicina Regenerativa SA; Guimarães Portugal
| | - Ana M. Frias
- Stemmatters, Biotecnologia e Medicina Regenerativa SA; Guimarães Portugal
| | - David A. Learmonth
- Stemmatters, Biotecnologia e Medicina Regenerativa SA; Guimarães Portugal
| | - Pedro Oliveira
- ISUP-EPI Unit, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto; Porto Portugal
| | - Joaquim M. Oliveira
- 3Bs Research Group - Biomaterials, Biodegradables and Biomimetics; University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine; Guimarães Portugal
- ICVS/3Bs-PT Government Associate Laboratory; Braga/Guimarães Portugal
| | - Rui A. Sousa
- Stemmatters, Biotecnologia e Medicina Regenerativa SA; Guimarães Portugal
| | - João D. Espregueira-Mendes
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho; Braga Portugal
- 3Bs Research Group - Biomaterials, Biodegradables and Biomimetics; University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine; Guimarães Portugal
- ICVS/3Bs-PT Government Associate Laboratory; Braga/Guimarães Portugal
- Clínica do Dragão, Espregueira-Mendes Sports Centre, FIFA Medical Centre of Excellence and D. Henrique Research Centre; Porto Portugal
| | - Rui L. Reis
- 3Bs Research Group - Biomaterials, Biodegradables and Biomimetics; University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine; Guimarães Portugal
- ICVS/3Bs-PT Government Associate Laboratory; Braga/Guimarães Portugal
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29
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Kraeutler MJ, Belk JW, Purcell JM, McCarty EC. Microfracture Versus Autologous Chondrocyte Implantation for Articular Cartilage Lesions in the Knee: A Systematic Review of 5-Year Outcomes. Am J Sports Med 2018; 46:995-999. [PMID: 28423287 DOI: 10.1177/0363546517701912] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Microfracture (MFx) and autologous chondrocyte implantation (ACI) are 2 surgical treatment options used to treat articular cartilage injuries of the knee joint. PURPOSE To compare the midterm to long-term clinical outcomes of MFx versus ACI for focal chondral defects of the knee. STUDY DESIGN Systematic review. METHODS A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to locate studies (level of evidence I-III) comparing the minimum average 5-year clinical outcomes of patients undergoing MFx versus ACI. Search terms used were "knee," "microfracture," "autologous chondrocyte implantation," and "autologous chondrocyte transplantation." Patients were evaluated based on treatment failure rates, magnetic resonance imaging, and patient-reported outcome scores (Lysholm, Knee Injury and Osteoarthritis Outcome Score [KOOS], and Tegner scores). RESULTS Five studies (3 level I evidence, 2 level II evidence) were identified that met the inclusion criteria, including a total of 210 patients (211 lesions) undergoing MFx and 189 patients (189 lesions) undergoing ACI. The average follow-up among all studies was 7.0 years. Four studies utilized first-generation, periosteum-based ACI (P-ACI), and 1 study utilized third-generation, matrix-associated ACI (M-ACI). Treatment failure occurred in 18.5% of patients undergoing ACI and 17.1% of patients undergoing MFx ( P = .70). Lysholm and KOOS scores were found to improve for both groups across studies, without a significant difference in improvement between the groups. The only significant difference in patient-reported outcome scores was found in the 1 study using M-ACI in which Tegner scores improved to a significantly greater extent in the ACI group compared with the MFx group ( P = .003). CONCLUSION Patients undergoing MFx or first/third-generation ACI for articular cartilage lesions in the knee can be expected to experience improvement in clinical outcomes at midterm to long-term follow-up without any significant difference between the groups.
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Affiliation(s)
- Matthew J Kraeutler
- CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - John W Belk
- CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Justin M Purcell
- CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Eric C McCarty
- CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
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Mistry H, Connock M, Pink J, Shyangdan D, Clar C, Royle P, Court R, Biant LC, Metcalfe A, Waugh N. Autologous chondrocyte implantation in the knee: systematic review and economic evaluation. Health Technol Assess 2018; 21:1-294. [PMID: 28244303 DOI: 10.3310/hta21060] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The surfaces of the bones in the knee are covered with articular cartilage, a rubber-like substance that is very smooth, allowing frictionless movement in the joint and acting as a shock absorber. The cells that form the cartilage are called chondrocytes. Natural cartilage is called hyaline cartilage. Articular cartilage has very little capacity for self-repair, so damage may be permanent. Various methods have been used to try to repair cartilage. Autologous chondrocyte implantation (ACI) involves laboratory culture of cartilage-producing cells from the knee and then implanting them into the chondral defect. OBJECTIVE To assess the clinical effectiveness and cost-effectiveness of ACI in chondral defects in the knee, compared with microfracture (MF). DATA SOURCES A broad search was done in MEDLINE, EMBASE, The Cochrane Library, NHS Economic Evaluation Database and Web of Science, for studies published since the last Health Technology Assessment review. REVIEW METHODS Systematic review of recent reviews, trials, long-term observational studies and economic evaluations of the use of ACI and MF for repairing symptomatic articular cartilage defects of the knee. A new economic model was constructed. Submissions from two manufacturers and the ACTIVE (Autologous Chondrocyte Transplantation/Implantation Versus Existing Treatment) trial group were reviewed. Survival analysis was based on long-term observational studies. RESULTS Four randomised controlled trials (RCTs) published since the last appraisal provided evidence on the efficacy of ACI. The SUMMIT (Superiority of Matrix-induced autologous chondrocyte implant versus Microfracture for Treatment of symptomatic articular cartilage defects) trial compared matrix-applied chondrocyte implantation (MACI®) against MF. The TIG/ACT/01/2000 (TIG/ACT) trial compared ACI with characterised chondrocytes against MF. The ACTIVE trial compared several forms of ACI against standard treatments, mainly MF. In the SUMMIT trial, improvements in knee injury and osteoarthritis outcome scores (KOOSs), and the proportion of responders, were greater in the MACI group than in the MF group. In the TIG/ACT trial there was improvement in the KOOS at 60 months, but no difference between ACI and MF overall. Patients with onset of symptoms < 3 years' duration did better with ACI. Results from ACTIVE have not yet been published. Survival analysis suggests that long-term results are better with ACI than with MF. Economic modelling suggested that ACI was cost-effective compared with MF across a range of scenarios. LIMITATIONS The main limitation is the lack of RCT data beyond 5 years of follow-up. A second is that the techniques of ACI are evolving, so long-term data come from trials using forms of ACI that are now superseded. In the modelling, we therefore assumed that durability of cartilage repair as seen in studies of older forms of ACI could be applied in modelling of newer forms. A third is that the high list prices of chondrocytes are reduced by confidential discounting. The main research needs are for longer-term follow-up and for trials of the next generation of ACI. CONCLUSIONS The evidence base for ACI has improved since the last appraisal by the National Institute for Health and Care Excellence. In most analyses, the incremental cost-effectiveness ratios for ACI compared with MF appear to be within a range usually considered acceptable. Research is needed into long-term results of new forms of ACI. STUDY REGISTRATION This study is registered as PROSPERO CRD42014013083. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Hema Mistry
- Warwick Evidence, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Martin Connock
- Warwick Evidence, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Joshua Pink
- Warwick Evidence, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Deepson Shyangdan
- Warwick Evidence, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Christine Clar
- Warwick Evidence, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Pamela Royle
- Warwick Evidence, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Rachel Court
- Warwick Evidence, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Leela C Biant
- Department of Trauma and Orthopaedic Surgery, University of Manchester, Manchester, UK
| | - Andrew Metcalfe
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Norman Waugh
- Warwick Evidence, Division of Health Sciences, University of Warwick, Coventry, UK
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31
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Shimomura K, Ando W, Fujie H, Hart DA, Yoshikawa H, Nakamura N. Scaffold-free tissue engineering for injured joint surface restoration. J Exp Orthop 2018; 5:2. [PMID: 29330730 PMCID: PMC5768574 DOI: 10.1186/s40634-017-0118-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 12/20/2017] [Indexed: 12/31/2022] Open
Abstract
Articular cartilage does not heal spontaneously due to its limited healing capacity, and thus effective treatments for cartilage injuries has remained challenging. Since the first report by Brittberg et al. in 1994, autologous chondrocyte implantation (ACI) has been introduced into the clinic. Recently, as an alternative for chondrocyte-based therapy, mesenchymal stem cell (MSC)-based therapy has received considerable research attention because of the relative ease in handling for tissue harvest, and subsequent cell expansion and differentiation. In this review, we discuss the latest developments regarding stem cell-based therapies for cartilage repair, with special focus on recent scaffold-free approaches.
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Affiliation(s)
- Kazunori Shimomura
- Medicine for Sports and Performing Arts, Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan.,Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Wataru Ando
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Hiromichi Fujie
- Division of Human Mechatronics Systems, Faculty of System Design, Tokyo Metropolitan University, 6-6 Asahigaoka, Hino City, Tokyo, 191-0065, Japan
| | - David A Hart
- McCaig Institute for Bone & Joint Health, University of Calgary, 3330 Hospital Drive Northwest, Calgary, AB, T2N 4N1, Canada
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Norimasa Nakamura
- Institute for Medical Science in Sports, Osaka Health Science University, 1-9-27 Tenma, Kita-ku, Osaka City, Osaka, 530-0043, Japan. .,Center for Advanced Medical Engineering and Informatics, Osaka University, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan.
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32
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Hinckel BB, Gomoll AH. Autologous Chondrocytes and Next-Generation Matrix-Based Autologous Chondrocyte Implantation. Clin Sports Med 2017; 36:525-548. [DOI: 10.1016/j.csm.2017.02.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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33
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Zarkadis NJ, Kusnezov NA, Garcia ESJ, Pallis MP, Waterman BR. Return to Preoperative Function After Autologous Cartilage Implantation of the Knee in Active Military Servicemembers. Orthop J Sports Med 2017; 5:2325967117706057. [PMID: 28589157 PMCID: PMC5444582 DOI: 10.1177/2325967117706057] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Autologous chondrocyte implantation (ACI) has been shown to provide adequate durability, pain relief, and improved long-term functional outcomes in the average patient, but proof of its efficacy in individuals with greater than average physical demands is scarce. Further knowledge is required to understand which patients may benefit from ACI and to identify which risk factors are associated with failure to return to the preinjury activity level. PURPOSE To determine the occupational outcomes, rates of reoperation, and variables predictive of suboptimal outcomes after ACI. STUDY DESIGN Case series; Level of evidence, 4. METHODS All active-duty military servicemembers in the United States who underwent ACI of the knee between 2004 and 2014 were identified. Demographic information, injury characteristics, surgical variables, and clinical and surgical outcomes were extracted from the medical record. Univariate and multivariate analyses were used to determine significant independent predictors of clinical and surgical failures. RESULTS A total of 90 patients (91 knees) met the inclusion criteria. The cohort was predominantly male (86%), with a mean age of 34.5 ± 6.3 years (range, 20-50 years). The most common location of the articular cartilage lesion was the patellofemoral compartment (54 lesions, 59%), and the mean Outerbridge grade and size were 3.8 ± 0.4 and 4.00 ± 2.77 cm2 (range, 1.2-15.0 cm2), respectively. A total of 72 patients (79%) had at least 1 previous knee procedure. Nearly three-quarters of patients (71%) underwent concomitant procedures. At a mean follow-up of 59.9 ± 27.1 months (range, 24.0-140.1 months), 60% of our patients reported significant improvement in knee pain and did not require further surgical intervention. Multivariate analysis identified age <30 years as the only significant independent predictor of both clinical (P = .011) and overall failure (P = .014). Moderate-demand military occupational specialties (P = .036), exclusive involvement of the patellofemoral compartment (P = .045), and use of a periosteal patch (P = .0173) were additionally found to be independent predictors of surgical failure. CONCLUSION Treatment of articular cartilage defects of the knee with ACI in physically active young individuals can return nearly two-thirds of individuals to daily activity with decreased pain and improved function. Risk factors for failure after ACI surgery were age younger than 30 years, lower demand occupation, exclusive involvement of the patellofemoral compartment, prior microfracture, and use of a periosteal patch.
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Affiliation(s)
| | | | | | - Mark P Pallis
- William Beaumont Army Medical Center, El Paso, Texas, USA
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Park YB, Ha CW, Lee CH, Park YG. Restoration of a large osteochondral defect of the knee using a composite of umbilical cord blood-derived mesenchymal stem cells and hyaluronic acid hydrogel: a case report with a 5-year follow-up. BMC Musculoskelet Disord 2017; 18:59. [PMID: 28148266 PMCID: PMC5288855 DOI: 10.1186/s12891-017-1422-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 01/19/2017] [Indexed: 02/06/2023] Open
Abstract
Background The treatment of articular cartilage defects is a therapeutic challenge for orthopaedic surgeons. Furthermore, large osteochondral defects needs restoration of the underlying bone for sufficient biomechanical characteristics as well as the overlying cartilage. Case presentation A symptomatic large osteochondral defect in the knee joint was restored using a composite of umbilical cord blood-derived mesenchymal stem cells (UCB-MSCs) 0.5 x 107/ml and 4% hyaluronic acid (HA) hydrogel. Significant improvements in pain and function of the knee joint were identified by the evaluation at 12 months after surgery. A hyaline-like cartilage completely filled the defect and was congruent with the surrounding normal cartilage as revealed by magnetic resonance imaging (MRI), a second-look arthroscopy and histological assessment. The improved clinical outcomes maintained until 5.5 years. MRI also showed the maintenance of the restored bony and cartilaginous tissues. Conclusion This case report suggests that the composite of allogeneic UCB-MSCs and HA hydrogel can be considered a safe and effective treatment option for large osteochondral defects of the knee.
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Affiliation(s)
- Yong-Beom Park
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea
| | - Chul-Won Ha
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea. .,Stem Cell & Regenerative Medicine Institute, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea. .,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea.
| | - Choong-Hee Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Yong-Geun Park
- Department of Orthopedic Surgery, Jeju National University Hospital, Jeju National University School of Medicine, 15 Aran 13-gil, Jeju-si, 63241, South Korea
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Ebert JR, Fallon M, Wood DJ, Janes GC. A Prospective Clinical and Radiological Evaluation at 5 Years After Arthroscopic Matrix-Induced Autologous Chondrocyte Implantation. Am J Sports Med 2017; 45:59-69. [PMID: 27587741 DOI: 10.1177/0363546516663493] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND While midterm outcomes after matrix-induced autologous chondrocyte implantation (MACI) are encouraging, the procedure permits an arthroscopic approach that may reduce the morbidity of arthrotomy and permit accelerated rehabilitation. HYPOTHESIS A significant improvement in clinical and radiological outcomes after arthroscopic MACI will exist through to 5 years after surgery. STUDY DESIGN Case series; Level of evidence, 4. METHODS We prospectively evaluated the first 31 patients (15 male, 16 female) who underwent MACI via arthroscopic surgery to address symptomatic tibiofemoral chondral lesions. MACI was followed by a structured rehabilitation program in all patients. Clinical scores were administered preoperatively and at 3 and 6 months as well as 1, 2, and 5 years after surgery. These included the Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm knee scale (LKS), Tegner activity scale (TAS), visual analog scale for pain, Short Form-36 Health Survey (SF-36), active knee motion, and 6-minute walk test. Isokinetic dynamometry was used to assess peak knee extension and flexion strength and limb symmetry indices (LSIs) between the operated and nonoperated limbs. High-resolution magnetic resonance imaging (MRI) was performed at 3 months and at 1, 2, and 5 years postoperatively to evaluate graft repair as well as calculate the MRI composite score. RESULTS There was a significant improvement ( P < .05) in all KOOS subscale scores, LKS and TAS scores, the SF-36 physical component score, pain frequency and severity, active knee flexion and extension, and 6-minute walk distance. Isokinetic knee extension strength significantly improved, and all knee extension and flexion LSIs were above 90% (apart from peak knee extension strength at 1 year). At 5 years, 93% of patients were satisfied with MACI to relieve their pain, 90% were satisfied with improving their ability to undertake daily activities, and 80% were satisfied with the improvement in participating in sport. Graft infill ( P = .033) and the MRI composite score ( P = .028) significantly improved over time, with 90% of patients demonstrating good to excellent tissue infill at 5 years. There were 2 graft failures at 5 years after surgery. CONCLUSION The arthroscopically performed MACI technique demonstrated good clinical and radiological outcomes up to 5 years, with high levels of patient satisfaction.
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Affiliation(s)
- Jay R Ebert
- School of Sport Science, Exercise and Health, University of Western Australia, Crawley, Australia
| | | | - David J Wood
- School of Surgery (Orthopaedics), University of Western Australia, Crawley, Australia
| | - Gregory C Janes
- Perth Orthopaedic and Sports Medicine Centre, West Perth, Australia
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Vedicherla S, Buckley CT. Cell-based therapies for intervertebral disc and cartilage regeneration- Current concepts, parallels, and perspectives. J Orthop Res 2017; 35:8-22. [PMID: 27104885 DOI: 10.1002/jor.23268] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 04/08/2016] [Indexed: 02/04/2023]
Abstract
Lower back pain from degenerative disc disease represents a global health burden, and presents a prominent opportunity for regenerative therapeutics. While current regenerative therapies such as autologous disc chondrocyte transplantation (ADCT), allogeneic juvenile chondrocyte implantation (NuQu®), and immunoselected allogeneic adipose derived precursor cells (Mesoblast) show exciting clinical potential, limitations remain. The heterogeneity of preclinical approaches and the paucity of clinical guidance have limited translational outcomes in disc repair, lagging almost a decade behind cartilage repair. Advances in cartilage repair have evolved to single step approaches with improved orthopedic repair and regeneration. Elements from cartilage regeneration endeavors could be adopted and applied to harness translatable approaches and deliver a clinically and economically feasible regenerative surgery for back pain. In this article, we trace the developments behind the translational success of cartilage repair, examine elements to consider in achieving disc regeneration, and the need for surgical redesign. We further discuss clinical parameters, objectives, and coordination required to deliver improved regenerative surgery. Cell source, processing, and delivery modalities are key issues to be addressed in considering surgical redesign. Advances in biomanufacturing, tissue cryobanking, and point of care cell processing technology may enable intraoperative solutions for single step procedures. To maximize translational success a triad partnership between clinicians, industry, and researchers will be critical in providing instructive clinical guidelines for design as well as practical and economic considerations. This will allow a consensus in research ventures and add regenerative surgery into the algorithm in managing and treating a debilitating condition such as back pain. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:8-22, 2017.
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Affiliation(s)
- Srujana Vedicherla
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland.,School of Medicine, Trinity College Dublin, Ireland
| | - Conor T Buckley
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland.,Department of Mechanical and Manufacturing Engineering, School of Engineering, Trinity College Dublin, Ireland
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Vaishya R, Patralekh M, Vaish A, Agarwal AK, Vijay V. The Top 10 Most Cited Indian Articles in Arthroscopy in Last 10 Years. Indian J Orthop 2017; 51:505-515. [PMID: 28966373 PMCID: PMC5609371 DOI: 10.4103/ortho.ijortho_168_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The interest in the field of arthroscopy is increasing globally and exponentially in the recent past, including in India. Clinicians interested in this area of super specialization have started publishing their research work in reputed journals in this field. The publication from Indian authors is contributed equally by both the teaching government institutions and nonteaching private hospital specialists. The contributions by the Indian teaching institutes have predominantly Indian authors only, whereas those from the private sectors usually have an association with the foreign authors in their research and publications. The publications with higher hierarchy and level of evidence (1 and 2) are associated with greater citations. In addition, the publications in high-impact, reputed journals attract more citations and therefore it is recommended that the "good" scientific research work should preferably be submitted to these journals to create greater impact and awareness about ones' research and publication.
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Affiliation(s)
- Raju Vaishya
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi, India,Address for correspondence: Dr. Raju Vaishya, Department of Orthopaedics and Joint Replacement Surgery, Institute of Orthopaedics, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi - 110 076, India. E-mail:
| | - Mohit Patralekh
- Central Institute of Orthopaedics, Safdarjung Hospital, New Delhi, India
| | - Abhishek Vaish
- Central Institute of Orthopaedics, Safdarjung Hospital, New Delhi, India
| | - Amit Kumar Agarwal
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi, India
| | - Vipul Vijay
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi, India
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The comparison between the different generations of autologous chondrocyte implantation with other treatment modalities: a systematic review of clinical trials. Knee Surg Sports Traumatol Arthrosc 2016; 24:3912-3926. [PMID: 26003481 DOI: 10.1007/s00167-015-3649-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 05/15/2015] [Indexed: 12/11/2022]
Abstract
PURPOSE This paper aims to review the current evidence for autologous chondrocyte implantation (ACI) generations relative to other treatment modalities, different cell delivery methods and different cell source application. METHODS Literature search was performed to identify all level I and II studies reporting the clinical and structural outcome of any ACI generation in human knees using the following medical electronic databases: PubMed, EMBASE, Cochrane Library, CINAHL, SPORTDiscus and NICE healthcare database. The level of evidence, sample size calculation and risk of bias were determined for all included studies to enable quality assessment. RESULTS Twenty studies were included in the analysis, reporting on a total of 1094 patients. Of the 20 studies, 13 compared ACI with other treatment modalities, seven compared different ACI cell delivery methods, and one compared different cell source for implantation. Studies included were heterogeneous in baseline design, preventing meta-analysis. Data showed a trend towards similar outcomes when comparing ACI generations with other repair techniques and when comparing different cell delivery methods and cell source selection. Majority of the studies (80 %) were level II evidence, and overall the quality of studies can be rated as average to low, with the absence of power analysis in 65 % studies. CONCLUSION At present, there are insufficient data to conclude any superiority of ACI techniques. Considering its two-stage operation and cost, it may be appropriate to reserve ACI for patients with larger defects or those who have had inadequate response to other repair procedures until hard evidence enables specific clinical recommendations be made. LEVEL OF EVIDENCE II.
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Niethammer TR, Holzgruber M, Gülecyüz MF, Weber P, Pietschmann MF, Müller PE. Matrix based autologous chondrocyte implantation in children and adolescents: a match paired analysis in a follow-up over three years post-operation. INTERNATIONAL ORTHOPAEDICS 2016; 41:343-350. [PMID: 27826762 DOI: 10.1007/s00264-016-3321-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 10/12/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study is the investigation of the clinical results after third generation autologous chondrocyte implantation in the knee in a follow-up over three years post-operation. Our primary focus is on the effects of this procedure on children and adolescent patients as there is a lack of knowledge regarding the clinical outcomes in children/adolescents in particular when compared with adults. METHODS A total of 40 patients (43 defects) <20 years with cartilage defects of the knee were treated with third generation ACI (Novocart® 3D). These defects were caused by osteochondritis dissecans (n = 13), acute trauma (<12 months) (n = 9), old trauma (>12 months) (n = 5) or unknown pathology (n = 13). The mean defect size was 5.2 cm2. IKDC subjective score and VAS (at rest and during activity) were used for clinical evaluation after 6, 12, 24 and 36 months post-operatively. The results of these patients were compared with 40 matched adult patients. Match paired analysis was performed by numbers of treated defects, defect location and defect size. All cartilage defects were arthroscopically classified with IKDC grade III-IV. All adult patients in the control group were treated with matrix based autologous chondrocyte implantation. RESULTS All patients showed significantly better clinical results compared with the pre-operative findings in the follow-up over three years. We observed significantly better results in the IKDC score and VAS during the whole postoperative follow-up in children and adolescents after six, 12, 24 and 36 months compared with the adult control group. The IKDC score improved from 46.5 preoperative to 77.5 (+31) after three years in children and adolescents. Similarly, significantly lower stress pain after six months and one, two and three years was found in this group. CONCLUSION This study showed that third generation autologous chondrocyte implantation is a suitable method for the treatment of full cartilage defects in children and adolescents.
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Affiliation(s)
- Thomas Richard Niethammer
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany.
| | - Martin Holzgruber
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Mehmet Fatih Gülecyüz
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Patrick Weber
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Matthias Frank Pietschmann
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Peter Ernst Müller
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
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Mundi R, Bedi A, Chow L, Crouch S, Simunovic N, Sibilsky Enselman E, Ayeni OR. Cartilage Restoration of the Knee: A Systematic Review and Meta-analysis of Level 1 Studies. Am J Sports Med 2016; 44:1888-95. [PMID: 26138733 DOI: 10.1177/0363546515589167] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Focal cartilage defects of the knee are a substantial cause of pain and disability in active patients. There has been an emergence of randomized controlled trials evaluating surgical techniques to manage such injuries, including marrow stimulation (MS), autologous chondrocyte implantation (ACI), and osteochondral autograft transfer (OAT). PURPOSE A meta-analysis was conducted to determine if any single technique provides superior clinical results at intermediate follow-up. STUDY DESIGN Systematic review and meta-analysis of randomized controlled trials. METHODS The MEDLINE, EMBASE, and Cochrane Library databases were systematically searched and supplemented with manual searches of PubMed and reference lists. Eligible studies consisted exclusively of randomized controlled trials comparing MS, ACI, or OAT techniques in patients with focal cartilage defects of the knee. The primary outcome of interest was function (Lysholm score, International Knee Documentation Committee score, Knee Osteoarthritis Outcome Score) and pain at 24 months postoperatively. A meta-analysis using standardized mean differences was performed to provide a pooled estimate of effect comparing treatments. RESULTS A total of 12 eligible randomized trials with a cumulative sample size of 765 patients (62% males) and a mean (±SD) lesion size of 3.9 ± 1.3 cm(2) were included in this review. There were 5 trials comparing ACI with MS, 3 comparing ACI with OAT, and 3 evaluating different generations of ACI. In a pooled analysis comparing ACI with MS, there was no difference in outcomes at 24-month follow-up for function (standardized mean difference, 0.47 [95% CI, -0.19 to 1.13]; P = .16) or pain (standardized mean difference, -0.13 [95% CI, -0.39 to 0.13]; P = .33). The comparisons of ACI to OAT or between different generations of ACI were not amenable to pooled analysis. Overall, 5 of the 6 trials concluded that there was no significant difference in functional outcomes between ACI and OAT or between generations of ACI. CONCLUSION There is no significant difference between MS, ACI, and OAT in improving function and pain at intermediate-term follow-up. Further randomized trials with long-term outcomes are warranted.
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Affiliation(s)
- Raman Mundi
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Asheesh Bedi
- MedSport, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Linda Chow
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Sarah Crouch
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Simunovic
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | | | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Abstract
Biomaterials have played an increasingly prominent role in the success of biomedical devices and in the development of tissue engineering, which seeks to unlock the regenerative potential innate to human tissues/organs in a state of deterioration and to restore or reestablish normal bodily function. Advances in our understanding of regenerative biomaterials and their roles in new tissue formation can potentially open a new frontier in the fast-growing field of regenerative medicine. Taking inspiration from the role and multi-component construction of native extracellular matrices (ECMs) for cell accommodation, the synthetic biomaterials produced today routinely incorporate biologically active components to define an artificial in vivo milieu with complex and dynamic interactions that foster and regulate stem cells, similar to the events occurring in a natural cellular microenvironment. The range and degree of biomaterial sophistication have also dramatically increased as more knowledge has accumulated through materials science, matrix biology and tissue engineering. However, achieving clinical translation and commercial success requires regenerative biomaterials to be not only efficacious and safe but also cost-effective and convenient for use and production. Utilizing biomaterials of human origin as building blocks for therapeutic purposes has provided a facilitated approach that closely mimics the critical aspects of natural tissue with regard to its physical and chemical properties for the orchestration of wound healing and tissue regeneration. In addition to directly using tissue transfers and transplants for repair, new applications of human-derived biomaterials are now focusing on the use of naturally occurring biomacromolecules, decellularized ECM scaffolds and autologous preparations rich in growth factors/non-expanded stem cells to either target acceleration/magnification of the body's own repair capacity or use nature's paradigms to create new tissues for restoration. In particular, there is increasing interest in separating ECMs into simplified functional domains and/or biopolymeric assemblies so that these components/constituents can be discretely exploited and manipulated for the production of bioscaffolds and new biomimetic biomaterials. Here, following an overview of tissue auto-/allo-transplantation, we discuss the recent trends and advances as well as the challenges and future directions in the evolution and application of human-derived biomaterials for reconstructive surgery and tissue engineering. In particular, we focus on an exploration of the structural, mechanical, biochemical and biological information present in native human tissue for bioengineering applications and to provide inspiration for the design of future biomaterials.
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Yasui Y, Ando W, Shimomura K, Koizumi K, Ryota C, Hamamoto S, Kobayashi M, Yoshikawa H, Nakamura N. Scaffold-free, stem cell-based cartilage repair. J Clin Orthop Trauma 2016; 7:157-63. [PMID: 27489410 PMCID: PMC4949412 DOI: 10.1016/j.jcot.2016.06.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 06/03/2016] [Indexed: 01/01/2023] Open
Abstract
Various approaches to treat articular cartilage have been widely investigated due to its poor intrinsic healing capacity. Stem cell-based therapy could be a promising approach as an alternative to chondrocyte-based therapy and some of these therapies have been already applied in clinical condition. This review discusses the current development of stem cell-based therapies in cartilage repair, specifically focusing on scaffold-free approaches.
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Affiliation(s)
- Yukihiko Yasui
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Wataru Ando
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazunori Shimomura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kota Koizumi
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Chijimatsu Ryota
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shuichi Hamamoto
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masato Kobayashi
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Norimasa Nakamura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan,Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan,Center for Advanced Medical Engineering and Informatics, Osaka University, Osaka, Japan,Corresponding author at: Institute for Medical Science in Sports, Osaka Health Science University, 1-9-27, Tenma, Kita-ku, Osaka city, Osaka 530-0043, Japan. Tel.: +81-6-6352-0093; fax: +81-6-6352-5995.
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Scotti C, Gobbi A, Karnatzikos G, Martin I, Shimomura K, Lane JG, Peretti GM, Nakamura N. Cartilage Repair in the Inflamed Joint: Considerations for Biological Augmentation Toward Tissue Regeneration. TISSUE ENGINEERING PART B-REVIEWS 2015; 22:149-59. [PMID: 26467024 DOI: 10.1089/ten.teb.2015.0297] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Cartilage repair/regeneration procedures (e.g., microfracture, autologous chondrocyte implantation [ACI]) typically result in a satisfactory outcome in selected patients. However, the vast majority of patients with chronic symptoms and, in general, a more diseased joint, do not benefit from these surgical techniques. The aims of this work were to (1) review factors negatively influencing the joint environment; (2) review current adjuvant therapies that can be used to improve results of cartilage repair/regeneration procedures in patients with more diseased joints, (3) outline future lines of research and promising experimental approaches. Chronicity of symptoms and advancing patient age appear to be the most relevant factors negatively affecting clinical outcome of cartilage repair/regeneration. Preliminary experience with hyaluronic acid, platelet-rich plasma, and mesenchymal stem cell has been positive but there is no strong evidence supporting the use of these products and this requires further assessment with high-quality, prospective clinical trials. The use of a Tissue Therapy strategy, based on more mature engineered tissues, holds promise to tackle limitations of standard ACI procedures. Current research has highlighted the need for more targeted therapies, and (1) induction of tolerance with granulocyte colony-stimulating factor (G-CSF) or by preventing IL-6 downregulation; (2) combined IL-4 and IL-10 local release; and (3) selective activation of the prostaglandin E2 (PGE2) signaling appear to be the most promising innovative strategies. For older patients and for those with chronic symptoms, adjuvant therapies are needed in combination with microfracture and ACI.
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Affiliation(s)
| | - Alberto Gobbi
- 2 Orthopedic Arthroscopic Surgery International (O.A.S.I.) Bioresearch Foundation , Gobbi Onlus, Milan, Italy
| | - Georgios Karnatzikos
- 2 Orthopedic Arthroscopic Surgery International (O.A.S.I.) Bioresearch Foundation , Gobbi Onlus, Milan, Italy
| | - Ivan Martin
- 3 Departments of Surgery and of Biomedicine, University Hospital Basel, University of Basel , Basel, Switzerland
| | - Kazunori Shimomura
- 4 Department of Orthopedics, Osaka University Graduate School of Medicine , Osaka, Japan
| | - John G Lane
- 5 COAST Surgery Center, University of California , San Diego, California
| | - Giuseppe Michele Peretti
- 1 IRCCS Istituto Ortopedico Galeazzi , Milan, Italy .,6 Department of Biomedical Sciences for Health, University of Milan , Milan, Italy
| | - Norimasa Nakamura
- 7 Institute for Medical Science in Sports, Osaka Health Science University , Osaka, Japan .,8 Center for Advanced Medical Engineering and Informatics, Osaka University , Osaka, Japan
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Basad E, Wissing FR, Fehrenbach P, Rickert M, Steinmeyer J, Ishaque B. Matrix-induced autologous chondrocyte implantation (MACI) in the knee: clinical outcomes and challenges. Knee Surg Sports Traumatol Arthrosc 2015; 23:3729-35. [PMID: 25218576 DOI: 10.1007/s00167-014-3295-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 08/28/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Matrix-induced autologous chondrocyte implantation (MACI) has demonstrated effectiveness in treating isolated cartilage defects of the knee but medium- and long-term evidence and information on the management of postoperative complications or partially successful cases are sparse. This study hypothesised that MACI is effective for up to 5 years and that patients with posttreatment problems may go on to obtain clinical benefit from other interventions. METHODS A follow-on, prospective case series of patients recruited into a previous controlled, randomised, prospective study or newly enroled. Patients were followed up 6, 12, 24 and 60 months after surgery. Outcome measures were Tegner (activity levels) and Lysholm (pain, stability, gait, clinical symptoms) scores. Zone-specific subgroups were analysed 6, 12 and 24 months postoperatively. RESULTS Sixty-five patients were treated with MACI. Median Tegner score improved from II to IV at 12 months; an improvement maintained to 60 months. Mean Lysholm score improved from 28.5 to 76.6 points (±19.8) at 24 months, settling back to 75.5 points after 5 years (p > 0.0001). No significant differences were identified in the zone-specific analysis. Posttreatment issues (N = 12/18.5 %) were resolved with microfracture, debridement, OATS or bone grafting. CONCLUSIONS MACI is safe and effective in the majority of patients. Patients in whom treatment is only partially successful can go on to obtain clinical benefit from other cartilage repair options. This study adds to the clinical evidence on the MACI procedure, offers insight into likely treatment outcomes, and highlights MACI's usefulness as part of an armamentarium of surgical approaches to the treatment of isolated knee defects. LEVEL OF EVIDENCE Prospective case control study with no control group, Level III.
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Affiliation(s)
- Erhan Basad
- ATOS Clinic, Center for Knee and Hip Replacement and Regenerative Joint Surgery, Bismarckstrasse 9-15, 69115, Heidelberg, Germany.
| | - Fabian R Wissing
- Department for Trauma and Orthopedic Surgery, Asklepios Klinik Langen, Röntgenstrasse 20, 63225, Langen, Germany.
| | - Patrick Fehrenbach
- Sportklinik Stuttgart GmbH, Taubenheimstr. 8, 70372, Stuttgart, Germany.
| | - Markus Rickert
- Department for Orthopaedic Surgery, Giessen University Hospital, Klinikstrasse 33, 35392, Giessen, Germany.
| | - Jürgen Steinmeyer
- Laboratory for Experimental Orthopaedics, University of Giessen, Paul-Meimberg-Str.3, 35392, Giessen, Germany.
| | - Bernd Ishaque
- Department for Orthopaedic Surgery, Giessen University Hospital, Klinikstrasse 33, 35392, Giessen, Germany.
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Abstract
As our patients become more physically active at all ages, the incidence of injuries to articular cartilage is increasing and is causing patients significant pain and disability at a younger age. The intrinsic healing response of articular cartilage is poor, because of its limited vascular supply and capacity for chondrocyte division. Nonsurgical management for the focal cartilage lesion is successful in the majority of patients. Those patients that fail conservative management may be candidates for a cartilage reparative or reconstructive procedure. The type of treatment available depends on a multitude of lesion-specific and patient-specific variables. First-line therapies for isolated cartilage lesions have demonstrated good clinical results in the correct patient but typically repair cartilage with fibrocartilage, which has inferior stiffness, inferior resilience, and poorer wear characteristics. Advances in cell-based cartilage restoration have provided the surgeon a means to address focal cartilage lesions utilizing mesenchymal stem cells, chondrocytes, and biomimetic scaffolds to restore hyaline cartilage.
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Affiliation(s)
- Jeffrey R Giuliani
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20889, USA.
- , 4227 Brookfield Dr, Kensington, MD, 20895, USA.
| | - Adam Pickett
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20889, USA.
- , 7500 Woodmont Ave. Apt 1202, Bethesda, MD, 20814, USA.
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Guermazi A, Roemer FW, Alizai H, Winalski CS, Welsch G, Brittberg M, Trattnig S. State of the Art: MR Imaging after Knee Cartilage Repair Surgery. Radiology 2015; 277:23-43. [DOI: 10.1148/radiol.2015141146] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Gopal K, Amirhamed HA, Kamarul T. Advances of human bone marrow-derived mesenchymal stem cells in the treatment of cartilage defects: a systematic review. Exp Biol Med (Maywood) 2015; 239:663-9. [PMID: 24764239 DOI: 10.1177/1535370214530364] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Mesenchymal stem cell (MSC)-based therapies represent a new option for treating damaged cartilage. However, the outcomes following its clinical application have seldom been previously compared. The present paper presents the systematic review of current literatures on MSC-based therapy for cartilage repair in clinical applications. Ovid, Scopus, PubMed, ISI Web of Knowledge and Google Scholar online databases were searched using several keywords, which include "cartilage" and "stem cells". Only studies using bone marrow-derived MSC (BM-MSC) to treat cartilage defects clinically were included in this review. The clinical outcomes were compared, and the quality of the tissue repair was analysed where possible. Of the 996 articles, only six (n = 6) clinical studies have described the use of BM-MSC in clinical applications. Two studies were cohort observational trials, three were case series, and one was a case report. In the two comparative trials, BM-MSCs produced superior repair to cartilage treatment without cells and have comparable outcomes to autologous chondrocyte implantation. The case series and case-control studies have demonstrated that use of BM-MSCs resulted in better short- to long-term clinical outcomes with minimal complications. In addition, histological analyses in two studies have resulted in good repair tissue formation at the damaged site, composed mainly of hyaline-like cartilage. Although results of the respective studies are highly indicative that BM-MSC-based therapy is superior, due to the differences in methods and selection criteria used, it was not possible to make direct comparison between the studies. In conclusion, published studies do suggest that BM-MSCs could provide superior cartilage repair. However, due to limited number of reports, more robust studies might be required before a definitive conclusion can be drawn.
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Hunziker EB, Lippuner K, Keel MJ, Shintani N. Age-Independent Cartilage Generation for Synovium-Based Autologous Chondrocyte Implantation. Tissue Eng Part A 2015; 21:2089-98. [DOI: 10.1089/ten.tea.2014.0599] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Ernst B. Hunziker
- Departments of Osteoporosis, Orthopaedic Surgery and Clinical Research, Center of Regenerative Medicine for Skeletal Tissues, Inselspital, University of Bern, Bern, Switzerland
| | - Kurt Lippuner
- Departments of Osteoporosis, Orthopaedic Surgery and Clinical Research, Center of Regenerative Medicine for Skeletal Tissues, Inselspital, University of Bern, Bern, Switzerland
| | - Marius J.B. Keel
- Departments of Osteoporosis, Orthopaedic Surgery and Clinical Research, Center of Regenerative Medicine for Skeletal Tissues, Inselspital, University of Bern, Bern, Switzerland
| | - Nahoko Shintani
- Departments of Osteoporosis, Orthopaedic Surgery and Clinical Research, Center of Regenerative Medicine for Skeletal Tissues, Inselspital, University of Bern, Bern, Switzerland
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Revision surgery after third generation autologous chondrocyte implantation in the knee. INTERNATIONAL ORTHOPAEDICS 2015; 39:1615-22. [PMID: 25947902 DOI: 10.1007/s00264-015-2792-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 04/04/2015] [Indexed: 01/30/2023]
Abstract
PURPOSE Third generation autologous chondrocyte implantation (ACI) is an established treatment for full thickness cartilage defects in the knee joint. However, little is known about cases when revision surgery is needed. The aim of the present study is to investigate the complication rates and the main reasons for revision surgery after third generation autologous chondrocyte implantation in the knee joint. It is of particular interest to examine in which cases revision surgery is needed and in which cases a "wait and see" strategy should be used. METHODS A total of 143 consecutive patients with 171 cartilage defects were included in this study with a minimum follow-up of two years. All defects were treated with third generation ACI (NOVACART®3D). Clinical evaluation was carried out after six months, followed by an annual evaluation using the International Knee Documentation Committee (IKDC) subjective score and the visual analogue scale (VAS) for rest and during activity. Revision surgery was documented. RESULTS The revision rate was 23.4 % (n = 36). The following major reasons for revision surgery were found in our study: symptomatic bone marrow edema (8.3 %, n = 3), arthrofibrosis (22.2 %, n = 8) and partial graft cartilage deficiency (47.2 %, n = 17). The following revision surgery was performed: retrograde drilling combined with Iloprost infusion therapy for bone marrow oedema (8.4 %, n = 3), arthroscopic arthrolysis of the suprapatellar recess (22.2 %, n = 8) and microfracturing/antegrade drilling (47.3 %, n = 17). Significant improvements of clinical scores after revision surgery were observed. CONCLUSION Revision surgery after third generation autologous chondrocyte implantation is common and is needed primarily in cases with arthrofibrosis, partial graft cartilage deficiency and symptomatic bone marrow oedema resulting in a significantly better clinical outcome.
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Niethammer TR, Valentin S, Gülecyüz MF, Roßbach BP, Ficklscherer A, Pietschmann MF, Müller PE. Bone Marrow Edema in the Knee and Its Influence on Clinical Outcome After Matrix-Based Autologous Chondrocyte Implantation: Results After 3-Year Follow-up. Am J Sports Med 2015; 43:1172-9. [PMID: 25784628 DOI: 10.1177/0363546515573935] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Third-generation autologous chondrocyte implantation (ACI) is an established method for treatment of full-thickness cartilage defects in the knee joint. Subchondral bone marrow edema (BME) is frequently observed after ACI, with unknown pathogenesis and clinical relevance. PURPOSE To investigate the occurrence and clinical relevance of BME after third-generation ACI in the knee joint during the postoperative course of 36 months. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 38 circumscribed full-thickness cartilage defects in 30 patients were included in this study. All defects were treated with third-generation ACI (Novocart 3D). A standardized MRI examination was carried out after 1.5, 3, 6, 12, 24, and 36 months. Bone marrow edema was observed in 78.9% of defects over the postoperative course, with initial occurrence in the first 12 months. The size of the BMEs were determined according to their maximum diameter and were classified as small (<1 cm), medium (<2 cm), large (<4 cm), and very large (diffuse; >4 cm). Clinical outcomes in patients were analyzed by use of the International Knee Documentation Committee (IKDC) scoring system and a visual analog scale for pain. RESULTS There were 5.3% (n=2) small, 28.9% (n=11) medium, 34.2% (n=13) large, and 10.5% (n=4) very large BMEs. In a subgroup analysis, cartilage defects of the medial femoral condyle showed significantly higher frequency of BME than did patellar defects. Clinical scores showed significant improvements throughout the entire study course (P<.05). Clinical patient outcome did not correlate with presence of BME at any time period (P>.05). CONCLUSION Midterm clinical results of the matrix-based third-generation ACI showed a substantial amount of BME over a 36-month follow-up, but this did not correlate with worse clinical outcome. Patients with femoral cartilage defects were more often affected than were those with patellar cartilage defects.
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Affiliation(s)
- Thomas R Niethammer
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Munich, Germany
| | - Siegfried Valentin
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Munich, Germany
| | - Mehmet F Gülecyüz
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Munich, Germany
| | - Björn P Roßbach
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Munich, Germany
| | - Andreas Ficklscherer
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Munich, Germany
| | - Matthias F Pietschmann
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Munich, Germany
| | - Peter E Müller
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich, Munich, Germany
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