1
|
Barrera Uso M, Boillat R, Blümel S, Schwab JM, Tannast M, Petek D. Drop in survivorship 13 years after AMIC procedures in aligned knees: A long-term follow-up. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38984906 DOI: 10.1002/ksa.12354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 05/29/2024] [Accepted: 06/06/2024] [Indexed: 07/11/2024]
Abstract
PURPOSE Autologous matrix-induced chondrogenesis (AMIC) showed promising short-term results comparable to microfracture. This study aims to assess the 19-year outcomes of AMIC, addressing the lack of long-term data. METHODS Retrospective cohort of 34 knees treated with AMIC underwent a 19-year follow-up. The primary outcome was AMIC survival, considering total knee arthroplasty as a failure event. Survival analysis for factors that were associated with longer survival of the AMIC was also performed. Clinical and radiological outcome scores were analysed for the AMIC group. RESULTS Twenty-three knees were available for follow-up analysis. Of these, 14 (61%) underwent revision surgery for total knee arthroplasty (TKA). The mean time was 13.3 ± 2.5 years (range: 9-17 years). Secondary outcomes showed that increased age at surgery (hazard ratio [HR]: 1.05; p = 0.021) and larger defect size (HR: 1.95; p = 0.018) were risk factors for failure. Concomitant proximal tibial osteotomy (HR: 0.22; p = 0.019) was associated with longer survival. The remaining nine knees (39%) were analysed as a single group. The mean clinical score at follow-up of 18.6 ± 0.9 SD years was 79.5 ± 19.7 SD for the Lysholm score, 1.8 ± 1.5 SD for the visual analog scale score, 74.2 ± 22.4 SD for the KOOS score and a median of 3 (range: 3-4) for the Tegner activity scale. CONCLUSIONS The mean survival time of 13.3 years indicates the durability of AMIC in properly aligned knees. Nonetheless, despite a 61% conversion to TKA, the knees that persisted until the 19-year follow-up remained stable, underscoring the procedure's longevity and consistent clinical outcomes. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Marc Barrera Uso
- Department of Orthopaedic Surgery and Traumatology, Hospital and University of Fribourg, Fribourg, Switzerland
| | - Romane Boillat
- Department of Orthopaedic Surgery and Traumatology, Hospital and University of Fribourg, Fribourg, Switzerland
| | - Stefan Blümel
- Department of Orthopaedic Surgery and Traumatology, Hospital and University of Fribourg, Fribourg, Switzerland
| | - Joseph M Schwab
- Department of Orthopaedic Surgery and Traumatology, Hospital and University of Fribourg, Fribourg, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery and Traumatology, Hospital and University of Fribourg, Fribourg, Switzerland
| | - Daniel Petek
- Department of Orthopaedic Surgery and Traumatology, Hospital and University of Fribourg, Fribourg, Switzerland
| |
Collapse
|
2
|
Gebhardt S, Vollmer M, Zimmerer A, Rochel I, Balcarek P, Niemeyer P, Wassilew GI. Factors Affecting Choice of Surgical Treatment of Cartilage Lesions of the Knee: An Analysis of Data From 5143 Patients From the German Cartilage Registry (KnorpelRegister DGOU). Orthop J Sports Med 2024; 12:23259671241255672. [PMID: 39070901 PMCID: PMC11273558 DOI: 10.1177/23259671241255672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/01/2024] [Indexed: 07/30/2024] Open
Abstract
Background Symptomatic full-thickness cartilage lesions of the knee joint are considered an indication for cartilage repair surgery. Patient- and lesion-specific factors like age, nutritional status, etiology of defect, or integrity of corresponding joint surface remain controversial in indicating cartilage repair surgery. Furthermore, the selection of the most suitable cartilage repair technique for a specific cartilage lesion remains debatable. Purpose To evaluate indications and choice of treatment method for cartilage repair surgery, depending on patient- and lesion-specific data from the German Cartilage Registry. Study Design Cross-sectional study; Level of evidence, 3. Methods A total of 6305 consecutive patients who underwent cartilage repair surgery of the knee evaluated and 5143 complete datasets were included in the analysis (follow-up rate, 81.5%). Patient-specific (age, body mass index, smoking status, previous operations, clinical leg axis) and lesion-specific (size, grading, location, etiology) data were provided by the attending surgeon at the time of surgery. Appropriate statistical tests were used to compare data depending on type and normality of data. Multivariable logistic regressions were calculated to investigate independent factors for the choice of specific cartilage repair techniques. Results The median size of treated cartilage lesions was 3.6 cm2, and most defects were of degenerative origin (54.8%). Of the registered patients, 39.2% were categorized as overweight and 19.6% as obese, while 23.3% were smokers. The most prevalently documented operative techniques were the autologous chondrocyte implantation (ACI) (52.4%), bone marrow stimulation (BMS) (17.3%), and BMS augmented with collagen scaffolds (9.3%). Independent factors that made the use of ACI more likely were bigger lesion size, previous surgery at the joint, and lesions located at the trochlea or the patella. On the contrary, BMS or augmented BMS were preferred in older patients, with damaged corresponding joint surface, and with more concomitant surgeries. Conclusion Cartilage repair surgery was indicated irrespective of nutritional status, smoking status, or etiology of the treated lesion. ACI was the most prevalent technique and was preferred for younger patients and patellar lesions. While older patients with degenerative changes to the joint were not excluded from cartilage repair surgery, the use of ACI was restricted.
Collapse
Affiliation(s)
- Sebastian Gebhardt
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Marcus Vollmer
- Institute of Bioinformatics, University Medicine Greifswald, Greifswald, Germany
| | - Alexander Zimmerer
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
- Orthopädische Klinik Paulinenhilfe, Diakonie-Klinikum Stuttgart, Stuttgart, Germany
| | - Ingo Rochel
- Klinik für Unfallchirurgie, Handchirurgie und Orthopädie, KRH Klinikum Nordstadt, Hannover, Germany
| | - Peter Balcarek
- ARCUS Sportklinik, Pforzheim, Germany
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Göttingen, Germany
| | - Philipp Niemeyer
- OCM-Orthopädische Chirurgie München, München, Germany
- Klinik für Orthopädie und Traumatologie, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Georgi I. Wassilew
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| |
Collapse
|
3
|
Shimomura K, Ando W, Hart DA, Nakamura N. A novel scaffold-free mesenchymal stem cell-derived tissue engineered construct for articular cartilage restoration - From basic to clinic. Regen Ther 2024; 26:124-131. [PMID: 38883147 PMCID: PMC11176953 DOI: 10.1016/j.reth.2024.05.007] [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: 03/25/2024] [Revised: 05/04/2024] [Accepted: 05/19/2024] [Indexed: 06/18/2024] Open
Abstract
Treatments for articular cartilage injuries are still challenging, due in part to its avascular and aneural surroundings. Since the first report of autologous chondrocyte implantation, cell-based therapies have been extensively studied with a variety of cell sources, including chondrocytes and mesenchymal stem/stromal cells (MSCs). Recently, MSC-based therapy has received considerable research attention because of the relative ease in handling for tissue harvest, and subsequent cell expansion and differentiation. Using such cells, we have originally developed a 3-dimensional scaffold-free tissue-engineered construct (TEC) through simple-cell culture methods and demonstrated its feasibility for cartilage repair and regeneration in the first-in-human clinical trial. This review summarizes our novel scaffold-free approaches to use MSC for the restoration of damaged articular cartilage, documenting the progression from basic to clinical studies.
Collapse
Affiliation(s)
- Kazunori Shimomura
- Department of Rehabilitation, Kansai University of Welfare Sciences, Osaka, Japan
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Wataru Ando
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Orthopaedic Surgery, Kansai Rosai Hospital, Hyogo, Japan
| | - David A Hart
- McCaig Institute for Bone & Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Norimasa Nakamura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
- Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan
- Global Center for Medical Engineering and Informatics, Osaka University, Osaka, Japan
| |
Collapse
|
4
|
Cognetti DJ, Defoor MT, Yuan TT, Sheean AJ. Knee Joint Preservation in Tactical Athletes: A Comprehensive Approach Based upon Lesion Location and Restoration of the Osteochondral Unit. Bioengineering (Basel) 2024; 11:246. [PMID: 38534520 DOI: 10.3390/bioengineering11030246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/18/2024] [Accepted: 02/28/2024] [Indexed: 03/28/2024] Open
Abstract
The unique physical demands of tactical athletes put immense stress on the knee joint, making these individuals susceptible to injury. In order to ensure operational readiness, management options must restore and preserve the native architecture and minimize downtime, while optimizing functionality. Osteochondral lesions (OCL) of the knee have long been acknowledged as significant sources of knee pain and functional deficits. The management of OCL is predicated on certain injury characteristics, including lesion location and the extent of subchondral disease. Techniques such as marrow stimulation, allograft and autologous chondrocyte implantation are examined in detail, with a focus on their application and suitability in tactical athlete populations. Moreover, the restoration of the osteochondral unit (OCU) is highlighted as a central aspect of knee joint preservation. The discussion encompasses the biomechanical considerations and outcomes associated with various cartilage restoration techniques. Factors influencing procedure selection, including lesion size, location, and patient-specific variables, are thoroughly examined. Additionally, the review underscores the critical role of post-operative rehabilitation and conditioning programs in optimizing outcomes. Strengthening the surrounding musculature, enhancing joint stability, and refining movement patterns are paramount in facilitating the successful integration of preservation procedures. This narrative review aims to provide a comprehensive resource for surgeons, engineers, and sports medicine practitioners engaged in the care of tactical athletes and the field of cartilage restoration. The integration of advanced preservation techniques and tailored rehabilitation protocols offers a promising avenue for sustaining knee joint health and function in this demanding population.
Collapse
Affiliation(s)
- Daniel J Cognetti
- Department of Orthopedic Surgery, Brooke Army Medical Center, 3551 Roger Brooke Drive, San Antonio, TX 78234, USA
| | - Mikalyn T Defoor
- Department of Orthopedic Surgery, Brooke Army Medical Center, 3551 Roger Brooke Drive, San Antonio, TX 78234, USA
| | - Tony T Yuan
- Advanced Exposures Diagnostics, Interventions and Biosecurity Group, 59 Medical Wing, Lackland Air Force Base, San Antonio, TX 78236, USA
- Center for Biotechnology (4D Bio3), Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Andrew J Sheean
- Department of Orthopedic Surgery, Brooke Army Medical Center, 3551 Roger Brooke Drive, San Antonio, TX 78234, USA
| |
Collapse
|
5
|
Kryuchkova A, Savin A, Kiseleva A, Dukhinova M, Krivoshapkina E, Krivoshapkin P. Magnetothermal spider silk-based scaffolds for cartilage regeneration. Int J Biol Macromol 2023; 253:127246. [PMID: 37797862 DOI: 10.1016/j.ijbiomac.2023.127246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 10/07/2023]
Abstract
Developing biocompatible, magnetically controlled polymers is a multifunctional solution to many surgical complications. By combining nanoparticle technology with the latest advancements in polymer materials science, we created a multicomponent hybrid system comprised of a robust native spider silk-based matrix; a Mn0.9Zn0.1Fe2O4 nanoparticles coating to provide a controlled thermal trigger for drug release; and liposomes, which act as drug carriers. Fluorescent microscope images show that the dye loaded into the liposomes is released when the system is exposed to an alternating magnetic field due to heating of ferromagnetic nanoparticles, which had a low Curie temperature (40-46°С). The silk matrix also demonstrated outstanding biocompatibility, creating a favorable environment for human postnatal fibroblast cell adhesion, and paving the way for their directed growth. This paper describes a complex approach to cartilage regeneration by developing a spider silk-based scaffold with anatomical mechanical properties for controlled drug delivery in a multifunctional autologous matrix-induced chondrogenesis.
Collapse
Affiliation(s)
- Anastasia Kryuchkova
- ITMO University, 9 Lomonosova Street, Saint Petersburg 191002, Russian Federation
| | - Artemii Savin
- ITMO University, 9 Lomonosova Street, Saint Petersburg 191002, Russian Federation
| | - Aleksandra Kiseleva
- ITMO University, 9 Lomonosova Street, Saint Petersburg 191002, Russian Federation
| | - Marina Dukhinova
- ITMO University, 9 Lomonosova Street, Saint Petersburg 191002, Russian Federation
| | - Elena Krivoshapkina
- ITMO University, 9 Lomonosova Street, Saint Petersburg 191002, Russian Federation
| | - Pavel Krivoshapkin
- ITMO University, 9 Lomonosova Street, Saint Petersburg 191002, Russian Federation.
| |
Collapse
|
6
|
Allegra F, Picchi A, Ratano M, Gumina S, Fidanza A, Logroscino G. Microfracture- and Xeno-Matrix-Induced Chondrogenesis for Treatment of Focal Traumatic Cartilage Defects of the Knee: Age-Based Mid-Term Results. Healthcare (Basel) 2023; 11:2995. [PMID: 37998487 PMCID: PMC10671418 DOI: 10.3390/healthcare11222995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/14/2023] [Accepted: 11/18/2023] [Indexed: 11/25/2023] Open
Abstract
The aim of this study was to investigate clinical and instrumental outcomes of the autologous matrix-induced chondrogenesis (AMIC) technique for the treatment of isolated traumatic condyle and femoropatellar cartilage lesions. A total of 25 patients (12 males, 13 females, mean age 47.3 years) treated between 2018 and 2021 were retrospectively reviewed and subdivided into two groups based on age (Group A, age < 45 years; Group B, age > 45 years). A clinical evaluation was performed using the International Knee Documentation Committee (IKDC), Lysholm score and Visual Analogue Score (VAS). Cartilage regeneration was evaluated via magnetic resonance (1.5 Tesla) and classified according to a Magnetic resonance Observation of CArtilage Repair Tissue (MOCART) scoring system. At a minimum follow-up of 2 years, Group A patients obtained greater instrumental results in comparison to group B: in fact, the MOCART score was statistically significantly correlated with IKDC (r = 0.223) (p < 0.001) exclusively in group A. Nevertheless, a significant improvement in clinical functionality was shown in Group B (p < 0.001), demonstrating that this technique is safe, reproducible and capable of offering satisfactory clinical results regardless of age.
Collapse
Affiliation(s)
| | - Aurelio Picchi
- Unit of Orthopaedics, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy (G.L.)
| | - Marco Ratano
- Unit of Orthopaedics, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy (G.L.)
| | - Stefano Gumina
- Department of Anatomy, Histology, Legal Medicine and Orthopaedics, Polo Pontino, Sapienza University of Rome, 00161 Rome, Italy
| | - Andrea Fidanza
- Unit of Orthopaedics, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy (G.L.)
| | - Giandomenico Logroscino
- Unit of Orthopaedics, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy (G.L.)
| |
Collapse
|
7
|
Yu TH, Yeh TT, Su CY, Yu NY, Chen IC, Fang HW. Preparation and Characterization of Extracellular Matrix Hydrogels Derived from Acellular Cartilage Tissue. J Funct Biomater 2022; 13:jfb13040279. [PMID: 36547539 PMCID: PMC9788521 DOI: 10.3390/jfb13040279] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Decellularized matrices can effectively reduce severe immune rejection with their cells and eliminated nucleic acid material and provide specific environments for tissue repair or tissue regeneration. In this study, we prepared acellular cartilage matrix (ACM) powder through the decellularization method and developed ACM hydrogels by physical, chemical, and enzymatic digestion methods. The results demonstrated that the small size group of ACM hydrogels exhibited better gel conditions when the concentration of ACM hydrogels was 30 and 20 mg/mL in 1N HCl through parameter adjustment. The data also confirmed that the ACM hydrogels retained the main components of cartilage: 61.18% of glycosaminoglycan (GAG) and 78.29% of collagen, with 99.61% of its DNA removed compared to samples without the decellularization procedure (set as 100%). Through turbidimetric gelation kinetics, hydrogel rheological property analysis, and hydrogel tissue physical property testing, this study also revealed that increasing hydrogel concentration is helpful for gelation. Besides, the ex vivo test confirmed that a higher concentration of ACM hydrogels had good adhesive properties and could fill in cartilage defects adequately. This study offers useful information for developing and manufacturing ACM hydrogels to serve as potential alternative scaffolds for future cartilage defect treatment.
Collapse
Affiliation(s)
- Tsong-Hann Yu
- Department of Orthopedics, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd., Taipei 114202, Taiwan
| | - Tsu-Te Yeh
- Department of Orthopedics, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd., Taipei 114202, Taiwan
| | - Chen-Ying Su
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, No. 1, Sec. 3, Zhongxiao E. Rd., Taipei 10608, Taiwan
| | - Ni-Yin Yu
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, No. 1, Sec. 3, Zhongxiao E. Rd., Taipei 10608, Taiwan
| | - I-Cheng Chen
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, No. 1, Sec. 3, Zhongxiao E. Rd., Taipei 10608, Taiwan
- Accelerator for Happiness and Health Industry, National Taipei University of Technology, No. 1, Sec. 3, Zhongxiao E. Rd., Taipei 10608, Taiwan
- Correspondence: (I.-C.C.); (H.-W.F.); Tel.: +886-2-2771-2171 (ext. 2521) (H.-W.F.)
| | - Hsu-Wei Fang
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, No. 1, Sec. 3, Zhongxiao E. Rd., Taipei 10608, Taiwan
- Accelerator for Happiness and Health Industry, National Taipei University of Technology, No. 1, Sec. 3, Zhongxiao E. Rd., Taipei 10608, Taiwan
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, No. 35, Keyan Road, Zhunan 35053, Taiwan
- Correspondence: (I.-C.C.); (H.-W.F.); Tel.: +886-2-2771-2171 (ext. 2521) (H.-W.F.)
| |
Collapse
|
8
|
Fibrin glue does not promote migration and proliferation of bone marrow derived mesenchymal stem cells in collagenic membranes: an in vitro study. Sci Rep 2022; 12:20660. [PMID: 36450814 PMCID: PMC9712600 DOI: 10.1038/s41598-022-25203-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022] Open
Abstract
During Autologous Matrix-Induced Chondrogenesis (AMIC), the membrane is often glued into the chondral defect. However, whether fibrin glue influences cells proliferation and migration remain unclear. This study evaluated the impact of fibrin glue addition to biologic membranes loaded with bone marrow-derived mesenchymal stem cells (B-MSCs). A porcine derived collagen membrane (Cartimaix, Matricel GmbH, Germany) was used. B-MSCs were harvested from three different unrelated donors. The membranes were embedded in mounting medium with DAPI (ABCAM, Cambridge, UK) and analysed at 1-, 2-, 3-, 4-, 6-, and at 8-week follow-up. The DAPI ties the DNA of the cell nucleus, emitting blue fluorescence. DAPI/nuclei signals were analysed with fluorescence microscopy at 100-fold magnification. The group without fibrin glue demonstrated greater migration of the B-MSCs within the membrane at week 4 (P < 0.001), 6 (P < 0.001), and 8 (P < 0.001). No difference was found at week 1, 2, and 3. The group without fibrin glue demonstrated greater proliferation of B-MSCs within the membrane. These differences were significant at week 1 (P = 0.02), 2 (P = 0.008), 3 (P = 0.0009), 4 (P < 0.0001), 6 (P < 0.0001), 8 (P < 0.0001). Concluding, in the present setting, the use of fibrin in a collagenic biomembrane impairs B-MSCs proliferation and migration in vitro.
Collapse
|
9
|
Autologous chondrocyte implantation in the knee is effective in skeletally immature patients: a systematic review. Knee Surg Sports Traumatol Arthrosc 2022; 31:2518-2525. [PMID: 36329188 PMCID: PMC10183428 DOI: 10.1007/s00167-022-07212-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE This systematic review evaluated the efficacy and safety of autologous chondrocyte implantation (ACI) for chondral defects of the knee in skeletally immature patients. Current available data from patients reported outcome measures (PROMs) and complications were collected, analyzed, and discussed. METHODS This systematic review was conducted according to the PRISMA guidelines. The following databases were accessed in May 2022: PubMed, Google scholar, Embase, and Scopus. All the clinical studies investigating the efficacy of ACI to manage chondral defects of the knee in skeletally immature patients were accessed. Articles treating patients with surgical procedures other than ACI were not eligible, nor were studies with a follow-up shorter than 12 months. RESULTS Data from 9 studies (251 procedures) were collected. 32% (80 of 251) of patients were females. The mean length of follow-up was 44.2 ± 29.4 (range, 12-115) months. The mean age of the patients was 16.4 ± 0.7 (range, 15-17) years. The Knee injury and Osteoarthritis Outcome Score (KOOS) and International Knee Document Committee (IKDC) increased of + 41.9/100 (P = 0.003) and + 33.2/100 (P = < 0.0001) points, respectively. The Lysholm Knee Score improved of + 20.6/100 (P = 0.02) points. The Visual Analogue Scale (VAS) for pain reduced of - 3.6/10 (P = 0.004) points. The Tegner scale did not show any statistically significant improvement from baseline to follow-up (P = n.s.). The rate of graft hypertrophy was 12.5% (5 of 40 patients), and the rate of failure 5.6% (8 of 142 patients). CONCLUSION ACI for chondral defects of the knee is effective to improve PROMs in skeletally immature patients. The safety profile of ACI still remains controversial. LEVEL OF EVIDENCE III.
Collapse
|
10
|
Chen YC, Liao HJ, Hsu YM, Shen YS, Chang CH. Delivery of Mesenchymal Stem Cell in Dialdehyde Methylcellulose-Succinyl-Chitosan Hydrogel Promotes Chondrogenesis in a Porcine Model. Polymers (Basel) 2022; 14:polym14071474. [PMID: 35406348 PMCID: PMC9002496 DOI: 10.3390/polym14071474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/22/2022] [Accepted: 03/27/2022] [Indexed: 02/04/2023] Open
Abstract
Due to the limitation in the current treatment modalities, such as secondary surgery in ACI and fibrocartilage formation in microfracture surgery, various scaffolds or hydrogels have been developed for cartilage regeneration. In the present study, we used sodium periodate to oxidize methylcellulose and formed dialdehyde methylcellulose (DAC) after dialysis and freeze-drying process, DAC was further mixed with succinyl-chitosan (SUC) to form an DAC-SUC in situ forming hydrogel. The hydrogel is a stiffness, elastic-like and porous hydrogel according to the observation of SEM and rheological analysis. DAC-SUC13 hydrogel possess well cell-compatibility as well as biodegradability. Most bone marrow mesenchymal stem cells (BM-pMSCs) were alive in the hydrogel and possess chondrogenesis potential. According to the results of animal study, we found DAC-SUC13 hydrogel can function as a stem cell carrier to promote glycosaminoglycans and type II collagen synthesis in the osteochondral defects of porcine knee. These findings suggested that DAC-SUC13 hydrogel combined with stem cell is a potential treatment for cartilage defects repair in the future.
Collapse
Affiliation(s)
- Yu-Chun Chen
- Department of Chemical Engineering, National United University, Miaoli 360302, Taiwan;
| | - Hsiu-Jung Liao
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan; (H.-J.L.); (Y.-M.H.); (Y.-S.S.)
| | - Yuan-Ming Hsu
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan; (H.-J.L.); (Y.-M.H.); (Y.-S.S.)
| | - Yi-Shan Shen
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan; (H.-J.L.); (Y.-M.H.); (Y.-S.S.)
- Department of Biomedical Engineering, National Taiwan University, Taipei 10617, Taiwan
| | - Chih-Hung Chang
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan; (H.-J.L.); (Y.-M.H.); (Y.-S.S.)
- Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan City 320315, Taiwan
- Correspondence:
| |
Collapse
|