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Yu Y, Lv B, Wu J, Chen W. Mussel-Based Biomimetic Strategies in Musculoskeletal Disorder Treatment: From Synthesis Principles to Diverse Applications. Int J Nanomedicine 2023; 18:455-472. [PMID: 36718191 PMCID: PMC9884062 DOI: 10.2147/ijn.s386635] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/03/2022] [Indexed: 01/26/2023] Open
Abstract
Musculoskeletal disorders are the second leading cause of disability worldwide, posing a huge global burden to the public sanitation system. Currently, tissue engineering-based approaches act as effective strategies, which are, however, challenging in limited application scenarios. Mussel-based biomimetic materials, exhibit numerous unique properties such as intense adhesion, biocompatibility, moisture resistance, and injectability, to name only a few, and have attracted extensive research interest. In particular, featuring state-of-the-art properties, mussel-inspired biomaterials have been widely explored in innumerable musculoskeletal disorder treatments including osteochondral defects, osteosarcoma, osteoarthritis, ligament rupture, and osteoporosis. Nevertheless, a comprehensive and timely discussion of their applications in musculoskeletal disorders is insufficient. In this review, we emphasize on (1) the main categories and characteristics of mussel foot proteins and their fundamental mechanisms for the spectacular adhesion in mussels; (2) the diverse synthetic methods and modification of various polymers; and (3) the emerging applications of mussel-biomimetic materials, the future perspectives, and challenges, especially in the area of musculoskeletal disorder. We envision that this review will provide a unique and insightful perspective to improve the development of a new generation of mussel biomimetic strategies.
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Affiliation(s)
- Yajie Yu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China,Department of Pharmacology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China,Hubei Key Laboratory for Drug Target Researches and Pharmacodynamic Evaluation, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China
| | - Bin Lv
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Juntao Wu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Wei Chen
- Department of Pharmacology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China,Hubei Key Laboratory for Drug Target Researches and Pharmacodynamic Evaluation, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China,Correspondence: Wei Chen, Email
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Ehmann YJ, Esser T, Seyam A, Rupp MC, Mehl J, Siebenlist S, Imhoff AB, Minzlaff P. Low postoperative complication rate with high survival rate and good clinical outcome 9 years after autologous chondrocyte transplantation of the knee joint. Arch Orthop Trauma Surg 2022; 143:2665-2674. [PMID: 36198844 PMCID: PMC10110693 DOI: 10.1007/s00402-022-04611-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/28/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To investigate postoperative complications and associated risk factors for failure following autologous chondrocyte transplantation ("ACT") as well as its long-term survival and clinical function. It was hypothesized that ACT is a safe technique for cartilage repair with a low incidence of postoperative complications and rare rates of revision surgery combined with a high long-term survival and good to excellent clinical outcome in long-term-follow-up. METHODS All patients undergoing ACT-Cs of the knee joint between 2006 and 2012 at the author's institution were included in this retrospective study. Concomitant procedures had been performed if necessary. Early postoperative complications, revision surgeries, failure and risk factors for those events were evaluated 6 months after the surgery. Long-term clinical outcome was assessed using the Lysholm Score, the Tegner Score, a 10-grade scale for satisfaction and the Visual Analogue Scale (VAS) at a minimum follow-up of 9 years postoperatively. Long-term survival was calculated using revision surgeries, clinical failures and conversion procedures to create a Kaplan-Meier analysis. A subgroup analysis for different defect locations was performed. 139 patients were included in this study (27% female/ 73%male; age 26.7 [21.7; 35.2] years). The median defect size was 4.0 [3.0; 6.0] cm2 (40% medial femoral condyle (MFC), 17% lateral femoral condyle (LFC), 36% patella, 19% trochlea). 97 (70%) of the patients had undergone previous surgery and 84 (60%) underwent concomitant procedures. RESULTS Postoperatively, 8% of patients had complications (4% bleeding, 2% arthrofibrosis, 2% infection), 7% of patients needed revision surgery. 12% of patients had a prolonged deficit in ROM, that did not require revision surgery. No significant difference in terms of complications was found between the patellofemoral and femorotibial group. Patients demonstrated good patient reported long-term outcomes 9-15 years after the index surgery (Tegner: 4.7 ± 1.8; VAS: 2.4 ± 2.1; Lysholm: 80 ± 14; satisfaction with operation: 7.3 ± 1.9). Survival rates were 88% at 9 years, 85% at 11 years, and 85% at 13 years after the index procedure. Reasons for failure included debridement of ACT (n = 4; 5%), revision ACT (n = 3, 3%), conversion to total knee arthroplasty (n = 3, 3%) and conversion to High tibial osteotomy (HTO) (n = 1; 1%)). CONCLUSION The present study indicates ACT as an effective treatment option for femorotibial- as well as patellofemoral cartilage defects with a high long-term survival and low conversion rate as well as good long-term results regarding knee function and satisfaction. Postoperative complications needing revision surgery are rare. Prolongated deficits of range of motion appear frequently up to six months especially in patellofemoral defects, but can often be successfully addressed by intensified physiotherapy without requiring an arthrolysis. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Yannick J Ehmann
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Thekla Esser
- Department of Orthopedic Sports Medicine, Orthoclinic Agatharied, Agatharied, Germany
| | - Amr Seyam
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Marco-Christopher Rupp
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Julian Mehl
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sebastian Siebenlist
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Philipp Minzlaff
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.,Department of Orthopedic Sports Medicine, Orthoclinic Agatharied, Agatharied, Germany
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3
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Gao Q, Kim BS, Gao G. Advanced Strategies for 3D Bioprinting of Tissue and Organ Analogs Using Alginate Hydrogel Bioinks. Mar Drugs 2021; 19:708. [PMID: 34940707 PMCID: PMC8708555 DOI: 10.3390/md19120708] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/12/2021] [Accepted: 12/12/2021] [Indexed: 12/15/2022] Open
Abstract
Alginate is a natural polysaccharide that typically originates from various species of algae. Due to its low cost, good biocompatibility, and rapid ionic gelation, the alginate hydrogel has become a good option of bioink source for 3D bioprinting. However, the lack of cell adhesive moieties, erratic biodegradability, and poor printability are the critical limitations of alginate hydrogel bioink. This review discusses the pivotal properties of alginate hydrogel as a bioink for 3D bioprinting technologies. Afterward, a variety of advanced material formulations and biofabrication strategies that have recently been developed to overcome the drawbacks of alginate hydrogel bioink will be focused on. In addition, the applications of these advanced solutions for 3D bioprinting of tissue/organ mimicries such as regenerative implants and in vitro tissue models using alginate-based bioink will be systematically summarized.
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Affiliation(s)
- Qiqi Gao
- Institute of Engineering Medicine, Beijing Institute of Technology, No. 5, South Street, Zhongguancun, Haidian District, Beijing 100081, China;
| | - Byoung-Soo Kim
- School of Biomedical Convergence Engineering, Pusan National University, Yangsan 626841, Kyungnam, Korea;
| | - Ge Gao
- Institute of Engineering Medicine, Beijing Institute of Technology, No. 5, South Street, Zhongguancun, Haidian District, Beijing 100081, China;
- Department of Medical Technology, Beijing Institute of Technology, No. 5, South Street, Zhongguancun, Haidian District, Beijing 100081, China
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4
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Viehöfer AF, Casari F, Waibel FW, Beeler S, Imhoff FB, Wirth SH, Ackermann J. Smoking Is Associated with Anterior Ankle Impingement After Isolated Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus. Cartilage 2021; 13:1366S-1372S. [PMID: 32940049 PMCID: PMC8808944 DOI: 10.1177/1947603520959405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To determine potential predictive associations between patient-/lesion-specific factors, clinical outcome and anterior ankle impingement in patients that underwent isolated autologous matrix-induced chondrogenesis (AMIC) for an osteochondral lesion of the talus (OLT). DESIGN Thirty-five patients with a mean age of 34.7 ± 15 years who underwent isolated cartilage repair with AMIC for OLTs were evaluated at a mean follow-up of 4.5 ± 1.9 years. Patients completed AOFAS (American Orthopaedic Foot and Ankle Society) scores at final follow-up, as well as Tegner scores at final follow-up and retrospectively for preinjury and presurgery time points. Pearson correlation and multivariate regression models were used to distinguish associations between patient-/lesion-specific factors, the need for subsequent surgery due to anterior ankle impingement and patient-reported outcomes. RESULTS At final follow-up, AOFAS and Tegner scores averaged 92.6 ± 8.3 and 5.1 ± 1.8, respectively. Both body mass index (BMI) and duration of symptoms were independent predictors for postoperative AOFAS and Δ preinjury to postsurgery Tegner with positive smoking status showing a trend toward worse AOFAS scores, but this did not reach statistical significance (P = 0.054). Nine patients (25.7%) required subsequent surgery due to anterior ankle impingement. Smoking was the only factor that showed significant correlation with postoperative anterior ankle impingement with an odds ratio of 10.61 when adjusted for BMI and duration of symptoms (95% CI, 1.04-108.57; P = 0.047). CONCLUSION In particular, patients with normal BMI and chronic symptoms benefit from AMIC for the treatment of OLTs. Conversely, smoking cessation should be considered before AMIC due to the increased risk of subsequent surgery and possibly worse clinical outcome seen in active smokers.
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Affiliation(s)
- Arnd F. Viehöfer
- Department of Orthopedics, University
Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Fabio Casari
- Department of Orthopedics, University
Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Felix W.A. Waibel
- Department of Orthopedics, University
Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Silvan Beeler
- Department of Orthopedics, University
Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Florian B. Imhoff
- Department of Orthopedics, University
Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Stephan H. Wirth
- Department of Orthopedics, University
Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Jakob Ackermann
- Department of Orthopedics, University
Hospital Balgrist, University of Zurich, Zurich, Switzerland,Jakob Ackermann, Department of Orthopedics,
University Hospital Balgrist, University of Zurich, Forchstrasse 340, Zurich,
8008, Switzerland.
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5
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Porous 3D Scaffolds Enhance MSC Vitality and Reduce Osteoclast Activity. Molecules 2021; 26:molecules26206258. [PMID: 34684837 PMCID: PMC8541337 DOI: 10.3390/molecules26206258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/13/2021] [Indexed: 11/16/2022] Open
Abstract
In the context of an aging population, unhealthy Western lifestyle, and the lack of an optimal surgical treatment, deep osteochondral defects pose a great challenge for the public health system. Biodegradable, biomimetic scaffolds seem to be a promising solution. In this study we investigated the biocompatibility of porous poly-((D,L)-lactide-ε-caprolactone)dimethacrylate (LCM) scaffolds in contrast to compact LCM scaffolds and blank cell culture plastic. Thus, morphology, cytotoxicity and metabolic activity of human mesenchymal stromal cells (MSC) seeded directly on the materials were analyzed after three and six days of culturing. Further, osteoclastogenesis and osteoclastic activity were assessed using reverse-transcriptase real-time PCR of osteoclast-specific genes, EIA and morphologic aspects after four, eight, and twelve days. LCM scaffolds did not display cytotoxic effects on MSC. After three days, metabolic activity of MSC was enhanced on 3D porous scaffolds (PS) compared to 2D compact scaffolds (CS). Osteoclast activity seemed to be reduced at PS compared to cell culture plastic at all time points, while no differences in osteoclastogenesis were detectable between the materials. These results indicate a good cytocompatibility of LCM scaffolds. Interestingly, porous 3D structure induced higher metabolic activity of MSC as well as reduced osteoclast activity.
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Alvarez-Lozano E, Martinez-Rodriguez H, Forriol F. Treatment of Chondral Knee Lesions with Autologous Chondrocytes Embedded in a Fibrin Scaffold. Clinical and Functional Assessment. Rev Bras Ortop 2021; 56:470-477. [PMID: 34483391 PMCID: PMC8405271 DOI: 10.1055/s-0040-1716764] [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: 01/05/2020] [Accepted: 07/06/2020] [Indexed: 11/28/2022] Open
Abstract
Objective
The aim of our study is to analyze the clinical and functional results obtained using autologous chondrocytes embedded in a fibrin scaffold in knee joint injuries.
Methods
We included 56 patients, 36 men and 20 women, with a mean age 36 years. Six of the patients were professional athletes, with single knee injuries that were either chondral or osteochondral (43 chondral, 9 osteochondral, 2 cases of osteochondritis dissecans and 2 osteochondral fractures), 2 to 10 cm
2
in size and ≤ 10 mm deep, with no signs of osteoarthritis. The location of the injury was in the patella (8), the medial femoral condyle (40) and lateral femoral condyle (7) and one in the trochlea. The mean follow-up was 3 (range: 1–6) years. The clinical course was assessed using the Cincinnati and Knee Injury and Osteoarthritis Outcome (KOOS) scores, 6 and 12 months after surgery. The paired Student t-test was used to compare pre-and postoperative results.
Results
Six months after the implant, patients resumed their everyday activities. On the assessment scores, their condition was improving in comparison with their presurgical state (
p
< 0.05). They were also able to carry out their sporting activities more easily than prior to surgery (
p
< 0.05).
Conclusion
The seeding of chondrocytes in fibrin may provide a favorable micro-environment for the synthesis of extracellular matrix and improved the clinical condition and activity of the patients 1 year after surgery.
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Affiliation(s)
- Eduardo Alvarez-Lozano
- Departamento de Cirurgia Ortopédica, Hospital Jose E Gonzalez, Universidad Autonóma de Nuevo Leon, Monterrey, México
| | | | - Francisco Forriol
- Facultad de Medicina, Universidade San Pablo CEU, IMMA, Boadilla del Monte, Madri, Espanha
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Systematic Postoperative Assessment of a Minimally-Invasive Sheep Model for the Treatment of Osteochondral Defects. Life (Basel) 2020; 10:life10120332. [PMID: 33297497 PMCID: PMC7762399 DOI: 10.3390/life10120332] [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: 11/09/2020] [Revised: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 11/26/2022] Open
Abstract
To assess the clinical course of a sheep stifle joint model for osteochondral (OC) defects, medial femoral condyles (MFC) were exposed without patella luxation using medial parapatellar skin (3–4 cm) and deep incisions (2–3 cm). Two defects (7 mm diameter; 10 mm depth; OC punch) were left empty or refilled with osteochondral autologous transplantation cylinders (OATS) and explanted after six weeks. Incision-to-suture time, anesthesia time, and postoperative wound or impairment scores were compared to those in sham-operated animals. Implant performance was assessed by X-ray, micro-computed tomography, histology, and immunohistology (collagens 1, 2; aggrecan). There were no surgery-related infections or patellar luxations. Operation, anesthesia, and time to complete stand were short (0.5, 1.4, and 1.5 h, respectively). The wound trauma score was low (0.4 of maximally 4; day 7). Empty-defect and OATS animals reached an impairment score of 0 significantly later than sham animals (7.4 and 4.0 days, respectively, versus 1.5 days). Empty defects showed incomplete healing and dedifferentiation/heterotopic differentiation; OATS-filled defects displayed advanced bone healing with remaining cartilage gaps and orthotopic expression of bone and cartilage markers. Minimally-invasive, medial parapatellar surgery of OC defects on the sheep MFC allows rapid and low-trauma recovery and appears well-suited for implant testing.
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8
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Egiazaryan KA, Lazishvili GD, Ratyev AP, Sirotin IV, But-Gusaim AB, Danilov MA, Shpak MA. MODERN TRENDS IN THE TREATMENT OF FOCAL CARTILAGE DEFECTS OF THE KNEE. SURGICAL PRACTICE 2020. [DOI: 10.38181/2223-2427-2020-3-65-72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The article is devoted to the current trend of modern orthopedics – the surgical treatment of local full-thickness defects in the hyaline cartilage of the knee joint. This pathology is diagnosed in 5-10% of patients with diseases and injuries of the knee joint.Materials and methods: The authors of the article presented one of the most modern and available technologies for the restoration of cartilage defects – the technology of matrix-induced autochondrogenesis (AMIC – autologous matrix-induced chondrogenesis). This operation technique was used in 63 patients. The article presents the indications and technique of surgery, considers possible errors, complications, criteria for evaluating treatment outcomes.Results: treatment outcomes in terms of up to 13 years were studied in 56 patients. Good treatment results were observed in 53 patients. In all cases, high-quality and regeneration of the cartilaginous surface of the femoral condyles was achieved.Conclusion: Analysis of the outcomes of treatment of patients after implantation of collagen membranes in various modifications allows the authors of the article to recommend this technique for widespread use in clinical practice.
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Affiliation(s)
- K. A. Egiazaryan
- Pirogov Russian National Research Medical University (Pirogov Medical University), department of traumatology, orthopaedics and military field surgery
| | - G. D. Lazishvili
- Pirogov Russian National Research Medical University (Pirogov Medical University), department of traumatology, orthopaedics and military field surgery
| | - A. P. Ratyev
- Pirogov Russian National Research Medical University (Pirogov Medical University), department of traumatology, orthopaedics and military field surgery
| | - I. V. Sirotin
- Pirogov Russian National Research Medical University (Pirogov Medical University), department of traumatology, orthopaedics and military field surgery
| | - A. B. But-Gusaim
- Pirogov Russian National Research Medical University (Pirogov Medical University), department of traumatology, orthopaedics and military field surgery
| | - M. A. Danilov
- Pirogov Russian National Research Medical University (Pirogov Medical University), department of traumatology, orthopaedics and military field surgery
| | - M. A. Shpak
- Pirogov Russian National Research Medical University (Pirogov Medical University), department of traumatology, orthopaedics and military field surgery
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9
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Potyondy T, Uquillas JA, Tebon PJ, Byambaa B, Hasan A, Tavafoghi M, Mary H, Aninwene Ii G, Pountos I, Khademhosseini A, Ashammakhi N. Recent advances in 3D bioprinting of musculoskeletal tissues. Biofabrication 2020; 13. [PMID: 33166949 DOI: 10.1088/1758-5090/abc8de] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 11/09/2020] [Indexed: 12/21/2022]
Abstract
The musculoskeletal system is essential for maintaining posture, protecting organs, facilitating locomotion, and regulating various cellular and metabolic functions. Injury to this system due to trauma or wear is common, and severe damage may require surgery to restore function and prevent further harm. Autografts are the current gold standard for the replacement of lost or damaged tissues. However, these grafts are constrained by limited supply and donor site morbidity. Allografts, xenografts, and alloplastic materials represent viable alternatives, but each of these methods also has its own problems and limitations. Technological advances in three-dimensional (3D) printing and its biomedical adaptation, 3D bioprinting, have the potential to provide viable, autologous tissue-like constructs that can be used to repair musculoskeletal defects. Though bioprinting is currently unable to develop mature, implantable tissues, it can pattern cells in 3D constructs with features facilitating maturation and vascularization. Further advances in the field may enable the manufacture of constructs that can mimic native tissues in complexity, spatial heterogeneity, and ultimately, clinical utility. This review studies the use of 3D bioprinting for engineering bone, cartilage, muscle, tendon, ligament, and their interface tissues. Additionally, the current limitations and challenges in the field are discussed and the prospects for future progress are highlighted.
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Affiliation(s)
- Tyler Potyondy
- Bioengineering, University of California Los Angeles, 410 Westwood Plaza, Los Angeles, California, 90095, UNITED STATES
| | - Jorge Alfredo Uquillas
- Eindhoven University of Technology Faculty of Biomedical Engineering, Eindhoven, 5600 MB, NETHERLANDS
| | - Peyton John Tebon
- Bioengineering, University of California Los Angeles, Los Angeles, California, UNITED STATES
| | - Batzaya Byambaa
- Brigham and Women's Hospital, Boston, Massachusetts, UNITED STATES
| | - Anwarul Hasan
- Department of Mechanical and Industrial Engineering, Qatar University, Doha, Ad Dawhah, QATAR
| | - Maryam Tavafoghi
- University of California Los Angeles, Los Angeles, California, UNITED STATES
| | - Héloïse Mary
- University of California Los Angeles, Los Angeles, California, UNITED STATES
| | - George Aninwene Ii
- University of California Los Angeles, Los Angeles, California, UNITED STATES
| | - Ippokratis Pountos
- University of Leeds, Leeds, West Yorkshire, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Ali Khademhosseini
- Center for Minimally Invasive Therapeutics, UCLA, Los Angeles, California, UNITED STATES
| | - Nureddin Ashammakhi
- University of California Los Angeles, Los Angeles, California, UNITED STATES
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Nour-Eldeen G, Abdel-Rasheed M, El-Rafei AM, Azmy O, El-Bassyouni GT. Adipose tissue-derived mesenchymal stem cells and chitosan/poly (vinyl alcohol) nanofibrous scaffolds for cartilage tissue engineering. CELL REGENERATION (LONDON, ENGLAND) 2020; 9:7. [PMID: 32588202 PMCID: PMC7306832 DOI: 10.1186/s13619-020-00045-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 03/27/2020] [Indexed: 12/12/2022]
Abstract
Osteoarthritis (OA) has been defined as a chronic inflammatory joint disease characterized by progressive articular cartilage degeneration. Recently growing interest in regenerative medicine, using cell therapy and tissue engineering, where cellular components in combination with engineered scaffolds and bioactive materials were used to induce functional tissue regeneration. In the present study, nanofibrous scaffold based on chitosan (CS)/poly (vinyl alcohol) (PVA) were used to develop biologically functionalized biomaterial to mimic the extracellular matrix, allowing the human adipose tissue derived mesenchymal stem cells (ADSCs) to proliferate and differentiate to chondrogenic cells. The morphology of the nanofibrous mat was examined using field emission scanning electron microscope (FE/SEM). The characteristic functional groups and the nature of the chemical bonds between atoms were evaluated using Fourier transform infrared spectroscopy (FTIR) spectrum. Characterization of the seeded cells was morphologically evaluated by scanning electron microscopy and by flow cytometry for the expression of the stem cell surface markers. The differentiation potential was verified after chondrogenic induction by analyzing the expression of chondrogenic marker genes using real-time (RT PCR). Current study suggest significant potential for the use of ADSCs with the nanofibrous scaffolds in improving the osteoarthritis pathology.
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Affiliation(s)
- Ghada Nour-Eldeen
- Molecular Genetics and Enzymology Department, National Research Centre, Dokki, Cairo, 12622, Egypt.,Stem Cell Research group, Medical Research Centre of Excellence, National Research Centre, Cairo, 12622, Egypt
| | - Mazen Abdel-Rasheed
- Stem Cell Research group, Medical Research Centre of Excellence, National Research Centre, Cairo, 12622, Egypt. .,Reproductive Health Research Department, National Research Centre, 33 El-Buhouth St, Dokki, Cairo, 12622, Egypt.
| | - Amira M El-Rafei
- Refractories, Ceramics and Building Materials Department, National Research Centre, Dokki, Cairo, 12622, Egypt
| | - Osama Azmy
- Stem Cell Research group, Medical Research Centre of Excellence, National Research Centre, Cairo, 12622, Egypt.,Reproductive Health Research Department, National Research Centre, 33 El-Buhouth St, Dokki, Cairo, 12622, Egypt
| | - Gehan T El-Bassyouni
- Refractories, Ceramics and Building Materials Department, National Research Centre, Dokki, Cairo, 12622, Egypt
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11
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Wu YC, Wang YC, Wang WT, Wang HMD, Lin HH, Su LJ, Kuo YR, Lai CS, Ho ML, Yu J. Fluorescent Nanodiamonds Enable Long-Term Detection of Human Adipose-Derived Stem/Stromal Cells in an In Vivo Chondrogenesis Model Using Decellularized Extracellular Matrices and Fibrin Glue Polymer. Polymers (Basel) 2019; 11:polym11091391. [PMID: 31450801 PMCID: PMC6780225 DOI: 10.3390/polym11091391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 08/15/2019] [Accepted: 08/16/2019] [Indexed: 12/16/2022] Open
Abstract
Clinically available materials, including allogeneic irradiated costal cartilage and fibrin glue polymer, were used as scaffolds for in vivo chondrogenic differentiation of human adipose-derived stem/stromal cells (hASCs) in the attempt to develop a more efficient treatment over current methods. Current studies include the use of growth-factor stimulation, tissue engineering, and biocompatible materials; however, most methods involve complicated processes and pose clinical limitations. In this report, the xenografts in the experimental group composed of a diced decellularized cartilage extracellular matrix (ECM), hASCs, and fibrin glue polymer were implanted into the subcutaneous layer of nude mice, and the results were compared with two groups of controls; one control group received implantation of decellularized cartilage ECM and fibrin glue polymer, and the other control group received implantation of hASCs mixed with fibrin glue polymer. To evaluate whether hASCs had in vivo chondrogenesis in the xenografts, hASCs were labeled with fluorescent nanodiamonds (FNDs), a biocompatible and photostable nanomaterial, to allow for long-term detection and histological analysis. Increased cellularity, glycosaminoglycan, and collagen deposition were found by the histological examination in the experimental group compared with control groups. With the background-free detection technique and time-gated fluorescence imaging, the numbers and locations of the FND-labeled hASCs could be detected by confocal microscopy. The chondrocyte-specific markers, such as aggrecan and type II collagen, were colocalized with cells containing signals of FNDs which indicated in vivo chondrogenesis of hASCs. Taken together, functional in vivo chondrogenesis of the hASCs could be achieved by clinically available decellularized cartilage ECM and fibrin glue polymer in the nude mice model without in vitro chondrogenic induction. The fluorescent signals of FNDs in hASCs can be detected in histological analysis, such as hematoxylin and eosin staining (H&E staining) without the interference of the autofluorescence. Our study may warrant future clinical applications of the combination of decellular cartilage ECM, fibrin glue polymer, and hASCs for cartilage repair.
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Affiliation(s)
- Yi-Chia Wu
- Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial Hospital at Linko, Taoyuan 333, Taiwan
- Ph.D. Program in Translational Medicine, Kaohsiung Medical University, Kaohsiung, and Academia Sinica, Taipei 115, Taiwan
- Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807 Taiwan
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- Center of Teaching and Research, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 801, Taiwan
| | - Ya-Chin Wang
- Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807 Taiwan
| | - Wei-Ting Wang
- Center of Teaching and Research, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 801, Taiwan
| | - Hui-Min David Wang
- Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807 Taiwan
- Graduate Institute of Biomedical Engineering, National Chung Hsing University, Taichung 402, Taiwan
| | - Hsin-Hung Lin
- Institute of Atomic and Molecular Sciences, Academia Sinica, Taipei 106, Taiwan
| | - Long-Jyun Su
- Institute of Atomic and Molecular Sciences, Academia Sinica, Taipei 106, Taiwan
| | - Yur-Ren Kuo
- Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807 Taiwan
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Chung-Sheng Lai
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Mei-Ling Ho
- Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807 Taiwan
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung 801, Taiwan
| | - John Yu
- Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial Hospital at Linko, Taoyuan 333, Taiwan.
- Institute of Cellular and Organismic Biology, Academia Sinica, Taipei 115, Taiwan.
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12
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Abstract
The goals of all orthopaedic surgeons treating articular cartilage injuries have been anatomic reduction and stable fixation of the articular cartilage surface with restoration of limb alignment and/or reestablishment of the joint stability, all while minimizing the risk of surgical complications. Recent developments in the study of articular cartilage injury have shown that there is a robust cellular response to joint injury. This response has been shown to involve the synoviocytes, chondrocytes, and osteocytes in and around the injured joint and if these responses are left unchecked, they can lead to the development of posttraumatic osteoarthritis (PTOA). Therefore, to predictably and successfully treat articular cartilage injuries, it is not sufficient to just restore articular congruity, limb alignment, and joint stability, but we must also recognize and attempt to mitigate this associated cellular response. Understanding not only the mechanical aspects of these joint injuries but also the biological aspects is paramount to giving our patients the best opportunity to heal their injuries, recover full function, and avoid the potential devastating development of PTOA. Gone is the simplistic view that if one can achieve articular congruity after intraarticular fracture, as well as joint stability after ligamentous injury, that our patients will do just fine. This review sheds new light on the molecular response to cartilage injury, how residual joint incongruity and instability affect the joint's ability to recover from injury, and how chondrocyte apoptosis in response to injury can influence joint. This article then briefly reviews how cellular and growth factors may be beneficial to the treatment of articular cartilage injury and how ultimately cartilage regeneration may be used in the future to salvage the joints ravaged by PTOA in response to injury.
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13
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Zhang T, Yao Y. Effects of inflammatory cytokines on bone/cartilage repair. J Cell Biochem 2019; 120:6841-6850. [PMID: 30335899 DOI: 10.1002/jcb.27953] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/02/2018] [Indexed: 01/24/2023]
Abstract
Many inflammatory factors can affect cell behaviors and work as a form of inter-regulatory networks through the inflammatory pathway. Inflammatory cytokines are critical for triggering bone regeneration after fracture or bone injury. Also, inflammatory cytokines play an important role in cartilage repair. The synergistic or antagonistic effects of both proinflammatory and anti-inflammatory cytokines have a great influence on fracture healing. This review discusses key inflammatory cytokines and signaling pathways involved in bone or cartilage repair.
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Affiliation(s)
- Tingshuai Zhang
- Department of Joint Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangdong Key Laboratory of Orthopaedic Technology And Implant Materials, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yongchang Yao
- Department of Joint Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangdong Key Laboratory of Orthopaedic Technology And Implant Materials, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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14
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Singh YP, Moses JC, Bhardwaj N, Mandal BB. Injectable hydrogels: a new paradigm for osteochondral tissue engineering. J Mater Chem B 2018; 6:5499-5529. [PMID: 32254962 DOI: 10.1039/c8tb01430b] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Osteochondral tissue engineering has become a promising strategy for repairing focal chondral lesions and early osteoarthritis (OA), which account for progressive joint pain and disability in millions of people worldwide. Towards improving osteochondral tissue repair, injectable hydrogels have emerged as promising matrices due to their wider range of properties such as their high water content and porous framework, similarity to the natural extracellular matrix (ECM), ability to encapsulate cells within the matrix and ability to provide biological cues for cellular differentiation. Further, their properties such as those that facilitate minimally invasive deployment or delivery, and their ability to repair geometrically complex irregular defects have been critical for their success. In this review, we provide an overview of innovative approaches to engineer injectable hydrogels towards improved osteochondral tissue repair. Herein, we focus on understanding the biology of osteochondral tissue and osteoarthritis along with the need for injectable hydrogels in osteochondral tissue engineering. Furthermore, we discuss in detail different biomaterials (natural and synthetic) and various advanced fabrication methods being employed for the development of injectable hydrogels in osteochondral repair. In addition, in vitro and in vivo applications of developed injectable hydrogels for osteochondral tissue engineering are also reviewed. Finally, conclusions and future perspectives of using injectable hydrogels in osteochondral tissue engineering are provided.
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Affiliation(s)
- Yogendra Pratap Singh
- Biomaterial and Tissue Engineering Laboratory, Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati-781039, Assam, India.
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15
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Huang J, Liang Y, Jia Z, Chen J, Duan L, Liu W, Zhu F, Liang Q, Zhu W, You W, Xiong J, Wang D. Development of Magnetic Nanocomposite Hydrogel with Potential Cartilage Tissue Engineering. ACS OMEGA 2018; 3:6182-6189. [PMID: 30023943 PMCID: PMC6044747 DOI: 10.1021/acsomega.8b00291] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/19/2018] [Indexed: 05/26/2023]
Abstract
Magnetic nanocomposite hydrogels show high potential to improve tissue engineering. In this study, a magnetic nanocomposite hydrogel was prepared from poly(vinyl alcohol), nano-hydroxyapatite (n-HA), and magnetic nanoparticles (Fe2O3) using the ultrasonic dispersion method and freeze-thaw cross-linking molding. The water content and crystallinity of the magnetic nanocomposite hydrogel were tested. Microscopic morphology assessment, mechanical testing, and characterization were performed. Additionally, the magnetic nanocomposite hydrogel was co-cultured with bone mesenchymal stem cells (BMSCs) to determine its cell compatibility. We found that the magnetic nanocomposite hydrogel had good mechanical properties and that its mechanical properties were enhanced by the addition of n-HA. The BMSCs showed uniform growth on the surface of the magnetic nanocomposite hydrogel and high rates of proliferation. BMSC growth was also enhanced by the addition of Fe2O3 and also significant stimulated chondrocyte-related gene expression. Thus, the magnetic nanocomposite hydrogel scaffold material we describe here could have broad applications in cartilage tissue engineering.
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Affiliation(s)
- Jianghong Huang
- Shenzhen
National Key Department of Orthopedics, Shenzhen Key Laboratory of Tissue
Engineering, and Shenzhen Laboratory of Digital Orthopedic Engineering, Shenzhen Second People’s Hospital (The First
Hospital Affiliated to Shenzhen University), Shenzhen 518035, China
| | - Yujie Liang
- Shenzhen
Institute of Mental Health, Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen 518020, Guangdong Province, China
- Departments
of Chemistry, The Chinese University of
Hong Kong, Shatin 999077, Hong Kong SAR, China
| | - ZhaoFeng Jia
- Shenzhen
National Key Department of Orthopedics, Shenzhen Key Laboratory of Tissue
Engineering, and Shenzhen Laboratory of Digital Orthopedic Engineering, Shenzhen Second People’s Hospital (The First
Hospital Affiliated to Shenzhen University), Shenzhen 518035, China
| | - Jielin Chen
- Shenzhen
National Key Department of Orthopedics, Shenzhen Key Laboratory of Tissue
Engineering, and Shenzhen Laboratory of Digital Orthopedic Engineering, Shenzhen Second People’s Hospital (The First
Hospital Affiliated to Shenzhen University), Shenzhen 518035, China
| | - Li Duan
- Shenzhen
National Key Department of Orthopedics, Shenzhen Key Laboratory of Tissue
Engineering, and Shenzhen Laboratory of Digital Orthopedic Engineering, Shenzhen Second People’s Hospital (The First
Hospital Affiliated to Shenzhen University), Shenzhen 518035, China
| | - Wei Liu
- Shenzhen
National Key Department of Orthopedics, Shenzhen Key Laboratory of Tissue
Engineering, and Shenzhen Laboratory of Digital Orthopedic Engineering, Shenzhen Second People’s Hospital (The First
Hospital Affiliated to Shenzhen University), Shenzhen 518035, China
| | - Feiyan Zhu
- Shenzhen
National Key Department of Orthopedics, Shenzhen Key Laboratory of Tissue
Engineering, and Shenzhen Laboratory of Digital Orthopedic Engineering, Shenzhen Second People’s Hospital (The First
Hospital Affiliated to Shenzhen University), Shenzhen 518035, China
| | - Qian Liang
- Shenzhen
National Key Department of Orthopedics, Shenzhen Key Laboratory of Tissue
Engineering, and Shenzhen Laboratory of Digital Orthopedic Engineering, Shenzhen Second People’s Hospital (The First
Hospital Affiliated to Shenzhen University), Shenzhen 518035, China
| | - Weimin Zhu
- Shenzhen
National Key Department of Orthopedics, Shenzhen Key Laboratory of Tissue
Engineering, and Shenzhen Laboratory of Digital Orthopedic Engineering, Shenzhen Second People’s Hospital (The First
Hospital Affiliated to Shenzhen University), Shenzhen 518035, China
| | - Wei You
- Shenzhen
National Key Department of Orthopedics, Shenzhen Key Laboratory of Tissue
Engineering, and Shenzhen Laboratory of Digital Orthopedic Engineering, Shenzhen Second People’s Hospital (The First
Hospital Affiliated to Shenzhen University), Shenzhen 518035, China
| | - Jianyi Xiong
- Shenzhen
National Key Department of Orthopedics, Shenzhen Key Laboratory of Tissue
Engineering, and Shenzhen Laboratory of Digital Orthopedic Engineering, Shenzhen Second People’s Hospital (The First
Hospital Affiliated to Shenzhen University), Shenzhen 518035, China
| | - Daping Wang
- Shenzhen
National Key Department of Orthopedics, Shenzhen Key Laboratory of Tissue
Engineering, and Shenzhen Laboratory of Digital Orthopedic Engineering, Shenzhen Second People’s Hospital (The First
Hospital Affiliated to Shenzhen University), Shenzhen 518035, China
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16
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Stem Cells for Osteochondral Regeneration. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1059:219-240. [DOI: 10.1007/978-3-319-76735-2_10] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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17
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Mathis DT, Kaelin R, Rasch H, Arnold MP, Hirschmann MT. Good clinical results but moderate osseointegration and defect filling of a cell-free multi-layered nano-composite scaffold for treatment of osteochondral lesions of the knee. Knee Surg Sports Traumatol Arthrosc 2018; 26:1273-1280. [PMID: 28712029 DOI: 10.1007/s00167-017-4638-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 07/06/2017] [Indexed: 02/05/2023]
Abstract
PURPOSE The aim of this retrospective study was to evaluate the clinical and radiological results of a nano-composite multi-layered three-dimensional biomaterial scaffold for treatment of osteochondral lesions (OCL) of the knee. It was a particular radiological interest to analyse the osseointegration, filling of the defects and the bone tracer uptake (BTU), and it was hypothesised that this scaffold, which was created to mimic the entire osteo-cartilaginous unit, is integrated within the bone 12 months postoperatively and comes along with improved patients symptoms and function. METHODS Fourteen patients (male:female = 11:3, mean age ± SD 33.1 ± 10.7 years) treated for OCL (size 1.0-3.5 cm2) were clinically and radiologically evaluated at 1 year postoperatively. The data were prospectively collected including SPECT/CT, Tegner and Lysholm scores. BTU was anatomically localised and volumetrically quantified in SPECT/CT. Defect filling was analysed in CT. Spearman's rho and Wilcoxon test were used for correlation of BTU in SPECT/CT and clinical scores (p < 0.05). RESULTS A significant improvement in Lysholm knee score (p < 0.001) and slight deterioration in Tegner score were found (p < 0.01). A complete filling of the defect was shown in 14%, a partial filling in 14% and only minor filling was seen in 72%. A significant correlation (p < 0.001) was found between location of osteochondral lesions and increased BTU. At the lesion sites pre- and postoperative BTU was markedly increased and did not show any decrease at 12-month follow-up. Median Tegner and mean Lysholm scores did not correlate with BTU at any time. CONCLUSIONS Treatment of OCL in the knee joint with a nano-composite multi-layered three-dimensional biomaterial scaffold resulted in a significant clinical improvement at 1-year follow-up. However, osseointegration was still ongoing at 12-month follow-up. LEVEL OF EVIDENCE Case series, Level IV.
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Affiliation(s)
- Dominic T Mathis
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland
| | - Raphael Kaelin
- LEONARDO, Hirslanden Klinik Birshof, 4142, Münchenstein, Switzerland
| | - Helmut Rasch
- Institute of Radiology and Nuclear Medicine, Kantonsspital Baselland, 4101, Bruderholz, Switzerland.,University of Basel, Basel, Switzerland
| | - Markus P Arnold
- LEONARDO, Hirslanden Klinik Birshof, 4142, Münchenstein, Switzerland.,University of Basel, Basel, Switzerland
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland. .,University of Basel, Basel, Switzerland.
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18
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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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19
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Ondrésik M, Oliveira JM, Reis RL. Advances for Treatment of Knee OC Defects. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1059:3-24. [PMID: 29736567 DOI: 10.1007/978-3-319-76735-2_1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Osteochondral (OC) defects are prevalent among young adults and are notorious for being unable to heal. Although they are traumatic in nature, they often develop silently. Detection of many OC defects is challenging, despite the criticality of early care. Current repair approaches face limitations and cannot provide regenerative or long-standing solution. Clinicians and researchers are working together in order to develop approaches that can regenerate the damaged tissues and protect the joint from developing osteoarthritis. The current concepts of tissue engineering and regenerative medicine, which have brought many promising applications to OC management, are overviewed herein. We will also review the types of stem cells that aim to provide sustainable cell sources overcoming the limitation of autologous chondrocyte-based applications. The various scaffolding materials that can be used as extracellular matrix mimetic and having functional properties similar to the OC unit are also discussed.
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Affiliation(s)
- Marta Ondrésik
- 3B's Research Group - 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.
| | - J Miguel Oliveira
- 3B's Research Group - 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 - 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
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20
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Abstract
Osteoarthritis is characterized by a chronic, progressive and irreversible degradation of the articular cartilage associated with joint inflammation and a reparative bone response. More than 100 million people are affected by this condition worldwide with significant health and welfare costs. Our available treatment options in osteoarthritis are extremely limited. Chondral or osteochondral grafts have shown some promising results but joint replacement surgery is by far the most common therapeutic approach. The difficulty lies on the limited regeneration capacity of the articular cartilage, poor blood supply and the paucity of resident progenitor stem cells. In addition, our poor understanding of the molecular signalling pathways involved in the senescence and apoptosis of chondrocytes is a major factor restricting further progress in the area. This review focuses on molecules and approaches that can be implemented to delay or even rescue chondrocyte apoptosis. Ways of modulating the physiologic response to trauma preventing chondrocyte death are proposed. The use of several cytokines, growth factors and advances made in altering several of the degenerative genetic pathways involved in chondrocyte apoptosis and degradation are also presented. The suggested approaches can help clinicians to improve cartilage tissue regeneration.
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Affiliation(s)
- Ippokratis Pountos
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, UK.
| | - Peter V Giannoudis
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, UK; NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, UK.
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21
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Tanima-Nagai M, Harada H, Aoyama T, Yamaguchi S, Ito A, Tajino J, Iijima H, Zhang X, Kuroki H, Kobayashi M. Pathohistological investigation of osteochondral tissue obtained during total knee arthroplasty after osteochondral autologous transfer: a case report. BMC Res Notes 2017; 10:194. [PMID: 28587673 PMCID: PMC5461697 DOI: 10.1186/s13104-017-2513-0] [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: 12/20/2016] [Accepted: 05/24/2017] [Indexed: 11/12/2022] Open
Abstract
Background Osteochondral autologous transfer is one of the repair techniques for cartilage defects of knee with promising knee function recovery. There are no reports including histopathological images concerning human osteochondral tissue after osteochondral autologous transfer. This is the first report to present pathohistological findings of transplanted plugs and host tissues extracted from the human body 3 years after osteochondral autologous transfer. This study aimed to explore the cause factor of chronic pain using histological techniques. Case presentation A 67-year-old Japanese man presented with adjusted total knee arthroplasty 3 years after osteochondral autologous transfer. Although in pain, arthroscopic assessment was not severe. The specimens which was gained during total knee arthroplasty were investigated in gross and microscopically using immunohistochemical staining technic. Histological examination revealed that the gap between grafted plugs and host osteochondral tissues was filled with fibrous tissue that stained positive for type I collagen. A degenerative change and some neovascularity were observed in the regenerated tissue and host trabecular bone. Furthermore, cysts and bone marrow edema were observed. Conclusion Our data suggests that the host osteochondral morbidity around grafted plugs might be related to chronical pain and revision surgery.
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Affiliation(s)
- Momoko Tanima-Nagai
- Congenital Anomaly Research Center, Kyoto University Graduate School of Medicine, Konoe-cho, Yoshida, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Hideto Harada
- Department of Orthopedic Surgery, Kyoto Katsura Hospital, 17 Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Tomoki Aoyama
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shoki Yamaguchi
- Department of Physical Therapy, School of Nursing and Rehabilitation Sciences at Odawara, International University of Health and Welfare, 1-2-25 Shiroyama, Odawara, Kanagawa, 250-8588, Japan
| | - Akira Ito
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Junichi Tajino
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hirotaka Iijima
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Xiankai Zhang
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hiroshi Kuroki
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Masahiko Kobayashi
- Department of Orthopedic Surgery, Knee/Shoulder Surgery & Sports Medicine, Kyoto Shimogamo Hospital, 17 Higashimorigamae-cho, Shimogamo, Sakyo-ku, Kyoto, 606-0866, Japan.
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22
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Goldberg A, Mitchell K, Soans J, Kim L, Zaidi R. The use of mesenchymal stem cells for cartilage repair and regeneration: a systematic review. J Orthop Surg Res 2017; 12:39. [PMID: 28279182 PMCID: PMC5345159 DOI: 10.1186/s13018-017-0534-y] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 02/13/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The management of articular cartilage defects presents many clinical challenges due to its avascular, aneural and alymphatic nature. Bone marrow stimulation techniques, such as microfracture, are the most frequently used method in clinical practice however the resulting mixed fibrocartilage tissue which is inferior to native hyaline cartilage. Other methods have shown promise but are far from perfect. There is an unmet need and growing interest in regenerative medicine and tissue engineering to improve the outcome for patients requiring cartilage repair. Many published reviews on cartilage repair only list human clinical trials, underestimating the wealth of basic sciences and animal studies that are precursors to future research. We therefore set out to perform a systematic review of the literature to assess the translation of stem cell therapy to explore what research had been carried out at each of the stages of translation from bench-top (in vitro), animal (pre-clinical) and human studies (clinical) and assemble an evidence-based cascade for the responsible introduction of stem cell therapy for cartilage defects. This review was conducted in accordance to PRISMA guidelines using CINHAL, MEDLINE, EMBASE, Scopus and Web of Knowledge databases from 1st January 1900 to 30th June 2015. In total, there were 2880 studies identified of which 252 studies were included for analysis (100 articles for in vitro studies, 111 studies for animal studies; and 31 studies for human studies). There was a huge variance in cell source in pre-clinical studies both of terms of animal used, location of harvest (fat, marrow, blood or synovium) and allogeneicity. The use of scaffolds, growth factors, number of cell passages and number of cells used was hugely heterogeneous. SHORT CONCLUSIONS This review offers a comprehensive assessment of the evidence behind the translation of basic science to the clinical practice of cartilage repair. It has revealed a lack of connectivity between the in vitro, pre-clinical and human data and a patchwork quilt of synergistic evidence. Drivers for progress in this space are largely driven by patient demand, surgeon inquisition and a regulatory framework that is learning at the same pace as new developments take place.
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Affiliation(s)
- Andy Goldberg
- Institute of Orthopaedics and Musculoskeletal Science, Royal National Orthopaedic Hospital (RNOH), Brockley Hill Stanmore, London, HA7 4LP UK
| | - Katrina Mitchell
- Institute of Orthopaedics and Musculoskeletal Science, Royal National Orthopaedic Hospital (RNOH), Brockley Hill Stanmore, London, HA7 4LP UK
| | - Julian Soans
- Institute of Orthopaedics and Musculoskeletal Science, Royal National Orthopaedic Hospital (RNOH), Brockley Hill Stanmore, London, HA7 4LP UK
| | - Louise Kim
- Joint Research and Enterprise Office, St George’s University of London and St George’s University Hospitals NHS Foundation Trust, Hunter Wing, Cranmer Terrace, London, SW17 0RE UK
| | - Razi Zaidi
- Institute of Orthopaedics and Musculoskeletal Science, Royal National Orthopaedic Hospital (RNOH), Brockley Hill Stanmore, London, HA7 4LP UK
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23
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Wang M, Yuan Z, Ma N, Hao C, Guo W, Zou G, Zhang Y, Chen M, Gao S, Peng J, Wang A, Wang Y, Sui X, Xu W, Lu S, Liu S, Guo Q. Advances and Prospects in Stem Cells for Cartilage Regeneration. Stem Cells Int 2017; 2017:4130607. [PMID: 28246531 PMCID: PMC5299204 DOI: 10.1155/2017/4130607] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/24/2016] [Accepted: 12/26/2016] [Indexed: 12/16/2022] Open
Abstract
The histological features of cartilage call attention to the fact that cartilage has a little capacity to repair itself owing to the lack of a blood supply, nerves, or lymphangion. Stem cells have emerged as a promising option in the field of cartilage tissue engineering and regenerative medicine and could lead to cartilage repair. Much research has examined cartilage regeneration utilizing stem cells. However, both the potential and the limitations of this procedure remain controversial. This review presents a summary of emerging trends with regard to using stem cells in cartilage tissue engineering and regenerative medicine. In particular, it focuses on the characterization of cartilage stem cells, the chondrogenic differentiation of stem cells, and the various strategies and approaches involving stem cells that have been used in cartilage repair and clinical studies. Based on the research into chondrocyte and stem cell technologies, this review discusses the damage and repair of cartilage and the clinical application of stem cells, with a view to increasing our systematic understanding of the application of stem cells in cartilage regeneration; additionally, several advanced strategies for cartilage repair are discussed.
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Affiliation(s)
- Mingjie Wang
- Institute of Orthopaedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopaedics, Key Laboratory of Musculoskeletal Trauma & War Injuries, PLA, 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Zhiguo Yuan
- Institute of Orthopaedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopaedics, Key Laboratory of Musculoskeletal Trauma & War Injuries, PLA, 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Ning Ma
- Institute of Orthopaedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopaedics, Key Laboratory of Musculoskeletal Trauma & War Injuries, PLA, 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Chunxiang Hao
- Anesthesiology Department, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Weimin Guo
- Institute of Orthopaedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopaedics, Key Laboratory of Musculoskeletal Trauma & War Injuries, PLA, 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Gengyi Zou
- Medical College, Nankai University, Tianjin, 300071, China
| | - Yu Zhang
- Institute of Orthopaedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopaedics, Key Laboratory of Musculoskeletal Trauma & War Injuries, PLA, 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Mingxue Chen
- Institute of Orthopaedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopaedics, Key Laboratory of Musculoskeletal Trauma & War Injuries, PLA, 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Shuang Gao
- Center for Biomedical Material and Tissue Engineering, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China
| | - Jiang Peng
- Institute of Orthopaedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopaedics, Key Laboratory of Musculoskeletal Trauma & War Injuries, PLA, 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Aiyuan Wang
- Institute of Orthopaedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopaedics, Key Laboratory of Musculoskeletal Trauma & War Injuries, PLA, 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Yu Wang
- Institute of Orthopaedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopaedics, Key Laboratory of Musculoskeletal Trauma & War Injuries, PLA, 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Xiang Sui
- Institute of Orthopaedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopaedics, Key Laboratory of Musculoskeletal Trauma & War Injuries, PLA, 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Wenjing Xu
- Institute of Orthopaedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopaedics, Key Laboratory of Musculoskeletal Trauma & War Injuries, PLA, 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Shibi Lu
- Institute of Orthopaedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopaedics, Key Laboratory of Musculoskeletal Trauma & War Injuries, PLA, 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Shuyun Liu
- Institute of Orthopaedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopaedics, Key Laboratory of Musculoskeletal Trauma & War Injuries, PLA, 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Quanyi Guo
- Institute of Orthopaedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopaedics, Key Laboratory of Musculoskeletal Trauma & War Injuries, PLA, 28 Fuxing Road, Haidian District, Beijing 100853, China
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Thambiah MD, Tan MKL, Hui JHP. Role of High Tibial Osteotomy in Cartilage Regeneration - Is Correction of Malalignment Mandatory for Success? Indian J Orthop 2017; 51:588-599. [PMID: 28966382 PMCID: PMC5609380 DOI: 10.4103/ortho.ijortho_260_17] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Malalignment of the knee can cause debilitating symptoms such as pain, resulting in a decline in function and mobility. Surgical options that exist to address this problem include realignment osteotomies and joint replacements. Realignment osteotomies are the more appropriate options in certain patient populations, especially with regard to age and level of activity. Since a high tibial osteotomy (HTO) was first used to manage malalignment of the knee and osteoarthritis, different techniques involving the use of specialized implants have been developed and further refined to good effect. There has also since been much research into the field of cartilage restoration techniques, both as a standalone treatment option and as an adjunct to a realignment osteotomy. This review attempts to detail the origin and the evolution of HTO, particularly in regard to combining this tried and tested procedure with adjunct cartilage restoration techniques, and the overall patient outcomes. A literature search on PubMed was performed, and articles pertaining to the outcomes of the use of an HTO and cartilage restoration techniques were reviewed. The literature in this field indicates good outcomes in terms of objective measurements of cartilage regeneration (such as arthroscopic visualization and magnetic resonance imaging evaluation) and subjective patient outcome scoring systems (such as the International Knee Documentation Committee and Lysholm scores) with a realignment osteotomy alone, and studies have shown that patient outcomes can be further improved with the use of a cartilage restoration procedure as an adjunct.
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Affiliation(s)
- Matthew Dhanaraj Thambiah
- National University of Singapore and University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore
| | - Melvin K L Tan
- National University of Singapore and University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore
| | - James H P Hui
- National University of Singapore and University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore,Address for correspondence: Prof. James H P Hui, National University of Singapore and University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore 119228, Singapore. E-mail:
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Gille J, Behrens P, Schulz AP, Oheim R, Kienast B. Matrix-Associated Autologous Chondrocyte Implantation: A Clinical Follow-Up at 15 Years. Cartilage 2016; 7:309-15. [PMID: 27688839 PMCID: PMC5029570 DOI: 10.1177/1947603516638901] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION A prospective clinical investigation was carried out in order to clarify whether Matrix-associated autologous chondrocyte implantation (MACI) results in clinical improvement at long-term follow-up. HYPOTHESIS MACI will result in clinical improvement at long-term follow-up. STUDY DESIGN Case series; level of evidence, 4. METHODS Thirty-eight patients were treated with MACI. These patients were evaluated for up to a mean of 16 years (range 15-17 years) after the intervention. Three different scores (Lysholm-Gilquist score, International Cartilage Repair Society score, and Tegner score) formed the basis of this study. Overall, we were able to obtain valid preoperative and postoperative results from 18 (47%) of 38 patients. In 1 patient, both knees were treated. In 4 patients, an arthroplasty was implanted over the course of time; thus they were excluded from this case series. In conclusion, follow-up of 15 knees was performed in the recent series. RESULTS In subjective rating, 12 out of 14 patients (86%) rated the function of their knee as much better or better than before the index procedure. All numerical outcome scores showed significant improvement compared to the preoperative value (preoperative/postoperative at 5 years/postoperative at 15 years): Lysholm score 59.6 (±24.6)/78.6 (±21.5)/82.7 (±11.3), International Knee Documentation Committee score 50.6 (±22.7)/64.7 (±21.6)/69.7 (±18.7), Tegner score 3.0 (±2.2)/3.6 (±1.5)/5.2 (±1.7). CONCLUSION The significantly improved results on 3 scores after 15 years suggest that MACI represents a suitable treatment of local cartilage defects in the knee.
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Affiliation(s)
- Justus Gille
- University of Schleswig-Holstein, Luebeck, Germany,Justus Gille, University of Schleswig-Holstein, Ratzeburger Allee 160, Luebeck, 23538, Germany.
| | | | | | - Ralf Oheim
- BG Trauma Hospital Hamburg, Hamburg, Germany
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Prodromo J, Rackley J, Mulcahey MK. A review of important medical and surgical considerations for obese patients undergoing arthroscopic surgery. PHYSICIAN SPORTSMED 2016; 44:231-9. [PMID: 27578242 DOI: 10.1080/00913847.2016.1221750] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Obesity represents a unique challenge in orthopaedic surgery, the impact of which is seen through all phases of injury: in the development of disease, during the operative procedure, and throughout the rehabilitation period. Given the high prevalence of obesity in the United States and around the world, this patient population represents a substantial proportion of patients in need of orthopedic care. The effects of this disease constrain both medical and financial resources. For obese patients undergoing orthopedic procedures, adequate steps must be taken to minimize the risks that occur before, during, and after surgical intervention. This literature review discusses the impact of obesity on arthroscopic procedures, with a focus on procedures involving the shoulder, hip, and knee. The management of obese patients during the perioperative period should address the specific concerns relating to these patients. Obesity is a risk factor for numerous comorbidities, is associated with surgical complications, and is a predictor of poor functional outcomes following arthroscopy. Efforts to minimize the negative impact of obesity on arthroscopic procedures are crucial.
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Affiliation(s)
- John Prodromo
- a Department of Orthopaedic Surgery , Drexel University College of Medicine , Philadelphia , PA , USA
| | - Justin Rackley
- b Drexel University College of Medicine , Philadelphia , PA , USA
| | - Mary K Mulcahey
- c Department of Orthopaedic Surgery , Hahnemann University Hospital/Drexel University College of Medicine , Philadelphia , PA , USA
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Bowland P, Ingham E, Jennings L, Fisher J. Review of the biomechanics and biotribology of osteochondral grafts used for surgical interventions in the knee. Proc Inst Mech Eng H 2016; 229:879-88. [PMID: 26614801 PMCID: PMC4676357 DOI: 10.1177/0954411915615470] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
A review of research undertaken to evaluate the biomechanical stability and biotribological behaviour of osteochondral grafts in the knee joint and a brief discussion of areas requiring further improvement in future studies are presented. The review takes into consideration osteochondral autografts, allografts, tissue engineered constructs and synthetic and biological scaffolds.
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Affiliation(s)
- Philippa Bowland
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - E Ingham
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Louise Jennings
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - John Fisher
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
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28
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Lindahl A. From gristle to chondrocyte transplantation: treatment of cartilage injuries. Philos Trans R Soc Lond B Biol Sci 2016; 370:20140369. [PMID: 26416680 DOI: 10.1098/rstb.2014.0369] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
This review addresses the progress in cartilage repair technology over the decades with an emphasis on cartilage regeneration with cell therapy. The most abundant cartilage is the hyaline cartilage that covers the surface of our joints and, due to avascularity, this tissue is unable to repair itself. The cartilage degeneration seen in osteoarthritis causes patient suffering and is a huge burden to society. The surgical approach to cartilage repair was non-existing until the 1950s when new surgical techniques emerged. The use of cultured cells for cell therapy started as experimental studies in the 1970s that developed over the years to a clinical application in 1994 with the introduction of the autologous chondrocyte transplantation technique (ACT). The technology is now spread worldwide and has been further refined by combining arthroscopic techniques with cells cultured on matrix (MACI technology). The non-regenerating hypothesis of cartilage has been revisited and we are now able to demonstrate cell divisions and presence of stem-cell niches in the joint. Furthermore, cartilage derived from human embryonic stem cells and induced pluripotent stem cells could be the base for new broader cell treatments for cartilage injuries and the future technology base for prevention and cure of osteoarthritis.
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Affiliation(s)
- Anders Lindahl
- Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, and Institute of Biomedicine, Department of Clinical Chemistry and Transfusion Medicine, Sahlgrenska University Hospital, SE413 45 Gothenburg, Sweden
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Lohan P, Treacy O, Lynch K, Barry F, Murphy M, Griffin MD, Ritter T, Ryan AE. Culture expanded primary chondrocytes have potent immunomodulatory properties and do not induce an allogeneic immune response. Osteoarthritis Cartilage 2016; 24:521-33. [PMID: 26493330 DOI: 10.1016/j.joca.2015.10.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 10/06/2015] [Accepted: 10/10/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Allogeneic cell therapies, such as mesenchymal stromal cells (MSC), which have potent regenerative and anti-inflammatory potential are being investigated as a therapy for osteoarthritis (OA) and cartilage injury. Here we describe another potential source of regenerative and anti-inflammatory allogeneic cells, culture expanded primary chondrocytes (CEPC). In direct comparison to allogeneic MSC, we extensively assess the immunological interactions of CEPC in an allogeneic setting. METHODS Chondrocytes were isolated from rat articular cartilage and cultured in normoxic or hypoxic conditions. In vitro co-culture assays with allogeneic lymphocytes and macrophages were used to assess the immunomodulatory capacities of the chondrocytes, followed by immune response analysis by flow cytometry, ELISA and qPCR. RESULTS CEPC showed reduced induction of proliferation, activation and cytotoxic granzyme B expression in allogeneic T cells. Importantly, exposure to pro-inflammatory cytokines did not increase CEPC immunogenicity despite increases in MHC-I. Furthermore, CEPC had a potent ability to suppress allogeneic T cell proliferation, which was dependent on nitric oxide production. This suppression was contact independent in hypoxia cultured CEPC. Finally, chondrocytes were shown to have the capacity to modulate pro-inflammatory macrophage activity by reducing MHC-II expression and TNF-α secretion. CONCLUSION These data indicate the potential use of allogeneic chondrocytes in OA and cartilage defects. The lack of evident immunogenicity, despite exposure to a pro-inflammatory environment, coupled with the immunomodulatory ability indicates that these cells have the potential to evade the host immune system and suppress inflammation, thus potentially facilitating the resolution of OA induced inflammation and cartilage regeneration.
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Affiliation(s)
- P Lohan
- Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland
| | - O Treacy
- Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland
| | - K Lynch
- Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland
| | - F Barry
- Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland
| | - M Murphy
- Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland
| | - M D Griffin
- Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland
| | - T Ritter
- Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland
| | - A E Ryan
- Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland; Discipline of Pharmacology and Therapeutics, School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland.
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Brix M, Kaipel M, Kellner R, Schreiner M, Apprich S, Boszotta H, Windhager R, Domayer S, Trattnig S. Successful osteoconduction but limited cartilage tissue quality following osteochondral repair by a cell-free multilayered nano-composite scaffold at the knee. INTERNATIONAL ORTHOPAEDICS 2016; 40:625-32. [PMID: 26803322 DOI: 10.1007/s00264-016-3118-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 01/11/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The treatment of larger osteochondral lesions in the knee is still a clinical challenge. One promising strategy to overcome this problem could be surgical repair by using a cell-free multilayered nano-composite scaffold. METHOD In this prospective cohort study eight consecutive patients which suffered from a single osteochondral lesion (≥1.5 cm(2)) on the femoral condyle were enrolled. The repair potential of the implant was assessed by using MRI based biochemical MR sequences (T2 mapping) as well as semi-quantitative morphological analyses (MOCART score) at 18 months after the surgery. The clinical outcome was determined at six, 12, 18, and 24 month follow ups by using IKDC, Tegner-Lysholm, and Cincinnati knee scores. RESULTS Seven out of eight patients showed a complete integration of the scaffold into the border zone and five out of eight patients excellent or good subchondral ossification of the implant at 18 months following implantation. The surface of the repair tissue was found to be intact in all eight patients. T2 mapping data and the zonal T2 index significantly differed in the repair tissue compared to the healthy control cartilage (P < 0.001) which indicates a limited quality of the repair cartilage. The clinical outcome scores consistently improved during the follow up period without reaching statistical significance. CONCLUSIONS Osteochondral repair by implanting the MaioRegen® scaffold provides a successful osteoconduction and filling of the cartilage defect. However there is evidence for a limited repair cartilage tissue quality at 18 months after the surgery.
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Affiliation(s)
- Martin Brix
- Centre of Excellence "High-field Magnetic Resonance (MR)", Medical University Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria
| | - Martin Kaipel
- Department of Orthopaedic and Trauma Surgery, Barmherzige Brüder Hospital, Johannes von Gott-Platz 1, A-7000, Eisenstadt, Austria.
| | - Richard Kellner
- Department of Orthopaedic and Trauma Surgery, Barmherzige Brüder Hospital, Johannes von Gott-Platz 1, A-7000, Eisenstadt, Austria
| | - Markus Schreiner
- Centre of Excellence "High-field Magnetic Resonance (MR)", Medical University Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria
| | - Sebastian Apprich
- Department of Orthopaedics, Medical University Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria
| | - Harald Boszotta
- Department of Orthopaedic and Trauma Surgery, Barmherzige Brüder Hospital, Johannes von Gott-Platz 1, A-7000, Eisenstadt, Austria
| | - Reinhard Windhager
- Department of Orthopaedics, Medical University Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria
| | - Stephan Domayer
- Centre of Excellence "High-field Magnetic Resonance (MR)", Medical University Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria
| | - Siegfried Trattnig
- Centre of Excellence "High-field Magnetic Resonance (MR)", Medical University Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria
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Kon E, Filardo G, Venieri G, Perdisa F, Marcacci M. Tibial plateau lesions. Surface reconstruction with a biomimetic osteochondral scaffold: Results at 2 years of follow-up. Injury 2014; 45 Suppl 6:S121-5. [PMID: 25457331 DOI: 10.1016/j.injury.2014.10.035] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Tibial plateau articular pathology caused by post-traumatic or degenerative lesions is a challenge for the orthopaedic surgeon and can lead to early osteoarthritis. The aim of the present study was to evaluate the results of treatment of these complex defects with implantation of an osteochondral scaffold, which is designed to target the cartilage surface and to reconstruct joint anatomy by addressing the entire osteochondral unit. MATERIALS AND METHODS Eleven patients (5 female and 6 male) with a mean age of 37.3 ± 11.0 years and osteochondral lesions of the tibial plateau (mean 5.1 ± 2.7 cm(2); range 3.0-12.5 cm(2)) were treated with the implantation of an osteochondral biomimetic collagen-hydroxyapatite scaffold (Maioregen(®), Fin-Ceramica, Faenza, Italy). Comorbidities were addressed taking care to restore the correct limb alignment. Patients were evaluated pre-operatively and prospectively followed-up for 2 years using the International Knee Documentation Committee (IKDC) subjective and objective scores; activity level was documented using the Tegner score. RESULTS Three patients experienced minor adverse events. No patients required further surgery for treatment failure during the study follow-up period, and 8 patients (72.7%) reported a marked improvement. The IKDC subjective score improved from 42.5 ± 10.2 before treatment to 69.8 ± 19.0 at 12 months (p<0.05), with stable results at 24 months. The IKDC objective score increased from 27.3% normal and nearly normal knees before treatment to 85.7% normal and nearly normal knees at 24 months of follow-up. The Tegner score increased from 2.3 ± 2.1 before treatment to 4.8 ± 2.4 at 12 months (p<0.05), and was stable at the final follow-up. CONCLUSION The present study on the implantation of an osteochondral scaffold for the treatment of tibial plateau lesions showed a promising clinical outcome at short-term follow-up, which indicates that this procedure can be considered as a possible treatment option, even in these complex defects, when comorbidities are concomitantly addressed.
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Affiliation(s)
- Elizaveta Kon
- Nano-Biotechnology Laboratory, II Orthopaedic Clinic, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, 40136 Bologna, Italy.
| | - Giuseppe Filardo
- Nano-Biotechnology Laboratory, II Orthopaedic Clinic, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Giulia Venieri
- Biomechanics Laboratory, II Orthopaedic Clinic, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Francesco Perdisa
- Biomechanics Laboratory, II Orthopaedic Clinic, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Maurilio Marcacci
- Biomechanics Laboratory, II Orthopaedic Clinic, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, 40136 Bologna, Italy
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Nieminen HJ, Salmi A, Karppinen P, Hæggström E, Hacking SA. The potential utility of high-intensity ultrasound to treat osteoarthritis. Osteoarthritis Cartilage 2014; 22:1784-99. [PMID: 25106678 DOI: 10.1016/j.joca.2014.07.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 07/22/2014] [Accepted: 07/29/2014] [Indexed: 02/02/2023]
Abstract
Osteoarthritis (OA) is a widespread musculoskeletal disease that reduces quality of life and for which there is no cure. The treatment of OA is challenging since cartilage impedes the local and systemic delivery of therapeutic compounds (TCs). This review identifies high-intensity ultrasound (HIU) as a non-contact technique to modify articular cartilage and subchondral bone. HIU enables new approaches to overcome challenges associated with drug delivery to cartilage and new non-invasive approaches for the treatment of joint disease. Specifically, HIU has the potential to facilitate targeted drug delivery and release deep within cartilage, to repair soft tissue damage, and to physically alter tissue structures including cartilage and bone. The localized, non-invasive ultrasonic delivery of TCs to articular cartilage and subchondral bone appears to be a promising technique in the immediate future.
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Affiliation(s)
- H J Nieminen
- Department of Physics, University of Helsinki, Finland.
| | - A Salmi
- Department of Physics, University of Helsinki, Finland.
| | - P Karppinen
- Department of Physics, University of Helsinki, Finland.
| | - E Hæggström
- Department of Physics, University of Helsinki, Finland.
| | - S A Hacking
- Department of Orthopaedics, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
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Constantinou L, Cobb TK, Walden AL. Long-term follow-up of osteochondral autologous transplantation in the metacarpophalangeal joints. Hand (N Y) 2014; 9:335-9. [PMID: 25191164 PMCID: PMC4152430 DOI: 10.1007/s11552-013-9596-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Louis Constantinou
- />Department of Clinical Research, Orthopaedic Specialists, Inc, 3385 Dexter Ct., Davenport, IA 52807 USA
| | - Tyson K. Cobb
- />Orthopaedic Specialists, Inc, 3385 Dexter Ct., Davenport, IA 52807 USA
| | - Anna L. Walden
- />Department of Clinical Research, Orthopaedic Specialists, Inc, 3385 Dexter Ct., Davenport, IA 52807 USA
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Hart DA. Perspectives on endogenous and exogenous tissue engineering following injury to tissues of the knee. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/jbise.2014.72009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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