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Manzi J, Arzani A, Hamula MJ, Manchanda K, Dhanaraj D, Chapman CB. Long-term Patient-Reported Outcome Measures Following Particulated Juvenile Allograft Cartilage Implantation for Treatment of Difficult Osteochondral Lesions of the Talus. Foot Ankle Int 2021; 42:1399-1409. [PMID: 34112022 DOI: 10.1177/10711007211014173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Conventional methods are not suitable for difficult to treat osteochondral lesions of the talus (OCLTs). The role of particulated juvenile allograft articular cartilage implantation is not well elucidated for long-term patient outcomes. METHODS Thirteen patients with difficult-to-treat OCLTs underwent arthroscopy-assisted implantation of particulated juvenile articular cartilage graft into defects from 2010 to 2012 by the same surgeon. "Difficult to treat" was defined as having at least 3 of the following features or 2 if both variables described lesion characteristics: (1) lesions size of 107 mm2 or greater, (2) shoulder lesions, (3) patients who failed microfracture, (4) patient aged ≥40 years, or (5) patient body mass index (BMI) >25. Patients were evaluated using physical examination, patient interviews, and outcome score measures. Patients had follow-up at 2 years, 4 years, and between 6 and 10 years at their most recent follow-up. Differences in functional outcome scores were compared before and after surgery. RESULTS Patients (age: 46.5 ± 11.8 years, BMI: 28.5 ± 6.1) had, on average, most recent follow-up of 8.0 years (range 72-113 months). Average visual analog scale for pain score decreased for patients by 3.9 points (95% confidence interval [CI] 2.18-5.60), when compared to preoperative assessment. Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sports subscale scores also improved from 46.5 to 80.9 (95% CI 21.35-47.43), and from 18.8 to 57.9 (95% CI 21.05-57.10), respectively. Short Form-36 Health Survey physical component scores showed significant improvement by an average of 45.5 points (95% CI 32.42-58.50). American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Scale scores improved from 55.2 to 80.3 (95% CI 12.459-37.741). CONCLUSION These results demonstrate positive patient-reported long-term outcomes for a cohort of patients with difficult OCLTs, followed over the course of 6-10 years after treatment with arthroscopy-assisted particulated juvenile articular cartilage implantation. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Joseph Manzi
- Weill Cornell Medical College, New York, NY, USA
| | | | | | - Kshitij Manchanda
- Miami Orthopedics & Sports Medicine Institute, Coral Gables, FL, USA
| | - Dinesh Dhanaraj
- Penn Medicine Princeton Medical Center, Plainsboro Township, NJ, USA
| | - Cary B Chapman
- Miami Orthopedics & Sports Medicine Institute, Coral Gables, FL, USA
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Xiong L, Cui M, Zhou Z, Wu M, Wang Q, Song H, Ding L. Primary culture of chondrocytes after collagenase IA or II treatment of articular cartilage from elderly patients undergoing arthroplasty. ASIAN BIOMED 2021; 15:91-99. [PMID: 37551401 PMCID: PMC10388763 DOI: 10.2478/abm-2021-0011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Joint replacement surgery provides articular cartilage samples for chondrocyte isolation. To our knowledge, the effect of the collagenase type on releasing of chondrocytes from the extracellular matrix of cartilage is not reported. Objectives To determine whether cartilage digested with collagenase IA yielded more chondrocytes than that digested with collagenase II and determine whether chondrocytes isolated with collagenase IA could be cultured in vitro. Methods Cartilage slices collected from 18 elderly patients who received joint replacement surgery (16 hips, 2 knees) were digested sequentially with 0.4% pronase E and 0.02% collagenase IA, or with 0.15% collagenase II alone, or sequentially with 0.4% pronase E and 0.02% collagenase II. We compared cell yield from each method. Cell viability by the most effective method was calculated and plotted. The morphology of cultured monolayer chondrocytes was recorded with a light microscope. Results Sequential digestion with pronase E and collagenase IA yielded 2566 ± 873 chondrocytes per mg wet cartilage, which was more effective than the other isolation methods (P = 0.018). The average chondrocyte viability could reach 84% ± 8% (n = 11). Light microscopic images showed typical chondrocyte morphology in monolayer cultures. Conclusion Sequential digestion of human articular cartilage with pronase E and collagenase IA was more effective than collagenase II alone or collagenase II combined with pronase E for releasing chondrocytes from extracellular matrix of cartilage. Chondrocytes isolated with this method could be maintained in monolayer cultures for at least 2 passages with unaltered morphology.
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Affiliation(s)
- Liuliu Xiong
- Department of Basic Medical Sciences, Jiangnan University Wuxi College of Medicine, Jiangsu214122, China
| | - Meng Cui
- Department of Basic Medical Sciences, Jiangnan University Wuxi College of Medicine, Jiangsu214122, China
| | - Ziye Zhou
- Department of Basic Medical Sciences, Jiangnan University Wuxi College of Medicine, Jiangsu214122, China
| | - Minchen Wu
- Department of Basic Medical Sciences, Jiangnan University Wuxi College of Medicine, Jiangsu214122, China
| | - Quanming Wang
- Department of Orthopaedic Surgery, Jiangnan University Affiliated Hospital, Jiangsu214062, China
| | - Haiyan Song
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Harbin Medical University, Harbin150001, China
| | - Lei Ding
- Department of Basic Medical Sciences, Jiangnan University Wuxi College of Medicine, Jiangsu214122, China
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Cao F, Qi J, Song H, Xie D, Zhou L, Han Y, Li H, Wu Q, Dong J, Zhang Y. Tsmu solution improves rabbit osteochondral allograft preservation and transplantation outcome. Cell Tissue Bank 2018; 19:549-558. [PMID: 29876883 DOI: 10.1007/s10561-018-9703-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 05/25/2018] [Indexed: 12/20/2022]
Abstract
To compare the effects of Tsmu solution with vitrification on chondrocyte viability and examine histological and biomechanical properties of osteochondral allografts (OCAs) after storage, OCAs from femoral condyles of New Zealand rabbits were harvested, stored for 35 days in Tsmu solution or by in vitro vitrification, and subjected to in vivo and in vitro assays. Stored OCAs were transplanted into knee femoral condyle cartilage defects in recipient rabbits. Chondrocyte viability and histological changes of cartilage grafts were assessed in vitro. Gross assessment, chondrocyte viability, histological assessment, OCA biomechanics, and immunological markers were evaluated in vivo 6 months after transplantation. Fresh OCAs served as in vitro and in vivo controls. Chondrocyte viability and scores for cartilage surface and histological quantitative assessment were superior for Tsmu solution compared with vitrification, but inferior compared with fresh OCAs in vitro and in vivo. With the exception of interleukin 6 content, biomechanical features of samples stored in Tsmu solution were superior to vitrification, and inferior to fresh OCAs in vivo. Thus, Tsmu solution provided suitable storage that improved chondrocyte viability, intact OCA cartilage matrix architecture, and transplantation outcomes.
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Affiliation(s)
- Famin Cao
- Institute of Sports Medicine, Taishan Medical University, 619 Great Wall Road, Tai'an, 271016, Shandong, China
| | - Jianhong Qi
- Institute of Sports Medicine, Taishan Medical University, 619 Great Wall Road, Tai'an, 271016, Shandong, China. .,Institute of Sports Medicine, Taishan Medical University, 619 Changcheng Road, Tai'an, 271016, Shandong, China.
| | - Hongqiang Song
- Institute of Sports Medicine, Taishan Medical University, 619 Great Wall Road, Tai'an, 271016, Shandong, China
| | - Di Xie
- Institute of Sports Medicine, Taishan Medical University, 619 Great Wall Road, Tai'an, 271016, Shandong, China
| | - Lu Zhou
- Institute of Sports Medicine, Taishan Medical University, 619 Great Wall Road, Tai'an, 271016, Shandong, China
| | - Yunning Han
- Institute of Sports Medicine, Taishan Medical University, 619 Great Wall Road, Tai'an, 271016, Shandong, China
| | - Hao Li
- Institute of Sports Medicine, Taishan Medical University, 619 Great Wall Road, Tai'an, 271016, Shandong, China
| | - Qi Wu
- Institute of Sports Medicine, Taishan Medical University, 619 Great Wall Road, Tai'an, 271016, Shandong, China
| | - Jun Dong
- Institute of Sports Medicine, Taishan Medical University, 619 Great Wall Road, Tai'an, 271016, Shandong, China
| | - Yanming Zhang
- Institute of Sports Medicine, Taishan Medical University, 619 Great Wall Road, Tai'an, 271016, Shandong, China
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Wang D, Eliasberg CD, Wang T, Fader RR, Coxe FR, Pais MD, Williams RJ. Similar Outcomes After Osteochondral Allograft Transplantation in Anterior Cruciate Ligament-Intact and -Reconstructed Knees: A Comparative Matched-Group Analysis With Minimum 2-Year Follow-Up. Arthroscopy 2017; 33:2198-2207. [PMID: 28800919 DOI: 10.1016/j.arthro.2017.06.034] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/19/2017] [Accepted: 06/19/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare failure rates and clinical outcomes of osteochondral allograft transplantation (OCA) in anterior cruciate ligament (ACL)-intact versus ACL-reconstructed knees at midterm follow-up. METHODS After a priori power analysis, a prospective registry of patients treated with OCA for focal chondral lesions ≥2 cm2 in size with minimum 2-year follow-up was used to match ACL-reconstructed knees with ACL-intact knees by age, sex, and primary chondral defect location. Exclusion criteria included meniscus transplantation, realignment osteotomy, or other ligamentous injury. Complications, reoperations, and patient responses to validated outcome measures were reviewed. Failure was defined by any procedure involving allograft removal/revision or conversion to arthroplasty. Kaplan-Meier analysis and multivariate Cox regression were performed to evaluate the association of ACL reconstruction (ACLR) with failure. RESULTS A total of 50 ACL-intact and 25 ACL-reconstructed (18 prior, 7 concomitant) OCA patients were analyzed. The mean age was 36.2 years (range, 14-62 years). Mean follow-up was 3.9 years (range, 2-14 years). Patient demographics and chondral lesion characteristics were similar between groups. ACL-reconstructed patients averaged 2.2 ± 1.9 prior surgeries on the ipsilateral knee compared with 1.4 ± 1.4 surgeries for ACL-intact patients (P = .014). Grafts used for the last ACLR included bone-patellar tendon-bone autograft, hamstring autograft, Achilles tendon allograft, and tibialis allograft (data available for only 11 of 25 patients). At final follow-up, 22% of ACL-intact and 32% of ACL-reconstructed patients had undergone reoperation. OCA survivorship was 90% and 96% at 2 years and 79% and 85% at 5 years in ACL-intact and ACL-reconstructed patients, respectively (P = .774). ACLR was not independently associated with failure. Both groups demonstrated clinically significant improvements in the Short Form-36 pain and physical functioning, International Knee Documentation Committee subjective, and Knee Outcome Survey-Activities of Daily Living scores at final follow-up (P < .001), with no significant differences in preoperative, postoperative, and change scores between groups. CONCLUSIONS OCA in the setting of prior or concomitant ACLR does not portend higher failure rates or compromise clinical outcomes. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Dean Wang
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, U.S.A..
| | - Claire D Eliasberg
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, U.S.A
| | - Tim Wang
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, U.S.A
| | - Ryan R Fader
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, U.S.A
| | - Francesca R Coxe
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, U.S.A
| | - Mollyann D Pais
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, U.S.A
| | - Riley J Williams
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, U.S.A
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Abstract
CONTEXT With increasing life expectancy, there is growing demand for preservation of native articular cartilage to delay joint arthroplasties, especially in younger, active patients. Damage to the hyaline cartilage of a joint has a limited intrinsic capacity to heal. This can lead to accelerated degeneration of the joint and early-onset osteoarthritis. Treatment in the past was limited, however, and surgical treatment options continue to evolve that may allow restoration of the natural biology of the articular cartilage. This article reviews the most current literature with regard to indications, techniques, and outcomes of these restorative procedures. EVIDENCE ACQUISITION MEDLINE and PubMed searches relevant to the topic were performed for articles published between 1995 and 2016. Older articles were used for historical reference. This paper places emphasis on evidence published within the past 5 years. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 4. RESULTS Autologous chondrocyte implantation and osteochondral allografts (OCAs) for the treatment of articular cartilage injury allow restoration of hyaline cartilage to the joint surface, which is advantageous over options such as microfracture, which heal with less favorable fibrocartilage. Studies show that these techniques are useful for larger chondral defects where there is no alternative. Additionally, meniscal transplantation can be a valuable isolated or adjunctive procedure to prolong the health of the articular surface. CONCLUSION Newer techniques such as autologous chondrocyte implantation and OCAs may safely produce encouraging outcomes in joint preservation.
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Affiliation(s)
- Philip J. York
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Frank B. Wydra
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Matthew E. Belton
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Armando F. Vidal
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, Colorado
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Abstract
There is an increasing need for articular cartilage restoration procedures. Hyaline cartilage lacks intrinsic healing capacity. Persistent osteochondral defects can lead to early and rapid degenerative changes. Microfracture and autologous chondrocyte implantation provide reasonable outcomes for smaller defects without bone loss. However, these techniques have limited effectiveness for lesions greater than 4 cm2 or with significant bony involvement. Ostochondral allografts provide an option for these lesions. This article reviews osteochondral allografts for articular defects. Emerging options provide different approaches to difficult cartilage defects. We discuss current screening, procurement, and storage methods, surgical techniques, outcomes, and bacterial/viral transmission.
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Affiliation(s)
- Frank B Wydra
- Department of Orthopedics, University of Colorado School of Medicine, 12631 East 17th Avenue, Room 4501 B202, Aurora, CO 80045, USA
| | - Philip J York
- Department of Orthopedics, University of Colorado School of Medicine, 12631 East 17th Avenue, Room 4501 B202, Aurora, CO 80045, USA
| | - Armando F Vidal
- Department of Orthopedics, University of Colorado School of Medicine, 12631 East 17th Avenue, Room 4501 B202, Aurora, CO 80045, USA.
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