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Lee SJ, Jeon O, Lee YB, Alt DS, Ding A, Tang R, Alsberg E. In situ cell condensation-based cartilage tissue engineering via immediately implantable high-density stem cell core and rapidly degradable shell microgels. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.20.590385. [PMID: 38712035 PMCID: PMC11071421 DOI: 10.1101/2024.04.20.590385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Formation of chondromimetic human mesenchymal stem cells (hMSCs) condensations typically required in vitro culture in defined environments. In addition, extended in vitro culture in differentiation media over several weeks is usually necessary prior to implantation, which is costly, time consuming and delays clinical treatment. Here, this study reports on immediately implantable core/shell microgels with a high-density hMSC-laden core and rapidly degradable hydrogel shell. The hMSCs in the core formed cell condensates within 12 hours and the oxidized and methacrylated alginate (OMA) hydrogel shells were completely degraded within 3 days, enabling spontaneous and precipitous fusion of adjacent condensed aggregates. By delivering transforming growth factor-β1 (TGF-β1) within the core, the fused condensates were chondrogenically differentiated and formed cartilage microtissues. Importantly, these hMSC-laden core/shell microgels, fabricated without any in vitro culture, were subcutaneously implanted into mice and shown to form cartilage tissue via cellular condensations in the core after 3 weeks. This innovative approach to form cell condensations in situ without in vitro culture that can fuse together with each other and with host tissue and be matured into new tissue with incorporated bioactive signals, allows for immediate implantation and may be a platform strategy for cartilage regeneration and other tissue engineering applications.
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Affiliation(s)
- Sang Jin Lee
- Richard and Loan Hill Department of Biomedical Engineering, University of Illinois at Chicago, 909 S. Wolcott Ave., Chicago, IL, 60612 USA
| | - Oju Jeon
- Richard and Loan Hill Department of Biomedical Engineering, University of Illinois at Chicago, 909 S. Wolcott Ave., Chicago, IL, 60612 USA
| | - Yu Bin Lee
- Richard and Loan Hill Department of Biomedical Engineering, University of Illinois at Chicago, 909 S. Wolcott Ave., Chicago, IL, 60612 USA
| | - Daniel S. Alt
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106 USA
| | - Aixiang Ding
- Richard and Loan Hill Department of Biomedical Engineering, University of Illinois at Chicago, 909 S. Wolcott Ave., Chicago, IL, 60612 USA
| | - Rui Tang
- Richard and Loan Hill Department of Biomedical Engineering, University of Illinois at Chicago, 909 S. Wolcott Ave., Chicago, IL, 60612 USA
| | - Eben Alsberg
- Jesse Brown Veterans Affairs Medical Center (JBVAMC), Chicago, IL 60612, USA
- Richard and Loan Hill Department of Biomedical Engineering, University of Illinois at Chicago, 909 S. Wolcott Ave., Chicago, IL, 60612 USA
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106 USA
- Departments of Mechanical & Industrial Engineering, Orthopaedic Surgery, and Pharmacology and Regenerative Medicine, University of Illinois at Chicago, 909 S. Wolcott Ave., Chicago, IL, 60612 USA
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2
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Brittberg M. Treatment of knee cartilage lesions in 2024: From hyaluronic acid to regenerative medicine. J Exp Orthop 2024; 11:e12016. [PMID: 38572391 PMCID: PMC10985633 DOI: 10.1002/jeo2.12016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/07/2024] [Indexed: 04/05/2024] Open
Abstract
Abstract Intact articular cartilage plays a vital role in joint homeostasis. Local cartilage repairs, where defects in the cartilage matrix are filled in and sealed to congruity, are therefore important treatments to restore a joint equilibrium. The base for all cartilage repairs is the cells; either chondrocytes or chondrogeneic cells from bone, synovia and fat tissue. The surgical options include bone marrow stimulation techniques alone or augmented with scaffolds, chondrogeneic cell implantations and osteochondral auto- or allografts. The current trend is to choose one-stage procedures being easier to use from a regulatory point of view. This narrative review provides an overview of the current nonoperative and surgical options available for the repair of various cartilage lesions. Level of Evidence Level IV.
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Affiliation(s)
- Mats Brittberg
- Cartilage Research Unit, Team Orthopedic Research Region Halland‐TOR, Region Halland Orthopaedics, Varberg HospitalUniversity of GothenburgVarbergSweden
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3
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Wang X, Ren Z, Liu Y, Ma Y, Huang L, Song W, Lin Q, Zhang Z, Li P, Wei X, Duan W. Characteristics and Clinical Outcomes After Osteochondral Allograft Transplantation for Treating Articular Cartilage Defects: Systematic Review and Single-Arm Meta-analysis of Studies From 2001 to 2020. Orthop J Sports Med 2023; 11:23259671231199418. [PMID: 37745815 PMCID: PMC10515554 DOI: 10.1177/23259671231199418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/03/2023] [Indexed: 09/26/2023] Open
Abstract
Background Osteochondral allograft transplantation (OCA) treats symptomatic focal cartilage defects with satisfactory clinical results. Purpose To comprehensively analyze the characteristics and clinical outcomes of OCA for treating articular cartilage defects. Study Design Systematic review; Level of evidence, 4. Methods We searched Embase, PubMed, Cochrane Database, and Web of Science for studies published between January 1, 2001, and December 31, 2020, on OCA for treating articular cartilage defects. Publication information, patient data, osteochondral allograft storage details, and clinical outcomes were extracted to conduct a comprehensive summative analysis. Results In total, 105 studies involving 5952 patients were included. The annual reported number of patients treated with OCA increased from 69 in 2001 to 1065 in 2020, peaking at 1504 cases in 2018. Most studies (90.1%) were performed in the United States. The mean age at surgery was 34.2 years, and 60.8% of patients were male and had a mean body mass index of 26.7 kg/m2. The mean lesion area was 5.05 cm2, the mean follow-up duration was 54.39 months, the mean graft size was 6.85 cm2, and the number of grafts per patient was 54.7. The failure rate after OCA was 18.8%, and 83.1% of patients reported satisfactory results. Allograft survival rates at 2, 5, 10, 15, 20, and 25 years were 94%, 87.9%, 80%, 73%, 55%, and 59.4%, respectively. OCA was mainly performed on the knee (88.9%). The most common diagnosis in the knee was osteochondritis dissecans (37.9%), and the most common defect location was the medial femoral condyle (52%). The most common concomitant procedures were high tibial osteotomy (28.4%) and meniscal allograft transplantation (24.7%). After OCA failure, 54.7% of patients underwent revision with primary total knee arthroplasty. Conclusion The annual reported number of patients who underwent OCA showed a significant upward trend, especially from 2016 to 2020. Patients receiving OCA were predominantly young male adults with a high body mass index. OCA was more established for knee cartilage than an injury at other sites, and its best indication was osteochondritis dissecans. This analysis demonstrated satisfactory long-term postoperative outcomes.
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Affiliation(s)
- Xueding Wang
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Zhiyuan Ren
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Yang Liu
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Yongsheng Ma
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Lingan Huang
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Wenjie Song
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Qitai Lin
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Zhipeng Zhang
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Pengcui Li
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Xiaochun Wei
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Wangping Duan
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
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Lai WC, Bohlen HL, Fackler NP, Wang D. Osteochondral Allografts in Knee Surgery: Narrative Review of Evidence to Date. Orthop Res Rev 2022; 14:263-274. [PMID: 35979427 PMCID: PMC9377395 DOI: 10.2147/orr.s253761] [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] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 08/08/2022] [Indexed: 01/14/2023] Open
Abstract
Knee articular cartilage defects can result in significant pain and loss of function in active patients. Osteochondral allograft (OCA) transplantation offers a single-stage solution to address large chondral and osteochondral defects by resurfacing focal cartilage defects with mature hyaline cartilage. To date, OCA transplantation of the knee has demonstrated excellent clinical outcomes and long-term survivorship. However, significant variability still exists among clinicians with regard to parameters for graft acceptance, surgical technique, and rehabilitation. Technologies to optimize graft viability during storage, improve osseous integration of the allograft, and shorten recovery timelines after surgery continue to evolve. The purpose of this review is to examine the latest evidence on treatment indications, graft storage and surgical technique, patient outcomes and survivorship, and rehabilitation after surgery.
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Affiliation(s)
- Wilson C Lai
- Department of Orthopaedic Surgery, UCI Health, Orange, CA, USA
| | - Hunter L Bohlen
- Department of Orthopaedic Surgery, UCI Health, Orange, CA, USA
| | - Nathan P Fackler
- Department of Orthopaedic Surgery, UCI Health, Orange, CA, USA.,Georgetown University School of Medicine, Washington, DC, USA
| | - Dean Wang
- Department of Orthopaedic Surgery, UCI Health, Orange, CA, USA.,Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
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Kunze KN, Ramkumar PN, Manzi JE, Wright-Chisem J, Nwachukwu BU, Williams RJ. Risk Factors for Failure After Osteochondral Allograft Transplantation of the Knee: A Systematic Review and Exploratory Meta-analysis. Am J Sports Med 2022; 51:1356-1367. [PMID: 35049404 DOI: 10.1177/03635465211063901] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Graft failure after osteochondral allograft transplantation (OCA) of the knee is a devastating outcome, often necessitating subsequent interventions. A comprehensive understanding of the risk factors for failure after OCA of the knee may provide enhanced prognostic data for the knee surgeon and facilitate more informed shared decision-making discussions before surgery. PURPOSE To perform a systematic review and meta-analysis of risk factors associated with graft failure after OCA of the knee. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS The PubMed, Ovid/MEDLINE, and Cochrane databases were queried in April 2021. Data pertaining to study characteristics and risk factors associated with failure after OCA were recorded. DerSimonian-Laird binary random-effects models were constructed to quantitatively evaluate the association between risk factors and graft failure by generating effect estimates in the form of odds ratios (ORs) with 95% CIs, while mean differences (MDs) were calculated for continuous data. Qualitative analysis was performed to describe risk factors that were variably reported. RESULTS A total of 16 studies consisting of 1401 patients were included. The overall pooled prevalence of failure was 18.9% (range, 10%-46%). There were 44 risk factors identified, of which 9 were explored quantitatively. There was strong evidence to support that the presence of bipolar chondral defects (OR, 4.20 [95% CI, 1.17-15.08]; P = .028) and male sex (OR, 2.04 [95% CI, 1.17-3.55]; P = .012) were significant risk factors for failure after OCA. Older age (MD, 5.06 years [95% CI, 1.44-8.70]; P = .006) and greater body mass index (MD, 1.75 kg/m2 [95% CI, 0.48-3.03]; P = .007) at the time of surgery were also significant risk factors for failure after OCA. There was no statistically significant evidence to incontrovertibly support that concomitant procedures, chondral defect size, and defect location were associated with an increased risk of failure after OCA. CONCLUSION Bipolar chondral defects, male sex, older age, and greater body mass index were significantly associated with an increased failure rate after OCA of the knee. No statistically significant evidence presently exists to support that chondral defect size and location or concomitant procedures are associated with an increased graft failure rate after OCA of the knee. Additional studies are needed to evaluate these associations.
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Affiliation(s)
- Kyle N Kunze
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Prem N Ramkumar
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Joshua Wright-Chisem
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Benedict U Nwachukwu
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Riley J Williams
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
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Sheppard WL, Hinckel BB, Arshi A, Sherman SL, Jones KJ. Accurate Reporting of Concomitant Procedures Is Highly Variable in Studies Investigating Knee Cartilage Restoration. Cartilage 2021; 12:333-343. [PMID: 30971096 PMCID: PMC8236649 DOI: 10.1177/1947603519841673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Successful clinical outcomes following cartilage restoration procedures are highly dependent on addressing concomitant pathology. The purpose of this study was to document methods for evaluating concomitant procedures of the knee when performed with articular cartilage restoration techniques, and to review their reported findings in high-impact clinical orthopedic studies. We hypothesized that there are substantial inconsistencies in reporting clinical outcomes associated with concomitant procedures relative to outcomes related to isolated cartilage repair. DESIGN A total of 133 clinical studies on articular cartilage repair of the knee were identified from 6 high-impact orthopedic journals between 2011 and 2017. Studies were included if they were primary research articles reporting clinical outcomes data following surgical treatment of articular cartilage lesions with a minimum sample size of 5 patients. Studies were excluded if they were review articles, meta-analyses, and articles reporting only nonclinical outcomes (e.g., imaging, histology). A full-text review was then used to evaluate details regarding study methodology and reporting on the following variables: primary cartilage repair procedure, and the utilization of concomitant procedures to address additional patient comorbidities, including malalignment, meniscus pathology, and ligamentous instability. Each study was additionally reviewed to document variation in clinical outcomes reporting in patients that had these comorbidities addressed at the time of surgery. RESULTS All studies reported on the type of primary cartilage repair procedure, with autologous chondrocyte implantation (ACI) noted in 43% of studies, microfracture (MF) reported in 16.5%, osteochondral allograft (OCA) in 15%, and osteochondral autograft transplant (OAT) in 8.2%. Regarding concomitant pathology, anterior cruciate ligament (ACL) reconstruction (24.8%) and meniscus repair (23.3%) were the most commonly addressed patient comorbidities. A total of 56 studies (42.1%) excluded patients with malalignment, meniscus injury, and ligamentous instability. For studies that addressed concomitant pathology, 72.7% reported clinical outcomes separately from the cohort treated with only cartilage repair. A total of 16.5% of studies neither excluded nor addressed concomitant pathologies. There was a significant amount of variation in the patient reported outcome scores used among the studies, with the majority of studies reporting International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcomes Score (KOOS) in 47.2% and 43.6% of articles, respectively. CONCLUSIONS In this study on knee cartilage restoration, recognition and management of concomitant pathology is inadequately reported in approximately 28% of studies. Only 30% of articles reported adequate treatment of concomitant ailments while scoring their outcomes using one of a potential 18 different scoring systems. These findings highlight the need for more standardized methods to be applied in future research with regard to inclusion, exclusion, and scoring concomitant pathologies with regard to treatment of cartilage defects in the knee.
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Affiliation(s)
- William L. Sheppard
- Department of Orthopaedic Surgery, University of California, Los Angeles, Santa Monica, CA, USA,David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Betina B. Hinckel
- Department of Orthopedic Surgery, University of Missouri Health, Columbia, MO, USA
| | - Armin Arshi
- Department of Orthopaedic Surgery, University of California, Los Angeles, Santa Monica, CA, USA,David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Seth L. Sherman
- Department of Orthopedic Surgery, University of Missouri Health, Columbia, MO, USA
| | - Kristofer J. Jones
- Department of Orthopaedic Surgery, University of California, Los Angeles, Santa Monica, CA, USA,David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA,Kristofer J. Jones, Department of Orthopaedic Surgery, Division of Sports Medicine and Shoulder Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, 76-143 CHS, Los Angeles, CA 90095-6902, USA. Emails:
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7
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Saltzman BM, Redondo ML, Beer A, Cotter EJ, Frank RM, Yanke AB, Cole BJ. Wide Variation in Methodology in Level I and II Studies on Cartilage Repair: A Systematic Review of Available Clinical Trials Comparing Patient Demographics, Treatment Means, and Outcomes Reporting. Cartilage 2021; 12:7-23. [PMID: 30378453 PMCID: PMC7755973 DOI: 10.1177/1947603518809398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The management of complex cartilage pathology in young, otherwise healthy patients can be difficult. PURPOSE To determine the nature of the design, endpoints chosen, and rate at which the endpoints were met in published studies and ongoing clinical trials that investigate cartilage repair and restoration procedures. STUDY DESIGN Systematic review. METHODS A systematic review of the publicly available level I/II literature and of the publicly listed clinical trials regarding cartilage repair and restoration procedures for the knee was conducted adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Seventeen published studies and 52 clinical trials were included. Within the 17 published studies, the most common procedure studied was microfracture (MFX) + augmentation (N = 5; 29.4%) and the most common comparison/control group was MFX (N = 10; 58.8%). In total, 13 different cartilage procedure groups were evaluated. For published studies, the most common patient-reported outcome (PRO) measures assessed is the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Visual Analog Scale-Pain (VAS) (N = 10 studies, 58.8% each, respectively). Overall, there are 10 different PROs used among the included studies. Ten studies demonstrate superiority, 5 demonstrate noninferiority, and 2 demonstrate inferiority to the comparison or control groups. For the clinical trials included, the most common procedure studied is MFX + augmentation (N = 16; 30.8%). The most common PRO assessed is KOOS (N = 36 trials; 69.2%), and overall there are 24 different PROs used among the included studies. CONCLUSIONS Recently published studies and clinical trials evaluate a variety of cartilage repair and restoration strategies for the knee, most commonly MFX + augmentation, at various time points of outcome evaluation, with KOOS and VAS scores being used most commonly. MFX remains the most common comparison group for these therapeutic investigations. Most studies demonstrate superiority versus comparison or control groups. Understanding the nature of published and ongoing clinical trials will be helpful in the investigation of emerging technologies required to navigate the regulatory process while studying a relatively narrow population of patients.
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Affiliation(s)
| | | | - Adam Beer
- Rush University Medical Center, Chicago, IL, USA
| | - Eric J. Cotter
- University of Wisconsin Madison School of Medicine and Public Health, Madison, WI, USA
| | | | | | - Brian J. Cole
- Rush University Medical Center, Chicago, IL, USA,Brian J. Cole, Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612-3833, USA.
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Calcei JG, Ray T, Sherman SL, Farr J. Management of Large Focal Chondral and Osteochondral Defects in the Knee. J Knee Surg 2020; 33:1187-1200. [PMID: 33260221 DOI: 10.1055/s-0040-1721053] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Large, focal articular cartilage defects of the knee (> 4 cm2) can be a source of significant morbidity and often require surgical intervention. Patient- and lesion-specific factors must be identified when evaluating a patient with an articular cartilage defect. In the management of large cartilage defects, the two classically utilized cartilage restoration procedures are osteochondral allograft (OCA) transplantation and cell therapy, or autologous chondrocyte implantation (ACI). Alternative techniques that are available or currently in clinical trials include a hyaluronan-based scaffold plus bone marrow aspirate concentrate, a third-generation autologous chondrocyte implant, and an aragonite-based scaffold. In this review, we will focus on OCA and ACI as the mainstay in management of large chondral and osteochondral defects of the knee. We will discuss the techniques and associated clinical outcomes for each, while including a brief mention of alternative treatments. Overall, cartilage restoration techniques have yielded favorable clinical outcomes and can be successfully employed to treat these challenging large focal lesions.
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Affiliation(s)
- Jacob G Calcei
- Department of Orthopaedic Surgery, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio
| | - Taylor Ray
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, California
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, California
| | - Jack Farr
- Knee Preservation and Cartilage Restoration Center, OrthoIndy, Indianapolis, Indiana
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Koenig F, Kilzer M, Hagl C, Thierfelder N. Successful decellularization of thick-walled tissue: Highlighting pitfalls and the need for a multifactorial approach. Int J Artif Organs 2018; 42:17-24. [PMID: 30442045 DOI: 10.1177/0391398818805624] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION: Decellularization of thick tissue is challenging and varying. Therefore, we tried to establish a multifactorial approach for reliable aortic wall decellularization. METHODS: Porcine aortic walls were decellularized according to different procedures. Decellularization was performed for 24 (G1), 48 (G2), and 72 h (G3) with a solution of 0.5% desoxycholate and 0.5% dodecyl sulfate. The procedure was characterized using intermittent washing steps, the inclusion of sonication as well as DNase and α-galactosidase treatment. The decellularization efficiency was measured by the evaluation of 4',6-diamidino-2-phenylindole and hematoxylin and eosin staining and quantitative DNA assays. Pentachrome and picrosirius red staining, scanning electron microscopy as well as glycosaminoglycan assays were performed to evaluate the effect of the procedure on the extracellular matrix. RESULTS: 4',6-Diamidino-2-phenylindole and hematoxylin and eosin staining revealed a large amount of remaining nuclei in all groups. However, consecutive DNase treatment had a significant effect. While the remaining DNA was detected in some samples of G1 and G2, samples of G3 were fully decellularized. Glycosaminoglycan content was significantly reduced to 50% after 24 h (G1) but remained constant for G2 and G3. Picrosirius red staining revealed an intact and stable collagen network without any visible defects. Pentachrome staining substantiated these results. Nonetheless, the fiber network remains intact, which could be confirmed by reflection electron microscopy analysis. CONCLUSION: In this study, we developed a procedure that grants successful decellularization of porcine aortic wall while maintaining the fibrous microstructure. We highlighted the significant effect of DNase and α-galactosidase treatment. In addition, we could show the need for a multifactorial treatment and comprehensive evaluation protocols for thick tissue decellularization.
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Affiliation(s)
- Fabian Koenig
- Department of Cardiac Surgery, Laboratory for Tissue Engineering, Grosshadern Medical Centre, Ludwig-Maximilians-University, Munich, Germany
| | - Marie Kilzer
- Department of Cardiac Surgery, Laboratory for Tissue Engineering, Grosshadern Medical Centre, Ludwig-Maximilians-University, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Laboratory for Tissue Engineering, Grosshadern Medical Centre, Ludwig-Maximilians-University, Munich, Germany
| | - Nikolaus Thierfelder
- Department of Cardiac Surgery, Laboratory for Tissue Engineering, Grosshadern Medical Centre, Ludwig-Maximilians-University, Munich, Germany
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10
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Farr J, Sherman SL. Evaluation of Novel Cartilage Treatment Options for Clinical Use. OPER TECHN SPORT MED 2018. [DOI: 10.1053/j.otsm.2018.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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11
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Balazs GC, Wang D, Burge AJ, Sinatro AL, Wong AC, Williams RJ. Return to Play Among Elite Basketball Players After Osteochondral Allograft Transplantation of Full-Thickness Cartilage Lesions. Orthop J Sports Med 2018; 6:2325967118786941. [PMID: 30109237 PMCID: PMC6083754 DOI: 10.1177/2325967118786941] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Osteochondral allograft transplantation (OCA) is a recognized option for full-thickness articular cartilage defects of the knee, especially in the setting of large lesions or those involving the subchondral bone. Previous heterogenous studies of athletes have shown a 75% to 79% rate of return to play after the procedure. Purpose: To define return-to-play rates in a cohort of elite collegiate and professional basketball players following osteochondral allograft of the knee. Study Design: Case series; Level of evidence, 4. Methods: Prospectively collected data from an institutional cartilage repair registry were retrospectively reviewed. Patients were eligible for inclusion if they were collegiate or professional basketball players at the time of surgery. Patient demographics, lesion size and location, and surgical details were collected. Postoperative magnetic resonance imaging scans were scored with the OCAMRISS system. Time to return to play and pre- versus postoperative player performance were determined with publicly available internet resources. Results: Eleven athletes (4 professional, 7 collegiate) with a total of 14 treated lesions (1 to the medial femoral condyle, 6 to the lateral femoral condyle, 5 to the trochlea, and 2 to the patella) were eligible for study inclusion. Mean lesion size was 509 mm2. All patients underwent OCA through an arthrotomy, with fresh grafts. The overall rate of return to play at the same level of competition was 80%. Median time to return to play was 14 months (range, 6-26 months). Among players with available statistics, there was no significant reduction in any performance category. Conclusion: OCA in elite basketball players results in an 80% return to previous level of competition, which is consistent with previous reports of athletes playing other sports. Osteochondral allografting is a reasonable option to consider for full-thickness cartilage lesions of the knee, even for elite jumping athletes.
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Affiliation(s)
- George C Balazs
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Dean Wang
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Alissa J Burge
- Department of Radiology, Hospital for Special Surgery, New York, New York, USA
| | - Alec L Sinatro
- Department of Radiology, Hospital for Special Surgery, New York, New York, USA
| | - Alexandra C Wong
- Department of Radiology, Hospital for Special Surgery, New York, New York, USA
| | - Riley J Williams
- Department of Radiology, Hospital for Special Surgery, New York, New York, USA
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Erivan R, Villatte G, Lecointe T, Descamps S, Boisgard S. Collection and reconstruction after harvesting donor tissues from the musculoskeletal system: Technique specific to the lower limbs. Orthop Traumatol Surg Res 2018; 104:529-532. [PMID: 29567322 DOI: 10.1016/j.otsr.2018.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 01/12/2018] [Accepted: 01/18/2018] [Indexed: 02/02/2023]
Abstract
The lack of available musculoskeletal grafts in France forces us to import a very large quantity of these tissues to use in complex reconstruction procedures. The goal of this article is to describe methods for collecting donor tissues from the musculoskeletal system and for reconstructing the harvested areas. We also provide a summary of the collection procedures performed, harvested grafts and available tissues. While tissue collection requires a significant time investment, the emergence of dedicated teams may be a solution for increasing the number and quality of human musculoskeletal allograft tissues.
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Affiliation(s)
- R Erivan
- Université Clermont-Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France; Institut de Chimie de Clermont-Ferrand (ICCF), UMR 6296, 24, avenue Blaise-Pascal, 63178 Aubiere, France.
| | - G Villatte
- Université Clermont-Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France; Institut de Chimie de Clermont-Ferrand (ICCF), UMR 6296, 24, avenue Blaise-Pascal, 63178 Aubiere, France
| | - T Lecointe
- Université Clermont-Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France; CHU Clermont-Ferrand, service de chirurgie orthopédique, 58, rue Montalemembert, BP 69, 63003 Clermont-Ferrand, France
| | - S Descamps
- Université Clermont-Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France; Institut de Chimie de Clermont-Ferrand (ICCF), UMR 6296, 24, avenue Blaise-Pascal, 63178 Aubiere, France
| | - S Boisgard
- Université Clermont-Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France; Institut de Chimie de Clermont-Ferrand (ICCF), UMR 6296, 24, avenue Blaise-Pascal, 63178 Aubiere, France
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Bicho D, Pina S, Oliveira JM, Reis RL. In Vitro Mimetic Models for the Bone-Cartilage Interface Regeneration. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1059:373-394. [PMID: 29736583 DOI: 10.1007/978-3-319-76735-2_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In embryonic development, pure cartilage structures are in the basis of bone-cartilage interfaces. Despite this fact, the mature bone and cartilage structures can vary greatly in composition and function. Nevertheless, they collaborate in the osteochondral region to create a smooth transition zone that supports the movements and forces resulting from the daily activities. In this sense, all the hierarchical organization is involved in the maintenance and reestablishment of the equilibrium in case of damage. Therefore, this interface has attracted a great deal of interest in order to understand the mechanisms of regeneration or disease progression in osteoarthritis. With that purpose, in vitro tissue models (either static or dynamic) have been studied. Static in vitro tissue models include monocultures, co-cultures, 3D cultures, and ex vivo cultures, mostly cultivated in flat surfaces, while dynamic models involve the use of bioreactors and microfluidic systems. The latter have emerged as alternatives to study the cellular interactions in a more authentic manner over some disadvantages of the static models. The current alternatives of in vitro mimetic models for bone-cartilage interface regeneration are overviewed and discussed herein.
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Affiliation(s)
- Diana Bicho
- 3B's Research Group - Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, Barco, Guimarães, Portugal.
- ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal.
| | - Sandra Pina
- ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - J Miguel Oliveira
- ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal
- The Discoveries Centre for Regenerative and Precision Medicine, Headquarters at University of Minho, Guimarães, Portugal
| | - Rui L Reis
- ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal
- The Discoveries Centre for Regenerative and Precision Medicine, Headquarters at University of Minho, Guimarães, Portugal
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Mandelbaum BR, Chahla J. Editorial Commentary: The Acellular Osteochondral Allograft, the Emperor Has New Clothes. Arthroscopy 2017; 33:2228-2230. [PMID: 29198358 DOI: 10.1016/j.arthro.2017.08.270] [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: 08/23/2017] [Revised: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 02/02/2023]
Abstract
For larger lesions (>2.5-cm2), clinical evidence and practice have shown that fresh osteochondral allograft have good durability, with 88% return to sport and greater than 75% 10-year survival rates for treatment of large femoral condyle lesions. That said, the use of fresh osteochondral allografts in clinical practice is limited by the availability of acceptable donor tissues for eligible patients in a timely fashion. Significant diminution of chondrocyte viability and density occurs during the preservation and storage period. All osteochondral allografts are not equal in performance and outcome. Chondrocyte density and viability are critical for successful transplantation and outcome in the short and long term. This commentary highlights the high failure rates of tissue when it is acellular.
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Affiliation(s)
- Bert R Mandelbaum
- Santa Monica Orthopaedic and Sports Medicine Group; Kerlan-Jobe Institute, Cedars-Sinai
| | - Jorge Chahla
- Santa Monica Orthopaedic and Sports Medicine Group
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