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Fugazzola MC, De Ruijter M, Veraa S, Plomp S, van Buul W, Hermsen G, van Weeren R. A hybrid repair strategy for full-thickness cartilage defects: Long-term experimental study in eight horses. J Orthop Res 2024. [PMID: 39292194 DOI: 10.1002/jor.25972] [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] [Received: 04/03/2024] [Revised: 07/19/2024] [Accepted: 08/19/2024] [Indexed: 09/19/2024]
Abstract
The objective of this study was to evaluate a non-resorbable implant for the focal repair of chondral defects in eight adult horses with 12-month follow-up. The bi-layered construct composed of a polycarbonate-urethane-urea biomaterial which was printed in 3D fashion onto a bone anchor was implanted into surgically created osteochondral defects into the femoropatellar joints of eight horses. The analysis of post-mortem outcomes were compared to defects treated with microfracture in the same animal on the contralateral femoropatellar jointfemoropatellar joint. The overall macroscopic scoring after 12 months yielded higher scores in the OCI-treated stifles compared to MF treatment (p = 0.09) with better quality and filling of the defect. Histology revealed good anchorage of repair tissue growing into the 3D structure of the implant and histopathology scoring for adjacent native cartilage showed no difference between groups. MRI and micro-CT showed overall less sclerotic reactions in the surrounding bone in the implant group and no foreign body reaction was detected. Biomechanical analysis of the repair tissue revealed a significantly higher peak modulus (p < 0.05) in the implant group (0.74 ± 0.45) compared to the microfracture control group (0.15 ± 0.11). Dynamic loading yielded higher values for the repair tissue overgrowing the implant group (0.23 ± 0.17) compared to the microfracture control (0.06 ± 0.06) (p < 0.05). The bi-layered osteochondral implant provided a safe implant for focal repair of full-thickness osteochondral defects, as no adverse reaction was seen within the joints and the level of degeneration of adjacent cartilage to the repair site was not different compared to that seen in defects treated with microfracture after 12 months.
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Affiliation(s)
- Maria C Fugazzola
- Department of Clinical Sciences, Faculty of Veterinary Science, Utrecht University, Utrecht, The Netherlands
| | - Mylène De Ruijter
- Department of Clinical Sciences, Faculty of Veterinary Science, Utrecht University, Utrecht, The Netherlands
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stefanie Veraa
- Department of Clinical Sciences, Faculty of Veterinary Science, Utrecht University, Utrecht, The Netherlands
| | - Saskia Plomp
- Department of Clinical Sciences, Faculty of Veterinary Science, Utrecht University, Utrecht, The Netherlands
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - René van Weeren
- Department of Clinical Sciences, Faculty of Veterinary Science, Utrecht University, Utrecht, The Netherlands
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Krakowski P, Rejniak A, Sobczyk J, Karpiński R. Cartilage Integrity: A Review of Mechanical and Frictional Properties and Repair Approaches in Osteoarthritis. Healthcare (Basel) 2024; 12:1648. [PMID: 39201206 PMCID: PMC11353818 DOI: 10.3390/healthcare12161648] [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: 06/29/2024] [Revised: 08/09/2024] [Accepted: 08/14/2024] [Indexed: 09/02/2024] Open
Abstract
Osteoarthritis (OA) is one of the most common causes of disability around the globe, especially in aging populations. The main symptoms of OA are pain and loss of motion and function of the affected joint. Hyaline cartilage has limited ability for regeneration due to its avascularity, lack of nerve endings, and very slow metabolism. Total joint replacement (TJR) has to date been used as the treatment of end-stage disease. Various joint-sparing alternatives, including conservative and surgical treatment, have been proposed in the literature; however, no treatment to date has been fully successful in restoring hyaline cartilage. The mechanical and frictional properties of the cartilage are of paramount importance in terms of cartilage resistance to continuous loading. OA causes numerous changes in the macro- and microstructure of cartilage, affecting its mechanical properties. Increased friction and reduced load-bearing capability of the cartilage accelerate further degradation of tissue by exerting increased loads on the healthy surrounding tissues. Cartilage repair techniques aim to restore function and reduce pain in the affected joint. Numerous studies have investigated the biological aspects of OA progression and cartilage repair techniques. However, the mechanical properties of cartilage repair techniques are of vital importance and must be addressed too. This review, therefore, addresses the mechanical and frictional properties of articular cartilage and its changes during OA, and it summarizes the mechanical outcomes of cartilage repair techniques.
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Affiliation(s)
- Przemysław Krakowski
- Department of Trauma Surgery and Emergency Medicine, Medical University, 20-059 Lublin, Poland
- Orthopaedic and Sports Traumatology Department, Carolina Medical Center, Pory 78, 02-757 Warsaw, Poland; (A.R.); (J.S.)
| | - Adrian Rejniak
- Orthopaedic and Sports Traumatology Department, Carolina Medical Center, Pory 78, 02-757 Warsaw, Poland; (A.R.); (J.S.)
| | - Jakub Sobczyk
- Orthopaedic and Sports Traumatology Department, Carolina Medical Center, Pory 78, 02-757 Warsaw, Poland; (A.R.); (J.S.)
| | - Robert Karpiński
- Department of Machine Design and Mechatronics, Faculty of Mechanical Engineering, University of Technology, 20-618 Lublin, Poland
- Department of Psychiatry, Psychotherapy and Early Intervention, Medical University, 20-059 Lublin, Poland
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Lewis JA, Nemke B, Lu Y, Sather NA, McClendon MT, Mullen M, Yuan SC, Ravuri SK, Bleedorn JA, Philippon MJ, Huard J, Markel MD, Stupp SI. A bioactive supramolecular and covalent polymer scaffold for cartilage repair in a sheep model. Proc Natl Acad Sci U S A 2024; 121:e2405454121. [PMID: 39106310 PMCID: PMC11331086 DOI: 10.1073/pnas.2405454121] [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: 03/18/2024] [Accepted: 07/01/2024] [Indexed: 08/09/2024] Open
Abstract
Regeneration of hyaline cartilage in human-sized joints remains a clinical challenge, and it is a critical unmet need that would contribute to longer healthspans. Injectable scaffolds for cartilage repair that integrate both bioactivity and sufficiently robust physical properties to withstand joint stresses offer a promising strategy. We report here on a hybrid biomaterial that combines a bioactive peptide amphiphile supramolecular polymer that specifically binds the chondrogenic cytokine transforming growth factor β-1 (TGFβ-1) and crosslinked hyaluronic acid microgels that drive formation of filament bundles, a hierarchical motif common in natural musculoskeletal tissues. The scaffold is an injectable slurry that generates a porous rubbery material when exposed to calcium ions once placed in cartilage defects. The hybrid material was found to support in vitro chondrogenic differentiation of encapsulated stem cells in response to sustained delivery of TGFβ-1. Using a sheep model, we implanted the scaffold in shallow osteochondral defects and found it can remain localized in mechanically active joints. Evaluation of resected joints showed significantly improved repair of hyaline cartilage in osteochondral defects injected with the scaffold relative to defects injected with the growth factor alone, including implantation in the load-bearing femoral condyle. These results demonstrate the potential of the hybrid biomimetic scaffold as a niche to favor cartilage repair in mechanically active joints using a clinically relevant large-animal model.
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Affiliation(s)
- Jacob A. Lewis
- Department of Biomedical Engineering, Northwestern University, Evanston, IL60208
- Simpson Querrey Institute for BioNanotechnology, Northwestern University, Chicago, IL60611
| | - Brett Nemke
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin–Madison, Madison, WI53706
| | - Yan Lu
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin–Madison, Madison, WI53706
| | - Nicholas A. Sather
- Simpson Querrey Institute for BioNanotechnology, Northwestern University, Chicago, IL60611
| | - Mark T. McClendon
- Simpson Querrey Institute for BioNanotechnology, Northwestern University, Chicago, IL60611
| | - Michael Mullen
- Center for Regenerative and Personalized Medicine, Steadman Philippon Research Institute, Vail, CO81657
| | - Shelby C. Yuan
- Department of Biomedical Engineering, Northwestern University, Evanston, IL60208
- Simpson Querrey Institute for BioNanotechnology, Northwestern University, Chicago, IL60611
| | - Sudheer K. Ravuri
- Center for Regenerative and Personalized Medicine, Steadman Philippon Research Institute, Vail, CO81657
| | - Jason A. Bleedorn
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin–Madison, Madison, WI53706
| | - Marc J. Philippon
- Center for Regenerative and Personalized Medicine, Steadman Philippon Research Institute, Vail, CO81657
| | - Johnny Huard
- Center for Regenerative and Personalized Medicine, Steadman Philippon Research Institute, Vail, CO81657
| | - Mark D. Markel
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin–Madison, Madison, WI53706
| | - Samuel I. Stupp
- Department of Biomedical Engineering, Northwestern University, Evanston, IL60208
- Simpson Querrey Institute for BioNanotechnology, Northwestern University, Chicago, IL60611
- Department of Chemistry, Northwestern University, Evanston, IL60208
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL60208
- Department of Medicine, Northwestern University, Chicago, IL60611
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Zhang Y, Chen J, Sun Y, Wang M, Liu H, Zhang W. Endogenous Tissue Engineering for Chondral and Osteochondral Regeneration: Strategies and Mechanisms. ACS Biomater Sci Eng 2024; 10:4716-4739. [PMID: 39091217 DOI: 10.1021/acsbiomaterials.4c00603] [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: 08/04/2024]
Abstract
Increasing attention has been paid to the development of effective strategies for articular cartilage (AC) and osteochondral (OC) regeneration due to their limited self-reparative capacities and the shortage of timely and appropriate clinical treatments. Traditional cell-dependent tissue engineering faces various challenges such as restricted cell sources, phenotypic alterations, and immune rejection. In contrast, endogenous tissue engineering represents a promising alternative, leveraging acellular biomaterials to guide endogenous cells to the injury site and stimulate their intrinsic regenerative potential. This review provides a comprehensive overview of recent advancements in endogenous tissue engineering strategies for AC and OC regeneration, with a focus on the tissue engineering triad comprising endogenous stem/progenitor cells (ESPCs), scaffolds, and biomolecules. Multiple types of ESPCs present within the AC and OC microenvironment, including bone marrow-derived mesenchymal stem cells (BMSCs), adipose-derived mesenchymal stem cells (AD-MSCs), synovial membrane-derived mesenchymal stem cells (SM-MSCs), and AC-derived stem/progenitor cells (CSPCs), exhibit the ability to migrate toward injury sites and demonstrate pro-regenerative properties. The fabrication and characteristics of scaffolds in various formats including hydrogels, porous sponges, electrospun fibers, particles, films, multilayer scaffolds, bioceramics, and bioglass, highlighting their suitability for AC and OC repair, are systemically summarized. Furthermore, the review emphasizes the pivotal role of biomolecules in facilitating ESPCs migration, adhesion, chondrogenesis, osteogenesis, as well as regulating inflammation, aging, and hypertrophy-critical processes for endogenous AC and OC regeneration. Insights into the applications of endogenous tissue engineering strategies for in vivo AC and OC regeneration are provided along with a discussion on future perspectives to enhance regenerative outcomes.
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Affiliation(s)
- Yanan Zhang
- School of Medicine, Southeast University, 210009 Nanjing, China
| | - Jialin Chen
- School of Medicine, Southeast University, 210009 Nanjing, China
- Jiangsu Key Laboratory for Biomaterials and Devices, Southeast University, 210096 Nanjing, China
- China Orthopedic Regenerative Medicine Group (CORMed), 310058 Hangzhou, China
| | - Yuzhi Sun
- Department of Orthopaedic Surgery, Institute of Digital Medicine, Nanjing First Hospital, Nanjing Medical University, 210006 Nanjing, China
| | - Mingyue Wang
- School of Medicine, Southeast University, 210009 Nanjing, China
| | - Haoyang Liu
- School of Medicine, Southeast University, 210009 Nanjing, China
| | - Wei Zhang
- School of Medicine, Southeast University, 210009 Nanjing, China
- Jiangsu Key Laboratory for Biomaterials and Devices, Southeast University, 210096 Nanjing, China
- China Orthopedic Regenerative Medicine Group (CORMed), 310058 Hangzhou, China
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Kolevar MP, Koshar A, Hirsch J, Choe RH, Wu J, Rocca MS, McLoughlin S, Venable-Croft A, Fisher JP, Packer JD. Development of a patient specific cartilage graft using magnetic resonance imaging and 3D printing. J ISAKOS 2024; 9:519-525. [PMID: 38556170 DOI: 10.1016/j.jisako.2024.03.011] [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: 12/31/2023] [Revised: 02/25/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVES The goal of this project was to develop and validate a patient-specific, anatomically correct graft for cartilage restoration using magnetic resonance imaging (MRI) data and 3-dimensional (3D) printing technology. The specific aim was to test the accuracy of a novel method for 3D printing and implanting individualized, anatomically shaped bio-scaffolds to treat cartilage defects in a human cadaveric model. We hypothesized that an individualized, anatomic 3D-printed scaffold designed from MRI data would provide a more optimal fill for a large cartilage defect compared to a generic flat scaffold. METHODS Four focal cartilage defects (FCDs) were created in paired human cadaver knees, age <40 years, in the weight-bearing surfaces of the medial femoral condyle (MFC), lateral femoral condyle (LFC), patella, and trochlea of each knee. MRIs were obtained, anatomic grafts were designed and 3D printed for the left knee as an experimental group, and generic flat grafts for the right knee as a control group. Grafts were implanted into corresponding defects and fixed using tissue adhesive. Repeat post-implant MRIs were obtained. Graft step-off was measured as the distance in mm between the surface of the graft and the native cartilage surface in a direction perpendicular to the subchondral bone. Graft contour was measured as the gap between the undersurface of the graft and the subchondral bone in a direction perpendicular to the joint surface. RESULTS Graft step-off was statistically significantly better for the anatomic grafts compared to the generic grafts in the MFC (0.0 ± 0.2 mm vs. 0.7 ± 0.5 mm, p < 0.001), LFC (0.1 ± 0.3 mm vs. 1.0 ± 0.2 mm, p < 0.001), patella (-0.2 ± 0.3 mm vs. -1.2 ± 0.4 mm, p < 0.001), and trochlea (-0.4 ± 0.3 vs. 0.4 ± 0.7, p = 0.003). Graft contour was statistically significantly better for the anatomic grafts in the LFC (0.0 ± 0.0 mm vs. 0.2 ± 0.4 mm, p = 0.022) and trochlea (0.0 ± 0.0 mm vs. 1.4 ± 0.7 mm, p < 0.001). The anatomic grafts had an observed maximum step-off of -0.9 mm and a maximum contour mismatch of 0.8 mm. CONCLUSION This study validates a process designed to fabricate anatomically accurate cartilage grafts using MRI and 3D printing technology. Anatomic grafts demonstrated superior fit compared to generic flat grafts. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Matthew P Kolevar
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Antoan Koshar
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Jeffrey Hirsch
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Robert H Choe
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, 20742, USA
| | - Jocelyn Wu
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Michael S Rocca
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Shannon McLoughlin
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, 20742, USA
| | | | - John P Fisher
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, 20742, USA
| | - Jonathan D Packer
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
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Abed V, Kapp S, Nichols M, Shephard L, Jacobs C, Conley C, Stone AV. Responsiveness of Patient-Reported Outcome Measures After Large Knee Articular Cartilage Transplantation: A Systematic Review and Meta-analysis. Am J Sports Med 2024; 52:2676-2682. [PMID: 38264794 DOI: 10.1177/03635465231196156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND Cartilage transplantation is commonly used to treat large (>4 cm2) articular cartilage defects of the knee. The 2 most common transplants are osteochondral allograft transplantation and autologous chondrocyte implantation. Several patient-reported outcome measures (PROMs) have been used to determine the efficacy of treatment, but it is unknown which measures are the most effective. PURPOSE To report the multiple PROMs used after large knee articular cartilage transplantation surgery and to compare the responsiveness between them. STUDY DESIGN Meta-analysis; Level of evidence, 4. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search of the PubMed/MEDLINE and Web of Science databases was performed. A total of 181 articles met inclusion criteria. Patient and study characteristics were extracted, including pre- and postoperative means for PROMs. From the articles that met inclusion criteria for responsiveness analysis (2+ PROMs reported, 1-year minimum follow-up, reported pre- and postoperative means and standard deviations; n = 131), the authors compared the responsiveness between PROM instruments using effect size and relative efficiency (RE) if a PROM could be compared with another in ≥10 articles. RESULTS A total of 10,015 patients (10,093 knees; mean age, 34.8 years; mean body mass index, 26.1) were included in this study. The mean follow-up time was 58.3 months (range, 1.5-247.2 months), imaging findings were reported in 80 articles (44.2%), patient satisfaction was reported in 39 articles (21.5%), and range of motion was reported in 10 articles (5.5%). There were 58 unique PROM instruments identified, with the most used being the International Knee Documentation Committee (IKDC) score (n = 118; 65.2%), followed by Knee injury and Osteoarthritis Outcome Score (KOOS) Pain (n = 58; 32.0%), KOOS Sport and Recreation (n = 58; 32.0%), KOOS Quality of Life (n = 57; 31.5%), KOOS Activities of Daily Living (n = 57; 31.5%), and KOOS Symptoms (n = 57; 31.5%). Overall, IKDC was found to have the greatest effect size (1.68) and the best responsiveness of the other PROMs, which include KOOS Pain (RE, 1.38), KOOS Symptoms (RE, 3.06), KOOS Activities of Daily Living (RE, 1.65), KOOS Sport and Recreation (RE, 1.44), Lysholm (RE, 1.76), and Tegner (RE, 1.56). CONCLUSION The IKDC is the most responsive PROM after large knee articular cartilage transplantation surgery. The IKDC score is recommended for assessing outcomes after cartilage transplantation surgery.
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Affiliation(s)
- Varag Abed
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Sabryn Kapp
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Michael Nichols
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Leah Shephard
- School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Cale Jacobs
- Mass General Brigham Sports Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Caitlin Conley
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Austin V Stone
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
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Swift B, Zhang T, Akhter F, Chilelli BJ. Single-Stage Combined Autologous-Allogenic Cartilage Restoration: Surgical Technique. Arthrosc Tech 2024; 13:103024. [PMID: 39233809 PMCID: PMC11369936 DOI: 10.1016/j.eats.2024.103024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 03/09/2024] [Indexed: 09/06/2024] Open
Abstract
Articular cartilage injuries in young patients pose a notable treatment dilemma. Multiple reported techniques exist, although some of the most prominent methods currently rely on multiple procedures for chondrocyte harvest and colony expansion prior to implantation. The associated cost and effort this requires limits availability on a global basis, which creates a need for a more widely available cartilage procedure. This Technical Note describes a method for cartilage restoration that incorporates autologous chondrocytes in allogenic extracellular matrix, along with biologic augmentation all performed in a single stage.
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Affiliation(s)
- Brendan Swift
- Mercy Health-Cincinnati Sports Medicine and Orthopaedic Center, Cincinnati SportsMedicine Research and Education Foundation, Cincinnati, Ohio, U.S.A
| | - Ting Zhang
- Mercy Health-Cincinnati Sports Medicine and Orthopaedic Center, Cincinnati SportsMedicine Research and Education Foundation, Cincinnati, Ohio, U.S.A
| | - Fauzan Akhter
- Mercy Health-Cincinnati Sports Medicine and Orthopaedic Center, Cincinnati SportsMedicine Research and Education Foundation, Cincinnati, Ohio, U.S.A
| | - Brian J. Chilelli
- Mercy Health-Cincinnati Sports Medicine and Orthopaedic Center, Cincinnati SportsMedicine Research and Education Foundation, Cincinnati, Ohio, U.S.A
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Marmor WA, Dennis ER, Buza SS, Gruber S, Propp BE, Burge AJ, Nguyen JT, Shubin Stein BE. Outcomes of Particulated Juvenile Articular Cartilage and Association With Defect Fill in Patients With Full-Thickness Patellar Chondral Lesions. Orthop J Sports Med 2024; 12:23259671241249121. [PMID: 39045351 PMCID: PMC11265243 DOI: 10.1177/23259671241249121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 11/16/2023] [Indexed: 07/25/2024] Open
Abstract
Background Cartilage restoration procedures for patellar cartilage defects have produced inconsistent results, and optimal management remains controversial. Particulated juvenile articular cartilage (PJAC) allograft tissue is an increasingly utilized treatment option for chondral defects, with previous studies demonstrating favorable short-term outcomes for patellar chondral defects. Purpose To identify whether there is an association between defect fill on magnetic resonance imaging (MRI) with functional outcomes in patients with full-thickness patellar cartilage lesions treated with PJAC. Study Design Case series; Level of evidence, 4. Methods A retrospective review of prospectively collected data was conducted on patients treated with PJAC for a full-thickness symptomatic patellar cartilage lesion between March 2014 and August 2019. MRI was performed for all patients at 6, 12, and 24 months postoperatively. Patient-reported outcome measures (PROMs) were obtained preoperatively and at 1, 2, and >2 years postoperatively. Clinical outcome scores-including the International Knee Documentation Committee (IKDC) score, the Kujala, the Knee injury and Osteoarthritis Outcome Score-Physical Function Short Form (KOOS-PS), the Knee Injury and Osteoarthritis Outcome Score-Quality of Life (KOOS-QoL), and the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS)-were analyzed and evaluated for a relationship with tissue fill on MRI. Results A total of 70 knees in 65 patients (mean age, 26.6 ± 8.1 years) were identified, of which 68 knees (97%) underwent a concomitant patellar stabilization or offloading procedure. Significant improvements were observed on all postoperative PROM scores at the 1-, 2-, and >2-year follow-up except for the Pedi-FABS, which showed no significant difference from baseline. From baseline to the 2-year follow-up, the KOOS-QoL improved from 24.7 to 62.1, the IKDC improved from 41.1 to 73.5, the KOOS-PS improved from 35.6 to 15, and the Kujala improved from 52 to 86.3. Imaging demonstrated no difference in the rate of cartilage defect fill between the 3-month (66%), 6-month (72%), 1-year (74%), and ≥2-year (69%) follow-ups. No association was observed between PROM scores and the percent fill of cartilage defect on MRI at the 1- and 2-year follow-up. Conclusion PROM scores were significantly improved at the 2-year follow-up in patients who underwent PJAC for full-thickness patellar cartilage defects. On MRI, a cartilage defect fill of >66% was achieved by 3 months in most patients. In our sample, PROM scores were not significantly associated with the defect fill percentage at the short-term follow-up.
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Affiliation(s)
- William A. Marmor
- Department of Orthopedic Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
- The Patellofemoral Center, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Elizabeth R. Dennis
- The Patellofemoral Center, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Stephanie S. Buza
- The Patellofemoral Center, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Simone Gruber
- The Patellofemoral Center, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Bennett E. Propp
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Alissa J. Burge
- Department of Radiology, Hospital for Special Surgery, New York, New York, USA
| | - Joseph T. Nguyen
- Biostatistics Core, HSS Research Institute, Hospital for Special Surgery, New York, New York, USA
| | - Beth E. Shubin Stein
- The Patellofemoral Center, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
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Thacher RR, Pascual-Leone N, Rodeo SA. Treatment of Knee Chondral Defects in Athletes. Sports Med Arthrosc Rev 2024; 32:75-86. [PMID: 38978201 DOI: 10.1097/jsa.0000000000000405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Cartilage lesions of the knee are a challenging problem, especially for active individuals and athletes who desire a return to high-load activities. They occur both through chronic repetitive loading of the knee joint or through acute traumatic injury and represent a major cause of pain and time lost from sport. They can arise as isolated lesions or in association with concomitant knee pathology. Management of these defects ultimately requires a sound understanding of their pathophysiologic underpinnings to help guide treatment. Team physicians should maintain a high index of suspicion for underlying cartilage lesions in any patient presenting with a knee effusion, whether painful or not. A thorough workup should include a complete history and physical examination. MRI is the most sensitive and specific imaging modality to assess these lesions and can provide intricate detail not only of the structure and composition of cartilage, but also of the surrounding physiological environment in the joint. Treatment of these lesions consists of both conservative or supportive measures, as well as surgical interventions designed to restore or regenerate healthy cartilage. Because of the poor inherent capacity for healing associated with hyaline cartilage, the vast majority of symptomatic lesions will ultimately require surgery. Surgical treatment options range from simple arthroscopic debridement to large osteochondral reconstructions. Operative decision-making is based on numerous patient- and defect-related factors and requires open lines of communication between the athlete, the surgeon, and the rest of the treatment team. Ultimately, a positive outcome is based on the creation of a durable, resistant repair that allows the athlete to return to pain-free sporting activities.
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Affiliation(s)
- Ryan R Thacher
- Department of Orthopaedic Surgery, Sports Medicine Institute, Hospital for Special Surgery, New York, NY
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Yu P, Ma Y, Zhu Y, Pei J, Zheng G, Liu Y, Fu K, Cai D, Khattab T, Zhou Y. Transforming growth factor-β1-loaded RADA-16 hydrogel scaffold for effective cartilage regeneration. Colloids Surf B Biointerfaces 2024; 239:113959. [PMID: 38772085 DOI: 10.1016/j.colsurfb.2024.113959] [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: 01/18/2024] [Revised: 04/29/2024] [Accepted: 05/07/2024] [Indexed: 05/23/2024]
Abstract
Cartilage repair remains a major challenge in clinical trials. These current cartilage repair materials can not effectively promote chondrocyte generation, limiting their practical application in cartilage repair. In this work, we develop an implantable scaffold of RADA-16 peptide hydrogel incorporated with TGF-β1 to provide a microenvironment for stem cell-directed differentiation and chondrocyte adhesion growth. The longest release of growth factor TGF-β1 release can reach up to 600 h under physiological conditions. TGF-β1/RADA-16 hydrogel was demonstrated to be a lamellar porous structure. Based on the cell culture with hBMSCs, TGF-β1/RADA-16 hydrogel showed excellent ability to promote cell proliferation, directed differentiation into chondrocytes, and functional protein secretion. Within 14 days, 80% of hBMSCs were observed to be directed to differentiate into vigorous chondrocytes in the co-culture of TGF-β1/RADA-16 hydrogels with hBMSCs. Specifically, these newly generated chondrocytes can secrete and accumulate large amounts of collagen II within 28 days, which can effectively promote the formation of cartilage tissue. Finally, the exploration of RADA-16 hydrogel-based scaffolds incorporated with TGF-β1 bioactive species would further greatly promote the practical clinical trials of cartilage remediation, which might have excellent potential to promote cartilage regeneration in areas of cartilage damage.
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Affiliation(s)
- Peng Yu
- Department of Joint Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, The Third School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China; Department of Joint Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan 570102, China
| | - Yuxing Ma
- Key Laboratory of Advanced Materials of Tropical Island Resources of Ministry of Education and School of Chemistry and Chemical Engineering, Hainan University, Haikou, Hainan 570228, China
| | - Yixin Zhu
- Key Laboratory of Advanced Materials of Tropical Island Resources of Ministry of Education and School of Chemistry and Chemical Engineering, Hainan University, Haikou, Hainan 570228, China
| | - Jie Pei
- Department of Joint Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan 570102, China
| | - Guangbin Zheng
- Key Laboratory of Advanced Materials of Tropical Island Resources of Ministry of Education and School of Chemistry and Chemical Engineering, Hainan University, Haikou, Hainan 570228, China
| | - Yuanyuan Liu
- Key Laboratory of Advanced Materials of Tropical Island Resources of Ministry of Education and School of Chemistry and Chemical Engineering, Hainan University, Haikou, Hainan 570228, China
| | - Kun Fu
- Department of Joint Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan 570102, China.
| | - Daozhang Cai
- Department of Joint Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, The Third School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
| | - Tawfik Khattab
- Textile Research and Technology Institute, National Research Centre, Cairo 12622, Egypt
| | - Yang Zhou
- Key Laboratory of Advanced Materials of Tropical Island Resources of Ministry of Education and School of Chemistry and Chemical Engineering, Hainan University, Haikou, Hainan 570228, China.
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11
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Palazzo B, Scialla S, Barca A, Sercia L, Izzo D, Gervaso F, Scalera F. Towards Complex Tissues Replication: Multilayer Scaffold Integrating Biomimetic Nanohydroxyapatite/Chitosan Composites. Bioengineering (Basel) 2024; 11:471. [PMID: 38790339 PMCID: PMC11118235 DOI: 10.3390/bioengineering11050471] [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: 03/16/2024] [Revised: 04/29/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024] Open
Abstract
This study explores an approach to design and prepare a multilayer scaffold mimicking interstratified natural tissue. This multilayer construct, composed of chitosan matrices with graded nanohydroxyapatite concentrations, was achieved through an in situ biomineralization process applied to individual layers. Three distinct precursor concentrations were considered, resulting in 10, 20, and 30 wt% nanohydroxyapatite content in each layer. The resulting chitosan/nanohydroxyapatite (Cs/n-HAp) scaffolds, created via freeze-drying, exhibited nanohydroxyapatite nucleation, homogeneous distribution, improved mechanical properties, and good cytocompatibility. The cytocompatibility analysis revealed that the Cs/n-HAp layers presented cell proliferation similar to the control in pure Cs for the samples with 10% n-HAp, indicating good cytocompatibility at this concentration, while no induction of apoptotic death pathways was demonstrated up to a 20 wt% n-Hap concentration. Successful multilayer assembly of Cs and Cs/n-HAp layers highlighted that the proposed approach represents a promising strategy for mimicking multifaceted tissues, such as osteochondral ones.
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Affiliation(s)
- Barbara Palazzo
- ENEA, Division for Sustainable Materials, Brindisi Research Center, S.S. 7 Appia Km. 706, 72100 Brindisi, Italy;
| | - Stefania Scialla
- Institute of Polymers, Composites and Biomaterials, National Research Council (IPCB-CNR), 80125 Naples, Italy;
| | - Amilcare Barca
- Laboratory of Applied Physiology, Department of Experimental Medicine, University of Salento, Campus Ecotekne, 73100 Lecce, Italy;
| | - Laura Sercia
- Centre for Regenerative Medicine “Stefano Ferrari”, Department of Life Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Daniela Izzo
- Department of Engineering for Innovation, University of Salento, 73100 Lecce, Italy
| | - Francesca Gervaso
- CNR NANOTEC—Institute of Nanotechnology, Campus Ecotekne, Via Monteroni, 73100 Lecce, Italy
| | - Francesca Scalera
- CNR NANOTEC—Institute of Nanotechnology, Campus Ecotekne, Via Monteroni, 73100 Lecce, Italy
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12
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Gao Y, Wei C, Yang M. Exploring osteochondral damage patterns in acute patellar dislocation: insights into morphological associations and risk factors. Sci Rep 2024; 14:6652. [PMID: 38509137 PMCID: PMC10954683 DOI: 10.1038/s41598-024-57363-w] [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: 01/06/2024] [Accepted: 03/18/2024] [Indexed: 03/22/2024] Open
Abstract
Osteochondral damage (OD) is a significant outcome following acute patellar dislocation (APD), yet the factors contributing to its susceptibility remain unclear. The primary objective of this study was to assess the association between demographic characteristics, patellofemoral (PF) joint morphology, and the occurrence of OD. A retrospective analysis identified 74 patients with APD who underwent treatment in our unit between 2019 and 2022. All patients received MRI within a week of injury to assess OD, subsequently categorized according to the injury pattern. The Caton-Deschamps index (CDI), tibial tuberosity-trochlear groove distance (TT-TG), lateral trochlear inclination (LTI), sulcus angle (SA), patellar width (PW), patellar thickness (PT), and femoral condyle geometry were calculated from the MRI scans and compared between groups. The findings revealed that OD predominantly manifested in the lateral femoral condyle (LFC) region and the medial patella (MP) region. In our patient cohort, this study identified a significant association between sulcus angle and the incidence of OD in both MP and LFC regions. Additionally, a significant correlation was discerned between skeletal maturity and the incidence of OD in the LFC region within demographic characteristics.
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Affiliation(s)
- Yu Gao
- Department of Orthopedics, China-Japan Union Hospital, Jilin University, 126 Xiantai Street, Changchun, 130033, People's Republic of China
| | - Chunxiao Wei
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, People's Republic of China
| | - Modi Yang
- Department of Orthopedics, China-Japan Union Hospital, Jilin University, 126 Xiantai Street, Changchun, 130033, People's Republic of China.
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13
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Ferreira SA, Tallia F, Heyraud A, Walker SA, Salzlechner C, Jones JR, Rankin SM. 3D printed hybrid scaffolds do not induce adverse inflammation in mice and direct human BM-MSC chondrogenesis in vitro. BIOMATERIALS AND BIOSYSTEMS 2024; 13:100087. [PMID: 38312434 PMCID: PMC10835132 DOI: 10.1016/j.bbiosy.2024.100087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/26/2023] [Accepted: 01/08/2024] [Indexed: 02/06/2024] Open
Abstract
Biomaterials that can improve the healing of articular cartilage lesions are needed. To address this unmet need, we developed novel 3D printed silica/poly(tetrahydrofuran)/poly(ε-caprolactone) (SiO2/PTHF/PCL-diCOOH) hybrid scaffolds. Our aim was to carry out essential studies to advance this medical device towards functional validation in pre-clinical trials. First, we show that the chemical composition, microarchitecture and mechanical properties of these scaffolds were not affected by sterilisation with gamma irradiation. To evaluate the systemic and local immunogenic reactivity of the sterilised 3D printed hybrid scaffolds, they were implanted subcutaneously into Balb/c mice. The scaffolds did not trigger a systemic inflammatory response over one week of implantation. The interaction between the host immune system and the implanted scaffold elicited a local physiological reaction with infiltration of mononuclear cells without any signs of a chronic inflammatory response. Then, we investigated how these 3D printed hybrid scaffolds direct chondrogenesis in vitro. Human bone marrow-derived mesenchymal stem/stromal cells (hBM-MSCs) seeded within the 3D printed hybrid scaffolds were cultured under normoxic or hypoxic conditions, with or without chondrogenic supplements. Chondrogenic differentiation assessed by both gene expression and protein production analyses showed that 3D printed hybrid scaffolds support hBM-MSC chondrogenesis. Articular cartilage-specific extracellular matrix deposition within these scaffolds was enhanced under hypoxic conditions (1.7 or 3.7 fold increase in the median of aggrecan production in basal or chondrogenic differentiation media). Our findings show that 3D printed SiO2/PTHF/PCL-diCOOH hybrid scaffolds have the potential to support the regeneration of cartilage tissue.
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Affiliation(s)
| | | | - Agathe Heyraud
- Department of Materials, Imperial College London, London, UK
| | - Simone A. Walker
- National Heart & Lung Institute, Imperial College London, London, UK
| | | | - Julian R. Jones
- Department of Materials, Imperial College London, London, UK
| | - Sara M. Rankin
- National Heart & Lung Institute, Imperial College London, London, UK
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14
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Yoo JC, Kim MS, Sohn S, Woo SH, Choi YR, Kwak AS, Lee DS. Atelocollagen Scaffold Enhances Cartilage Regeneration in Osteochondral Defects: A Study in Rabbits. Tissue Eng Regen Med 2024; 21:329-339. [PMID: 37853285 PMCID: PMC10825099 DOI: 10.1007/s13770-023-00589-y] [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: 05/24/2023] [Revised: 07/19/2023] [Accepted: 08/08/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND To enhance articular cartilage healing, microfractures (Mfx) and bone marrow aspirate concentrate (BMAC) are commonly used, and some form of scaffold is often used together to increase its efficacy. Herein, we compared the efficacy of atelocollagen scaffold to that of collagen scaffold when used with Mfx or BMAC on osteochondral defect of animal. METHODS This experiment was designed in two stages, and therapeutic effects of Mfx and BMAC were respectively evaluated when used with atelocollagen or collagen scaffold. Femoral condyle defects were artificially created in male New Zealand White rabbits, and in each stage, 12 rabbits were randomly allocated into three treatment groups: test group with additional atelocollagen scaffold, the positive control group with collagen scaffold, and the negative control group. Then, for 12 weeks, macroscopic and histological evaluations were performed. RESULTS At 12 weeks, defects in the test group were fully regenerated with normal cartilage-like tissue, and were well integrated with the surrounding cartilage at both stages experiment, whereas defects in the control groups were not fully filled with regenerated tissue, and the tissue appeared as fibrous tissue. Histologically, the regenerated tissue in the test group showed a statistically significant improvement compared to the positive and negative control groups, achieving a similar structure as normal articular cartilage. CONCLUSION The results showed that implantation of the atelocollagen scaffold enhanced cartilage regeneration following osteochondral defects in rabbits. This suggests that the atelocollagen scaffold can be used with Mfx or BMAC for effective regeneration of osteochondral defects.
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Affiliation(s)
- Ji-Chul Yoo
- R&D Division, Cellontech Co., Ltd, 04783, Seoul, Republic of Korea.
| | - Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University, Seoul, Republic of Korea
| | - Sueen Sohn
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
| | - Sang Hun Woo
- R&D Division, Cellontech Co., Ltd, 04783, Seoul, Republic of Korea
| | - Yu Ri Choi
- R&D Division, Cellontech Co., Ltd, 04783, Seoul, Republic of Korea
| | - Andrew S Kwak
- R&D Division, Cellontech Co., Ltd, 04783, Seoul, Republic of Korea
| | - Dong Shin Lee
- R&D Division, Cellontech Co., Ltd, 04783, Seoul, Republic of Korea
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15
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Abe K, Tsumaki N. Regeneration of joint surface defects by transplantation of allogeneic cartilage: application of iPS cell-derived cartilage and immunogenicity. Inflamm Regen 2023; 43:56. [PMID: 37964383 PMCID: PMC10644611 DOI: 10.1186/s41232-023-00307-0] [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: 08/09/2023] [Accepted: 10/27/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Because of its poor intrinsic repair capacity, articular cartilage seldom heals when damaged. MAIN BODY Regenerative treatment is expected for the treatment of articular cartilage damage, and allogeneic chondrocytes or cartilage have an advantage over autologous chondrocytes, which are limited in number. However, the presence or absence of an immune response has not been analyzed and remains controversial. Allogeneic-induced pluripotent stem cell (iPSC)-derived cartilage, a new resource for cartilage regeneration, reportedly survived and integrated with native cartilage after transplantation into chondral defects in knee joints without immune rejection in a recent primate model. Here, we review and discuss the immunogenicity of chondrocytes and the efficacy of allogeneic cartilage transplantation, including iPSC-derived cartilage. SHORT CONCLUSION Allogeneic iPSC-derived cartilage transplantation, a new therapeutic option, could be a good indication for chondral defects, and the development of translational medical technology for articular cartilage damage is expected.
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Affiliation(s)
- Kengo Abe
- Department of Tissue Biochemistry, Graduate School of Medicine, Osaka University, Osaka, Japan.
| | - Noriyuki Tsumaki
- Department of Tissue Biochemistry, Graduate School of Medicine, Osaka University, Osaka, Japan
- Department of Tissue Biochemistry, Graduate School of Frontier Biosciences, Osaka University, Osaka, Japan
- Premium Research Institute for Human Metaverse Medicine (WPI-PRIMe), Osaka University, Osaka, Japan
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16
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Jarecki J, Waśko MK, Widuchowski W, Tomczyk-Warunek A, Wójciak M, Sowa I, Blicharski T. Knee Cartilage Lesion Management-Current Trends in Clinical Practice. J Clin Med 2023; 12:6434. [PMID: 37892577 PMCID: PMC10607427 DOI: 10.3390/jcm12206434] [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: 07/19/2023] [Revised: 09/26/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023] Open
Abstract
Many patients, particularly those aged above 40, experience knee joint pain, which hampers both sports activities and daily living. Treating isolated chondral and osteochondral defects in the knee poses a significant clinical challenge, particularly in younger patients who are not typically recommended partial or total knee arthroplasty as alternatives. Several surgical approaches have been developed to address focal cartilage defects. The treatment strategies are characterized as palliation (e.g., chondroplasty and debridement), repair (e.g., drilling and microfracture), or restoration (e.g., autologous chondrocyte implantation, osteochondral autograft, and osteochondral allograft). This review offers an overview of the commonly employed clinical methods for treating articular cartilage defects, with a specific focus on the clinical trials conducted in the last decade. Our study reveals that, currently, no single technology fully meets the essential requirements for effective cartilage healing while remaining easily applicable during surgical procedures. Nevertheless, numerous methods are available, and the choice of treatment should consider factors such as the location and size of the cartilage lesion, patient preferences, and whether it is chondral or osteochondral in nature. Promising directions for the future include tissue engineering, stem cell therapies, and the development of pre-formed scaffolds from hyaline cartilage, offering hope for improved outcomes.
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Affiliation(s)
- Jaromir Jarecki
- Department of Orthopaedics and Rehabilitation, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Marcin Krzysztof Waśko
- Department of Radiology and Imaging, The Medical Centre of Postgraduate Education, 01-813 Warsaw, Poland;
| | - Wojciech Widuchowski
- Department of Physiotherapy, The College of Physiotherapy, 50-038 Wrocław, Poland;
| | - Agnieszka Tomczyk-Warunek
- Laboratory of Locomotor Systems Research, Department of Rehabilitation and Physiotherapy, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Magdalena Wójciak
- Department of Analytical Chemistry, Medical University of Lublin, Chodzki 4a, 20-093 Lublin, Poland; (M.W.); (I.S.)
| | - Ireneusz Sowa
- Department of Analytical Chemistry, Medical University of Lublin, Chodzki 4a, 20-093 Lublin, Poland; (M.W.); (I.S.)
| | - Tomasz Blicharski
- Department of Orthopaedics and Rehabilitation, Medical University of Lublin, 20-059 Lublin, Poland;
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17
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Nathwani D, McNicholas M, Hart A, Miles J, Bobić V. The BioPoly Partial Resurfacing Knee Implant Provides Beneficial Clinical Outcomes: A Concise Follow-up, at 5 Years, of a Previous Report. JB JS Open Access 2023; 8:e23.00008. [PMID: 37908223 PMCID: PMC10615441 DOI: 10.2106/jbjs.oa.23.00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
Abstract We previously conducted a single-arm, prospective study in which 31 patients (mean age [and standard deviation], 42.5 ± 11.3 years) with cartilage lesions were treated with use of the BioPoly Partial Resurfacing Knee Implant. Treatment outcomes were compared with those reported for the standard of care, microfracture. We found that the mean KOOS (Knee injury and Osteoarthritis Outcome Score) Quality of Life score at 5 years in the BioPoly cohort was noninferior to (p = 0.004), and indeed greater than (p = 0.021), that in the microfracture cohort. The BioPoly cohort demonstrated improvement in the mean scores for all KOOS domains at every postoperative time point (p < 0.025). The mean score for the visual analog scale (VAS) for pain significantly improved (p < 0.025) at all time points up to 4 years and trended toward significant improvement at 5 years (p = 0.027). This study indicated that the BioPoly implant was safe, provided significant improvement starting at 6 months and continuing to 5 years, and provided greater improvement than microfracture for some outcome measures. Level of Evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Dinesh Nathwani
- Imperial College Healthcare NHS Trust, London, United Kingdom
- The London Clinic, London, United Kingdom
| | | | - Alister Hart
- Royal National Orthopaedic Hospital, Stanmore, United Kingdom
- University College London, London, United Kingdom
- Cleveland Clinic London, London, United Kingdom
| | - Jonathan Miles
- Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Vladimir Bobić
- Chester Knee Clinic, Nuffield Health, The Grosvenor Hospital, Chester, United Kingdom
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18
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Guillén-García P, Guillén-Vicente I, Rodríguez-Iñigo E, Guillén-Vicente M, Fernández-Jaén TF, Navarro R, Aboli L, Torres R, Abelow S, López-Alcorocho JM. Cartilage Defect Treatment Using High-Density Autologous Chondrocyte Implantation (HD-ACI). Bioengineering (Basel) 2023; 10:1083. [PMID: 37760185 PMCID: PMC10525711 DOI: 10.3390/bioengineering10091083] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Hyaline cartilage's inability to self-repair can lead to osteoarthritis and joint replacement. Various treatments, including cell therapy, have been developed for cartilage damage. Autologous chondrocyte implantation (ACI) is considered the best option for focal chondral lesions. In this article, we aimed to create a narrative review that highlights the evolution and enhancement of our chondrocyte implantation technique: High-Density-ACI (HD-ACI) Membrane-assisted Autologous Chondrocyte Implantation (MACI) improved ACI using a collagen membrane as a carrier. However, low cell density in MACI resulted in softer regenerated tissue. HD-ACI was developed to improve MACI, implanting 5 million chondrocytes per cm2, providing higher cell density. In animal models, HD-ACI formed hyaline-like cartilage, while other treatments led to fibrocartilage. HD-ACI was further evaluated in patients with knee or ankle defects and expanded to treat hip lesions and bilateral defects. HD-ACI offers a potential solution for cartilage defects, improving outcomes in regenerative medicine and cell therapy. HD-ACI, with its higher cell density, shows promise for treating chondral defects and advancing cartilage repair in regenerative medicine and cell therapy.
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Sumii J, Nakasa T, Kato Y, Miyaki S, Adachi N. The Subchondral Bone Condition During Microfracture Affects the Repair of the Osteochondral Unit in the Cartilage Defect in the Rat Model. Am J Sports Med 2023; 51:2472-2479. [PMID: 37306063 DOI: 10.1177/03635465231177586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Microfracture (MF) is frequently performed as a first-line treatment for articular cartilage defects. Although good clinical outcomes are often obtained in the short term, poor clinical outcomes sometimes occur because of subchondral bone deterioration. The condition of the subchondral bone treated with MF may affect the repair of the osteochondral unit. PURPOSE To analyze histological findings of the osteochondral unit after performing MF on subchondral bone in different states-normal, absorption, and sclerosis-in a rat model. STUDY DESIGN Controlled laboratory study. METHODS Full-thickness cartilage defects (5.0 × 3.0 mm) were created in the weightbearing area of the medial femoral condyle in both knees of 47 Sprague-Dawley rats. Five MF holes were created within the cartilage defect using a 0.55-mm needle to a depth of 1 mm at 0 weeks (normal group), 2 weeks (absorption group), and 4 weeks (sclerosis group) after the cartilage defect was created. In the left knee, MF holes were filled with β-tricalcium phosphate (β-TCP). At 2 and 4 weeks after MF, knee joints were harvested and histologically analyzed. RESULTS MF holes were enlarged at 2 weeks and further enlarged at 4 weeks in all groups. In the absorption group, osteoclast accumulation around the MF holes and cyst formation were observed. The trabecular bone surrounding the MF holes was thickened in the sclerosis group. The diameter of the MF hole was largest in the absorption group at 2 and 4 weeks after MF compared with the other groups. No subchondral bone cysts were observed after β-TCP implantation. Pineda scores in all groups were significantly better with β-TCP implantation than without β-TCP implantation at 2 and 4 weeks. CONCLUSION MF for subchondral bone with bone absorption induced enlargement of the MF holes, cyst formation, and delay of cartilage defect coverage. Implantation of β-TCP into the MF holes enhanced remodeling of the MF holes and improved repair of the osteochondral unit compared with MF only. Therefore, the condition of the subchondral bone treated with MF affects repair of the osteochondral unit in a cartilage defect.
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Affiliation(s)
- Junichi Sumii
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomoyuki Nakasa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuichi Kato
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shigeru Miyaki
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Lee J, Bin SI, Kim JM, Lee BS, Jeon T, Bae K, Kim D. Survivorship After Lateral Meniscal Allograft Transplantation Plus Concurrent Cartilage Procedure in Patients With Poor Cartilage Status: A Comparative Study. Am J Sports Med 2023; 51:2120-2126. [PMID: 37259969 DOI: 10.1177/03635465231173692] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND The effect of a concurrent cartilage procedure in lateral meniscal allograft transplantation (MAT) in patients with bipolar cartilage lesions (high-grade lesions on both the femoral and the tibial side) is not well studied. An objective evaluation of graft status after MAT and a concurrent cartilage procedure has not been reported. PURPOSE To investigate the effect of concurrent cartilage procedures and lateral MAT on objective and clinical outcomes, including survival, in patients with bipolar cartilage lesions. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 149 patients with high-grade (International Cartilage Regeneration & Joint Preservation Society grade 3 or 4) cartilage lesions were enrolled and assigned to 1 of 3 groups based on the cartilage procedure and cartilage status at the time of MAT. Femoral cartilage procedures (microfracture, n = 18; osteochondral autograft transfer, n = 13) and lateral MAT were performed in 31 patients with bipolar cartilage lesions (cartilage procedure group). Another 70 patients with bipolar lesions underwent only lateral MAT without cartilage procedure (bipolar lesion group). The remaining 48 patients, who had high-grade lesions only on the tibial side and underwent lateral MAT without a cartilage procedure, were selected as a control group (unipolar lesion group). Anatomic survival was objectively assessed by follow-up magnetic resonance imaging and second-look arthroscopy. Clinical survivorship was determined with a Lysholm score <65 or need for additional surgery, such as revision MAT. RESULTS The mean Lysholm score improved from 67.2 ± 15.9 preoperatively to 86.7 ± 11.1 with a mean follow-up of 78.0 ± 51.2 months (P < .001). The postoperative scores were not significantly different between the 3 groups. The estimated 5-year anatomic survival rate in the cartilage procedure group (86.7%) was higher than that in the bipolar lesion group (65.0%; P = .043) but comparable with that in the unipolar lesion group (90.2%; P = .572). The estimated 5-year clinical survival rates were not significantly different between the groups (P = .187). CONCLUSION A concurrent femoral cartilage procedure improved the anatomic survival rate in patients with bipolar chondral lesions who underwent lateral MAT. This finding suggests that the cartilage procedure is an effective treatment choice and may improve the status of an allograft after lateral MAT for patients with bipolar cartilage lesions.
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Affiliation(s)
- Jongjin Lee
- Department of Orthopedic Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - Seong-Il Bin
- Department of Orthopedic Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - Jong-Min Kim
- Department of Orthopedic Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - Bum-Sik Lee
- Department of Orthopedic Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - Taehyeon Jeon
- Department of Orthopedic Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - Kinam Bae
- Department of Orthopedic Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - Donghyok Kim
- Department of Orthopedic Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
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Singh D, Lindsay S, Gurbaxani S, Crawford A, Claeyssens F. Elastomeric Porous Poly(glycerol sebacate) Methacrylate (PGSm) Microspheres as 3D Scaffolds for Chondrocyte Culture and Cartilage Tissue Engineering. Int J Mol Sci 2023; 24:10445. [PMID: 37445620 DOI: 10.3390/ijms241310445] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/12/2023] [Accepted: 06/16/2023] [Indexed: 07/15/2023] Open
Abstract
Cartilage defects can be difficult to treat; therefore, tissue engineering of cartilage is emerging as a promising potential therapy. One interesting area of research explores the delivery of cells to the cartilage defect via scaffold-based cell delivery vehicles and microsurgery. This study explores the use of novel poly(glycerol sebacate) methacrylate (PGSm)-polymerised high internal phase emulsion (polyHIPE) microspheres as scaffolds with embedded cells for cartilage tissue engineering. Porous microsphere scaffolds (100 µm-1 mm diameter) were produced from emulsions consisting of water and a methacrylate-based photocurable resin of poly(glycerol sebacate). These resins were used in conjunction with a T-junction fluidic device and an ultraviolet (UV) curing lamp to produce porous microspheres with a tuneable size. This technique produced biodegradable PGSm microspheres with similar mechanical properties to cartilage. We further explore these microspheres as scaffolds for three-dimensional culture of chondrocytes. The microspheres proved to be very efficient scaffolds for primary chondrocyte culture and were covered by a dense extracellular matrix (ECM) network during the culture period, creating a tissue disk. The presence of glycosaminoglycans (GAGs) and collagen-II was confirmed, highlighting the utility of the PGSm microspheres as a delivery vehicle for chondrocytes. A number of imaging techniques were utilised to analyse the tissue disk and develop methodologies to characterise the resultant tissue. This study highlights the utility of porous PGSm microspheres for cartilage tissue engineering.
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Affiliation(s)
- Dharaminder Singh
- Kroto Research Institute, Department of Materials Science and Engineering, The University of Sheffield, Broad Lane, Sheffield S3 7HQ, UK
| | - Sarah Lindsay
- School of Clinical Dentistry, The University of Sheffield, Claremont Crescent, Sheffield S10 2TN, UK
| | - Shruti Gurbaxani
- School of Clinical Dentistry, The University of Sheffield, Claremont Crescent, Sheffield S10 2TN, UK
| | - Aileen Crawford
- School of Clinical Dentistry, The University of Sheffield, Claremont Crescent, Sheffield S10 2TN, UK
| | - Frederik Claeyssens
- Kroto Research Institute, Department of Materials Science and Engineering, The University of Sheffield, Broad Lane, Sheffield S3 7HQ, UK
- Insigneo Institute for in Silico Medicine, The University of Sheffield, Sheffield S10 2TN, UK
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22
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Cong B, Sun T, Zhao Y, Chen M. Current and Novel Therapeutics for Articular Cartilage Repair and Regeneration. Ther Clin Risk Manag 2023; 19:485-502. [PMID: 37360195 PMCID: PMC10290456 DOI: 10.2147/tcrm.s410277] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/28/2023] [Indexed: 06/28/2023] Open
Abstract
Articular cartilage repair is a sophisticated process that has is being recently investigated. There are several different approaches that are currently reported to promote cartilage repair, like cell-based therapies, biologics, and physical therapy. Cell-based therapies involve the using stem cells or chondrocytes, which make up cartilage, to promote the growth of new cartilage. Biologics, like growth factors, are also being applied to enhance cartilage repair. Physical therapy, like exercise and weight-bearing activities, can also be used to promote cartilage repair by inducing new cartilage growth and improving joint function. Additionally, surgical options like osteochondral autograft, autologous chondrocyte implantation, microfracture, and others are also reported for cartilage regeneration. In the current literature review, we aim to provide an up-to-date discussion about these approaches and discuss the current research status.
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Affiliation(s)
- Bo Cong
- Department of Orthopedics, Yantaishan Hospital Affiliated to Binzhou Medical University, Yantai, 264003, People’s Republic of China
- Yantai Key Laboratory for Repair and Reconstruction of Bone & Joint, Yantai, 264003, People’s Republic of China
| | - Tao Sun
- Department of Orthopedics, Yantaishan Hospital Affiliated to Binzhou Medical University, Yantai, 264003, People’s Republic of China
- Yantai Key Laboratory for Repair and Reconstruction of Bone & Joint, Yantai, 264003, People’s Republic of China
| | - Yuchi Zhao
- Department of Orthopedics, Yantaishan Hospital Affiliated to Binzhou Medical University, Yantai, 264003, People’s Republic of China
- Yantai Key Laboratory for Repair and Reconstruction of Bone & Joint, Yantai, 264003, People’s Republic of China
| | - Mingqi Chen
- Department of Orthopedics, Yantaishan Hospital Affiliated to Binzhou Medical University, Yantai, 264003, People’s Republic of China
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23
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Hammersen T, Buchert J, Zietzschmann S, Diederichs S, Richter W. Inverse Regulation of Cartilage Neogenesis at Physiologically Relevant Calcium Conditions by Human Articular Chondrocytes and Mesenchymal Stromal Cells. Cells 2023; 12:1659. [PMID: 37371129 DOI: 10.3390/cells12121659] [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: 05/19/2023] [Revised: 06/07/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
Elaborate bioreactor cultivation or expensive growth factor supplementation can enhance extracellular matrix production in engineered neocartilage to provide sufficient mechanical resistance. We here investigated whether raising extracellular calcium levels in chondrogenic cultures to physiologically relevant levels would provide a simple and inexpensive alternative to enhance cartilage neogenesis from human articular chondrocytes (AC) or bone marrow-derived mesenchymal stromal cells (BMSC). Interestingly, AC and BMSC-derived chondrocytes showed an opposite response to a calcium increase from 1.8 mM to 8 mM by which glycosaminoglycan (GAG) and collagen type II production were elevated during BMSC chondrogenesis but depressed in AC, leading to two-fold higher GAG/DNA values in BMSC-based neocartilage compared to the AC group. According to control treatments with Mg2+ or sucrose, these effects were specific for CaCl2 rather than divalent cations or osmolarity. Importantly, undesired pro-hypertrophic traits were not stimulated by calcium treatment. Specific induction of PTHrP mRNA and protein by 8.0mM calcium only in AC, along with negative effects of recombinant PTHrP1-34 on cartilage matrix production, suggested that the PTHrP pathway contributed to the detrimental effects in AC-based neocartilage. Altogether, raising extracellular calcium levels was discovered as a novel, simple and inexpensive stimulator for BMSC-based cartilage neogenesis without the need for special bioreactors, whereas such conditions should be avoided for AC.
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Affiliation(s)
- Tim Hammersen
- Research Center for Experimental Orthopaedics, Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Justyna Buchert
- Research Center for Experimental Orthopaedics, Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Severin Zietzschmann
- Orthopaedic Hospital, Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Solvig Diederichs
- Research Center for Experimental Orthopaedics, Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Wiltrud Richter
- Research Center for Experimental Orthopaedics, Department of Orthopaedics, Heidelberg University Hospital, 69118 Heidelberg, Germany
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24
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Deichsel A, Palma Kries LK, Raschke MJ, Peez C, Briese T, Glasbrenner J, Herbst E, Kittl C. Refixation of a Large Osteochondral Fragment with Magnesium Compression Screws-A Case Report. Life (Basel) 2023; 13:life13051179. [PMID: 37240824 DOI: 10.3390/life13051179] [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: 04/04/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION Osteochondrosis dissecans (OCD) is a disease affecting the subchondral bone and the overlying articular cartilage. The etiology is most likely a combination of biological and mechanical factors. The incidence is highest in children >12 years old and it predominantly affects the knee. In high-grade OCD lesions, free osteochondral fragments usually are refixed via titanium screws or biodegradable screws or pins. In this case, headless compression screws made from magnesium were used for refixation. CASE REPORT A thirteen-year-old female patient with a two-year history of knee pain was diagnosed with an OCD lesion of the medial femoral condyle. After initial conservative treatment, displacement of the osteochondral fragment occurred. Refixation was performed using two headless magnesium compression screws. At the 6 months follow up, the patient was pain free, and the fragment showed progressive healing while the implants were biodegrading. DISCUSSION Existing implants for refixation of OCD lesions either require subsequent removal or show less stability and possible inflammatory reactions. The new generation of magnesium screws used in this case did not lead to a gas release, as described for previous magnesium implants, while maintaining stability during continuous biodegradation. CONCLUSIONS The data available to date on magnesium implants for the treatment of OCD are promising. However, the evidence on the magnesium implants in refixation surgery of OCD lesions is still limited. Further research needs to be conducted to provide data on outcomes and possible complications.
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Affiliation(s)
- Adrian Deichsel
- Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Münster, Germany
| | - Lucas Klaus Palma Kries
- Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Münster, Germany
| | - Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Münster, Germany
| | - Christian Peez
- Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Münster, Germany
| | - Thorben Briese
- Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Münster, Germany
| | - Johannes Glasbrenner
- Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Münster, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Münster, Germany
| | - Christoph Kittl
- Department of Trauma, Hand and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Münster, Germany
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Peng J, Wang Q, Xu Y, He H. Platelet-rich plasma treatment for talar cartilage repair: a systematic review and meta-analysis. BMC Musculoskelet Disord 2023; 24:366. [PMID: 37161527 PMCID: PMC10169378 DOI: 10.1186/s12891-023-06466-y] [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: 11/21/2022] [Accepted: 04/26/2023] [Indexed: 05/11/2023] Open
Abstract
PURPOSE To systematically review the studies regarding to the safety, efficacy and application methods of PRP in promoting the talar cartilage repair. METHODS A systematic review was performed by searching PubMed, Web of Science, OVID and EMBASE to identify studies that compared the clinical efficacy of PRP for talar cartilage repair. Main outcome was the American Orthopedic Foot and Ankle Society (AOFAS) score for function and Visual Analog Scale (VAS) for pain was the second outcome. RESULTS A total of 10 studies were included in this systematic review, including 4 randomized controlled trials, 1 controlled trial, 3 case series and 2 cohort studies. Four RCTs were analyzed using meta-analysis. For all outcomes, statistical results favored PRP group (AOFAS: MD = 7.84; 95% CI= [-0.13, 15.80], I2 = 83%, P < 0.01; VAS: MD = 1.86; 95% CI= [0.68, 3.04], I2 = 85%, P < 0.01). There were almost no reports of adverse events related to PRP intervention. Subgroup analysis showed that whether PRP was used alone or combined with other treatments could result in high heterogeneity but no more specific factors were identified to contribute to this. CONCLUSION PRP is safe and effective for talar cartilage repair. In addition to the standardization of PRP preparation and application, it is necessary to distinguish the effects of PRP used alone or in combination with other treatments. In PRP studies, surgical treatment of talar cartilage repair remains the mainstream. The regulation of PRP in surgical applications are worth exploring. The most relative component is the mesenchymal stem cell because it is the only exposed chondrocyte precursor in the articular cavity whether it is microfracture or cell transplantation. TRIAL REGISTRATION The study was registered in the PROSPERO International prospective register of systematic reviews (CRD42022360183).
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Affiliation(s)
- Jialei Peng
- Department of Rehabilitation Medicine, Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, #37 Guoxue Street, Wuhou District, Chengdu, Sichuan, 610041, P. R. China
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, 610041, P. R. China
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Chengdu, 610041, P. R. China
| | - Qian Wang
- Department of Rehabilitation Medicine, Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, #37 Guoxue Street, Wuhou District, Chengdu, Sichuan, 610041, P. R. China
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, 610041, P. R. China
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Chengdu, 610041, P. R. China
| | - Yang Xu
- Department of Rehabilitation Medicine, Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, #37 Guoxue Street, Wuhou District, Chengdu, Sichuan, 610041, P. R. China
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, 610041, P. R. China
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Chengdu, 610041, P. R. China
| | - Hongchen He
- Department of Rehabilitation Medicine, Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, #37 Guoxue Street, Wuhou District, Chengdu, Sichuan, 610041, P. R. China.
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, 610041, P. R. China.
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Chengdu, 610041, P. R. China.
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26
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Autologous Collagen-Induced Chondrogenesis: From Bench to Clinical Development. Medicina (B Aires) 2023; 59:medicina59030530. [PMID: 36984531 PMCID: PMC10056533 DOI: 10.3390/medicina59030530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/04/2023] [Accepted: 03/07/2023] [Indexed: 03/11/2023] Open
Abstract
Microfracture is a common technique that uses bone marrow components to stimulate cartilage regeneration. However, the clinical results of microfracture range from poor to good. To enhance cartilage healing, several reinforcing techniques have been developed, including porcine-derived collagen scaffold, hyaluronic acid, and chitosan. Autologous collagen-induced chondrogenesis (ACIC) is a single-step surgical technique for cartilage regeneration that combines gel-type atelocollagen scaffolding with microfracture. Even though ACIC is a relatively new technique, literature show excellent clinical results. In addition, all procedures of ACIC are performed arthroscopically, which is increasing in preference among surgeons and patients. The ACIC technique also is called the Shetty–Kim technique because it was developed from the works of A.A. Shetty and S.J. Kim. This is an up-to-date review of the history of ACIC.
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27
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Snow M, Middleton L, Mehta S, Roberts A, Gray R, Richardson J, Kuiper JH, Smith A, White S, Roberts S, Griffiths D, Mohammed A, Moholkar K, Ashraf T, Green M, Hutchinson J, Bhullar T, Chitnis S, Shaw A, van Niekerk L, Hui A, Drogset JO, Knutsen G, McNicholas M, Bowditch M, Johnson D, Turner P, Chugh S, Hunt N, Ali S, Palmer S, Perry A, Davidson A, Hill P, Deo S, Satish V, Radford M, Langstaff R, Houlihan-Burne D, Spicer D, Phaltankar P, Hegab A, Marsh D, Cannon S, Briggs T, Pollock R, Carrington R, Skinner J, Bentley G, Price A, Schranz P, Mandalia V, O'Brien S. A Randomized Trial of Autologous Chondrocyte Implantation Versus Alternative Forms of Surgical Cartilage Management in Patients With a Failed Primary Treatment for Chondral or Osteochondral Defects in the Knee. Am J Sports Med 2023; 51:367-378. [PMID: 36661257 DOI: 10.1177/03635465221141907] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND There are limited randomized controlled trials with long-term outcomes comparing autologous chondrocyte implantation (ACI) versus alternative forms of surgical cartilage management within the knee. PURPOSE To determine at 5 years after surgery whether ACI was superior to alternative forms of cartilage management in patients after a failed previous treatment for chondral or osteochondral defects in the knee. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS In total, 390 participants were randomly assigned to receive either ACI or alternative management. Patients aged 18 to 55 years with one or two symptomatic cartilage defects who had failed 1 previous therapeutic surgical procedure in excess of 6 months prior were included. Dual primary outcome measures were used: (1) patient-completed Lysholm knee score and (2) time from surgery to cessation of treatment benefit. Secondary outcome measures included International Knee Documentation Committee and Cincinnati Knee Rating System scores, as well as number of serious adverse events. Analysis was performed on an intention-to-treat basis. RESULTS Lysholm scores were improved by 1 year in both groups (15.4 points [95% CI, 11.9 to 18.8] and 15.2 points [95% CI, 11.6 to 18.9]) for ACI and alternative, with this improvement sustained over the duration of the trial. However, no evidence of a difference was found between the groups at 5 years (2.9 points; 95% CI, -1.8 to 7.5; P = .46). Approximately half of the participants (55%; 95% CI, 47% to 64% with ACI) were still experiencing benefit at 5 years, with time to cessation of treatment benefit similar in both groups (hazard ratio, 0.97; 95% CI, 0.72 to 1.32; P > .99). There was a differential effect on Lysholm scores in patients without previous marrow stimulation compared with those with marrow stimulation (P = .03; 6.4 points in favor of ACI; 95% CI, -0.4 to 13.1). More participants experienced a serious adverse event with ACI (P = .02). CONCLUSION Over 5 years, there was no evidence of a difference in Lysholm scores between ACI and alternative management in patients who had previously failed treatment. Previous marrow stimulation had a detrimental effect on the outcome of ACI. REGISTRATION International Standard Randomised Controlled Trial Number: 48911177.
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Affiliation(s)
- Martyn Snow
- Orthopaedics Department, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK; School of Pharmacy and Bioengineering, Keele University, Staffordshire, UK
| | - Lee Middleton
- Birmingham Clinical Trials Unit, Birmingham University, Midlands, UK
| | - Samir Mehta
- Birmingham Clinical Trials Unit, Birmingham University, Midlands, UK
| | - Andrew Roberts
- Orthopaedics Department, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK
| | - Richard Gray
- Nuffield Department of Population Health, Oxford University, Oxfordshire, UK
| | - James Richardson
- Orthopaedics Department, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK; School of Pharmacy and Bioengineering, Keele University, Staffordshire, UK
| | - Jan Herman Kuiper
- School of Pharmacy and Bioengineering, Keele University, Staffordshire, UK
| | | | - Anthony Smith
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry
| | - Steve White
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry
| | - Simon Roberts
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry
| | - David Griffiths
- County Hospital, Stafford, University Hospitals of North Midlands NHS Trust, Stoke
| | - Aslam Mohammed
- Wrightington Wigan and Leigh teaching hospitals NHSFT, Wigan
| | | | | | - Marcus Green
- Royal Orthopaedic Hospital Birmingham, Birmingham
| | - James Hutchinson
- Edith Cavell Hospital Peterborough [now Peterborough City Hospital], NW Anglia NHSFT, Peterborough
| | - Tony Bhullar
- Edith Cavell Hospital Peterborough [now Peterborough City Hospital], NW Anglia NHSFT, Peterborough
| | | | - Andrew Shaw
- Royal Alexandra Hospital, Paisley; NHS Greater Glasgow and Clyde, Paisley
| | - Louw van Niekerk
- Friarage Hospital, South Tees; South Tees Hospitals NHSFT, Northallerton
| | - Anthony Hui
- The James Cook University Hospital, Middlesborough; South Tees Hospitals NHSFT, Middlesborough
| | | | | | | | - Mark Bowditch
- Ipswich Hospital, East Suffolk and North Essex NHSFT, Ipswich
| | | | | | - Sanjiv Chugh
- New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton
| | - Neil Hunt
- York Hospital, York and Scarborough Teaching Hospitals NHSFT, York
| | - Salman Ali
- Russels Hall Hospital, The Dudley Group NHSFT, Dudley
| | - Simon Palmer
- Worthing Hospital, University Hospitals Sussex NHSFT, Worthing
| | - Andrew Perry
- Frimley Park Hospital, Frimley Health NHSFT, Frimley Park
| | | | - Peter Hill
- Frimley Park Hospital, Frimley Health NHSFT, Frimley Park
| | - Sunny Deo
- The Great Western Hospitals NHSFT, Swindon
| | | | - Michael Radford
- Weston General Hospital, Weston Area Health NHS Trust, Weston-Super-Mare
| | - Ron Langstaff
- Hillingdon Hospital, The Hillingdon Hospitals NHSFT, Hillingdon
| | | | - Dominic Spicer
- St Mary's Hospital, Imperial College Healthcare NHS Trust, Paddington
| | - Padman Phaltankar
- North Manchester General Hospital, Manchester University NHSFT, Manchester
| | - Ahmed Hegab
- Fairfield General Hospital, Northern Care Alliance NHSFT, Bury
| | - David Marsh
- The Royal National Orthopaedic Hospital Stanmore, Stanmore
| | - Steve Cannon
- The Royal National Orthopaedic Hospital Stanmore, Stanmore
| | - Tim Briggs
- The Royal National Orthopaedic Hospital Stanmore, Stanmore
| | - Rob Pollock
- The Royal National Orthopaedic Hospital Stanmore, Stanmore
| | | | - John Skinner
- The Royal National Orthopaedic Hospital Stanmore, Stanmore
| | - George Bentley
- The Royal National Orthopaedic Hospital Stanmore, Stanmore
| | - Andrew Price
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHSFT, Oxford
| | | | | | - Shaun O'Brien
- Sunderland Royal Hospital, South Tyneside and Sunderland NHSFT, Sunderland.,Investigation performed at the Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK
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28
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Guo X, Ma Y, Min Y, Sun J, Shi X, Gao G, Sun L, Wang J. Progress and prospect of technical and regulatory challenges on tissue-engineered cartilage as therapeutic combination product. Bioact Mater 2023; 20:501-518. [PMID: 35846847 PMCID: PMC9253051 DOI: 10.1016/j.bioactmat.2022.06.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/19/2022] [Accepted: 06/19/2022] [Indexed: 12/18/2022] Open
Abstract
Hyaline cartilage plays a critical role in maintaining joint function and pain. However, the lack of blood supply, nerves, and lymphatic vessels greatly limited the self-repair and regeneration of damaged cartilage, giving rise to various tricky issues in medicine. In the past 30 years, numerous treatment techniques and commercial products have been developed and practiced in the clinic for promoting defected cartilage repair and regeneration. Here, the current therapies and their relevant advantages and disadvantages will be summarized, particularly the tissue engineering strategies. Furthermore, the fabrication of tissue-engineered cartilage under research or in the clinic was discussed based on the traid of tissue engineering, that is the materials, seed cells, and bioactive factors. Finally, the commercialized cartilage repair products were listed and the regulatory issues and challenges of tissue-engineered cartilage repair products and clinical application would be reviewed. Tissue engineered cartilage, a promising strategy for articular cartilage repair. Nearly 20 engineered cartilage repair products in clinic based on clinical techniques. Combination product, the classification of tissue-engineered cartilage. Key regulatory compliance issues for combination products.
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Affiliation(s)
- Xiaolei Guo
- Center for Medical Device Evaluation, National Medical Products Administration, Beijing, PR China
- Corresponding author.
| | - Yuan Ma
- State Key Laboratory of Tribology, Tsinghua University, Beijing, PR China
| | - Yue Min
- Center for Medical Device Evaluation, National Medical Products Administration, Beijing, PR China
| | - Jiayi Sun
- Center for Medical Device Evaluation, National Medical Products Administration, Beijing, PR China
| | - Xinli Shi
- Center for Medical Device Evaluation, National Medical Products Administration, Beijing, PR China
- Corresponding author. Center for Medical Device Evaluation, National Medical Products Administration, Beijing, 100081, PR China
| | - Guobiao Gao
- Center for Medical Device Evaluation, National Medical Products Administration, Beijing, PR China
| | - Lei Sun
- Center for Medical Device Evaluation, National Medical Products Administration, Beijing, PR China
| | - Jiadao Wang
- State Key Laboratory of Tribology, Tsinghua University, Beijing, PR China
- Corresponding author. State Key Laboratory of Tribology, Tsinghua University, Beijing 100084, China.
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29
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De Luigi AJ, Tow S, Flowers R, Gordon AH. Special Populations in Orthobiologics. Phys Med Rehabil Clin N Am 2023; 34:199-237. [DOI: 10.1016/j.pmr.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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30
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Niemeyer P, Albrecht D, Aurich M, Becher C, Behrens P, Bichmann P, Bode G, Brucker P, Erggelet C, Ezechieli M, Faber S, Fickert S, Fritz J, Hoburg A, Kreuz P, Lützner J, Madry H, Marlovits S, Mehl J, Müller PE, Nehrer S, Niethammer T, Pietschmann M, Plaass C, Rössler P, Rhunau K, Schewe B, Spahn G, Steinwachs M, Tischer T, Volz M, Walther M, Zinser W, Zellner J, Angele P. Empfehlungen der AG Klinische Geweberegeneration zur Behandlung von Knorpelschäden am Kniegelenk. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023; 161:57-64. [PMID: 35189656 DOI: 10.1055/a-1663-6807] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The Working Group of the German Orthopedic and Trauma Society (DGOU) on Tissue Regeneration has published recommendations on the indication of different surgical approaches for treatment of full-thickness cartilage defects in the knee joint in 2004, 2013 and 2016. Based upon new scientific knowledge and new developments, this recommendation is an update based upon the best clinical evidence available. In addition to prospective randomised controlled clinical trials, this also includes studies with a lower level of evidence. In the absence of evidence, the decision is based on a consensus process within the members of the working group.The principle of making decision dependent on defect size has not been changed in the new recommendation either. The indication for arthroscopic microfracturing has been reduced up to a defect size of 2 cm2 maximum, while autologous chondrocyte implantation is the method of choice for larger cartilage defects. Additionally, matrix-augmented bone marrow stimulation (mBMS) has been included in the recommendation for defects ranging from 1 to 4.5 cm2. For the treatment of smaller osteochondral defects, in addition to osteochondral transplantation (OCT), mBMS is also recommended. For larger defects, matrix-augmented autologous chondrocyte implantation (mACI/mACT) in combination with augmentation of the subchondral bone is recommended.
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Affiliation(s)
- Philipp Niemeyer
- OCM Orthopädische Chirurgie München, München, Deutschland.,Klinik für Orthopädie und Unfallchirurgie, Albert-Ludwigs-Universität Freiburg, Freiburg im Breisgau, Deutschland
| | - Dirk Albrecht
- Chirurgie, Klinik im Kronprinzenbau, Reutlingen, Deutschland
| | - Matthias Aurich
- Department für Orthopädie, Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland.,Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost Halle, Halle (Saale, Deutschland
| | - Christoph Becher
- HKF - Internationales Zentrum für Hüft-, Knie- und Fußchirurgie, ATOS Klinik Heidelberg, Heidelberg, Deutschland
| | | | - Peter Bichmann
- Klinik für Unfallchirurgie und Orthopädie, Nordwest Krankenhaus Sanderbusch GmbH, Sande, Deutschland
| | - Gerrit Bode
- Klinik für Orthopädie und Unfallchirurgie, Albert-Ludwigs-Universität Freiburg, Freiburg im Breisgau, Deutschland
| | | | | | - Marco Ezechieli
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, St. Josefs Krankenhaus Salzkotten, Salzkotten, Deutschland
| | - Svea Faber
- Orthopädische Chirurgie, OCM Klinik München, München, Deutschland
| | - Stefan Fickert
- University Medical Center Mannheim Medical Faculty Mannheim, Heidelberg University, Sportorthopaedicum Regensburg/Straubing, Straubing, Deutschland
| | - Jürgen Fritz
- Orthopädie und Unfallchirurgie, Orthopädisch Chirurgisches Centrum, Tübingen, Deutschland
| | - Arnd Hoburg
- Gelenk- und Wirbelsäulenzentrum, Gelenk- und Wirbelsäulenzentrum Steglitz-Berlin, Berlin, Deutschland
| | - Peter Kreuz
- Zentrum für Orthopädie und Unfallchirurgie, Asklepios Stadtklinik Bad Tolz, Bad Tölz, Deutschland
| | - Jörg Lützner
- Klinik und Poliklinik für Orthopädie, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Deutschland
| | - Henning Madry
- Zentrum für Experimentelle Orthopädie, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - Stefan Marlovits
- Klinik für Unfallchirurgie, Medizinische Universität Wien, Wien, Österreich
| | - Julian Mehl
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, TUM, München, Deutschland
| | - Peter E Müller
- Orthopädische Klinik, Ludwig-Maximiliams-Universität München, München, Deutschland
| | - Stefan Nehrer
- Fakultät für Gesundheit und Medizin, Donau-Universität Krems, Krems, Österreich
| | - Thomas Niethammer
- Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Ludwig-Maximilians-Universität, München, Deutschland
| | - Matthias Pietschmann
- Orthopädische Klinik, Ludwig-Maximiliams-Universität München, München, Deutschland
| | - Christian Plaass
- Diakovere Annastift, Klinik für Orthopädie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Philip Rössler
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Klaus Rhunau
- Orthopedics, Viktoria Klinik Bochum, Bochum, Deutschland
| | - Bernhard Schewe
- Orthopädisch Chirurgisches Centrum, Orthopädisch Chirurgisches Centrum Tübingen, Tübingen, Deutschland
| | - Gunter Spahn
- Unfallchirurgie und Orthopädie, Praxisklinik für Unfallchirurgie und Orthopädie, Eisenach, Deutschland.,Klinik für Unfall,- Hand- und Wiederherstellungschirurgie, Universitätsklinikum Jena, Jena, Deutschland
| | - Matthias Steinwachs
- Zentrum für Orthobiologie und Knorpelregeneration, Schulthess Klinik, Zürich, Schweiz
| | - Thomas Tischer
- Orthopaedic Surgery, University Medicine Rostock, Rostock, Deutschland
| | - Martin Volz
- Orthopädie & Unfallchirurgie, Sportklinik Ravensburg, Ravensburg, Deutschland
| | - Markus Walther
- Foot and Ankle Surgery, Schön Klinik München Harlaching, München, Deutschland
| | - Wolfgang Zinser
- Klinik für Orthopädie und Unfallchirurgie, St. Vinzenz-Hospital Dinslaken, Dinslaken, Deutschland
| | | | - Peter Angele
- sporthopaedicum Regensburg, Regensburg, Deutschland.,Universitätsklinikum Regensburg, Regensburg, Deutschland
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Tee CA, Han J, Hui JHP, Lee EH, Yang Z. Perspective in Achieving Stratified Articular Cartilage Repair Using Zonal Chondrocytes. TISSUE ENGINEERING. PART B, REVIEWS 2023. [PMID: 36416231 DOI: 10.1089/ten.teb.2022.0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Articular cartilage is composed of superficial, medial, and deep zones, which endow the tissue with biphasic mechanical properties to withstand shearing force and compressional loading. The tissue has very limited self-healing capacity once it is damaged due to its avascular nature. To prevent the early onset of osteoarthritis, surgical intervention is often needed to repair the injured cartilage. Current noncell-based and cell-based treatments focus on the regeneration of homogeneous cartilage to achieve bulk compressional properties without recapitulating the zonal matrix and mechanical properties, and often oversight in aiding cartilage integration between host and repair cartilage. It is hypothesized that achieving zonal architecture in articular cartilage tissue repair could improve the structural and mechanical integrity and thus the life span of the regenerated tissue. Engineering stratified cartilage constructs using zonal chondrocytes have been hypothesized to improve the functionality and life span of the regenerated tissues. However, stratified articular cartilage repair has yet to be realized to date due to the lack of an efficient zonal chondrocyte isolation method and an expansion platform that would allow both cell propagation and phenotype maintenance. Various attempts and challenges in achieving stratified articular cartilage repair in a clinical setting are evaluated. In this review, different perspectives on achieving stratified articular cartilage repair using zonal chondrocytes are described. The effectiveness of different zonal chondrocyte isolation and zonal chondrocyte phenotype maintenance methodologies during expansion are compared, with the focus on recent advancements in zonal chondrocyte isolation and expansion that could present a possible strategy to overcome the limitation of applying zonal chondrocytes to facilitate zonal architecture development in articular cartilage regeneration. Impact Statement The zonal properties of articular cartilage contribute to the biphasic mechanical properties of the tissues. Recapitulation of the zonal architecture in regenerated articular cartilage has been hypothesized to improve the mechanical integrity and life span of the regenerated tissue. This review provides a comprehensive discussion on the current state of research relevant to achieving stratified articular cartilage repair using zonal chondrocytes from different perspectives. This review further elaborates on a zonal chondrocyte production pipeline that can potentially overcome the current clinical challenges and future work needed to realize stratified zonal chondrocyte implantation in a clinical setting.
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Affiliation(s)
- Ching Ann Tee
- Critical Analytics for Manufacturing Personalised-Medicine Interdisciplinary Research Group, Singapore-MIT Alliance in Research and Technology, Singapore, Singapore.,Department of Orthopaedic Surgery, National University of Singapore, Singapore, Singapore
| | - Jongyoon Han
- Critical Analytics for Manufacturing Personalised-Medicine Interdisciplinary Research Group, Singapore-MIT Alliance in Research and Technology, Singapore, Singapore.,Department of Electrical Engineering and Computer Science, Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - James Hoi Po Hui
- Department of Orthopaedic Surgery, National University of Singapore, Singapore, Singapore.,NUS Tissue Engineering Program, Life Sciences Institute, National University of Singapore, Singapore, Singapore
| | - Eng Hin Lee
- Critical Analytics for Manufacturing Personalised-Medicine Interdisciplinary Research Group, Singapore-MIT Alliance in Research and Technology, Singapore, Singapore.,Department of Orthopaedic Surgery, National University of Singapore, Singapore, Singapore.,NUS Tissue Engineering Program, Life Sciences Institute, National University of Singapore, Singapore, Singapore
| | - Zheng Yang
- Critical Analytics for Manufacturing Personalised-Medicine Interdisciplinary Research Group, Singapore-MIT Alliance in Research and Technology, Singapore, Singapore.,Department of Orthopaedic Surgery, National University of Singapore, Singapore, Singapore.,NUS Tissue Engineering Program, Life Sciences Institute, National University of Singapore, Singapore, Singapore
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32
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Cai Y, Wu C, Ou Q, Zeng M, Xue S, Chen J, Lu Y, Ding C. Enhanced osteoarthritis therapy by nanoengineered mesenchymal stem cells using biomimetic CuS nanoparticles loaded with plasmid DNA encoding TGF-β1. Bioact Mater 2023; 19:444-457. [PMID: 35574050 PMCID: PMC9079106 DOI: 10.1016/j.bioactmat.2022.04.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/11/2022] [Accepted: 04/21/2022] [Indexed: 11/21/2022] Open
Abstract
Mesenchymal stem cells (MSCs) therapy shows the potential benefits to relieve clinical symptoms of osteoarthritis (OA), but it is uncertain if it can repair articular cartilage lesions — the main pathology of OA. Here, we prepared biomimetic cupper sulfide@phosphatidylcholine (CuS@PC) nanoparticles (NPs) loaded with plasmid DNA (pDNA) encoding transforming growth factor-beta 1 (TGF-β1) to engineer MSCs for enhanced OA therapy via cartilage regeneration. We found that the NPs not only promoted cell proliferation and migration, but also presented a higher pDNA transfection efficiency relative to commercial transfection reagent lipofectamine 3000. The resultant CuS/TGF-β1@PC NP-engineered MSCs (termed CTP-MSCs) were better than pure MSCs in terms of chondrogenic gene expression, glycosaminoglycan deposition and type II collagen formation, favoring cartilage repair. Further, CTP-MSCs inhibited extracellular matrix degradation in interleukin-1β-induced chondrocytes. Consequently, intraarticular administration of CTP-MSCs significantly enhanced the repair of damaged cartilage, whereas pure MSCs exhibited very limited effects on cartilage regeneration in destabilization of the medial meniscus (DMM) surgical instability mice. Hence, this work provides a new strategy to overcome the limitation of current stem cell therapy in OA treatment through developing more effective nanoengineered MSCs. Biomimetic CuS nanoparticles (NPs) loaded with TGF-β1 pDNA are prepared for nanoengineering of MSCs. CuS/TGF-β1@PC NPs are more efficient than commercial transfection agent in terms of pDNA transfection. The NP-engineered CTP-MSCs exhibit enhanced migration, chondrogenesis and inhibition of ECM degradation. CTP-MSCs effectively treat osteoarthritis (OA) mice models via cartilage regeneration.
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33
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Kutaish H, Tscholl PM, Cosset E, Bengtsson L, Braunersreuther V, Mor FM, Laedermann J, Furfaro I, Stafylakis D, Hannouche D, Gerstel E, Krause KH, Assal M, Menetrey J, Tieng V. Articular Cartilage Repair After Implantation of Hyaline Cartilage Beads Engineered From Adult Dedifferentiated Chondrocytes: Cartibeads Preclinical Efficacy Study in a Large Animal Model. Am J Sports Med 2023; 51:237-249. [PMID: 36592016 DOI: 10.1177/03635465221138099] [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: 01/03/2023]
Abstract
BACKGROUND Chondrocyte-based cell therapy to repair cartilage has been used for >25 years despite current limitations. This work presents a new treatment option for cartilage lesions. HYPOTHESIS High-quality hyaline cartilage microtissues called Cartibeads are capable of treating focal chondral lesions once implanted in the defect, by complete fusion of Cartibeads among themselves and their integration with the surrounding native cartilage and subchondral bone. STUDY DESIGN Controlled laboratory study. METHODS Cartibeads were first produced from human donors and characterized using histology (safranin O staining of glycosaminoglycan [GAG] and immunohistochemistry of collagen I and II) and GAG dosage. Cartibeads from 6 Göttingen minipigs were engineered and implanted in an autologous condition in the knee (4 or 5 lesions per knee). One group was followed up for 3 months and the other for 6 months. Feasibility and efficacy were measured using histological analysis and macroscopic and microscopic scores. RESULTS Cartibeads revealed hyaline features with strong staining of GAG and collagen II. High GAG content was obtained: 24.6-µg/mg tissue (wet weight), 15.52-µg/mg tissue (dry weight), and 35 ± 3-µg GAG/bead (mean ± SD). Histological analysis of Göttingen minipigs showed good integration of Cartibeads grafts at 3 and 6 months after implantation. The Bern Score of the histological assay comparing grafted versus empty lesions was significant at 3 months (grafted, n = 10; nongrafted, n = 4; score, 3.3 and 5.3, respectively) and 6 months (grafted, n = 11; nongrafted, n = 3; score, 1.6 and 5.1). CONCLUSION We developed an innovative 3-step method allowing, for the first time, the use of fully dedifferentiated adult chondrocytes with a high number of cell passage (owing to the extensive amplification in culture). Cartibeads engineered from chondrocytes hold potential as an advanced therapy medicinal product for treating cartilage lesions with established efficacy. CLINICAL RELEVANCE This successful preclinical study, combined with standardized manufacturing of Cartibeads according to good manufacturing practice guidelines, led to the approval of first-in-human clinical trial by the ethics committee and local medical authority. The generated data highlighted a promising therapy to treat cartilage lesions from a small amount of starting biopsy specimen. With our innovative cell amplification technology, very large lesions can be treated, and older active patients can benefit from it.
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Affiliation(s)
- Halah Kutaish
- Department of Pathology and Immunology, Medical School, University of Geneva, Geneva, Switzerland. University Medical Center, University of Geneva, Geneva, Switzerland. Foot and Ankle Surgery Centre, Centre Assal, Clinique La Colline, Hirslanden Geneva, Switzerland.,Investigation performed at the Faculty of Medicine, University of Geneva, in collaboration with Geneva University Hospitals, Geneva, Switzerland
| | - Philippe Matthias Tscholl
- Department of Orthopaedics Surgery, Geneva University Hospitals, Geneva, Switzerland.,Investigation performed at the Faculty of Medicine, University of Geneva, in collaboration with Geneva University Hospitals, Geneva, Switzerland
| | - Erika Cosset
- University Medical Center, University of Geneva, Geneva, Switzerland. Laboratory of Tumor Immunology, Oncology Department, Center for Translational Research in Onco- Hematology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.,Investigation performed at the Faculty of Medicine, University of Geneva, in collaboration with Geneva University Hospitals, Geneva, Switzerland
| | - Laura Bengtsson
- University Medical Center, University of Geneva, Geneva, Switzerland. Vanarix SA, Lausanne, Switzerland.,Investigation performed at the Faculty of Medicine, University of Geneva, in collaboration with Geneva University Hospitals, Geneva, Switzerland
| | - Vincent Braunersreuther
- Service of Clinical Pathology, Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland.,Investigation performed at the Faculty of Medicine, University of Geneva, in collaboration with Geneva University Hospitals, Geneva, Switzerland
| | - Flavio Maurizio Mor
- Tissue Engineering Laboratory, HEPIA/HES-SO, University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland.,Investigation performed at the Faculty of Medicine, University of Geneva, in collaboration with Geneva University Hospitals, Geneva, Switzerland
| | - Jeremy Laedermann
- Wyss Center for Bio and Neuroengineering, Geneva, Switzerland.,Investigation performed at the Faculty of Medicine, University of Geneva, in collaboration with Geneva University Hospitals, Geneva, Switzerland
| | - Ivan Furfaro
- Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, École Polytechnique Fédeérale de Lausanne (EPFL), Switzerland.,Investigation performed at the Faculty of Medicine, University of Geneva, in collaboration with Geneva University Hospitals, Geneva, Switzerland
| | - Dimitrios Stafylakis
- Department of Orthopaedics Surgery, Geneva University Hospitals, Geneva, Switzerland.,Investigation performed at the Faculty of Medicine, University of Geneva, in collaboration with Geneva University Hospitals, Geneva, Switzerland
| | - Didier Hannouche
- University Medical Center, University of Geneva, Geneva, Switzerland. Department of Orthopaedics Surgery, Geneva University Hospitals, Geneva, Switzerland.,Investigation performed at the Faculty of Medicine, University of Geneva, in collaboration with Geneva University Hospitals, Geneva, Switzerland
| | - Eric Gerstel
- University Medical Center, University of Geneva, Geneva, Switzerland. Clinique la Colline, Hirslanden, Geneva, Switzerland.,Investigation performed at the Faculty of Medicine, University of Geneva, in collaboration with Geneva University Hospitals, Geneva, Switzerland
| | - Karl-Heinz Krause
- Department of Pathology and Immunology, Medical School, University of Geneva, Geneva, Switzerland. University Medical Center, University of Geneva, Geneva, Switzerland.,Investigation performed at the Faculty of Medicine, University of Geneva, in collaboration with Geneva University Hospitals, Geneva, Switzerland
| | - Mathieu Assal
- University Medical Center, University of Geneva, Geneva, Switzerland. Foot and Ankle Surgery Centre, Centre Assal, Clinique La Colline, Hirslanden Geneva, Switzerland.,Investigation performed at the Faculty of Medicine, University of Geneva, in collaboration with Geneva University Hospitals, Geneva, Switzerland
| | - Jacques Menetrey
- University Medical Center, University of Geneva, Geneva, Switzerland. Centre for Sports Medicine and Exercise, Clinique la Colline, Hirslanden, Geneva, Switzerland.,Investigation performed at the Faculty of Medicine, University of Geneva, in collaboration with Geneva University Hospitals, Geneva, Switzerland
| | - Vannary Tieng
- University Medical Center, University of Geneva, Geneva, Switzerland. Vanarix SA, Lausanne, Switzerland.,Investigation performed at the Faculty of Medicine, University of Geneva, in collaboration with Geneva University Hospitals, Geneva, Switzerland
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Thorup AS, Dell'Accio F, Eldridge SE. A Mouse Model of Acute Cartilage Injury and Repair. Methods Mol Biol 2023; 2598:337-344. [PMID: 36355303 DOI: 10.1007/978-1-0716-2839-3_24] [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] [Indexed: 11/12/2022]
Abstract
Chondral defects are common and disabling. The development of pharmacological approaches for cartilage repair requires the availability of in vivo models which are amenable for gain and loss of function and ideally to genetic modification. In this chapter, we describe a method to induce full-thickness cartilage defects which, in young DBA/1 mice, heal spontaneously, but fail to heal in C57BL/6 mice of the same age or in aged DBA/1 mice. This model (or variants) has been used for genetic screenings to identify genes associated to repair capacity, to study stem cells involved in cartilage repair, and to study the function of molecules involved in repair mechanisms.
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Affiliation(s)
- Anne-Sophie Thorup
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Francesco Dell'Accio
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
| | - Suzanne E Eldridge
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
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35
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Browe DC, Burdis R, Díaz-Payno PJ, Freeman FE, Nulty JM, Buckley CT, Brama PA, Kelly DJ. Promoting endogenous articular cartilage regeneration using extracellular matrix scaffolds. Mater Today Bio 2022; 16:100343. [PMID: 35865410 PMCID: PMC9294195 DOI: 10.1016/j.mtbio.2022.100343] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/23/2022] [Accepted: 06/25/2022] [Indexed: 12/13/2022] Open
Abstract
Articular cartilage defects fail to heal spontaneously, typically progressing to osteoarthritis. Bone marrow stimulation techniques such as microfracture (MFX) are the current surgical standard of care; however MFX typically produces an inferior fibro-cartilaginous tissue which provides only temporary symptomatic relief. Here we implanted solubilised articular cartilage extracellular matrix (ECM) derived scaffolds into critically sized chondral defects in goats, securely anchoring these implants to the joint surface using a 3D-printed fixation device that overcame the need for sutures or glues. In vitro these ECM scaffolds were found to be inherently chondro-inductive, while in vivo they promoted superior articular cartilage regeneration compared to microfracture. In an attempt to further improve the quality of repair, we loaded these scaffolds with a known chemotactic factor, transforming growth factor (TGF)-β3. In vivo such TGF-β3 loaded scaffolds promoted superior articular cartilage regeneration. This study demonstrates that ECM derived biomaterials, either alone and particularly when combined with exogenous growth factors, can successfully treat articular cartilage defects in a clinically relevant large animal model.
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Affiliation(s)
- David C. Browe
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
- Department of Mechanical, Manufacturing and Biomedical Engineering, School of Engineering, Trinity College Dublin, Ireland
- Advanced Materials and Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland and Trinity College Dublin, Ireland
| | - Ross Burdis
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
- Department of Mechanical, Manufacturing and Biomedical Engineering, School of Engineering, Trinity College Dublin, Ireland
| | - Pedro J. Díaz-Payno
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
- Department of Mechanical, Manufacturing and Biomedical Engineering, School of Engineering, Trinity College Dublin, Ireland
| | - Fiona E. Freeman
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
- Department of Mechanical, Manufacturing and Biomedical Engineering, School of Engineering, Trinity College Dublin, Ireland
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge, MA, 02142, USA
- Department of Medicine Division of Engineering in Medicine Brigham and Women’s Hospital Harvard Medical School Boston, MA, 02115, USA
| | - Jessica M. Nulty
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
- Department of Mechanical, Manufacturing and Biomedical Engineering, School of Engineering, Trinity College Dublin, Ireland
| | - Conor T. Buckley
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
- Department of Mechanical, Manufacturing and Biomedical Engineering, School of Engineering, Trinity College Dublin, Ireland
- Advanced Materials and Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland and Trinity College Dublin, Ireland
- Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Pieter A.J. Brama
- Section of Veterinary Clinical Sciences, School of Veterinary Medicine, University College Dublin, Ireland
| | - Daniel J. Kelly
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
- Department of Mechanical, Manufacturing and Biomedical Engineering, School of Engineering, Trinity College Dublin, Ireland
- Advanced Materials and Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland and Trinity College Dublin, Ireland
- Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
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36
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Jiang W, Xiang X, Song M, Shen J, Shi Z, Huang W, Liu H. An all-silk-derived bilayer hydrogel for osteochondral tissue engineering. Mater Today Bio 2022; 17:100485. [PMID: 36388458 PMCID: PMC9660579 DOI: 10.1016/j.mtbio.2022.100485] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/29/2022] [Accepted: 11/01/2022] [Indexed: 11/11/2022] Open
Abstract
Osteochondral repair remains a challenge in clinical practice nowadays despite extensive advances in tissue engineering. The insufficient recruitment of endogenous cells in the early stage and incomplete cell differentiation in the later stage constitute the major difficulty of osteochondral repair. Here, a novel all-silk-derived multifunctional biomaterial platform for osteochondral engineering is reported. The bilayer methacrylated silk fibroin (SilMA) hydrogel was fabricated through stratified photocuring as the basic provisional matrix for tissue regeneration. Platelet-rich plasma (PRP) incorporation promoted the migration and pre-differentiation of the bone marrow mesenchymal stem cells (BMSCs) in the early stage of implantation. The long-term regulation of BMSCs chondrogenesis and osteogenesis was realized by the stratified anchoring of the silk fibroin (SF) microspheres respectively loaded with Kartogenin (KGN) and berberine (BBR) in the hydrogel. The composite hydrogels were further demonstrated to promote BMSCs chondrogenic and osteogenic differentiation under an inflammatory microenvironment and to achieve satisfying cartilage and subchondral bone regeneration with great biocompatibility after 8 weeks of implantation. Since all the components used are readily available and biocompatible and can be efficiently integrated via a simple process, this composite hydrogel scaffold has tremendous potential for clinical use in osteochondral regeneration.
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37
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Bielajew BJ, Donahue RP, Lamkin EK, Hu JC, Hascall VC, Athanasiou KA. Proteomic, mechanical, and biochemical development of tissue-engineered neocartilage. Biomater Res 2022; 26:34. [PMID: 35869489 PMCID: PMC9308280 DOI: 10.1186/s40824-022-00284-4] [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] [Received: 04/04/2022] [Accepted: 07/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background The self-assembling process of cartilage tissue engineering is a promising technique to heal cartilage defects, preventing osteoarthritic changes. Given that chondrocytes dedifferentiate when expanded, it is not known if cellular expansion affects the development of self-assembled neocartilage. The objective of this study was to use proteomic, mechanical, and biochemical analyses to quantitatively investigate the development of self-assembled neocartilage derived from passaged, rejuvenated costal chondrocytes. Methods Yucatan minipig costal chondrocytes were used to create self-assembled neocartilage constructs. After 1, 4, 7, 14, 28, 56, or 84 days of self-assembly, constructs were analyzed through a variety of histological, biomechanical, biochemical, and proteomic techniques. Results It was found that temporal trends in neocartilage formation are similar to those seen in native hyaline articular cartilage development. For example, between days 7 and 84 of culture, tensile Young’s modulus increased 4.4-times, total collagen increased 2.7-times, DNA content decreased 69.3%, collagen type II increased 1.5-times, and aggrecan dropped 55.3%, mirroring trends shown in native knee cartilage. Importantly, collagen type X, which is associated with cartilage calcification, remained at low levels (≤ 0.05%) at all neocartilage developmental time points, similar to knee cartilage (< 0.01%) and unlike donor rib cartilage (0.98%). Conclusions In this work, bottom-up proteomics, a powerful tool to interrogate tissue composition, was used for the first time to quantify and compare the proteome of a developing engineered tissue to a recipient tissue. Furthermore, it was shown that self-assembled, costal chondrocyte-derived neocartilage is suitable for a non-homologous approach in the knee. Supplementary Information The online version contains supplementary material available at 10.1186/s40824-022-00284-4.
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38
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Wodzig M, Peters M, Emanuel K, Van Hugten P, Wijnen W, Jutten L, Boymans T, Loeffen D, Emans P. Minced Autologous Chondral Fragments with Fibrin Glue as a Simple Promising One-Step Cartilage Repair Procedure: A Clinical and MRI Study at 12-Month Follow-Up. Cartilage 2022; 13:19-31. [PMID: 36305343 PMCID: PMC9924984 DOI: 10.1177/19476035221126343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate early radiological and clinical outcome of autologous minced cartilage treatment as a single-step treatment option in patients with a chondral or osteochondral lesion (OCL) in the knee. DESIGN Eighteen patients with an OCL in the knee were included. Cartilage from healthy-appearing loose bodies and/or the periphery of the defect were minced into small chips and sealed in the defect using fibrin glue. Preoperatively, and at 3 (n = 14) and 12 (n = 18) months follow-up, magnetic resonance imaging (MRI) was performed. The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 score was used to assess the cartilage repair tissue on MRI at 12 months. The International Knee Documentation Score, Knee Injury and Osteoarthritis Outcome Score, EuroQoL-5D, and Visual Analogue Scale pain were collected preoperatively and 12 months after surgery. RESULTS Three months postoperative, MRI showed complete defect filling in 11 out of 14 patients. Mean MOCART 2.0 score at 12 months was 65.0 ± 18.9 with higher scores for lateral femoral chondral lesions compared to medial femoral chondral lesions (75.8 ± 14.3, 52.5 ± 15.8 respectively, P = 0.02). Clinical and statistical significant improvements were observed in the patient-reported outcome measures at 12 months postoperatively compared to preoperatively. CONCLUSION Treatment of OCLs using the autologous minced cartilage procedure resulted in good cartilage repair measured by MOCART 2.0. Clinically relevant improvements were observed in the clinical scores. This study suggests autologous minced cartilage as a promising, single-step treatment for OCLs.
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Affiliation(s)
- M.H.H. Wodzig
- Department of Orthopedic Surgery,
Joint-Preserving Clinic, Maastricht University Medical Center, Maastricht, The
Netherlands,M.H.H. Wodzig, Department of Orthopedic
Surgery, Joint-Preserving Clinic, Maastricht University Medical Center,
Maastricht 6229 HX, The Netherlands.
| | | | - K.S. Emanuel
- Department of Orthopedic Surgery,
Joint-Preserving Clinic, Maastricht University Medical Center, Maastricht, The
Netherlands,Department of Orthopedic Surgery,
Amsterdam UMC, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - P.P.W. Van Hugten
- Department of Orthopedic Surgery,
Joint-Preserving Clinic, Maastricht University Medical Center, Maastricht, The
Netherlands
| | - W. Wijnen
- Department of Orthopedic Surgery,
Joint-Preserving Clinic, Maastricht University Medical Center, Maastricht, The
Netherlands
| | - L.M. Jutten
- Department of Orthopedic Surgery,
Joint-Preserving Clinic, Maastricht University Medical Center, Maastricht, The
Netherlands
| | - T.A. Boymans
- Department of Orthopedic Surgery,
Joint-Preserving Clinic, Maastricht University Medical Center, Maastricht, The
Netherlands
| | - D.V. Loeffen
- Department of Radiology, Maastricht
University Medical Center, Maastricht, The Netherlands
| | - P.J. Emans
- Department of Orthopedic Surgery,
Joint-Preserving Clinic, Maastricht University Medical Center, Maastricht, The
Netherlands
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Filippo M, Laura M, Riccardo G, Valeria V, Eschweiler J, Maffulli N. Mesenchymal stem cells augmentation for surgical procedures in patients with symptomatic chondral defects of the knee: a systematic review. J Orthop Surg Res 2022; 17:415. [PMID: 36104803 PMCID: PMC9476260 DOI: 10.1186/s13018-022-03311-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 09/01/2022] [Indexed: 01/22/2023] Open
Abstract
Abstract
Background
The efficacy and safety profile of mesenchymal stem cells (MSCs) augmentation in chondral procedures are controversial. This systematic review updated the current evidence on MSCs augmentation for chondral procedures in patients with symptomatic chondral defects of the knee.
Methods
This study followed the PRISMA guidelines. The literature search was updated in August 2022. Two independent authors accessed PubMed, Google scholar, Embase, and Scopus. No additional filters or time constrains were used for the search. A cross reference of the bibliographies was also performed. All the clinical studies investigating surgical procedures for chondral defects of the knee augmented with MSCs were accessed. Defects of both tibiofemoral and patellofemoral joints were included. The following patient reported outcomes measures (PROMs) were retrieved at baseline and last follow-up: Visual Analogic Scale (VAS), Tegner Activity Scale, Lysholm Knee Scoring System, International Knee Documentation Committee (IKDC). Return to daily activities and data on hypertrophy, failure, revision surgery were also collected. Failures were defined as the recurrence of symptoms attributable to the index procedure. Revisions were defined as any reoperation at the site of the index procedure.
Results
A total of 15 clinical studies (411 procedures) were included. Patients returned to their prior sport activity at 2.8 ± 0.4 months. All the PROMs improved at last follow-up: Tegner (P = 0.0002), Lysholm (P < 0.0001), the IKDC (P < 0.0001), VAS (P < 0.0001). At a mean of 30.1 ± 13.9 months, 3.1% (2 of 65 patients) reported graft hypertrophy, 3.2% (2 of 63) were considered failures. No surgical revision procedures were reported. Given the lack of available quantitative data for inclusion, a formal comparison of surgical procedures was not conducted.
Conclusion
MSCs augmentation in selected chondral procedures could be effective, with a low rate of complications. Further investigations are required to overcome the current limitations to allow the clinical translation of MSCs in regenerative medicine.
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Augmented Marrow Stimulation: Drilling Techniques and Scaffold Options. OPER TECHN SPORT MED 2022. [DOI: 10.1016/j.otsm.2022.150958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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41
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Next Generation Cartilage Repair and the Pre-arthroplasty Patient. OPER TECHN SPORT MED 2022. [DOI: 10.1016/j.otsm.2022.150956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Sofu H, Gumussuyu G, Guler O, Ucpunar H, Duman S, Camurcu Y. Lesion size and varus malalignment are the major determinants leading to poorer clinical outcomes after combined microfracture treatment for focal cartilage lesions during anterior cruciate ligament reconstruction. Arch Orthop Trauma Surg 2022; 142:1941-1949. [PMID: 34448044 DOI: 10.1007/s00402-021-04138-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 08/20/2021] [Indexed: 10/20/2022]
Abstract
The purposes of this study were to evaluate the clinical effects of microfracture (MFX) performed for Outerbridge grade 3 or 4 focal cartilage lesion during the same surgery with arthroscopic anterior cruciate ligament (ACL) reconstruction and to analyze the major determinants of these potential effects on the clinical outcome. The clinical and radiographic data of 119 patients were evaluated. The mean follow-up time was 32.6 ± 6 months. Isolated arthroscopic ACL reconstruction was performed in 70 patients (Group 1), whereas MFX for Outerbridge grade 3 or 4 chondral lesion during ACL surgery was performed in 49 patients (Group 2). Visual analogue scale (VAS) score, Lysholm knee score, and Tegner activity scale were the instruments used as outcome measures to evaluate the clinical status of the patients. Routine X-ray and MRI were also performed for all patients pre-operatively as well as at the latest follow-up visit. Lineer regression analysis was performed to determine major factors predicting the poorer clinical outcome. Clinical outcomes were similar between isolated ACL reconstruction and combined procedure. On the other hand, according to lineer regression analysis, cartilage lesion size > 2 cm2 and > 5 degrees of varus alignment were detected as the major determinants leading to poorer outcomes in combined ACL reconstruction and MFX.Level of evidence: III - Retrospective Comparative Study.
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Affiliation(s)
- Hakan Sofu
- Orthopedics and Traumatology, Altinbas University Faculty of Medicine, Istanbul, Turkey. .,Altinbas University MedicalPark Bahcelievler Hospital, Bahcelievler mahallesi E-5 Yan yolu Kultur sokak No: 1, 34160, Istanbul, Turkey.
| | - Gurkan Gumussuyu
- Orthopedics and Traumatology, Liv Hospital, Istinye University, Istanbul, Turkey
| | - Olcay Guler
- Orthopedics and Traumatology, Memorial Health Group Sisli Hospital, Istanbul, Turkey
| | - Hanifi Ucpunar
- Orthopedics and Traumatology, Baltalimani Bone and Joint Diseases Hospital, Istanbul, Turkey
| | - Serda Duman
- Orthopedics and Traumatology, Diyarbakir Selahaddin Eyyubi State Hospital, Diyarbakir, Turkey
| | - Yalkin Camurcu
- Orthopedics and Traumatology, Aritmi Hospital Group, Bursa, Turkey
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Stachel N, Orth P, Zurakowski D, Menger MD, Laschke MW, Cucchiarini M, Madry H. Subchondral Drilling Independent of Drill Hole Number Improves Articular Cartilage Repair and Reduces Subchondral Bone Alterations Compared With Debridement in Adult Sheep. Am J Sports Med 2022; 50:2669-2679. [PMID: 35834876 DOI: 10.1177/03635465221104775] [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: 01/31/2023]
Abstract
BACKGROUND Subchondral drilling is an established marrow stimulation technique for small cartilage defects, but whether drilling is required at all and if the drill hole density affects repair remains unclear. HYPOTHESES Osteochondral repair is improved when the subchondral bone is perforated by a higher number of drill holes per unit area, and drilling is superior to defect debridement alone. STUDY DESIGN Controlled laboratory study. METHODS Rectangular full-thickness chondral defects (4 × 8 mm) were created in the trochlea of adult sheep (N = 16), debrided down to the subchondral bone plate without further treatment as controls (no treatment; n = 7) or treated with either 2 or 6 (n = 7 each) subchondral drill holes (diameter, 1.0 mm; depth, 10.0 mm). Osteochondral repair was assessed at 6 months postoperatively by standardized (semi-)quantitative macroscopic, histological, immunohistochemical, biochemical, and micro-computed tomography analyses. RESULTS Compared with defect debridement alone, histological overall cartilaginous repair tissue quality (P = .025) and the macroscopic aspect of the adjacent cartilage (P≤ .032) were improved after both drilling densities. Only drilling with 6 holes increased type 2 collagen content in the repair tissue compared with controls (P = .038). After debridement, bone mineral density was significantly decreased in the subchondral bone plate (P≤ .015) and the subarticular spongiosa (P≤ .041) compared with both drilling groups. Debridement also significantly increased intralesional osteophyte sectional area compared with drilling (P≤ .034). No other differences in osteochondral repair existed between subchondral drilling with 6 or 2 drill holes. CONCLUSION Subchondral drilling independent of drill hole density significantly improves structural cartilage repair compared with sole defect debridement of full-thickness cartilage defects in sheep after 6 months. Subchondral drilling also leads to a better reconstitution of the subchondral bone compartment below the defects. Simultaneously, drilling reduced the formation of intralesional osteophytes caused by osseous overgrowth compared with debridement. CLINICAL RELEVANCE These results have important clinical implications, as they support subchondral drilling independent of drill hole number but discourage debridement alone for the treatment of small cartilage defects. Clinical studies are warranted to further quantify the effects of subchondral drilling in similar settings.
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Affiliation(s)
- Niklas Stachel
- Center of Experimental Orthopaedics, Saarland University Medical Center and Saarland University, Homburg/Saar, Germany
| | - Patrick Orth
- Center of Experimental Orthopaedics, Saarland University Medical Center and Saarland University, Homburg/Saar, Germany
| | - David Zurakowski
- Departments of Anesthesia and Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael D Menger
- Institute for Clinical and Experimental Surgery, Saarland University Medical Center and Saarland University, Homburg/Saar, Germany
| | - Matthias W Laschke
- Institute for Clinical and Experimental Surgery, Saarland University Medical Center and Saarland University, Homburg/Saar, Germany
| | - Magali Cucchiarini
- Center of Experimental Orthopaedics, Saarland University Medical Center and Saarland University, Homburg/Saar, Germany
| | - Henning Madry
- Center of Experimental Orthopaedics, Saarland University Medical Center and Saarland University, Homburg/Saar, Germany
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Microenvironmentally optimized 3D-printed TGFβ-functionalized scaffolds facilitate endogenous cartilage regeneration in sheep. Acta Biomater 2022; 150:181-198. [PMID: 35896136 DOI: 10.1016/j.actbio.2022.07.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/22/2022] [Accepted: 07/19/2022] [Indexed: 11/21/2022]
Abstract
Clinically, microfracture is the most commonly applied surgical technique for cartilage defects. However, an increasing number of studies have shown that the clinical improvement remains questionable, and the reason remains unclear. Notably, recent discoveries revealed that signals from regenerated niches play a critical role in determining mesenchymal stem cell fate specification and differentiation. We speculate that a microenvironmentally optimized scaffold that directs mesenchymal stem cell fate will be a good therapeutic strategy for cartilage repair. Therefore, we first explored the deficiency of microfractures in cartilage repair. The microfracture not only induced inflammatory cell aggregation in blood clots but also consisted of loose granulation tissue with increased levels of proteins related to fibrogenesis. We then fabricated a functional cartilage scaffold using two strong bioactive cues, transforming growth factor-β3 and decellularized cartilage extracellular matrix, to modulate the cell fate of mesenchymal stem cells. Additionally, poly(ε-caprolactone) was also coprinted with extracellular matrix-based bioinks to provide early mechanical support. The in vitro studies showed that microenvironmentally optimized scaffolds exert powerful effects on modulating the mesenchymal stem cell fate, such as promoting cell migration, proliferation and chondrogenesis. Importantly, this strategy achieved superior regeneration in sheep via scaffolds with biomechanics (restored well-organized collagen orientation) and antiapoptotic properties (cell death-related genes were also downregulated). In summary, this study provides evidence that microenvironmentally optimized scaffolds improve cartilage regeneration in situ by regulating the microenvironment and support further translation in human cartilage repair. STATEMENT OF SIGNIFICANCE: Although microfracture (MF)-based treatment for chondral defects has been commonly used, critical gaps exist in understanding the biochemistry of MF-induced repaired tissue. More importantly, the clinically unsatisfactory effects of MF treatment have prompted researchers to focus on tissue engineering scaffolds that may have sufficient therapeutic efficacy. In this manuscript, a 3D printing ink containing cartilage tissue-specific extracellular matrix (ECM), methacrylate gelatin (GelMA), and transforming growth factor-β3 (TGF-β3)-embedded polylactic-coglycolic acid (PLGA) microspheres was coprinted with poly(ε-caprolactone) (PCL) to fabricate tissue engineering scaffolds for chondral defect repair. The sustained release of TGF-β3 from scaffolds successfully directed endogenous stem/progenitor cell migration and differentiation. This microenvironmentally optimized scaffold produced improved tissue repair outcomes in the sheep animal model, explicitly guiding more organized neotissue formation and therefore recapitulating the anisotropic structure of native articular cartilage. We hypothesized that the cell-free scaffolds might improve the clinical applicability and become a new therapeutic option for chondral defect repair.
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Fortier LM, Knapik DM, Dasari SP, Polce EM, Familiari F, Gursoy S, Chahla J. Clinical and Magnetic Resonance Imaging Outcomes After Microfracture Treatment With and Without Augmentation for Focal Chondral Lesions in the Knee: A Systematic Review and Meta-analysis. Am J Sports Med 2022:3635465221087365. [PMID: 35736251 DOI: 10.1177/03635465221087365] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Focal cartilage lesions represent a common source of knee pain and disability, with the potential for the development and progression of osteoarthritis. Currently, microfracture (MFx) represents the most utilized first-line surgical treatment for small, focal chondral lesions. Recent investigations have examined methods of overcoming the limitations of MFx utilizing various augmentation techniques. PURPOSE To perform a systematic review and meta-analysis evaluating clinical and radiographic outcomes in patients undergoing isolated MFx versus MFx augmented with orthobiologics or scaffolds for focal chondral defects of the knee. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS A systematic review was performed to identify studies evaluating outcomes and adverse events in patients undergoing isolated MFx versus augmented MFx for focal chondral defects in the knee from 1945 to June 1, 2021. Data were extracted from each article that met the inclusion/exclusion criteria. Meta-analyses were performed for all outcomes reported in a minimum of 3 studies. RESULTS A total of 14 studies were identified, utilizing 7 different types of injectable augmentation regimens and 5 different scaffolding regimens. Across the 14 studies, a total of 744 patients were included. The mean patient age was 46.8 years (range, 34-58 years), and 58.3% (n = 434/744) of patients were women. The mean final follow-up time was 26.7 months (range, 12-60 months). The mean chondral defect size ranged from 1.3 to 4.8 cm2. A post hoc analysis comparing mean improvement in postoperative outcomes scores compared with preoperative values found no significant differences in the improvement in the visual analog scale (VAS), International Knee Documentation Committee (IKDC), or Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores between patients undergoing isolated MFx and those undergoing MFx + augmentation. Patients undergoing MFx + augmentation reported significantly greater improvements in the Lysholm score and postoperative MOCART (magnetic resonance observation of cartilage repair tissue) scores compared with the isolated MFx group. CONCLUSION Patients undergoing combined MFx + augmentation reported significant improvements in mean Lysholm and MOCART scores, without significant improvements in VAS, IKDC, or WOMAC scores when compared with patients undergoing isolated MFx.
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Affiliation(s)
- Luc M Fortier
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, Washington University Medical Center, Saint Louis, Missouri, USA
| | - Suhas P Dasari
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Evan M Polce
- University of Wisconsin School of Medicine, Madison, Wisconsin, USA
| | - Filippo Familiari
- Department of Orthopaedic Surgery, Magna Graecia University, Catanzaro, Italy
| | - Safa Gursoy
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Janacova V, Szomolanyi P, Kirner A, Trattnig S, Juras V. Adjacent cartilage tissue structure after successful transplantation: a quantitative MRI study using T 2 mapping and texture analysis. Eur Radiol 2022; 32:8364-8375. [PMID: 35737095 DOI: 10.1007/s00330-022-08897-y] [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: 01/21/2022] [Revised: 05/03/2022] [Accepted: 05/19/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to assess the texture of repair tissue and tissue adjacent to the repair site after matrix-associated chondrocyte transplantation (MACT) of the knee using gray-level co-occurrence matrix (GLCM) texture analysis of T2 quantitative maps. METHODS Twenty patients derived from the MRI sub-study of multicenter, single-arm phase III study underwent examination on a 3 T MR scanner, including a T2 mapping sequence 12 and 24 months after MACT. Changes between the time points in mean T2 values and 20 GLCM features were assessed for repair tissue, adjacent tissue, and reference cartilage. Differences in T2 values and selected GLCM features between the three cartilage sites at two time points were analyzed using linear mixed-effect models. RESULTS A significant decrease in T2 values after MACT, between time points, was observed only in repair cartilage (p < 0.001). Models showed significant differences in GLCM features between repair tissue and reference cartilage, namely, autocorrelation (p < 0.001), correlation (p = 0.015), homogeneity (p = 0.002), contrast (p < 0.001), and difference entropy (p = 0.047). The effect of time was significant in a majority of models with regard to GLCM features (except autocorrelation) (p ≤ 0.001). Values in repair and adjacent tissue became similar to reference tissue over time. CONCLUSIONS GLCM is a useful add-on to T2 mapping in the evaluation of knee cartilage after MACT by increasing the sensitivity to changes in cartilage structure. The results suggest that cartilage tissue adjacent to the repair site heals along with the cartilage implant. KEY POINTS • GLCM is a useful add-on to T2 mapping in the evaluation of knee cartilage after MACT by increasing the sensitivity to changes in cartilage structure. • Repair and adjacent tissue became similar to reference tissue over time. • The results suggest that cartilage tissue adjacent to the repair site heals along with the cartilage implant.
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Affiliation(s)
- Veronika Janacova
- High-Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, BT32, Lazarettgasse 14, 1090, Vienna, Austria
| | - Pavol Szomolanyi
- High-Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, BT32, Lazarettgasse 14, 1090, Vienna, Austria.,Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Alexandra Kirner
- TETEC Tissue Engineering Technologies AG, Aspenhaustraße 18, 72770, Reutlingen, Germany
| | - Siegfried Trattnig
- High-Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, BT32, Lazarettgasse 14, 1090, Vienna, Austria. .,CD Laboratory for Clinical Molecular MR Imaging, Vienna, Austria. .,Austrian Cluster for Tissue Regeneration, Vienna, Austria. .,Institute for Clinical Molecular MRI in the Musculoskeletal System, Karl Landsteiner Society, Vienna, Austria.
| | - Vladimir Juras
- High-Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, BT32, Lazarettgasse 14, 1090, Vienna, Austria
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Swindell HW, Kerzner B, Obioha OA, Fortier LM, Khan ZA, Dasari SP, Mameri ES, Gelber PE, Chahla J. Osteochondral Allograft Transplantation of the Lateral Femoral Condyle and Distal Femoral Osteotomy in the Setting of Failed Osteochondritis Dissecans Fixation. Arthrosc Tech 2022; 11:e1301-e1310. [PMID: 35936851 PMCID: PMC9353333 DOI: 10.1016/j.eats.2022.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/09/2022] [Indexed: 02/03/2023] Open
Abstract
Osteochondritis dissecans (OCD) is a pathologic condition, most commonly affecting the knee joint in adolescents and young adults, although pathology can also be found at the elbow and ankle. Lesions to the medial femoral condyle are classically associated with varus alignment, while lesions to the lateral femoral condyle are seen in patients with valgus malalignment. Common risk factors for failed fixation of OCD lesions include unstable lesions to the lateral femoral condyle, screw breakage, older age, and closed physes. The purpose of this technical note is to describe the preoperative planning and step-by-step surgical approach for treatment of failed fixation of an OCD lesion of the posterior aspect of the lateral femoral condyle in young, active patients using an osteochondral allograft, a lateral opening wedge distal femoral osteotomy to correct malalignment, and a tibial tubercle osteotomy to facilitate access to the lesion.
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Affiliation(s)
- Hasani W. Swindell
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Benjamin Kerzner
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Obianuju A. Obioha
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Luc M. Fortier
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Zeeshan A. Khan
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Suhas P. Dasari
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Enzo S. Mameri
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Pablo E. Gelber
- Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Catalunya, Spain,Institut Català de Traumatologia i Medicina de l’Esport, Hospital Universitari Dexeus, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Jorge Chahla
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A,Address correspondence to Jorge Chahla, M.D., Ph.D., Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St. Suite 300, Chicago, IL 60612, U.S.A.
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Migliorini F, Maffulli N, Baroncini A, Bell A, Hildebrand F, Schenker H. Autologous matrix-induced chondrogenesis is effective for focal chondral defects of the knee. Sci Rep 2022; 12:9328. [PMID: 35661147 PMCID: PMC9167289 DOI: 10.1038/s41598-022-13591-6] [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] [Received: 11/09/2021] [Accepted: 05/17/2022] [Indexed: 12/05/2022] Open
Abstract
Focal chondral defects of the knee are common and their management is challenging. This study investigated the efficacy and safety of Autologous Matrix-Induced Chondrogenesis (AMIC) for focal chondral defects of the knee. A systematic review and meta-analysis was conducted (according to the 2020 PRISMA statement) to investigate the efficacy of AMIC in improving symptoms and to compare AMIC versus microfracture (MFx). In January 2022, the following databases were accessed: Pubmed, Web of Science, Google Scholar, Embase. No time constrain was used for the search. All the clinical trials investigating AMIC and/or those comparing AMIC versus MFx for focal chondral defects of the knee were accessed. Only studies published in peer reviewed journals were considered. Studies which investigated other locations of the defects rather than knee were not eligible, nor those reporting data form mixed locations. Studies which reported data on revision settings, as well as those investigating efficacy on kissing lesions or multiple locations, were not suitable. The mean difference (MD) and odd ratio (OR) effect measure were used for continuous and binary data, respectively. Data from 18 studies (548 patients) were retrieved with a mean follow-up of 39.9 ± 26.5 months. The mean defect size was 3.2 ± 1.0 cm2. The visual analogue scale (VAS) decreased of − 3.9/10 (95% confidence interval (CI) − 4.0874 to -3.7126), the Tegner Activity Scale increased of + 0.8/10 (95% CI 0.6595 to 0.9405). The Lysholm Knee Scoring System increased of + 28.9/100 (95% CI 26.8716 to 29.1284), as did the International Knee Documentation Committee (IKDC) + 33.6/100 (95% CI 32.5800 to 34.6200). At last follow-up no patient showed signs of hypertrophy. 4.3% (9 of 210) of patients underwent revision procedures. The rate of failure was 3.8% (9 of 236). Compared to MFx, AMIC demonstrated lower VAS score (MD: − 1.01; 95% CI − 1.97 to 0.05), greater IKDC (MD: 11.80; 95% CI 6.65 to 16.94), and lower rate of revision (OR: 0.16; 95% CI 0.06 to 0.44). AMIC is effective for focal chondral defects of the knee. Furthermore, AMIC evidenced greater IKDC, along with a lower value of VAS and rate of revision compared to MFx.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy.,School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, ST4 7QB, Stoke on Trent, England.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, E1 4DG, London, England
| | - Alice Baroncini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Andreas Bell
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152, Simmerath, Germany
| | - Frank Hildebrand
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Hanno Schenker
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
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Franceschini M, Boffa A, Andriolo L, Di Martino A, Zaffagnini S, Filardo G. The 50 most-cited clinical articles in cartilage surgery research: a bibliometric analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:1901-1914. [PMID: 35034148 DOI: 10.1007/s00167-021-06834-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/02/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE Articular cartilage lesions remain a challenge for orthopedic surgeons. The identification of the most important articles can help identifying the most influential techniques of the past, the current prevalent focus, and emerging strategies. The aim of this study was to identify milestones and trends in cartilage research. METHODS This study is a bibliometric analysis based on published articles. All citation count data included in the "Scopus database" were used to identify eligible studies up to December 2020. The 50 most-cited articles on cartilage surgery were ranked based on the citation count and analyzed regarding citation density and quality (Coleman score and RoB 2.0 tool). A further search was performed to identify the most promising clinical studies among the latest publications on cartilage surgery. RESULTS Different kinds of cartilage treatments were investigated in the 50 most-cited clinical articles. Regenerative techniques with chondrocytes were the most reported with a total of 23 articles, followed by microfracture technique in 17 articles and mosaicplasty or osteochondral autograft transplantation (OAT) in 11. Forty-five articles focused on the knee. A higher citation density was found in the most recent articles (p = 0.004). The study of the most promising landmarks of the most recent articles showed new cell-free or tissue engineering-based procedures and an overall increasing quality of the published studies. CONCLUSION This bibliometric analysis documented an increasing interest in cartilage surgery, with efforts toward high-quality studies. Over the years, the focus switched from reconstructive toward regenerative techniques, with emerging options including cell-free and tissue-engineering strategies to restore the cartilage surface. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Marco Franceschini
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Angelo Boffa
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Andriolo
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Alessandro Di Martino
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Filardo
- Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland.,Facoltà Di Scienze Biomediche, Università della Svizzera Italiana, Lugano, Switzerland
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Platelet-Rich Plasma and Adipose-Derived Mesenchymal Stem Cells in Association with Arthroscopic Microfracture of Knee Articular Cartilage Defects: A Pilot Randomized Controlled Trial. Adv Orthop 2022; 2022:6048477. [PMID: 35529427 PMCID: PMC9072009 DOI: 10.1155/2022/6048477] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/16/2022] [Indexed: 11/17/2022] Open
Abstract
Background This study aims to compare the effects of platelet-rich plasma (PRP) alone or in combination with adipose-derived mesenchymal stem cells (AD-MSCs) in patients affected by cartilage defects, undergoing knee arthroscopic microfracture. Methods Thirty-eight patients diagnosed with a knee monocompartmental cartilage defect (Outerbridge grade IV) on the MRI, underwent an arthroscopic procedure. After the confirmation of the lesion, they all received the same bone marrow stimulation technique (microfracture) and were randomized into two groups: the first one had additional PRP injection (group A), while the second received PRP and AD-MSC injection (group B). Knee assessment and pain score were documented with Knee Injury Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score, Short-Form (SF) 12, and Visual Analogue Scale (VAS) before the treatment and at 1, 3, 6, and 12 months of follow-up postoperatively. An additional arthroscopic procedure, performed in four patients for a subsequent meniscal lesion, let us evaluate cartilage evolution by performing a macro/microscopical assessment on cartilage biopsy specimens. Results At the 12-month follow-up, both groups showed a comparable functional improvement. The scores on the IKDC form, KOOS, pain VAS, and SF-12 significantly improved from baseline (p < 0.05) to 12 months postoperatively in both treatment groups. The four second-look arthroscopies showed a complete repair of the articular defects by smooth solid cartilage layer, with a good chondrocytic population, in both groups. A thick smooth hyaline-like cartilage with a predominantly viable cell population and normal mineralization (a form closely resembling native tissue) was observed in group B. Conclusions Modern regenerative medicine techniques, such as PRP and AD-MSC, associated with traditional arthroscopic bone marrow stimulating techniques, seem to enhance cartilage restoration ability. The preliminary results of this pilot study encourage the synergic use of these regenerative modulating systems to improve the quality of the regenerated cartilage.
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