1
|
Zhang Z, Mu Y, Zhou H, Yao H, Wang DA. Cartilage Tissue Engineering in Practice: Preclinical Trials, Clinical Applications, and Prospects. TISSUE ENGINEERING. PART B, REVIEWS 2023; 29:473-490. [PMID: 36964757 DOI: 10.1089/ten.teb.2022.0190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
Articular cartilage defects significantly compromise the quality of life in the global population. Although many strategies are needed to repair articular cartilage, including microfracture, autologous osteochondral transplantation, and osteochondral allograft, the therapeutic effects remain suboptimal. In recent years, with the development of cartilage tissue engineering, scientists have continuously improved the formulations of therapeutic cells, biomaterial-based scaffolds, and biological factors, which have opened new avenues for better therapeutics of cartilage lesions. This review focuses on advances in cartilage tissue engineering, particularly in preclinical trials and clinical applications, prospects, and challenges.
Collapse
Affiliation(s)
- Zhen Zhang
- Department of Biomedical Engineering, City University of Hong Kong, Kowloon, Hong Kong SAR
| | - Yulei Mu
- Department of Biomedical Engineering, City University of Hong Kong, Kowloon, Hong Kong SAR
| | - Huiqun Zhou
- Department of Biomedical Engineering, City University of Hong Kong, Kowloon, Hong Kong SAR
| | - Hang Yao
- School of Chemistry and Chemical Engineering, Yangzhou University, Yangzhou, P.R. China
| | - Dong-An Wang
- Department of Biomedical Engineering, City University of Hong Kong, Kowloon, Hong Kong SAR
- Karolinska Institutet Ming Wai Lau Centre for Reparative Medicine, HKSTP, Sha Tin, Hong Kong SAR
- Shenzhen Research Institute, City University of Hong Kong, Shenzhen, P.R. China
| |
Collapse
|
2
|
Lineham B, Wijayathunga H, Moran E, Shuweihdi F, Gupta H, Pandit H, Wijayathunga N. A systematic review demonstrating correlation of MRI compositional parameters with clinical outcomes following articular cartilage repair interventions in the knee. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100388. [PMID: 37560388 PMCID: PMC10407572 DOI: 10.1016/j.ocarto.2023.100388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/21/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE Compositional-MRI parameters enable the assessment of cartilage ultrastructure. Correlation of these parameters with clinical outcomes is unclear. This systematic review investigated the correlation of various compositional- MRI parameters with clinical outcome measures following cartilage repair or regeneration interventions in the knee. DESIGN This study was registered with PROSPERO and reported in accordance with PRISMA. PubMed, Institute of Science Index, Scopus, Cochrane Central Register of Controlled Trials, and Embase databases were searched. All studies, regardless of type, that presented correlation of compositional- MRI parameters with clinical outcome measures were included. Two researchers independently performed data extraction and QUADAS-2 analysis. Compositional-MRI parameter change following intervention and correlation with clinical outcome measures were evaluated. RESULTS 19 studies were included. Risk of bias was generally low. 5 different compositional parameters were observed from the included studies. However, due to the significant variability in the reporting of compositional-MRI parameters across studies, meta-analyses were possible only for T2 values and T2 index values (T2 value of repair cartilage relative to normal cartilage). Correlation of T2 values of repair cartilage with clinical outcome score was r = 0.33 [0.15, 0.52]. Correlation of T2 index with clinical outcome score was r = 0.52 [0.32, 0.77]. CONCLUSIONS Correlation between T2 values and clinical outcome scores following knee cartilage repair were found. The heterogeneity of the correlations extracted from the included studies limited the scope for the meta-analysis. Thus, standardised, high-quality studies are required for better assessment of correlation between compositional MRI parameters and clinical outcome measures after cartilage repair. REGISTRATION NUMBER PROSPERO CRD42021287364.Study protocol available on PROSPERO website.
Collapse
Affiliation(s)
- Beth Lineham
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK
| | | | - Emma Moran
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Harun Gupta
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Hemant Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK
| | | |
Collapse
|
3
|
Vogelmann T, Roessler PP, Buhs M, Ostermeier S, Gille J, Hoburg A, Zöllner Y, Schwarz S, Schubert T, Grebe M, Zinser W. Long-term cost-effectiveness of matrix-associated chondrocyte implantation in the German health care system: a discrete event simulation. Arch Orthop Trauma Surg 2023; 143:1417-1427. [PMID: 35064292 PMCID: PMC9957880 DOI: 10.1007/s00402-021-04318-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cartilage defects in the knee can be caused by injury, various types of arthritis, or degeneration. As a long-term consequence of cartilage defects, osteoarthritis can develop over time, often leading to the need for a total knee replacement (TKR). The treatment alternatives of chondral defects include, among others, microfracture, and matrix-associated autologous chondrocyte implantation (M-ACI). The purpose of this study was to determine cost-effectiveness of M-ACI in Germany with available mid- and long-term outcome data, with special focus on the avoidance of TKR. MATERIALS AND METHODS We developed a discrete-event simulation (DES) that follows up individuals with cartilage defects of the knee over their lifetimes. The DES was conducted with a status-quo scenario in which M-ACI is available and a comparison scenario with no M-ACI available. The model included 10,000 patients with articular cartilage defects. We assumed Weibull distributions for short- and long-term effects for implant failures. Model outcomes were costs, number of TKRs, and quality-adjusted life years (QALYs). All analyses were performed from the perspective of the German statutory health insurance. RESULTS The majority of patients was under 45 years old, with defect sizes between 2 and 7 cm2 (mean: 4.5 cm2); average modeled lifetime was 48 years. In the scenario without M-ACI, 26.4% of patients required a TKR over their lifetime. In the M-ACI scenario, this was the case in only 5.5% of cases. Thus, in the modeled cohort of 10,000 patients, 2700 TKRs, including revisions, could be avoided. Patients treated with M-ACI experienced improved quality of life (22.53 vs. 21.21 QALYs) at higher treatment-related costs (18,589 vs. 14,134 € /patient) compared to those treated without M-ACI, yielding an incremental cost-effectiveness ratio (ICER) of 3376 € /QALY. CONCLUSION M-ACI is projected to be a highly cost-effective treatment for chondral defects of the knee in the German healthcare setting.
Collapse
Affiliation(s)
| | | | | | | | - Justus Gille
- University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | | | - York Zöllner
- Hamburg University of Applied Sciences, Hamburg, Germany
| | | | - Tino Schubert
- LinkCare GmbH, Kyffhäuserstr. 64, 70469 Stuttgart, Germany
| | | | - Wolfgang Zinser
- OrthoExpert Fohnsdorf, Austria and GFO-Kliniken Niederrhein, Dinslaken, Germany
| |
Collapse
|
4
|
Shinohara M, Akagi R, Watanabe A, Kato Y, Sato Y, Morikawa T, Iwasaki J, Nakagawa K, Akatsu Y, Ohtori S, Sasho T. Time-Dependent Change in Cartilage Repair Tissue Evaluated by Magnetic Resonance Imaging up to 2 years after Atelocollagen-Assisted Autologous Cartilage Transplantation: Data from the CaTCh Study. Cartilage 2022; 13:19476035221109227. [PMID: 35815923 PMCID: PMC9277438 DOI: 10.1177/19476035221109227] [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: 11/16/2022] Open
Abstract
OBJECTIVE To elucidate the time course of magnetic resonance imaging (MRI)-based morphological and qualitative outcomes after an atelocollagen-assisted autologous chondrocyte implantation (ACI) and to analyze the correlation between arthroscopic and MRI-based assessment. DESIGN We included ACI recipients from a multicenter registration study (CaTCh [Cartilage Treatment in Chiba] study). Morphological (3-dimensional magnetic resonance observation of cartilage repair tissue: 3D-MOCART, MOCART2.0) and qualitative assessment (T2- and T1rho-mapping) by MRI were conducted at 6, 12, and 24 months post-implantation. Global T2 and T1rho indices (T2 and T1rho in repair tissue divided by T2 and T1rho in normal cartilage) were calculated. Arthroscopic second-look assessment was performed in 4 and 15 knees at 12 and 24 months post-implantation, respectively. RESULTS The 3D-MOCART over 12 months witnessed significant patient improvement, but some presented subchondral bone degeneration as early as 6 months. The MOCART2.0 improved from 57.5 to 71.3 between 6 and 24 months (P = 0.02). The global T2 index decreased from 1.7 to 1.2 between 6 and 24 months (P < 0.001). The global T1rho index decreased from 1.5 to 1.3 between 6 and 24 months (P = 0.004). Normal or nearly normal ICRS-CRA (cartilage repair assessment scale developed by the International Cartilage Repair Society) grades were achieved in 86% and 93% of the lesions at 12 and 24 months, respectively. Better ICRS-CRA grade corresponded to better MOCART2.0, with no trend in the T2 and T1rho values. CONCLUSIONS Atelocollagen-assisted ACI improved the MRI-based morphological and qualitative outcomes until 24 months post-surgery, and normal or nearly normal grades were achieved in most lesions by arthroscopic assessment. MRI assessment may be an alternative to arthroscopic assessment.
Collapse
Affiliation(s)
- Masashi Shinohara
- Department of Orthopaedic Surgery,
Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ryuichiro Akagi
- Department of Orthopaedic Surgery,
Graduate School of Medicine, Chiba University, Chiba, Japan,Ryuichiro Akagi, Department of Orthopaedic
Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuou,
Chiba 260-8677, Japan.
| | - Atsuya Watanabe
- Department of Orthopaedic Surgery,
Eastern Chiba Medical Center, Togane, Japan
| | - Yuki Kato
- Department of Sports Medicine, Kameda
Medical Center, Kamogawa, Japan
| | - Yusuke Sato
- Department of Orthopaedic Surgery,
Eastern Chiba Medical Center, Togane, Japan
| | - Tsuguo Morikawa
- Department of Orthopaedic Surgery,
Chiba Medical Center, Chiba, Japan
| | - Junichi Iwasaki
- Department of Orthopaedic Surgery,
Chiba Medical Center, Chiba, Japan
| | - Koichi Nakagawa
- Department of Orthopaedic Surgery, Toho
University Sakura Medical Center, Sakura, Japan
| | - Yorikazu Akatsu
- Department of Orthopaedic Surgery, Toho
University Sakura Medical Center, Sakura, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery,
Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takahisa Sasho
- Department of Musculoskeletal Disease
and Pain, Center for Preventive Medical Sciences, Chiba University, Chiba,
Japan
| |
Collapse
|
5
|
Jung M, Karampinos DC, Holwein C, Suchowierski J, Diallo TD, Gersing AS, Bamberg F, Baumann FA, Ruschke S, Jungmann PM. Quantitative 3-T Magnetic Resonance Imaging After Matrix-Associated Autologous Chondrocyte Implantation With Autologous Bone Grafting of the Knee: The Importance of Subchondral Bone Parameters. Am J Sports Med 2021; 49:476-486. [PMID: 33427489 DOI: 10.1177/0363546520980134] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Matrix-associated autologous chondrocyte implantation (MACI) with autologous bone grafting (ABG) is an effective surgical treatment for osteochondral defects. Quantitative magnetic resonance imaging (MRI) techniques are increasingly applied as noninvasive biomarkers to assess the biochemical composition of cartilage repair tissue. PURPOSE To evaluate the association of quantitative MRI parameters of cartilage repair tissue and subchondral bone marrow with magnetic resonance morphologic and clinical outcomes after MACI with ABG of the knee. STUDY DESIGN Case series; Level of evidence, 4. METHODS Qualitative and quantitative 3 T MRI of the knee was performed in 21 patients (16 male) at 2.5 years after MACI with ABG at the medial (18/21) or lateral (3/21) femoral condyle for the treatment of osteochondral defects. Morphologic MRI sequences were assessed using MOCART (magnetic resonance observation of cartilage repair tissue) 2.0 scores. T2 relaxation time measurements for the assessment of cartilage repair tissue (CRT2) were obtained. Single-voxel magnetic resonance spectroscopy was performed in underlying subchondral bone marrow (BM) and at both central femoral condyles. The presence of pain and Tegner scores were noted. Statistical analyses included Student t tests, correlation analyses, and multivariate regression models. RESULTS The mean defect size was 4.9 ± 1.9 cm2. At a follow-up of 2.5 ± 0.3 years, 9 of 21 patients were asymptomatic. Perfect defect filling was achieved in 66.7% (14/21) of patients. MOCART 2.0 scores (74.1 ± 18.4) did not indicate pain (68.3 ± 19.0 [pain] vs 81.7 ± 15.4 [no pain]; P = .102). However, knee pain was present in 85.7% (6/7) of patients with deep bony defects (odds ratio, 8.0; P = .078). Relative CRT2 was higher in hypertrophic cartilage repair tissue than in repair tissue with normal filling (1.54 ± 0.42 vs 1.13 ± 0.21, respectively; P = .022). The underlying BM edema-like lesion (BMEL) volume was larger in patients with underfilling compared with patients with perfect defect filling (1.87 ± 1.32 vs 0.31 ± 0.51 cm3, respectively; P = .002). Patients with severe pain showed a higher BMEL volume (1.2 ± 1.3 vs 0.2 ± 0.4 cm3, respectively; P = .046) and had a higher BM water fraction (26.0% ± 12.3% vs 8.6% ± 8.1%, respectively; P = .026) than did patients without pain. CONCLUSION Qualitative and quantitative MRI parameters including the presence of subchondral defects, CRT2, BMEL volume, and BM water fraction were correlated with cartilage repair tissue quality and clinical symptoms. Therefore, the integrity of subchondral bone was associated with outcomes after osteochondral transplantation.
Collapse
Affiliation(s)
- Matthias Jung
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Dimitrios C Karampinos
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christian Holwein
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.,Department of Trauma and Orthopaedic Surgery, BG Unfallklinik Murnau, Murnau am Staffelsee, Germany
| | - Joachim Suchowierski
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Thierno D Diallo
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Alexandra S Gersing
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Frederic A Baumann
- Department of Clinical and Interventional Angiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stefan Ruschke
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Pia M Jungmann
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| |
Collapse
|
6
|
Yang BW, Brusalis CM, Fabricant PD, Greditzer HG. Articular Cartilage Repair in the Knee: Postoperative Imaging. J Knee Surg 2021; 34:2-10. [PMID: 32898909 DOI: 10.1055/s-0040-1716357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Diagnostic and therapeutic advancements have improved clinical outcomes for patients with focal chondral injuries of the knee. An increased number and complexity of surgical treatment options have, in turn, resulted in a commensurate proliferation of patients requiring postoperative evaluation and management. In addition to patient-reported clinical outcomes, magnetic resonance imaging (MRI) offers clinicians with noninvasive, objective data to assist with postoperative clinical decision making. However, successful MRI interpretation in this setting is clinically challenging; it relies upon an understanding of the evolving and procedure-specific nature of normal postoperative imaging. Moreover, further research is required to better elucidate the correlation between MRI findings and long-term clinical outcomes. This article focuses on how specific morphologic features identified on MRI can be utilized to evaluate patients following the most commonly performed cartilage repair surgeries of the knee.
Collapse
Affiliation(s)
- Brian W Yang
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | | | - Peter D Fabricant
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.,Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Harry G Greditzer
- Division of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| |
Collapse
|
7
|
Lansdown DA, Ma CB. Clinical Utility of Advanced Imaging of the Knee. J Orthop Res 2020; 38:473-482. [PMID: 31498473 DOI: 10.1002/jor.24462] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 07/17/2019] [Indexed: 02/04/2023]
Abstract
Advanced imaging modalities, including computed tomography, magnetic resonance imaging (MRI), and dynamic fluoroscopic imaging, allow for a comprehensive evaluation of the knee joint. Compositional sequences for MRI can allow for an evaluation of the biochemical properties of cartilage, meniscus, and ligament that offer further insight into pathology that may not be apparent on conventional clinical imaging. Advances in image processing, shape modeling, and dynamic studies also offer a novel way to evaluate common conditions and to monitor patients after treatment. The purpose of this article is to review advanced imaging modalities of the knee and their current and anticipated future applications to clinical practice. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:473-482, 2020.
Collapse
Affiliation(s)
- Drew A Lansdown
- Department of Orthopedic Surgery, Sports Medicine & Shoulder Surgery, University of California, San Francisco, San Francisco, California
| | - C Benjamin Ma
- Department of Orthopedic Surgery, Sports Medicine & Shoulder Surgery, University of California, San Francisco, San Francisco, California
| |
Collapse
|
8
|
MR imaging of cartilage repair surgery of the knee. Clin Imaging 2019; 58:129-139. [DOI: 10.1016/j.clinimag.2019.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/25/2019] [Accepted: 07/11/2019] [Indexed: 12/17/2022]
|
9
|
Jungmann PM, Gersing AS, Baumann F, Holwein C, Braun S, Neumann J, Zarnowski J, Hofmann FC, Imhoff AB, Rummeny EJ, Link TM. Cartilage repair surgery prevents progression of knee degeneration. Knee Surg Sports Traumatol Arthrosc 2019; 27:3001-3013. [PMID: 30542744 DOI: 10.1007/s00167-018-5321-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 12/04/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate, whether cartilage repair surgery for focal osteochondral defects at the knee results in less degenerative changes over 6 years in a MR imaging follow-up than morphologically initially identical defects in non-operated control subjects from the osteoarthritis initiative (OAI). METHODS A total of 32 individuals received baseline and follow-up MRI. In n = 16 patients with cartilage repair [osteochondral autograft transfer system (OATS), n = 12; spongiosa-augmented matrix-associated autologous chondrocyte implantation (MACI), n = 4] MRI was performed preoperatively and after 5.7 ± 2.3 year follow-up. Baseline MRIs of non-operated subjects from the OAI were screened for initially identical cartilage defects (n = 16). Morphological knee abnormalities were assessed using WORMS, AMADEUS and MOCART scores. A sagittal 2D MSME sequence was implemented for quantitative cartilage T2 relaxation time measurements in all (0, 2, 4, 6 and 8-years) follow-ups from the OAI and in the postoperative MRI protocol. RESULTS For both groups, focal osteochondral defects were located at the femoral condyle in 8/16 cases (5 medial, 3 lateral) and at the patella in 8/16 cases. At baseline, the mean cartilage defect size ± SD was 1.4 ± 1.3 cm2 for the control group and 1.3 ± 1.2 cm2 for the cartilage repair group (n.s.). WORMS scores were not significantly different between the cartilage repair group and the control group at baseline [mean difference ± SEM (95%CI); 0.5 ± 2.5 (- 4.7, 5.7), n.s.]. During identical follow-up times, the progression of total WORMS scores [19.9 ± 2.3 (15.0, 24.9), P < 0.001] and of cartilage defects scores in the affected (P < 0.001) and in the opposing (P = 0.029) compartment was significantly more severe in non-operated individuals (P < 0.05). In non-operated subjects, T2 values increased continuously from baseline to the 8-year follow-up (P = 0.001). CONCLUSIONS Patients with cartilage repair showed less progression of degenerative MRI changes at 6-year follow-up than a control cohort from the OAI with initially identical osteochondral defects. Patients with focal cartilage defects may profit from cartilage repair surgery since it may prevent progression of early osteoarthritis at the knee joint. LEVEL OF EVIDENCE Prognostic study, Level II.
Collapse
Affiliation(s)
- Pia M Jungmann
- Department of Neuroradiology, University Hospital of Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
| | - Alexandra S Gersing
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Frederic Baumann
- Clinical and Interventional Angiology, University Hospital of Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Christian Holwein
- Department of Sportsorthopedic Surgery, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- BG Unfallklinik Murnau, Prof.-Küntscher-Strasse 8, 82418, Murnau, Germany
| | - Sepp Braun
- Department of Sportsorthopedic Surgery, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- Gelenkpunkt, Sports and Joint Surgery Innsbruck, Olympiastrasse 39, 6020, Innsbruck, Austria
| | - Jan Neumann
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| | - Julia Zarnowski
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| | - Felix C Hofmann
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| | - Andreas B Imhoff
- Department of Sportsorthopedic Surgery, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Ernst J Rummeny
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Thomas M Link
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| |
Collapse
|
10
|
Ossendorff R, Franke K, Erdle B, Uhl M, Südkamp NP, Salzmann GM. Clinical and radiographical ten years long-term outcome of microfracture vs. autologous chondrocyte implantation: a matched-pair analysis. INTERNATIONAL ORTHOPAEDICS 2018; 43:553-559. [PMID: 29909583 DOI: 10.1007/s00264-018-4025-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/04/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE To compare the clinical and radiographical long-term outcome of microfracture (MFX) and first-generation periosteum-covered autologous chondrocyte implantation (ACI-P). METHODS All subjects (n = 86) who had been treated with knee joint ACI-P or microfracture (n = 76) with a post-operative follow-up of at least ten years were selected. Clinical pre- and post-operative outcomes were analyzed by numeric analog scale (NAS) for pain, Lysholm, Tegner, IKDC, and KOOS score. Radiographical evaluation was visualized by magnetic resonance imaging (MRI). Assessment of the regenerate quality was performed by the magnetic resonance observation of cartilage repair tissue (MOCART) and modified knee osteoarthritis scoring system (mKOSS). Relaxation time (RT) of T2 maps enabled a microstructural cartilage analysis. RESULTS MFX and ACI of 44 patients (24 females, 20 males; mean age 38.9 ± 12.1 years) resulted in a good long-term outcome with low pain scores and significant improved clinical scores. The final Lysholm and functional NAS scores were significantly higher in the MFX group (Lysholm: MFX 82 ± 15 vs. ACI-P 71 ± 18 p = 0.027; NAS function: MFX 8.1 ± 3.5 vs. ACI-P 6.0 ± 2.5; p = 0.003). The MOCART score did not show any qualitative differences. KOSS analysis demonstrated that cartilage repair of small defects resulted in a significant better outcome. T2-relaxation times were without difference between groups at the region of the regenerate tissue. CONCLUSION This study did not demonstrate coherent statistical differences between both cartilage repair procedures. MFX might be superior in the treatment of small cartilage defects.
Collapse
Affiliation(s)
- Robert Ossendorff
- Department of Orthopaedics and Trauma Surgery, University Medical Center, Albert-Ludwigs University Freiburg, Freiburg, Germany. .,Department of Orthopaedics and Trauma Surgery, University Medical Center, Friedrich-Wilhelms University Bonn, Bonn, Germany.
| | - Kilian Franke
- Department of Orthopaedics and Trauma Surgery, University Medical Center, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Benjamin Erdle
- Department of Orthopaedics and Trauma Surgery, University Medical Center, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Markus Uhl
- RKK Klinikum - St. Josefskrankenhaus, Freiburg, Germany
| | - Norbert P Südkamp
- Department of Orthopaedics and Trauma Surgery, University Medical Center, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Gian M Salzmann
- Department of Orthopaedics and Trauma Surgery, University Medical Center, Albert-Ludwigs University Freiburg, Freiburg, Germany.,Schulthess Clinic, Zürich, Switzerland.,Gelenkzentrum Rhein-Main, Wiesbaden, Germany
| |
Collapse
|
11
|
Lansdown DA, Wang K, Cotter E, Davey A, Cole BJ. Relationship Between Quantitative MRI Biomarkers and Patient-Reported Outcome Measures After Cartilage Repair Surgery: A Systematic Review. Orthop J Sports Med 2018; 6:2325967118765448. [PMID: 29662912 PMCID: PMC5898666 DOI: 10.1177/2325967118765448] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background Treatment of articular cartilage injuries remains a clinical challenge, and the optimal tools to monitor and predict clinical outcomes are unclear. Quantitative magnetic resonance imaging (qMRI) allows for a noninvasive biochemical evaluation of cartilage and may offer advantages in monitoring outcomes after cartilage repair surgery. Hypothesis qMRI sequences will correlate with early pain and functional measures. Study Design Systematic review; Level of evidence, 3. Methods A PubMed search was performed with the following search terms: knee AND (cartilage repair OR cartilage restoration OR cartilage surgery) AND (delayed gadolinium-enhanced MRI OR t1-rho OR T2 mapping OR dgemric OR sodium imaging OR quantitative imaging). Studies were included if correlation data were included on quantitative imaging results and patient outcome scores. Results Fourteen articles were included in the analysis. Eight studies showed a significant relationship between quantitative cartilage imaging and patient outcome scores, while 6 showed no relationship. T2 mapping was examined in 11 studies, delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) in 4 studies, sodium imaging in 2 studies, glycosaminoglycan chemical exchange saturation transfer (gagCEST) in 1 study, and diffusion-weighted imaging in 1 study. Five studies on T2 mapping showed a correlation between T2 relaxation times and clinical outcome scores. Two dGEMRIC studies found a correlation between T1 relaxation times and clinical outcome scores. Conclusion Multiple studies on T2 mapping, dGEMRIC, and diffusion-weighted imaging showed significant correlations with patient-reported outcome measures after cartilage repair surgery, although other studies showed no significant relationship. qMRI sequences may offer a noninvasive method to monitor cartilage repair tissue in a clinically meaningful way, but further refinements in imaging protocols and clinical interpretation are necessary to improve utility.
Collapse
Affiliation(s)
- Drew A Lansdown
- Department of Orthopedic Surgery, Sports Medicine & Shoulder Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Kevin Wang
- Department of Orthopaedic Surgery, Sports Medicine & Shoulder Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Eric Cotter
- Department of Orthopaedic Surgery, Sports Medicine & Shoulder Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Annabelle Davey
- Department of Orthopaedic Surgery, Sports Medicine & Shoulder Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian J Cole
- Department of Orthopaedic Surgery, Sports Medicine & Shoulder Surgery, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
12
|
Erdle B, Herrmann S, Porichis S, Uhl M, Ghanem N, Schmal H, Suedkamp N, Niemeyer P, Salzmann GM. Sporting Activity Is Reduced 11 Years After First-Generation Autologous Chondrocyte Implantation in the Knee Joint. Am J Sports Med 2017; 45:2762-2773. [PMID: 28787185 DOI: 10.1177/0363546517716920] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Little is known about long-term sporting activity after periosteal autologous chondrocyte implantation (ACI-P) and its correlation to clinical, morphological, and ultrastructural cartilage characteristics on magnetic resonance imaging (MRI). PURPOSE To evaluate long-term sporting activity after ACI-P and to correlate with clinical and MRI findings. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients who underwent ACI-P for isolated cartilage defects of the knee joint between 1997 and 2001 were analyzed for sporting ability for 3 different time points: lifetime until the onset of pain, the year before ACI-P, and 11 years (range, 9.0-13.4 years) postoperatively. Sporting activity was assessed and patients' level of activity scaled using standardized questionnaires. MRI scans of the affected knee joint at follow-up were analyzed using the MOCART (magnetic resonance observation of cartilage repair tissue) score and T2 mapping. RESULTS Seventy of 86 patients (81% follow-up rate) consisting of 25 female and 45 male patients, with a mean age of 33.3 ± 10.2 years at the time of surgery, mean defect size of 6.5 ± 4.0 cm2, and 1.17 treated defects per patient, agreed to participate in the study at a mean 10.9 ± 1.1 years after ACI-P. Fifty-nine patients (69% of total; 84% of follow-up) agreed to MRI, allowing the complete evaluation of 71 transplant sites. Before the onset of symptoms (lifetime), 95.7% of patients played a mean 6.0 sporting activities at a competitive level. In the year before ACI-P, 81.4% of patients played a mean 3.4 sporting activities in 2.4 sessions during 5.4 hours per week at a recreational level. At follow-up, 82.9% of the patients played a mean 3.0 sporting activities in 1.8 sessions during 3.0 hours per week at a recreational level. In contrast to objective factors, 65.6% of the patients felt that their subjective sporting ability had improved or strongly improved after ACI-P, whereas 12.9% felt that their situation had declined or strongly declined, and 21.4% stated that their sporting ability had undergone no change because of surgery. Factors of sporting activity correlated significantly with clinical long-term outcomes. MRI analysis with a mean repair tissue T2 relaxation time of 35.2 milliseconds and mean MOCART score of 44.9 showed no conclusive significant correlation to sporting activity. Level of performance was the only sporting activity factor to show a weak correlation with subgroups of the MOCART score. CONCLUSION The premorbid level of sporting and recreational activities cannot be achieved 11 years after ACI-P. The MRI results determined at this time point did not conclusively correlate with long-term sporting activity.
Collapse
Affiliation(s)
- Benjamin Erdle
- Department of Orthopedics and Trauma Surgery, University Medical Center Freiburg, Faculty of Medicine, Albert Ludwig University of Freiburg, Freiburg, Germany
| | - Simon Herrmann
- Department of Orthopedics and Trauma Surgery, University Medical Center Freiburg, Faculty of Medicine, Albert Ludwig University of Freiburg, Freiburg, Germany
| | - Stella Porichis
- Department of Orthopedics and Trauma Surgery, University Medical Center Freiburg, Faculty of Medicine, Albert Ludwig University of Freiburg, Freiburg, Germany.,Center of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Markus Uhl
- Department of Diagnostic and Therapeutic Radiology, St. Josef's Hospital, Freiburg, Germany
| | - Nadir Ghanem
- Department of Diagnostic and Therapeutic Radiology, St. Josef's Hospital, Freiburg, Germany.,Diagnostic Imaging Center, Singen, Germany
| | - Hagen Schmal
- Department of Orthopedics and Trauma Surgery, University Medical Center Freiburg, Faculty of Medicine, Albert Ludwig University of Freiburg, Freiburg, Germany.,Department of Orthopaedics and Traumatology and Department of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Norbert Suedkamp
- Department of Orthopedics and Trauma Surgery, University Medical Center Freiburg, Faculty of Medicine, Albert Ludwig University of Freiburg, Freiburg, Germany
| | - Philipp Niemeyer
- Department of Orthopedics and Trauma Surgery, University Medical Center Freiburg, Faculty of Medicine, Albert Ludwig University of Freiburg, Freiburg, Germany.,OCM Clinic, Munich, Germany
| | - Gian M Salzmann
- Department of Orthopedics and Trauma Surgery, University Medical Center Freiburg, Faculty of Medicine, Albert Ludwig University of Freiburg, Freiburg, Germany.,Department of Lower Extremity Orthopaedics, Musculoskeletal Centre, Schulthess Clinic, Zurich, Switzerland.,Gelenkzentrum Rhein-Main, Wiesbaden, Germany
| |
Collapse
|
13
|
Delayed gadolinium-enhanced MRI of cartilage and T2 mapping for evaluation of reparative cartilage-like tissue after autologous chondrocyte implantation associated with Atelocollagen-based scaffold in the knee. Skeletal Radiol 2016; 45:1357-63. [PMID: 27484703 DOI: 10.1007/s00256-016-2438-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/20/2016] [Accepted: 07/11/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To elucidate the quality of tissue-engineered cartilage after an autologous chondrocyte implantation (ACI) technique with Atelocollagen gel as a scaffold in the knee in the short- to midterm postoperatively, we assessed delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) and T2 mapping and clarified the relationship between T1 and T2 values and clinical results. MATERIALS AND METHODS In this cross-sectional study, T1 and T2 mapping were performed on 11 knees of 8 patients (mean age at ACI, 37.2 years) with a 3.0-T MRI scanner. T1implant and T2implant values were compared with those of the control cartilage region (T1control and T2control). Lysholm scores were also assessed for clinical evaluation. The relationships between the T1 and T2 values and the clinical Lysholm score were also assessed. RESULTS There were no significant differences in the T1 values between the T1implant (386.64 ± 101.78 ms) and T1control (375.82 ± 62.89 ms) at the final follow-up. The implants showed significantly longer T2 values compared to the control cartilage (53.83 ± 13.89 vs. 38.21 ± 4.43 ms). The postoperative Lysholm scores were significantly higher than the preoperative scores. A significant correlation was observed between T1implant and clinical outcomes, but not between T2implant and clinical outcomes. CONCLUSION Third-generation ACI implants might have obtained an almost equivalent glycosaminoglycan concentration compared to the normal cartilage, but they had lower collagen density at least 3 years after transplantation. The T1implant value, but not the T2 value, might be a predictor of clinical outcome after ACI.
Collapse
|
14
|
Ryu YJ, Hong SH, Kim H, Choi JY, Yoo HJ, Kang Y, Park SJ, Kang HS. Fat-suppressed T 2 mapping of femoral cartilage in the porcine knee joint: A comparison with conventional T 2 mapping. J Magn Reson Imaging 2016; 45:1076-1081. [PMID: 27527688 DOI: 10.1002/jmri.25430] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 08/01/2016] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To investigate the effect of fat suppression on T2 mapping of the articular cartilage in the porcine knee joint using magnetic resonance imaging (MRI). MATERIALS AND METHODS Eleven porcine knee joints were harvested en bloc with intact capsules. We performed T2 mapping of the articular cartilage in the medial femoral condyle at 3T either with (fat-suppressed T2 mapping) or without (conventional T2 mapping) fat suppression in the sagittal plane under two frequency-encoding directions: from superior to inferior (SI) and inferior to superior (IS). Two observers measured the T2 values of the medial femoral condyle cartilage in four regions: in the anterior oblique, central horizontal, posterior oblique, and posterior vertical portions. We evaluated reproducibility of the fat-suppressed and conventional T2 mapping by changing the frequency-encoding direction. RESULTS The mean T2 values of fat-suppressed T2 mapping were significantly lower than those of conventional T2 mapping for five of eight comparisons (P < 0.017). The mean T2 values between fat-suppressed T2 -SI and fat-suppressed T2 -IS did not differ significantly in any region (P = 0.077-0.873). However, the mean T2 values of conventional T2 -SI were significantly lower compared with conventional T2 -IS in three of the regions (P < 0.05). The intraclass correlation coefficient (ICC) between the two fat-suppressed T2 maps was higher than the ICC between the two conventional T2 maps (0.276-0.800 vs. -0.032-0.455) for three regions. CONCLUSION Compared with conventional T2 mapping, fat-suppressed T2 mapping provides lower T2 values of the articular cartilage and more reproducible results for the porcine knee joint. LEVEL OF EVIDENCE 2 J. Magn. Reson. Imaging 2017;45:1076-1081.
Collapse
Affiliation(s)
- Young Jin Ryu
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Hwan Hong
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeonjin Kim
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ja-Young Choi
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hye Jin Yoo
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yusuhn Kang
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Joon Park
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Heung Sik Kang
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
15
|
Bilateral cartilage T2 mapping 9 years after Mega-OATS implantation at the knee: a quantitative 3T MRI study. Osteoarthritis Cartilage 2015; 23:2119-2128. [PMID: 26115937 DOI: 10.1016/j.joca.2015.06.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 05/30/2015] [Accepted: 06/09/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate morphological and quantitative MR findings 9 years after autograft transfer of the posterior femoral condyle (Mega-OATS) and to correlate these findings with clinical outcomes. Quantitative MR measurements were also obtained of the contralateral knee and the utility as reference standard was investigated. DESIGN Both knees of 20 patients with Mega-OATS osteochondral repair at the medial femoral condyle (MFC) were studied using 3T MRI 9 years after the procedure. MR-sequences included morphological sequences and a 2D multislice multiecho (MSME) spin echo (SE) sequence for quantitative cartilage T2 mapping. Cartilage segmentation was performed at the cartilage repair site and six additional knee compartments. Semi-quantitative MR observation of cartilage repair tissue (MOCART) scores and clinical Lysholm scores were obtained. Paired t-tests and Spearman correlations were used for statistical analysis. RESULTS Global T2-values were significantly higher at ipsilateral knees compared to contralateral knees (42.1 ± 3.0 ms vs 40.4 ± 2.6 ms, P = 0.018). T2-values of the Mega-OATS site correlated significantly with MOCART scores (R = -0.64, P = 0.006). The correlations between MOCART and Lysholm scores and between absolute T2-values and Lysholm scores were not significant (P > 0.05). However, higher T2 side-to-side differences at the femoral condyles correlated significantly with more severe clinical symptoms (medial, R = -0.53, P = 0.030; lateral, R = -0.51, P = 0.038). CONCLUSIONS Despite long-term survival, 9 years after Mega-OATS procedures, T2-values of the grafts were increased compared to contralateral knees. Clinical scores correlated best with T2 side-to-side differences of the femoral condyles, indicating that intraindividual adjustment may be beneficial for outcome evaluation.
Collapse
|
16
|
Morphological and compositional monitoring of a new cell-free cartilage repair hydrogel technology - GelrinC by MR using semi-quantitative MOCART scoring and quantitative T2 index and new zonal T2 index calculation. Osteoarthritis Cartilage 2015; 23:2224-2232. [PMID: 26187572 DOI: 10.1016/j.joca.2015.07.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 06/24/2015] [Accepted: 07/07/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate cartilage repair tissue (RT) using MOCART scoring for morphological and T2 mapping for biochemical assessment following implantation of GelrinC, a biosynthetic, biodegradable hydrogel implant. DESIGN MR imaging (1.5/3T) was performed on 21 patients at six sites. Standard protocols were used for MOCART evaluation at 1 week (baseline) 1, 3, 6, 12, 18 and 24 months. Multi-echo SE was used for T2 mapping. Global (T2 in RT divided by T2 in normal cartilage) and zonal T2 index (deep T2 divided by superficial T2) of RT were calculated. RESULTS Average MOCART score was 71.8 (95% CI 62.2 to 81.3) at six, 75.2 (95% CI 62.8 to 87.5) at twelve, 71.8 (95% CI 55.4 to 88.2) at eighteen and 84.4 (95% CI 77.7 to 91.0) at twenty-four months. The global T2 index ranged between 0.8 and 1.2 (normal healthy cartilage) in 1/11 (9%) patients at baseline, 8/12 (67%) at 12 months, 11/13 (85%) at 18 months and 13/16 (81%) at 24 months. The zonal T2 index for RT was <20% difference to the zonal T2 index for normal cartilage in: 6/12 patients (50%) at 12 months, 7/13 (53.8%) at 18 months and 10/16 (63.5%) at 24 months. The standard deviation for T2 showed a significant decrease over the study. CONCLUSIONS The increase of MOCART scores over follow-up indicates improving cartilage repair tissue. Global and zonal T2 repair values at 24 months reached normal cartilage in 81% and 63.5% of the patients respectively, reflecting collagen organization similar to hyaline cartilage.
Collapse
|
17
|
Wang VM, Karas V, Lee AS, Yin Z, Van Thiel GS, Hussey K, Sumner DR, Chubinskaya S, Magin RL, Verma NN, Romeo AA, Cole BJ. Assessment of glenoid chondral healing: comparison of microfracture to autologous matrix-induced chondrogenesis in a novel rabbit shoulder model. J Shoulder Elbow Surg 2015; 24:1789-800. [PMID: 26238005 PMCID: PMC4618188 DOI: 10.1016/j.jse.2015.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 05/19/2015] [Accepted: 06/01/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Management of glenohumeral arthrosis in young patients is a considerable challenge, with a growing need for non-arthroplasty alternatives. The objectives of this study were to develop an animal model to study glenoid cartilage repair and to compare surgical repair strategies to promote glenoid chondral healing. METHODS Forty-five rabbits underwent unilateral removal of the entire glenoid articular surface and were divided into 3 groups--untreated defect (UD), microfracture (MFx), and MFx plus type I/III collagen scaffold (autologous matrix-induced chondrogenesis [AMIC])--for the evaluation of healing at 8 weeks (12 rabbits) and 32 weeks (33 rabbits) after injury. Contralateral shoulders served as unoperated controls. Tissue assessments included 11.7-T magnetic resonance imaging (long-term healing group only), equilibrium partitioning of an ionic contrast agent via micro-computed tomography (EPIC-μCT), and histologic investigation (grades on International Cartilage Repair Society II scoring system). RESULTS At 8 weeks, x-ray attenuation, thickness, and volume did not differ by treatment group. At 32 weeks, the T2 index (ratio of T2 values of healing to intact glenoids) was significantly lower for the MFx group relative to the AMIC group (P = .01) whereas the T1ρ index was significantly lower for AMIC relative to MFx (P = .01). The micro-computed tomography-derived repair tissue volume was significantly higher for MFx than for UD. Histologic investigation generally suggested inferior healing in the AMIC and UD groups relative to the MFx group, which exhibited improvements in both integration of repair tissue with subchondral bone and tidemark formation over time. DISCUSSION Improvements conferred by AMIC were limited to magnetic resonance imaging outcomes, whereas MFx appeared to promote increased fibrous tissue deposition via micro-computed tomography and more hyaline-like repair histologically. The findings from this novel model suggest that MFx promotes biologic resurfacing of full-thickness glenoid articular injury.
Collapse
Affiliation(s)
- Vincent M Wang
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Vasili Karas
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Andrew S Lee
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Ziying Yin
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Kristen Hussey
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - D Rick Sumner
- Department of Anatomy and Cell Biology, Rush University Medical Center, Chicago, IL, USA
| | - Susan Chubinskaya
- Department of Biochemistry, Rush University Medical Center, Chicago, IL, USA
| | - Richard L Magin
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA
| | - Nikhil N Verma
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Anthony A Romeo
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Brian J Cole
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
| |
Collapse
|
18
|
Kubosch EJ, Erdle B, Izadpanah K, Kubosch D, Uhl M, Südkamp NP, Niemeyer P. Clinical outcome and T2 assessment following autologous matrix-induced chondrogenesis in osteochondral lesions of the talus. INTERNATIONAL ORTHOPAEDICS 2015; 40:65-71. [PMID: 26346373 DOI: 10.1007/s00264-015-2988-z] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 08/25/2015] [Indexed: 01/10/2023]
Abstract
PURPOSE Scientific evidence for the treatment of osteochondral lesions (OCLs) of the talus is limited. The aim of this study was an evaluation of the clinical outcome after a one-step autologous subchondral cancellous bone graft and autologous matrix-induced chondrogenesis (AMIC) in medial OCLs of the talus and the assessment of the repair tissue (RT). METHODS Seventeen patients (eight women, nine men; mean age, 38.8 ± 15.7 years) with an OCL of the medial talus underwent surgery. Clinical and radiological assessment was performed after a mean follow-up of 39.5 ± 18.4 months, including established scoring systems (American Orthopaedic Foot and Ankle Society [AOFAS] Score, Foot Function Index [FFI], visual analogue scale [VAS]), evaluation of Magnetic Resonance Observation of Cartilage Repair Tissue scoring system (MOCART Score) and T2 mapping. RESULTS Preoperative pain (7.8 ± 2.1) significantly improved to an average of 3.2 ± 2.4 postoperatively. AOFAS Score averaged 82.6 ± 13.4, MOCART Score 52.7 ± 15.9. Mean T2 relaxation time of the RT was 41.6 ± 6.3 ms and showed no significant differences to the surrounding cartilage (mean, 38.8 ± 8.5; p = 0.58). MOCART Score significantly correlated with the AOFAS Score (rho = 0.574, p = 0.040). T2 relaxation time of the RT significantly correlated with the MOCART Score (rho = 0.593, p = 0.033). CONCLUSIONS The one-step autologous subchondral cancellous bone grafting and AMIC leads to a significant reduction in postoperative pain and satisfying postoperative functional outcome in mid-term follow-up. Magnetic resonance imaging (MRI) assessment demonstrated a good quality of regenerative tissue similar to the MRI ultrastructure of the surrounding cartilage.
Collapse
Affiliation(s)
- Eva Johanna Kubosch
- Department of Surgery, Clinic for Orthopaedic and Trauma Surgery, University Medical Centre, Albert-Ludwigs University Freiburg, Freiburg, Germany.
| | - Benjamin Erdle
- Department of Surgery, Clinic for Orthopaedic and Trauma Surgery, University Medical Centre, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Kaywan Izadpanah
- Department of Surgery, Clinic for Orthopaedic and Trauma Surgery, University Medical Centre, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - David Kubosch
- Department of Surgery, Clinic for Orthopaedic and Trauma Surgery, University Medical Centre, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Markus Uhl
- Department of Radiology, St. Josef's Hospital, Sautierstraße 1, 79104, Freiburg, Germany
| | - Norbert P Südkamp
- Department of Surgery, Clinic for Orthopaedic and Trauma Surgery, University Medical Centre, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Philipp Niemeyer
- Department of Surgery, Clinic for Orthopaedic and Trauma Surgery, University Medical Centre, Albert-Ludwigs University Freiburg, Freiburg, Germany
| |
Collapse
|
19
|
Evaluation and analysis of graft hypertrophy by means of arthroscopy, biochemical MRI and osteochondral biopsies in a patient following autologous chondrocyte implantation for treatment of a full-thickness-cartilage defect of the knee. Arch Orthop Trauma Surg 2015; 135:819-30. [PMID: 25762093 DOI: 10.1007/s00402-015-2194-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Indexed: 02/09/2023]
Abstract
Graft hypertrophy represents a characteristic complication following autologous chondrocyte implantation (ACI) for treatment of cartilage defects. Although some epidemiological data suggest that incidence is associated with first-generation ACI using autologous chondrocyte implantation, it has also been reported in other technical modifications of ACI using different biomaterials. Nevertheless, it has not been described in autologous, non-periosteum, implant-free associated ACI. In addition, little is known about histological and T2-relaxation appearance of graft hypertrophy. The present case report provides a rare case of extensive graft hypertrophy following ACI using an autologous spheres technique with clinical progression over time. Detailed clinical, MR tomographic and histological evaluation has been performed, which demonstrates a high quality of repair tissue within the hypertrophic as well as non-hypertrophic transplanted areas of the repair tissue. No expression of collagen type X (a sign of chondrocyte hypertrophy), only slight changes of the subchondral bone and a nearly normal cell-matrix ratio suggest that tissue within the hypertrophic area does not significantly differ from intact and high-quality repair tissue and therefore seems not to cause graft hypertrophy. This is in contrast to the assumption that histological hypertrophy might cause or contribute to an overwhelming growth of the repair tissue within the transplantation site. Data presented in this manuscript might contribute to further explain the etiology of graft hypertrophy following ACI.
Collapse
|
20
|
Jungmann PM, Baum T, Schaeffeler C, Sauerschnig M, Brucker PU, Mann A, Ganter C, Bieri O, Rummeny EJ, Woertler K, Bauer JS. 3.0T MR imaging of the ankle: Axial traction for morphological cartilage evaluation, quantitative T2 mapping and cartilage diffusion imaging-A preliminary study. Eur J Radiol 2015; 84:1546-1554. [PMID: 26003193 DOI: 10.1016/j.ejrad.2015.04.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 04/21/2015] [Accepted: 04/26/2015] [Indexed: 01/21/2023]
Abstract
PURPOSE To determine the impact of axial traction during high resolution 3.0T MR imaging of the ankle on morphological assessment of articular cartilage and quantitative cartilage imaging parameters. MATERIALS AND METHODS MR images of n=25 asymptomatic ankles were acquired with and without axial traction (6kg). Coronal and sagittal T1-weighted (w) turbo spin echo (TSE) sequences with a driven equilibrium pulse and sagittal fat-saturated intermediate-w (IMfs) TSE sequences were acquired for morphological evaluation on a four-point scale (1=best, 4=worst). For quantitative assessment of cartilage degradation segmentation was performed on 2D multislice-multiecho (MSME) SE T2, steady-state free-precession (SSFP; n=8) T2 and SSFP diffusion-weighted imaging (DWI; n=8) images. Wilcoxon-tests and paired t-tests were used for statistical analysis. RESULTS With axial traction, joint space width increased significantly and delineation of cartilage surfaces was rated superior (P<0.05). Cartilage surfaces were best visualized on coronal T1-w images (P<0.05). Differences for cartilage matrix evaluation were smaller. Subchondral bone evaluation, motion artifacts and image quality were not significantly different between the acquisition methods (P>0.05). T2 values were lower at the tibia than at the talus (P<0.001). Reproducibility was better for images with axial traction. CONCLUSION Axial traction increased the joint space width, allowed for better visualization of cartilage surfaces and improved compartment discrimination and reproducibility of quantitative cartilage parameters.
Collapse
Affiliation(s)
- Pia M Jungmann
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Munich, Germany.
| | - Thomas Baum
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Munich, Germany.
| | - Christoph Schaeffeler
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Munich, Germany; Musculoskeletal Imaging, Kantonsspital Graubuenden, Loestrasse 170, CH-7000 Chur, Switzerland.
| | - Martin Sauerschnig
- Department of Trauma Surgery, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Munich, Germany; Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Munich, Germany.
| | - Peter U Brucker
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Munich, Germany.
| | - Alexander Mann
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Munich, Germany; Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Munich, Germany.
| | - Carl Ganter
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Munich, Germany.
| | - Oliver Bieri
- Division of Radiological Physics, Department of Radiology, University of Basel Hospital, Petersgraben 4, 4031 Basel, Switzerland.
| | - Ernst J Rummeny
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Munich, Germany.
| | - Klaus Woertler
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Munich, Germany.
| | - Jan S Bauer
- Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Munich, Germany; Department of Neuroradiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Munich, Germany.
| |
Collapse
|
21
|
The biomarkers changes in serum and the correlation with quantitative MRI markers by histopathologic evaluation of the cartilage in surgically-induced osteoarthritis rabbit model. PLoS One 2015; 10:e0124717. [PMID: 25884951 PMCID: PMC4401749 DOI: 10.1371/journal.pone.0124717] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 03/14/2015] [Indexed: 12/27/2022] Open
Abstract
Purpose To investigate the biomarkers change in serum and the correlation with quantitative MRI markers by histopathologic evaluation of the cartilage in surgically-induced osteoarthritis(OA) rabbit model. Materials and Methods Thirty-six mature New Zealand rabbits were used. Eighteen rabbits were divided into six groups randomly and equally and subjected to surgery using the improved Hulth method. The other eighteen rabbits were also allocated into six groups randomly and equally which served as the control. At multiple time points after surgery, the BMP-2, CTX-II and COMP levels in the serum were analyzed by ELISA, and quantitative MRI was performed. Histopathology was examined with HE, and Mankin scores were assessed. The changes in the biochemical biomarkers and imaging markers in the OA groups were compared with those in the control groups using paired-samples T tests. The correlation of quantitative MRI markers with biomarkers and Mankin scores were analyzed. The analysis of Mankin scores was conducted with non-parametric wilcoxon signed rank tests. Results The BMP-2 levels were increased at various times after surgery, and significant differences were observed between the OA and control groups(all the P values <0.001). CTX-II levels were significantly elevated at several intervals after surgery, including W2, W8, W12, W16 and W20(P=0.019, 0.004, 0.007, <0.001 and 0.016 respectively), but not at W4(P=0.764). Significant differences in the COMP levels from W2 to W20 were observed between the OA and the control groups(P<0.001, <0.001, <0.001, <0.001,=0.002 and =0.004 respectively). The T2 values increased at W8 post-surgery and were significantly different between the OA and control groups(P=0.001, <0.001, <0.001 and <0.001 respectively). T2* values increased from W2 to W20 and were significantly different between the control and OA groups(P=0.002, =0.001, <0.001, <0.001, =0.001 and <0.001 respectively). T2 values had significant correlation with BMP-2 and CTX-II(P<0.001 and =0.014), except COMP(P=0.305)., while the correlation of T2* values with BMP-2, CTX-II and COMP was significant(P=0.043, 0.005 and 0.025 respectively). In addition, a positive correlation of T2 values and Mankin scores was observed(P<0.001). Conclusion With the relevance of the multiple time point analysis of the serum biomarkers and imaging markers compared with histological findings, BMP-2, CTX-II and COMP combined with T2 and T2* can be used to reflect and monitor OA progression potentially.
Collapse
|
22
|
Salzmann GM, Erdle B, Porichis S, Uhl M, Ghanem N, Schmal H, Kubosch D, Südkamp NP, Niemeyer P. Long-term T2 and Qualitative MRI Morphology After First-Generation Knee Autologous Chondrocyte Implantation: Cartilage Ultrastructure Is Not Correlated to Clinical or Qualitative MRI Outcome. Am J Sports Med 2014; 42:1832-40. [PMID: 24936583 DOI: 10.1177/0363546514536682] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There are several reports on long-term clinical outcomes after autologous chondrocyte implantation (ACI) for knee cartilage defect treatment. Few published articles have evaluated defect quality using quantitative magnetic resonance (MR) imaging techniques. PURPOSE To evaluate clinical outcomes and the quality of repair tissue (RT) after first-generation periosteum-covered ACI (ACI-P) using qualitative MR outcomes and T2-weighted relaxation times. STUDY DESIGN Case series; Level of evidence, 4. METHODS All patients (n = 86) who underwent knee joint ACI-P (from 1997 through 2001) with a postoperative follow-up of at least 10 years were invited for clinical and MR evaluation. Clinical outcomes analysis included pre- and postoperative Lysholm and numeric analog scale (NAS) for pain (10 = worst, 0 = best). Radiographic analysis included postoperative T2-weighted mapping of the RT, RT-associated regions, and healthy control cartilage; MOCART (magnetic resonance observation of cartilage repair tissue) score; a modified Knee Osteoarthritis Scoring System (mKOSS; 0 = best, 15 = worst) score; as well as numeric grading for subjective RT and whole knee joint evaluation (1 = best, 6 = worst). RESULTS A total of 70 patients (45 male, 25 female; mean age, 33.3 ± 10.2 years; 81% follow-up rate) with 82 defects were available for follow-up at an average 10.9 ± 1.1 years postoperatively, with MR analysis for 59 patients with 71 transplant sites (average defect size, 6.5 ± 4.0 cm(2)). Final Lysholm (71.0 ± 17.4) and NAS (7.2 ± 1.9) scores improved significantly when compared with preoperative scores (Lysholm: 42.0 ± 22.5; NAS: 2.1 ± 2.1; P < .01 for both). Average transplant T2 was 35.2 ± 11.3 ms and thereby significantly lower (P = .005) when compared to the intraknee healthy femur T2 (39.7 ± 6.8 ms). The MOCART was 44.9 ± 23.6 and mKOSS was 4.8 ± 3.2. RT subjective grading was 3.3 ± 1.4, while it was 2.3 ± 0.7 for whole joint evaluation. The RT T2 significantly correlated with postoperative NAS (P = .04; r = -0.28); it also correlated with the healthy femur T2 (P = .004; r = 0.4). The MOCART significantly correlated with the mKOSS (P < .001). CONCLUSION The MRI outcome is imperfect in this collective of patients. There is only weak correlation of quantitative imaging data and clinical function. Qualitative imaging data are much better correlated to functional outcomes.
Collapse
Affiliation(s)
- Gian M Salzmann
- Department of Orthopaedic and Trauma Surgery, University Medical Center, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Benjamin Erdle
- Department of Orthopaedic and Trauma Surgery, University Medical Center, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Stella Porichis
- Department of Orthopaedic and Trauma Surgery, University Medical Center, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Markus Uhl
- Institute of Diagnostic Radiology, St Josefskrankenhaus, Freiburg, Germany
| | | | - Hagen Schmal
- Department of Orthopaedic and Trauma Surgery, University Medical Center, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - David Kubosch
- Department of Orthopaedic and Trauma Surgery, University Medical Center, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Norbert P Südkamp
- Department of Orthopaedic and Trauma Surgery, University Medical Center, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Philipp Niemeyer
- Department of Orthopaedic and Trauma Surgery, University Medical Center, Albert-Ludwigs University Freiburg, Freiburg, Germany
| |
Collapse
|
23
|
|
24
|
Sauerschnig M, Bauer JS, Kohn L, Hinterwimmer S, Landwehr S, Woertler K, Jungmann PM, Koestler W, Niemeyer P, Imhoff AB, Salzmann GM. Alignment does not influence cartilage T2 in asymptomatic knee joints. Knee Surg Sports Traumatol Arthrosc 2014; 22:1396-403. [PMID: 24292942 DOI: 10.1007/s00167-013-2756-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Accepted: 10/28/2013] [Indexed: 01/23/2023]
Abstract
PURPOSE To investigate whether the static knee alignment affects articular cartilage ultrastructures when measured using T2 relaxation among asymptomatic subjects. METHODS Both knee joints (n = 96) of 48 asymptomatic volunteers (26 females, 22 males; 25.4 ± 1.7 years; no history of major knee trauma or surgery) were evaluated clinically (Lysholm, Tegner) and by MRI (hip-knee-ankle angle, standard knee protocol, T2 mapping). Group (n = 4) division was as follows: neutral (<1° varus/valgus), mild varus (2°-4° varus), severe varus (>4° varus) and valgus (2°-4° valgus) deformity with n = 12 subjects/group; n = 24 knees/group. Regions of interest (ROI) for T2 assessment were placed within full-thickness cartilage across the whole joint surface and were divided respecting compartmental as well as functional joint anatomy. RESULTS Leg alignment was 0.7° ± 0.5° varus among neutral, 3.0° ± 0.6° varus among mild varus, 5.0° ± 1.1° varus among severe varus and 2.5° ± 0.7° valgus among valgus group subjects and thus significantly different. No differences between the groups emerged from clinical measures. No morphological pathology was detected in any knee joint. Global T2 values (42.3 ± 2.3; 37.7-47.9 ms) of ROIs placed within every knee joint per subject were not different between alignment groups or between genders, respectively. CONCLUSION Static frontal plane leg malalignment does not affect cartilage ultrastructure among young, asymptomatic individuals as measured by T2 quantitative imaging. LEVEL OF EVIDENCE Cross-sectional study, Level II-III.
Collapse
Affiliation(s)
- M Sauerschnig
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technische Universitaet Muenchen, Ismaninger Str. 69, 81675, Munich, Germany
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Cartilage repair surgery: outcome evaluation by using noninvasive cartilage biomarkers based on quantitative MRI techniques? BIOMED RESEARCH INTERNATIONAL 2014; 2014:840170. [PMID: 24877139 PMCID: PMC4024422 DOI: 10.1155/2014/840170] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 03/25/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND New quantitative magnetic resonance imaging (MRI) techniques are increasingly applied as outcome measures after cartilage repair. OBJECTIVE To review the current literature on the use of quantitative MRI biomarkers for evaluation of cartilage repair at the knee and ankle. METHODS Using PubMed literature research, studies on biochemical, quantitative MR imaging of cartilage repair were identified and reviewed. RESULTS Quantitative MR biomarkers detect early degeneration of articular cartilage, mainly represented by an increasing water content, collagen disruption, and proteoglycan loss. Recently, feasibility of biochemical MR imaging of cartilage repair tissue and surrounding cartilage was demonstrated. Ultrastructural properties of the tissue after different repair procedures resulted in differences in imaging characteristics. T2 mapping, T1rho mapping, delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), and diffusion weighted imaging (DWI) are applicable on most clinical 1.5 T and 3 T MR scanners. Currently, a standard of reference is difficult to define and knowledge is limited concerning correlation of clinical and MR findings. The lack of histological correlations complicates the identification of the exact tissue composition. CONCLUSIONS A multimodal approach combining several quantitative MRI techniques in addition to morphological and clinical evaluation might be promising. Further investigations are required to demonstrate the potential for outcome evaluation after cartilage repair.
Collapse
|
26
|
Brown DS, Durkan MG, Foss EW, Szumowski J, Crawford DC. Temporal in vivo assessment of fresh osteochondral allograft transplants to the distal aspect of the femur by dGEMRIC (delayed gadolinium-enhanced MRI of cartilage) and zonal T2 mapping MRI. J Bone Joint Surg Am 2014; 96:564-72. [PMID: 24695923 DOI: 10.2106/jbjs.k.01456] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Zonal T2 mapping and dGEMRIC (delayed gadolinium-enhanced magnetic resonance imaging of cartilage) are diagnostic quantitative techniques to evaluate the biochemical health of articular cartilage. We adapted these techniques to investigate the results of osteochondral allograft transplantation and correlated the findings with patient-reported outcomes. METHODS Nine patients with contained ICRS (International Cartilage Repair Society) grade-4 defects of the articular portion of a femoral condyle were treated with fresh osteochondral allografts and were evaluated prospectively with dGEMRIC and T2 mapping before and after gadolinium administration. The KOOS (Knee Injury Osteoarthritis Outcome Score) and IKDC (International Knee Documentation Committee) subjective scores were obtained at baseline and at one and two years postoperatively. For quantitative T2 mapping, regions of interest were drawn in the deep and superficial layers of allograft and control cartilage. For dGEMRIC analyses, the relaxation rate, post-gadolinium change in relaxation rate, and ratio between changes in the allograft and control regions of interest were calculated from T1 values. RESULTS The mean ratio between the post-gadolinium changes in the allograft and control cartilage was 1.13 at one year and 1.55 at two years, and the ratio increased in eight of nine patients from one to two years. There was no difference between the mean T2 values in the deep zone of the allograft and control cartilage at one or two years (p > 0.05), but mean T2 values were higher in the superficial zone of the allograft cartilage at one (p < 0.0001) and two (p < 0.028) years. The mean improvement from baseline was significant at one and two years for the IKDC and all five KOOS subdomains (p < 0.05). All or nearly all patients showed improvements in all clinical outcomes scores at one year. CONCLUSIONS Functional MRI techniques can be applied to noninvasively assess the biochemical health of cartilage after osteochondral allograft transplantation. The MRI findings correlated with certain patient-reported outcomes in the early postoperative period. Relative glycosaminoglycan content and the collagen structure of allograft cartilage may undergo time-dependent degeneration. A patient's perception of clinical outcome and quality of life is likely multifactorial and is impacted by more than the health of the allograft cartilage.
Collapse
Affiliation(s)
- Dawson S Brown
- Departments of Orthopaedics and Rehabilitation (D.S.B. and D.C.C.) and Radiology (E.W.F. and J.S.), Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Mail Code OP31, Portland, OR 97239. E-mail address for D.C. Crawford:
| | | | - Erik W Foss
- Departments of Orthopaedics and Rehabilitation (D.S.B. and D.C.C.) and Radiology (E.W.F. and J.S.), Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Mail Code OP31, Portland, OR 97239. E-mail address for D.C. Crawford:
| | - Jerzy Szumowski
- Departments of Orthopaedics and Rehabilitation (D.S.B. and D.C.C.) and Radiology (E.W.F. and J.S.), Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Mail Code OP31, Portland, OR 97239. E-mail address for D.C. Crawford:
| | - Dennis C Crawford
- Departments of Orthopaedics and Rehabilitation (D.S.B. and D.C.C.) and Radiology (E.W.F. and J.S.), Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Mail Code OP31, Portland, OR 97239. E-mail address for D.C. Crawford:
| |
Collapse
|
27
|
Shimomura K, Moriguchi Y, Ando W, Nansai R, Fujie H, Hart DA, Gobbi A, Kita K, Horibe S, Shino K, Yoshikawa H, Nakamura N. Osteochondral repair using a scaffold-free tissue-engineered construct derived from synovial mesenchymal stem cells and a hydroxyapatite-based artificial bone. Tissue Eng Part A 2014; 20:2291-304. [PMID: 24655056 DOI: 10.1089/ten.tea.2013.0414] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
For an ideal osteochondral repair, it is important to facilitate zonal restoration of the subchondral bone and the cartilage, layer by layer. Specifically, restoration of the osteochondral junction and secure integration with adjacent cartilage could be considered key factors. The purpose of the present study was to investigate the feasibility of a combined material comprising a scaffold-free tissue-engineered construct (TEC) derived from synovial mesenchymal stem cells (MSCs) and a hydroxyapatite (HA) artificial bone using a rabbit osteochondral defect model. Osteochondral defects were created on the femoral groove of skeletally mature rabbits. The TEC and HA artificial bone were hybridized to develop a combined implant just before use, which was then implanted into defects (N=23). In the control group, HA alone was implanted (N=18). Histological evaluation and micro-indentation testing was performed for the evaluation of repair tissue. Normal knees were used as an additional control group for biomechanical testing (N=5). At hybridization, the TEC rapidly attached onto the surface of HA artificial bone block, which was implantable to osteochondral defects. Osteochondral defects treated with the combined implants exhibited more rapid subchondral bone repair coupled with the development of cartilaginous tissue with good tissue integration to the adjacent host cartilage when assessed at 6 months post implantation. Conversely, the control group exhibited delayed subchondral bone repair. In addition, the repair cartilaginous tissue in this group had poor integration to adjacent cartilage and contained clustered chondrocytes, suggesting an early osteoarthritis (OA)-like degenerative change at 6 months post implantation. Biomechanically, the osteochondral repair tissue treated with the combined implants at 6 months restored tissue stiffness, similar to normal osteochondral tissue. The combined implants significantly accelerated and improved osteochondral repair. Specifically, earlier restoration of subchondral bone, as well as good tissue integration of repair cartilage to adjacent host tissue could be clinically relevant in terms of the acceleration of postoperative rehabilitation and longer-term durability of repaired articular surface in patients with osteochondral lesions, including those with OA. In addition, the combined implant could be considered a promising MSC-based bio-implant with regard to safety and cost-effectiveness, considering that the TEC is a scaffold-free implant and HA artificial bone has been widely used in clinical practice.
Collapse
Affiliation(s)
- Kazunori Shimomura
- 1 Department of Orthopaedics, Osaka University Graduate School of Medicine , Suita, Osaka, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Chen Q, Zuo Q, Hu Q, Feng Y, Cui W, Fan W, Zou Y. Morphological MRI and T2 mapping of cartilage repair tissue after mosaicplasty with tissue-engineered cartilage in a pig model. J Biomed Res 2014; 28:309-19. [PMID: 25050115 PMCID: PMC4102845 DOI: 10.7555/jbr.28.20120119] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 01/22/2013] [Accepted: 09/11/2013] [Indexed: 11/03/2022] Open
Abstract
The aim of this study was to evaluate the efficacy of mosaicplasty with tissue-engineered cartilage for the treatment of osteochondral defects in a pig model with advanced MR technique. Eight adolescent miniature pigs were used. The right knee underwent mosaicplasty with tissue-engineered cartilage for treatment of focal osteochondral defects, while the left knee was repaired via single mosaicplasty as controls. At 6, 12, 18 and 26 weeks after surgery, repair tissue was evaluated by magnetic resonance imaging (MRI) with the cartilage repair tissue (MOCART) scoring system and T2 mapping. Then, the results of MRI for 26 weeks were compared with findings of macroscopic and histologic studies. The MOCART scores showed that the repaired tissue of the tissue-engineered cartilage group was statistically better than that of controls (P < 0.001). A significant correlation was found between macroscopic and MOCART scores (P < 0.001). Comparable mean T2 values were found between adjacent cartilage and repair tissue in the experimental group (P > 0.05). For zonal T2 value evaluation, there were no significant zonal T2 differences for repair tissue in controls (P > 0.05). For the experimental group, zonal T2 variation was found in repair tissue (P < 0.05). MRI, macroscopy and histology showed better repair results and bony incorporation in mosaicplasty with the tissue-engineered cartilage group than those of the single mosaicplasty group. Mosaicplasty with the tissue-engineered cartilage is a promising approach to repair osteochodndral defects. Morphological MRI and T2 mapping provide a non-invasive method for monitoring the maturation and integration of cartilage repair tissue in vivo.
Collapse
Affiliation(s)
- Qichun Chen
- Department of Radiology, the Second Hospital of Anhui Medical University, Hefei, Anhui 230601, China
| | - Qiang Zuo
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Qianqian Hu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yang Feng
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Weiding Cui
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Weimin Fan
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yuefen Zou
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| |
Collapse
|
29
|
Baum T, Joseph G, Karampinos D, Jungmann P, Link T, Bauer J. Cartilage and meniscal T2 relaxation time as non-invasive biomarker for knee osteoarthritis and cartilage repair procedures. Osteoarthritis Cartilage 2013; 21:1474-84. [PMID: 23896316 PMCID: PMC3929642 DOI: 10.1016/j.joca.2013.07.012] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 06/21/2013] [Accepted: 07/17/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this work was to review the current literature on cartilage and meniscal T2 relaxation time. METHODS Electronic searches in PubMed were performed to identify relevant studies about T2 relaxation time measurements as non-invasive biomarker for knee osteoarthritis (OA) and cartilage repair procedures. RESULTS Initial osteoarthritic changes include proteoglycan loss, deterioration of the collagen network, and increased water content within the articular cartilage and menisci. T2 relaxation time measurements are affected by these pathophysiological processes. It was demonstrated that cartilage and meniscal T2 relaxation time values were significantly increased in subjects with compared to those without radiographic OA and focal knee lesions, respectively. Subjects with OA risk factors such as overweight/obesity showed significantly greater cartilage T2 values than normal controls. Elevated cartilage and meniscal T2 relaxation times were found in subjects with vs without knee pain. Increased cartilage T2 at baseline predicted morphologic degeneration in the cartilage, meniscus, and bone marrow over 3 years. Furthermore, cartilage repair tissue could be non-invasively assessed by using T2 mapping. Reproducibility errors for T2 measurements were reported to be smaller than the T2 differences in healthy and diseased cartilage indicating that T2 relaxation time may be a reliable discriminatory biomarker. CONCLUSIONS Cartilage and meniscal T2 mapping may be suitable as non-invasive biomarker to diagnose early stages of knee OA and to monitor therapy of OA.
Collapse
Affiliation(s)
- T. Baum
- Institut für Radiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 München, Germany,Address correspondence and reprint requests to: T. Baum, Institut für Radiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 München, Germany. Tel: 49-89-4140-2621; Fax: 49-89-4140-4834
| | - G.B. Joseph
- Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA 94107, USA
| | - D.C. Karampinos
- Institut für Radiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 München, Germany
| | - P.M. Jungmann
- Institut für Radiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 München, Germany
| | - T.M. Link
- Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA 94107, USA
| | - J.S. Bauer
- Institut für Radiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 München, Germany,Abteilung für Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 München, Germany
| |
Collapse
|
30
|
de Windt TS, Welsch GH, Brittberg M, Vonk LA, Marlovits S, Trattnig S, Saris DBF. Is magnetic resonance imaging reliable in predicting clinical outcome after articular cartilage repair of the knee? A systematic review and meta-analysis. Am J Sports Med 2013; 41:1695-702. [PMID: 23364897 DOI: 10.1177/0363546512473258] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND While MRI can provide a detailed morphological evaluation after articular cartilage repair, its additional value in determining clinical outcome has yet to be determined. PURPOSE To evaluate the correlation between MRI and clinical outcome after cartilage repair and to identify parameters that are most important in determining clinical outcome. STUDY DESIGN Systematic review and meta-analysis. METHODS A systematic search was performed in Embase, MEDLINE, and the Cochrane Collaboration. Articles were screened for relevance and appraised for quality. Guidelines in the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) Statement were used. Chi-square tests were performed to find variables that could determine correlation between clinical and radiological parameters. RESULTS A total of 32 articles (total number of patients, 1019) were included. A majority (81%) were case series or cohort studies that used similar standardized MRI techniques. The mean Coleman score was 63 (range, 42-96). For the majority of MRI parameters, limited or no correlation was found. Nine studies (28%) found a correlation between clinical outcome and the composite magnetic resonance observation of cartilage repair tissue (MOCART) or Henderson score and 7 (22%) with defect fill. In 5 studies, a weak to moderate correlation was found between clinical outcome and the T2 index (mean Pearson coefficient r = .53). CONCLUSION Strong evidence to determine whether morphological MRI is reliable in predicting clinical outcome after cartilage repair is lacking. Future research aiming specifically at clinical sensitivity of advanced morphological and biochemical MRI techniques after articular cartilage repair could be of great importance to the field.
Collapse
Affiliation(s)
- Tommy S de Windt
- Department of Orthopaedics, University Medical Center Utrecht, POB 85500, 3508 GA, Utrecht, the Netherlands
| | | | | | | | | | | | | |
Collapse
|
31
|
Blackman AJ, Smith MV, Flanigan DC, Matava MJ, Wright RW, Brophy RH. Correlation between magnetic resonance imaging and clinical outcomes after cartilage repair surgery in the knee: a systematic review and meta-analysis. Am J Sports Med 2013; 41:1426-34. [PMID: 23631884 DOI: 10.1177/0363546513485931] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is often used to assess cartilage after surgical repair. The correlation between MRI and clinical outcomes is not well understood. HYPOTHESIS Postoperative MRI findings correlate with clinical outcome measures in patients after articular cartilage surgery of the knee. STUDY DESIGN Meta-analysis. METHODS A systematic review of the literature was performed to identify studies in which MRI and clinical outcomes were correlated after autologous chondrocyte implantation (ACI), osteochondral autograft transfer system (OATS), or microfracture. Studies that reported correlation coefficients (r) for different MRI parameters were then included in a meta-analysis. RESULTS A total of 26 studies were identified for inclusion in this systematic review, 15 of which were included in the meta-analysis. Most of the studies (n = 19) involved ACI, although studies were available for OATS (n = 5) and microfracture (n = 4). The strongest MRI correlates with clinical outcomes after ACI were graft hypertrophy (r = 0.72) and repair tissue signal (r = 0.71). After microfracture, the strongest MRI correlates were the Henderson score (r = 0.97), subchondral edema (r = 0.77), and repair tissue signal (r = 0.76). Correlations after OATS were not as strong, with defect fill (r = 0.53) and repair tissue structure (r = 0.51) being the strongest. CONCLUSION The MRI findings do correlate with clinical outcomes after cartilage repair surgery in the knee, although the specific parameters that correlate best vary by the type of procedure performed. No current MRI classification system has been shown to correlate with clinical outcomes after all types of cartilage repair surgery.
Collapse
Affiliation(s)
- Andrew J Blackman
- Department of Orthopaedic Surgery, Washington University, Chesterfield, MO 63017, USA
| | | | | | | | | | | |
Collapse
|
32
|
Kon E, Filardo G, Di Matteo B, Perdisa F, Marcacci M. Matrix assisted autologous chondrocyte transplantation for cartilage treatment: A systematic review. Bone Joint Res 2013; 2:18-25. [PMID: 23610698 PMCID: PMC3626217 DOI: 10.1302/2046-3758.22.2000092] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 11/21/2012] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Matrix-assisted autologous chondrocyte transplantation (MACT) has been developed and applied in the clinical practice in the last decade to overcome most of the disadvantages of the first generation procedures. The purpose of this systematic review is to document and analyse the available literature on the results of MACT in the treatment of chondral and osteochondral lesions of the knee. METHODS ALL STUDIES PUBLISHED IN ENGLISH ADDRESSING MACT PROCEDURES WERE IDENTIFIED, INCLUDING THOSE THAT FULFILLED THE FOLLOWING CRITERIA: 1) level I-IV evidence, 2) measures of functional or clinical outcome, 3) outcome related to cartilage lesions of the knee cartilage. RESULTS The literature analysis showed a progressively increasing number of articles per year. A total of 51 articles were selected: three randomised studies, ten comparative studies, 33 case series and five case reports. Several scaffolds have been developed and studied, with good results reported at short to medium follow-up. CONCLUSIONS MACT procedures are a therapeutic option for the treatment of chondral lesions that can offer a positive outcome over time for specific patient categories, but high-level studies are lacking. Systematic long-term evaluation of these techniques and randomised controlled trials are necessary to confirm the potential of this treatment approach, especially when comparing against less ambitious traditional treatments.
Collapse
Affiliation(s)
- E. Kon
- Rizzoli Orthopaedic Institute, Biomechanics
Laboratory and II Orthopaedic Clinic, Via di Barbiano
n. 1/10, Bologna 40136, Italy
| | - G. Filardo
- Rizzoli Orthopaedic Institute, Biomechanics
Laboratory and II Orthopaedic Clinic, Via di Barbiano
n. 1/10, Bologna 40136, Italy
| | - B. Di Matteo
- Rizzoli Orthopaedic Institute, Biomechanics
Laboratory and II Orthopaedic Clinic, Via di Barbiano
n. 1/10, Bologna 40136, Italy
| | - F. Perdisa
- Rizzoli Orthopaedic Institute, Biomechanics
Laboratory and II Orthopaedic Clinic, Via di Barbiano
n. 1/10, Bologna 40136, Italy
| | - M. Marcacci
- Rizzoli Orthopaedic Institute, Biomechanics
Laboratory and II Orthopaedic Clinic, Via di Barbiano
n. 1/10, Bologna 40136, Italy
| |
Collapse
|
33
|
Filardo G, Kon E, Roffi A, Di Martino A, Marcacci M. Scaffold-based repair for cartilage healing: a systematic review and technical note. Arthroscopy 2013; 29:174-86. [PMID: 23159494 DOI: 10.1016/j.arthro.2012.05.891] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 05/07/2012] [Accepted: 05/08/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this systematic review was to address the treatment of chondral and osteochondral knee lesions through the use of scaffolds, by showing surgical options and results of this scaffold-based repair approach for the healing of the articular surface. METHODS All studies published in English addressing cartilage scaffold-based treatment were identified, including those that fulfilled the following criteria: (1) Levels I to IV evidence addressing the outlined areas of interest, (2) measures of functional or clinical outcome, (3) knee cartilage lesions, and (4) minimum of 2 years of follow-up. RESULTS The analysis showed a progressively increasing number of articles per year from 1995 to February 2012. The number of selected articles was 51, with 40 focusing on 2-step procedures and 11 focusing on 1-step procedures. The evaluation of evidence level showed 3 randomized studies, 10 comparative studies, 33 case series, and 5 case reports. CONCLUSIONS Regenerative scaffold-based procedures are emerging as a therapeutic option for the treatment of chondral lesions, but well-designed studies are lacking. Systematic long-term evaluation of these techniques and randomized studies are necessary to confirm the potential of this treatment approach, especially compared with the available traditional treatments. Different 1-step scaffold-based strategies are emerging to simplify the procedure and reduce costs. LEVEL OF EVIDENCE Level IV, systematic review of Level I to IV studies.
Collapse
|
34
|
Jungmann PM, Li X, Nardo L, Subburaj K, Lin W, Ma CB, Majumdar S, Link TM. Do cartilage repair procedures prevent degenerative meniscus changes?: longitudinal t1ρ and morphological evaluation with 3.0-T MRI. Am J Sports Med 2012; 40:2700-8. [PMID: 23104606 PMCID: PMC4074395 DOI: 10.1177/0363546512461594] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cartilage repair (CR) procedures are widely accepted for treatment of isolated cartilage defects in the knee joint. However, it is not well known whether these procedures prevent degenerative joint disease. HYPOTHESIS Cartilage repair procedures prevent accelerated qualitative and quantitative progression of meniscus degeneration in individuals with focal cartilage defects. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Ninety-four subjects were studied. Cartilage repair procedures were performed on 34 patients (osteochondral transplantation, n = 16; microfracture, n = 18); 34 controls were matched. An additional 13 patients received CR and anterior cruciate ligament (ACL) reconstruction (CR&ACL), and 13 patients received only ACL reconstruction. Magnetic resonance imaging at 3.0-tesla with T(1ρ) mapping and sagittal fat-saturated intermediate-weighted fast spin echo (FSE) sequences was performed to quantitatively and qualitatively analyze menisci (Whole-Organ Magnetic Resonance Imaging Score [WORMS] assessment). Patients in the CR and CR&ACL groups were examined 4 months (n = 34; n = 13), 1 year (n = 21; n = 8), and 2 years (n = 9; n = 5) after CR. Control subjects were scanned at baseline and after 1 and 2 years, ACL patients after 1 and 2 years. RESULTS At baseline, global meniscus T(1ρ) values (mean ± SEM) were higher in individuals with CR (14.2 ± 0.5 ms; P = .004) and in individuals with CR&ACL (17.1 ± 0.9 ms; P < .001) when compared with controls (12.8 ± 0.6 ms). After 2 years, there was a statistical difference between T(1ρ) at the overlying meniscus above cartilage defects (16.4 ± 1.0 ms) and T(1ρ) of the subgroup of control knees without cartilage defects (12.1 ± 0.8 ms; P < .001) and a statistical trend to the CR group (13.3 ± 1.0 ms; P = .09). At baseline, 35% of subjects with CR showed morphological meniscus tears at the overlying meniscus; 10% of CR subjects showed an increase in the WORMS meniscus score within the first year, and none progressed in the second year. Control subjects with (without) cartilage defects showed meniscus tears in 30% (5%) at baseline; 38% (19%) increased within the first year, and 15% (10%) within the second year. CONCLUSION This study demonstrated more severe meniscus degeneration after CR surgery compared with controls. However, progression of T(1ρ) values was not observed from 1 to 2 years after surgery. These results suggest that CR may prevent degenerative meniscus changes.
Collapse
Affiliation(s)
- Pia M. Jungmann
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA 94107, USA
,Institute of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Xiaojuan Li
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA 94107, USA
| | - Lorenzo Nardo
- Department of Orthpaedic Surgery, University of California San Francisco, 1500 Owens Street, San Francisco, CA 94158, USA
| | - Karupppasamy Subburaj
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA 94107, USA
| | - Wilson Lin
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA 94107, USA
| | - C. Benjamin Ma
- Department of Orthpaedic Surgery, University of California San Francisco, 1500 Owens Street, San Francisco, CA 94158, USA
| | - Sharmila Majumdar
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA 94107, USA
| | - Thomas M. Link
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA 94107, USA
| |
Collapse
|
35
|
Marlovits S, Aldrian S, Wondrasch B, Zak L, Albrecht C, Welsch G, Trattnig S. Clinical and radiological outcomes 5 years after matrix-induced autologous chondrocyte implantation in patients with symptomatic, traumatic chondral defects. Am J Sports Med 2012; 40:2273-80. [PMID: 22922521 DOI: 10.1177/0363546512457008] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND To date, few studies have been published reporting the 5-year follow-up of clinical and radiological outcomes for chondral defects treated with matrix-induced autologous chondrocyte implantation (MACI). HYPOTHESIS A significant improvement in clinical and radiological outcomes after treatment of symptomatic, traumatic chondral defects of the knee with the MACI implant will be maintained up to 5 years after surgery. STUDY DESIGN Case series; Level of evidence, 4. METHODS A prospective evaluation of the MACI procedure was performed in 21 patients with chondral defects of the knee. After the MACI procedure, patients were clinically assessed with the Knee injury and Osteoarthritis Outcome Score (KOOS), the Tegner-Lysholm score, the International Knee Documentation Committee (IKDC) Subjective Knee Form, and the modified Cincinnati score at years 1, 2, and 5. The quality of repair tissue was assessed by magnetic resonance imaging using the magnetic resonance observation of cartilage repair tissue (MOCART) score at months 3 and 6 and years 1, 2, and 5. RESULTS Significant improvements (P < .05) were observed for all 5 KOOS subcategories at year 1 and were maintained through year 5 in 90.5% of patients (19/21). Treatment failure occurred in only 9.5% of patients (2/21). Significant improvements (P < .05) from baseline to year 5 were also observed for the IKDC score (30.1 to 74.3), the modified Cincinnati score (38.1 to 79.6), and the Tegner-Lysholm activity score (1.8 to 4.3). Similarly, the MOCART score significantly improved (P < .001) from baseline to year 5 (52.9 to 75.8). After 5 years, complete filling (83%) and integration (82%) of the graft were seen in the majority of patients. Signs of subchondral bone edema were still present in 47% of patients at 5 years. No product-specific adverse events were reported over the 5-year follow-up period. CONCLUSION Patients treated with a MACI implant demonstrated significant clinical improvement and good quality repair tissue 5 years after surgery. The MACI procedure was shown to be a safe and effective treatment for symptomatic, traumatic chondral knee defects in this study.
Collapse
Affiliation(s)
- Stefan Marlovits
- Medical University of Vienna, Department of Traumatology, Waehringer Guertel 18-20, Vienna, A-1090 Austria.
| | | | | | | | | | | | | |
Collapse
|
36
|
Buchmann S, Salzmann GM, Glanzmann MC, Wörtler K, Vogt S, Imhoff AB. Early clinical and structural results after autologous chondrocyte transplantation at the glenohumeral joint. J Shoulder Elbow Surg 2012; 21:1213-21. [PMID: 22047789 DOI: 10.1016/j.jse.2011.07.030] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 07/16/2011] [Accepted: 07/24/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of the study was to report early functional and radiographic results of a small series of patients who underwent autologous chondrocyte transplantation-collagen membrane seeding (ACT-Cs) for focal chondral defects of the shoulder. METHODS The outcome of 4 consecutive male patients (mean age, 29.3 ± 6.2 years; range, 21-36 years) who underwent ACT-Cs for treatment of large symptomatic glenohumeral cartilage defects was retrospectively evaluated with clinical and radiographic measures at a mean of 41.3 ± 24.9 months (range, 11-71 months) after surgery. The evaluation included a visual analog scale for pain, the Constant score, the American Shoulder and Elbow Surgeons shoulder index, the Rowe score, and a satisfaction scale. Magnetic resonance imaging evaluation was performed according to the Magnetic Resonance Observation of Cartilage Repair Tissue scoring system. RESULTS There were 3 humeral full-thickness cartilage defects (each 6.0 cm(2)) and 1 glenoid full-thickness cartilage defect (2.0 cm(2)). The mean postoperative visual analog scale score (0.3 of 10), the mean unweighted Constant score (83.3 ± 9.9), and the mean American Shoulder and Elbow Surgeons index (95.3 ± 8.1) were representative of satisfactory shoulder function. The Magnetic Resonance Observation of Cartilage Repair Tissue score was indicative of satisfactory defect coverage with signs of fibrocartilaginous repair tissue. CONCLUSIONS Autologous chondrocyte transplantation at the glenohumeral joint is a remote option for young adults with symptomatic, isolated, large-diameter cartilage lesions. Potential complications as a result of the open approach and 2-step procedure have to be considered carefully. Long-term data, larger patient populations, and randomized studies are required to determine the potential for chondrocyte transplantation techniques to be standard procedure for treatment of symptomatic, large-diameter, full-thickness cartilage defects in the glenohumeral joint.
Collapse
Affiliation(s)
- Stefan Buchmann
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.
| | | | | | | | | | | |
Collapse
|
37
|
Long-term results 8 years after autologous osteochondral transplantation: 7 T gagCEST and sodium magnetic resonance imaging with morphological and clinical correlation. Osteoarthritis Cartilage 2012; 20:357-363. [PMID: 22353692 DOI: 10.1016/j.joca.2012.01.020] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 01/02/2012] [Accepted: 01/28/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To correlate long-term clinical outcome and the results of morphological as well as advanced biochemical magnetic resonance imaging (MRI) techniques [T2-mapping, glycosaminoglycan chemical exchange saturation transfer (gagCEST), sodium-23-imaging] in patients after autologous osteochondral transplantation (AOT) in knee joints. METHOD Nine AOT patients (two female and seven male; median age, 49) had clinical [International Knee Documentation Committee (IKDC), modified Lysholm, visual analog scale (VAS)] and radiological long-term follow-up examinations at a median of 7.9 years (inter-quartile range, 7.7-8.2). Standard morphological MRI and T2-mapping of cartilage were performed on a 3 T MR unit. Biochemical imaging further included sodium-23-imaging and chemical exchange saturation transfer (CEST) imaging at 7 T. The Magnetic resonance Observation of CArtilage Repair Tissue (MOCART) score was used for quantitative assessment of morphological MRI. RESULTS Clinical outcome was good with a median modified Lysholm score of 90. Median VAS revealed 1.0 and median MOCART score 75 points. The difference between native and repair cartilage was statistically significant for all three biochemical imaging techniques. The strongest correlation was found between the results of the advanced biochemical imaging methods sodium-23 and CEST [ρ = 0.952, 95% confidence interval (CI): (0.753; 0.992)]. Comparing the results from morphological and biochemical imaging, a correlation was found between MOCART score and CEST ratio [ρ = -0.749, 95% CI: (-0.944; -0.169)]. Comparing the results from clinical scores with MRI, a correlation between modified Lysholm and T2-mapping [ρ = -0.667, 95% CI: (-0.992; -0.005)] was observed. CONCLUSION Long-term clinical outcome in patients 7.9 years after AOT was good, but did not correlate with morphological and biochemical imaging results except for T2-mapping.
Collapse
|
38
|
Roemer FW, Crema MD, Trattnig S, Guermazi A. Advances in imaging of osteoarthritis and cartilage. Radiology 2011; 260:332-54. [PMID: 21778451 DOI: 10.1148/radiol.11101359] [Citation(s) in RCA: 159] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Osteoarthritis (OA) is the most frequent form of arthritis, with major implications for individual and public health care without effective treatment available. The field of joint imaging, and particularly magnetic resonance (MR) imaging, has evolved rapidly owing to technical advances and the application of these to the field of clinical research. Cartilage imaging certainly is at the forefront of these developments. In this review, the different aspects of OA imaging and cartilage assessment, with an emphasis on recent advances, will be presented. The current role of radiography, including advances in the technology for joint space width assessment, will be discussed. The development of various MR imaging techniques capable of facilitating assessment of cartilage morphology and the methods for evaluating the biochemical composition of cartilage will be presented. Advances in quantitative morphologic cartilage assessment and semiquantitative whole-organ assessment will be reviewed. Although MR imaging is the most important modality in imaging of OA and cartilage, others such as ultrasonography play a complementary role that will be discussed briefly.
Collapse
Affiliation(s)
- Frank W Roemer
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118, USA.
| | | | | | | |
Collapse
|
39
|
Shafiee A, Soleimani M, Chamheidari GA, Seyedjafari E, Dodel M, Atashi A, Gheisari Y. Electrospun nanofiber-based regeneration of cartilage enhanced by mesenchymal stem cells. J Biomed Mater Res A 2011; 99:467-78. [PMID: 21887742 DOI: 10.1002/jbm.a.33206] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 06/06/2011] [Accepted: 06/10/2011] [Indexed: 12/26/2022]
Abstract
Application of biomaterials in combination with stem cells is a novel tissue engineering approach to regenerate cartilage. The objective of this study was to investigate the potential of poly(vinyl alcohol)/polycaprolactone (PVA/PCL) nanofiber scaffolds seeded with rabbit bone marrow-mesenchymal stem cell (BM-MSC) for cartilage tissue engineering in vitro and in vivo. We tested the biocompatibility and mechanical properties of nanofibrous scaffolds using scanning electron microscope, MTT assay, and tensile measurements. The capacity of MSC for chondrogenic differentiation on scaffolds was examined using reverse transcription-polymer chain reaction and immunostaining. For in vivo assessments, PVA/PCL nanofiber scaffolds with or without MSC were implanted into rabbit full-thickness cartilage defects. To evaluate cartilage regeneration, semi-quantitative grading and histological analysis were performed. Our results showed that PVA/PCL scaffolds supported the proliferation and chondrogenic differentiation of MSC in vitro. Moreover, the animals treated with cell-seeded PVA/PCL scaffolds showed improved healing of defects compared with untreated control and those which received cell-free scaffolds. Our findings suggest that PVA/PCL scaffolds incorporated with MSC can serve as a suitable graft for articular cartilage reconstruction.
Collapse
Affiliation(s)
- Abbas Shafiee
- Stem Cell Biology, Nanotechnology and Tissue Engineering Departments, Stem Cell Technology Research Center, Tehran, Iran
| | | | | | | | | | | | | |
Collapse
|
40
|
The use of the Tegner Activity Scale for articular cartilage repair of the knee: a systematic review. Knee Surg Sports Traumatol Arthrosc 2011; 19:604-14. [PMID: 21076815 DOI: 10.1007/s00167-010-1301-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2010] [Accepted: 10/12/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE The Tegner Activity Scale (TAS) was developed in 1984 and has been widely used in studies on knee populations. The primary objective of this study was to undertake a systematic review on the use of the TAS for articular cartilage repair (ACR) of the knee. METHODS A systematic review was conducted using electronic databases (MEDLINE, CINAHL, SPORTDiscus™, NHS Evidence, ISI Web of Knowledge, AMED, BNI, PEDro and The Cochrane Collaboration of Systematic Reviews) and reference lists from extracted articles. Studies were selected that were published between 1984 and 2009 in which the TAS was reported for patients who had undergone ACR of the knee. RESULTS The search strategy identified 442 citations of which 34 articles met the inclusion criteria. There was a large degree of study heterogeneity especially regarding data reporting a wide variation in the number of participants (range 5-137), participant age (range 12-76 years), follow-up time (range 3-120 months) and male-to-female participant ratio. Where pre- to postoperative TAS change was analysed, 88% of studies demonstrated a significant improvement in postoperative TAS scores. CONCLUSIONS In general, TAS data were inconsistently reported and methodological detail was often lacking. Caution is advised in the interpretation of TAS scores following ACR of the knee where there are large ranges in postoperative follow-up times, mixed gender cohorts and wide ranges in participant ages. TAS data should be presented and analysed fully and ideally in a standardised fashion to facilitate the comparison of outcomes between studies.
Collapse
|
41
|
Jiang YZ, Zhang SF, Qi YY, Wang LL, Ouyang HW. Cell transplantation for articular cartilage defects: principles of past, present, and future practice. Cell Transplant 2010; 20:593-607. [PMID: 20887665 DOI: 10.3727/096368910x532738] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
As articular cartilage has very limited self-repair capability, the repair and regeneration of damaged cartilage is a major challenge. This review aims to outline the past, present, and future of cell therapies for articular cartilage defect repair. Autologous chondrocyte implantation (ACI) has been used clinically for more than 20 years, and the short, medium, and long-term clinical outcomes of three generation of ACI are extensively overviewed. Also, strategies of clinical outcome evaluation, ACI limitations, and the comparison of ACI clinical outcomes with those of other surgical techniques are discussed. Moreover, mesenchymal stem cells and pluripotent stem cells for cartilage regeneration in vitro, in vivo, and in a few clinical studies are reviewed. This review not only comprehensively analyzes the ACI clinical data but also considers the findings from state-of-the-art stem cell research on cartilage repair from bench and bedside. The conclusion provides clues for the future development of strategies for cartilage regeneration.
Collapse
Affiliation(s)
- Yang Zi Jiang
- Center for Stem Cell and Tissue Engineering, School of Medicine, Zhejiang University, Hangzhou, China
| | | | | | | | | |
Collapse
|