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Dickerson DA, Fortier LA, Nauman EA, Potter HG, Quinlan C. Novel Osteochondral Biotemplate Improves Long-term Cartilage Repair Compared With Microfracture in an Ovine Model. Am J Sports Med 2023; 51:3288-3303. [PMID: 37602735 DOI: 10.1177/03635465231189808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
BACKGROUND Current cartilage repair therapies do not re-create the complex mechanical interface between cartilage and bone, which is critical for long-term repair durability. New biomaterial designs that include hard tissue-soft tissue interface structures offer promise to improve clinical outcomes. PURPOSE/HYPOTHESIS The purpose of this study was to evaluate the efficacy and safety of a naturally derived osteochondral biotemplate with a novel contiguous hard tissue-soft tissue interface in an ovine model as a regenerative solution for articular cartilage defects. It was hypothesized that the osteochondral biotemplate would produce structurally superior repair tissue compared with microfracture over a 13-month period. STUDY DESIGN Controlled laboratory study. METHODS Osteochondral biotemplates were manufactured from porcine cancellous bone. Skeletally mature sheep (N = 30) were randomly allocated to 3 groups: early healing stage (euthanasia at 4 months), 6-month treatment, and 13-month treatment. In the early healing stage group, an 8 mm-diameter by 5 mm-deep osteochondral defect was created on the medial femoral condyle and treated at the time of iatrogenic injury with an osteochondral biotemplate. The contralateral limb received the same treatment 2 months later. In the 6- and 13-month treatment groups, 1 limb received the same osteochondral procedure as the early healing stage group. In the contralateral limb, an 8 mm-diameter, full-thickness cartilage defect (1-2 mm deep) was created and treated with microfracture. Cartilage repair and integration were quantitatively and qualitatively assessed with gross inspection, histological evaluation, and magnetic resonance imaging (MRI). Wilcoxon signed-rank and McNemar tests were used to compare the treatments. RESULTS At 6 and 13 months after treatment, the biotemplate was not present histologically. At 13 months, the biotemplate treatment demonstrated statistically higher histological scores than microfracture for integration with surrounding cartilage (biotemplate: 74 ± 31; microfracture: 28 ± 39; P = .03), type 2 collagen (biotemplate: 72 ± 33; microfracture: 40 ± 38; P = .02), total cartilage (biotemplate: 71 ± 9; microfracture: 59 ± 9; P = .01), and total integration (biotemplate: 85 ± 15; microfracture: 66 ± 20; P = .04). The osteochondral biotemplate treatment produced a notable transient nonneutrophilic inflammatory response that appeared to approach resolution at 13 months. MRI results were not statistically different between the 2 treatments. CONCLUSION Even with the inflammatory response, after 13 months, the osteochondral biotemplate outperformed microfracture in cartilage regeneration and demonstrated superiority in integration between the repair tissue and host tissue as well as integration between the newly formed cartilage and the underlying bone. CLINICAL RELEVANCE This work has demonstrated the clinical potential of a novel biomaterial template to regenerate the complex mechanical interface between cartilage and the subchondral bone.
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Affiliation(s)
- Darryl A Dickerson
- Department of Mechanical and Materials Engineering, Florida International University, Miami, Florida, USA
| | - Lisa A Fortier
- Department of Clinical Sciences, Cornell University, Ithaca, New York, USA
| | - Eric A Nauman
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, USA
| | - Hollis G Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA
| | - Cassandra Quinlan
- Department of Clinical Sciences, Cornell University, Ithaca, New York, USA
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Gu X, Zha Y, Li Y, Chen J, Liu S, Du Y, Zhang S, Wang J. Integrated polycaprolactone microsphere-based scaffolds with biomimetic hierarchy and tunable vascularization for osteochondral repair. Acta Biomater 2022; 141:190-197. [PMID: 35041901 DOI: 10.1016/j.actbio.2022.01.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/08/2022] [Accepted: 01/12/2022] [Indexed: 12/27/2022]
Abstract
Osteochondral lesion potentially causes a variety of joint degenerative diseases if it cannot be treated effectively and timely. Microfracture as the conservative surgical choice achieves limited results for the larger defect whereas cartilage patches trigger integrated instability and cartilage fibrosis. To tackle aforementioned issues, here we explore to fabricate an integrated osteochondral scaffold for synergetic regeneration of cartilage and subchondral bone in one system. On the macro level, we fabricated three integrated scaffolds with distinct channel patterns of Non-channel, Consecutive-channel and Inconsecutive-channel via Selective Laser Sintering (SLS). On the micro level, both cartilage zone and subchondral bone zone of integrated scaffold were made of small polycaprolactone (PCL) microspheres and large PCL microspheres, respectively. Our findings showed that Inconsecutive-channel scaffolds possessed integrated hierarchical structure, adaptable compression strength, gradient interconnected porosity. Cartilage zone presented a dense phase for the inhibition of vessel invasion while subchondral bone zone generated a porous phase for the ingrowth of bone and vessel. Both cartilage regeneration and subchondral bone remodeling in the group of Inconsecutive-channel scaffolds have been demonstrated by histological evaluation and immunofluorescence staining in vivo. Consequently, our current work not only achieves an effective and regenerative microsphere scaffold for osteochondral reconstruction, but also provides a feasible methodology to recover injured joint through integrated design with diverse hierarchy. STATEMENT OF SIGNIFICANCE: Recovery of osteochondral lesion highly depends on hierarchical architecture and tunable vascularization in distinct zones. We therefore design a special integrated osteochondral scaffold with inconsecutive channel structure and vascularized modulation. The channel pattern impacts on mechanical strength and the infiltration of bone marrow, and eventually triggers synergetic repair of osteochondral defect. The cartilage zone of integrated scaffolds consisted of small PCL microspheres forms a dense phase for physical restriction of vascularized infiltration whereas the subchondral bone zone made of large PCL microspheres generates porous trabecula-like structure for promoting vascularization. Consequently, the current work indicates both mechanical adaptation and regional vascularized modulation play a pivotal role on osteochondral repair.
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Vayas R, Reyes R, Arnau MR, Évora C, Delgado A. Injectable Scaffold for Bone Marrow Stem Cells and Bone Morphogenetic Protein-2 to Repair Cartilage. Cartilage 2021; 12:293-306. [PMID: 30971092 PMCID: PMC8236655 DOI: 10.1177/1947603519841682] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The limits of the microfracture (MFX) treatment in terms of lesion size and long-term tissue functionality makes it necessary to investigate different alternatives to repair focal cartilage lesions. The present study aims at evaluating the efficacy of a minimally invasive approach against the conventional MFX to repair a chondral defect in rabbits. An injectable scaffold of BMP-2 pre-encapsulated in PLGA microspheres dispersed in a Pluronic F-127 solution is proposed as support of cells and controlled delivery system for the growth factor. DESIGN MFX was compared versus the injectable system seeded with mesenchymal stem cells (MSCs), both without BMP-2 and under controlled release of BMP-2 at 2 different doses (3 and 12 µg/scaffold). The different treatments were evaluated on a 4-mm diameter chondral defect model using 9 experimental groups of 4 rabbits (8 knees) each, throughout 24 weeks. RESULTS Histologically, all the treated groups, except MFX treated, responded significantly better than the control group (nontreated defect). Although no significant differences were found between the treated groups, only BMP(12), MSC-BMP(12), and MFX-BMP(3) groups showed nonsignificant differences when compared with the normal cartilage. CONCLUSIONS The hydrogel system proposed to control the release rate of the BMP-2 was safe, easily injectable, and also provided good support for cells. Treatments with MSCs or BMP-2 repaired efficiently the chondral lesion created in rabbits, being less invasive than MFX treatment.
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Affiliation(s)
- Raquel Vayas
- Department of Chemical Engineering and Pharmaceutical Technology, Universidad de La Laguna, La Laguna, Spain
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Hospitalario Universitario Ntra, Sra. de Candelaria, Santa Cruz de Tenerife, Spain
| | - Ricardo Reyes
- Institute of Biomedical Technologies, Center for Biomedical Research of the Canary Islands, Universidad de La Laguna, La Laguna, Spain
- Department of Biochemistry, Microbiology, Cell Biology and Genetics, Universidad de La Laguna, La Laguna, Spain
| | - María Rosa Arnau
- Servicio de Estabulario y Animalario del Servicio General de Apoyo a la Investigación, Universidad de La Laguna, La Laguna, Spain
| | - Carmen Évora
- Department of Chemical Engineering and Pharmaceutical Technology, Universidad de La Laguna, La Laguna, Spain
- Institute of Biomedical Technologies, Center for Biomedical Research of the Canary Islands, Universidad de La Laguna, La Laguna, Spain
| | - Araceli Delgado
- Department of Chemical Engineering and Pharmaceutical Technology, Universidad de La Laguna, La Laguna, Spain
- Institute of Biomedical Technologies, Center for Biomedical Research of the Canary Islands, Universidad de La Laguna, La Laguna, Spain
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Abdulghani S, Morouço PG. Biofabrication for osteochondral tissue regeneration: bioink printability requirements. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2019; 30:20. [PMID: 30689057 DOI: 10.1007/s10856-019-6218-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 01/09/2019] [Indexed: 06/09/2023]
Abstract
Biofabrication allows the formation of 3D scaffolds through a precise spatial control. This is of foremost importance when aiming to mimic heterogeneous and anisotropic architecture, such as that of the osteochondral tissue. Osteochondral defects are a supreme challenge for tissue engineering due to the compositional and structural complexity of stratified architecture and contrasting biomechanical properties of the cartilage-bone interface. This review highlights the advancements and retreats witnessed by using developed bioinks for tissue regeneration, taking osteochondral tissue as a challenging example. Methods, materials and requirements for bioprinting were discussed, highlighting the pre and post-processing factors that researchers should consider towards the development of a clinical treatment.
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Affiliation(s)
- Saba Abdulghani
- Centre for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, Rua de Portugal - Zona Industrial., Marinha Grande, 2430-028, Portugal.
| | - Pedro G Morouço
- Centre for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, Rua de Portugal - Zona Industrial., Marinha Grande, 2430-028, Portugal
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Iqbal B, Muhammad N, Rahim A, Iqbal F, Sharif F, Safi SZ, Khan AS, Gonfa G, Uroos M, Rehman IU. Development of collagen/PVA composites patches for osteochondral defects using a green processing of ionic liquid. INT J POLYM MATER PO 2018. [DOI: 10.1080/00914037.2018.1474358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Bushra Iqbal
- Interdisciplinary Research Centre in Biomedical Materials (IRCBM), COMSATS Institute of Information Technology, Lahore, Pakistan
| | - Nawshad Muhammad
- Interdisciplinary Research Centre in Biomedical Materials (IRCBM), COMSATS Institute of Information Technology, Lahore, Pakistan
| | - Abdur Rahim
- Interdisciplinary Research Centre in Biomedical Materials (IRCBM), COMSATS Institute of Information Technology, Lahore, Pakistan
| | - Farasit Iqbal
- Interdisciplinary Research Centre in Biomedical Materials (IRCBM), COMSATS Institute of Information Technology, Lahore, Pakistan
| | - Faiza Sharif
- Interdisciplinary Research Centre in Biomedical Materials (IRCBM), COMSATS Institute of Information Technology, Lahore, Pakistan
| | - Sher Zaman Safi
- Interdisciplinary Research Centre in Biomedical Materials (IRCBM), COMSATS Institute of Information Technology, Lahore, Pakistan
| | - Amir Sada Khan
- Department of Chemical Engineering, Center for Research in Ionic Liquids, Universiti Teknologi PETRONAS (UTP), Tronoh, Perak, Malaysia
| | - Girma Gonfa
- College of Biological and Chemical Engineering Addis Ababa Science and Technology University, Addis Ababa, Ethiopia
| | - Maliha Uroos
- Department of Chemistry, University of the Punjab, Lahore, Pakistan
| | - Ihtesham Ur Rehman
- Department of Materials Science & Engineering, Kroto Research Institute, University of Sheffield, Sheffield, United Kingdom
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Nakano N, Gohal C, Duong A, Ayeni OR, Khanduja V. Outcomes of cartilage repair techniques for chondral injury in the hip-a systematic review. INTERNATIONAL ORTHOPAEDICS 2018. [PMID: 29536127 DOI: 10.1007/s00264-018-3862-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE/PURPOSE The aim of the study was to assess the options of treatment and their related outcomes for chondral injuries in the hip based on the available evidence whilst highlighting new and innovative techniques. METHODS A systematic review of the literature from PubMed (Medline), EMBASE, Google Scholar, British Nursing Index (BNI), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Allied and Complementary Medicine Database (AMED) was undertaken from their inception to March 2017 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Clinical outcome studies, prospective/retrospective case series and case reports that described the outcome of cartilage repair technique for the chondral injury in the hip were included. Studies on total hip replacement, animal studies, basic studies, trial protocols and review articles were excluded. RESULTS The systematic review found 21 relevant papers with 596 hips. Over 80% of the included studies were published in or after 2010. Most studies were case series or case reports (18 studies, 85.7%). Arthroscopy was used in 11 studies (52.4%). The minimum follow-up period was six months. Mean age of the participants was 37.2 years; 93.5% of patients had cartilage injuries of the acetabulum and 6.5% of them had injuries of the femoral head. Amongst the 11 techniques described in the systematic review, autologous matrix-induced chondrogenesis, osteochondral autograft transplantation and microfracture were the three frequently reported techniques. CONCLUSION Over ten different techniques are available for cartilage repair in the hip, and most of them have good short- to medium-term outcomes. However, there are no robust comparative studies to assess superiority of one technique over another, and further research is required in this arena.
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Affiliation(s)
- Naoki Nakano
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 37, Hills Road, Cambridge, CB2 0QQ, UK
| | - Chetan Gohal
- Department of Orthopaedics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Andrew Duong
- Department of Orthopaedics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Olufemi R Ayeni
- Department of Orthopaedics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Vikas Khanduja
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 37, Hills Road, Cambridge, CB2 0QQ, UK.
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Dias IR, Viegas CA, Carvalho PP. Large Animal Models for Osteochondral Regeneration. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1059:441-501. [PMID: 29736586 DOI: 10.1007/978-3-319-76735-2_20] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Namely, in the last two decades, large animal models - small ruminants (sheep and goats), pigs, dogs and horses - have been used to study the physiopathology and to develop new therapeutic procedures to treat human clinical osteoarthritis. For that purpose, cartilage and/or osteochondral defects are generally performed in the stifle joint of selected large animal models at the condylar and trochlear femoral areas where spontaneous regeneration should be excluded. Experimental animal care and protection legislation and guideline documents of the US Food and Drug Administration, the American Society for Testing and Materials and the International Cartilage Repair Society should be followed, and also the specificities of the animal species used for these studies must be taken into account, such as the cartilage thickness of the selected defect localization, the defined cartilage critical size defect and the joint anatomy in view of the post-operative techniques to be performed to evaluate the chondral/osteochondral repair. In particular, in the articular cartilage regeneration and repair studies with animal models, the subchondral bone plate should always be taken into consideration. Pilot studies for chondral and osteochondral bone tissue engineering could apply short observational periods for evaluation of the cartilage regeneration up to 12 weeks post-operatively, but generally a 6- to 12-month follow-up period is used for these types of studies.
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Affiliation(s)
- Isabel R Dias
- Department of Veterinary Sciences, Agricultural and Veterinary Sciences School, University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal. .,3B's Research Group - Biomaterials, Biodegradables and Biomimetics, Department of Polymer Engineering, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark - Parque da Ciência e Tecnologia, Zona Industrial da Gandra, Barco - Guimarães, 4805-017, Portugal. .,Department of Veterinary Medicine, ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
| | - Carlos A Viegas
- Department of Veterinary Sciences, Agricultural and Veterinary Sciences School, University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal.,3B's Research Group - Biomaterials, Biodegradables and Biomimetics, Department of Polymer Engineering, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark - Parque da Ciência e Tecnologia, Zona Industrial da Gandra, Barco - Guimarães, 4805-017, Portugal.,Department of Veterinary Medicine, ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Pedro P Carvalho
- Department of Veterinary Medicine, University School Vasco da Gama, Av. José R. Sousa Fernandes 197, Lordemão, Coimbra, 3020-210, Portugal.,CIVG - Vasco da Gama Research Center, University School Vasco da Gama, Coimbra, Portugal
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Tanima-Nagai M, Harada H, Aoyama T, Yamaguchi S, Ito A, Tajino J, Iijima H, Zhang X, Kuroki H, Kobayashi M. Pathohistological investigation of osteochondral tissue obtained during total knee arthroplasty after osteochondral autologous transfer: a case report. BMC Res Notes 2017; 10:194. [PMID: 28587673 PMCID: PMC5461697 DOI: 10.1186/s13104-017-2513-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 05/24/2017] [Indexed: 11/12/2022] Open
Abstract
Background Osteochondral autologous transfer is one of the repair techniques for cartilage defects of knee with promising knee function recovery. There are no reports including histopathological images concerning human osteochondral tissue after osteochondral autologous transfer. This is the first report to present pathohistological findings of transplanted plugs and host tissues extracted from the human body 3 years after osteochondral autologous transfer. This study aimed to explore the cause factor of chronic pain using histological techniques. Case presentation A 67-year-old Japanese man presented with adjusted total knee arthroplasty 3 years after osteochondral autologous transfer. Although in pain, arthroscopic assessment was not severe. The specimens which was gained during total knee arthroplasty were investigated in gross and microscopically using immunohistochemical staining technic. Histological examination revealed that the gap between grafted plugs and host osteochondral tissues was filled with fibrous tissue that stained positive for type I collagen. A degenerative change and some neovascularity were observed in the regenerated tissue and host trabecular bone. Furthermore, cysts and bone marrow edema were observed. Conclusion Our data suggests that the host osteochondral morbidity around grafted plugs might be related to chronical pain and revision surgery.
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Affiliation(s)
- Momoko Tanima-Nagai
- Congenital Anomaly Research Center, Kyoto University Graduate School of Medicine, Konoe-cho, Yoshida, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Hideto Harada
- Department of Orthopedic Surgery, Kyoto Katsura Hospital, 17 Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Tomoki Aoyama
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shoki Yamaguchi
- Department of Physical Therapy, School of Nursing and Rehabilitation Sciences at Odawara, International University of Health and Welfare, 1-2-25 Shiroyama, Odawara, Kanagawa, 250-8588, Japan
| | - Akira Ito
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Junichi Tajino
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hirotaka Iijima
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Xiankai Zhang
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hiroshi Kuroki
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Masahiko Kobayashi
- Department of Orthopedic Surgery, Knee/Shoulder Surgery & Sports Medicine, Kyoto Shimogamo Hospital, 17 Higashimorigamae-cho, Shimogamo, Sakyo-ku, Kyoto, 606-0866, Japan.
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Fisher MB, Belkin NS, Milby AH, Henning EA, Bostrom M, Kim M, Pfeifer C, Meloni G, Dodge GR, Burdick JA, Schaer TP, Steinberg DR, Mauck RL. Cartilage repair and subchondral bone remodeling in response to focal lesions in a mini-pig model: implications for tissue engineering. Tissue Eng Part A 2014; 21:850-60. [PMID: 25318414 DOI: 10.1089/ten.tea.2014.0384] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Preclinical large animal models are essential for evaluating new tissue engineering (TE) technologies and refining surgical approaches for cartilage repair. Some preclinical animal studies, including the commonly used minipig model, have noted marked remodeling of the subchondral bone. However, the mechanisms underlying this response have not been well characterized. Thus, our objective was to compare in-vivo outcomes of chondral defects with varied injury depths and treatments. DESIGN Trochlear chondral defects were created in 11 Yucatan minipigs (6 months old). Groups included an untreated partial-thickness defect (PTD), an untreated full-thickness defect (FTD), and FTDs treated with microfracture, autologous cartilage transfer (FTD-ACT), or an acellular hyaluronic acid hydrogel. Six weeks after surgery, micro-computed tomography (μCT) was used to quantitatively assess defect fill and subchondral bone remodeling. The quality of cartilage repair was assessed using the ICRS-II histological scoring system and immunohistochemistry for type II collagen. A finite element model (FEM) was developed to assess load transmission. RESULTS Using μCT, substantial bone remodeling was observed for all FTDs, but not for the PTD group. The best overall histological scores and greatest type II collagen staining was found for the FTD-ACT and PTD groups. The FEM confirmed that only the FTD-ACT group could initially restore appropriate transfer of compressive loads to the underlying bone. CONCLUSIONS The bony remodeling observed in this model system appears to be a biological phenomena and not a result of altered mechanical loading, with the depth of the focal chondral defect (partial vs. full thickness) dictating the bony remodeling response. The type of cartilage injury should be carefully controlled in studies utilizing this model to evaluate TE approaches for cartilage repair.
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Affiliation(s)
- Matthew B Fisher
- 1 McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
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Guillén-García P, Rodríguez-Iñigo E, Guillén-Vicente I, Caballero-Santos R, Guillén-Vicente M, Abelow S, Giménez-Gallego G, López-Alcorocho JM. Increasing the Dose of Autologous Chondrocytes Improves Articular Cartilage Repair: Histological and Molecular Study in the Sheep Animal Model. Cartilage 2014; 5:114-22. [PMID: 26069691 PMCID: PMC4297083 DOI: 10.1177/1947603513515903] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND We hypothesized that implanting cells in a chondral defect at a density more similar to that of the intact cartilage could induce them to synthesize matrix with the features more similar to that of the uninjured one. METHODS We compared the implantation of different doses of chondrocytes: 1 million (n = 5), 5 million (n = 5), or 5 million mesenchymal cells (n = 5) in the femoral condyle of 15 sheep. Tissue generated by microfracture at the trochlea, and normal cartilage from a nearby region, processed as the tissues resulting from the implantation, were used as references. Histological and molecular (expression of type I and II collagens and aggrecan) studies were performed. RESULTS The features of the cartilage generated by implantation of mesenchymal cells and elicited by microfractures were similar and typical of a poor repair of the articular cartilage (presence of fibrocartilage, high expression of type I collagen and a low mRNA levels of type II collagen and aggrecan). Nevertheless, in the samples obtained from tissues generated by implantation of chondrocytes, hyaline-like cartilage, cell organization, low expression rates of type I collagen and high levels of mRNA corresponding to type II collagen and aggrecan were observed. These histological features, show less variability and are more similar to those of the normal cartilage used as control in the case of 5 million cells implantation than when 1 million cells were used. CONCLUSIONS The implantation of autologous chondrocytes in type I/III collagen membranes at high density could be a promising tool to repair articular cartilage.
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Patil S, Steklov N, Song L, Bae WC, D'Lima DD. Comparative biomechanical analysis of human and caprine knee articular cartilage. Knee 2014; 21:119-25. [PMID: 23583005 DOI: 10.1016/j.knee.2013.03.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 10/19/2012] [Accepted: 03/14/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND The goat is one of the most commonly used preclinical models for focal defect repair and regeneration. While the biomechanics of the human knee has been studied extensively, less is known about the biomechanics of the caprine knee. Differences between human and caprine knees have not been quantified and their significance is largely unknown. METHODS We conducted a biomechanical analysis of the differences in goat and human knees to assess the validity of these preclinical in vivo models. RESULTS CT and MRI scans revealed several differences in articular geometry: the caprine tibial plateaux were more convex and the menisci were significantly thicker and covered a larger proportion of the tibial articular surface. Caprine cartilage thickness was consistently thinner, while elastic modulus on indentation testing was consistently stiffer than human cartilage measured at eight different articular locations. Contact area and pressure were measured with electronic pressure sensors under loads normalized by multiples of body weight and at knee flexion angles reported for walking. The highest peaks in contact pressure were measured in the patellofemoral joint in goat and human knees. Peak contact pressure measured at 2 times body weight at the goat tibiofemoral joint at 70° flexion was significantly higher than for any other condition at the human tibiofemoral joint. CONCLUSION These differences in contact conditions might explain the lower quality of local repair reported for caprine femoral condylar defects relative to trochlear defects. Further comparative analysis, including biologic response, is necessary to determine the extent to which the goat knee reproduces clinical conditions.
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Affiliation(s)
- Shantanu Patil
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, United States
| | - Nikolai Steklov
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, United States
| | - Lin Song
- Stryker Orthopaedics, Mahwah, NJ, United States
| | - Won C Bae
- University of California, San Diego, La Jolla, CA, United States
| | - Darryl D D'Lima
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, United States.
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Schneider-Wald B, von Thaden AK, Schwarz MLR. [Defect models for the regeneration of articular cartilage in large animals]. DER ORTHOPADE 2013; 42:242-53. [PMID: 23575559 DOI: 10.1007/s00132-012-2044-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Several animal models are available for the analysis of regeneration of articular cartilage in large animals, such as sheep, pigs, goats, dogs and horses. The subchondral bone lamella must be considered when ACT and MACT techniques are examined in order to protect the implant against migration of cells from the bone marrow, although recruitment of cells is often desirable in the regeneration of human cartilage. MATERIAL AND METHODS The defects are mainly positioned at the condyles and the trochlea often bilaterally and spontaneous healing should be excluded. The follow-up period for assessment of the effectiveness of cartilage regeneration is 6-12 months. Shorter observation times up to 12 weeks can be used for pilot studies. Scores based on histological, immunohistological and biochemical staining are mostly used for assessing the regenerated tissue. Biomechanical tests with destructive features need isolated specimens from the animal but modern slice imaging techniques can reflect the progression of the healing processes over the time span of the study in vivo. CONCLUSION Approaches to standardize the evaluation of the regeneration of articular cartilage have been sporadically described whereas they are required from the point of view of the approval of new concepts for therapy and the protection of animals.
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Affiliation(s)
- B Schneider-Wald
- Sektion experimentelle Orthopädie und Unfallchirurgie, Orthopädisch-Unfallchirurgisches Zentrum, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
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Santo VE, Gomes ME, Mano JF, Reis RL. Controlled release strategies for bone, cartilage, and osteochondral engineering--Part I: recapitulation of native tissue healing and variables for the design of delivery systems. TISSUE ENGINEERING. PART B, REVIEWS 2013; 19:308-26. [PMID: 23268651 PMCID: PMC3690094 DOI: 10.1089/ten.teb.2012.0138] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 12/11/2012] [Indexed: 12/12/2022]
Abstract
The potential of growth factors to stimulate tissue healing through the enhancement of cell proliferation, migration, and differentiation is undeniable. However, critical parameters on the design of adequate carriers, such as uncontrolled spatiotemporal presence of bioactive factors, inadequate release profiles, and supraphysiological dosages of growth factors, have impaired the translation of these systems onto clinical practice. This review describes the healing cascades for bone, cartilage, and osteochondral interface, highlighting the role of specific growth factors for triggering the reactions leading to tissue regeneration. Critical criteria on the design of carriers for controlled release of bioactive factors are also reported, focusing on the need to provide a spatiotemporal control over the delivery and presentation of these molecules.
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Affiliation(s)
- Vítor E. Santo
- 3Bs Research Group—Biomaterials, Biodegradables, and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, Guimarães, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Manuela E. Gomes
- 3Bs Research Group—Biomaterials, Biodegradables, and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, Guimarães, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - João F. Mano
- 3Bs Research Group—Biomaterials, Biodegradables, and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, Guimarães, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Rui L. Reis
- 3Bs Research Group—Biomaterials, Biodegradables, and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, Guimarães, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
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14
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Survival analysis of microfracture in the osteoarthritic knee-minimum 10-year follow-up. Arthroscopy 2013; 29:244-50. [PMID: 23369477 DOI: 10.1016/j.arthro.2012.09.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 09/08/2012] [Accepted: 09/18/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to evaluate the survival of microfractures in patients with degenerative osteoarthritic knees and to analyze the factors affecting length of time before total knee arthroplasty (TKA) is performed. METHODS This study reviewed 134 knees in 124 patients in whom microfracture was performed and for whom a minimum of 10 years of follow-up data were available. Mean follow-up was 11.2 years. The survival rate was evaluated. Failure was defined as the need for TKA. Another definition of failure was substantial symptoms in a patient whose pain score during follow-up was lower than the preoperative pain score or <60. We evaluated factors affecting survival, including size of the cartilage defect and severity of the preoperative varus deformity. The mechanical axis percentage (MA%) was defined as the percentage by which the mechanical axis bisected the total width of the tibia. RESULTS The survival rate was 88.8% at 5 years and 67.9% at 10 years. Fifty-one patients proceeded to TKA a mean of 6.8 years after microfracture, and 6 knees were categorized as clinical failures. Age, gender, body mass index (BMI), and presence of meniscus lesions did not affect the survival of microfractures. Survival of microfractures in patients with a cartilage defect on the medial femoral condyle <2 cm(2) in size was better than that of microfractures in patients with larger defects. Survival of microfractures in patients with MA% >25% was better than that of patients with MA% <25%. CONCLUSIONS Among 134 knees, 51 knees (38.1%) proceeded to TKA a mean of 6.8 years after microfracture in this study, and 6 knees were categorized as clinical failures. The survival rate was 88.8% at 5 years and decreased over time to 67.9% at 10 years. When considering microfracture, surgeons must consider factors affecting survival, such as size of the cartilage defect and severity of the preoperative varus deformity. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Schuurman W, Klein TJ, Dhert WJA, van Weeren PR, Hutmacher DW, Malda J. Cartilage regeneration using zonal chondrocyte subpopulations: a promising approach or an overcomplicated strategy? J Tissue Eng Regen Med 2012; 9:669-78. [PMID: 23135870 DOI: 10.1002/term.1638] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 08/30/2012] [Accepted: 09/27/2012] [Indexed: 01/01/2023]
Abstract
Cartilage defects heal imperfectly and osteoarthritic changes develop frequently as a result. Although the existence of specific behaviours of chondrocytes derived from various depth-related zones in vitro has been known for over 20 years, only a relatively small body of in vitro studies has been performed with zonal chondrocytes and current clinical treatment strategies do not reflect these native depth-dependent (zonal) differences. This is surprising since mimicking the zonal organization of articular cartilage in neo-tissue by the use of zonal chondrocyte subpopulations could enhance the functionality of the graft. Although some research groups including our own have made considerable progress in tailoring culture conditions using specific growth factors and biomechanical loading protocols, we conclude that an optimal regime has not yet been determined. Other unmet challenges include the lack of specific zonal cell sorting protocols and limited amounts of cells harvested per zone. As a result, the engineering of functional tissue has not yet been realized and no long-term in vivo studies using zonal chondrocytes have been described. This paper critically reviews the research performed to date and outlines our view of the potential future significance of zonal chondrocyte populations in regenerative approaches for the treatment of cartilage defects. Secondly, we briefly discuss the capabilities of additive manufacturing technologies that can not only create patient-specific grafts directly from medical imaging data sets but could also more accurately reproduce the complex 3D zonal extracellular matrix architecture using techniques such as hydrogel-based cell printing.
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Affiliation(s)
- W Schuurman
- Department of Orthopaedics, University Medical Center Utrecht, The Netherlands.,Department of Equine Sciences, Faculty of Veterinary Sciences, Utrecht University, The Netherlands
| | - T J Klein
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia
| | - W J A Dhert
- Department of Orthopaedics, University Medical Center Utrecht, The Netherlands.,Faculty of Veterinary Sciences, University of Utrecht, The Netherlands
| | - P R van Weeren
- Department of Equine Sciences, Faculty of Veterinary Sciences, Utrecht University, The Netherlands
| | - D W Hutmacher
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia
| | - J Malda
- Department of Orthopaedics, University Medical Center Utrecht, The Netherlands.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia
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Pallante AL, Görtz S, Chen AC, Healey RM, Chase DC, Ball ST, Amiel D, Sah RL, Bugbee WD. Treatment of articular cartilage defects in the goat with frozen versus fresh osteochondral allografts: effects on cartilage stiffness, zonal composition, and structure at six months. J Bone Joint Surg Am 2012; 94:1984-95. [PMID: 23138239 PMCID: PMC3489067 DOI: 10.2106/jbjs.k.00439] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Understanding the effectiveness of frozen as compared with fresh osteochondral allografts at six months after surgery and the resultant consequences of traditional freezing may facilitate in vivo maintenance of cartilage integrity. Our hypothesis was that the state of the allograft at implantation affects its performance after six months in vivo. METHODS The effect of frozen as compared with fresh storage on in vivo allograft performance was determined for osteochondral allografts that were transplanted into seven recipient goats and analyzed at six months. Allograft performance was assessed by examining osteochondral structure (cartilage thickness, fill, surface location, surface degeneration, and bone-cartilage interface location), zonal cartilage composition (cellularity, matrix content), and cartilage biomechanical function (stiffness). Relationships between cartilage stiffness or cartilage composition and surface degeneration were assessed with use of linear regression. RESULTS Fresh allografts maintained cartilage load-bearing function, while also maintaining zonal organization of cartilage cellularity and matrix content, compared with frozen allografts. Overall, allograft performance was similar between fresh allografts and nonoperative controls. However, cartilage stiffness was approximately 80% lower (95% confidence interval [CI], 73% to 87%) in the frozen allografts than in the nonoperative controls or fresh allografts. Concomitantly, in frozen allografts, matrix content and cellularity were approximately 55% (95% CI, 22% to 92%) and approximately 96% (95% CI, 94% to 99%) lower, respectively, than those in the nonoperative controls and fresh allografts. Cartilage stiffness correlated positively with cartilage cellularity and matrix content, and negatively with surface degeneration. CONCLUSIONS Maintenance of cartilage load-bearing function in allografts is associated with zonal maintenance of cartilage cellularity and matrix content. In this animal model, frozen allografts displayed signs of failure at six months, with cartilage softening, loss of cells and matrix, and/or graft subsidence, supporting the importance of maintaining cell viability during allograft storage and suggesting that outcomes at six months may be indicative of long-term (dys)function. CLINICAL RELEVANCE Fresh versus frozen allografts represent the "best versus worst" conditions with respect to chondrocyte viability, but "difficult versus simple" with respect to acquisition and distribution. The outcomes described from these two conditions expand the current understanding of in vivo cartilage remodeling and describe structural properties (initial graft subsidence), which may have implications for impending graft failure.
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Affiliation(s)
- Andrea L. Pallante
- Department of Bioengineering, University of California at San Diego, 9500 Gilman Drive, MC 0412, La Jolla, CA 92093-0412
| | - Simon Görtz
- Department of Orthopaedic Surgery, University of California at San Diego, 200 West Arbor Drive, MC 8894, San Diego, CA 92103-8894
| | - Albert C. Chen
- Department of Bioengineering, University of California at San Diego, 9500 Gilman Drive, MC 0412, La Jolla, CA 92093-0412
| | - Robert M. Healey
- Department of Orthopaedic Surgery, University of California at San Diego, 9500 Gilman Drive, MC 0863, La Jolla, CA 92093-0863
| | - Derek C. Chase
- Department of Orthopaedic Surgery, University of California at San Diego, 200 West Arbor Drive, MC 8894, San Diego, CA 92103-8894
| | - Scott T. Ball
- Department of Orthopaedic Surgery, University of California at San Diego, 200 West Arbor Drive, MC 8894, San Diego, CA 92103-8894
| | - David Amiel
- Department of Orthopaedic Surgery, University of California at San Diego, 9500 Gilman Drive, MC 0863, La Jolla, CA 92093-0863
| | - Robert L. Sah
- Department of Bioengineering, University of California at San Diego, 9500 Gilman Drive, MC 0412, La Jolla, CA 92093-0412
| | - William D. Bugbee
- Division of Orthopaedic Surgery, Scripps Clinic, 10666 North Torrey Pines Road, MS 116, La Jolla, CA 92037. E-mail address:
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Chan EF, Liu IL, Semler EJ, Aberman HM, Simon TM, Chen AC, Truncale KG, Sah RL. Association of 3-Dimensional Cartilage and Bone Structure with Articular Cartilage Properties in and Adjacent to Autologous Osteochondral Grafts after 6 and 12 months in a Goat Model. Cartilage 2012; 3. [PMID: 24224069 PMCID: PMC3818730 DOI: 10.1177/1947603511435272] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The articular cartilage of autologous osteochondral grafts is typically different in structure and function from local host cartilage and thereby presents a remodeling challenge. The hypothesis of this study was that properties of the articular cartilage of trochlear autografts and adjacent femoral condyle are associated with the 3-D geometrical match between grafted and contralateral joints at 6 and 12 months after surgery. DESIGN Autografts were transferred unilaterally from the lateral trochlea (LT) to the medial femoral condyle (MFC) in adult Spanish goats. Operated and contralateral Non-Operated joints were harvested at 6 and 12 months, and analyzed by indentation testing, micro-computed tomography, and histology to compare (1) histological indices of repair, (2) 3-D structure (articular surface deviation, bone-cartilage interface deviation, cartilage thickness), (3) indentation stiffness, and (4) correlations between stiffness and 3-D structure. RESULTS Cartilage deterioration was present in grafts at 6 months and more severe at 12 months. Cartilage thickness and normalized stiffness of Operated MFC were lower than Non-Operated MFC within the graft and proximal adjacent host regions. Operated MFC articular surfaces were recessed relative to Non-Operated MFC and exhibited lower cartilage stiffness with increasing recession. Sites with large bone-cartilage interface deviations, both proud and recessed, were associated with recessed articular surfaces and low cartilage stiffness. CONCLUSION The effectiveness of cartilage repair by osteochondral grafting is associated with the match of 3-D cartilage and bone geometry to the native osteochondral structure.
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Affiliation(s)
- Elaine F. Chan
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, USA
| | - I-Ling Liu
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, USA
| | | | | | | | - Albert C. Chen
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, USA
| | | | - Robert L. Sah
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, USA,Institute of Engineering in Medicine, University of California, San Diego, La Jolla, CA, USA
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Vaquero J, Forriol F. Knee chondral injuries: clinical treatment strategies and experimental models. Injury 2012; 43:694-705. [PMID: 21733516 DOI: 10.1016/j.injury.2011.06.033] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Revised: 05/30/2011] [Accepted: 06/15/2011] [Indexed: 02/02/2023]
Abstract
Articular cartilage has a very limited capacity to repair and as such premature joint degeneration is often the end point of articular injuries. Patients with chondral injury have asymptomatic periods followed by others in which discomfort or pain is bearable. The repair of focal cartilage injuries requires a precise diagnosis, a completed knee evaluation to give the correct indication for surgery proportional to the damage and adapted to each patient. Many of the surgical techniques currently performed involve biotechnology. The future of cartilage repair should be based on an accurate diagnosis using new MRI techniques. Clinical studies would allow us to establish the correct indications and surgical techniques implanting biocompatible and biodegradable matrices with or without stem cells and growth factors. Arthroscopic techniques with the design of new instruments can facilitate repair of patella and tibial plateau lesions.
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Affiliation(s)
- Javier Vaquero
- Hospital Gregorio Marañon, Orthopaedic Surgery Department, Madrid, Spain
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Allon AA, Ng KW, Hammoud S, Russell BH, Jones CM, Rivera JJ, Schwartz J, Hook M, Maher SA. Augmenting the articular cartilage-implant interface: Functionalizing with a collagen adhesion protein. J Biomed Mater Res A 2012; 100:2168-75. [PMID: 22615182 DOI: 10.1002/jbm.a.34144] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 01/12/2012] [Accepted: 01/25/2012] [Indexed: 11/11/2022]
Abstract
The lack of integration between implants and articular cartilage is an unsolved problem that negatively impacts the development of treatments for focal cartilage defects. Many approaches attempt to increase the number of matrix-producing cells that can migrate to the interface, which may help to reinforce the boundary over time but does not address the problems associated with an initially unstable interface. The objective of this study was to develop a bioadhesive implant to create an immediate bond with the extracellular matrix components of articular cartilage. We hypothesized that implant-bound collagen adhesion protein (CNA) would increase the interfacial strength between a poly(vinly alcohol) implant and an articular cartilage immediately after implantation, without preventing cell migration into the implant. By way of a series of in vitro immunohistochemical and mechanical experiments, we demonstrated that (i) free CNA can bind to articular cartilage, (ii) implant-bound CNA can bind to collagen type II and (iii) implants functionalized with CNA result in a fourfold increase in interfacial strength with cartilage relative to untreated implants at day zero. Of note, the interfacial strength significantly decreased after 21 days in culture, which may be an indication that the protein itself has lost its effectiveness. Our data suggest that functionalizing scaffolds with CNA may be a viable approach toward creating an initially stable interface between scaffolds and articular cartilage. Further efforts are required to ensure long-term interface stability.
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Affiliation(s)
- Aliza A Allon
- Hospital for Special Surgery, New York, New York, USA
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Fedorovich NE, Schuurman W, Wijnberg HM, Prins HJ, van Weeren PR, Malda J, Alblas J, Dhert WJA. Biofabrication of osteochondral tissue equivalents by printing topologically defined, cell-laden hydrogel scaffolds. Tissue Eng Part C Methods 2011; 18:33-44. [PMID: 21854293 DOI: 10.1089/ten.tec.2011.0060] [Citation(s) in RCA: 322] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Osteochondral defects are prone to induce osteoarthritic degenerative changes. Many tissue-engineering approaches that aim to generate osteochondral implants suffer from poor tissue formation and compromised integration. This illustrates the need for further improvement of heterogeneous tissue constructs. Engineering of these structures is expected to profit from strategies addressing the complexity of tissue organization and the simultaneous use of multiple cell types. Moreover, this enables the investigation of the effects of three-dimensional (3D) organization and architecture on tissue function. In the present study, we characterize the use of a 3D fiber deposition (3DF) technique for the fabrication of cell-laden, heterogeneous hydrogel constructs for potential use as osteochondral grafts. Changing fiber spacing or angle of fiber deposition yielded scaffolds of varying porosity and elastic modulus. We encapsulated and printed fluorescently labeled human chondrocytes and osteogenic progenitors in alginate hydrogel yielding scaffolds of 1×2 cm with different parts for both cell types. Cell viability remained high throughout the printing process, and cells remained in their compartment of the printed scaffold for the whole culture period. Moreover, distinctive tissue formation was observed, both in vitro after 3 weeks and in vivo (6 weeks subcutaneously in immunodeficient mice), at different locations within one construct. These results demonstrate the possibility of manufacturing viable centimeter-scaled structured tissues by the 3DF technique, which could potentially be used for the repair of osteochondral defects.
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Affiliation(s)
- Natalja E Fedorovich
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
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Lane JG. Letter to the editor. ‘‘Can osteochondral grafting be augmented with microfracture in an extended-sized lesion of articular cartilage?’'. Am J Sports Med 2010; 38:NP5; author reply NP5. [PMID: 20971970 DOI: 10.1177/0363546510385079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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