Treatment of a Focal Articular Cartilage Defect of the Talus with Polymer-Based Autologous Chondrocyte Implantation: A 12-Year Follow-Up Period

Four cases report: Treatment of knee joint cartilage defects using autologous chondrocyte patch implantation

INTRODUCTION

Autologous chondrocyte implantation (ACI) is a crucial method for the treatment of defects in articular cartilage. However, the extant methods for the preparation of autologous chondrocyte patch are relatively complicated and money-consuming. Therefore, an efficient, reliable, easy-to-follow, and cost-effective technique is needed to overcome constraints. This case report aims to introduce an autologous chondrocyte patch fabrication technique to repair knee joint cartilage defects and report our typical cases with a 2-year follow-up.

CASE PRESENTATION

We described four cases in which patients complained of knee joint pain. According to radiological examination, the patients were diagnosed as knee joint cartilage defect. Arthroscopy and autologous chondrocyte patch implantation were performed as well as a 2-year follow up of patients. The autologous chondrocyte patch for knee joint cartilage repair was fabricated using a "sandwich" technique. The preoperative and postoperative knee function was evaluated by four subjective evaluation systems. MRI was performed for all patients to achieve more intuitionistic observation of the postoperative radiological changes of defect sites. The quality of repaired tissue was evaluated by Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART). Postoperative follow-up showed improvement in clinical and MOCART scores for all patients. However, one patient complained of knee joint pain after walking for a long time or recreational activities from 12- to 18-month postoperatively. The location of pain for this patient was not in accordance with the location of cartilage defect.

CONCLUSION

The patients undergoing autologous chondrocyte patch implantation demonstrated clinical improvement and good quality of repaired tissue postoperatively. The procedure is an efficient and cost-effective treatment for knee joint cartilage defect in this report. In addition, patients with osteoarthritis carry the risk of a poor outcome after the procedure, and whether to have a procedure should be considered carefully.

Nanohydroxyapatite Hydrogel Can Promote the Proliferation and Migration of Chondrocytes and Better Repair Talar Articular Cartilage

As an important load-bearing part of the body, joints are prone to articular cartilage degradation during exercise, resulting in joint pain, swelling, and deformity, which has an adverse impact on patients’ life quality and social medical security. Therefore, this study aims to test an effective biopolymer scaffold in promoting the growth of chondrocytes in talus. Hydrogel (Gel)-nanohydroxyapatite (nHA) was invented as a new type of biopolymer scaffold for osteoarthritis treatment in this research. To detect the effects of Gel-nHA on guidance, cartilage matrix secretion, mineralization, proliferation, and migration of chondrocyte, we cultured chondrocytes to study the biological properties of nHA. It was found that Gel could guide chondrocytes to permeate and migrate, so it could be used as acellular matrix scaffolds for chondrocyte regeneration. In addition, nHA could stimulate chondrocytes to secrete cartilage matrix, such as type II collagen and mucopolysaccharide (GAGs). At the same time, nHA help to induce chondrocyte mineralization and stimulate the secretion of type X collagen, so as to better maintain the integrity of bone cartilage interface. In Gel-nHA, chondrocyte viability could be better maintained, and the proliferation and migration of chondrocytes could be better promoted, so as to better repair the articular cartilage of talus. Therefore, the Gel-nHA scaffold is expected to become an effective method for repairing talus cartilage in the future.

Demographics in Patients Receiving Matrix-Assisted Chondrocyte Implantation (MACI) in the Ankle

Objective. To compare demographics and cartilage lesion characteristics of patients enrolled in clinical trials investigating autologous chondrocyte implantation (ACI) in the ankle joint with those actually scheduled for matrix-assisted chondrocyte implantation (MACI) using database records. Design. Anonymized data from patients scheduled for MACI treatment in the ankle in Australia/Asia and Europe were obtained from the Genzyme/Sanofi database. Average age, defect size, and male-female ratio were analyzed and compared by country. A literature search was performed on PubMed and Google Scholar and clinical cohort studies and prospective comparative trials using ACI and related treatments in the ankle joint were identified. Weighted average age, weighted defect size, and male-female ratio were analyzed and compared with database data. Results. The 167 patients included from the databases from Europe and Australia had a mean age of 33.4 years (range 14-64 years) and a mean defect size of 2.27 cm² (range 0.25-16 cm²). Male-female ratio was 4:3. Patients from European countries were significantly younger and had significantly larger defects compared with patients from Australia. From the literature search a total of 472 patients were included from 28 studies. The mean age was 32.2 years (range 15-62 years). Male-female ratio was 3:2. Weighted mean size was 1.94cm² (range 0.3-16). There were no significant differences between previous studies and databases. Conclusion. No differences in sizes and age were found between patients enrolled in clinical trials and patients scheduled for MACI outside clinical trials. The sizes of treated defects followed the general recommendations. There were, however, significant differences between countries.

Leveraging advances in chemistry to design biodegradable polymeric implants using chitosan and other biomaterials

The metamorphosis of biodegradable polymers in biomedical applications is an auspicious myriad of indagation. The utmost challenge in clinical conditions includes trauma, organs failure, soft and hard tissues, infection, cancer and inflammation, congenital disorders which are still not medicated efficiently. To overcome this bone of contention, proliferation in the concatenation of biodegradable materials for clinical applications has emerged as a silver bullet owing to eco-friendly, nontoxicity, exorbitant mechanical properties, cost efficiency, and degradability. Several bioimplants are designed and fabricated in a way to reabsorb or degrade inside the body after performing the specific function rather than eliminating the bioimplants. The objective of this comprehensive is to unfurl the anecdote of emerging biological polymers derived implants including silk, lignin, soy, collagen, gelatin, chitosan, alginate, starch, etc. by explicating the selection, fabrication, properties, and applications. Into the bargain, emphasis on the significant characteristics of current discernment and purview of nanotechnology integrated biopolymeric implants has also been expounded. This robust contrivance shed light on recent inclinations and evolution in tissue regeneration and targeting organs followed by precedency and fly in the ointment concerning biodegradable implants evolved by employing fringe benefits provided by 3D printing technology for building tissues or organs construct for implantation.

Research on quantitative measurement method of articular cartilage thickness change based on MR image

In order to study the quantitative measurement method of articular cartilage thickness change based on MR image, 140 patients with no knee joint symptoms and 17 patients with knee joint damage were studied. FLASH, SE and FISP 3 sequences were scanned for all normal knee joints to determine the articular cartilage thickness. 17 patients with knee joint damage were followed up for six months. The thickness of their femoral condyle and femoral trochlea cartilage was measured by FLASH sequence and thickness changes are recorded. The results show that the thickness distribution of normal knee articular cartilage in different parts is not equal, and the thickness of articular cartilage will be gradually thinner in different ages; MR image technique can observe the change of articular cartilage thickness in patients with knee joint damage, reflecting the recovery status of the patient's condition. The results of quantitative measurement of changes in articular cartilage thickness based on MR images are presented herein, and the results are as expected. Experimental data were provided for the clinical treatment of acute knee injury and osteoarthritis. Although there are still some shortcomings in the research process, the research results still provide some reference and guidance for the future exploration of the use of MR images to monitor the condition of arthritis, so this study is a significant research topic.