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Tsai YH, Tseng CC, Lin YC, Nail HM, Chiu KY, Chang YH, Chang MW, Lin FH, Wang HMD. Novel artificial tricalcium phosphate and magnesium composite graft facilitates angiogenesis in bone healing. Biomed J 2024:100750. [PMID: 38838984 DOI: 10.1016/j.bj.2024.100750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 03/22/2024] [Accepted: 05/30/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Bone grafting is the standard treatment for critical bone defects, but autologous grafts have limitations like donor site morbidity and limited availability, while commercial artificial grafts may have poor integration with surrounding bone tissue, leading to delayed healing. Magnesium deficiency negatively impacts angiogenesis and bone repair. Therefore, incorporating magnesium into a synthetic biomaterial could provide an excellent bone substitute. This study aims to evaluate the morphological, mechanical, and biological properties of a calcium phosphate cement (CPC) sponge composed of tetracalcium phosphate (TTCP) and monocalcium phosphate monohydrate (MCPM), which could serve as an excellent bone substitute by incorporating magnesium. METHODS This study aims to develop biomedical materials composed mainly of TTCP and MCPM powder, magnesium powder, and collagen. The materials were prepared using a wet-stirred mill and freeze-dryer methods. The particle size, composition, and microstructure of the materials were investigated. Finally, the biological properties of these materials, including 3-(4,5-dimethylthiazol-2-yl)-2,5- diphenyltetrazolium bromide (MTT) assay for biocompatibility, effects on bone cell differentiation by alkaline phosphatase (ALP) activity assay and tartrate-resistant acid phosphatase (TRAP) activity assay, and endothelial cell tube formation assay for angiogenesis, were evaluated as well. RESULTS The data showed that the sub-micron CPC powder, composed of TTCP/MCPM in a 3.5:1 ratio, had a setting time shorter than 15 minutes and a compressive strength of 4.39±0.96 MPa. This reveals that the sub-micron CPC powder had an adequate setting time and mechanical strength. We found that the sub-micron CPC sponge containing magnesium had better biocompatibility, including increased proliferation and osteogenic induction effects without cytotoxicity. The CPC sponge containing magnesium also promoted angiogenesis. CONCLUSION In summary, we introduced a novel CPC sponge, which had a similar property to human bone promoted the biological functions of bone cells, and could serve as a promising material used in bone regeneration for critical bone defects.
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Affiliation(s)
- Yuan-Hsin Tsai
- Ph.D. Program in Tissue Engineering and Regenerative Medicine, National Chung Hsing University, Taichung 402, Taiwan Republic of China; Department of Orthopedic Surgery, Show-Chwan Memorial Hospital, Changhua 500, Taiwan Republic of China
| | - Chun-Chieh Tseng
- Metal Industries Research & Development Centre, 1001 Kaonan Highway, Nanzi Dist., Kaohsiung 811, Taiwan Republic of China; Combination Medical Device Technology Division, Medical Devices R&D Service Department, Metal Industries Research & Development Centre, Kaohsiung 802, Taiwan Republic of China
| | - Yun-Chan Lin
- Department of Food Science and Biotechnology, National Chung Hsing University, Taichung 402, Taiwan Republic of China
| | - Howida M Nail
- Graduate Institute of Biomedical Engineering, National Chung Hsing University, Taichung 402, Taiwan Republic of China
| | - Kuan-Yu Chiu
- Metal Industries Research & Development Centre, 1001 Kaonan Highway, Nanzi Dist., Kaohsiung 811, Taiwan Republic of China; Combination Medical Device Technology Division, Medical Devices R&D Service Department, Metal Industries Research & Development Centre, Kaohsiung 802, Taiwan Republic of China
| | - Yen-Hao Chang
- Metal Industries Research & Development Centre, 1001 Kaonan Highway, Nanzi Dist., Kaohsiung 811, Taiwan Republic of China; Combination Medical Device Technology Division, Medical Devices R&D Service Department, Metal Industries Research & Development Centre, Kaohsiung 802, Taiwan Republic of China
| | - Ming-Wei Chang
- Nanotechnology and Integrated Bioengineering Centre, University of Ulster, Belfast, BT151AB, Northern Ireland, UK
| | - Feng-Huei Lin
- Ph.D. Program in Tissue Engineering and Regenerative Medicine, National Chung Hsing University, Taichung 402, Taiwan Republic of China; Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan Republic of China; Institute of Biomedical Engineering and Nano-medicine, National Health Research Institutes, Zhunan, Miaoli 350, Taiwan Republic of China.
| | - Hui-Min David Wang
- Graduate Institute of Biomedical Engineering, National Chung Hsing University, Taichung 402, Taiwan Republic of China; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan Republic of China; Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichung City 404, Taiwan Republic of China.
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Karaca MA, Kancagi DD, Ozbek U, Ovali E, Gok O. Betulin Stimulates Osteogenic Differentiation of Human Osteoblasts-Loaded Alginate-Gelatin Microbeads. Bioengineering (Basel) 2024; 11:553. [PMID: 38927789 PMCID: PMC11201098 DOI: 10.3390/bioengineering11060553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/06/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
Osteoporosis, a terminal illness, has emerged as a global public health problem in recent years. The long-term use of bone anabolic drugs to treat osteoporosis causes multi-morbidity in elderly patients. Alternative therapies, such as allogenic and autogenic tissue grafts, face important issues, such as a limited source of allogenic grafts and tissue rejection in autogenic grafts. However, stem cell therapy has been shown to increase bone regeneration and decrease osteoporotic bone formation. Stem cell therapy combined with betulin (BET) supplementation might be adequate for bone remodeling and new bone tissue generation. In this study, the effect of BET on the viability and osteogenic differentiation of hFOB 1.19 cells was investigated. The cells were encapsulated in alginate-gelatin (AlGel) microbeads. In vitro tests were conducted during the 12 d of incubation. While BET showed cytotoxic activity (>1 µM) toward non-encapsulated hFOB 1.19 cells, encapsulated cells retained their functionality for up to 12 days, even at 5 µM BET. Moreover, the expression of osteogenic markers indicates an enhanced osteo-inductive effect of betulin on encapsulated hFOB 1.19, compared to the non-encapsulated cell culture. The 3D micro-environment of the AlGel microcapsules successfully protects the hFOB 1.19 cells against BET cytotoxicity, allowing BET to improve the mineralization and differentiation of osteoblast cells.
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Affiliation(s)
- Mehmet Ali Karaca
- Department of Medical Biotechnology, Institute of Health Sciences, Acibadem Mehmet Ali Aydinlar University, 34752 Istanbul, Turkey;
| | - Derya Dilek Kancagi
- Acibadem Labcell Cellular Therapy Laboratory, 34752 Istanbul, Turkey; (D.D.K.); (E.O.)
| | - Ugur Ozbek
- Medical Genetics Department, School of Medicine, Acibadem Mehmet Ali Aydinlar University, 34752 Istanbul, Turkey;
| | - Ercument Ovali
- Acibadem Labcell Cellular Therapy Laboratory, 34752 Istanbul, Turkey; (D.D.K.); (E.O.)
| | - Ozgul Gok
- Department of Biomedical Engineering, Faculty of Engineering and Natural Sciences, Acibadem Mehmet Ali Aydinlar University, 34752 Istanbul, Turkey
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Huang C, Shi S, Qin M, Rong X, Ding Z, Fu X, Zeng W, Luo L, Wang D, Luo Z, Li Y, Zhou Z. A Composite Hydrogel Functionalized by Borosilicate Bioactive Glasses and VEGF for Critical-Size Bone Regeneration. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024:e2400349. [PMID: 38713747 DOI: 10.1002/advs.202400349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/08/2024] [Indexed: 05/09/2024]
Abstract
Critical-size bone defects pose a formidable challenge in clinical treatment, prompting extensive research efforts to address this problem. In this study, an inorganic-organic multifunctional composite hydrogel denoted as PLG-g-TA/VEGF/Sr-BGNPs is developed, engineered for the synergistic management of bone defects. The composite hydrogel demonstrated the capacity for mineralization, hydroxyapatite formation, and gradual release of essential functional ions and vascular endothelial growth factor (VEGF) and also maintained an alkaline microenvironment. The composite hydrogel promoted the proliferation and osteogenic differentiation of rat bone marrow mesenchymal stem cells (rBMSCs), as indicated by increased expression of osteogenesis-related genes and proteins in vitro. Moreover, the composite hydrogel significantly enhanced the tube-forming capability of human umbilical vein endothelial cells (HUVECs) and effectively inhibited the process of osteoblastic differentiation of nuclear factor kappa-B ligand (RANKL)-induced Raw264.7 cells and osteoclast bone resorption. After the implantation of the composite hydrogel into rat cranial bone defects, the expression of osteogenic and angiogenic biomarkers increased, substantiating its efficacy in promoting bone defect repair in vivo. The commendable attributes of the multifunctional composite hydrogel underscore its pivotal role in expediting hydrogel-associated bone growth and repairing critical bone defects, positioning it as a promising adjuvant therapy candidate for large-segment bone defects.
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Affiliation(s)
- Chao Huang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P. R. China
| | - Shun Shi
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, Sichuan, 610065, P. R. China
| | - Muyan Qin
- School of Materials Science and Engineering, Tongji University, Shanghai, 201804, P. R. China
| | - Xiao Rong
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P. R. China
| | - Zichuan Ding
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P. R. China
| | - Xiaoxue Fu
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P. R. China
| | - Weinan Zeng
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P. R. China
| | - Lei Luo
- West China School of Clinical Medicine, Sichuan University, Chengdu, Sichuan, 610041, P. R. China
| | - Deping Wang
- School of Materials Science and Engineering, Tongji University, Shanghai, 201804, P. R. China
| | - Zeyu Luo
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P. R. China
| | - Yiwen Li
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, Sichuan, 610065, P. R. China
| | - Zongke Zhou
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P. R. China
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Freischmidt H, Guehring T, Thomé P, Armbruster J, Reiter G, Grützner PA, Nolte PC. Treatment of Large Femoral and Tibial Bone Defects With Plate-Assisted Bone Segment Transport. J Orthop Trauma 2024; 38:285-290. [PMID: 38381977 PMCID: PMC11017834 DOI: 10.1097/bot.0000000000002784] [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] [Received: 09/04/2023] [Accepted: 02/06/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVES The purposes of this study were to assess clinical and radiographic outcomes following plate-assisted bone segment transport (PABST) in large bone defects of the lower extremities. METHODS DESIGN Retrospective study of prospectively collected data. SETTING Level-1 trauma center located in Germany. PATIENT SELECTION CRITERIA Patients who underwent PABST and were at least 1 year postoperatively were included. OUTCOME MEASURES AND COMPARISONS Demographic data were collected. Radiographic apparent bone gap (RABG), time to consolidation, time to full weight-bearing, and consolidation index were calculated. Numeric rating scale, lower extremity functional scale (LEFS), and complications were assessed. RESULTS Fifteen patients [13 male; mean age 51 years (range, 20-75)] underwent PABST and had follow-up at a mean of 29.1 months. The tibia was affected in 8 and the femur in 7 patients. Preoperative RABG was 60 mm [interquartile range (IQR): 40-125], and bone defects were caused by septic nonunions in 73% of patients. Fourteen patients (93%) demonstrated consolidated transport callus at 7.3 months [95% confidence interval (95% CI), 6-8.5], and 9 patients (60%) demonstrated complete consolidation of both docking site and transport callus at 11.5 months (95% CI, 7.3-15.3). Postoperative RABG was 0.1 mm (IQR: 0-0.8), and consolidation index was 1.9 months/cm (95% CI, 1.3-2.5). All patients achieved full weight-bearing at 8.7 months (IQR: 6.5-10.3). LEFS was 42 (95% CI, 34-50), and numeric rating scale was 3 (95% CI, 2-4). Patients treated for tibial defects had a significantly higher consolidation rate compared with patients treated for femoral defects ( P = 0.040). CONCLUSIONS PABST demonstrated high consolidation of transport callus with few complications. Although full weight-bearing was achieved in all patients, complete consolidation of the docking site was only present in 60% of cases. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Holger Freischmidt
- Department of Trauma and Orthopedic Surgery, BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany; and
| | - Thorsten Guehring
- Department of Shoulder and Elbow Surgery, Sportsmedicine & Traumatology, Diakonie Clinic Paulinenhilfe, Stuttgart, Germany
| | - Patrick Thomé
- Department of Trauma and Orthopedic Surgery, BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany; and
| | - Jonas Armbruster
- Department of Trauma and Orthopedic Surgery, BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany; and
| | - Gregor Reiter
- Department of Trauma and Orthopedic Surgery, BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany; and
| | - Paul Alfred Grützner
- Department of Trauma and Orthopedic Surgery, BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany; and
| | - Philip-Christian Nolte
- Department of Trauma and Orthopedic Surgery, BG Klinik Ludwigshafen, Ludwigshafen am Rhein, Germany; and
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Gagnon D, Mouallem M, Leduc S, Rouleau DM, Chapleau J. A systematic scoping review of the latest data on orthobiologics in the surgical treatment of non-union. Orthop Traumatol Surg Res 2024:103896. [PMID: 38663743 DOI: 10.1016/j.otsr.2024.103896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/02/2024] [Accepted: 04/18/2024] [Indexed: 05/03/2024]
Abstract
INTRODUCTION Recent studies have shown a growing concern regarding the cost-effectiveness and the lack of supporting data for the biologic agents that are being increasingly used in the orthopedic field. Our aim was to conduct a systematic scoping review of recent publications (last five years) on the use of orthobiologics to treat fracture non-union and summarize the latest available data. PATIENTS AND METHODS The inclusion criteria for this review were articles published in English, from 2016 to 2022, and focusing on the use of orthobiologics for the surgical treatment of non-union. Searches were conducted in March 2023 using Pubmed/MEDLINE and Embase. Studies on spinal fusion or gene therapy were excluded. Reviews, case reports with five cases or less, conference proceedings, preliminary reports, pediatric or non-human studies were excluded as well. RESULTS The search found 1807 articles, 15 were eligible after PRISMA checklist and exclusions. The evidence was heterogenous and there was only one level II RCT. Recent data suggests that bone morphogenic protein (BMP-2) products could be effective for septic and aseptic tibial non-unions. However, the evidence was not conclusive regarding BMP-7, plasma rich platelets (PRP), stem cells or demineralized bone matrix (DBM). DISCUSSION Every non-union case is different in terms of bone defect, biology, mechanical stability, surgical technique and host factors, which contributes to the conflicting reports on the efficacy of orthobiologics in the literature. We might never see a level 1, high powered and robust study defining the efficacy, safety profile and cost-effectiveness of such products. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- David Gagnon
- Faculty of Medicine, Université de Montréal, 2900 boulevard Edouard-Montpetit, Montreal, QC. H3T 1J4, Canada
| | - Maya Mouallem
- Faculty of Medicine, Université de Montréal, 2900 boulevard Edouard-Montpetit, Montreal, QC. H3T 1J4, Canada
| | - Stéphane Leduc
- Faculty of Medicine, Université de Montréal, 2900 boulevard Edouard-Montpetit, Montreal, QC. H3T 1J4, Canada; Department of orthopedic surgery, CIUSSS du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, C2095-5400 Boul. Gouin O., Montreal, QC. H4J 1C5, Canada
| | - Dominique M Rouleau
- Faculty of Medicine, Université de Montréal, 2900 boulevard Edouard-Montpetit, Montreal, QC. H3T 1J4, Canada; Department of orthopedic surgery, CIUSSS du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, C2095-5400 Boul. Gouin O., Montreal, QC. H4J 1C5, Canada
| | - Julien Chapleau
- Faculty of Medicine, Université de Montréal, 2900 boulevard Edouard-Montpetit, Montreal, QC. H3T 1J4, Canada; Department of orthopedic surgery, CIUSSS du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, C2095-5400 Boul. Gouin O., Montreal, QC. H4J 1C5, Canada.
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Chua SKK, Wong WSY, Koh DTS, Sultana R, Soong J, Lee KH, Bin Abd Razak HR. Faster Bone Gap Union in Medial Opening Wedge High Tibial Osteotomy With 3D-Printed Synthetic Bioresorbable Polycaprolactone and Tricalcium Phosphate Osteotomy Gap Fillers Compared to Allogeneic Osteotomy Gap Fillers: A Retrospective Matched-Pair Cohort Study. Cartilage 2024:19476035241246609. [PMID: 38624072 DOI: 10.1177/19476035241246609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Abstract
OBJECTIVE The use of synthetic bone substitute material (BSM) as osteotomy gap fillers have been reported to improve outcomes in medial opening wedge high tibial osteotomy (MOWHTO). This study aims to evaluate the early radiological outcomes (bone union) and complication rates of the novel patient-specific 3D-printed honeycomb-structured polycaprolactone and tricalcium phosphate (PCL-TCP) synthetic graft compared to allogeneic bone grafts as an osteotomy gap filler in MOWHTO. METHODS A retrospective matched-pair analysis of patients who underwent MOWHTO with either PCL-TCP synthetic graft or allogenic femoral head allograft as osteotomy gap filler was performed. The osteotomy gap was split into equal zones (Zone 1-5), and bone union was evaluated on anteroposterior radiographs based on the van Hemert classification at 1, 3, 6, and 12 months postoperatively. Postoperative complications including infection, lateral hinge fractures, and persistent pain was measured. The study and control group were matched for age, smoking status, diabetes mellitus, and osteotomy gap size. RESULTS Significantly greater bone union progression was observed in the PCL-TCP group than in the allograft group at 1 month (Zones 1-3), 3 months (Zones 1-4), 6 months (Zones 1-2, 4), and 12 months (Zones 2-3, 5) postoperatively (P < 0.05). No significant difference in complications rates was noted between the two groups at 1 year. CONCLUSIONS Bone union rates observed in patients who underwent MOWHTO with the PCL-TCP synthetic graft osteotomy gap filler were superior to those in the allograft group at 1 year postoperatively, with no significant difference in complication rates (postoperative infection, lateral hinge fractures, and persistent pain).
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Affiliation(s)
| | | | | | - Rehena Sultana
- Duke-National University of Singapore Medical School, Singapore
| | - Junwei Soong
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Kong Hwee Lee
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Hamid Rahmatullah Bin Abd Razak
- Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore
- SingHealth Duke-National University of Singapore Musculoskeletal Sciences Academic Clinical Programme, Singapore
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Fred EJ, Minardi S, Goodwin AM, Nandurkar TS, Plantz MA, Lyons JG, Paul JT, Foley JP, Wintring AJ, Furman AA, Jeong S, Yun C, Stock SR, Hsu WK, Hsu EL. A Mechanistic and Preclinical Assessment of BioRestore Bioactive Glass as a Synthetic Bone Graft Extender and Substitute for Osteoinduction and Spine Fusion. Clin Spine Surg 2024:01933606-990000000-00281. [PMID: 38531819 DOI: 10.1097/bsd.0000000000001597] [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: 06/21/2023] [Accepted: 11/29/2023] [Indexed: 03/28/2024]
Abstract
STUDY DESIGN Preclinical animal study. OBJECTIVE Evaluate the osteoinductivity and bone regenerative capacity of BioRestore bioactive glass. SUMMARY OF BACKGROUND DATA BioRestore is a Food and Drug Administration (FDA)-approved bone void filler that has not yet been evaluated as a bone graft extender or substitute for spine fusion. METHODS In vitro and in vivo methods were used to compare BioRestore with other biomaterials for the capacity to promote osteodifferentiation and spinal fusion. The materials evaluated (1) absorbable collagen sponge (ACS), (2) allograft, (3) BioRestore, (4) Human Demineralized Bone Matrix (DBM), and (5) MasterGraft. For in vitro studies, rat bone marrow-derived stem cells (BMSC) were cultured on the materials in either standard or osteogenic media (SM, OM), followed by quantification of osteogenic marker genes (Runx2, Osx, Alpl, Bglap, Spp1) and alkaline phosphatase (ALP) activity. Sixty female Fischer rats underwent L4-5 posterolateral fusion (PLF) with placement of 1 of 5 implants: (1) ICBG from syngeneic rats; (2) ICBG+BioRestore; (3) BioRestore alone; (4) ICBG+Allograft; or (5) ICBG+MasterGraft. Spines were harvested 8 weeks postoperatively and evaluated for bone formation and fusion via radiography, blinded manual palpation, microCT, and histology. RESULTS After culture for 1 week, BioRestore promoted similar expression levels of Runx2 and Osx to cells grown on DBM. At the 2-week timepoint, the relative ALP activity for BioRestore-OM was significantly higher (P<0.001) than that of ACS-OM and DBM-OM (P<0.01) and statistically equivalent to cells grown on allograft-OM. In vivo, radiographic and microCT evaluation showed some degree of bridging bone formation in all groups tested, with the exception of BioRestore alone, which did not produce successful fusions. CONCLUSIONS This study demonstrates the capacity of BioRestore to promote osteoinductivity in vitro. In vivo, BioRestore performed similarly to commercially available bone graft extender materials but was incapable of producing fusion as a bone graft substitute. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Elianna J Fred
- Simpson Querrey Institute (SQI), Northwestern University, Chicago, IL
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
| | - Silvia Minardi
- Simpson Querrey Institute (SQI), Northwestern University, Chicago, IL
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
| | - Alyssa M Goodwin
- Simpson Querrey Institute (SQI), Northwestern University, Chicago, IL
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
| | - Tejas S Nandurkar
- Simpson Querrey Institute (SQI), Northwestern University, Chicago, IL
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
| | - Mark A Plantz
- Simpson Querrey Institute (SQI), Northwestern University, Chicago, IL
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
| | - Joseph G Lyons
- Simpson Querrey Institute (SQI), Northwestern University, Chicago, IL
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
| | - Jonathan T Paul
- Simpson Querrey Institute (SQI), Northwestern University, Chicago, IL
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
| | - James P Foley
- Simpson Querrey Institute (SQI), Northwestern University, Chicago, IL
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
| | - Allison J Wintring
- Simpson Querrey Institute (SQI), Northwestern University, Chicago, IL
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
| | - Andrew A Furman
- Simpson Querrey Institute (SQI), Northwestern University, Chicago, IL
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
| | | | - Chawon Yun
- Simpson Querrey Institute (SQI), Northwestern University, Chicago, IL
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
| | - Stuart R Stock
- Simpson Querrey Institute (SQI), Northwestern University, Chicago, IL
- Department of Cell and Developmental Biology, Northwestern University, Chicago, IL
| | - Wellington K Hsu
- Simpson Querrey Institute (SQI), Northwestern University, Chicago, IL
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
| | - Erin L Hsu
- Simpson Querrey Institute (SQI), Northwestern University, Chicago, IL
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL
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El Sewify O, Abi-Rafeh J, Legler J, Karimi S, Baradaran A, Efanov JI. Clinical, Radiologic, and Functional Outcomes following Bone Grafting for Metacarpal Non-Unions: A Systematic Review. J Clin Med 2024; 13:1148. [PMID: 38398461 PMCID: PMC10889921 DOI: 10.3390/jcm13041148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
Objectives: Metacarpal non-unions are complex hand defects that can lead to severe hand impairment. Treatment may require the use of artificial or autologous bone grafts. This systematic review aims to describe the outcomes of bone grafting following metacarpal non-union in an attempt to establish an optimal therapeutic protocol for this complication. Methods: A systematic review was conducted in adherence with PRISMA guidelines. Data collection and analysis were performed in duplicate and confirmed by a third investigator. Our primary outcomes focused on radiological time to bone fusion and rates of non-union. Additionally, functional outcomes and complications were analyzed as means of central tendency. Results: Eighteen studies were included in the systematic review, accounting for a total of 47 patients. The average follow-up time was 12.4 months. Fourteen studies analyzed radiological outcomes, with atrophic non-union representing the most common type. The time to bone fusion, assessed radiologically, following bone graft was an average of 6.9 months (n = 14), with a 100% rate of union in 42 patients. Regarding patient-reported pain improvement, 76% of patients experienced pain relief. Moreover, all patients reported a complete subjective return to baseline hand function. Adverse events, limited to hematoma and seroma, were seen in three patients, representing a complication rate of 11.8% in the examined population. Conclusions: Metacarpal non-union can be treated successfully via vascularized and non-vascularized bone grafting. Based on the available evidence, bone grafts demonstrate favorable union rates, post-operative pain reduction, hand function recovery, earlier bone fusion times, and minimal complications in the context of metacarpal non-union management.
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Affiliation(s)
- Omar El Sewify
- Faculty of Medicine, Laval University, Quebec, QC G1V0A6, Canada
| | - Jad Abi-Rafeh
- Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, McGill University, Montreal, QC H3G2M1, Canada
| | - Jack Legler
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3G2M1, Canada
| | - Shayan Karimi
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3G2M1, Canada
| | - Aslan Baradaran
- Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, McGill University, Montreal, QC H3G2M1, Canada
| | - Johnny I. Efanov
- Plastic and Reconstructive Surgery, Department of Surgery, Centre hospitalier de l’Universite de Montreal (CHUM), Montreal, QC H2X3E4, Canada
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Ansari M, Darvishi A, Sabzevari A. A review of advanced hydrogels for cartilage tissue engineering. Front Bioeng Biotechnol 2024; 12:1340893. [PMID: 38390359 PMCID: PMC10881834 DOI: 10.3389/fbioe.2024.1340893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
With the increase in weight and age of the population, the consumption of tobacco, inappropriate foods, and the reduction of sports activities in recent years, bone and joint diseases such as osteoarthritis (OA) have become more common in the world. From the past until now, various treatment strategies (e.g., microfracture treatment, Autologous Chondrocyte Implantation (ACI), and Mosaicplasty) have been investigated and studied for the prevention and treatment of this disease. However, these methods face problems such as being invasive, not fully repairing the tissue, and damaging the surrounding tissues. Tissue engineering, including cartilage tissue engineering, is one of the minimally invasive, innovative, and effective methods for the treatment and regeneration of damaged cartilage, which has attracted the attention of scientists in the fields of medicine and biomaterials engineering in the past several years. Hydrogels of different types with diverse properties have become desirable candidates for engineering and treating cartilage tissue. They can cover most of the shortcomings of other treatment methods and cause the least secondary damage to the patient. Besides using hydrogels as an ideal strategy, new drug delivery and treatment methods, such as targeted drug delivery and treatment through mechanical signaling, have been studied as interesting strategies. In this study, we review and discuss various types of hydrogels, biomaterials used for hydrogel manufacturing, cartilage-targeting drug delivery, and mechanosignaling as modern strategies for cartilage treatment.
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Affiliation(s)
- Mojtaba Ansari
- Department of Biomedical Engineering, Meybod University, Meybod, Iran
| | - Ahmad Darvishi
- Department of Biomedical Engineering, Meybod University, Meybod, Iran
| | - Alireza Sabzevari
- Department of Biomedical Engineering, Meybod University, Meybod, Iran
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10
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Mommsen P, März V, Krezdorn N, Aktas G, Sehmisch S, Vogt PM, Großner T, Omar Pacha T. Reconstruction of an Extensive Segmental Radial Shaft Bone Defect by Vascularized 3D-Printed Graft Cage. J Pers Med 2024; 14:178. [PMID: 38392611 PMCID: PMC10890561 DOI: 10.3390/jpm14020178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/24/2024] Open
Abstract
We report here a 46-year-old male patient with a 14 cm segmental bone defect of the radial shaft after third degree open infected fracture caused by a shrapnel injury. The patient underwent fixed-angle plate osteosynthesis and bone reconstruction of the radial shaft by a vascularized 3D-printed graft cage, including plastic coverage with a latissimus dorsi flap and an additional central vascular pedicle. Bony reconstruction of segmental defects still represents a major challenge in musculo-skeletal surgery. Thereby, 3D-printed scaffolds or graft cages display a new treatment option for bone restoration. As missing vascularization sets the limits for the treatment of large-volume bone defects by 3D-printed scaffolds, in the present case, we firstly describe the reconstruction of an extensive radial shaft bone defect by using a graft cage with additional vascularization.
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Affiliation(s)
- Philipp Mommsen
- Department of Trauma Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Vincent März
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Nicco Krezdorn
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, 30625 Hannover, Germany
- Department of Plastic and Breast Surgery, Roskilde University Hospital, 4000 Roskilde, Denmark
| | - Gökmen Aktas
- Department of Trauma Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Stephan Sehmisch
- Department of Trauma Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Peter Maria Vogt
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Tobias Großner
- BellaSeno GmbH, 04103 Leipzig, Germany
- BellaSeno Pty Ltd., Brisbane, QLD 4220, Australia
| | - Tarek Omar Pacha
- Department of Trauma Surgery, Hannover Medical School, 30625 Hannover, Germany
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11
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Wang J, Liu M, Yang C, Pan Y, Ji S, Han N, Sun G. Biomaterials for bone defect repair: Types, mechanisms and effects. Int J Artif Organs 2024; 47:75-84. [PMID: 38166512 DOI: 10.1177/03913988231218884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
Bone defects or bone discontinuities caused by trauma, infection, tumours and other diseases have led to an increasing demand for bone grafts and biomaterials. Autologous bone grafts, bone grafts with vascular tips, anastomosed vascular bone grafts and autologous bone marrow components are all commonly used in clinical practice, while oversized bone defects require the use of bone tissue engineering-related biomaterials to repair bone defects and promote bone regeneration. Currently, inorganic components such as polysaccharides and bioceramics, as well as a variety of bioactive proteins, metal ions and stem cells can be loaded into hydrogels or 3D printed scaffold materials to achieve better therapeutic results. In this review, we provide an overview of the types of materials, applications, potential mechanisms and current developments in the repair of bone defects.
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Affiliation(s)
- Jiaming Wang
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Mingchong Liu
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chensong Yang
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yutao Pan
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shengchao Ji
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ning Han
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Guixin Sun
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
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12
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Koshy J, Sangeetha D. Recent progress and treatment strategy of pectin polysaccharide based tissue engineering scaffolds in cancer therapy, wound healing and cartilage regeneration. Int J Biol Macromol 2024; 257:128594. [PMID: 38056744 DOI: 10.1016/j.ijbiomac.2023.128594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/12/2023] [Accepted: 12/02/2023] [Indexed: 12/08/2023]
Abstract
Natural polymers and its mixtures in the form of films, sponges and hydrogels are playing a major role in tissue engineering and regenerative medicine. Hydrogels have been extensively investigated as standalone materials for drug delivery purposes as they enable effective encapsulation and sustained release of drugs. Biopolymers are widely utilised in the fabrication of hydrogels due to their safety, biocompatibility, low toxicity, and regulated breakdown by human enzymes. Among all the biopolymers, polysaccharide-based polymer is well suited to overcome the limitations of traditional wound dressing materials. Pectin is a polysaccharide which can be extracted from different plant sources and is used in various pharmaceutical and biomedical applications including cartilage regeneration. Pectin itself cannot be employed as scaffolds for tissue engineering since it decomposes quickly. This article discusses recent research and developments on pectin polysaccharide, including its types, origins, applications, and potential demands for use in AI-mediated scaffolds. It also covers the materials-design process, strategy for implementation to material selection and fabrication methods for evaluation. Finally, we discuss unmet requirements and current obstacles in the development of optimal materials for wound healing and bone-tissue regeneration, as well as emerging strategies in the field.
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Affiliation(s)
- Jijo Koshy
- Department of Chemistry, School of Advanced Sciences, Vellore Institute of Technology, Vellore 632014, Tamil Nadu, India
| | - D Sangeetha
- Department of Chemistry, School of Advanced Sciences, Vellore Institute of Technology, Vellore 632014, Tamil Nadu, India.
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Mao Y, Yao L, Li J, Li J, Xiong Y. No Superior Bone Union Outcomes with Allografts Compared to No Grafts and Autografts Following Medial Opening Wedge High Tibial Osteotomy: A Retrospective Cohort Study. Orthop Surg 2024; 16:363-373. [PMID: 38111034 PMCID: PMC10834220 DOI: 10.1111/os.13961] [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] [Received: 09/01/2023] [Revised: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVE There has been long-standing debate about whether a medial opening wedge high tibial osteotomy (MOWHTO) gap should be filled with autologous bone graft or any other filler to expedite the healing process. The main purpose of this study was to compare the clinical and radiological outcomes of MOWHTO with an opening gap ≥10 mm, utilizing autograft, allograft, or no graft at 1 year postoperatively. METHODS A total of 68 patients were included in this retrospective study and divided into three treatment groups: Group A (no bone graft), Group B (autologous iliac crest graft), and Group C (allogenous tibia plateau graft). At postoperative 1-year follow-up, the area of callus filling in the most medial side of the knee was measured using anteroposterior radiographs, and a modified van Hemert scoring system was used to evaluate bone union outcomes in five mediolaterally divided zones. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and relevant complications were assessed. The correlations between the gap width and bone union scores were evaluated. RESULTS Patients in the autograft group demonstrated better bone union progression (p = 0.031) and higher bone union scores (p < 0.01) compared to patients in the allograft or no graft groups. There were no significant differences in terms of postoperative WOMAC scores and incidence of complications among the three groups. No discernible linear relationships between the width of the opening gap and the bone union score were found. CONCLUSION For MOWHTOs with an average gap opening width of 12.1 mm, autografts resulted in superior bone union outcomes compared to allografts and no graft at 1 year postoperatively. However, no bone graft achieved similar outcomes to allografts, suggesting that routine use of allografts should not be recommended.
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Affiliation(s)
- Yunhe Mao
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Yao
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Junqiao Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics, Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Xiong
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics, Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
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14
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Vigliar MFR, Marega LF, Duarte MAH, Alcalde MP, Rosso MPDO, Ferreira Junior RS, Barraviera B, Reis CHB, Buchaim DV, Buchaim RL. Photobiomodulation Therapy Improves Repair of Bone Defects Filled by Inorganic Bone Matrix and Fibrin Heterologous Biopolymer. Bioengineering (Basel) 2024; 11:78. [PMID: 38247955 PMCID: PMC10813421 DOI: 10.3390/bioengineering11010078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/22/2023] [Accepted: 01/11/2024] [Indexed: 01/23/2024] Open
Abstract
Biomaterials are used extensively in graft procedures to correct bone defects, interacting with the body without causing adverse reactions. The aim of this pre-clinical study was to analyze the effects of photobiomodulation therapy (PBM) with the use of a low-level laser in the repair process of bone defects filled with inorganic matrix (IM) associated with heterologous fibrin biopolymer (FB). A circular osteotomy of 4 mm in the left tibia was performed in 30 Wistar male adult rats who were randomly divided into three groups: G1 = IM + PBM, G2 = IM + FB and G3 = IM + FB + PBM. PBM was applied at the time of the experimental surgery and three times a week, on alternate days, until euthanasia, with 830 nm wavelength, in two points of the operated site. Five animals from each group were euthanized 14 and 42 days after surgery. In the histomorphometric analysis, the percentage of neoformed bone tissue in G3 (28.4% ± 2.3%) was higher in relation to G1 (24.1% ± 2.91%) and G2 (22.2% ± 3.11%) at 14 days and at 42 days, the percentage in G3 (35.1% ± 2.55%) was also higher in relation to G1 (30.1% ± 2.9%) and G2 (31.8% ± 3.12%). In the analysis of the birefringence of collagen fibers, G3 showed a predominance of birefringence between greenish-yellow in the neoformed bone tissue after 42 days, differing from the other groups with a greater presence of red-orange fibers. Immunohistochemically, in all experimental groups, it was possible to observe immunostaining for osteocalcin (OCN) near the bone surface of the margins of the surgical defect and tartrate-resistant acid phosphatase (TRAP) bordering the newly formed bone tissue. Therefore, laser photobiomodulation therapy contributed to improving the bone repair process in tibial defects filled with bovine biomaterial associated with fibrin biopolymer derived from snake venom.
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Affiliation(s)
- Maria Fernanda Rossi Vigliar
- Graduate Program in Anatomy of Domestic and Wild Animals, Faculty of Veterinary Medicine and Animal Science, University of Sao Paulo (FMVZ/USP), Sao Paulo 05508-270, Brazil; (M.F.R.V.); (D.V.B.)
| | - Lais Furlaneto Marega
- Department of Biological Sciences, Bauru School of Dentistry, University of Sao Paulo (FOB/USP), Bauru 17012-901, Brazil; (L.F.M.); (M.P.d.O.R.); (C.H.B.R.)
| | - Marco Antonio Hungaro Duarte
- Department of Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of Sao Paulo (FOB/USP), Bauru 17012-901, Brazil; (M.A.H.D.); (M.P.A.)
| | - Murilo Priori Alcalde
- Department of Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of Sao Paulo (FOB/USP), Bauru 17012-901, Brazil; (M.A.H.D.); (M.P.A.)
| | - Marcelie Priscila de Oliveira Rosso
- Department of Biological Sciences, Bauru School of Dentistry, University of Sao Paulo (FOB/USP), Bauru 17012-901, Brazil; (L.F.M.); (M.P.d.O.R.); (C.H.B.R.)
| | - Rui Seabra Ferreira Junior
- Center for the Study of Venoms and Venomous Animals (CEVAP), Sao Paulo State University (University Estadual Paulista, UNESP), Botucatu 18610-307, Brazil; (R.S.F.J.); (B.B.)
- Graduate Programs in Tropical Diseases and Clinical Research, Botucatu Medical School (FMB), Sao Paulo State University (UNESP–University Estadual Paulista), Botucatu 18618-687, Brazil
| | - Benedito Barraviera
- Center for the Study of Venoms and Venomous Animals (CEVAP), Sao Paulo State University (University Estadual Paulista, UNESP), Botucatu 18610-307, Brazil; (R.S.F.J.); (B.B.)
- Graduate Programs in Tropical Diseases and Clinical Research, Botucatu Medical School (FMB), Sao Paulo State University (UNESP–University Estadual Paulista), Botucatu 18618-687, Brazil
| | - Carlos Henrique Bertoni Reis
- Department of Biological Sciences, Bauru School of Dentistry, University of Sao Paulo (FOB/USP), Bauru 17012-901, Brazil; (L.F.M.); (M.P.d.O.R.); (C.H.B.R.)
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, Postgraduate Department, University of Marilia (UNIMAR), Marilia 17525-902, Brazil
| | - Daniela Vieira Buchaim
- Graduate Program in Anatomy of Domestic and Wild Animals, Faculty of Veterinary Medicine and Animal Science, University of Sao Paulo (FMVZ/USP), Sao Paulo 05508-270, Brazil; (M.F.R.V.); (D.V.B.)
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, Postgraduate Department, University of Marilia (UNIMAR), Marilia 17525-902, Brazil
- Medical School, University Center of Adamantina (UNIFAI), Adamantina 17800-000, Brazil
| | - Rogerio Leone Buchaim
- Graduate Program in Anatomy of Domestic and Wild Animals, Faculty of Veterinary Medicine and Animal Science, University of Sao Paulo (FMVZ/USP), Sao Paulo 05508-270, Brazil; (M.F.R.V.); (D.V.B.)
- Department of Biological Sciences, Bauru School of Dentistry, University of Sao Paulo (FOB/USP), Bauru 17012-901, Brazil; (L.F.M.); (M.P.d.O.R.); (C.H.B.R.)
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Lai Y, Chuanqing M, Zhiyu C, Chengyong W, Meng L, Jing L, Chen WH. Comparison of two preserved cartilage iliac crest cortical-cancellous bone blocks graft harvesting techniques in children: A prospective, double-blind, randomized clinical trial. J Craniomaxillofac Surg 2023; 51:716-722. [PMID: 37821308 DOI: 10.1016/j.jcms.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/06/2023] [Accepted: 09/30/2023] [Indexed: 10/13/2023] Open
Abstract
PURPOSE To compare donor-site morbidity for alveolar bone grafting results following cartilage-preserving outer and inner cortico-cancellous iliac crest (OCIC and ICIC) bone block grafting in children. MATERIALS AND METHODS Patients were randomly divided into two groups and prospectively reviewed. In the OCIC and ICIC groups, cortico-cancellous bone blocks were harvested at outer and inner iliac crest respectively. Patient characteristics and surgical parameters were compared; pain intensity and duration, lateral femoral cutaneous nerve (LFCN) injury, gait disturbance, scar and contour satisfaction were analysed postoperatively. RESULTS Forty-nine consecutive patients (OCIC, 24; ICIC, 25) were included. There were no significant differences in patient characteristics or donor-site surgical parameters. The mean pain score on the first post-operative day was significantly lower in the OCIC group (3.75±1.70) than in the ICIC group (5.20±2.08) (p=0.012). The pain duration was similar in the two groups (median: 5 days). Temporary LFCN injury only occurred in 3 patients in the ICIC group. Postoperatively, the duck and circle gaits were observed in the OCIC and ICIC groups, respectively. There were no significant differences in the claudication duration, scar and contour satisfaction between the groups. CONCLUSION OCIC bone graft harvesting is marginally advantageous in children due to less early postoperative donor-site pain and a lower risk of nerve damage.
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Affiliation(s)
- Yongzhen Lai
- Department of Oral and Cranio-maxillofacial Science, Fujian Medical University Union Hospital, No. 28, Xinquan Road, Fuzhou City, 350001, Fujian Province, China; Stomatological Key Laboratory of Fujian College and University, Fuzhou, China
| | - Mao Chuanqing
- Department of Oral and Cranio-maxillofacial Science, Fujian Medical University Union Hospital, No. 28, Xinquan Road, Fuzhou City, 350001, Fujian Province, China
| | - Cai Zhiyu
- Department of Oral and Cranio-maxillofacial Science, Fujian Medical University Union Hospital, No. 28, Xinquan Road, Fuzhou City, 350001, Fujian Province, China
| | - Wang Chengyong
- Department of Oral and Cranio-maxillofacial Science, Fujian Medical University Union Hospital, No. 28, Xinquan Road, Fuzhou City, 350001, Fujian Province, China
| | - Lu Meng
- Department of Oral and Cranio-maxillofacial Science, Fujian Medical University Union Hospital, No. 28, Xinquan Road, Fuzhou City, 350001, Fujian Province, China
| | - Liu Jing
- Department of Stomatology, Fujian Maternal and Child Health Hospital, No 18 Dao Shan Road, Fuzhou City, 350001, Fujian Province, China
| | - Wei Hui Chen
- Department of Oral and Cranio-maxillofacial Science, Fujian Medical University Union Hospital, No. 28, Xinquan Road, Fuzhou City, 350001, Fujian Province, China.
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da Rocha LR, Dias RB, Fernandes MBC, Prinz R, Eirado TP, Costa IDS, Monteiro MJ, da Silva CER, Dos Santos CT, Fogagnolo F. A new option for bone regeneration: a rapid methodology for cellularization of allograft with human bone marrow stromal cells with in vivo bone-forming potential. Injury 2023; 54 Suppl 6:110777. [PMID: 38143129 DOI: 10.1016/j.injury.2023.05.008] [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] [Received: 02/27/2023] [Revised: 04/26/2023] [Accepted: 05/01/2023] [Indexed: 12/26/2023]
Abstract
The treatment of severe musculoskeletal injuries, such as loss of bone tissue and consolidation disorders, requires bone transplantation, and the success of this bone reconstruction depends on the grafts transplant's osteogenic, osteoconductive, and osteoinductive properties. Although the gold standard is autograft, it is limited by availability, morbidity, and infection risk. Despite their low capacity for osteoinduction and osteogenesis, decellularized bone allografts have been used in the search for alternative therapeutic strategies to improve bone regeneration. Considering that bone marrow stromal cells (BMSCs) are responsible for the maintenance of bone turnover throughout life, we believe that associating BMSCs with allograft could produce a material that is biologically similar to autologous bone graft. For this reason, this study evaluated the osteogenic potential of bone allograft cellularized with BMSCs. First, BMSC was characterized and allograft decellularization was confirmed by histology, scanning electron microscopy, and DNA quantification. Subsequently, the BMSCs and allografts were associated and evaluated for adhesion, proliferation, and in vitro and in vivo osteogenic potential. We demonstrated that, after 2 hours, BMSCs had already adhered to the surface of allografts and remained viable for 14 days. In vitro osteogenic assays indicated increased osteogenic potential of allografts compared with beta-tricalcium phosphate (β-TCP). In vivo transplantation assays in immunodeficient mice confirmed the allograft's potential to induce bone formation, with significantly better results than β-TCP. Finally, our results indicate that allograft can provide structural support for BMSC adhesion, offering a favorable microenvironment for cell survival and differentiation and inducing new bone formation. Taken together, our data indicate that this rapid methodology for cellularization of allograft with BMSCs might be a new therapeutic alternative in regenerative medicine and bone bioengineering.
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Affiliation(s)
- Leonardo Rosa da Rocha
- Teaching and Research Division, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad (INTO), Av. Brasil, 500, Rio de Janeiro, RJ 20940-070, Brazil.
| | - Rhayra Braga Dias
- Teaching and Research Division, INTO, Av. Brasil, 500, Rio de Janeiro, RJ 20940-070, Brazil
| | | | - Rafael Prinz
- Teaching and Research Division, INTO, Av. Brasil, 500, Rio de Janeiro, RJ 20940-070, Brazil
| | - Thiago Penna Eirado
- Teaching and Research Division, INTO, Av. Brasil, 500, Rio de Janeiro, RJ 20940-070, Brazil
| | - Isabela de Souza Costa
- Teaching and Research Division, INTO, Av. Brasil, 500, Rio de Janeiro, RJ 20940-070, Brazil
| | - Mauricio J Monteiro
- Materials Division, Instituto Nacional de Tecnologia (INT), Av. Venezuela 82, Rio de Janeiro, RJ 20081-312, Brazil.
| | | | | | - Fabricio Fogagnolo
- Department of Orthopaedics and Anaesthesiology, Ribeirão Preto Medical School, Universidade de São Paulo (USP), Av. Bandeirantes, 3900, São Paulo, SP 14049900, Brazil
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17
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Wu W, Liu B, Wang H. Caecum Rupture Secondary to Iliac Crest Bone Graft: A Case Report. Cureus 2023; 15:e49545. [PMID: 38156144 PMCID: PMC10753155 DOI: 10.7759/cureus.49545] [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] [Accepted: 11/26/2023] [Indexed: 12/30/2023] Open
Abstract
Autogenous bone grafting is a common surgical method in orthopaedics. The anterior iliac crest is a common site for harvesting autologous bone grafts. There are many complications after iliac bone harvesting, and pain and discomfort at the donor site are the most common sequelae. However, intestinal rupture after iliac bone harvesting has not been reported. We report a case of caecum rupture in a 58-year-old male after harvesting bone from his iliac crest. After proper surgical repair, the patient was discharged from the ICU and his bowel function recovered. This serious complication of bone harvesting from the iliac crest prompted investigation of the technique of iliac crest harvesting and donor site reconstruction.
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Affiliation(s)
- Wangsheng Wu
- Orthopaedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, CHN
- Orthopaedics, The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, CHN
| | - Bingsheng Liu
- Orthopaedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, CHN
| | - Huajuan Wang
- Anaesthesiology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, CHN
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Sun S, Xu X, Zhang Z, Zhang Y, Wei W, Guo K, Jiang YN. A novel concentrated growth factor (CGF) and bio-oss based strategy for second molar protection after impacted mandibular third molar extraction: a randomized controlled clinical study. BMC Oral Health 2023; 23:750. [PMID: 37828455 PMCID: PMC10571244 DOI: 10.1186/s12903-023-03411-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 09/12/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND The extraction of impacted mandibular third molars might cause large bone defects in the distal area of second molars. A new strategy was innovatively employed here combining autologous bone, Bio-Oss, concentrated growth factors (CGF) gel and CGF membrane for bone repair, and the present study aimed at exploring safety as well as short- and long-term efficacy of this new protocol clinically. MATERIALS AND METHODS A total of 66 participants were enrolled in this randomized single-blind clinical trial, and randomly allocated to control group (only blood clots), test A group (autogenous bone, Bio-Oss with barrier membrane) and test B group (autogenous bone, Bio-Oss, CGF gel with CGF membrane). The postoperative outcomes including PoSSe scale, periodontal probing depth (PD), degree of gingival recession and computed tomography measurements were assessed at 3rd, 6th, 12th month. A p-value < 0.05 was considered statistically significant. RESULTS In PoSSe scale, no significant difference was observed except a significant alleviation of early-stage pain perception in test B group (p < 0.05). Also, test B group exhibited better effect on periodontal healing and gingival recession reduction after 6 months (p < 0.05). Both two test groups showed more new bone formation than the control group (p < 0.05). It is noteworthy that the bone repair of test B group was significantly better than that of test A at 3rd and 6th month (p < 0.05), yet no difference was observed at 12th month (p > 0.05). CONCLUSION Both two test groups could achieve stable long-term efficacy on bone defect repair. The use of CGF gel and CGF membrane could accelerate early-stage bone repair, alleviate short-term pain after surgery, reduce long-term probing depth and relieve economic cost for patients. This new bone repair protocol is worthy of promoting by clinicians. TRIAL REGISTRATION This study was registered with the identification number ChiCTR2300068466 on 20/02/2023 at Chinese Clinical Trial Registry. Also, it was ethically approved from the institutional ethics committee at the Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (No:2023-010-01), and has been conducted in accordance to the guidelines of the declaration of Helsinki. Written informed consent was obtained from all participants in the study.
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Affiliation(s)
- Shoufu Sun
- Department of Stomatology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 Xianxia Road, Shanghai, 200336 People’s Republic of China
| | - Xiaodong Xu
- Department of Stomatology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 Xianxia Road, Shanghai, 200336 People’s Republic of China
| | - Zhongxiao Zhang
- Tongren Hospital, Hongqiao International Institute of Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336 People’s Republic of China
| | - Ying Zhang
- Department of Stomatology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 Xianxia Road, Shanghai, 200336 People’s Republic of China
| | - Wenjia Wei
- Department of Stomatology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 Xianxia Road, Shanghai, 200336 People’s Republic of China
| | - Ke Guo
- Department of Stomatology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 Xianxia Road, Shanghai, 200336 People’s Republic of China
| | - Yunan N. Jiang
- Department of Stomatology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 Xianxia Road, Shanghai, 200336 People’s Republic of China
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Fischer C, Mendel T, Hückstädt M, Hofmann GO, Klauke F. [Reconstruction of a metadiaphyseal bone defect after open comminuted fracture of the proximal femur using a modified Masquelet technique]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:812-816. [PMID: 36599965 DOI: 10.1007/s00113-022-01278-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 01/06/2023]
Abstract
The reconstruction of segmental bone defects after surgical treatment of infected delayed unions as well as nonunions, places the highest demands on the surgical technical implementation. After treating the fracture-related infection, guaranteeing biomechanical stability is crucial for the success of the treatment. The presented case describes the successful treatment of an infected delayed union after an open metadiaphyseal comminuted fracture of the proximal femur using a modified Masquelet technique. A solid allogeneic bone graft in combination with autologous cancellous bone were inserted into a 7 cm subtrochanteric defect zone and stabilized with a combined plate and nail osteosynthesis.
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Affiliation(s)
- C Fischer
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost Halle (Saale), Merseburger Straße 165, 06112, Halle (Saale), Deutschland.
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
| | - T Mendel
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost Halle (Saale), Merseburger Straße 165, 06112, Halle (Saale), Deutschland
| | - M Hückstädt
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost Halle (Saale), Merseburger Straße 165, 06112, Halle (Saale), Deutschland
| | - G O Hofmann
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost Halle (Saale), Merseburger Straße 165, 06112, Halle (Saale), Deutschland
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - F Klauke
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost Halle (Saale), Merseburger Straße 165, 06112, Halle (Saale), Deutschland
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
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20
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Shen J, Wei Z, Wang S, Wang X, Lin W, Liu L, Wang G. Treatment of infected bone defects with the induced membrane technique. Bone Joint Res 2023; 12:546-558. [PMID: 37697974 PMCID: PMC10495849 DOI: 10.1302/2046-3758.129.bjr-2022-0439.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Abstract
Aims This study aimed to evaluate the effectiveness of the induced membrane technique for treating infected bone defects, and to explore the factors that might affect patient outcomes. Methods A comprehensive search was performed in PubMed, Embase, and the Cochrane Central Register of Controlled Trials databases between 1 January 2000 and 31 October 2021. Studies with a minimum sample size of five patients with infected bone defects treated with the induced membrane technique were included. Factors associated with nonunion, infection recurrence, and additional procedures were identified using logistic regression analysis on individual patient data. Results After the screening, 44 studies were included with 1,079 patients and 1,083 segments of infected bone defects treated with the induced membrane technique. The mean defect size was 6.8 cm (0.5 to 30). After the index second stage procedure, 85% (797/942) of segments achieved union, and 92% (999/1,083) of segments achieved final healing. The multivariate analysis with data from 296 patients suggested that older age was associated with higher nonunion risk. Patients with external fixation in the second stage had a significantly higher risk of developing nonunion, increasing the need for additional procedures. The autografts harvested from the femur reamer-irrigator-aspirator increased nonunion, infection recurrence, and additional procedure rates. Conclusion The induced membrane technique is an effective technique for treating infected bone defects. Internal fixation during the second stage might effectively promote bone healing and reduce additional procedures without increasing infection recurrence. Future studies should standardize individual patient data prospectively to facilitate research on the affected patient outcomes.
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Affiliation(s)
- Jie Shen
- Trauma Medical Centre, Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
- Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Zhiyuan Wei
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Shulin Wang
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Xiaohua Wang
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Wei Lin
- Department of Gynecology, West China Women’s and Children’s Hospital, Sichuan University, Chengdu, China
| | - Lei Liu
- Department of Orthopaedics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Guanglin Wang
- Trauma Medical Centre, Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
- Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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21
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Lai Y, Jiang XX, Lu M, Mao C, Cai Z, Wang C, Liu J, Chen W. A Comparative Evaluation of Iliac Crest Cortical-Cancellous Bone Blocks Graft With and Without Concentrated Growth Factors (CGFs) in Secondary Alveolar Bone Grafting: A Retrospective Study. J Craniofac Surg 2023; 34:1789-1794. [PMID: 37010314 DOI: 10.1097/scs.0000000000009300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/28/2022] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate the clinical effect and bone resorption of iliac crest cortical-cancellous bone block grafts combined with concentrated growth factor (CGF) compared with iliac crest cortical-cancellous bone block grafts only in secondary alveolar bone grafting. MATERIALS AND METHODS Eighty-six patients (43 in the CGF group and 43 in the non-CGF group) with unilateral alveolar clefts were examined. Patients (17 in the CGF group and 17 in the non-CGF group) were randomly chosen for radiologic evaluation. Quantitative evaluation of the bone resorption rate was made with cone-beam computed tomography and Mimics 19.0 software at 1 week and 12 months after surgery. RESULTS The success rate of bone grafting was 95.3% and 79.1% in the CGF and non-CGF groups, respectively ( P =0.025). The mean bone resorption rate at 12 months postoperatively was 35.66±15.80% and 41.39±19.57% in the CGF and non-CGF groups, respectively ( P =0.355). The bone resorption patterns of the 2 groups were similar on the labial, alveolar process, and palatal sides, and there was no obvious bone resorption on the labial side in either group. Nasal side bone resorption in the CGF group was significantly less than that in the non-CGF group ( P =0.047). CONCLUSIONS Cortical-cancellous bone block grafts reduce labial bone resorption, while CGF reduces nasal bone resorption and improves the success rate. The combination of bone block and CGF in secondary alveolar bone grafting is worthy of further clinical application.
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Affiliation(s)
- Yongzhen Lai
- Department of Oral and Craniomaxillofacial Science, Fujian Medical University Union Hospital
| | - Xiao Xian Jiang
- Department of Oral and Craniomaxillofacial Science, Fujian Medical University Union Hospital
| | - Meng Lu
- Department of Oral and Craniomaxillofacial Science, Fujian Medical University Union Hospital
| | - Chuanqing Mao
- Department of Oral and Craniomaxillofacial Science, Fujian Medical University Union Hospital
| | - Zhiyu Cai
- Department of Oral and Craniomaxillofacial Science, Fujian Medical University Union Hospital
| | - Chengyong Wang
- Department of Oral and Craniomaxillofacial Science, Fujian Medical University Union Hospital
| | - Jing Liu
- Department of Stomatology, Fujian Maternal and Child Health Hospital, Fuzhou, Fujian Province, China
| | - Weihui Chen
- Department of Oral and Craniomaxillofacial Science, Fujian Medical University Union Hospital
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22
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Wang H, Zhang Z, Wang W, Sun X. Scooping Technique to Acquire Cancellous Bone for Grafting in the Masquelet Procedure: A Retrospective Study. Indian J Orthop 2023; 57:1267-1275. [PMID: 37525726 PMCID: PMC10386989 DOI: 10.1007/s43465-023-00909-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/08/2023] [Indexed: 08/02/2023]
Abstract
Background The Masquelet procedure is effective in overcoming large bone defects; however, the limited number of cancellous bone and donor site complications remains a challenge. We developed a scooping technique to harvest sufficient cancellous bone from iliac crests for grafting during the Masquelet procedure. We hypothesized that this method would be efficient and safe. Methods This retrospective study included 13 patients who underwent the Masquelet procedure with cancellous bone grafting using the scooping technique. The following parameters were observed: (1) duration and total volume of cancellous bone extraction; (2) amount of bleeding and drainage fluid, and Visual Analog Scale (VAS) score of pain at the donor site during different periods; and (3) complications and bone regeneration at the ilium at the final follow-up. Results The median follow-up duration was 17 months. There were 3 unilateral and 10 bilateral extraction sites. The mean total amount extracted, extraction duration, bleeding, and drainage were 39 mL, 23 min, 49 mL, and 44 mL, respectively. Only three patients felt pain (VAS score: 1 point) at the final follow-up. Postoperatively, one case each of hematoma and lateral femoral cutaneous nerve injury supervened, and no infections or other complications occurred. The last computed tomography examination showed varying degrees of bone regeneration in the ilium. Conclusion The scooping technique for the iliac crest produced a substantial amount of autogenous cancellous bone using a small incision. It retained the appearance and morphology of the ilium with few complications. We believe it is a successful and safe option for treating bone defects.
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Affiliation(s)
- Hui Wang
- Department of Orthopedics Surgery, The 900th Hospital of Joint Logistics Support Force, PLA 156 West Second Ring North Road, Gulou District, Fuzhou, 350025 Fujian China
- Fuzong Clinical Medical College of Fujian Medical University, 88 Jiaotong Road, Taijiang District, Fuzhou, 350025 Fujian China
| | - Zhihong Zhang
- Department of Orthopedics Surgery, The 900th Hospital of Joint Logistics Support Force, PLA 156 West Second Ring North Road, Gulou District, Fuzhou, 350025 Fujian China
| | - Wanming Wang
- Department of Orthopedics Surgery, The 900th Hospital of Joint Logistics Support Force, PLA 156 West Second Ring North Road, Gulou District, Fuzhou, 350025 Fujian China
| | - Xiaotang Sun
- Department of Orthopedics Surgery, The 900th Hospital of Joint Logistics Support Force, PLA 156 West Second Ring North Road, Gulou District, Fuzhou, 350025 Fujian China
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23
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Ahmed H, Shakshak M, Trompeter A. A review of the Masquelet technique in the treatment of lower limb critical-size bone defects. Ann R Coll Surg Engl 2023. [PMID: 37367227 DOI: 10.1308/rcsann.2023.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
The need for bone tissue to heal effectively is paramount given its role in the mechanical support of tissues. Bone has a very good natural healing potential in comparison with most other tissue types, largely regenerating to its pre-injury state in the vast majority of cases. Certain factors such as high energy trauma, tumour resection, revision surgery, developmental deformities and infection can lead to the formation of bone defects, where the intrinsic healing potential of bone is diminished owing to bone loss. Various approaches to resolving bone defects exist in current practice, each with their respective benefits and drawbacks. These include bone grafting, free tissue transfer, Ilizarov bone transport and the Masquelet induced membrane technique. This review focuses on evaluating the Masquelet technique, discussing its method and underlying mechanisms, the effectiveness of certain modifications, and its potential future directions.
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Affiliation(s)
- H Ahmed
- St George's, University of London, UK
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24
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Dai H, Zhang H, Qiu Z, Shi Q. Periosteum-derived skeletal stem cells encapsulated in platelet-rich plasma enhance the repair of bone defect. Tissue Cell 2023; 83:102144. [PMID: 37354707 DOI: 10.1016/j.tice.2023.102144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/09/2023] [Accepted: 06/14/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Spontaneous restoration of large bone defects remains a challenge under infections, tumors, and crushing conditions. Current stem cell-based therapies for treating bone defects need improvement, because the used stem cells are isolated by a traditional protocol, which is based on their properties of in-vitro plastic adherence and fibroblastic colony formation. The stem cells isolated by the traditional protocol belong to a multicellular type mixture, individual cells vary in proliferative and osteogenic potential. Thus, developing a protocol capable of isolating stem cell subset with higher purity is required and urgent. AIM This study aimed to sort a subpopulation of stem cells from periosteum using flow cytometry (named as FC-PSCs), and evaluate the proliferative and osteogenic capacity of FC-PSCs in-vitro, and then establish a new stem cell-based therapies for treating bone defects by delivering the FC-PSCs within platelet-rich plasma (PRP). METHODS Mouse periosteum was used to sort FC-PSCs using flow cytometry with CD45-TER119-TIE2-ITGAV+CD90 + 6C3-CD105- markers, or isolate periosteum-derived stem cells with the traditional protocol (TP-PSCs) as control. After evaluating the FC-PSCs proliferation and osteogenic differentiation in-vitro as well as the promotive efficacy of platelet-rich plasma (PRP) on FC-PSCs proliferation and osteogenic differentiation, the FC-PSCs were delivered into the femoral epiphysis bone defect site of a mouse model by platelet-rich plasma (PRP). At postoperative 14 or 28 days, these mice were euthanized for harvest the femur specimens for micro-CT, histological evaluation. RESULTS In-vitro results determined that the FC-PSCs showed more capacity for proliferation and osteogenic differentiation compared with the TP-PSCs. In addition, in-vitro results showed the promotive efficacy of PRP on FC-PSCs proliferation and osteogenic differentiation. In-vivo results showed that the FC-PSCs delivered by PRP was able to facilitate the repair of bone defects by stimulating new bone formation and remodeling. CONCLUSION FC-PSCs delivered by PRP enhance the repair of bone defects by stimulating new bone formation and remodeling.
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Affiliation(s)
- Haibo Dai
- Department of Orthopedics (Second ward), Xiangtan Central Hospital, Xiangtan 411199, China; Xiangtan Clinical College, Xiangya Medical School, Central South University, Xiangtan 411199, China
| | - Haici Zhang
- Department of Orthopedics (Second ward), Xiangtan Central Hospital, Xiangtan 411199, China; Xiangtan Clinical College, Xiangya Medical School, Central South University, Xiangtan 411199, China
| | - Zhilong Qiu
- Department of Orthopedics (Second ward), Xiangtan Central Hospital, Xiangtan 411199, China; Xiangtan Clinical College, Xiangya Medical School, Central South University, Xiangtan 411199, China
| | - Qiang Shi
- Department of Spine Surgery, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha 410018, China; Clinical College of Changsha Central Hospital, Xiangya Medical College, Central South University, Changsha 410018, China; Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.
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25
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Nauth A, Crist BD, Morshed S, Watson JT, Pape HC. Management of aseptic nonunions and severe bone defects: let us get this thing healed! OTA Int 2023; 6:e258. [PMID: 37533443 PMCID: PMC10392436 DOI: 10.1097/oi9.0000000000000258] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/29/2022] [Indexed: 08/04/2023]
Abstract
Effective nonunion and bone defect management requires consideration of multiple potential contributing factors including biomechanics, biology, metabolic, and patient factors. This article reviews these factors as well as several potential nonunion or bone defect treatments including bone grafts, bone graft substitutes, the induced membrane technique, and distraction osteogenesis. A summary of these concepts and guidelines for an overall approach to management are also provided.
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Affiliation(s)
- Aaron Nauth
- Department of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Brett D. Crist
- Department of Orthopaedic Surgery, One Hospital, Columbia, MO
| | - Saam Morshed
- UCSF/SFGH Orthopaedic Trauma Institute, San Francisco, CA
| | - J. Tracy Watson
- Department of Orthopaedic Surgery, St. Louis University Health Science Center, Saint Louis, MO; and
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Kowalczyk P, Kopeć K, Wojasiński M, Jaroszewicz J, Ciach T. Composite microgranular scaffolds with surface modifications for improved initial osteoblastic cell proliferation. BIOMATERIALS ADVANCES 2023; 151:213489. [PMID: 37267750 DOI: 10.1016/j.bioadv.2023.213489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/22/2023] [Accepted: 05/28/2023] [Indexed: 06/04/2023]
Abstract
Polyester-based granular scaffolds are a potent material for tissue engineering due to their porosity, controllable pore size, and potential to be molded into various shapes. Additionally, they can be produced as composite materials, e.g., mixed with osteoconductive β-tricalcium phosphate or hydroxyapatite. Such polymer-based composite materials often happen to be hydrophobic, which disrupts cell attachment and decreases cell growth on the scaffold, undermining its primary function. In this work, we propose the experimental comparison of three modification techniques for granular scaffolds to increase their hydrophilicity and cell attachment. Those techniques include atmospheric plasma treatment, polydopamine coating, and polynorepinephrine coating. Composite polymer/β-tricalcium phosphate granules have been produced in a solution-induced phase separation (SIPS) process using commercially available biomedical polymers: poly(lactic acid), poly(lactic-co-glycolic acid), and polycaprolactone. We used thermal assembly to prepare cylindrical scaffolds from composite microgranules. Atmospheric plasma treatment, polydopamine coating, and polynorepinephrine coating showed similar effects on polymer composites' hydrophilic and bioactive properties. All modifications significantly increased human osteosarcoma MG-63 cell adhesion and proliferation in vitro compared to cells cultured on unmodified materials. In the case of polycaprolactone/β-tricalcium phosphate scaffolds, modifications were the most necessary, as unmodified polycaprolactone-based material disrupted the cell attachment. Modified polylactide/β-tricalcium phosphate scaffold supported excellent cell growth and showed ultimate compressive strength exceeding this of human trabecular bone. This suggests that all investigated modification techniques can be used interchangeably for increasing wettability and cell attachment properties of various scaffolds for medical applications, especially those with high surface and volumetric porosity, like granular scaffolds.
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Affiliation(s)
- Piotr Kowalczyk
- Warsaw University of Technology, Faculty of Chemical and Process Engineering, Department of Biotechnology and Bioprocess Engineering, Ludwika Waryńskiego 1, 00-645 Warsaw, Poland; Centre for Advanced Materials and Technology CEZAMAT, Poleczki 19, 02-822 Warsaw, Poland.
| | - Kamil Kopeć
- Warsaw University of Technology, Faculty of Chemical and Process Engineering, Department of Biotechnology and Bioprocess Engineering, Ludwika Waryńskiego 1, 00-645 Warsaw, Poland
| | - Michał Wojasiński
- Warsaw University of Technology, Faculty of Chemical and Process Engineering, Department of Biotechnology and Bioprocess Engineering, Ludwika Waryńskiego 1, 00-645 Warsaw, Poland
| | - Jakub Jaroszewicz
- Warsaw University of Technology, Faculty of Material Science and Engineering, Wołoska 141, 02-507 Warsaw, Poland
| | - Tomasz Ciach
- Warsaw University of Technology, Faculty of Chemical and Process Engineering, Department of Biotechnology and Bioprocess Engineering, Ludwika Waryńskiego 1, 00-645 Warsaw, Poland; Centre for Advanced Materials and Technology CEZAMAT, Poleczki 19, 02-822 Warsaw, Poland
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Matsugaki A, Ito M, Kobayashi Y, Matsuzaka T, Ozasa R, Ishimoto T, Takahashi H, Watanabe R, Inoue T, Yokota K, Nakashima Y, Kaito T, Okada S, Hanawa T, Matsuyama Y, Matsumoto M, Taneichi H, Nakano T. Innovative design of bone quality-targeted intervertebral spacer: accelerated functional fusion guiding oriented collagen and apatite microstructure without autologous bone graft. Spine J 2023; 23:609-620. [PMID: 36539040 DOI: 10.1016/j.spinee.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 11/28/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND CONTEXT Although autologous bone grafting is widely considered as an ideal source for interbody fusion, it still carries a risk of nonunion. The influence of the intervertebral device should not be overlooked. Requirements for artificial spinal devices are to join the vertebrae together and recover the original function of the spine rapidly. Ordered mineralization of apatite crystals on collagen accelerates bone functionalization during the healing process. Particularly, the stable spinal function requires the ingrowth of an ordered collagen and apatite matrix which mimics the intact intervertebral microstructure. This collagen and apatite ordering is imperative for functional bone regeneration, which has not been achieved using classical autologous grafting. PURPOSE We developed an intervertebral body device to achieve high stability between the host bone and synthesized bone by controlling the ordered collagen and apatite microstructure. STUDY DESIGN This was an in vivo animal study. METHODS Intervertebral spacers with a through-pore grooved surface structure, referred to as a honeycomb tree structure, were produced using metal 3D printing. These spacers were implanted into normal sheep at the L2-L3 or L4-L5 disc levels. As a control group, grafting autologous bone was embedded. The mechanical integrity of the spacer/bone interface was evaluated through push-out tests. RESULTS The spacer with honeycomb tree structure induced anisotropic trabecular bone growth with textured collagen and apatite orientation in the through-pore and groove directions. The push-out load of the spacer was significantly higher than that of the conventional autologous graft spacer. Moreover, the load was significantly correlated with the anisotropic texture of the newly formed bone matrix. CONCLUSIONS The developed intervertebral spacer guided the regenerated bone matrix orientation of collagen and apatite, resulting in greater strength at the spacer/host bone interface than that obtained using a conventional gold-standard autologous bone graft. CLINICAL SIGNIFICANCE Our results provide a foundation for designing future spacers for interbody fusion in human.
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Affiliation(s)
- Aira Matsugaki
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka, 565-0871, Japan; Anisotropic Design and Additive Manufacturing Research Center, Osaka University, 2-1 Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Manabu Ito
- Department of Spine and Spinal Cord Disorders, National Hospital Organization, Hokkaido Medical Center,5-7-1-1, Yamanote, Nishi-ku, Sapporo, Hokkaido, 063-0005, Japan
| | - Yoshiya Kobayashi
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Tadaaki Matsuzaka
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Ryosuke Ozasa
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka, 565-0871, Japan; Anisotropic Design and Additive Manufacturing Research Center, Osaka University, 2-1 Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Takuya Ishimoto
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka, 565-0871, Japan; Anisotropic Design and Additive Manufacturing Research Center, Osaka University, 2-1 Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Hiroyuki Takahashi
- Teijin Nakashima Medical Co., Ltd., 688-1 Joto-Kitagata, Higashi-ku, Okayama, 709-0625, Japan
| | - Ryota Watanabe
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka, 565-0871, Japan; Teijin Nakashima Medical Co., Ltd., 688-1 Joto-Kitagata, Higashi-ku, Okayama, 709-0625, Japan
| | - Takayuki Inoue
- Teijin Nakashima Medical Co., Ltd., 688-1 Joto-Kitagata, Higashi-ku, Okayama, 709-0625, Japan
| | - Katsuhiko Yokota
- Teijin Nakashima Medical Co., Ltd., 688-1 Joto-Kitagata, Higashi-ku, Okayama, 709-0625, Japan
| | - Yoshio Nakashima
- Teijin Nakashima Medical Co., Ltd., 688-1 Joto-Kitagata, Higashi-ku, Okayama, 709-0625, Japan
| | - Takashi Kaito
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Seiji Okada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Takao Hanawa
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka, 565-0871, Japan; Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroshi Taneichi
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Takayoshi Nakano
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka, 565-0871, Japan; Anisotropic Design and Additive Manufacturing Research Center, Osaka University, 2-1 Yamada-Oka, Suita, Osaka, 565-0871, Japan.
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Endothelial Progenitor Cell Therapy for Fracture Healing: A Dose-Response Study in a Rat Femoral Defect Model. J Tissue Eng Regen Med 2023. [DOI: 10.1155/2023/8105599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Endothelial progenitor cell (EPC) therapy has been successfully used in orthopaedic preclinical models to heal bone defects. However, no previous studies have investigated the dose-response relationship between EPC therapy and bone healing. This study aimed to assess the effect of different EPC doses on bone healing in a rat model to define an optimal dose. Five-millimeter segmental defects were created in the right femora of Fischer 344 rats, followed by stabilization with a miniplate and screws. Rats were assigned to one of six groups (control, 0.1 M, 0.5 M, 1.0 M, 2.0 M, and 4.0 M; n = 6), receiving 0, 1 × 105, 5 × 105, 1 × 106, 2 × 106, and 4 × 106 EPCs, respectively, delivered into the defect on a gelatin scaffold. Radiographs were taken every two weeks until the animals were euthanized 10 weeks after surgery. The operated femora were then evaluated using micro-computed tomography and biomechanical testing. Overall, the groups that received higher doses of EPCs (0.5 M, 1.0 M, 2.0 M, and 4.0 M) reached better outcomes. At 10 weeks, full radiographic union was observed in 67% of animals in the 0.5 M group, 83% of animals in the 1.0 M group, and 100% of the animals in the 2.0 M and 4.0 M groups, but none in the control and 0.1 M groups. The 2.0 M group also displayed the strongest biomechanical properties, which significantly improved relative to the control and 0.1 M groups. In summary, this study defined a dose-response relationship between EPC therapy and bone healing, with 2 × 106 EPCs being the optimal dose in this model. Our findings emphasize the importance of dosing considerations in the application of cell therapies aimed at tissue regeneration and will help guide future investigations and clinical translation of EPC therapy.
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A New Osteogenic Membrane to Enhance Bone Healing: At the Crossroads between the Periosteum, the Induced Membrane, and the Diamond Concept. Bioengineering (Basel) 2023; 10:bioengineering10020143. [PMID: 36829637 PMCID: PMC9952848 DOI: 10.3390/bioengineering10020143] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/25/2023] Open
Abstract
The lack of viability of massive bone allografts for critical-size bone defect treatment remains a challenge in orthopedic surgery. The literature has reviewed the advantages of a multi-combined treatment with the synergy of an osteoconductive extracellular matrix (ECM), osteogenic stem cells, and growth factors (GFs). Questions are still open about the need for ECM components, the influence of the decellularization process on the latter, the related potential loss of function, and the necessity of using pre-differentiated cells. In order to fill in this gap, a bone allograft surrounded by an osteogenic membrane made of a decellularized collagen matrix from human fascia lata and seeded with periosteal mesenchymal stem cells (PMSCs) was analyzed in terms of de-/recellularization, osteogenic properties, PMSC self-differentiation, and angiogenic potential. While the decellularization processes altered the ECM content differently, the main GF content was decreased in soft tissues but relatively increased in hard bone tissues. The spontaneous osteogenic differentiation was necessarily obtained through contact with a mineralized bone matrix. Trying to deepen the knowledge on the complex matrix-cell interplay could further propel these tissue engineering concepts and lead us to provide the biological elements that allow bone integration in vivo.
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Xie C, Wang C, Huang W, Huang Y, Li Q, Yu C, Yin D. Recombinant human bone morphogenetic protein is a valid alternative to autologous bone graft for long bone non-unions: a systematic review and meta-analysis. Surgeon 2023:S1479-666X(22)00134-2. [PMID: 36682906 DOI: 10.1016/j.surge.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 06/23/2022] [Accepted: 11/14/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To compare the efficacy of recombinant human bone morphogenetic proteins (rhBMPs) and autologous bone graft (ABG) on the healing of long bone non-union. METHODS A systematic literature search was conducted on PubMed, Web of Science, Cochrane Library, and CNKI up to December 2021. Two authors independently screened the studies, extracted data, and assessed the quality of the trials. A Meta-analysis was performed using state software (version 12.0). RESULTS A total of 14 studies were included in this meta-analysis. Overall, there was no significant difference between the rhBMPs group and the ABG group in terms of healing rate (RR = 1.04, 95% CI = 0.96-1.12, p = 0.365) and healing time (SMD = -0.31, 95% CI = -0.76-0.14, p = 0.175). Subgroup analysis showed rhBMPs lead to higher healing rates (RR = 1.35, 95% CI = 1.17-1.56, p < 0.001), and shorter healing time (SMD = -0.65, 95% CI = -1.08 to -0.22, p = 0.003) in the subgroup of moderate-quality studies. Sensitivity analysis proved that our conclusions were relatively robust. No significant publication bias was recognized in all studies (Begg's test, p = 0.193; Egger's test, p = 0.307). CONCLUSIONS RhBMPs or combined with allografts bone, inorganic bone was a valid alternative to ABG for the treatment of long bone non-union.
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Affiliation(s)
- Chengxin Xie
- Department of Joint Surgery and Sports Medicine, The People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Academy of Medical Sciences, 530021 Nanning, China.
| | - Chenglong Wang
- Department of Joint Surgery and Sports Medicine, The People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Academy of Medical Sciences, 530021 Nanning, China.
| | - Wenwen Huang
- Department of Joint Surgery and Sports Medicine, The People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Academy of Medical Sciences, 530021 Nanning, China.
| | - Yu Huang
- Department of Traumatic Surgery & Microsurgery & Hand Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Academy of Medical Sciences, 530021 Nanning, China.
| | - Qinglong Li
- Department of Traumatic Surgery & Microsurgery & Hand Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Academy of Medical Sciences, 530021 Nanning, China.
| | - Chengqiang Yu
- Department of Spine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Academy of Medical Sciences, 530021 Nanning, China.
| | - Dong Yin
- Department of Joint Surgery and Sports Medicine, The People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Academy of Medical Sciences, 530021 Nanning, China.
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Fekrazad S, Sohrabi M, Fekrazad R. Angiogenetic and anti-inflammatory effects of photobiomodulation on bone regeneration in rat: A histopathological, immunohistochemical, and molecular analysis. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY. B, BIOLOGY 2023; 238:112599. [PMID: 36493717 DOI: 10.1016/j.jphotobiol.2022.112599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 04/27/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022]
Abstract
Post-surgical bone defects require new alternative approaches for a better healing process. For this matter, photobiomodulation therapy (PBMT) has been used in order to improve the process of healing, pain, and inflammation reduction and tissue rejuvenation. This study is set to evaluate the effect of PBMT on angiogenic and inflammatory factors for bone regeneration in rat post-surgical cranial defects. Thirty male Wistar rats were distributed accidentally into two groups (Subdivided into 3 groups according to their follow-up durations). During operation, an 8-mm critical-sized calvarial defect was made in each rat. A continuous diode laser was used (power density 100 mW/cm2, wavelength 810 nm, the energy density of 4 J/cm2). Bone samples were assessed histomorphometrically and histologically after hematoxylin and eosin (H&E) staining. ALP, PTGIR, OCN, and IL-1 levels were measured by RT-PCR. VEGF expression was studied by immunohistochemistry analysis. The level of IL-1 expression decreased significantly in the PBMT group compared to the control after 7 days (p < 0.05), while, the PTGIR level was improved significantly compared to the control group after 7 days. Furthermore, levels of OCN and ALP improved after PBM use; however, the alterations were not statistically meaningful (p > 0.05). Evaluation with IHC displayed a significant rise in VEGF expression after 3 days in the PBMT group compared to the control (p > 0.05). In this study's conditions, the results showed a meaningful alteration in osteogenic, inflammatory, and angiogenic mediators in post-surgical calvarial defect following PBMT. It appears that PBM can accelerate angiogenesis in the bone healing procedure which can be helpful in bone tissue engineering.
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Affiliation(s)
- Sepehr Fekrazad
- Department of General Surgery, Subdivision of Surgical Oncology, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Mona Sohrabi
- Department of Pediatrics, Dental School, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Reza Fekrazad
- Radiation Sciences Research Center, AJA University of Medical Sciences - International Network for Photo Medicine and Photo Dynamic Therapy (INPMPDT), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
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Zhang Y, Cao J, Jian M, Zhou Z, Anwar N, Xiao L, Ma Y, Zhang D, Zhang J, Wang X. Fabrication of Interleukin-4 Encapsulated Bioactive Microdroplets for Regulating Inflammation and Promoting Osteogenesis. Int J Nanomedicine 2023; 18:2019-2035. [PMID: 37155503 PMCID: PMC10122853 DOI: 10.2147/ijn.s397359] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 04/11/2023] [Indexed: 05/10/2023] Open
Abstract
Background Despite the inherent regenerative ability of bone, large bone defect regeneration remains a major clinical challenge for orthopedic surgery. Therapeutic strategies medicated by M2 phenotypic macrophages or M2 macrophage inducer have been widely used to promote tissue remodeling. In this study, ultrasound-responsive bioactive microdroplets (MDs) encapsulated with bioactive molecule interleukin-4 (IL4, hereafter designated MDs-IL4) were fabricated to regulate macrophage polarization and potentiate the osteogenic differentiation of human mesenchymal stem cells (hBMSCs). Materials and Methods The MTT assay, live and dead staining, and phalloidin/DAPI dual staining were used to evaluate biocompatibility in vitro. H&E staining was used to evaluate biocompatibility in vivo. Inflammatory macrophages were further induced via lipopolysaccharide (LPS) stimulation to mimic the pro-inflammatory condition. The immunoregulatory role of the MDs-IL4 was tested via macrophage phenotypic marker gene expression, pro-inflammatory cytokine level, cell morphological analysis, and immunofluorescence staining, etc. The immune-osteogenic response of hBMSCs via macrophages and hBMSCs interactions was further investigated in vitro. Results The bioactive MDs-IL4 scaffold showed good cytocompatibility in RAW 264.7 macrophages and hBMSCs. The results confirmed that the bioactive MDs-IL4 scaffold could reduce inflammatory phenotypic macrophages, as evidenced by changing in morphological features, reduction in pro-inflammatory marker gene expression, increase of M2 phenotypic marker genes, and inhibition of pro-inflammatory cytokine secretion. Additionally, our results indicate that the bioactive MDs-IL4 could significantly enhance the osteogenic differentiation of hBMSCs via its potential immunomodulatory properties. Conclusion Our results demonstrate that the bioactive MDs-IL4 scaffold could be used as novel carrier system for other pro-osteogenic molecules, thus having potential applications in bone tissue regeneration.
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Affiliation(s)
- Yi Zhang
- Department of Hygiene Toxicology, Zunyi Medical University, Zunyi, Guizhou, 563000, People’s Republic of China
| | - Jin Cao
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563003, People’s Republic of China
| | - Minghui Jian
- Department of Hygiene Toxicology, Zunyi Medical University, Zunyi, Guizhou, 563000, People’s Republic of China
| | - Zhixiao Zhou
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563003, People’s Republic of China
| | - Nadia Anwar
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563003, People’s Republic of China
| | - Lan Xiao
- School of Mechanical, Medical and Process Engineering, Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, 4059, Australia
- Australia-China Centre for Tissue Engineering and Regenerative Medicine, Queensland University of Technology, Brisbane, QLD, 4059, Australia
| | - Yaping Ma
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563003, People’s Republic of China
| | - Dingmei Zhang
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563003, People’s Republic of China
| | - Jun Zhang
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563003, People’s Republic of China
| | - Xin Wang
- Department of Hygiene Toxicology, Zunyi Medical University, Zunyi, Guizhou, 563000, People’s Republic of China
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563003, People’s Republic of China
- School of Mechanical, Medical and Process Engineering, Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, 4059, Australia
- Australia-China Centre for Tissue Engineering and Regenerative Medicine, Queensland University of Technology, Brisbane, QLD, 4059, Australia
- Correspondence: Xin Wang, Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563003, People’s Republic of China, Tel +86 136 3928 8558, Fax +86-851-2860 8903, Email
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van Trikt CH, Donders JCE, Klinger CE, Wellman DS, Helfet DL, Kloen P. Operative treatment of nonunions in the elderly: Clinical and radiographic outcomes in patients at minimum 75 years of age. BMC Geriatr 2022; 22:985. [PMID: 36539691 PMCID: PMC9764700 DOI: 10.1186/s12877-022-03670-8] [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] [Received: 03/29/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Limited information exists on nonunion treatment in the elderly. This retrospective study evaluates whether results of operative treatment of nonunion of the humerus or femur in patients aged ≥ 75 years are comparable to those in younger patients. METHODS We identified patients age ≥ 75 years with a nonunion of humerus or femur treated with open reduction and internal fixation. The Non-Union Scoring System was calculated. Complications, clinical outcome, and radiographic findings were assessed. Primary endpoint was nonunion healing. A literature review compared time to healing of humeral and femoral nonunion in younger populations. RESULTS We identified 45 patients treated for a nonunion of humerus or femur with > 12 months follow-up. Median age was 79 years (range 75-96). Median time to presentation was 12 months (range 4-127) after injury, median number of prior surgeries was 1 (range 0-4). Union rate was 100%, with median time to union 6 months (range 2-42). Six patients underwent revision for persistent nonunion and healed without further complications. CONCLUSIONS Using a protocol of debridement, alignment, compression, stable fixation, bone grafting and early motion, patients aged 75 years or older can reliably achieve healing when faced with a nonunion of the humerus or femur. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Clinton H. van Trikt
- grid.509540.d0000 0004 6880 3010Department of Orthopedic Surgery and Sports Medicine, Amsterdam University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Johanna C. E. Donders
- grid.509540.d0000 0004 6880 3010Department of Orthopedic Surgery and Sports Medicine, Amsterdam University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Craig E. Klinger
- grid.5386.8000000041936877XOrthopaedic Trauma Service, Hospital for Special Surgery and New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY USA
| | - David S. Wellman
- grid.260917.b0000 0001 0728 151XOrthopaedic Trauma Service, Westchester Medical Center, New York Medical College, Valhalla, NY USA
| | - David L. Helfet
- grid.5386.8000000041936877XOrthopaedic Trauma Service, Hospital for Special Surgery and New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY USA
| | - Peter Kloen
- grid.509540.d0000 0004 6880 3010Department of Orthopedic Surgery and Sports Medicine, Amsterdam University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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Experimental model of normotrophic pseudarthrosis of a rabbit’s tibia. ACTA BIOMEDICA SCIENTIFICA 2022. [DOI: 10.29413/abs.2022-7.5-2.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background. The formation of a pseudarthrosis is one of the most severe complications of bone fractures. Pseudarthrosis occurs as a result of a disorder in the fracture union, has a poor prognosis and requires long-term treatment and repeated surgeries. A small number of representative pseudarthrosis models makes it difficult to conduct preclinical studies of promising pharmacological substances, bone replacement materials and surgical methods of treatment.The aim. To develop and to validate an experimental model of normotrophic pseudarthrosis of a rabbit’s tibia by creating diastasis between bone fragments, forming local vascularization disturbance and using unstable fixation.Materials and methods. The study was carried out on Soviet Chinchilla rabbits. The animals were divided into 2 groups: in experimental group, we formed tibial pseudarthrosis; in control group, we made a simple transverse tibial fracture. The pseudarthrosis was formed by segmental resection (5 mm) of the middle third of the tibia, bone fragments dilatation for 5 mm, removal of periosteum and bone marrow within 5 mm followed by daily destabilization of a fracture in an external fixation device. The duration of the experiment was 6 weeks. X-ray examination of the fracture area was carried out weekly, multi-layer spiral computed tomography (MSCT) and histological examinations were carried out at the end of the experiment.Results. The survival value in the experiment was 100 %. According to weekly X-ray examination, fracture union was registered only in the control group and occurred on average on the 22,8 ± 5,1 day, while the formation of pseudarthrosis was observed only in the experimental group, and radiographic signs of a pseudarthrosis were noted on average on the 33,6 ± 3,5 day. The formation of a pseudarthrosis by the end of the experiment was confirmed by MSCT and histological studies.Conclusions. The developed model of the normotrophic pseudarthrosis of a rabbit’s tibia can be used for experimental tests of various factors for stimulating reparative regeneration and methods for treatment of the pseudarthrosis.
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Ma L, Fu L, Gu C, Wang H, Yu Z, Gao X, Zhao D, Ge B, Zhang N. Delivery of bone morphogenetic protein-2 by crosslinking heparin to nile tilapia skin collagen for promotion of rat calvaria bone defect repair. Prog Biomater 2022; 12:61-73. [PMID: 36495399 PMCID: PMC9958213 DOI: 10.1007/s40204-022-00213-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 11/26/2022] [Indexed: 12/14/2022] Open
Abstract
Collagen has been widely used as a biomaterial for tissue regeneration. At the present, aqua-collagen derived from fish is poorly explored for biomedical material applications due to its insufficient thermal stability. To improve the bone repair ability and thermal stability of fish collagen, the tilapia skin collagen was crosslinked by EDC/NHS with heparin to bind specifically to BMP-2. The thermal stability of tilapia skin collagen crosslinked with heparin (HC-COL) was detected by differential scanning calorimetry (DSC). Cytotoxicity of HC-COL was assessed by detecting MC3T3-E1 cell proliferation using CCK-8 assay. The specific binding of BMP-2 to HC-COL was tested and the bioactivity of BMP-2-loaded HC-COL (HC-COL-BMP-2) was evaluated in vitro by inducing MC3T3-E1 cell differentiation. In vivo, the bone repair ability of HC-COL-2 was evaluated using micro-CT and histological observation. After crosslinking by EDC/NHS, the heparin-linked and the thermostability of the collagen of Nile Tilapia were improved simultaneously. HC-COL has no cytotoxicity. In addition, the binding of BMP-2 to HC-COL was significantly increased. Furthermore, the in vitro study revealed the effective bioactivity of BMP-2 binding on HC-COL by inducing MC3T3-E1 cells with higher ALP activity and the formation of mineralized nodules. In vivo studies showed that more mineralized and mature bone formation was achieved in HC-COL-BMP-2 group. The prepared HC-COL was an effective BMP-2 binding carrier with enough thermal stability and could be a useful biomaterial for bone repair.
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Affiliation(s)
- Lina Ma
- grid.440653.00000 0000 9588 091XDepartment of Diagnostics, The Second School of Medicine, Binzhou Medical University, Laishan, Yantai, 264003 Shandong China ,grid.440653.00000 0000 9588 091XRongxiang Xu Regenerative Medicine Research Center, Binzhou Medical University, Laishan, Yantai, 264003 Shandong China
| | - Li Fu
- grid.440653.00000 0000 9588 091XRongxiang Xu Regenerative Medicine Research Center, Binzhou Medical University, Laishan, Yantai, 264003 Shandong China ,grid.440653.00000 0000 9588 091XDepartment of Human Anatomy, School of Basic MedicalScience, Binzhou Medical University, Laishan, Yantai, 264003 Shandong China
| | - Chengxu Gu
- grid.440653.00000 0000 9588 091XDepartment of Human Anatomy, School of Basic MedicalScience, Binzhou Medical University, Laishan, Yantai, 264003 Shandong China
| | - Haonan Wang
- grid.497420.c0000 0004 1798 1132State Key Laboratory of Heavy Oil Processing and Center for Bioengineering and Biotechnology, China University of Petroleum (East China), Qingdao, 266580 People’s Republic of China
| | - Zhenghai Yu
- grid.440653.00000 0000 9588 091XDepartment of Human Anatomy, School of Basic MedicalScience, Binzhou Medical University, Laishan, Yantai, 264003 Shandong China
| | - Xiuwei Gao
- Shandong Junxiu Biotechnology Co. LTD, 32 Zhujiang Road, Economic and Technological Development Zone, Yantai, 264006 Shandong China
| | - Dongmei Zhao
- Department of Human Anatomy, School of Basic MedicalScience, Binzhou Medical University, Laishan, Yantai, 264003, Shandong, China.
| | - Baosheng Ge
- State Key Laboratory of Heavy Oil Processing and Center for Bioengineering and Biotechnology, China University of Petroleum (East China), Qingdao, 266580, People's Republic of China.
| | - Naili Zhang
- Rongxiang Xu Regenerative Medicine Research Center, Binzhou Medical University, Laishan, Yantai, 264003, Shandong, China. .,Department of Human Anatomy, School of Basic MedicalScience, Binzhou Medical University, Laishan, Yantai, 264003, Shandong, China.
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Bei T, Yang L, Huang Q, Wu J, Liu J. Effectiveness of bone substitute materials in opening wedge high tibial osteotomy: a systematic review and meta-analysis. Ann Med 2022; 54:565-577. [PMID: 35166617 PMCID: PMC8856078 DOI: 10.1080/07853890.2022.2036805] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND A meta-analysis of eligible studies was performed to evaluate the effectiveness of bone substitute materials (BSMs) in opening wedge high tibial osteotomy (OWHTO) for knee osteoarthritis. METHODS A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A comprehensive literature search was performed, and studies comparing BSM with bone graft (BG) and without bone graft (WG) were included. The Cochrane risk of bias tool (version 1.0) and Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool were used to assess the risk of bias for randomized controlled trials (RCTs) and non-randomized studies (NRSs), respectively. The outcomes measured were the osteotomy gap size, the occurrence rates of non-union and lateral hinge fractures, knee functional score, infection and the Visual Analogue Scale (VAS). The quality of evidences was evaluated by Grades of Recommendation, Assessment, Development and Evaluation (GRADE) Working Group system. RESULTS Five RCTs and eight NRS including 769 participants were included in our meta-analysis. The BSM group had a larger osteotomy gap size than the control group (MD: 0.41 mm, 95% confidence interval (CI): [0.06, 0.76], p=.02, I2=0%), with a significant difference. No significant difference was found between BSM and control group in main analysis in terms of bone non-union, but with a higher non-union rate when BSM combined with long locking plate was used. No significant differences were found in other outcome measures except for VAS from NRS subgroup. The quality of evidence for outcomes was low. CONCLUSIONS BSM combined with locking plate techniques offers a safe and efficient alternative option in OWHTO for osteotomy gap larger than 10 mm, but be aware of the possibility of bone non-union. Given the inherent heterogeneity and low quality of the included studies, future well-designed RCTs are essential to verify the findings.KEY MESSAGEThe treatment of the osteotomy gap is still controversial.BSM combined with a locking plate offers a safe and efficient alternative option for OWHTO with an over 10 mm of osteotomy gap over 10 mm.Due to the inherent heterogeneity and low quality of the included studies, the results should be cautiously interpreted in clinical practice.
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Affiliation(s)
- Tao Bei
- Department of Orthopaedics Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Liping Yang
- Department of Orthopaedics Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | | | - Jiaheng Wu
- Guangxi Medical University, Nanning, China
| | - Junting Liu
- Guangxi Engineering Center in Biomedical Materials for Tissue and Organ Regeneration, Guangxi Collaborative Innovation Center for Biomedicine, Guangxi Key Laboratory of Regenerative Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.,Department of Acute Care Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Masquelet's induced membrane technique associated with Reamer Irrigation Aspiration grafting and intramedullary Nailing (MaRIAN) for chronic diaphyseal osteomyelitis of the lower limb. Orthop Traumatol Surg Res 2022; 108:103395. [PMID: 36084914 DOI: 10.1016/j.otsr.2022.103395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 03/29/2022] [Accepted: 04/08/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Masquelet's induced membrane technique offers a definitive contribution to the treatment of diaphyseal osteomyelitis. To overcome its drawbacks while maintaining its principles, technical modifications have been proposed: antibiotic cement, femoral intramedullary autograft harvested by RIA (Reamer Irrigation Aspiration) and interlocking nails. MATERIAL AND METHOD This retrospective study gathered patients with chronic osteomyelitis of the femur or tibia. The first surgical stage consisted of bone resection in the healthy zone and use of a gentamicin cement spacer to fill the bone defect. The second stage consisted of the placement of a statically locked intramedullary nail associated with a bone autograft using the RIA technique. RESULTS Among this group of 12 men with diaphyseal osteomyelitis; 9 tibial and 2 femoral, and 1 knee nonunion, the mean bone defect was 7.3cm (±6.7). The mean time between the 2 stages was 2.7months (±3) with a mean antibiotic period of 3.25weeks (±3). There was a femoral diaphyseal fracture at the donor site, and a wrong trajectory intraoperatively during the RIA. Two patients with tibial nonunion presented with nail rupture without septic recurrence. A septic recurrence was healed by removal of the nail. At a minimum follow-up of 18months, with an average of 5years, consolidation was complete without infectious recurrence. Despite the statistical weakness related to the size of the cohort, the resumption of early weight bearing (OR=-7.68 95% CI [-13.33 to -2.08] (p=0.01)) and nail dynamization seemed to have an impact on the formation of complete consolidation (OR=-0.86 95% CI [-1.39 to -0.33] (p=0.007)). DISCUSSION AND CONCLUSION This short series, compared to the literature, demonstrated that the proposed technical modifications improved the overall management of this rare and challenging condition while maintaining the reliability of the original technique. Dynamization was also seen to be of particular interest. LEVEL OF EVIDENCE IV, retrospective study.
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Elhessy AH, Eltayeby HH, Kane SC, Garonzik IM, Conway JE, Conway JD. Fusion Revision Surgery With Reamer-Irrigator-Aspirator to Harvest Autograft After Spinal Pseudarthrosis. Cureus 2022; 14:e27503. [PMID: 35949743 PMCID: PMC9356659 DOI: 10.7759/cureus.27503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background and purpose Spinal pseudarthrosis (SPA) is a common complication after attempted cervical or lumbosacral spinal fusion surgery. Revision surgeries usually necessitate bone graft implementation as an adjunct to hardware revision. Iliac crest bone graft is the gold standard but availability can be limited and usage often leads to persistent postoperative pain at the donor site. There is scant literature regarding the use of reamer-irrigator-aspirator (RIA)-harvested bone graft in lumbar spinal fusion. This is a collaborative study between orthopedic surgery and neurosurgery departments to utilize femur intramedullary autograft harvested using the RIA system as an adjunct graft in SPA revision surgeries. Materials and methods A retrospective review was conducted at a single center between August 2014 and December 2017 of patients aged ≥ 18 years and diagnosed with cervical, thoracic, or lumbar SPA who underwent revision fusion surgery using femur intramedullary autograft harvested using the RIA system. Plain radiographs and CT scans were utilized to confirm successful fusion. Results Eleven patients underwent 12 SPA revision surgeries using the RIA system as a source for bone graft in addition to bone morphogenetic protein 2 (BMP-2) and allograft. The mean amount of graft harvested was 51.3 mL (range: 20-70 mL). Nine patients achieved successful fusion (81.8%). The average time to fusion was 9.1 months. Four patients (36.4%) had postoperative knee pain. Regarding patient position and approach for harvesting, 66.7% (n = 8) of cases were positioned prone and a retrograde approach was utilized in 91.7% (n = 11) of cases. Interpretation This is the first case series in known literature to report the RIA system as a reliably considerable source of autologous bone graft for SPA revision surgeries. It provides a useful adjunct to the known types of bone grafts. Patient positioning and the approach choice for graft harvesting can be adjusted according to the fusion approach and the surgeon’s preference.
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Xu Y, Yan S, Chen C, Lu B, Zhao R. Constructing Injectable Bone-Forming Units by Loading a Subtype of Osteoprogenitors on Decellularized Bone Matrix Powders for Bone Regeneration. Front Cell Dev Biol 2022; 10:910819. [PMID: 35874802 PMCID: PMC9298785 DOI: 10.3389/fcell.2022.910819] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022] Open
Abstract
Bone defects resulting from trauma or tumor are one of the most challenging problems in clinical settings. Current tissue engineering (TE) strategies for managing bone defects are insufficient, owing to without using optimal osteoconductive material and seeding cells capable of superior osteogenic potential; thus their efficacy is instable. Herein, a novel TE strategy was developed for treating bone defects. First, the decellularized bone matrix (DBM) was manufactured into powders, and these DBM powders preserved the ultrastructural and compositional properties of native trabecular bone, are non-cytotoxic and low-immunogenic, and are capable of inducing the interacted stem cells differentiating into osteogenic lineage. Then, a subtype of osteoprogenitors was isolated from mouse long bones, and its high osteogenic potential was identified in vitro. After that, we constructed a “bone-forming unit” by seeding the special subtype of osteoprogenitors onto the DBM powders. In vivo performance of the “bone-forming units” was determined by injecting into the defect site of a mouse femoral epiphysis bone defect model. The results indicated that the “bone-forming unit” was capable of enhancing bone defect healing by regulating new bone formation and remodeling. Overall, the study establishes a protocol to construct a novel “bone-forming unit,” which may be an alternative strategy in future bone TE application.
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Affiliation(s)
- Yan Xu
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Shaohang Yan
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | - Can Chen
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | - Bangbao Lu
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | - Ruibo Zhao
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
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Tonk G, Yadav PKR, Agarwal S, Jamoh K. Donor site morbidity in autologous bone grafting – A comparison between different techniques of anterior iliac crest bone harvesting: A prospective study. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2022. [DOI: 10.1177/22104917221092163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The aim of this study is to compare morbidities at the donor site in autologous bone harvesting from an anterior iliac crest via the outer cortex, inner cortex and table splitting technique. Methods: The randomized, prospective and comparative study was conducted in 60 patients who were treated with bone grafting as a part of their treatment plan. Group A underwent the outer cortex technique (20 patients), Group B underwent the inner cortex technique (20 patients) and Group C underwent the table splitting technique (20 patients). The comparison of morbidities associated with various techniques of anterior iliac crest bone graft harvesting was done for a period of one year. Results: Most common morbidity observed was pain, measured by the visual analogue scale score (60/60, 100% of patients). The visual analogue scale score was significantly higher for the outer cortex group followed by the inner cortex group, and then the lowest score was for the table splitting group ( p < 0.05). Followed by numbness (40/60, 66%), least in the table splitting group and maximum in the outer cortex group ( p < 0.05). Next was abnormal gait, which was mostly seen in patients with the outer table method and least in the table split group ( p < 0.05). Other complications were infections (4), itching at the surgical site (3) and hematoma (1). There were no significant difference regarding scar satisfaction among comparison groups. Conclusion: we conclude that few differences do exist in harvest-site morbidities between different techniques used in our study. Overall, the most common morbidity observed were pain, numbness and abnormal gait. However, the table splitting group has the lowest morbidity, therefore bone harvesting by the table splitting appears to be a very good option.
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Affiliation(s)
- Gyneshwar Tonk
- Department of Orthopedic, LLRM Medical College, Meerut, Uttar Pradesh, India
| | - Pradeep KR Yadav
- Department of Orthopedic, LLRM Medical College, Meerut, Uttar Pradesh, India
| | - Sumit Agarwal
- Department of Orthopedic, LLRM Medical College, Meerut, Uttar Pradesh, India
| | - Kalom Jamoh
- Department of Orthopedic, ESIC-PGIMSR, Basaidarapur, New Delhi, India
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Xie C, Wang C, Huang Y, Li Q, Tian X, Huang W, Yin D. Therapeutic effect of autologous bone grafting with adjuvant bone morphogenetic protein on long bone nonunion: a systematic review and meta-analysis. J Orthop Surg Res 2022; 17:298. [PMID: 35659033 PMCID: PMC9166588 DOI: 10.1186/s13018-022-03185-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 05/18/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The recombinant human bone morphogenetic protein (rhBMP) is a common graft substitute for treating cases of long bone nonunion. However, the feasibility of combining an autologous bone graft (ABG) with rhBMPs remains uncertain. Thus, this systematic review and meta-analysis aimed to evaluate the synergistic effect of ABG and rhBMPs on the healing of long bone nonunion. METHODS A systematic literature search was performed on PubMed, Web of Science, Cochrane Library, and China National Knowledge Infrastructure. Two authors independently screened the studies, extracted data, and assessed the quality of the trials. Statistical analyses were performed using Stata 12.0. RESULTS Of the 202 citations, five studies involving a total of 394 cases met the eligibility criteria; thus, they were included in this study. The pooled data revealed no significant differences among the groups in terms of postoperative healing rate (risk ratio [RR] = 1.01, 95% confidence interval [CI] = 0.96-1.06, P = 0.744), healing time (standardised mean difference = - 0.20, 95% CI = - 0.95-0.56, P = 0.610), and pain (RR = 1.44, 95% CI = 0.25-8.29, P = 0.681). The combination of ABG and rhBMPs resulted in good limb function (RR = 1.31, 95% CI = 1.04-1.66, P = 0.023). CONCLUSIONS The combination of ABG and rhBMPs did not result in the healing of long bone nonunion and pain reduction. Nevertheless, it conferred good limb function. Thus, the findings in this study are insufficient to support the use of rhBMPs as an adjuvant to ABG.
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Affiliation(s)
- Chengxin Xie
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province & Taizhou Hospital Affiliated to Wenzhou Medical University, No.150 Ximen Road, Linhai, 317000, Zhejiang Province, China.
| | - Chenglong Wang
- Department of Joint Surgery and Sports Medicine, Guangxi Academy of Medical Sciences & The People's Hospital of Guangxi Zhuang Autonomous Region, No.6 Taoyuan Road, Nanning, 530001, Guangxi Zhuang Autonomous Region, China
| | - Yu Huang
- Department of Traumatic Surgery & Microsurgery & Hand Surgery, Guangxi Academy of Medical Sciences & The People's Hospital of Guangxi Zhuang Autonomous Region, No.6 Taoyuan Road, Nanning, 530001, Guangxi Zhuang Autonomous Region, China
| | - Qinglong Li
- Department of Traumatic Surgery & Microsurgery & Hand Surgery, Guangxi Academy of Medical Sciences & The People's Hospital of Guangxi Zhuang Autonomous Region, No.6 Taoyuan Road, Nanning, 530001, Guangxi Zhuang Autonomous Region, China
| | - Xin Tian
- Department of Joint Surgery and Sports Medicine, Guangxi Academy of Medical Sciences & The People's Hospital of Guangxi Zhuang Autonomous Region, No.6 Taoyuan Road, Nanning, 530001, Guangxi Zhuang Autonomous Region, China
| | - Wenwen Huang
- Department of Joint Surgery and Sports Medicine, Guangxi Academy of Medical Sciences & The People's Hospital of Guangxi Zhuang Autonomous Region, No.6 Taoyuan Road, Nanning, 530001, Guangxi Zhuang Autonomous Region, China.
| | - Dong Yin
- Department of Joint Surgery and Sports Medicine, Guangxi Academy of Medical Sciences & The People's Hospital of Guangxi Zhuang Autonomous Region, No.6 Taoyuan Road, Nanning, 530001, Guangxi Zhuang Autonomous Region, China.
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Peña Fernández M, Sasso SJ, McPhee S, Black C, Kanczler J, Tozzi G, Wolfram U. Nonlinear micro finite element models based on digital volume correlation measurements predict early microdamage in newly formed bone. J Mech Behav Biomed Mater 2022; 132:105303. [PMID: 35671669 DOI: 10.1016/j.jmbbm.2022.105303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 04/27/2022] [Accepted: 05/27/2022] [Indexed: 12/21/2022]
Abstract
Bone regeneration in critical-sized defects is a clinical challenge, with biomaterials under constant development aiming at enhancing the natural bone healing process. The delivery of bone morphogenetic proteins (BMPs) in appropriate carriers represents a promising strategy for bone defect treatment but optimisation of the spatial-temporal release is still needed for the regeneration of bone with biological, structural, and mechanical properties comparable to the native tissue. Nonlinear micro finite element (μFE) models can address some of these challenges by providing a tool able to predict the biomechanical strength and microdamage onset in newly formed bone when subjected to physiological or supraphysiological loads. Yet, these models need to be validated against experimental data. In this study, experimental local displacements in newly formed bone induced by osteoinductive biomaterials subjected to in situ X-ray computed tomography compression in the apparent elastic regime and measured using digital volume correlation (DVC) were used to validate μFE models. Displacement predictions from homogeneous linear μFE models were highly correlated to DVC-measured local displacements, while tissue heterogeneity capturing mineralisation differences showed negligible effects. Nonlinear μFE models improved the correlation and showed that tissue microdamage occurs at low apparent strains. Microdamage seemed to occur next to large cavities or in biomaterial-induced thin trabeculae, independent of the mineralisation. While localisation of plastic strain accumulation was similar, the amount of damage accumulated in these locations was slightly higher when including material heterogeneity. These results demonstrate the ability of the nonlinear μFE model to capture local microdamage in newly formed bone tissue and can be exploited to improve the current understanding of healing bone and mechanical competence. This will ultimately aid the development of BMPs delivery systems for bone defect treatment able to regenerate bone with optimal biological, mechanical, and structural properties.
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Affiliation(s)
- Marta Peña Fernández
- School of Engineering and Physical Sciences, Institute of Mechanical, Process and Energy Engineering, Heriot-Watt University, EH14 4AS, UK.
| | - Sebastian J Sasso
- School of Engineering and Physical Sciences, Institute of Mechanical, Process and Energy Engineering, Heriot-Watt University, EH14 4AS, UK
| | - Samuel McPhee
- School of Engineering and Physical Sciences, Institute of Mechanical, Process and Energy Engineering, Heriot-Watt University, EH14 4AS, UK
| | - Cameron Black
- Bone & Joint Research Group, Centre for Human Development, Stem Cells and Regeneration, Human Development & Health, Institute of Development Sciences, University of Southampton, SO16 6YD, UK
| | - Janos Kanczler
- Bone & Joint Research Group, Centre for Human Development, Stem Cells and Regeneration, Human Development & Health, Institute of Development Sciences, University of Southampton, SO16 6YD, UK
| | - Gianluca Tozzi
- Zeiss Global Centre, School of Mechanical and Design Engineering, University of Portsmouth, PO1 3DJ, UK
| | - Uwe Wolfram
- School of Engineering and Physical Sciences, Institute of Mechanical, Process and Energy Engineering, Heriot-Watt University, EH14 4AS, UK.
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Wu S, Quan K, Mei J, Dai M, Song S. Cortical allograft strut augmented with platelet-rich plasma for the treatment of long bone non-union in lower limb- a pilot study. BMC Musculoskelet Disord 2022; 23:512. [PMID: 35637466 PMCID: PMC9150336 DOI: 10.1186/s12891-022-05375-w] [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: 01/29/2022] [Accepted: 04/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background The autogenous iliac bone graft is the first choice of surgical treatment for long bone non-union. However, many factors limit the use of autogenous bone, such as insufficient bone harvest and complications in the donor site. This study aimed to pilot-test the effectiveness of the cortical allograft strut augmented with Platelet-rich plasma (PRP) on long bone non-union in the lower limb. Method This study was a one-armed pilot trial, with thirteen men and four women patients scheduled for surgery. Revision surgery for managing long bone non-union included debridement, internal fixation of the cortical allograft strut, and adding PRP in the fracture site. After surgery, outcome measurements of healing rate, healing time, the incidence of revision, and complications, were assessed at least one-year follow-up. Results Fourteen of seventeen participants completed all follow-ups. The mean age of 14 patients was 35.9 years (range, 18–56 years), and the mean BMI was 22.44 ± 1.53 kg/m2. All nonunions united after the operation. The mean healing time was 4.6 ± 0.7 months. There was no revision or complication. Conclusion Cortical allograft strut augmented with PRP led to healing long bone non-union in the lower limb. More clinical research is required before widespread use.
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Affiliation(s)
- Shenghui Wu
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 YiShan Road, Shanghai, 200233, China
| | - Kun Quan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jiong Mei
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 YiShan Road, Shanghai, 200233, China
| | - Min Dai
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Sa Song
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 YiShan Road, Shanghai, 200233, China.
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Hampel GA, Yilmaz E, Massrey C, Clifton W, Iwanaga J, Loukas M, Tubbs RS. History of Bone Grafts in Spine Surgery. Cureus 2022; 14:e24655. [PMID: 35663670 PMCID: PMC9156791 DOI: 10.7759/cureus.24655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2022] [Indexed: 11/19/2022] Open
Abstract
Bone grafting replaces damaged or missing bone with new bone and is used for surgical arthrodesis. Patients benefit from a huge variety of bone graft techniques and options for spinal fusions. This article reviews the rich history of bone grafts in surgery with particular emphasis on spinal fusion. During the early years of bone grafting in spine surgery, bone grafts were used on tuberculosis patients, and the structural support of the graft was most the important consideration. Between 1960 and 2000, many advances were made, specifically in the use of bone graft substitutes. The field of bone grafts in spine surgery has evolved rapidly since first described.
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Chakraborty J, Roy S, Ghosh S. 3D Printed Hydroxyapatite Promotes Congruent Bone Ingrowth in Rat Load Bearing Defects. Biomed Mater 2022; 17. [PMID: 35381582 DOI: 10.1088/1748-605x/ac6471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/05/2022] [Indexed: 11/11/2022]
Abstract
3D porous hydroxyapatite scaffolds produced by conventional foaming processes have limited control over the scaffold's pore size, geometry, and pore interconnectivity. In addition, random internal pore architecture often results in limited clinical success. Imitating the intricate 3D architecture and the functional dynamics of skeletal deformations is a difficult task, highlighting the necessity for a custom-made, on-demand tissue replacement, for which 3D printing is a potential solution. To combat these problems, here we report the ability of 3D printed hydroxyapatite scaffolds for in vivo bone regeneration in a rat tibial defect model. Rapid prototyping using the direct-write technique to fabricate 25 mm2 hydroxyapatite scaffolds were employed for precise control over geometry (both external and internal) and scaffold chemistry. Bone ingrowth was determined using histomorphometry and a novel micro-CT image analysis. Substantial bone ingrowth was observed in implants that filled the defect site. Further validating this quantitatively by micro-CT, the Bone mineral density of the implant at the defect site was 1024 mgHA/ccm, which was approximately 61.5% more than the bone mineral density found with the sham control at the defect site. In addition, no evident immunoinflammatory response was observed in the H&E micrographs. Interestingly, the present study showed a positive correlation with the outcomes obtained in our previous in vitro study. Overall, the results suggest that 3D printed hydroxyapatite scaffolds developed in this study offer a suitable matrix for rendering patient-specific and defect-specific bone formation and warrant further testing for clinical application.
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Affiliation(s)
- Juhi Chakraborty
- Indian Institute of Technology Delhi, Hauz Khas, New Delhi, Delhi, 110016, INDIA
| | - Subhadeep Roy
- Indian Institute of Technology Delhi, Hauz Khas, New Delhi, Delhi, 110016, INDIA
| | - Sourabh Ghosh
- Department of Textile Technology, Indian Institute of Technology Delhi, TX-110C, Hauz Khas, New Delhi, 110016, New Delhi, 110016, INDIA
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Bridge plating with decortication, autologous bone graft, and tight closure: a “stepwise surgical diamond concept” for treatment of nonunion in a series of fifty five patients. INTERNATIONAL ORTHOPAEDICS 2022; 46:1241-1251. [DOI: 10.1007/s00264-022-05379-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
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Cohn-Schwartz D, Schary Y, Yalon E, Krut Z, Da X, Schwarz EM, Gazit D, Pelled G, Gazit Z. PTH-Induced Bone Regeneration and Vascular Modulation Are Both Dependent on Endothelial Signaling. Cells 2022; 11:cells11050897. [PMID: 35269519 PMCID: PMC8909576 DOI: 10.3390/cells11050897] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 12/10/2022] Open
Abstract
The use of a bone allograft presents a promising approach for healing nonunion fractures. We have previously reported that parathyroid hormone (PTH) therapy induced allograft integration while modulating angiogenesis at the allograft proximity. Here, we hypothesize that PTH-induced vascular modulation and the osteogenic effect of PTH are both dependent on endothelial PTH receptor-1 (PTHR1) signaling. To evaluate our hypothesis, we used multiple transgenic mouse lines, and their wild-type counterparts as a control. In addition to endothelial-specific PTHR1 knock-out mice, we used mice in which PTHR1 was engineered to be constitutively active in collagen-1α+ osteoblasts, to assess the effect of PTH signaling activation exclusively in osteoprogenitors. To characterize resident cell recruitment and osteogenic activity, mice in which the Luciferase reporter gene is expressed under the Osteocalcin promoter (Oc-Luc) were used. Mice were implanted with calvarial allografts and treated with either PTH or PBS. A micro-computed tomography-based structural analysis indicated that the induction of bone formation by PTH, as observed in wild-type animals, was not maintained when PTHR1 was removed from endothelial cells. Furthermore, the induction of PTH signaling exclusively in osteoblasts resulted in significantly less bone formation compared to systemic PTH treatment, and significantly less osteogenic activity was measured by bioluminescence imaging of the Oc-Luc mice. Deletion of the endothelial PTHR1 significantly decreased the PTH-induced formation of narrow blood vessels, formerly demonstrated in wild-type mice. However, the exclusive activation of PTH signaling in osteoblasts was sufficient to re-establish the observed PTH effect. Collectively, our results show that endothelial PTHR1 signaling plays a key role in PTH-induced osteogenesis and has implications in angiogenesis.
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Affiliation(s)
- Doron Cohn-Schwartz
- Department of Internal Medicine B, Division of Internal Medicine, Rambam Healthcare Campus, Haifa 3109601, Israel;
- Skeletal Biotech Laboratory, Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 91120, Israel; (Y.S.); (E.Y.); (D.G.); (G.P.)
| | - Yeshai Schary
- Skeletal Biotech Laboratory, Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 91120, Israel; (Y.S.); (E.Y.); (D.G.); (G.P.)
| | - Eran Yalon
- Skeletal Biotech Laboratory, Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 91120, Israel; (Y.S.); (E.Y.); (D.G.); (G.P.)
| | - Zoe Krut
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Xiaoyu Da
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
| | - Edward M. Schwarz
- The Center for Musculoskeletal Research, Department of Orthopaedics, School of Medicine & Dentistry, University of Rochester, Rochester, NY 14642, USA;
| | - Dan Gazit
- Skeletal Biotech Laboratory, Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 91120, Israel; (Y.S.); (E.Y.); (D.G.); (G.P.)
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Gadi Pelled
- Skeletal Biotech Laboratory, Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 91120, Israel; (Y.S.); (E.Y.); (D.G.); (G.P.)
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Zulma Gazit
- Skeletal Biotech Laboratory, Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 91120, Israel; (Y.S.); (E.Y.); (D.G.); (G.P.)
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Correspondence:
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Chen C, Yan S, Geng Z, Wang Z. Fracture repair by IOX2: Regulation of the hypoxia inducible factor-1α signaling pathway and BMSCs. Eur J Pharmacol 2022; 921:174864. [PMID: 35219731 DOI: 10.1016/j.ejphar.2022.174864] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 02/22/2022] [Indexed: 11/03/2022]
Abstract
The treatment of fracture delayed union and nonunion has become a challenging problem. Hypoxia inducible factor-1α (HIF-1α) is reported to be a key factor in fracture healing, and is degraded by hydroxylation of prolyl hydroxylase (PHDs) under normal oxygen. Small molecules could inhibit the activity of PHDs, stabilize HIF-1α protein, regulate the expression of downstream target genes of HIF-1α, and make the body adapt to hypoxia. The migration and osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) is the most promising candidate for the treatment of fracture nonunion. Here we reported that IOX2, an HIF-1α PHD inhibitor, markedly improved the proliferation and migration of BMSCs by upregulating intracellular Ca2+ and concomitant decreasing reactive oxygen species (ROS) in vitro, and facilitated the repair of bone fracture by increasing the number of BMSCs and cartilage formation in vivo. No significant influence of IOX2 on the proliferation and migration of BMSCs after silencing of the HIF-1α. Together, our findings indicated that IOX2 promoted the proliferation and migration of BMSCs via the HIF-1α pathway and further accelerated fracture healing. These results provide a deeper understanding of the mechanism by which HIF promotes fracture healing.
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Affiliation(s)
- Chunxia Chen
- State Key Laboratory of Coordination Chemistry, School of Chemistry and Chemical Engineering, Nanjing University, Nanjing, 210023, China; Joint National Laboratory for Antibody Drug Engineering, The First Affiliated Hospital, Henan University, Kaifeng, 475004, China
| | - Shihai Yan
- State Key Laboratory of Coordination Chemistry, School of Chemistry and Chemical Engineering, Nanjing University, Nanjing, 210023, China; Department of Pharmacology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, 210029, China
| | - Zhirong Geng
- State Key Laboratory of Coordination Chemistry, School of Chemistry and Chemical Engineering, Nanjing University, Nanjing, 210023, China
| | - Zhilin Wang
- State Key Laboratory of Coordination Chemistry, School of Chemistry and Chemical Engineering, Nanjing University, Nanjing, 210023, China.
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Reeh FM, Sachse S, Wedekind L, Hofmann GO, Lenz M. Nonunions and Their Operative Treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:869-875. [PMID: 36352531 PMCID: PMC9989962 DOI: 10.3238/arztebl.m2022.0300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 02/25/2022] [Accepted: 08/03/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Nonunions, which arise as a complication of fractures, are an impor - tant medical and socio-economic problem. The goal of this study was to analyze nonunions in Germany with respect to the patients' age and sex, the anatomical site of the lesions, and their operative treatment. METHODS The study was performed on the basis of DRG (diagnosis-related group) data acquired for billing purposes and collected by the German Federal Statistical Office. The administrative frequencies of nonunions and fractures treated in the inpatient setting, broken down by sex and age group, were calculated from the documentation of ICD codes. An investigation was also made of surgical treatments for nonunion, as they were categorized by the German procedure classification (Operationen- und Prozedurenschlüssel, OPS). RESULTS The administrative frequency of nonunion was 14.84 per 100 000 persons per year, with a 2% decline in case numbers over the period 2007-2019. Nonunions develop in 2% of fractures. Nonunions affect men more often than women (58% vs. 42%). In men, their incidence as a function of age is highest under age 30; in women, it rises steadily with increasing age. The most common type of surgical treatment is a combination of resection, bone transplantation, and osteosynthesis. CONCLUSION This is the first detailed nationwide study of diagnoses of nonunions in Germany and their surgical treatment. Despite a slow decline in their incidence, nonunions remain an important problem in the inpatient setting. The risk profile for nonunions is sex-, age-, and site-specific.
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Affiliation(s)
- Freya M Reeh
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Jena, FriedrichSchiller University of Jena; Institute for Medical Statistics, Computer and Data Sciences, University Hospital of Jena, Friedrich-Schiller-University of Jena
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Sawauchi K, Fukui T, Oe K, Kumabe Y, Oda T, Yoshikawa R, Takase K, Matsushita T, Matsumoto T, Hayashi S, Kuroda R, Niikura T. Low-Intensity Pulsed Ultrasound Promotes Osteogenic Differentiation of Reamer-Irrigator-Aspirator Graft-Derived Cells in Vitro. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:313-322. [PMID: 34785092 DOI: 10.1016/j.ultrasmedbio.2021.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 09/29/2021] [Accepted: 10/04/2021] [Indexed: 06/13/2023]
Abstract
Recently, reamer-irrigator-aspirator (RIA) systems have been increasingly used to harvest autologous bone grafts. RIA graft materials contain bone marrow, which provides a viable source to derive large numbers of mesenchymal stem cells. Low-intensity pulsed ultrasound (LIPUS) significantly accelerates the differentiation of stem cells derived from bone marrow. This in vitro study investigated the effect of LIPUS on the osteogenic activity and differentiation of RIA graft-derived cells. A small amount of RIA graft was obtained from seven patients. After the cells derived from RIA grafts were cultured, they were divided into two groups: the LIPUS and control groups. LIPUS was applied once daily for 20 min (1.5 MHz, pulse duration: 200 µs, pulse repetition rate: 1 kHz, spatial average-temporal average intensity: 30 mW/cm2). Alkaline phosphatase activity (113.4% and 130.1% on days 7 and 14), expression of osteoblast-related genes (ALP, Runx2) and mineralization (135.2% on day 21) of the RIA graft-derived cells were significantly higher in the LIPUS group than in the control group. However, LIPUS did not affect the cell proliferation of RIA graft-derived cells. This study indicates that LIPUS may enhance the healing of non-union and critical bone defects treated by autologous bone grafting using the RIA system.
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Affiliation(s)
- Kenichi Sawauchi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoaki Fukui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, 650-0017, Japan
| | - Keisuke Oe
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, 650-0017, Japan
| | - Yohei Kumabe
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, 650-0017, Japan
| | - Takahiro Oda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, 650-0017, Japan
| | - Ryo Yoshikawa
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, 650-0017, Japan
| | - Kyohei Takase
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, 650-0017, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, 650-0017, Japan
| | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, 650-0017, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, 650-0017, Japan.
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