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Sangiorgio A, Andriolo L, Gersoff W, Kon E, Nakamura N, Nehrer S, Vannini F, Filardo G. Subchondral bone: An emerging target for the treatment of articular surface lesions of the knee. J Exp Orthop 2024; 11:e12098. [PMID: 39040436 PMCID: PMC11260998 DOI: 10.1002/jeo2.12098] [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: 04/24/2024] [Revised: 06/11/2024] [Accepted: 06/17/2024] [Indexed: 07/24/2024] Open
Abstract
Purpose When dealing with the health status of the knee articular surface, the entire osteochondral unit has gained increasing attention, and in particular the subchondral bone, which plays a key role in the integrity of the osteochondral unit. The aim of this article was to discuss the current evidence on the role of the subchondral bone. Methods Experts from different geographical regions were involved in performing a review on highly discussed topics about the subchondral bone, ranging from its etiopathogenetic role in joint degeneration processes to its prognostic role in chondral and osteochondral defects, up to treatment strategies to address both the subchondral bone and the articular surface. Discussion Subchondral bone has a central role both from an aetiologic point of view and as a diagnostic tool, and its status was found to be relevant also as a prognostic factor in the follow-up of chondral treatment. Finally, the recognition of its importance in the natural history of these lesions led to consider subchondral bone as a treatment target, with the development of osteochondral scaffolds and procedures to specifically address osteochondral lesions. Conclusion Subchondral bone plays a central role in articular surface lesions from different points of view. Several aspects still need to be understood, but a growing interest in subchondral bone is to be expected in the upcoming future towards the optimization of joint preservation strategies. Level of Evidence Level V, expert opinion.
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Affiliation(s)
| | - Luca Andriolo
- Clinica Ortopedica e Traumatologica 2IRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Wayne Gersoff
- Orthopedic Centers of Colorado Joint Preservation Institute, Clinical InstructorUniversity of Colorado Health Sciences CenterAuroraColoradoUSA
| | - Elizaveta Kon
- IRCCS Humanitas Research HospitalRozzanoItaly
- Department of Biomedical SciencesHumanitas University, Pieve EmanueleMilanItaly
- Department of Traumatology, Orthopaedics and Disaster SurgerySechenov First Moscow State Medical University (Sechenov University)MoscowRussia
| | - Norimasa Nakamura
- Institute for Medical Science in SportsOsaka Health Science UniversityOsakaJapan
- Center for Advanced Medical Engineering and InformaticsOsaka UniversitySuitaJapan
| | - Stefan Nehrer
- Faculty Health & MedicineUniversity for Continuing EducationKremsAustria
- Department of Orthopaedics and TraumatologyUniversity Hospital Krems, Karl Landsteiner University of Health SciencesKremsAustria
| | - Francesca Vannini
- Clinica Ortopedica e Traumatologica1 IRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of SurgeryEOCLuganoSwitzerland
- Faculty of Biomedical SciencesUniversità della Svizzera ItalianaLuganoSwitzerland
- Applied and Translational Research (ATR) CenterIRCCS Istituto Ortopedico RizzoliBolognaItaly
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2
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Thacher RR, Pascual-Leone N, Rodeo SA. Treatment of Knee Chondral Defects in Athletes. Sports Med Arthrosc Rev 2024; 32:75-86. [PMID: 38978201 DOI: 10.1097/jsa.0000000000000405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Cartilage lesions of the knee are a challenging problem, especially for active individuals and athletes who desire a return to high-load activities. They occur both through chronic repetitive loading of the knee joint or through acute traumatic injury and represent a major cause of pain and time lost from sport. They can arise as isolated lesions or in association with concomitant knee pathology. Management of these defects ultimately requires a sound understanding of their pathophysiologic underpinnings to help guide treatment. Team physicians should maintain a high index of suspicion for underlying cartilage lesions in any patient presenting with a knee effusion, whether painful or not. A thorough workup should include a complete history and physical examination. MRI is the most sensitive and specific imaging modality to assess these lesions and can provide intricate detail not only of the structure and composition of cartilage, but also of the surrounding physiological environment in the joint. Treatment of these lesions consists of both conservative or supportive measures, as well as surgical interventions designed to restore or regenerate healthy cartilage. Because of the poor inherent capacity for healing associated with hyaline cartilage, the vast majority of symptomatic lesions will ultimately require surgery. Surgical treatment options range from simple arthroscopic debridement to large osteochondral reconstructions. Operative decision-making is based on numerous patient- and defect-related factors and requires open lines of communication between the athlete, the surgeon, and the rest of the treatment team. Ultimately, a positive outcome is based on the creation of a durable, resistant repair that allows the athlete to return to pain-free sporting activities.
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Affiliation(s)
- Ryan R Thacher
- Department of Orthopaedic Surgery, Sports Medicine Institute, Hospital for Special Surgery, New York, NY
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Ragni E, De Luca P, Landoni S, Valli F, Mortati L, Palombella S, Talò G, Moretti M, de Girolamo L. High efficiency protocol for platelet derived fibrin gel loaded with mesenchymal stromal cells extracellular vesicles. Regen Ther 2024; 26:442-457. [PMID: 39070124 PMCID: PMC11276930 DOI: 10.1016/j.reth.2024.06.020] [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: 05/17/2024] [Revised: 06/11/2024] [Accepted: 06/27/2024] [Indexed: 07/30/2024] Open
Abstract
Introduction Extracellular vesicles from mesenchymal stromal cells (MSC-EVs) are potent stimulators of naïve cartilage and their injection is studied in clinical trials for cartilage lesions, since often cartilage repaired with conventional approaches is incomplete or less performant leading to joint degeneration. The main pitfall of these innovative approaches is the high EVs dispersion into the joint cavity and consequent low concentration at lesion site. Thus, biological scaffolds for concentration of EVs where needed might be a promising option. This work aimed at producing an enhanced platelet-derived fibrin gel loaded with adipose-derived MSCs (ASCs)-EVs. Methods EVs' embedment efficiency in platelet gel, their release and incorporation in OA chondrocytes and cartilage explants were monitored by flow cytometry, microfluidic approaches, scansion electron microscopy and real-time quantitative multimodal nonlinear optics imaging. The effect of released EVs was tested in OA chondrocytes by gene expression studies. Results A protocol ensuring high incorporation EVs efficiency in platelet gels was defined, relying on a one-step modification of the standard procedure used in current clinical practice. Trapped EVs were released continuously for up to 4 weeks and uptaken in pathologic chondrocytes and cartilage explants. The release of the EVs-loaded platelet gel had stronger and synergic anti-inflammatory/matrix remodelling effects with respect to both EVs per se and unloaded gel released products. Conclusions These results suggest the feasibility of producing a platelet gel loaded with MSC-EVs at high efficiency that can be used as an enhanced tool to foster chondrocyte homeostasis, a key requisite for proper cartilage healing.
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Affiliation(s)
- Enrico Ragni
- IRCCS Istituto Ortopedico Galeazzi, Laboratorio di Biotecnologie Applicate all’Ortopedia, Via Cristina Belgioioso 173, 20157 Milano, Italy
| | - Paola De Luca
- IRCCS Istituto Ortopedico Galeazzi, Laboratorio di Biotecnologie Applicate all’Ortopedia, Via Cristina Belgioioso 173, 20157 Milano, Italy
| | - Simona Landoni
- IRCCS Istituto Ortopedico Galeazzi, Laboratorio di Biotecnologie Applicate all’Ortopedia, Via Cristina Belgioioso 173, 20157 Milano, Italy
| | - Federico Valli
- IRCCS Istituto Ortopedico Galeazzi, Chirurgia Articolare Sostitutiva e Chirurgia Ortopedica (C.A.S.C.O.), Via Cristina Belgioioso 173, 20157 Milano, Italy
| | - Leonardo Mortati
- Istituto Nazionale di Ricerca Metrologica (INRIM), Str. delle Cacce 91, 10135 Torino, Italy
| | - Silvia Palombella
- IRCCS Istituto Ortopedico Galeazzi, Cell and Tissue Engineering Laboratory, Via C. Belgioioso 173, 20157, Milano, Italy
| | - Giuseppe Talò
- IRCCS Istituto Ortopedico Galeazzi, Cell and Tissue Engineering Laboratory, Via C. Belgioioso 173, 20157, Milano, Italy
| | - Matteo Moretti
- IRCCS Istituto Ortopedico Galeazzi, Cell and Tissue Engineering Laboratory, Via C. Belgioioso 173, 20157, Milano, Italy
- Regenerative Medicine Technologies Lab, Laboratories for Translational Research, Ente Ospedaliero Cantonale, via Chiesa 5, 6500 Bellinzona, Switzerland
- Service of Orthopaedics and Traumatology, Department of Surgery, Ente Ospedaliero Cantonale, via Tesserete 46, 6900 Lugano, Switzerland
- Euler Institute, Faculty of Biomedical Sciences, Università della Svizzera italiana (USI), via Buffi 13, 6900 Lugano, Switzerland
| | - Laura de Girolamo
- IRCCS Istituto Ortopedico Galeazzi, Laboratorio di Biotecnologie Applicate all’Ortopedia, Via Cristina Belgioioso 173, 20157 Milano, Italy
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Muthu S, Viswanathan VK, Sakthivel M, Thabrez M. Does progress in microfracture techniques necessarily translate into clinical effectiveness? World J Orthop 2024; 15:266-284. [PMID: 38596189 PMCID: PMC10999967 DOI: 10.5312/wjo.v15.i3.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/21/2023] [Accepted: 01/23/2024] [Indexed: 03/15/2024] Open
Abstract
BACKGROUND Multitudinous advancements have been made to the traditional microfracture (MFx) technique, which have involved delivery of various acellular 2nd generation MFx and cellular MFx-III components to the area of cartilage defect. The relative benefits and pitfalls of these diverse modifications of MFx technique are still not widely understood. AIM To comparatively analyze the functional, radiological, and histological outcomes, and complications of various generations of MFx available for the treatment of cartilage defects. METHODS A systematic review was performed using PubMed, EMBASE, Web of Science, Cochrane, and Scopus. Patients of any age and sex with cartilage defects undergoing any form of MFx were considered for analysis. We included only randomized controlled trials (RCTs) reporting functional, radiological, histological outcomes or complications of various generations of MFx for the management of cartilage defects. Network meta-analysis (NMA) was conducted in Stata and Cochrane's Confidence in NMA approach was utilized for appraisal of evidence. RESULTS Forty-four RCTs were included in the analysis with patients of mean age of 39.40 (± 9.46) years. Upon comparing the results of the other generations with MFX-I as a constant comparator, we noted a trend towards better pain control and functional outcome (KOOS, IKDC, and Cincinnati scores) at the end of 1-, 2-, and 5-year time points with MFx-III, although the differences were not statistically significant (P > 0.05). We also noted statistically significant Magnetic resonance observation of cartilage repair tissue score in the higher generations of microfracture (weighted mean difference: 17.44, 95% confidence interval: 0.72, 34.16, P = 0.025; without significant heterogeneity) at 1 year. However, the difference was not maintained at 2 years. There was a trend towards better defect filling on MRI with the second and third generation MFx, although the difference was not statistically significant (P > 0.05). CONCLUSION The higher generations of traditional MFx technique utilizing acellular and cellular components to augment its potential in the management of cartilage defects has shown only marginal improvement in the clinical and radiological outcomes.
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Affiliation(s)
- Sathish Muthu
- Department of Orthopaedics, Orthopaedic Research Group, Coimbatore 641045, Tamil Nadu, India
- Department of Biotechnology, Karpagam Academy of Higher Education, Coimbatore 641021, Tamil Nadu, India
- Department of Orthopaedics, Government Medical College, Karur 639004, Tamil Nadu, India
| | | | - Manoharan Sakthivel
- Department of Orthopaedics, Government Medical College, Karur 639004, Tamil Nadu, India
| | - Mohammed Thabrez
- Department of Medical Oncology, Aster Medcity Hospital, Kochi 682034, India
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Chen Z, Zhang S, Duan P, Yin Z, Dong S, Pang R, Tan H. Intra-articular injection of ascorbic acid enhances microfracture-mediated cartilage repair. Sci Rep 2024; 14:3811. [PMID: 38361039 PMCID: PMC10869716 DOI: 10.1038/s41598-024-54514-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/13/2024] [Indexed: 02/17/2024] Open
Abstract
Previous studies have confirmed that ascorbic acid (AA) can promote cartilage repair and improve cartilage differentiation in bone marrow mesenchymal stem cells. However, the use of microfracture (MFX) combined with AA to repair cartilage damage has not been studied. This study established a rabbit animal model and treated cartilage injury with different concentrations of AA combined with MFX. Macroscopic observations, histological analysis, immunohistochemical analysis and reverse transcription quantitative polymerase chain reaction analysis of TGF-β, AKT/Nrf2, and VEGF mRNA expression were performed. The results showed that intra-articular injection of AA had a positive effect on cartilage repair mediated by microfractures. Moreover, 10 mg/ml AA was the most effective at promoting cartilage repair mediated by microfractures. Intra-articular injection of AA promoted the synthesis of type II collagen and the formation of glycosaminoglycans by downregulating the mRNA expression of TGF-β and VEGF. In summary, this study confirmed that AA could promote cartilage repair after MFX surgery.
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Affiliation(s)
- Zhian Chen
- Graduate School, Kunming Medical University, Kunming City, Yunnan Province, China
| | - Sihe Zhang
- Department of Cell Biology, School of Medicine, Nankai University, Tianjin, China
| | - Peiya Duan
- Neurology Department, Longling County People's Hospital, Baoshan City, Yunnan Province, China
| | - Zhengbo Yin
- Graduate School, Kunming Medical University, Kunming City, Yunnan Province, China
| | - Shuangbin Dong
- Graduate School, Kunming Medical University, Kunming City, Yunnan Province, China
| | - Rongqing Pang
- Basic Medical Laboratory, People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming City, Yunnan Province, China.
| | - Hongbo Tan
- Department of Orthopaedics, People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming City, Yunnan Province, China.
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Koshy J, Sangeetha D. Recent progress and treatment strategy of pectin polysaccharide based tissue engineering scaffolds in cancer therapy, wound healing and cartilage regeneration. Int J Biol Macromol 2024; 257:128594. [PMID: 38056744 DOI: 10.1016/j.ijbiomac.2023.128594] [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: 08/15/2023] [Revised: 11/12/2023] [Accepted: 12/02/2023] [Indexed: 12/08/2023]
Abstract
Natural polymers and its mixtures in the form of films, sponges and hydrogels are playing a major role in tissue engineering and regenerative medicine. Hydrogels have been extensively investigated as standalone materials for drug delivery purposes as they enable effective encapsulation and sustained release of drugs. Biopolymers are widely utilised in the fabrication of hydrogels due to their safety, biocompatibility, low toxicity, and regulated breakdown by human enzymes. Among all the biopolymers, polysaccharide-based polymer is well suited to overcome the limitations of traditional wound dressing materials. Pectin is a polysaccharide which can be extracted from different plant sources and is used in various pharmaceutical and biomedical applications including cartilage regeneration. Pectin itself cannot be employed as scaffolds for tissue engineering since it decomposes quickly. This article discusses recent research and developments on pectin polysaccharide, including its types, origins, applications, and potential demands for use in AI-mediated scaffolds. It also covers the materials-design process, strategy for implementation to material selection and fabrication methods for evaluation. Finally, we discuss unmet requirements and current obstacles in the development of optimal materials for wound healing and bone-tissue regeneration, as well as emerging strategies in the field.
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Affiliation(s)
- Jijo Koshy
- Department of Chemistry, School of Advanced Sciences, Vellore Institute of Technology, Vellore 632014, Tamil Nadu, India
| | - D Sangeetha
- Department of Chemistry, School of Advanced Sciences, Vellore Institute of Technology, Vellore 632014, Tamil Nadu, India.
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Taufik S A, Dirja BT, Utomo DN, Usman MA, Sakti M, Saleh MR, Hatta M, Budu. Double membrane platelet-rich fibrin (PRF) - Synovium succeeds in regenerating cartilage defect at the knee: An experimental study on rabbit. Heliyon 2023; 9:e13139. [PMID: 36747521 PMCID: PMC9898638 DOI: 10.1016/j.heliyon.2023.e13139] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/14/2023] [Accepted: 01/18/2023] [Indexed: 01/23/2023] Open
Abstract
Background This study aims to prove the healing results (regeneration) in cartilage defects using a combination treatment of microfractures and transplantation synovium-platelet rich fibrin (S-PRF). Methods A cartilage defect was made in the trochlear groove of the knee of adult New Zealand white rabbits, and was classified into three treatment groups. The group 1 was cartilage defect without treatment, 2 with microfracture treatment, and 3 with microfracture covered with a synovium-platelet rich fibrin (S-PRF) membrane. Twelve weeks after the intervention, the animals were macroscopically and histologically examined, and evaluated by the International Cartilage Repair Society (ICRS). Additionally, the expression of aggrecan and type 2 collagen was examined by real-time-PCR. Results The ICSR scores for macroscopic were significantly higher in the microfracture and S-PRF transplant group than in the other groups. Also, the ICSR scores for histology were significantly higher in this group. The expression of aggrecan and type 2 collagen was higher in the group that received complete treatment. Conclusions Microfractures and transplantation of synovium-platelet rich fibrin (S-PRF) can regenerate knee cartilage defects which have been shown to increase the expression of mRNA aggrecan and mRNA type 2 collagen resulting in excellent repair.
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Affiliation(s)
- Ahmad Taufik S
- Faculty of Medicine Mataram University, Mataram, Indonesia,Department of Molecular Biology and Immunology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia,Corresponding author. Faculty of Medicine Mataram University, Mataram, Indonesia.
| | | | - Dwikora Novembri Utomo
- Department of Orthopaedic, Faculty of Medicine Airlangga University, Surabaya, Indonesia
| | - Muhammad Andry Usman
- Department of Orthopaedic, Faculty of Medicine Hasanuddin University, Makasar, Indonesia
| | - Muhammad Sakti
- Department of Orthopaedic, Faculty of Medicine Hasanuddin University, Makasar, Indonesia
| | - Muhammad Ruksal Saleh
- Department of Orthopaedic, Faculty of Medicine Hasanuddin University, Makasar, Indonesia
| | - Mochammad Hatta
- Department of Molecular Biology and Immunology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Budu
- Department of Opthalmology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
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Zhou Z, Zheng J, Meng X, Wang F. Effects of Electrical Stimulation on Articular Cartilage Regeneration with a Focus on Piezoelectric Biomaterials for Articular Cartilage Tissue Repair and Engineering. Int J Mol Sci 2023; 24:ijms24031836. [PMID: 36768157 PMCID: PMC9915254 DOI: 10.3390/ijms24031836] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
There is increasing evidence that chondrocytes within articular cartilage are affected by endogenous force-related electrical potentials. Furthermore, electrical stimulation (ES) promotes the proliferation of chondrocytes and the synthesis of extracellular matrix (ECM) molecules, which accelerate the healing of cartilage defects. These findings suggest the potential application of ES in cartilage repair. In this review, we summarize the pathogenesis of articular cartilage injuries and the current clinical strategies for the treatment of articular cartilage injuries. We then focus on the application of ES in the repair of articular cartilage in vivo. The ES-induced chondrogenic differentiation of mesenchymal stem cells (MSCs) and its potential regulatory mechanism are discussed in detail. In addition, we discuss the potential of applying piezoelectric materials in the process of constructing engineering articular cartilage, highlighting the important advances in the unique field of tissue engineering.
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Affiliation(s)
- Zhengjie Zhou
- The Key Laboratory of Pathobiology Ministry of Education, College of Basic Medical Sciences, Jilin University, Changchun 130021, China
| | - Jingtong Zheng
- The Key Laboratory of Pathobiology Ministry of Education, College of Basic Medical Sciences, Jilin University, Changchun 130021, China
| | - Xiaoting Meng
- Department of Histology & Embryology, College of Basic Medical Sciences, Jilin University, Changchun 130021, China
- Correspondence: (X.M.); (F.W.); Tel.: +86-0431-8561-9486 (X.M. & F.W.)
| | - Fang Wang
- The Key Laboratory of Pathobiology Ministry of Education, College of Basic Medical Sciences, Jilin University, Changchun 130021, China
- Correspondence: (X.M.); (F.W.); Tel.: +86-0431-8561-9486 (X.M. & F.W.)
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9
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Augmented Marrow Stimulation: Drilling Techniques and Scaffold Options. OPER TECHN SPORT MED 2022. [DOI: 10.1016/j.otsm.2022.150958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Injectable immunomodulation-based porous chitosan microspheres/HPCH hydrogel composites as a controlled drug delivery system for osteochondral regeneration. Biomaterials 2022; 285:121530. [DOI: 10.1016/j.biomaterials.2022.121530] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/23/2022] [Accepted: 04/14/2022] [Indexed: 12/16/2022]
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Yip CCH, Yip DKH. Patellar Microfracture: Internal Stabilization House-on-Stilts Technique to Achieve Better Results. Arthrosc Tech 2022; 11:e531-e536. [PMID: 35493040 PMCID: PMC9051665 DOI: 10.1016/j.eats.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Microfractures are the common first choice for the treatment of osteochondral lesions, because of their high efficacy and low cost and operating time compared with other surgical techniques. Results of microfractures for retropatellar chondral defects are subpar compared with other compartments of the knee, despite the patellofemoral compartment being the second most common compartment for such lesions. One major reason for the inferiority is the mobility of the patella, which is most prominent when the patient's knee is extended, as is the case in this type of surgery. Traditionally, this obstacle was dealt with by applying manual pressure, which is unreliable and prone to technical difficulties, such as skiving of the awl and a narrowed operating view, as well as complications such as fractures. This Technical Note introduces a new technique, which we have named "house-on-stilts," that uses multiple Kirschner wire fixations through the patella and femur to immobilize the patella and is essentially an internal stabilization. This technique aids not only the microfracturing process but also the preceding debridement stage, at no increased cost or operating time.
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Affiliation(s)
- Christopher Chun Hei Yip
- Faculty of Medicine, University of Hong Kong, Hong Kong, China,Address correspondence to Christopher Chun Hei Yip, 701 Central Building, 1 Pedder St, Central, Hong Kong, China.
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Hurley ET, Davey MS, Jamal MS, Manjunath AK, Alaia MJ, Strauss EJ. Return-to-Play and Rehabilitation Protocols following Cartilage Restoration Procedures of the Knee: A Systematic Review. Cartilage 2021; 13:907S-914S. [PMID: 31855062 PMCID: PMC8808781 DOI: 10.1177/1947603519894733] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The purpose of this study is to systematically review the literature and to evaluate the reported rehabilitation protocols, return-to-play guidelines, and subsequent rates of return to play following cartilage restoration procedures in the knee. DESIGN MEDLINE, EMBASE, and the Cochrane Library were searched according to the PRISMA guidelines to find studies on cartilage restoration procedures in the knee, including (1) microfracture (Mfx), (2) osteochondral autograft transfer (AOT), (3) osteochondral allograft implantation (OCA), and (4) autologous chondrocyte implantation (ACI). Studies were included if they reported return-to-play data or rehabilitation protocols. RESULTS Overall, 179 studies fit our inclusion criteria, with 48 on Mfx, 34 on AOT, 54 on OCA, and 51 on ACI. The rate of return to play was reported as high as 88.2% with AOT, and as low as 77.2% following OCA, with rates of return to play at the same/higher level as high as 79.3% with AOT, and as low as 57.3% following ACI. The average reported time of return to play was as low as 4.9 months with AOT, and as high as 11.6 months following ACI. CONCLUSIONS The majority of patients are able to return to play following cartilage restoration procedures in the knee, regardless of surgical procedure utilized. However, while the rate of return to play at the same level was similar to the overall rate of return following AOT, there was a large number of patients unable to return to the same level following Mfx, OCA, and ACI. Additionally, there is wide variety in the rehabilitation protocols, and scant literature on return-to-play protocols.
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Affiliation(s)
- Eoghan T. Hurley
- Department of Orthopaedic Surgery, New
York University Langone Health, New York, NY, USA
| | - Martin S. Davey
- Department of Orthopaedic Surgery, New
York University Langone Health, New York, NY, USA
| | - M. Shazil Jamal
- Department of Orthopaedic Surgery, New
York University Langone Health, New York, NY, USA
| | - Amit K. Manjunath
- Department of Orthopaedic Surgery, New
York University Langone Health, New York, NY, USA
| | - Michael J. Alaia
- Department of Orthopaedic Surgery, New
York University Langone Health, New York, NY, USA
| | - Eric J. Strauss
- Department of Orthopaedic Surgery, New
York University Langone Health, New York, NY, USA,Eric J. Strauss, Department of Orthopaedic
Surgery, New York University Langone Health, New York, NY, USA.
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13
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Logan CA, Gao X, Utsunomiya H, Scibetta AC, Talwar M, Ravuri SK, Ruzbarsky JJ, Arner JW, Zhu D, Lowe WR, Philippon MJ, Huard J. The Beneficial Effect of an Intra-articular Injection of Losartan on Microfracture-Mediated Cartilage Repair Is Dose Dependent. Am J Sports Med 2021; 49:2509-2521. [PMID: 34259597 DOI: 10.1177/03635465211008655] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A previous publication demonstrated that the oral intake of losartan promoted microfracture-mediated hyaline-like cartilage repair in osteochondral defects of a rabbit knee model. However, an intra-articular (IA) injection of losartan may have direct beneficial effects on cartilage repair and has not been studied. PURPOSE To determine the dosage and beneficial effects of an IA injection of losartan on microfracture-mediated cartilage repair and normal cartilage homeostasis. STUDY DESIGN Controlled laboratory study. METHODS Rabbits were divided into 5 groups (n = 6 each): a microfracture group (MFX group) and 4 different losartan treatment groups that received varying doses of IA losartan (0.1, 1, 10, and 100 mg per knee). An osteochondral defect (5 mm) was created in the trochlear groove cartilage of 1 limb in each rabbit, and 5 microfracture perforations were made in the osteochondral defect. Both the injured and the contralateral knee joints were injected with IA losartan immediately after microfracture and at 2 and 4 weeks after surgery. Rabbits were sacrificed at 6 weeks after surgery for analysis including gross observation, micro-computed tomography, histology, and reverse transcription quantitative polymerase chain reaction. RESULTS Micro-computed tomography and gross observation demonstrated comparable subchondral bone healing and hyaline-like cartilage morphology in the 0.1-, 1-, and 10-mg losartan groups relative to the MFX group. Conversely, the 100-mg losartan group showed neither bony defect healing nor cartilage repair. Histology revealed higher O'Driscoll scores and hyaline-like cartilage regeneration in the 1-mg losartan group compared with the MFX group. In contrast, the 100-mg losartan group showed the lowest histology score and no cartilage repair. An IA injection of losartan at the doses of 0.1, 1, and 10 mg did not cause adverse effects on uninjured cartilage, while the 100-mg dose induced cartilage damage. Quantitative polymerase chain reaction results showed downregulation of the transforming growth factor β (TGF-β) signaling pathway after IA losartan injection. CONCLUSION An IA injection of losartan at the dose of 1 mg was most effective for the enhancement of microfracture-mediated cartilage repair without adversely affecting uninjured cartilage. Conversely, a high dose (100 mg) IA injection of losartan inhibited cartilage repair in the osteochondral defect and was chondrotoxic to normal articular cartilage. CLINICAL RELEVANCE An IA injection of losartan at an optimal dosage represents a novel microfracture enhancement therapy and warrants a clinical trial for future clinical applications.
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Affiliation(s)
- Catherine A Logan
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Xueqin Gao
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA.,Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Hajime Utsunomiya
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Alex C Scibetta
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Mika Talwar
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Sudheer K Ravuri
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Joseph J Ruzbarsky
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Justin W Arner
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Dandan Zhu
- Department of Integrative Biology and Pharmacology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Walter R Lowe
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Marc J Philippon
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Johnny Huard
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA.,Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
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14
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Walther M, Valderrabano V, Wiewiorski M, Usuelli FG, Richter M, Baumfeld TS, Kubosch J, Gottschalk O, Wittmann U. Is there clinical evidence to support autologous matrix-induced chondrogenesis (AMIC) for chondral defects in the talus? A systematic review and meta-analysis. Foot Ankle Surg 2021; 27:236-245. [PMID: 32811744 DOI: 10.1016/j.fas.2020.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/10/2020] [Accepted: 07/29/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study is to systematically review the literature on clinical outcomes of patients who have undergone autologous matrix-induced chondrogenesis (AMIC) for treatment of osteochondral lesions of the talus (OCL) and compare the studies' outcomes. METHODS Pubmed and Embase were searched in January 2020 for articles concerning OCL surgery. Studies were included if they had a minimum 1-year follow-up and the primary measures were functional outcomes. The meta-analysis compared the Visual Analogic Score (VAS), the American Orthopedic Foot and Ankle Score (AOFAS), and the Foot Function Index (FFI) between baseline and follow-up of 1-2years, and 3-5years. A random effects model was used to evaluate outcome changes. RESULTS The search returned 15 studies, with a total of 492 patients. The VAS improved 4.45 and 4.6 points from baseline to the 1-2year and 3-5yearfollow-up, respectively (p<0.001). AOFAS improved 31.59 and 32.47 points from baseline to the 1-2year and 3-5yearfollow-up, respectively (p<0.001). The FFI showed a significant improvement of 30.93 points from baseline to year 3-5 (p<0.001). A total of 6 patients with revision surgeries have been reported within the follow up period. It was not possible to correlate clinical features like lesion size, surgical approach, and bone marrow stimulation technique to the reported outcome. CONCLUSION Surgical treatment of OCL via the AMIC procedure provided significant improvement in the functional outcome and pain scores when compared to the pre-operative values. Improvements were observed up to 5years post-operatively.
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Affiliation(s)
- Markus Walther
- Schön Klinik München Harlaching - FIFA Medical Centre, Harlachinger Straße 51, 81547 München, Germany.
| | - Victor Valderrabano
- Swiss Ortho Center Schmerzklinik Basel, Swiss Medical Network, Hirschgässlein 15, 4010 Basel, Switzerland.
| | - Martin Wiewiorski
- Kantonspital Winterthur, Zeughausstrasse 73, 8400 Winterthur, Switzerland.
| | - Federico Giuseppe Usuelli
- Istituto Ortopedico Galeazzi, USPeC - Unità Specialistica Piede e Caviglia, Foot and Ankle Department, Italy.
| | - Martinus Richter
- Klinik for Foot and Ankle Surgery, Rummelsberg 71, 90592 Schwarzenbruck, Germany.
| | - Tiago Soares Baumfeld
- Hospital Felicio Rocho, Department of Orthopaedics, Av. do Contorno, 9530 Belo Horizonte, MG, Brazil.
| | - Johanna Kubosch
- Department of Orthopedics and Trauma Surgery, Medical Center, Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany.
| | - Oliver Gottschalk
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU, Munich, Germany; Schön Klinik München Harlaching - FIFA Medical Centre, Harlachinger Straße 51, 81547 München, Germany.
| | - Udo Wittmann
- Consult AG, Tramstrasse 10, 8050 Zürich, Switzerland.
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15
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Dávila Castrodad IM, Simone ES, Kurowicki J, Melendez JX, Mease SJ, McInerney VK, Scillia AJ. Improved Short-Term Outcomes of Osteochondral Lesions of the Knee Following Arthroscopic Treatment With Bone Marrow Aspirate Concentrate and Cartilage-Derived Matrix. Arthrosc Sports Med Rehabil 2021; 3:e477-e484. [PMID: 34027458 PMCID: PMC8129480 DOI: 10.1016/j.asmr.2020.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 11/03/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose To assess the postoperative objective, subjective, and functional outcomes as well as complication rates in osteochondral defect patients treated with bone marrow aspirate concentrate (BMAC) and cartilage-derived matrix (CDM) during knee arthroscopy. Methods A retrospective chart review was performed for patients treated arthroscopically with BMAC and CDM between August 2015 and August 2018 and had more than 1-year follow-up. Demographic factors such as age, sex, body mass index, and comorbidities were collected for all patients. Size and location of the osteochondral lesions also were documented. Results A total of 14 patients were identified with a mean follow-up of 19 months. On average, patients were 34 years of age (range 16-58 years) and 43% were female. Postoperatively, knee flexion increased by 8° from 124° to 132° (P = .002). All patients regained full extension; however, 1 patient later acquired a 2° extension contracture after a traumatic event. The average hamstring strength significantly increased from 4.1 to 4.6 postoperatively (P = .33). The average quadriceps strength significantly increased from 4.0 to 4.5 postoperatively (P = .007). Mean visual analog scale scores significantly decreased postoperatively (4.5 vs 1.4; P = .001). There was a significant increase in Knee Outcome Survey Activities of Daily Living scores (53.8 vs 92.9; P = .007). Mean Knee Outcome Survey-Sports scores also increased, although this was nonsignificant (28.2 vs 79.5; P = .560). No significant differences were noted in pain and functional outcomes when stratified by the osteochondral defect size and location. Complications included a stitch abscess, Baker's cyst, and residual pain treated with hyaluronic acid injection. Conclusions This study demonstrated arthroscopic BMAC and CDM implantation appears to be safe and has the potential to improve patient outcomes in the short-term postoperative period. Level of Evidence IV, therapeutic case series.
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Affiliation(s)
- Iciar M Dávila Castrodad
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, U.S.A.,New Jersey Orthopaedic Institute, Wayne, New Jersey, U.S.A
| | - Erica S Simone
- New Jersey Orthopaedic Institute, Wayne, New Jersey, U.S.A
| | - Jennifer Kurowicki
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, U.S.A
| | | | - Samuel J Mease
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, U.S.A
| | - Vincent K McInerney
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, U.S.A.,New Jersey Orthopaedic Institute, Wayne, New Jersey, U.S.A.,Department of Orthopaedic Surgery, Hackensack Meridian School of Medicine at Seton Hall University, Nutley, New Jersey, U.S.A
| | - Anthony J Scillia
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, U.S.A.,New Jersey Orthopaedic Institute, Wayne, New Jersey, U.S.A.,Department of Orthopaedic Surgery, Hackensack Meridian School of Medicine at Seton Hall University, Nutley, New Jersey, U.S.A
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16
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Autologous Chondrocyte Implantation as a Two Stage Approach (MACI). OPER TECHN SPORT MED 2020. [DOI: 10.1016/j.otsm.2020.150783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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17
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Dávila Castrodad IM, Mease SJ, Werheim E, McInerney VK, Scillia AJ. Arthroscopic Chondral Defect Repair With Extracellular Matrix Scaffold and Bone Marrow Aspirate Concentrate. Arthrosc Tech 2020; 9:e1241-e1247. [PMID: 33024662 PMCID: PMC7528213 DOI: 10.1016/j.eats.2020.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/08/2020] [Indexed: 02/03/2023] Open
Abstract
Chondral defects of the knee are prevalent and often encountered during arthroscopic procedures. Despite the limited healing potential of chondral defects, several treatment options have been proposed. However, microfracture, osteochondral autograft (or allograft) transfer, autologous chondrocyte implantation, and matrix-induced autologous chondrocyte implantation are all associated with their respective shortcomings. As such, the optimal treatment for chondral defects of the knee remains unclear. Recently, many authors have advocated treating chondral defects with biological therapies and scaffold-based treatments. Bone marrow aspirate concentrate, a cell-based injection, has gained particular attention because of its differentiation capacity and potential role in tissue regeneration. In addition, scaffold cartilage treatments have emerged and reached clinical practice. BioCartilage is one form of scaffold, which consists of extracellular matrix, and has been claimed to promote the regeneration of hyaline-like cartilage. This article presents our technique of arthroscopic chondral defect repair using BMAC and BioCartilage.
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Affiliation(s)
- Iciar M. Dávila Castrodad
- Department of Orthopaedic Surgery, St Joseph’s University Medical Center, Paterson, New Jersey, U.S.A.,New Jersey Orthopaedic Institute, Wayne, New Jersey, U.S.A
| | - Samuel J. Mease
- Department of Orthopaedic Surgery, St Joseph’s University Medical Center, Paterson, New Jersey, U.S.A
| | - Erik Werheim
- New Jersey Orthopaedic Institute, Wayne, New Jersey, U.S.A
| | - Vincent K. McInerney
- Department of Orthopaedic Surgery, St Joseph’s University Medical Center, Paterson, New Jersey, U.S.A.,New Jersey Orthopaedic Institute, Wayne, New Jersey, U.S.A.,Department of Orthopaedic Surgery, Hackensack Meridian School of Medicine at Seton Hall University, Nutley, New Jersey, U.S.A
| | - Anthony J. Scillia
- Department of Orthopaedic Surgery, St Joseph’s University Medical Center, Paterson, New Jersey, U.S.A.,New Jersey Orthopaedic Institute, Wayne, New Jersey, U.S.A.,Department of Orthopaedic Surgery, Hackensack Meridian School of Medicine at Seton Hall University, Nutley, New Jersey, U.S.A.,Address correspondence to Anthony J. Scillia, M.D., St Joseph’s University Medical Center, 703 Main St, Paterson, NJ 07503, U.S.A.
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18
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Kim SJ, Shetty AA, Kurian NM, Ahmed S, Shetty N, Stelzeneder D, Shin YW, Cho YJ, Lee SH. Articular cartilage repair using autologous collagen-induced chondrogenesis (ACIC): a pragmatic and cost-effective enhancement of a traditional technique. Knee Surg Sports Traumatol Arthrosc 2020; 28:2598-2603. [PMID: 32064573 DOI: 10.1007/s00167-020-05884-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 01/23/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The autologous collagen-induced chondrogenesis technique is described, and the results of a 6-year follow-up clinical study using this technique are presented. METHODS 30 patients with International Cartilage Repair Society (ICRS) Grade III/IVa symptomatic chondral defects of the knee treated with enhanced microdrilling using atelocollagen were prospectively examined in this clinical series. The median age of the patients was 39.0 years (range 19-61 years). Patients were followed up to 72 months. Clinical evaluation was performed using functional knee scores and radiologically. Both quantitative and qualitative assessments were performed. RESULTS Statistically significant and clinically relevant improvement was observed in 2 years and was sustained for the 6 years of the study observation. At 6 years, the mean Lysholm score was 79.7 (SD 6.8) compared to 52.6 (SD 10.7) pre-operatively (p < 0.05). The symptomatic Knee Injury and Osteoarthritis Outcome Score (KOOS) improved from 68.3 (SD 11.4) to 90.2 (SD 4.3) (p < 0.05). The subjective International Knee Documentation Committee (IKDC) also showed improvement from 39.1 (SD 4.1) to 81.6 (SD 7.8) (p < 0.05). The calculated T2* relaxation times were 26.0 (SD 4.2) seconds and 30.3 (SD 6.2) seconds for the repair tissue and native cartilage, respectively. The average magnetic resonance observation of cartilage repair tissue (MOCART) score was 78.5 (SD 9.6) for all lesions. CONCLUSION The enhanced microdrilling using atelocollagen is an enhancement of the traditional microfracture method using an off-the-shelf product. When used to treat moderate to severe chondral lesions, this enhancement produces hyaline-like cartilage with a corresponding improvement in symptoms. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Seok Jung Kim
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Asode Ananthram Shetty
- Institute of Medical Sciences, Faculty of Health and Social Sciences, Canterbury Christ Church University, 30 Pembroke Court, Chatham Maritime, ME4 4UF, Kent, UK. .,Kent Knee Unit, Spire Alexandra Hospital, Chatham, Kent, UK.
| | - Nibu M Kurian
- Institute of Medical Sciences, Faculty of Health and Social Sciences, Canterbury Christ Church University, 30 Pembroke Court, Chatham Maritime, ME4 4UF, Kent, UK.,Kent Knee Unit, Spire Alexandra Hospital, Chatham, Kent, UK
| | - Saif Ahmed
- Institute of Medical Sciences, Faculty of Health and Social Sciences, Canterbury Christ Church University, 30 Pembroke Court, Chatham Maritime, ME4 4UF, Kent, UK.,Kent Knee Unit, Spire Alexandra Hospital, Chatham, Kent, UK
| | - Neha Shetty
- Institute of Medical Sciences, Faculty of Health and Social Sciences, Canterbury Christ Church University, 30 Pembroke Court, Chatham Maritime, ME4 4UF, Kent, UK.,Kent Knee Unit, Spire Alexandra Hospital, Chatham, Kent, UK
| | - David Stelzeneder
- Department of Orthopaedics and Trauma Surgery, Hanush Hospital, Vienna, Austria
| | - Yong-Woon Shin
- Department of Orthopaedic Surgery, College of Medicine, The Inje University of Korea, Seoul, Republic of Korea
| | - Yoon Joo Cho
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Heon Lee
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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García-Fernández L, Olmeda-Lozano M, Benito-Garzón L, Pérez-Caballer A, San Román J, Vázquez-Lasa B. Injectable hydrogel-based drug delivery system for cartilage regeneration. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 110:110702. [DOI: 10.1016/j.msec.2020.110702] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/18/2019] [Accepted: 01/27/2020] [Indexed: 01/12/2023]
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20
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Boffa A, Previtali D, Altamura SA, Zaffagnini S, Candrian C, Filardo G. Platelet-Rich Plasma Augmentation to Microfracture Provides a Limited Benefit for the Treatment of Cartilage Lesions: A Meta-analysis. Orthop J Sports Med 2020; 8:2325967120910504. [PMID: 32341925 PMCID: PMC7175068 DOI: 10.1177/2325967120910504] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 02/01/2020] [Indexed: 01/06/2023] Open
Abstract
Background: Microfracture is the most common first-line option for the treatment of small chondral lesions, although increasing evidence shows that the clinical benefit of microfracture decreases over time. Platelet-rich plasma (PRP) has been suggested as an effective biological augmentation to improve clinical outcomes after microfracture. Purpose: To evaluate the clinical evidence regarding the application of PRP, documenting safety and efficacy of this augmentation technique to improve microfracture for the treatment of cartilage lesions. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review was performed in PubMed, EBSCOhost database, and the Cochrane Library to identify comparative studies evaluating the clinical efficacy of PRP augmentation to microfracture. A meta-analysis was performed on articles that reported results for visual analog scale (VAS) for pain, International Knee Documentation Committee (IKDC), and American Orthopaedic Foot and Ankle Society (AOFAS) scores. Risk of bias was documented through use of the Cochrane Collaboration Risk of Bias 2.0 and Risk of Bias in Non-randomized Studies of Interventions assessment tools. The quality assessment was performed according to the Grading of Recommendations Assessment, Development and Evaluation guidelines. Results: A total of 7 studies met the inclusion criteria and were included in the meta-analysis: 4 randomized controlled trials, 2 prospective comparative studies, and 1 retrospective comparative study, for a total of 234 patients. Of the 7 studies included, 4 studies evaluated the effects of PRP treatment in the knee, and 3 studies evaluated effects in the ankle. The analysis of all scores showed a difference favoring PRP treatment in knees (VAS, P = .002 and P < .001 at 12 and 24 months, respectively; IKDC, P < .001 at both follow-up points) and ankles (both VAS and AOFAS, P < .001 at 12 months). The improvement offered by PRP did not reach the minimal clinically important difference (MCID). Conclusion: PRP provided an improvement to microfracture in knees and ankles at short-term follow-up. However, this improvement did not reach the MCID, and thus it was not clinically perceivable by the patients. Moreover, the overall low evidence and the paucity of high-level studies indicate further research is needed to confirm the potential of PRP augmentation to microfracture for the treatment of cartilage lesions.
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Affiliation(s)
- Angelo Boffa
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide Previtali
- Orthopaedic and Traumatology Unit, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland
| | | | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Stefano Zaffagnini, MD, Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy ()
| | - Christian Candrian
- Orthopaedic and Traumatology Unit, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland
| | - Giuseppe Filardo
- Orthopaedic and Traumatology Unit, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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21
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Zamborsky R, Danisovic L. Surgical Techniques for Knee Cartilage Repair: An Updated Large-Scale Systematic Review and Network Meta-analysis of Randomized Controlled Trials. Arthroscopy 2020; 36:845-858. [PMID: 32139062 DOI: 10.1016/j.arthro.2019.11.096] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/28/2019] [Accepted: 11/04/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to investigate the most appropriate surgical interventions for patients with knee articular cartilage defects from the level I randomized clinical trials. METHODS We searched five databases for level I randomized clinical trials. Treatments were compared if reported in more than one study using network meta-analysis to boost the number of included studies per comparison. RESULTS We studied 21 articles that included 891 patients. Traumatic lesion was the most common cause in the included patients. There were significantly higher failure rates in the microfracture (MF) group compared to autologous chondrocyte implantation (ACI) group at 10-year follow-up. Moreover, osteochondral autograft transplantation (OAT) showed significantly more excellent or good results at > 3-year follow-up compared to MF, whereas MF showed significantly more poor results versus ACI and matrix-induced autologous chondrocyte implantation (MACI). Furthermore, OAT showed significantly more poor results than MACI at 1-year follow-up. Similarly, patients who underwent OAT had higher return-to-activity rates than those with MF. It is noteworthy that the Knee injury and Osteoarthritis Outcome Score was higher in patients who underwent characterized chondrocyte implantation or MACI compared to MF. Finally, there were no significant differences among the various interventions regarding reintervention, biopsy types or adverse events. According to the P scores for interventions ranking, there was a disagreement concerning the best intervention; however, MF was always ranked as the last. CONCLUSIONS Cartilage repair techniques, rather than MF, provide higher quality repair of tissue and have lower failure and higher return-to-activity rates. Moreover, OAT had significantly more excellent or good results compared to MF, whereas MF had significantly more poor results than ACI and MACI. Future studies need to have longer follow-up periods and more representative populations to investigate the efficacy and safety of these interventions. LEVEL OF EVIDENCE Level I: meta-analysis of Level I studies.
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Affiliation(s)
- Radoslav Zamborsky
- Department of Orthopaedics, Comenius University Bratislava and the National Institute of Children's Diseases, Bratislava, Slovakia; Expert Medical Services s.r.o, Bratislava, Slovakia.
| | - Lubos Danisovic
- Institute of Medical Biology, Genetics and Clinical Genetics, Comenius University, Bratislava, Slovakia
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22
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Song SJ, Park CH. Microfracture for cartilage repair in the knee: current concepts and limitations of systematic reviews. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S108. [PMID: 31576315 DOI: 10.21037/atm.2019.05.11] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Sang Jun Song
- Department of Orthopaedic Surgery, College of Medicine, Graduate School, Kyung Hee University, Seoul, Korea
| | - Cheol Hee Park
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea
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Abstract
Hyaline articular cartilage is critical for the normal functioning of the knee joint. Untreated focal cartilage defects have the potential to rapidly progress to diffuse osteoarthritis. Over the last several decades, a variety of interventions aiming at preserving articular cartilage and preventing osteoarthritis have been investigated. Reparative cartilage procedures, such as microfracture, penetrate the subchondral bone plate in effort to fill focal cartilage defects with marrow elements and stimulate fibrocartilaginous repair. In contrast, restorative cartilage procedures aim to replace the defective articular surface with autologous or allogeneic hyaline cartilage. This review focuses on the preservation of articular cartilage, and discusses the current reparative and restorative surgical techniques available for treating focal cartilage defects.
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Mesenchymal Stem/Progenitor Cells Derived from Articular Cartilage, Synovial Membrane and Synovial Fluid for Cartilage Regeneration: Current Status and Future Perspectives. Stem Cell Rev Rep 2018; 13:575-586. [PMID: 28721683 DOI: 10.1007/s12015-017-9753-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Large articular cartilage defects remain an immense challenge in the field of regenerative medicine because of their poor intrinsic repair capacity. Currently, the available medical interventions can relieve clinical symptoms to some extent, but fail to repair the cartilaginous injuries with authentic hyaline cartilage. There has been a surge of interest in developing cell-based therapies, focused particularly on the use of mesenchymal stem/progenitor cells with or without scaffolds. Mesenchymal stem/progenitor cells are promising graft cells for tissue regeneration, but the most suitable source of cells for cartilage repair remains controversial. The tissue origin of mesenchymal stem/progenitor cells notably influences the biological properties and therapeutic potential. It is well known that mesenchymal stem/progenitor cells derived from synovial joint tissues exhibit superior chondrogenic ability compared with those derived from non-joint tissues; thus, these cell populations are considered ideal sources for cartilage regeneration. In addition to the progress in research and promising preclinical results, many important research questions must be answered before widespread success in cartilage regeneration is achieved. This review outlines the biology of stem/progenitor cells derived from the articular cartilage, the synovial membrane, and the synovial fluid, including their tissue distribution, function and biological characteristics. Furthermore, preclinical and clinical trials focusing on their applications for cartilage regeneration are summarized, and future research perspectives are discussed.
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van der Bruggen W, Hirschmann MT, Strobel K, Kampen WU, Kuwert T, Gnanasegaran G, Van den Wyngaert T, Paycha F. SPECT/CT in the Postoperative Painful Knee. Semin Nucl Med 2018; 48:439-453. [PMID: 30193650 DOI: 10.1053/j.semnuclmed.2018.05.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This review summarizes the role of SPECT/CT in patients with a painful postoperative knee and describes typical diagnostic criteria in these patients. Pain after knee surgery is common and is influenced by the underlying pathology, the type of surgery, and the patient. Knee joint-preserving surgery includes osteotomy, ligament reconstruction, meniscus surgery, and cartilage repair procedures, often used in combination. Knee arthroplasty procedures consist of unicondylar, patellofemoral, and primary or revision total knee prosthesis. In patients with pain after knee joint-preserving surgery, MRI remains the reference standard. After ligament reconstruction, CT can evaluate postoperative tunnel positioning, and bone SPECT/CT can contribute by assessing overloading or biodegradation problems. After meniscal or cartilage surgery, SPECT/CT can be particularly helpful to identify compartment overloading or nonhealing chondral or osteochondral lesions as cause of pain. SPECT/CT arthrography can assess cartilage damage at an early stage due to altered biomechanical forces. After corrective osteotomy of the knee, SPECT/CT can reveal complications such as overloading, nonunion, or patellofemoral problems. After arthroplasty, conventional radiographs lack both sensitivity to detect aseptic loosening and specificity in differentiating aseptic from infectious loosening. Secondly, hardware-induced artifacts still hamper CT and MRI, despite improving and increasingly available metal artifact reduction techniques. Bone scintigraphy is a proven useful adjunct to conventional radiography and MRI to reveal the pain generator and is less hampered by artifacts from metallic implants compared with CT and MRI. Nevertheless, the optimal imaging strategy in evaluating complications after knee arthroplasty is still a matter of debate. Although the evidence of the use of BS SPECT/CT is still limited, it is growing steadily. In particular, recent data on specific uptake patterns in tibial and femoral zones after total knee arthroplasty and the impact of integrating biomechanics into the assessment of SPECT/CT appear promising, but more research is needed.
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Affiliation(s)
- Wouter van der Bruggen
- Department of Radiology and Nuclear Medicine, Slingeland Hospital, Doetinchem, The Netherlands..
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, Switzerland
| | - Klaus Strobel
- Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | | | - Torsten Kuwert
- Clinic of Nuclear Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Gopinath Gnanasegaran
- Department of Nuclear Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Tim Van den Wyngaert
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Frédéric Paycha
- Department of Nuclear Medicine, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
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Arshi A, Fabricant PD, Go DE, Williams RJ, McAllister DR, Jones KJ. Can Biologic Augmentation Improve Clinical Outcomes Following Microfracture for Symptomatic Cartilage Defects of the Knee? A Systematic Review. Cartilage 2018; 9:146-155. [PMID: 29241343 PMCID: PMC5871129 DOI: 10.1177/1947603517746722] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective To perform a systematic review of clinical outcomes following microfracture augmented with biological adjuvants (MFX+) compared with microfracture (MFX) alone. Design The MEDLINE, Scopus, and Cochrane databases were searched for clinical studies on MFX+ for chondral defects of the knee. Study characteristics and clinical outcome score data were collected. Subjective synthesis was performed using data from randomized controlled studies to determine effect size of MFX+ procedures performed with either injectable or scaffold-based augmentation compared with MFX alone. Results A total of 18 articles reporting on 625 patients (491 MFX+, 134 MFX) were identified. Six studies were level II evidence and 1 study was level I evidence. Mean patient age range was 26 to 51 years, and mean follow-up ranged from 2 to 5 years. All studies demonstrated significant improvement in reported clinical outcome scores at follow-up after MFX+ therapy, and 87% of patients reported satisfaction with treatment. The most commonly reported treatment complication was postoperative stiffness (3.9% of patients). Subjective synthesis on randomized controlled trials demonstrated that 2/2 injectable MFX+ interventions had significantly greater improvements in International Knee Documentation Committee Subjective Knee Form (IKDC; P = 0.004) and Knee injury and Osteoarthritis Outcome Score (KOOS; P = 0.012) scores compared with MFX alone, while 2/2 trials on scaffolding MFX+ adjuvants showed comparable postoperative improvements. Conclusions MFX+ biological adjuvants are safe supplements to marrow stimulation for treating cartilage defects in the adult knee. Early literature is heterogenous and extremely limited in quality. Individual trials report both equivalent and superior clinical outcomes compared with MFX alone, making definitive conclusions on the efficacy of MFX+ difficult without higher quality evidence.
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Affiliation(s)
- Armin Arshi
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Peter D. Fabricant
- Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Derek E. Go
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Riley J. Williams
- Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA
| | - David R. McAllister
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Kristofer J. Jones
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Kristofer J. Jones, Department of Orthopaedic Surgery, Division of Sports Medicine and Shoulder Surgery, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Avenue, 76-143 CHS, Los Angeles, CA 90095-6902, USA.
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Emerging Concepts in Treating Cartilage, Osteochondral Defects, and Osteoarthritis of the Knee and Ankle. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1059:25-62. [PMID: 29736568 DOI: 10.1007/978-3-319-76735-2_2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The management and treatment of cartilage lesions, osteochondral defects, and osteoarthritis remain a challenge in orthopedics. Moreover, these entities have different behaviors in different joints, such as the knee and the ankle, which have inherent differences in function, biology, and biomechanics. There has been a huge development on the conservative treatment (new technologies including orthobiologics) as well as on the surgical approach. Some surgical development upraises from technical improvements including advanced arthroscopic techniques but also from increased knowledge arriving from basic science research and tissue engineering and regenerative medicine approaches. This work addresses the state of the art concerning basic science comparing the knee and ankle as well as current options for treatment. Furthermore, the most promising research developments promising new options for the future are discussed.
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Sánchez-Téllez DA, Téllez-Jurado L, Rodríguez-Lorenzo LM. Hydrogels for Cartilage Regeneration, from Polysaccharides to Hybrids. Polymers (Basel) 2017; 9:E671. [PMID: 30965974 PMCID: PMC6418920 DOI: 10.3390/polym9120671] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 11/24/2017] [Accepted: 11/29/2017] [Indexed: 12/12/2022] Open
Abstract
The aims of this paper are: (1) to review the current state of the art in the field of cartilage substitution and regeneration; (2) to examine the patented biomaterials being used in preclinical and clinical stages; (3) to explore the potential of polymeric hydrogels for these applications and the reasons that hinder their clinical success. The studies about hydrogels used as potential biomaterials selected for this review are divided into the two major trends in tissue engineering: (1) the use of cell-free biomaterials; and (2) the use of cell seeded biomaterials. Preparation techniques and resulting hydrogel properties are also reviewed. More recent proposals, based on the combination of different polymers and the hybridization process to improve the properties of these materials, are also reviewed. The combination of elements such as scaffolds (cellular solids), matrices (hydrogel-based), growth factors and mechanical stimuli is needed to optimize properties of the required materials in order to facilitate tissue formation, cartilage regeneration and final clinical application. Polymer combinations and hybrids are the most promising materials for this application. Hybrid scaffolds may maximize cell growth and local tissue integration by forming cartilage-like tissue with biomimetic features.
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Affiliation(s)
- Daniela Anahí Sánchez-Téllez
- Instituto Politécnico Nacional-ESIQIE, Depto. Ing. en Metalurgia y Materiales, UPALM-Zacatenco, Mexico City 07738, Mexico.
- Networking Biomedical Research Centre in Bioengineering, Biomaterials and Nanomedicine, Centro de Investigación Biomédica en Red-Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Av. Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain.
| | - Lucía Téllez-Jurado
- Instituto Politécnico Nacional-ESIQIE, Depto. Ing. en Metalurgia y Materiales, UPALM-Zacatenco, Mexico City 07738, Mexico.
| | - Luís María Rodríguez-Lorenzo
- Networking Biomedical Research Centre in Bioengineering, Biomaterials and Nanomedicine, Centro de Investigación Biomédica en Red-Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Av. Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain.
- Department Polymeric Nanomaterials and Biomaterials, ICTP-CSIC, Juan de la Cierva 3, 28006 Madrid, Spain.
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Frank RM, Cotter EJ, Nassar I, Cole B. Failure of Bone Marrow Stimulation Techniques. Sports Med Arthrosc Rev 2017; 25:2-9. [PMID: 28045867 DOI: 10.1097/jsa.0000000000000134] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Marrow stimulation techniques, including microfracture, are among the most commonly performed cartilage restoration procedures for symptomatic chondral defects of the knee. For the vast majority of patients, marrow stimulation results in reduced pain and improved function, providing overall satisfactory outcomes. In some cases, however, marrow stimulation fails, resulting in symptom recurrence and often, the need for repeat surgery. This review will describe the indications and outcomes of microfracture as a primary surgical treatment for focal chondral defects of the knee, identify patient and procedure-specific factors associated with poor clinical outcomes, and will discuss treatment options and their respective outcomes for patients with a failed prior microfracture surgery.
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Affiliation(s)
- Rachel M Frank
- *Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL †El-Hadara University Hospital, Alexandria University, Alexandria, Egypt
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Treatment of medial compartment knee osteoarthritis by arthroscopic 'L' medial release procedure. INTERNATIONAL ORTHOPAEDICS 2017; 41:2025-2035. [PMID: 28600698 DOI: 10.1007/s00264-017-3508-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 05/07/2017] [Indexed: 02/08/2023]
Abstract
PURPOSE To evaluate the clinical outcomes of an arthroscopic 'L' medial release (ALMR) procedure for the treatment of medial compartment knee osteoarthritis (MCKOA). METHODS Between January 2012 and December 2013, 372 patients with MCKOA of Kellgren's radiographic grade I-III were diagnosed. Among them, 252 patients with MCKOA received ALMR performed by a single surgeon. The other 120 patients received supportive treatment and were regarded as the control group. The Knee Society Score (KSS) at baseline and 2 years, and the subjective visual analogue scale (VAS) at baseline and 1st, 2nd, 6th, 12th, and 24th months were used for outcome studies. RESULTS There were 286 patients available for follow-up for more than 2 years and the mean follow-up period was 28 months. There were 202 patients with unilateral MCKOA in the ALMR group and 84 in the control group. The mean subjective VAS showed a statistically significant improvement after 6 months, and then remained relatively stable between the 6th and 24th month. The mean KSS for pain and function improved statistically at 2 years of follow-up. CONCLUSIONS This ALMR appears to be an effective and safe treatment for mild and moderate MCKOA.
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