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Chen CP, Weng PW, Lee KT, Chiang LY, Liao WJ, Shaw L. Biphasic Scaffold Loaded With Autologous Cartilage Yields Better Clinical Outcome and Magnetic Resonance Imaging Filling Compared With Marrow Stimulation for Focal Osteochondral Lesions in the Knee. Arthroscopy 2024:S0749-8063(24)00302-5. [PMID: 38719177 DOI: 10.1016/j.arthro.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/31/2024] [Accepted: 04/09/2024] [Indexed: 06/04/2024]
Abstract
PURPOSE To evaluate the effectiveness of marrow stimulation (MS) versus biphasic scaffold loaded with autologous cartilage (scaffold) in treating focal osteochondral lesions of the knee. METHODS In total, 54 patients with symptomatic focal chondral or osteochondral lesion in the knee were randomized to either the scaffold group or the MS group. International Knee Documentation Committee subjective score, the Knee Injury Osteoarthritis Outcome Score, and magnetic resonance imaging (MRI) were assessed preoperatively and at 1 and 2 years after operation to compare treatment outcomes. Biopsy and second-look arthroscopy were performed at 1 year postoperatively for consenting patients. RESULTS There were 27 patients (mean age 31.33 ± 10.95 years) in the scaffold group, and 27 patients (31.74 ± 11.44) in the MS group. The scaffold group and the MS group both included 23 patients with lesions ≤12.5 × 12.5 mm2 mm in size. In addition, each group had 4 patients with lesions between than 12.5 × 12.5 mm2 and ≤12.5 × 25 mm2. Both interventions achieved significant improvement in clinical outcome scores at 2 years. The scaffold group had greater International Knee Documentation Committee score than the MS group at 2 years (93.85 ± 9.55 vs 92.11 ± 9.84) and in the Symptoms/Stiffness and Sport/Recreation subscales of Knee Injury Osteoarthritis Outcome Score at 2 years (96.57 ± 5.97 vs 93.57 ± 6.52, P < .05) and (90.2 ± 17.76 vs 82.8 ± 16.08, P < .05). CONCLUSIONS The use of biphasic scaffold loaded with autologous cartilage in treating focal osteochondral lesions demonstrates superior clinical outcomes and better cartilage refill on magnetic resonance imaging at the 2-year follow-up compared to marrow stimulation. LEVEL OF EVIDENCE Level I, Randomized controlled trial.
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Affiliation(s)
- Chao-Ping Chen
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Health Services Administration, China Medical University, Taichung, Taiwan; Department of Acupressure Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Pei-Wei Weng
- International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kun-Tsan Lee
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Post-Baccalaureate Medicine, National Chung-Hsing University, Taichung, Taiwan
| | - Liang-Yu Chiang
- Department of Orthopedic Surgery, Taichung Armed Forces General Hospital, Taichung, Taiwan; School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Jen Liao
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Leo Shaw
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan.
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Rosa FM, Fernandes JC, Delisle J, Ranger P, Albano MB, Filho ES. Clinical and quality-of-life outcomes of a combined synthetic scaffold and autogenous tissue graft procedure for articular cartilage repair in the knee. J Orthop Surg Res 2022; 17:112. [PMID: 35184759 PMCID: PMC8859907 DOI: 10.1186/s13018-022-03010-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/09/2022] [Indexed: 11/21/2022] Open
Abstract
Background Injuries to the articular cartilage of the knee often fail to heal properly due to the hypocellular and avascular nature of this tissue. Subsequent disability can limit participation in sports and decrease quality of life. Subchondral bone perforations are used for the treatment of small defects. Filling out the central portion in larger lesions becomes difficult, and scaffolds can be used as adjuvants, providing a matrix onto which the defect can be filled in completely. Also, autogenous cartilage grafts can be combined, acting as an inducer and improving healing quality, all in a single procedure.
Methods This observational study evaluated the clinical and quality-of-life outcomes of patients with articular cartilage lesions of the knee undergoing repair via a microfracture technique combined with a synthetic scaffold and autogenous cartilage graft, with transosseous sutures and fibrin glue fixation, at 12 months of follow-up. Secondarily, it assessed whether combined procedures, previous surgical intervention, traumatic aetiology, lesion location, and age affect outcomes. The sample consisted of adult patients (age 18–66 years) with symptoms consistent with chondral or osteochondral lesions, isolated or multiple, ICRS grade III/IV, 2–12 cm2 in size. Patients with corrected angular deviations or instabilities were included. Those with BMI > 40 kg/m2, prior total or subtotal (> 30%) meniscectomy, second-look procedures, and follow-up < 6 months were excluded. Pain (VAS), physical activity (IKDC), osteoarthritis (WOMAC), and general quality of life (SF-36) were assessed. Results 64 procedures were included, comprising 60 patients. There was significant improvement (P < 0.05) in VAS score (5.92–2.37), IKDC score (33.44–56.33), and modified WOMAC score (53.26–75.93) after surgery. The SF-36 showed significant improvements in the physical and mental domains (30.49–40.23 and 46.43–49.84 respectively; both P < 0.05). Conclusions Combination of microfractures, autogenous crushed cartilage graft, synthetic scaffold, and transosseous sutures with fibrin glue provides secure fixation for treatment of articular cartilage lesions of the knee. At 12-month follow-up, function had improved by 20 points on the IKDC and WOMAC, and quality of life, by 10 points on the SF-36. Age > 45 years had a negative impact on outcomes.
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Andrade R, Nunes J, Hinckel BB, Gruskay J, Vasta S, Bastos R, Oliveira JM, Reis RL, Gomoll AH, Espregueira-Mendes J. Cartilage Restoration of Patellofemoral Lesions: A Systematic Review. Cartilage 2021; 13:57S-73S. [PMID: 31845590 PMCID: PMC8808938 DOI: 10.1177/1947603519893076] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
PURPOSE This study aimed to systematically analyze the postoperative clinical, functional, and imaging outcomes, complications, reoperations, and failures following patellofemoral cartilage restoration surgery. METHODS This review was conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed, EMBASE, and Cochrane Library databases were searched up to August 31, 2018, to identify clinical studies that assessed surgical outcomes of patellofemoral cartilage restoration surgery. The Methodological Index for Non-Randomized Studies (MINORS) was used to assess study quality. RESULTS Forty-two studies were included comprising 1,311 knees (mean age of 33.7 years and 56% males) and 1,309 patellofemoral defects (891 patella, 254 trochlear, 95 bipolar, and 69 multiple defects, including the patella or trochlea) at a mean follow-up of 59.2 months. Restoration techniques included autologous chondrocyte implantation (56%), particulated juvenile allograft cartilage (12%), autologous matrix-induced chondrogenesis (9%), osteochondral autologous transplantation (9%), and osteochondral allograft transplantation (7%). Significant improvement in at least one score was present in almost all studies and these surpassed the minimal clinically important difference threshold. There was a weighted 19%, 35%, and 6% rate of reported complications, reoperations, and failures, respectively. Concomitant patellofemoral surgery (51% of patients) mostly did not lead to statistically different postoperative outcomes. CONCLUSION Numerous patellofemoral restoration techniques result in significant functional improvement with a low rate of failure. No definitive conclusions could be made to determine the best surgical technique since comparative studies on this topic are rare, and treatment choice should be made according to specific patient and defect characteristics. LEVEL OF EVIDENCE Level IV, systematic review of level II to IV studies.
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Affiliation(s)
- Renato Andrade
- Clínica do Dragão, Espregueira-Mendes
Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal,Dom Henrique Research Centre, Porto,
Portugal,Faculty of Sports, University of Porto,
Porto, Portugal
| | | | - Betina B. Hinckel
- Brigham and Woman’s Hospital, Harvard
Medical School, Boston, MA, USA
| | | | - Sebastiano Vasta
- Orthopaedics and Trauma Surgery
Department, University Campus Bio-Medico of Rome, Rome, Italy
| | - Ricardo Bastos
- Clínica do Dragão, Espregueira-Mendes
Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal,Dom Henrique Research Centre, Porto,
Portugal,3B’s Research Group, I3Bs–Research
Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho,
Headquarters of the European Institute of Excellence on Tissue Engineering and
Regenerative Medicine, Barco, Guimarães, Portugal,ICVS/3B’s–PT Government Associate
Laboratory, Braga/Guimarães, Portugal,Fluminense Federal University,
Niterói, Rio de Janeiro, Brazil
| | - J. Miguel Oliveira
- 3B’s Research Group, I3Bs–Research
Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho,
Headquarters of the European Institute of Excellence on Tissue Engineering and
Regenerative Medicine, Barco, Guimarães, Portugal,ICVS/3B’s–PT Government Associate
Laboratory, Braga/Guimarães, Portugal,The Discoveries Centre for
Regenerative and Precision Medicine, Headquarters at University of Minho, Barco,
Guimarães, Portugal
| | - Rui L. Reis
- 3B’s Research Group, I3Bs–Research
Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho,
Headquarters of the European Institute of Excellence on Tissue Engineering and
Regenerative Medicine, Barco, Guimarães, Portugal,ICVS/3B’s–PT Government Associate
Laboratory, Braga/Guimarães, Portugal,The Discoveries Centre for
Regenerative and Precision Medicine, Headquarters at University of Minho, Barco,
Guimarães, Portugal
| | | | - João Espregueira-Mendes
- Clínica do Dragão, Espregueira-Mendes
Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal,Dom Henrique Research Centre, Porto,
Portugal,ICVS/3B’s–PT Government Associate
Laboratory, Braga/Guimarães, Portugal,Orthopaedics Department of Minho
University, Braga, Portugal,João Espregueira-Mendes, Clínica do Dragão,
Espregueira-Mendes Sports Centre, FIFA Medical Centre of Excellence, Via Futebol
Clube do Porto, F. C. Porto Stadium, Porto, Portugal.
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Wang D, Nawabi DH, Krych AJ, Jones KJ, Nguyen J, Elbuluk AM, Farshad-Amacker NA, Potter HG, Williams RJ. Synthetic Biphasic Scaffolds versus Microfracture for Articular Cartilage Defects of the Knee: A Retrospective Comparative Study. Cartilage 2021; 13:1002S-1013S. [PMID: 32046514 PMCID: PMC8808844 DOI: 10.1177/1947603520903418] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The purpose of this study was to compare the results of a biphasic synthetic scaffold (TruFit, Smith & Nephew) to microfracture for the treatment of knee cartilage defects and identify patient- and lesion-specific factors that influence outcomes. DESIGN Prospectively collected data from 132 patients (mean age, 41.8 years; 69% male) with isolated chondral or osteochondral femoral defects treated with biphasic synthetic scaffolds (n = 66) or microfracture (n = 66) were reviewed. Clinical outcomes were evaluated longitudinally over 5 years with the Short Form-36 (SF-36), Activities of Daily Living of the Knee Outcome Survey (KOS-ADL), International Knee Documentation Committee (IKDC), and Marx Activity Scale. Cartilage-sensitive magnetic resonance imaging (MRI) was performed to evaluate osseous integration and cartilage fill in a subgroup of patients. Multivariate regression analysis was used to identify predictors of clinical outcomes within the scaffold group. RESULTS Both groups demonstrated clinically significant improvements in knee clinical scores over 5 years (P < 0.01). There were no significant differences in KOS-ADL and IKDC scores between groups up to 5 years postoperatively. Marx activity level scores in the microfracture group declined over time, while significant improvements in activity level scores were observed in the scaffold group over 5 years (P < 0.01). Good-quality tissue fill and cartilage isointensity were more often observed in the scaffold group compared with the microfracture group, particularly with longer time intervals. Increasing age, high body mass index, prior microfracture, and traumatic etiology were predictors for inferior outcomes in the scaffold group. CONCLUSIONS Activity level and MRI appearance following treatment of cartilage lesions with the biphasic synthetic scaffold were superior to microfracture over time in this nonrandomized, retrospective comparison.
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Affiliation(s)
- Dean Wang
- Department of Orthopaedic Surgery,
University of California Irvine, Orange, CA, USA,Dean Wang, UC Irvine Health, 101 The City
Drive South, Pavilion III, Building 29A, Orange, CA 92868, USA.
| | - Danyal H. Nawabi
- Sports Medicine Service, Hospital for
Special Surgery, New York, NY, USA
| | - Aaron J. Krych
- Department of Orthopaedic Surgery, Mayo
Clinic, Rochester, MN, USA
| | - Kristofer J. Jones
- Department of Orthopaedic Surgery, David
Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Joseph Nguyen
- Sports Medicine Service, Hospital for
Special Surgery, New York, NY, USA
| | - Ameer M. Elbuluk
- Sports Medicine Service, Hospital for
Special Surgery, New York, NY, USA
| | | | - Hollis G. Potter
- Department of Radiology and Imaging,
Hospital for Special Surgery, New York, NY, USA
| | - Riley J. Williams
- Sports Medicine Service, Hospital for
Special Surgery, New York, NY, USA
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5
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Wei W, Dai H. Articular cartilage and osteochondral tissue engineering techniques: Recent advances and challenges. Bioact Mater 2021; 6:4830-4855. [PMID: 34136726 PMCID: PMC8175243 DOI: 10.1016/j.bioactmat.2021.05.011] [Citation(s) in RCA: 108] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/20/2021] [Accepted: 05/11/2021] [Indexed: 12/18/2022] Open
Abstract
In spite of the considerable achievements in the field of regenerative medicine in the past several decades, osteochondral defect regeneration remains a challenging issue among diseases in the musculoskeletal system because of the spatial complexity of osteochondral units in composition, structure and functions. In order to repair the hierarchical tissue involving different layers of articular cartilage, cartilage-bone interface and subchondral bone, traditional clinical treatments including palliative and reparative methods have showed certain improvement in pain relief and defect filling. It is the development of tissue engineering that has provided more promising results in regenerating neo-tissues with comparable compositional, structural and functional characteristics to the native osteochondral tissues. Here in this review, some basic knowledge of the osteochondral units including the anatomical structure and composition, the defect classification and clinical treatments will be first introduced. Then we will highlight the recent progress in osteochondral tissue engineering from perspectives of scaffold design, cell encapsulation and signaling factor incorporation including bioreactor application. Clinical products for osteochondral defect repair will be analyzed and summarized later. Moreover, we will discuss the current obstacles and future directions to regenerate the damaged osteochondral tissues.
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Affiliation(s)
- Wenying Wei
- State Key Laboratory of Advanced Technology for Materials Synthesis and Processing, Biomedical Materials and Engineering Research Center of Hubei Province, Wuhan University of Technology, Wuhan, 430070, China
- International School of Materials Science and Engineering, Wuhan University of Technology, Wuhan, 430070, China
| | - Honglian Dai
- State Key Laboratory of Advanced Technology for Materials Synthesis and Processing, Biomedical Materials and Engineering Research Center of Hubei Province, Wuhan University of Technology, Wuhan, 430070, China
- Foshan Xianhu Laboratory of the Advanced Energy Science and Technology Guangdong Laboratory, Xianhu Hydrogen Valley, Foshan, 528200, China
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6
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Ai C, Lee YHD, Tan XH, Tan SHS, Hui JHP, Goh JCH. Osteochondral tissue engineering: Perspectives for clinical application and preclinical development. J Orthop Translat 2021; 30:93-102. [PMID: 34722152 PMCID: PMC8517716 DOI: 10.1016/j.jot.2021.07.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/15/2021] [Accepted: 07/28/2021] [Indexed: 01/17/2023] Open
Abstract
The treatment of osteochondral defects (OCD) remains challenging. Among currently available surgical treatments for OCDs, scaffold-based treatments are promising to regenerate the osteochondral unit. However, there is still no consensus regarding the clinical effectiveness of these scaffold-based therapies for OCDs. Previous reviews have described the gradient physiological characteristics of osteochondral tissue and gradient scaffold design for OCD, tissue engineering strategies, biomaterials, and fabrication technologies. However, the discussion on bridging the gap between the clinical need and preclinical research is still limited, on which we focus in the present review, providing an insight into what is currently lacking in tissue engineering methods that failed to yield satisfactory outcomes, and what is needed to further improve these techniques. Currently available surgical treatments for OCDs are firstly summarized, followed by a comprehensive review on experimental animal studies in recent 5 years on osteochondral tissue engineering. The review will then conclude with what is currently lacking in these animal studies and the recommendations that would help enlighten the community in developing more clinically relevant implants. The translational potential of this article This review is attempting to summarize the lessons from clinical and preclinical failures, providing an insight into what is currently lacking in TE methods that failed to yield satisfactory outcomes, and what is needed to further improve these implants.
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Affiliation(s)
- Chengchong Ai
- Integrative Sciences and Engineering Programme, NUS Graduate School, National University of Singapore, Singapore.,Department of Biomedical Engineering, National University of Singapore, Singapore
| | - Yee Han Dave Lee
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | - Xuan Hao Tan
- Integrative Sciences and Engineering Programme, NUS Graduate School, National University of Singapore, Singapore.,Department of Biomedical Engineering, National University of Singapore, Singapore
| | - Si Heng Sharon Tan
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | - James Hoi Po Hui
- Department of Orthopaedic Surgery, National University Health System, Singapore.,NUS Tissue Engineering Programme, Life Sciences Institute, National University of Singapore, Singapore.,Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - James Cho-Hong Goh
- Integrative Sciences and Engineering Programme, NUS Graduate School, National University of Singapore, Singapore.,Department of Biomedical Engineering, National University of Singapore, Singapore.,NUS Tissue Engineering Programme, Life Sciences Institute, National University of Singapore, Singapore.,Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Boffa A, Solaro L, Poggi A, Andriolo L, Reale D, Di Martino A. Multi-layer cell-free scaffolds for osteochondral defects of the knee: a systematic review and meta-analysis of clinical evidence. J Exp Orthop 2021; 8:56. [PMID: 34331140 PMCID: PMC8324705 DOI: 10.1186/s40634-021-00377-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/23/2021] [Indexed: 01/13/2023] Open
Abstract
Purpose The aim of this study was to analyze the clinical results provided by multi-layer cell-free scaffolds for the treatment of knee osteochondral defects. Methods A systematic review was performed on PubMed, Web of Science, and Cochrane to identify studies evaluating the clinical efficacy of cell-free osteochondral scaffolds for knee lesions. A meta-analysis was performed on articles reporting results of the International Knee Documentation Committee (IKDC) and Tegner scores. The scores were analyzed as improvement from baseline to 1, 2, and ≥ 3 years of follow-up. The modified Coleman Methodology Score was used to assess the study methodology. Results A total of 34 studies (1022 patients) with a mean follow-up of 35 months was included. Only three osteochondral scaffolds have been investigated in clinical trials: while TruFit® has been withdrawn from the market for the questionable results, the analysis of MaioRegen and Agili-C™ provided clinical improvements at 1, 2, and ≥ 3 years of follow-up (all significantly higher than the baseline, p < 0.05), although with a limited recovery of the sport-activity level. A low rate of adverse events and an overall failure rate of 7.0% were observed, but the overall evidence level of the available studies is limited. Conclusions Multi-layer scaffolds may provide clinical benefits for the treatment of knee osteochondral lesions at short- and mid-term follow-up and with a low number of failures, although the sport-activity level obtained seems to be limited. Further research with high-level studies is needed to confirm the role of multi-layer scaffold for the treatment of knee osteochondral lesions.
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Affiliation(s)
- Angelo Boffa
- Clinica Ortopedica E Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1 - 40136, Bologna, Italy
| | - Luca Solaro
- Clinica Ortopedica E Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1 - 40136, Bologna, Italy
| | - Alberto Poggi
- Clinica Ortopedica E Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1 - 40136, Bologna, Italy.
| | - Luca Andriolo
- Clinica Ortopedica E Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1 - 40136, Bologna, Italy
| | - Davide Reale
- Clinica Ortopedica E Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1 - 40136, Bologna, Italy
| | - Alessandro Di Martino
- Clinica Ortopedica E Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1 - 40136, Bologna, Italy
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The development of natural polymer scaffold-based therapeutics for osteochondral repair. Biochem Soc Trans 2021; 48:1433-1445. [PMID: 32794551 DOI: 10.1042/bst20190938] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/21/2020] [Accepted: 07/24/2020] [Indexed: 02/07/2023]
Abstract
Due to the limited regenerative capacity of cartilage, untreated joint defects can advance to more extensive degenerative conditions such as osteoarthritis. While some biomaterial-based tissue-engineered scaffolds have shown promise in treating such defects, no scaffold has been widely accepted by clinicians to date. Multi-layered natural polymer scaffolds that mimic native osteochondral tissue and facilitate the regeneration of both articular cartilage (AC) and subchondral bone (SCB) in spatially distinct regions have recently entered clinical use, while the transient localized delivery of growth factors and even therapeutic genes has also been proposed to better regulate and promote new tissue formation. Furthermore, new manufacturing methods such as 3D bioprinting have made it possible to precisely tailor scaffold micro-architectures and/or to control the spatial deposition of cells in requisite layers of an implant. In this way, natural and synthetic polymers can be combined to yield bioactive, yet mechanically robust, cell-laden scaffolds suitable for the osteochondral environment. This mini-review discusses recent advances in scaffolds for osteochondral repair, with particular focus on the role of natural polymers in providing regenerative templates for treatment of both AC and SCB in articular joint defects.
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9
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Shivji FS, Mumith A, Yasen S, Melton JT, Wilson AJ. Treatment of focal chondral lesions in the knee using a synthetic scaffold plug: Long-term clinical and radiological results. J Orthop 2020; 20:12-16. [PMID: 32021049 DOI: 10.1016/j.jor.2020.01.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 01/12/2020] [Indexed: 11/18/2022] Open
Abstract
The management of symptomatic articular cartilage lesions, especially in the young, fit individual remains an area of considerable controversy. Articular cartilage repair or reconstruction techniques may offer these patients alternatives to arthroplasty. The TruFit™ plug is a synthetic biphasic polymer scaffold that is designed for implantation at the site of a focal chondral defect. The aim of this study is to report the long-term clinical and radiological outcomes of patients treated with the TruFit™ plug for chondral defects within the knee. 11 patients underwent TruFit™ plug implantation. Long-term outcome scores were available for 6 patients at a mean follow up of 121 months (SD 12.0 months, 1 patient unavailable and 4 excluded after arthroplasty surgery). There was no statistically significant improvements in any score although all scores did improve. At a mean radiographic follow up of 70 months (17-113) of 9 patients, the mean MOCART score was 22.2 (SD 15.6). All patients had incomplete or no evidence of plug incorporation and persistent chondral loss. Based on these results, we do not recommend the use of the TruFit™ plug.
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Affiliation(s)
- Faiz S Shivji
- Basingstoke & North Hampshire Hospital, Aldermaston Road, Basingstoke, RG24 9NA, UK
| | - Aadil Mumith
- Basingstoke & North Hampshire Hospital, Aldermaston Road, Basingstoke, RG24 9NA, UK
| | - Sam Yasen
- Basingstoke & North Hampshire Hospital, Aldermaston Road, Basingstoke, RG24 9NA, UK
| | - Joel Tk Melton
- Basingstoke & North Hampshire Hospital, Aldermaston Road, Basingstoke, RG24 9NA, UK
| | - Adrian J Wilson
- Basingstoke & North Hampshire Hospital, Aldermaston Road, Basingstoke, RG24 9NA, UK
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Fox MG, Chang EY, Amini B, Bernard SA, Gorbachova T, Ha AS, Iyer RS, Lee KS, Metter DF, Mooar PA, Shah NA, Singer AD, Smith SE, Taljanovic MS, Thiele R, Tynus KM, Kransdorf MJ. ACR Appropriateness Criteria® Chronic Knee Pain. J Am Coll Radiol 2018; 15:S302-S312. [DOI: 10.1016/j.jacr.2018.09.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/07/2018] [Indexed: 12/12/2022]
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Tamaddon M, Liu C. Enhancing Biological and Biomechanical Fixation of Osteochondral Scaffold: A Grand Challenge. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1059:255-298. [PMID: 29736578 DOI: 10.1007/978-3-319-76735-2_12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Osteoarthritis (OA) is a degenerative joint disease, typified by degradation of cartilage and changes in the subchondral bone, resulting in pain, stiffness and reduced mobility. Current surgical treatments often fail to regenerate hyaline cartilage and result in the formation of fibrocartilage. Tissue engineering approaches have emerged for the repair of cartilage defects and damages to the subchondral bones in the early stage of OA and have shown potential in restoring the joint's function. In this approach, the use of three-dimensional scaffolds (with or without cells) provides support for tissue growth. Commercially available osteochondral (OC) scaffolds have been studied in OA patients for repair and regeneration of OC defects. However, some controversial results are often reported from both clinical trials and animal studies. The objective of this chapter is to report the scaffolds clinical requirements and performance of the currently available OC scaffolds that have been investigated both in animal studies and in clinical trials. The findings have demonstrated the importance of biological and biomechanical fixation of the OC scaffolds in achieving good cartilage fill and improved hyaline cartilage formation. It is concluded that improving cartilage fill, enhancing its integration with host tissues and achieving a strong and stable subchondral bone support for overlying cartilage are still grand challenges for the early treatment of OA.
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Affiliation(s)
- Maryam Tamaddon
- Institute of Orthopaedics & Musculoskeletal Science, Division of Surgery & Interventional Science, University College London, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Chaozong Liu
- Institute of Orthopaedics & Musculoskeletal Science, Division of Surgery & Interventional Science, University College London, Royal National Orthopaedic Hospital, Stanmore, UK.
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12
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Clinical Trials and Management of Osteochondral Lesions. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1058:391-413. [DOI: 10.1007/978-3-319-76711-6_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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13
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Zellner J, Grechenig S, Pfeifer CG, Krutsch W, Koch M, Welsch G, Scherl M, Seitz J, Zeman F, Nerlich M, Angele P. Clinical and Radiological Regeneration of Large and Deep Osteochondral Defects of the Knee by Bone Augmentation Combined With Matrix-Guided Autologous Chondrocyte Transplantation. Am J Sports Med 2017; 45:3069-3080. [PMID: 28777662 DOI: 10.1177/0363546517717679] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Large osteochondral defects of the knee are a challenge for regenerative treatment. While matrix-guided autologous chondrocyte transplantation (MACT) represents a successful treatment for chondral defects, the treatment potential in combination with bone grafting by cancellous bone or bone block augmentation for large and deep osteochondral defects has not been evaluated. PURPOSE To evaluate 1- to 3-year clinical outcomes and radiological results on magnetic resonance imaging (MRI) after the treatment of large osteochondral defects of the knee with bone augmentation and MACT. Special emphasis is placed on different methods of bone grafting (cancellous bone grafting or bone block augmentation). STUDY DESIGN Case series; Level of evidence, 4. METHODS Fifty-one patients were included. Five patients were lost to follow-up. This left 46 patients (mean age, 28.2 years) with a median follow-up time of 2 years. The 46 patients had 47 deep, large osteochondral defects of the knee joint (1 patient with bilateral defects; mean defect size, 6.7 cm2). The origin of the osteochondral defects was osteochondritis dissecans (n = 34), osteonecrosis (n = 8), or subchondral cysts (n = 5). Depending on the depth, all defects were treated by cancellous bone grafting (defect depth ≤10 mm; n = 16) or bone block augmentation (defect depth >10 mm; n = 31) combined with MACT. Clinical outcomes were followed at 3 months, 6 months, 1 year, 2 years, and 3 years and evaluated using the International Knee Documentation Committee (IKDC) score and Cincinnati score. A magnetic resonance imaging (MRI) evaluation was performed at 1 and 2 years, and the magnetic resonance observation of cartilage repair tissue (MOCART) score with additional specific subchondral bone parameters (bone regeneration, bone signal quality, osteophytes, sclerotic areas, and edema) was analyzed. RESULTS The clinical outcome scores revealed a significant increase at follow-up (6 months to 3 years) compared with the preclinical results. The median IKDC score increased from 42.6 preoperatively to 75.3 at 1 year, 79.7 at 2 years, and 84.3 at 3 years. The median Cincinnati score significantly increased from 39.8 preoperatively to 72.0 at 1 year, 78.0 at 2 years, and 80.3 at 3 years. The MRI evaluation revealed a MOCART score of 82.6 at 1 year without a deterioration at the later follow-up time point. Especially, the subchondral bone analysis showed successful regeneration. All bone blocks and cancellous bone grafts were integrated in the bony defects, and no chondrocyte transplant failure could be detected throughout the follow-up. CONCLUSION Large and deep osteochondral defects of the knee joint can be treated successfully with bone augmentation and MACT. The treatment of shallow bony defects with cancellous bone grafting and deep bony defects with bone block augmentation shows promising results.
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Affiliation(s)
- Johannes Zellner
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Stephan Grechenig
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Christian G Pfeifer
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Werner Krutsch
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Matthias Koch
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Goetz Welsch
- Department of Athletics and Sports Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Madeleine Scherl
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | | | - Florian Zeman
- Clinical Study Center, University Medical Center Regensburg, Regensburg, Germany
| | - Michael Nerlich
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Peter Angele
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany.,Sporthopaedicum Regensburg, Regensburg, Germany
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14
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Datta P, Dhawan A, Yu Y, Hayes D, Gudapati H, Ozbolat IT. Bioprinting of osteochondral tissues: A perspective on current gaps and future trends. Int J Bioprint 2017; 3:007. [PMID: 33094191 PMCID: PMC7575632 DOI: 10.18063/ijb.2017.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 06/07/2017] [Indexed: 01/06/2023] Open
Abstract
Osteochondral tissue regeneration has remained a critical challenge in orthopaedic surgery, especially due to complications of arthritic degeneration arising out of mechanical dislocations of joints. The common gold standard of autografting has several limitations in presenting tissue engineering strategies to solve the unmet clinical need. However, due to the complexity of joint anatomy, and tissue heterogeneity at the interface, the conventional tissue engineering strategies have certain limitations. The advent of bioprinting has now provided new opportunities for osteochondral tissue engineering. Bioprinting can uniquely mimic the heterogeneous cellular composition and anisotropic extra-cellular matrix (ECM) organization, while allowing for targeted gene delivery to achieve heterotypic differentiation. In this perspective, we discuss the current advances made towards bioprinting of composite osteochondral tissues and present an account of challenges-in terms of tissue integration, long-term survival, and mechanical strength at the time of implantation-required to be addressed for effective clinical translation of bioprinted tissues. Finally, we highlight some of the future trends related to osteochondral bioprinting with the hope of in-clinical translation.
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Affiliation(s)
- Pallab Datta
- Centre for Healthcare Science and Technology, Indian Institute of Engineering Science and Technology Shibpur, Howrah, West Bengal 711103, India
| | - Aman Dhawan
- Orthopedics and Rehabilitation, Penn State University, Hershey, PA 17033, USA
| | - Yin Yu
- Department of Surgery, Harvard Medical School, Harvard University, Cambridge, MA 02138, USA.,The Center for Engineering in Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Dan Hayes
- The Huck Institutes of the Life Sciences, Penn State University, University Park, PA 16802, USA.,Biomedical Engineering, Penn State University, University Park, PA 16802, USA
| | - Hemanth Gudapati
- The Huck Institutes of the Life Sciences, Penn State University, University Park, PA 16802, USA.,Engineering Science and Mechanics Department, Penn State University, University Park, PA 16802, USA
| | - Ibrahim T Ozbolat
- The Huck Institutes of the Life Sciences, Penn State University, University Park, PA 16802, USA.,Biomedical Engineering, Penn State University, University Park, PA 16802, USA.,Engineering Science and Mechanics Department, Penn State University, University Park, PA 16802, USA.,Materials Research Institute, Penn State University, University Park, PA 16802, USA
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15
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Niemeyer P, Albrecht D, Andereya S, Angele P, Ateschrang A, Aurich M, Baumann M, Bosch U, Erggelet C, Fickert S, Gebhard H, Gelse K, Günther D, Hoburg A, Kasten P, Kolombe T, Madry H, Marlovits S, Meenen NM, Müller PE, Nöth U, Petersen JP, Pietschmann M, Richter W, Rolauffs B, Rhunau K, Schewe B, Steinert A, Steinwachs MR, Welsch GH, Zinser W, Fritz J. Autologous chondrocyte implantation (ACI) for cartilage defects of the knee: A guideline by the working group "Clinical Tissue Regeneration" of the German Society of Orthopaedics and Trauma (DGOU). Knee 2016; 23:426-35. [PMID: 26947215 DOI: 10.1016/j.knee.2016.02.001] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/13/2016] [Accepted: 02/01/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Autologous chondrocyte implantation (ACI) is an established and well-accepted procedure for the treatment of localised full-thickness cartilage defects of the knee. METHODS The present review of the working group "Clinical Tissue Regeneration" of the German Society of Orthopaedics and Trauma (DGOU) describes the biology and function of healthy articular cartilage, the present state of knowledge concerning therapeutic consequences of primary cartilage lesions and the suitable indication for ACI. RESULTS Based on best available scientific evidence, an indication for ACI is given for symptomatic cartilage defects starting from defect sizes of more than three to four square centimetres; in the case of young and active sports patients at 2.5cm(2), while advanced degenerative joint disease needs to be considered as the most important contraindication. CONCLUSION The present review gives a concise overview on important scientific background and the results of clinical studies and discusses the advantages and disadvantages of ACI. LEVEL OF EVIDENCE Non-systematic Review.
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Affiliation(s)
- P Niemeyer
- Department Orthopädie und Traumatologie, Universitätsklinikum Freiburg, Germany.
| | - D Albrecht
- Klinik im Kronprinzenbau, Reutlingen, Germany
| | - S Andereya
- Orthopädie und Unfallchirurgie, Ortho AC, Aachen, Germany
| | - P Angele
- Abteilung für Unfallchirurgie, Universitätsklinikum Regensburg, Germany; Sportopaedicum, Straubing, Berlin, Regensburg, München, Germany
| | - A Ateschrang
- Berufsgenossenschaftliche Unfallklinik Tübingen, Germany
| | - M Aurich
- Kliniken Leipziger Land GmbH, Klinikum Borna, Germany
| | - M Baumann
- Kreiskliniken Esslingen, Klinik f. Unfallchirurgie - Orthopädische Chirurgie, Esslingen, Germany
| | - U Bosch
- Zentrum f. Orthopädische Chirurgie, Sporttraumatologie, INI Hannover, Germany
| | - C Erggelet
- Center of Biologie Joint Repair, Zürich, Switzerland
| | - S Fickert
- Sportopaedicum, Straubing, Berlin, Regensburg, München, Germany
| | - H Gebhard
- Abteilung für Unfallchirurgie, Universitätsklinikum Regensburg, Germany
| | - K Gelse
- Abteilung für Unfallchirurgie, Universitätsklinikum Erlangen, Germany
| | - D Günther
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover (MHH), Germany
| | - A Hoburg
- Universitätsmedizin Berlin-Charite, Klinik für Orthopädie, Unfall u. Wiederherstellungschirurgie, Germany
| | - P Kasten
- Orthopädisch Chirurgisches Centrum, Tübingen, Germany
| | - T Kolombe
- Unfallchirurgie/Orthopädie, DRK Krankenhaus Luckenwalde, Germany
| | - H Madry
- Zentrum für Experimentelle Orthopädie, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - S Marlovits
- Universitätsklinik für Unfallchirurgie, Medizinische Universität Wien und Austrian Cluster for Tissue Regeneration, Austria
| | - N M Meenen
- Sektion Pädiatrische Sportmedizin, Kinderorthopädie, Altonaer Kinderkrankenhaus Hamburg, Germany
| | - P E Müller
- Orthopädische Klinik, Ludwig-Maximiliams-Universität München, Germany
| | - U Nöth
- Evangelisches Waldkrankenhaus Spandau, Klinik f. Orthopädie und Unfallchirurgie, Berlin, Germany
| | - J P Petersen
- Zentrum f. operative Medizin, Klinik für Unfall-, Hand- u. Wiederherstellungschirurgie, Universitätsklinikum Hamburg-Eppendorf, Germany
| | - M Pietschmann
- Orthopädische Klinik, Ludwig-Maximiliams-Universität München, Germany
| | - W Richter
- Forschungszentrum für Experimentelle Orthopädie, Universitätsklinikum Heidelberg, Germany
| | - B Rolauffs
- Berufsgenossenschaftliche Unfallklinik Tübingen, Germany
| | | | - B Schewe
- Orthopädisch Chirurgisches Centrum, Tübingen, Germany
| | - A Steinert
- Orthopädische Klinik, König-Ludwig-Haus, Universität Würzburg, Germany
| | | | | | - W Zinser
- Klinik für Orthopädie und Unfallchirurgie, St. Vinzenz-Hospital Dinslaken, Germany
| | - J Fritz
- Orthopädisch Chirurgisches Centrum, Tübingen, Germany
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16
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Blanke F, Vogt S. Zellfreie Biomaterialien. ARTHROSKOPIE 2016. [DOI: 10.1007/s00142-016-0067-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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17
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Zhang K, He S, Yan S, Li G, Zhang D, Cui L, Yin J. Regeneration of hyaline-like cartilage and subchondral bone simultaneously by poly(l-glutamic acid) based osteochondral scaffolds with induced autologous adipose derived stem cells. J Mater Chem B 2016; 4:2628-2645. [PMID: 32263287 DOI: 10.1039/c5tb02113h] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Osteochondral tissue engineering is challenged by the difficulty in the regeneration of hyaline cartilage and the simultaneous regeneration of subchondral bone. In the present study, nhydroxyapatite-graft-poly(l-glutamic acid) (nHA-g-PLGA) was prepared by surface-initiated ring-opening polymerization, which was then used to fabricate an osteogenic scaffold (scaffold O) instead of nHA to achieve better mechanical performance. Then, a single osteochondral scaffold was fabricated by combining the poly(l-glutamic acid) (PLGA)/chitosan (CS) amide bonded hydrogel and the PLGA/CS/nHA-g-PLGA polyelectrolyte complex (PEC), possessing two different regions to support both hyaline cartilage and underlying bone regeneration, respectively. Autologous adipose derived stem cells (ASCs) were seeded into the osteochondral scaffold. The chondrogenesis of ASCs in the scaffold was triggered in vitro by TGF-β1 and IGF-1 for 7 days. In vitro, a chondrogenic scaffold (scaffold C) exhibited the ability to drive adipose derived stem cell (ASC) aggregates to form multicellular spheroids with a diameter of 80-110 μm in situ, thus promoting the chondrogenesis while limiting COL I deposition when compared to ASCs adhered in scaffold O. Scaffold O showed the ability to bind abundant BMP-2. Osteochondral scaffolds with induced ASC spheroids in scaffold C and bonded BMP-2 in scaffold O were transplanted into rabbit osteochondral defects as group I for in vivo regeneration. At the same time, osteochondral scaffolds with only bonded BMP-2 in scaffold O and bare osteochondral scaffolds were filled into rabbit osteochondral defects to serve as group II and group III, respectively. After 12 weeks post-implantation, cartilage and subchondral bone tissues were both regenerated with the support of induced ASC spheroids and bonded BMP-2 in group I. However, in group II, cartilage was not repaired while subchondral bone was regenerated. In group III, the regeneration of both cartilage and subchondral bone was limited.
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Affiliation(s)
- Kunxi Zhang
- Department of Polymer Materials, Shanghai University, 99 Shangda Road, Shanghai 200444, P. R. China.
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18
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Implantation of a Polycaprolactone Scaffold with Subchondral Bone Anchoring Ameliorates Nodules Formation and Other Tissue Alterations. Int J Artif Organs 2016; 38:659-66. [DOI: 10.5301/ijao.5000457] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2015] [Indexed: 11/20/2022]
Abstract
Purpose Articular cartilage has limited repair capacity. Two different implant devices for articular cartilage regeneration were tested in vivo in a sheep model to evaluate the effect of subchondral bone anchoring for tissue repair. Methods The implants were placed with press-fit technique in a cartilage defect after microfracture surgery in the femoral condyle of the knee joint of the sheep and histologic and mechanical evaluation was done 4.5 months later. The first group consisted of a biodegradable polycaprolactone (PCL) scaffold with double porosity. The second test group consisted of a PCL scaffold attached to a poly(L-lactic acid) (PLLA) pin anchored to the subchondral bone. Results For both groups most of the defects (75%) showed an articular surface that was completely or almost completely repaired with a neotissue. Nevertheless, the surface had a rougher appearance than controls and the repair tissue was immature. In the trials with solely scaffold implantation, severe subchondral bone alterations were seen with many large nodular formations. These alterations were ameliorated when implanting the scaffold with a subchondral bone anchoring pin. Discussions The results show that tissue repair is improved by implanting a PCL scaffold compared to solely microfracture surgery, and most importantly, that subchondral bone alterations, normally seen after microfracture surgery, were partially prevented when implanting the PCL scaffold with a fixation system to the subchondral bone.
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19
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Goodrich LR, Chen AC, Werpy NM, Williams AA, Kisiday JD, Su AW, Cory E, Morley PS, McIlwraith CW, Sah RL, Chu CR. Addition of Mesenchymal Stem Cells to Autologous Platelet-Enhanced Fibrin Scaffolds in Chondral Defects: Does It Enhance Repair? J Bone Joint Surg Am 2016; 98:23-34. [PMID: 26738900 PMCID: PMC4697360 DOI: 10.2106/jbjs.o.00407] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The chondrogenic potential of culture-expanded bone-marrow-derived mesenchymal stem cells (BMDMSCs) is well described. Numerous studies have also shown enhanced repair when BMDMSCs, scaffolds, and growth factors are placed into chondral defects. Platelets provide a rich milieu of growth factors and, along with fibrin, are readily available for clinical use. The objective of this study was to determine if the addition of BMDMSCs to an autologous platelet-enriched fibrin (APEF) scaffold enhances chondral repair compared with APEF alone. METHODS A 15-mm-diameter full-thickness chondral defect was created on the lateral trochlear ridge of both stifle joints of twelve adult horses. In each animal, one defect was randomly assigned to receive APEF+BMDMSCs and the contralateral defect received APEF alone. Repair tissues were evaluated one year later with arthroscopy, histological examination, magnetic resonance imaging (MRI), micro-computed tomography (micro-CT), and biomechanical testing. RESULTS The arthroscopic findings, MRI T2 map, histological scores, structural stiffness, and material stiffness were similar (p > 0.05) between the APEF and APEF+BMDMSC-treated repairs at one year. Ectopic bone was observed within the repair tissue in four of twelve APEF+BMDMSC-treated defects. Defects repaired with APEF alone had less trabecular bone edema (as seen on MRI) compared with defects repaired with APEF+BMDMSCs. Micro-CT analysis showed thinner repair tissue in defects repaired with APEF+BMDMSCs than in those treated with APEF alone (p < 0.05). CONCLUSIONS APEF alone resulted in thicker repair tissue than was seen with APEF+BMDMSCs. The addition of BMDMSCs to APEF did not enhance cartilage repair and stimulated bone formation in some cartilage defects. CLINICAL RELEVANCE APEF supported repair of critical-size full-thickness chondral defects in horses, which was not improved by the addition of BMDMSCs. This work supports further investigation to determine whether APEF enhances cartilage repair in humans.
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Affiliation(s)
- Laurie R. Goodrich
- Gail Holmes Equine Orthopedic Research Center, Colorado State University, 300 West Drake Road, Fort Collins, CO 80523
| | - Albert C. Chen
- Department of Bioengineering, Mail Code 0412, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0412
| | - Natasha M. Werpy
- Large Animal Clinical Sciences, 2015 S.W. 16th Avenue, Gainesville, FL 32608
| | - Ashley A. Williams
- Department of Orthopedic Surgery, Stanford University School of Medicine, 450 Broadway Street, Redwood City, CA 94063
| | - John D. Kisiday
- Gail Holmes Equine Orthopedic Research Center, Colorado State University, 300 West Drake Road, Fort Collins, CO 80523
| | - Alvin W. Su
- Department of Bioengineering, Mail Code 0412, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0412
| | - Esther Cory
- Department of Bioengineering, Mail Code 0412, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0412
| | - Paul S. Morley
- Gail Holmes Equine Orthopedic Research Center, Colorado State University, 300 West Drake Road, Fort Collins, CO 80523
| | - C. Wayne McIlwraith
- Gail Holmes Equine Orthopedic Research Center, Colorado State University, 300 West Drake Road, Fort Collins, CO 80523
| | - Robert L. Sah
- Department of Bioengineering, Mail Code 0412, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0412
| | - Constance R. Chu
- Department of Orthopedic Surgery, Stanford University School of Medicine, 450 Broadway Street, Redwood City, CA 94063.,E-mail address for C.R. Chu:
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