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Subramanian A, Bhogoju S, Snaith O, Miller AD, Newell H, Wang D, Siegal G, Oborny K, Baumann-Berg J, Viljoen H. Continuous Low-Intensity Ultrasound Improves Cartilage Repair in Rabbit Model of Subchondral Injury. Tissue Eng Part A 2024; 30:357-366. [PMID: 38318848 PMCID: PMC11040182 DOI: 10.1089/ten.tea.2023.0246] [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: 09/15/2023] [Accepted: 01/11/2024] [Indexed: 02/07/2024] Open
Abstract
Subchondral drilling (SD), a bone marrow stimulation technique, is used to repair cartilage lesions that lack regenerative potential. Cartilage repair outcomes upon SD are typically fibrocartilaginous in nature with inferior functionality. The lack of cues to foster the chondrogenic differentiation of egressed mesenchymal stromal cells upon SD can be attributed for the poor outcomes. Continuous low-intensity ultrasound (cLIUS) at 3.8 MHz is proposed as a treatment modality for improving cartilage repair outcomes upon marrow stimulation. Bilateral defects were created by SD on the femoral medial condyle of female New Zealand white rabbits (n = 12), and the left joint received cLIUS treatment (3.8 MHz, 3.5 Vpp, 8 min/application/day) and the contralateral right joint served as the control. On day 7 postsurgery, synovial fluid was aspirated, and the cytokine levels were assessed by Quantibody™ assay. Rabbits were euthanized at 8 weeks and outcomes were assessed macroscopically and histologically. Defect areas in the right joints exhibited boundaries, incomplete fill, irregular cartilage surfaces, loss of glycosaminoglycan (GAG), and absence of chondrocytes. In contrast, the repaired defect area in the joints that received cLIUS showed complete fill, positive staining for GAG with rounded chondrocyte morphology, COL2A1 staining, and columnar organization. Synovial fluid collected from cLIUS-treated left knee joints had lower levels of IL1, TNFα, and IFNγ when compared to untreated right knee joints, alluding to the potential of cLIUS to mitigate early inflammation. Further at 8 weeks, left knee joints (n = 12) consistently scored higher on the O'Driscoll scale, with a higher percent hyaline cartilage score. No adverse impact on bone or change in the joint space was noted. Upon a single exposure of cLIUS to TNFα-treated cells, nuclear localization of pNFκB and SOX9 was visualized by double immunofluorescence and the expression of markers associated with the NFκB pathway was assayed by quantitative real-time polymerase chain reaction. cLIUS extends its chondroprotective effects by titrating pNFκB levels, preventing its nuclear translocation, while maintaining the expression of SOX9, the collagen II transcription factor. Our combined results demonstrate that healing of chondral defects treated with marrow stimulation by SD can be accelerated by employing cLIUS regimen that possesses chondroinductive and chondroprotective properties. Impact statement Repair of cartilage represents an unsolved biomedical burden. In vitro, continuous low-intensity ultrasound (cLIUS) has been demonstrated to possess chondroinductive and chondroprotective potential. To our best knowledge, the use of cLIUS to improve cartilage repair outcomes upon marrow stimulation, in vivo, has not been reported and our work reported here fills that gap. Our results demonstrated enhanced cartilage repair outcomes under cLIUS (3.8 MHz) in a rabbit model of subchondral injury by subchondral drilling. Enhanced repair stemmed from mesenchymal stem cell differentiation in vivo and the subsequent synthesis of articular cartilage-specific matrix.
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Affiliation(s)
- Anuradha Subramanian
- Department of Chemical and Materials Engineering, The University of Alabama-Huntsville, Huntsville, Alabama, USA
| | - Sarayu Bhogoju
- Department of Chemical and Materials Engineering, The University of Alabama-Huntsville, Huntsville, Alabama, USA
| | - Oraine Snaith
- Life Sciences Annex, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - April D. Miller
- Department of Chemical and Biomolecular Engineering, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Heather Newell
- Department of Chemical and Biomolecular Engineering, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Denzhi Wang
- Life Sciences Annex, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Gene Siegal
- Life Sciences Annex, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Katelin Oborny
- Life Sciences Annex, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Jesse Baumann-Berg
- Life Sciences Annex, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Hendrik Viljoen
- Department of Chemical and Biomolecular Engineering, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
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Kolevar MP, Koshar A, Hirsch J, Choe RH, Wu J, Rocca MS, McLoughlin S, Venable-Croft A, Fisher JP, Packer JD. Development of a patient specific cartilage graft using magnetic resonance imaging and 3D printing. J ISAKOS 2024:S2059-7754(24)00056-7. [PMID: 38556170 DOI: 10.1016/j.jisako.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/25/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVES The goal of this project was to develop and validate a patient-specific, anatomically correct graft for cartilage restoration using magnetic resonance imaging (MRI) data and 3-dimensional (3D) printing technology. The specific aim was to test the accuracy of a novel method for 3D printing and implanting individualized, anatomically shaped bio-scaffolds to treat cartilage defects in a human cadaveric model. We hypothesized that an individualized, anatomic 3D-printed scaffold designed from MRI data would provide a more optimal fill for a large cartilage defect compared to a generic flat scaffold. METHODS Four focal cartilage defects (FCDs) were created in paired human cadaver knees, age <40 years, in the weight-bearing surfaces of the medial femoral condyle (MFC), lateral femoral condyle (LFC), patella, and trochlea of each knee. MRIs were obtained, anatomic grafts were designed and 3D printed for the left knee as an experimental group, and generic flat grafts for the right knee as a control group. Grafts were implanted into corresponding defects and fixed using tissue adhesive. Repeat post-implant MRIs were obtained. Graft step-off was measured as the distance in mm between the surface of the graft and the native cartilage surface in a direction perpendicular to the subchondral bone. Graft contour was measured as the gap between the undersurface of the graft and the subchondral bone in a direction perpendicular to the joint surface. RESULTS Graft step-off was statistically significantly better for the anatomic grafts compared to the generic grafts in the MFC (0.0 ± 0.2 mm vs. 0.7 ± 0.5 mm, p < 0.001), LFC (0.1 ± 0.3 mm vs. 1.0 ± 0.2 mm, p < 0.001), patella (-0.2 ± 0.3 mm vs. -1.2 ± 0.4 mm, p < 0.001), and trochlea (-0.4 ± 0.3 vs. 0.4 ± 0.7, p = 0.003). Graft contour was statistically significantly better for the anatomic grafts in the LFC (0.0 ± 0.0 mm vs. 0.2 ± 0.4 mm, p = 0.022) and trochlea (0.0 ± 0.0 mm vs. 1.4 ± 0.7 mm, p < 0.001). The anatomic grafts had an observed maximum step-off of -0.9 mm and a maximum contour mismatch of 0.8 mm. CONCLUSION This study validates a process designed to fabricate anatomically accurate cartilage grafts using MRI and 3D printing technology. Anatomic grafts demonstrated superior fit compared to generic flat grafts. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Matthew P Kolevar
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Antoan Koshar
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Jeffrey Hirsch
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Robert H Choe
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, 20742, USA
| | - Jocelyn Wu
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Michael S Rocca
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Shannon McLoughlin
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, 20742, USA
| | | | - John P Fisher
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, 20742, USA
| | - Jonathan D Packer
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
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Thomas VJ, Buchweitz NF, Baek JJ, Wu Y, Mercuri JJ. The development of a nucleus pulposus-derived cartilage analog scaffold for chondral repair and regeneration. J Biomed Mater Res A 2024; 112:421-435. [PMID: 37964720 PMCID: PMC10842041 DOI: 10.1002/jbm.a.37639] [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: 08/11/2023] [Revised: 08/16/2023] [Accepted: 10/20/2023] [Indexed: 11/16/2023]
Abstract
Focal chondral defects (FCDs) significantly impede quality of life for patients and impose severe economic costs on society. One of the most promising treatment options-autologous matrix-induced chondrogenesis (AMIC)-could benefit from a scaffold that contains both of the primary cartilage matrix components-sulfated glycosaminoglycans (sGAGs) and collagen type II. Here, 17 different protocols were evaluated to determine the most optimum strategy for decellularizing (decelling) the bovine nucleus pulposus (bNP) to yield a natural biomaterial with a cartilaginous constituency. The resulting scaffold was then characterized with respect to its biochemistry, biomechanics and cytocompatibility. Results indicated that the optimal decell protocol involved pre-crosslinking the tissue prior to undergoing decell with trypsin and Triton X-100. The residual DNA content of the scaffold was found to be 32.64 ± 9.26 ng/mg dry wt. of tissue with sGAG and hydroxyproline (HYP) contents of 72.53 ± 16.43. and 78.38 ± 8.46 μg/mg dry wt. respectively. The dynamic viscoelastic properties were found to be preserved (complex modulus: 17.92-16.62 kPa across a range of frequencies) while the equilibrium properties were found to have significantly decreased (aggregate modulus: 11.51 ± 9.19 kPa) compared to the non-decelled fresh bNP tissue. Furthermore, the construct was also found to be cytocompatible with bone marrow stem cells (BMSCs). While it was not permissive of cellular infiltration, the BMSCs were still found to have lined the laser drilled channels in the scaffold. Taken together, the biomaterial developed herein could be a valuable addition to the AMIC family of scaffolds or serve as an off-the-shelf standalone option for cartilage repair.
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Affiliation(s)
- Vishal Joseph Thomas
- The Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
| | - Nathan Foster Buchweitz
- The Orthopaedic Bioengineering Laboratory, Department of Bioengineering, Clemson University, Charleston, South Carolina, USA
| | - Jay John Baek
- The Orthopaedic Bioengineering Laboratory, Department of Bioengineering, Clemson University, Charleston, South Carolina, USA
| | - Yongren Wu
- The Orthopaedic Bioengineering Laboratory, Department of Bioengineering, Clemson University, Charleston, South Carolina, USA
| | - Jeremy John Mercuri
- The Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
- The Frank H. Stelling and C. Dayton Riddle Orthopaedic Research and Education Laboratory, Clemson University Biomedical Engineering Innovation Campus, Greenville, South Carolina, USA
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Figueroa F, Figueroa D, Calvo R, Stocker E, Itriago M, Nuñez M. Age influences the efficacy of osteochondral autograft transfer: Promising results for patients under 40. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024:S1888-4415(24)00038-9. [PMID: 38246344 DOI: 10.1016/j.recot.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/28/2023] [Accepted: 01/11/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Previous research using osteochondral autograft transfer (OAT) has shown poorer outcomes with increasing patient age. The aim of this article is to evaluate a cohort of patients that received an OAT and to correlate their clinical results with their age at procedure. METHODS Patients that underwent an OAT to treat an osteochondral (OC) lesion with a minimum 24-month follow-up were included. Patients were categorized into two groups based on their age at procedure (<40 years and ≥40 years). Postoperatively, each patient completed the Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC), and Lysholm scales. RESULTS 51 patients were included (35<40 years, 16≥40 years). Mean follow-up was 4.2 years (2-7). For patients<40 years, IKDC averaged 80.8 (SD 15.9) versus 71.2 (SD 19.4) in ≥40 years (p=0.03). For patients <40 years, Lysholm averaged 85.9 (SD 10.8) versus 77.0 (SD 21.6) in ≥40 years (p=0.02). For patients<40 years, KOOS averaged 78.3 (SD 11.8) versus 68.9 (SD 18.5) in ≥40 years (p=0.01). There was a 100% sensibility in identifying all the patients with a poor IKDC and Lysholm from 34 years old (AUC 0.76 and 0.8). CONCLUSIONS OAT has better outcomes in patients younger than 40 years compared to patients older than 40 years. Based on the prognostic capacity of age, the ideal candidate for an OAT is a patient younger than 34 years old.
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Affiliation(s)
- F Figueroa
- Departamento de Ortopedia y Traumatología, Clínica Alemana, Av. Vitacura #5591, Vitacura, Región Metropolitana de Santiago, Chile; Facultad de Medicina, Universidad del Desarrollo, Rep. de Honduras #12590, Las Condes, Región Metropolitana de Santiago, Chile; Departamento de Ortopedia y Traumatología, Hospital Sótero del Río, Av. Concha y Toro #3459, Puente Alto, Región Metropolitana de Santiago, Chile.
| | - D Figueroa
- Departamento de Ortopedia y Traumatología, Clínica Alemana, Av. Vitacura #5591, Vitacura, Región Metropolitana de Santiago, Chile; Facultad de Medicina, Universidad del Desarrollo, Rep. de Honduras #12590, Las Condes, Región Metropolitana de Santiago, Chile
| | - R Calvo
- Departamento de Ortopedia y Traumatología, Clínica Alemana, Av. Vitacura #5591, Vitacura, Región Metropolitana de Santiago, Chile; Facultad de Medicina, Universidad del Desarrollo, Rep. de Honduras #12590, Las Condes, Región Metropolitana de Santiago, Chile
| | - E Stocker
- Departamento de Ortopedia y Traumatología, Clínica Alemana, Av. Vitacura #5591, Vitacura, Región Metropolitana de Santiago, Chile; Facultad de Medicina, Universidad del Desarrollo, Rep. de Honduras #12590, Las Condes, Región Metropolitana de Santiago, Chile
| | - M Itriago
- Departamento de Ortopedia y Traumatología, Clínica Alemana, Av. Vitacura #5591, Vitacura, Región Metropolitana de Santiago, Chile; Facultad de Medicina, Universidad del Desarrollo, Rep. de Honduras #12590, Las Condes, Región Metropolitana de Santiago, Chile
| | - M Nuñez
- Departamento de Ortopedia y Traumatología, Clínica Alemana, Av. Vitacura #5591, Vitacura, Región Metropolitana de Santiago, Chile; Facultad de Medicina, Universidad del Desarrollo, Rep. de Honduras #12590, Las Condes, Región Metropolitana de Santiago, Chile
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Thomas V, Mercuri J. In vitro and in vivo efficacy of naturally derived scaffolds for cartilage repair and regeneration. Acta Biomater 2023; 171:1-18. [PMID: 37708926 DOI: 10.1016/j.actbio.2023.09.008] [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: 05/26/2023] [Revised: 08/13/2023] [Accepted: 09/07/2023] [Indexed: 09/16/2023]
Abstract
Intrinsically present bioactive cues allow naturally derived materials to mimic important characteristics of cartilage while also facilitating cellular recruitment, infiltration, and differentiation. Such traits are often what tissue engineers desire when they fabricate scaffolds, and yet, literature from the past decade is replete with examples of how most natural constructs with native biomolecules have only offered sub-optimal results in the treatment of cartilage defects. This paper provides an in-depth investigation of the performance of such scaffolds through a review of a collection of natural materials that have been used so far in repairing/regenerating articular cartilage. Although in vivo and clinical studies are the best indicators of scaffold efficacy, it was, however, observed that a large number of natural constructs had very promising scaffold characteristics to begin with, and would often show good in vitro/in vivo results. Finally, an examination of the biochemistry and biomechanics of repair tissues in studies that reported positive outcomes showed that these attributes often approached target cartilage values. The paper concludes with an outline of current trends as well as future directions for the field. STATEMENT OF SIGNIFICANCE: This review offers an exclusive focus on natural scaffold materials for cartilage repair and regeneration and provides a quantitative and qualitative analysis of their performance under a variety of in vitro and in vivo conditions. Readers can learn about environments where natural scaffolds have had the most success and tailor strategies to optimize their own work. Furthermore, given how the glycosaminoglycan (GAG) to hydroxyproline (HYP) ratio and moduli are fundamental attributes of hyaline cartilage, this paper adds to the body of knowledge by exploring how these characteristics reflect in preclinical outcomes. Such perspectives can greatly aid researchers better utilize natural materials for Cartilage Tissue Engineering (CTE).
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Affiliation(s)
- Vishal Thomas
- The Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, 401-5 Rhodes Engineering Research Center, Clemson, SC 29631, USA
| | - Jeremy Mercuri
- The Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, 401-5 Rhodes Engineering Research Center, Clemson, SC 29631, USA.
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Bumberger A, Seiferth NL, Angele P, Faber SO, Zellner J, Niemeyer P. Bipolar Lesions of the Knee Are Associated With Inferior Clinical Outcome Following Articular Cartilage Regeneration. A Propensity Score-Matched Analysis Including 238 Patients of the German Cartilage Registry (KnorpelRegister DGOU). Arthroscopy 2023; 39:2167-2173. [PMID: 36931479 DOI: 10.1016/j.arthro.2023.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/22/2023] [Accepted: 02/26/2023] [Indexed: 03/19/2023]
Abstract
PURPOSE To determine whether bipolar lesions (BL) are associated with inferior clinical outcome following articular cartilage regeneration (CR) compared to unipolar lesions (UL). METHODS A registry-based study, including patients undergoing isolated CR for focal knee cartilage lesions was performed. Lesions were considered UL or BL depending on the opposing cartilage. Propensity score matching was applied to eliminate potential confounders. Two groups comprising 119 patients with similar baseline characteristics were matched. The Knee Injury and Osteoarthritis Outcome Score (KOOS) at baseline, 6, 12, 24, and 36 months following CR served as primary outcome measure. KOOS improvement, reaching the minimal clinically important difference (MCID), KOOS subcomponents, and failure rates were calculated. RESULTS Autologous chondrocyte implantation (ACI) was the most frequently performed procedure in both groups with 63.0% (BL) and 46.6% (UL). There was a significant difference regarding KOOS at 24 months between UL (76.39 ± 14.96) and BL (69.83 ± 18.83; P = .028), which did not exceed the threshold of MCID. No significant difference was detected at any other follow-up. KOOS improvement from baseline was lower in the BL group at all follow-ups and peaked at 36 months in both groups (UL [26.00 ± 16.12] vs. BL [16.63 ± 17.29]; P = .024). The failure rate in the BL group was higher at 8.2% (9/110) compared to the UL group at 3.9% (4/98) (P = .256). CONCLUSIONS BL were associated with worse clinical outcome 2 years following CR compared to UL. However, both groups showed an ongoing clinical improvement up to 3 years postoperatively and a low failure rate. While inferior clinical improvement and a lower clinical response rate may be expected in BL patients, the observed differences do not justify excluding these patients from CR. LEVEL OF EVIDENCE Level III, retrospective comparative prognostic trial.
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Affiliation(s)
- Alexander Bumberger
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria; Orthopädische Chirurgie München, Munich, Germany.
| | - Nick Luca Seiferth
- Department of Orthopedics and Trauma Surgery, University Medical Center Freiburg, Albert-Ludwig University of Freiburg, Freiburg, Germany
| | - Peter Angele
- University Medical Center Regensburg, Regensburg, Germany; Sporthopaedicum Regensburg/Straubing, Regensburg, Germany
| | - Svea Olivia Faber
- Muskuloskelettales Universitätszentrum München, LMU Klinikum, Ludwig-Maximilian-University, Munich, Germany
| | | | - Philipp Niemeyer
- Orthopädische Chirurgie München, Munich, Germany; Department of Orthopedics and Trauma Surgery, University Medical Center Freiburg, Albert-Ludwig University of Freiburg, Freiburg, Germany
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Fang CH, Lin YW, Sun CK, Sun JS. Small-Molecule Loaded Biomimetic Biphasic Scaffold for Osteochondral Regeneration: An In Vitro and In Vivo Study. Bioengineering (Basel) 2023; 10:847. [PMID: 37508874 PMCID: PMC10376318 DOI: 10.3390/bioengineering10070847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/31/2023] [Accepted: 07/09/2023] [Indexed: 07/30/2023] Open
Abstract
Osteoarthritis is a prevalent musculoskeletal disorder in the elderly, which leads to high rates of morbidity. Mesenchymal stem cells (MSCs) are a promising approach to promote tissue regeneration in the absence of effective long-term treatments. Small molecules are relatively inexpensive and can selectively alter stem cell behavior during their differentiation, making them an attractive option for clinical applications. In this study, we developed an extracellular matrix (ECM)-based biphasic scaffold (BPS) loaded with two small-molecule drugs, kartogenin (KGN) and metformin (MET). This cell-free biomimetic biphasic scaffold consists of a bone (gelatin/hydroxyapatite scaffold embedded with metformin [GHSM]) and cartilage (nano-gelatin fiber embedded with kartogenin [NGFK]) layer designed to stimulate osteochondral regeneration. Extracellular matrix (ECM)-based biomimetic scaffolds can promote native cell recruitment, infiltration, and differentiation even in the absence of additional growth factors. The biphasic scaffold (BPS) showed excellent biocompatibility in vitro, with mesenchymal stem cells (MSCs) adhering, proliferating, and differentiated on the biomimetic biphasic scaffolds (GHSM and NGFK layers). The biphasic scaffolds upregulated both osteogenic and chondrogenic gene expression, sulfated glycosaminoglycan (sGAG), osteo- and chondrogenic biomarker, and relative mRNA gene expression. In an in vivo rat model, histo-morphological staining showed effective regeneration of osteochondral defects. This novel BPS has the potential to enhance both subchondral bone repair and cartilage regeneration, demonstrating excellent effects on cell homing and the recruitment of endogenous stem cells.
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Affiliation(s)
- Chih-Hsiang Fang
- Trauma and Emergency Center, China Medical University Hospital, No. 2, Xueshi Road, North Dist., Taichung City 40447, Taiwan
| | - Yi-Wen Lin
- Institute of Biomedical Engineering, College of Medicine, National Taiwan University, No. 1, Sec. 4, Roosevelt Road, Taipei 10617, Taiwan
| | - Chung-Kai Sun
- Institute of Traditional Medicine, School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei 11221, Taiwan
| | - Jui-Sheng Sun
- Department of Orthopedic Surgery, En Chu Kong Hospital, No. 399, Fuxing Road, New Taipei City 23741, Taiwan
- Department of Orthopedic Surgery, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 10002, Taiwan
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Shigley C, Trivedi J, Meghani O, Owens BD, Jayasuriya CT. Suppressing Chondrocyte Hypertrophy to Build Better Cartilage. Bioengineering (Basel) 2023; 10:741. [PMID: 37370672 DOI: 10.3390/bioengineering10060741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
Current clinical strategies for restoring cartilage defects do not adequately consider taking the necessary steps to prevent the formation of hypertrophic tissue at injury sites. Chondrocyte hypertrophy inevitably causes both macroscopic and microscopic level changes in cartilage, resulting in adverse long-term outcomes following attempted restoration. Repairing/restoring articular cartilage while minimizing the risk of hypertrophic neo tissue formation represents an unmet clinical challenge. Previous investigations have extensively identified and characterized the biological mechanisms that regulate cartilage hypertrophy with preclinical studies now beginning to leverage this knowledge to help build better cartilage. In this comprehensive article, we will provide a summary of these biological mechanisms and systematically review the most cutting-edge strategies for circumventing this pathological hallmark of osteoarthritis.
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Affiliation(s)
- Christian Shigley
- The Warren Alpert Medical School, Brown University, Providence, RI 02903, USA
| | - Jay Trivedi
- Department of Orthopaedics, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI 02903, USA
| | - Ozair Meghani
- Department of Orthopaedics, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI 02903, USA
| | - Brett D Owens
- Department of Orthopaedics, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI 02903, USA
- Division of Sports Surgery, Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI 02903, USA
| | - Chathuraka T Jayasuriya
- Department of Orthopaedics, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI 02903, USA
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Vinod E, Lisha J J, Parasuraman G, Livingston A, Daniel AJ, Sathishkumar S. Evaluation of ghrelin as a distinguishing marker for human articular cartilage-derived chondrocytes and chondroprogenitors. J Clin Orthop Trauma 2023; 41:102175. [PMID: 37303495 PMCID: PMC10248861 DOI: 10.1016/j.jcot.2023.102175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/22/2023] [Accepted: 05/28/2023] [Indexed: 06/13/2023] Open
Abstract
Purpose of the study Cell-based therapeutics for articular cartilage repair primarily employed bone marrow-derived mesenchymal stem cells and chondrocytes. Research to overcome their limitation of formation of a functionally poor fibro-hyaline type of repair tissue led to the discovery of chondroprogenitors (CPCs), cartilage resident stem cells. These cells isolated by adhesion assay using fibronectin (FAA-CPs) and migration of progenitors from explants (MCPs) display higher chondrogenic and lower terminal differentiation potential. During in-vitro culture, chondrocytes tend to de-differentiate and acquire characteristics similar to stem cells, thus making it challenging to distinguish them from other cell groups. Ghrelin, a cytoplasmic growth hormone secretagogue, has been proposed to play a vital role in chondrogenesis, with reports of its higher expression in chondrocytes than BM-MSCs. The aim of this study was to compare the mRNA expression of Ghrelin between BM-MSCs, chondrocytes, FAA-CPs and MCP and the possibility of it serving as a distinguishing marker. Methods The four populations isolated from three human osteoarthritic knee joints were characterised by CD marker expression for positive (CD 90, CD73 and CD105) and negative (HLA-DR, CD34 and CD45) MSC markers and trilineage differentiation (adipogenic, osteogenic and chondrogenic) and subjected to qRT-PCR to assess Ghrelin's gene expression. Results This study showed that all groups exhibited similar expression of CD markers and multilineage potential. Though chondrocytes showed greater expression of Ghrelin, it was not statistically significant to classify it as a distinguishing marker between these cell populations. Conclusion Ghrelin does not serve to differentiate the subpopulations in terms of their mRNA expression. Further evaluation using their associated enzymes and receptors could provide valuable information to uncover their potential as unequivocal biomarkers.
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Affiliation(s)
- Elizabeth Vinod
- Department of Physiology, Christian Medical College, Vellore, India
- Centre for Stem Cell Research, (A Unit of InStem, Bengaluru), Christian Medical College, Vellore, India
| | - Jeya Lisha J
- Department of Physiology, Christian Medical College, Vellore, India
| | - Ganesh Parasuraman
- Centre for Stem Cell Research, (A Unit of InStem, Bengaluru), Christian Medical College, Vellore, India
| | - Abel Livingston
- Department of Orthopaedics, Christian Medical College, Vellore, India
| | - Alfred Job Daniel
- Department of Orthopaedics, Christian Medical College, Vellore, India
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Pathak P, Fasano J, Kim YC, Song SE, Cho HJ. Design and Fabrication of Micro Saw Enabling Root-Side Cutting of Bone. MICROMACHINES 2023; 14:856. [PMID: 37421089 DOI: 10.3390/mi14040856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 07/09/2023]
Abstract
A novel micro saw was fabricated using a combination of photolithography and electroplating techniques, resembling a miniature timing belt with sideways blades. The rotation or oscillation direction of the micro saw is designed to be perpendicular to the cutting direction so that transverse cutting of the bone is attainable to extract a preoperatively planned bone-cartilage donor for osteochondral auto-graft transplantation. The mechanical property of the fabricated micro saw obtained using the nanoindentation test shows that the mechanical properties of the micro saw are almost an order of magnitude higher than bone, which indicates its potential bone-cutting application. To demonstrate the cutting capability of the fabricated micro saw, an in vitro animal bone cutting was performed using a custom test rig consisting of a microcontroller, 3D printer, and other readily available parts.
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Affiliation(s)
- Pawan Pathak
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL 32816, USA
| | - Jack Fasano
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL 32816, USA
| | - Young-Cheon Kim
- Research Center for Energy and Clean Technology, School of Materials Science and Engineering, Andong National University, Andong 36729, Republic of Korea
| | - Sang-Eun Song
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL 32816, USA
| | - Hyoung Jin Cho
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL 32816, USA
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11
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Demott C, Jones MR, Chesney CD, Grunlan MA. Adhesive Hydrogel Building Blocks to Reconstruct Complex Cartilage Tissues. ACS Biomater Sci Eng 2023; 9:1952-1960. [PMID: 36881710 PMCID: PMC10848198 DOI: 10.1021/acsbiomaterials.2c01438] [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: 12/02/2022] [Accepted: 02/14/2023] [Indexed: 03/09/2023]
Abstract
Cartilage has an intrinsically low healing capacity, thereby requiring surgical intervention. However, limitations of biological grafting and existing synthetic replacements have prompted the need to produce cartilage-mimetic substitutes. Cartilage tissues perform critical functions that include load bearing and weight distribution, as well as articulation. These are characterized by a range of high moduli (≥1 MPa) as well as high hydration (60-80%). Additionally, cartilage tissues display spatial heterogeneity, resulting in regional differences in stiffness that are paramount to biomechanical performance. Thus, cartilage substitutes would ideally recapitulate both local and regional properties. Toward this goal, triple network (TN) hydrogels were prepared with cartilage-like hydration and moduli as well as adhesivity to one another. TNs were formed with either an anionic or cationic 3rd network, resulting in adhesion upon contact due to electrostatic attractive forces. With the increased concentration of the 3rd network, robust adhesivity was achieved as characterized by shear strengths of ∼80 kPa. The utility of TN hydrogels to form cartilage-like constructs was exemplified in the case of an intervertebral disc (IVD) having two discrete but connected zones. Overall, these adhesive TN hydrogels represent a potential strategy to prepare cartilage substitutes with native-like regional properties.
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Affiliation(s)
- Connor
J. Demott
- Department
of Biomedical Engineering, Texas A&M
University, College
Station, Texas 77843-3003, United States
| | - McKenzie R. Jones
- Department
of Biomedical Engineering, Texas A&M
University, College
Station, Texas 77843-3003, United States
| | - Caleb D. Chesney
- Department
of Biomedical Engineering, Texas A&M
University, College
Station, Texas 77843-3003, United States
| | - Melissa A. Grunlan
- Department
of Biomedical Engineering, Texas A&M
University, College
Station, Texas 77843-3003, United States
- Department
of Materials Science & Engineering, Texas A&M University, College
Station, Texas 77843-3003, United States
- Department
of Chemistry, Texas A&M University, College Station, Texas 77843-3003, United States
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12
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Dhillon J, Kraeutler MJ, Fasulo SM, Belk JW, Mulcahey MK, Scillia AJ, McCulloch PC. Cartilage Repair of the Tibiofemoral Joint With Versus Without Concomitant Osteotomy: A Systematic Review of Clinical Outcomes. Orthop J Sports Med 2023; 11:23259671231151707. [PMID: 36970318 PMCID: PMC10034300 DOI: 10.1177/23259671231151707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/10/2022] [Indexed: 03/29/2023] Open
Abstract
Background The extent to which concomitant osteotomy provides an improvement in clinical outcomes after cartilage repair procedures is unclear. Purpose To review the existing literature to compare clinical outcomes of patients undergoing cartilage repair of the tibiofemoral joint with versus without concomitant osteotomy. Study Design Systematic review; Level of evidence, 4. Methods A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching PubMed, the Cochrane Library, and Embase to identify studies that directly compared outcomes between cartilage repair of the tibiofemoral joint alone (group A) versus cartilage repair with concomitant osteotomy (high tibial osteotomy [HTO] or distal femoral osteotomy [DFO]) (group B). Studies on cartilage repair of the patellofemoral joint were excluded. The search terms used were as follows: osteotomy AND knee AND ("autologous chondrocyte" OR "osteochondral autograft" OR "osteochondral allograft" OR microfracture). Outcomes in groups A and B were compared based on reoperation rate, complication rate, procedure payments, and patient-reported outcomes (Knee injury and Osteoarthritis Outcome Score [KOOS], visual analog scale [VAS] for pain, satisfaction, and WOMAC). Results Included in the review were 5 studies (1 level 2 study, 2 level 3 studies, 2 level 4 studies) with 1747 patients in group A and 520 patients in group B. The mean patient ages were 34.7 and 37.5 years in groups A and B, respectively, and the mean lesion sizes were 4.0 and 4.5 cm2, respectively. The mean follow-up time was 44.6 months. The most common lesion location was the medial femoral condyle (n = 999). Preoperative alignment averaged 1.8° and 5.5° of varus in groups A and B, respectively. One study found significant differences between groups in KOOS, VAS, and satisfaction, favoring group B. The reoperation rates were 47.4% and 17.3% in groups A and B, respectively (P < .0001). Conclusion Patients undergoing cartilage repair of the tibiofemoral joint with concomitant osteotomy might be expected to experience greater improvement in clinical outcomes with a lower reoperation rate compared with those undergoing cartilage repair alone. Surgeons preparing for cartilage procedures of the knee joint should pay particular attention to preoperative malalignment of the lower extremity to optimize outcomes.
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Affiliation(s)
- Jaydeep Dhillon
- Rocky Vista University College of Osteopathic Medicine, Parker,
Colorado, USA
| | - Matthew J. Kraeutler
- Department of Orthopedics & Sports Medicine, Houston Methodist
Hospital, Houston, Texas, USA
- Matthew J. Kraeutler, MD, Department of Orthopedics & Sports
Medicine, Houston Methodist Hospital, 6445 Main Street, Suite 2300, Houston, TX
77030, USA ()
| | - Sydney M. Fasulo
- Department of Orthopaedic Surgery, St. Joseph’s University Medical
Center, Paterson, New Jersey, USA
| | - John W. Belk
- University of Colorado School of Medicine, Aurora, Colorado,
USA
| | - Mary K. Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of
Medicine, New Orleans, Louisiana, USA
| | - Anthony J. Scillia
- Department of Orthopaedic Surgery, St. Joseph’s University Medical
Center, Paterson, New Jersey, USA
- Academy Orthopaedics, Wayne, New Jersey, USA
| | - Patrick C. McCulloch
- Department of Orthopedics & Sports Medicine, Houston Methodist
Hospital, Houston, Texas, USA
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13
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Demott CJ, Grunlan MA. Emerging polymeric material strategies for cartilage repair. J Mater Chem B 2022; 10:9578-9589. [PMID: 36373438 DOI: 10.1039/d2tb02005j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cartilage is found throughout the body, serving an array of essential functions. Owing to the limited healing capacity of cartilage, damage or degeneration is often permanent and so requires clinical intervention. Established surgical techniques generally rely on biological grafting. However, recent advances in polymeric materials provide an encouraging alternative to overcome limits of auto- and allografts. For regenerative engineering of cartilage, a polymeric scaffold ideally supports and instructs tissue regeneration while also providing mechanical integrity. Scaffolds direct regeneration via chemical and mechanical cues, as well as delivery and support of exogenous cells and bioactive factors. Advanced polymeric scaffolds aim to direct regeneration locally, replicating the heterogeneities of native tissues. Alternatively, new cartilage-mimetic hydrogels have potential to serve as synthetic cartilage replacements. Prepared as multi-network or composite hydrogels, the most promising candidates have simultaneously realized the hydration, mechanical, and tribological properties of native cartilage. Collectively, the recent rise in polymers for cartilage regeneration and replacement proposes a changing paradigm, with a new generation of materials paving the way for improved clinical outcomes.
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Affiliation(s)
- Connor J Demott
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843-3003, USA
| | - Melissa A Grunlan
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843-3003, USA.,Department of Materials Science & Engineering, Texas A&M University, College Station, TX 77843-3003, USA.,Department of Chemistry, Texas A&M University, College Station, TX 77843-3003, USA.
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14
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Demott CJ, Jones MR, Chesney CD, Yeisley DJ, Culibrk RA, Hahn MS, Grunlan MA. Ultra-High Modulus Hydrogels Mimicking Cartilage of the Human Body. Macromol Biosci 2022; 22:e2200283. [PMID: 36040017 DOI: 10.1002/mabi.202200283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/12/2022] [Indexed: 12/25/2022]
Abstract
The human body is comprised of numerous types of cartilage with a range of high moduli, despite their high hydration. Owing to the limitations of cartilage tissue healing and biological grafting procedures, synthetic replacements have emerged but are limited by poorly matched moduli. While conventional hydrogels can achieve similar hydration to cartilage tissues, their moduli are substantially inferior. Herein, triple network (TN) hydrogels are prepared to synergistically leverage intra-network electrostatic repulsive and hydrophobic interactions, as well as inter-network electrostatic attractive interactions. They are comprised of an anionic 1st network, a neutral 2nd network (capable of hydrophobic associations), and a cationic 3rd network. Collectively, these interactions act synergistically as effective, yet dynamic crosslinks. By tuning the concentration of the cationic 3rd network, these TN hydrogels achieve high moduli of ≈1.5 to ≈3.5 MPa without diminishing cartilage-like water contents (≈80%), strengths, or toughness values. This unprecedented combination of properties poises these TN hydrogels as cartilage substitutes in applications spanning articulating joints, intervertebral discs (IVDs), trachea, and temporomandibular joint disc (TMJ).
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Affiliation(s)
- Connor J Demott
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, 77843-3003, USA
| | - McKenzie R Jones
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, 77843-3003, USA
| | - Caleb D Chesney
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, 77843-3003, USA
| | - Daniel J Yeisley
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, 12180-3590, USA
| | - Robert A Culibrk
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, 12180-3590, USA
| | - Mariah S Hahn
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, 12180-3590, USA
| | - Melissa A Grunlan
- Department of Biomedical Engineering, Department of Materials Science & Engineering, and Department of Chemistry, Texas A&M University, College Station, TX, 77843-3003, USA
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15
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Koh J, Diaz RL, Tafur JC, Lin Y, Echenique DB, Amirouche F. Small Chondral Defects Affect Tibiofemoral Contact Area and Stress: Should a Lower Threshold Be Used for Intervention? Orthop J Sports Med 2022; 10:23259671221129308. [PMID: 36419474 PMCID: PMC9677309 DOI: 10.1177/23259671221129308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/27/2022] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Chondral defects in the knee have biomechanical differences because of defect size and location. Prior literature only compares the maximum stress experienced with large defects. HYPOTHESIS It was hypothesized that pressure surrounding the chondral defect would increase with size and vary in location, such that a size cutoff exists that suggests surgical intervention. STUDY DESIGN Controlled laboratory study. METHODS Isolated chondral defects from 0.09 to 1.0 cm2 were created on the medial and lateral femoral condyles of 6 human cadaveric knees. The knees were fixed to a uniaxial load frame and loaded from 0 to 600 N at full extension. Another defect was created at the point of tibiofemoral contact at 30° of flexion. Tibiofemoral contact pressures were measured. Peak contact pressure was the highest value in the area delimited within a 3-mm rim around the defect. The location of the peak contact pressure was determined. RESULTS At full extension, the mean maximum pressures on the medial femoral condyle ranged from 4.30 to 6.91 MPa at 0.09 and 1.0 cm2, respectively (P < .01). The location of the peak pressure was found posteromedial in defects between 0.09 and 0.25 cm2, shifting anterolaterally at sizes 0.49 and 1.0 cm2 (P < .01). The maximum pressures on the lateral femoral condyle ranged from 3.63 to 5.81 MPa at 0.09 and 1.0 cm2, respectively (P = .02). The location of the peak contact pressure point was anterolateral in defects between 0.09 and 0.25 cm2, shifting posterolaterally at 0.49 and 1.0 cm2 (P < .01). No differences in contact pressure between full extension and 30° of flexion were found for either the lateral or medial condyles. CONCLUSION Full-thickness chondral defects bilaterally had a significant increase in contact pressure between defect sizes of 0.49 and 1.0 cm2. The location of the maximum contact pressures surrounding the lesion also varied with larger defects. Contact area redistribution and cartilage stress change may affect adjacent cartilage integrity. CLINICAL RELEVANCE Size cutoffs may exist earlier in the natural history of chondral defects than previously realized, suggesting a lower threshold for intervention.
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Affiliation(s)
- Jason Koh
- Orthopaedic and Spine Institute, NorthShore University Health
System, Evanston, Illinois, USA
| | - Roberto Leonardo Diaz
- Department of Orthopaedics, University of Illinois at Chicago,
Chicago, Illinois, USA
| | - Julio Castillo Tafur
- Department of Orthopaedics, University of Illinois at Chicago,
Chicago, Illinois, USA
| | - Ye Lin
- Department of Orthopaedics, University of Illinois at Chicago,
Chicago, Illinois, USA
| | | | - Farid Amirouche
- Orthopaedic and Spine Institute, NorthShore University Health
System, Evanston, Illinois, USA
- Department of Orthopaedics, University of Illinois at Chicago,
Chicago, Illinois, USA
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16
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Advances in Biomaterial-Mediated Gene Therapy for Articular Cartilage Repair. Bioengineering (Basel) 2022; 9:bioengineering9100502. [PMID: 36290470 PMCID: PMC9598732 DOI: 10.3390/bioengineering9100502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022] Open
Abstract
Articular cartilage defects caused by various reasons are relatively common in clinical practice, but the lack of efficient therapeutic methods remains a substantial challenge due to limitations in the chondrocytes’ repair abilities. In the search for scientific cartilage repair methods, gene therapy appears to be more effective and promising, especially with acellular biomaterial-assisted procedures. Biomaterial-mediated gene therapy has mainly been divided into non-viral vector and viral vector strategies, where the controlled delivery of gene vectors is contained using biocompatible materials. This review will introduce the common clinical methods of cartilage repair used, the strategies of gene therapy for cartilage injuries, and the latest progress.
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17
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Gobbi A, Lane JG, Morales M, D'Ambrosi R. Articular cartilage delamination at eight years following cellular-based repair procedures: a case reports. J Exp Orthop 2022; 9:90. [PMID: 36069954 PMCID: PMC9452617 DOI: 10.1186/s40634-022-00527-2] [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] [Received: 05/07/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022] Open
Abstract
This report describes two cases of late cartilage delamination in two young adults after two different autologous cell-based techniques for cartilage restoration: 1. Matrix-assisted autologous chondrocyte implantation (MACI) and 2. Hyaluronic acid-bone marrow aspirate concentrate (HA-BMAC). Both cases demonstrate that even in patients who do not present with any ongoing symptoms after primary surgery, a cellular-based graft's subsequent delamination can occur later. It is possible that regardless of the technique used or the time passed since the surgery, a graft failure may occur at some level, causing delamination of a previously asymptomatic cartilage restoration graft and a traumatic event with long-term follow-up. Surgeons must be alert to this injury and describe histologic findings to determine where failure occurs.
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Affiliation(s)
- Alberto Gobbi
- O.A.S.I. Bioresearch Foundation Gobbi Onlus, Milan, Italy
| | - John G Lane
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, USA
| | | | - Riccardo D'Ambrosi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy. .,Dipartimento Di Scienze Biomediche Per La Salute, Università Degli Studi Di Milano, Milan, Italy.
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18
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Lai WC, Bohlen HL, Fackler NP, Wang D. Osteochondral Allografts in Knee Surgery: Narrative Review of Evidence to Date. Orthop Res Rev 2022; 14:263-274. [PMID: 35979427 PMCID: PMC9377395 DOI: 10.2147/orr.s253761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 08/08/2022] [Indexed: 01/14/2023] Open
Abstract
Knee articular cartilage defects can result in significant pain and loss of function in active patients. Osteochondral allograft (OCA) transplantation offers a single-stage solution to address large chondral and osteochondral defects by resurfacing focal cartilage defects with mature hyaline cartilage. To date, OCA transplantation of the knee has demonstrated excellent clinical outcomes and long-term survivorship. However, significant variability still exists among clinicians with regard to parameters for graft acceptance, surgical technique, and rehabilitation. Technologies to optimize graft viability during storage, improve osseous integration of the allograft, and shorten recovery timelines after surgery continue to evolve. The purpose of this review is to examine the latest evidence on treatment indications, graft storage and surgical technique, patient outcomes and survivorship, and rehabilitation after surgery.
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Affiliation(s)
- Wilson C Lai
- Department of Orthopaedic Surgery, UCI Health, Orange, CA, USA
| | - Hunter L Bohlen
- Department of Orthopaedic Surgery, UCI Health, Orange, CA, USA
| | - Nathan P Fackler
- Department of Orthopaedic Surgery, UCI Health, Orange, CA, USA.,Georgetown University School of Medicine, Washington, DC, USA
| | - Dean Wang
- Department of Orthopaedic Surgery, UCI Health, Orange, CA, USA.,Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
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19
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The Utilization of Osteoarticular Transfer System in the Treatment of Distal Femur Osteoid Osteoma: A Case Report. Tech Orthop 2022. [DOI: 10.1097/bto.0000000000000598] [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: 11/26/2022]
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20
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Steele JAM, Moore AC, St-Pierre JP, McCullen SD, Gormley AJ, Horgan CC, Black CR, Meinert C, Klein T, Saifzadeh S, Steck R, Ren J, Woodruff MA, Stevens MM. In vitro and in vivo investigation of a zonal microstructured scaffold for osteochondral defect repair. Biomaterials 2022; 286:121548. [PMID: 35588688 PMCID: PMC7615488 DOI: 10.1016/j.biomaterials.2022.121548] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/28/2022] [Accepted: 04/23/2022] [Indexed: 01/15/2023]
Abstract
Articular cartilage is comprised of zones that vary in architecture, extracellular matrix composition, and mechanical properties. Here, we designed and engineered a porous zonal microstructured scaffold from a single biocompatible polymer (poly [ϵ-caprolactone]) using multiple fabrication strategies: electrospinning, spherical porogen leaching, directional freezing, and melt electrowriting. With this approach we mimicked the zonal structure of articular cartilage and produced a stiffness gradient through the scaffold which aligns with the mechanics of the native tissue. Chondrocyte-seeded scaffolds accumulated extracellular matrix including glycosaminoglycans and collagen II over four weeks in vitro. This prompted us to further study the repair efficacy in a skeletally mature porcine model. Two osteochondral lesions were produced in the trochlear groove of 12 animals and repaired using four treatment conditions: (1) microstructured scaffold, (2) chondrocyte seeded microstructured scaffold, (3) MaioRegen™, and (4) empty defect. After 6 months the defect sites were harvested and analyzed using histology, micro computed tomography, and Raman microspectroscopy mapping. Overall, the scaffolds were retained in the defect space, repair quality was repeatable, and there was clear evidence of osteointegration. The repair quality of the microstructured scaffolds was not superior to the control based on histological scoring; however, the lower score was biased by the lack of histological staining due to the limited degradation of the implant at 6 months. Longer follow up studies (e.g., 1 yr) will be required to fully evaluate the efficacy of the microstructured scaffold. In conclusion, we found consistent scaffold retention, osteointegration, and prolonged degradation of the microstructured scaffold, which we propose may have beneficial effects for the long-term repair of osteochondral defects.
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Affiliation(s)
- Joseph A M Steele
- Department of Materials, Imperial College London, SW7 2AZ, UK; Department of Bioengineering, Imperial College London, SW7 2AZ, UK; Institute of Biomedical Engineering, Imperial College London, SW7 2AZ, UK; Division of Biomaterials and Regenerative Medicine, Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm, SE 171 77, Sweden
| | - Axel C Moore
- Department of Materials, Imperial College London, SW7 2AZ, UK; Department of Bioengineering, Imperial College London, SW7 2AZ, UK; Institute of Biomedical Engineering, Imperial College London, SW7 2AZ, UK
| | - Jean-Philippe St-Pierre
- Department of Materials, Imperial College London, SW7 2AZ, UK; Department of Bioengineering, Imperial College London, SW7 2AZ, UK; Institute of Biomedical Engineering, Imperial College London, SW7 2AZ, UK
| | - Seth D McCullen
- Department of Materials, Imperial College London, SW7 2AZ, UK; Department of Bioengineering, Imperial College London, SW7 2AZ, UK; Institute of Biomedical Engineering, Imperial College London, SW7 2AZ, UK
| | - Adam J Gormley
- Department of Materials, Imperial College London, SW7 2AZ, UK; Department of Bioengineering, Imperial College London, SW7 2AZ, UK; Institute of Biomedical Engineering, Imperial College London, SW7 2AZ, UK; Division of Biomaterials and Regenerative Medicine, Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm, SE 171 77, Sweden
| | - Conor C Horgan
- Department of Materials, Imperial College London, SW7 2AZ, UK; Department of Bioengineering, Imperial College London, SW7 2AZ, UK; Institute of Biomedical Engineering, Imperial College London, SW7 2AZ, UK
| | - Cameron Rm Black
- Bone and Joint Research Group, Centre for Human Development, Stem Cells and Regeneration, Developmental Origins of Health and Disease, Institute of Developmental Sciences, University of Southampton Medical School, Southampton, SO16 6YD, UK; Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia; Medical Engineering Research Facility, Queensland University of Technology, Brisbane, Australia
| | - Christoph Meinert
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Travis Klein
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia; ARC Training Centre in Additive Biomanufacturing, Brisbane, Australia
| | - Siamak Saifzadeh
- Medical Engineering Research Facility, Queensland University of Technology, Brisbane, Australia
| | - Roland Steck
- Medical Engineering Research Facility, Queensland University of Technology, Brisbane, Australia
| | - Jiongyu Ren
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia; ARC Training Centre in Additive Biomanufacturing, Brisbane, Australia
| | - Maria A Woodruff
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia; ARC Training Centre in Additive Biomanufacturing, Brisbane, Australia.
| | - Molly M Stevens
- Department of Materials, Imperial College London, SW7 2AZ, UK; Department of Bioengineering, Imperial College London, SW7 2AZ, UK; Institute of Biomedical Engineering, Imperial College London, SW7 2AZ, UK; Division of Biomaterials and Regenerative Medicine, Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm, SE 171 77, Sweden.
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21
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Crowley SG, Pedersen A, Fortney TA, Swindell HW, Saltzman BM, Popkin CA, Trofa DP. Rehabilitation Variability Following Osteochondral Autograft and Allograft Transplantation of the Knee. Cartilage 2022; 13:19476035221093071. [PMID: 35762400 PMCID: PMC9247380 DOI: 10.1177/19476035221093071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The aim of this study is to assess the variability of postoperative rehabilitation protocols used by orthopedic surgery residency programs for osteochondral autograft transplantation (OAT) and osteochondral allograft transplantation (OCA) of the knee. DESIGN Online postoperative OAT and OCA rehabilitation protocols from US orthopedic programs and the scientific literature were reviewed. A custom scoring rubric was developed to analyze each protocol for the presence of discrete rehabilitation modalities and the timing of each intervention. RESULTS A total of 16 programs (10.3%) from 155 US academic orthopedic programs published online protocols and a total of 35 protocols were analyzed. Twenty-one protocols (88%) recommended immediate postoperative bracing following OAT and 17 protocols (100%) recommended immediate postoperative bracing following OCA. The average time protocols permitted weight-bearing as tolerated (WBAT) was 5.2 weeks (range = 0-8 weeks) following OAT and 6.2 weeks (range = 0-8 weeks) following OCA. There was considerable variation in the inclusion and timing of strength, proprioception, agility, and pivoting exercises. Following OAT, 2 protocols (8%) recommended functional testing as criteria for return to sport at an average time of 12.0 weeks (range = 12-24 weeks). Following OCA, 1 protocol (6%) recommended functional testing as criteria for return to sport at an average time of 12.0 weeks (range = 12-24 weeks). CONCLUSION A minority of US academic orthopedic programs publish OAT and OCA rehabilitation protocols online. Among the protocols currently available, there is significant variability in the inclusion of specific rehabilitation components and timing of many modalities. Evidence-based standardization of elements of postoperative rehabilitation may help improve patient care and subsequent outcomes.
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Affiliation(s)
- Stephen G. Crowley
- Albany Medical Center, Albany, NY,
USA,Stephen G. Crowley, Albany Medical Center,
Albany, NY 12208, USA.
| | | | - Thomas A. Fortney
- Center for Shoulder, Elbow and Sports
Medicine, Columbia University, New York, NY, USA
| | | | | | - Charles A. Popkin
- Center for Shoulder, Elbow and Sports
Medicine, Columbia University, New York, NY, USA
| | - David P. Trofa
- Center for Shoulder, Elbow and Sports
Medicine, Columbia University, New York, NY, USA
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22
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Heiss DMR, Guermazi A, Janka PDMR, Uder PDMM, Li X, Hayashi D, Roemer FW. Update: Posttreatment Imaging of the Knee after Cartilage Repair. Semin Musculoskelet Radiol 2022; 26:216-229. [PMID: 35654091 DOI: 10.1055/s-0042-1743405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Focal cartilage lesions are common pathologies at the knee joint that are considered important risk factors for the premature development of osteoarthritis. A wide range of surgical options, including but not limited to marrow stimulation, osteochondral auto- and allografting, and autologous chondrocyte implantation, allows for targeted treatment of focal cartilage defects. Arthroscopy is the standard of reference for the assessment of cartilage integrity and quality before and after repair. However, deep cartilage layers, intrachondral composition, and the subchondral bone are only partially or not at all visualized with arthroscopy. In contrast, magnetic resonance imaging offers noninvasive evaluation of the cartilage repair site, the subchondral bone, and the soft tissues of the joint pre- and postsurgery. Radiologists need to be familiar with the different surgical procedures available and their characteristic postsurgical imaging appearances to assess treatment success and possible complications adequately. We provide an overview of the most commonly performed surgical procedures for cartilage repair at the knee and typical postsurgical imaging characteristics.
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Affiliation(s)
- Dr Med Rafael Heiss
- Department of Radiology, Universityhospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Ali Guermazi
- Department of Radiology, VA Healthcare System, West Roxbury, Massachusetts.,Department of Radiology, Boston University School of Medicine, Boston, Massachusetts
| | - Prof Dr Med Rolf Janka
- Department of Radiology, Universityhospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Prof Dr Med Michael Uder
- Department of Radiology, Universityhospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Xinning Li
- Department of Orthopedic Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Daichi Hayashi
- Department of Radiology, Stony Brook University Renaissance School of Medicine, Stony Brook, New York
| | - Frank W Roemer
- Department of Radiology, Universityhospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.,Department of Radiology, Boston University School of Medicine, Boston, Massachusetts
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Nagelli CV, De La Vega RE, Coenen M, De Padilla CL, Panos JA, Tovar A, Müller SA, Evans CH. Expedited gene delivery for osteochondral defect repair in a rabbit knee model: A one-year investigation. OSTEOARTHRITIS AND CARTILAGE OPEN 2022; 4. [PMID: 36338933 PMCID: PMC9635382 DOI: 10.1016/j.ocarto.2022.100257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective: To evaluate a single-step, gene-based procedure for repairing osteochondral lesions. Design: Osteochondral lesions were created in the patellar groove of skeletally mature rabbits. Autologous bone marrow aspirates were mixed with adenovirus vectors carrying cDNA encoding green fluorescent protein (Ad.GFP) or transforming growth factor-β1 (Ad.TGF-β1) and allowed to clot. The clotted marrow was press-fit into the defects. Animals receiving Ad.GFP were euthanized at 2 weeks and intra-articular expression of GFP examined by fluorescence microscopy. Animals receiving Ad.TGF-β1 were euthanized at 3 months and 12 months; repair was compared to empty defects using histology and immunohistochemistry. Complementary in vitro experiments assessed transgene expression and chondrogenesis in marrow clots and fibrin gels. In a subsequent pilot study, repair at 3 months using a fibrin gel to encapsulate Ad.TGF-β1 was evaluated. Results: At 2 weeks, GFP expression was seen at variable levels within the cartilaginous lesion. At 3 months, there was no statistically significant improvement (p > 0.05) in healing of lesions receiving Ad.TGF-β1 and variability was high. At 12 months, there were still no significant difference (p > 0.05) between the empty defects and those receiving Ad.TGF-β1 in the overall, cartilage, and bone scores. Variability was still high. In vitro experiments suggested that variability reflected variable transduction efficiency and chondrogenic activity of the marrow clots; using fibrin gels instead of marrow may address this issue but more research is needed. Conclusions: This approach to improving the repair of osteochondral lesions needs further refinement to reduce variability and provide a more robust outcome.
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Corncob Cellulose Scaffolds: A New Sustainable Temporary Implant for Cartilage Replacement. J Funct Biomater 2022; 13:jfb13020063. [PMID: 35645271 PMCID: PMC9149862 DOI: 10.3390/jfb13020063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/12/2022] [Accepted: 05/19/2022] [Indexed: 01/16/2023] Open
Abstract
Tissue engineering using scaffolds is a promising strategy to repair damaged articular cartilage, whose self-repair is inefficient. Cellulose properties have been recognized for their application in the biomedical field. The aim of this study was to fabricate and characterize novel scaffolds based on poly(ɛ-caprolactone) (PCL) and sustainable cellulose. Thus, the performance of corncob-derived cellulose (CC) in scaffolds as an alternative to wood cellulose (WC) was also investigated to reduce the environmental footprint. Two concentrations of CC in scaffolds were tested, 1% and 2% (w/w), and commercial WC using the same concentrations, as a control. Morphologically, all the developed scaffolds presented pore sizes of ~300 µm, 10 layers, a circular shape and well-dispersed cellulose. Thus, all of these characteristics and properties provide the manufactured scaffolds suitable for use in cartilage-replacement strategies. The use of 2% CC results in higher porosity (54.24%), which promotes cell infiltration/migration and nutrient exchange, and has similar mechanical properties to WC. As for the effects of enzymatic degradation of the scaffolds, no significant changes (p > 0.05) were observed in resistance over time. However, the obtained compressive modulus of the scaffold with 2% CC was similar to that of WC. Overall, our results suggest that the integration of 2% corncob cellulose in PCL scaffolds could be a novel way to replace wood-cellulose-containing scaffolds, highlighting its potential for cartilage-replacement strategies.
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25
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Lee DR, Reinholz AK, Till SE, Lu Y, Camp CL, DeBerardino TM, Stuart MJ, Krych AJ. Current Reviews in Musculoskeletal Medicine: Current Controversies for Treatment of Meniscus Root Tears. Curr Rev Musculoskelet Med 2022; 15:231-243. [PMID: 35476312 PMCID: PMC9276892 DOI: 10.1007/s12178-022-09759-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The role of the meniscus in preserving the biomechanical function of the knee joint has been clearly defined. The hypothesis that meniscus root integrity is a prerequisite for meniscus function is supported by the development of progressive knee osteoarthritis (OA) following meniscus root tears (MRTs) treated either non-operatively or with meniscectomy. Consequently, there has been a resurgence of interest in the diagnosis and treatment of MRTs. This review examines the contemporary literature surrounding the natural history, clinical presentation, evaluation, preferred surgical repair technique and outcomes. RECENT FINDINGS Surgeons must have a high index of suspicion in order to diagnose a MRT because of the nonspecific clinical presentation and difficult visualization on imaging. Compared with medial MRTs that commonly occur in middle age/older patients, lateral meniscus root injuries tend to occur in younger males with lower BMIs, less cartilage degeneration, and with concomitant ligament injury. Subchondral insufficiency fractures of the knee have been found to be associated with both MRTs and following arthroscopic procedures. Meniscus root repair has demonstrated good outcomes, and acute injuries with intact cartilage should be repaired. Cartilage degeneration, BMI, and malalignment are important considerations when choosing surgical candidates. Meniscus centralization has emerged as a viable adjunct strategy aimed at correcting meniscus extrusion. Meniscus root repair results in a decreased rate of OA and arthroplasty and is economically advantageous when compared with nonoperative treatment and partial meniscectomy. The transtibial pull-through technique with the addition of centralization for the medial meniscus is associated with encouraging early results.
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Affiliation(s)
- Dustin R. Lee
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Anna K. Reinholz
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Sara E. Till
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Yining Lu
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Christopher L. Camp
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Thomas M. DeBerardino
- Department of Orthopaedics, Joe R. and Teresa Lozano Long School of Medicine, UT Health San Antonio, San Antonio, TX USA
| | - Michael J. Stuart
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
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26
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Strickland CD, Ho CK, Merkle AN, Vidal AF. MR Imaging of Knee Cartilage Injury and Repair Surgeries. Magn Reson Imaging Clin N Am 2022; 30:227-239. [DOI: 10.1016/j.mric.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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27
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Yari D, Ebrahimzadeh MH, Movaffagh J, Shahroodi A, Shirzad M, Qujeq D, Moradi A. Biochemical Aspects of Scaffolds for Cartilage Tissue Engineering; from Basic Science to Regenerative Medicine. THE ARCHIVES OF BONE AND JOINT SURGERY 2022; 10:229-244. [PMID: 35514762 PMCID: PMC9034797 DOI: 10.22038/abjs.2022.55549.2766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 01/19/2022] [Indexed: 12/14/2022]
Abstract
Chondral defects are frequent and important causes of pain and disability. Cartilage has limited self-repair and regeneration capacity. The ideal approach for articular cartilage defects is the regeneration of hyaline cartilage with sustainable symptom-free constructs. Tissue engineering provides new strategies for the regeneration of functional cartilage tissue through optimized scaffolds with architectural, mechanical, and biochemical properties similar to the native cartilage tissue. In this review, the basic science of cartilage structure, interactions between proteins, stem cells, as well as biomaterials, scaffold characteristics and fabrication methods, as well as current and potential therapies in regenerative medicine will be discussed mostly from a biochemical point of view. Furthermore, the recent trends in scaffold-based therapies and supplementary factors in cartilage tissue engineering will be considered.
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Affiliation(s)
- Davood Yari
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran,Department of Clinical Biochemistry, Babol University of Medical Sciences, Babol, Iran,Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Jebrail Movaffagh
- Department of Pharmaceutics, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Azadeh Shahroodi
- Department of Pharmaceutics, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Moein Shirzad
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran,Department of Clinical Biochemistry, Babol University of Medical Sciences, Babol, Iran
| | - Durdi Qujeq
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran,Department of Clinical Biochemistry, Babol University of Medical Sciences, Babol, Iran
| | - Ali Moradi
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran,Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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Melugin HP, Bernard CD, Camp CL, Saris DB, Krych AJ. Bipolar Cartilage Lesions of the Knee: A Systematic Review of Techniques, Outcomes, and Complications. Cartilage 2021; 13:17S-30S. [PMID: 31204486 PMCID: PMC8808778 DOI: 10.1177/1947603519855761] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The purpose of this systematic review was to determine (1) treatment options for bipolar cartilage lesions of the knee, (2) patient-reported outcomes following various surgical treatments, and (3) complication and failure rates following surgery. DESIGN A literature search of PubMed, the Cochrane Library, and CINHAL was performed using PRISMA guidelines. Patients were included if they had bipolar cartilage lesions of the knee treated surgically. Lesion characteristics, surgical technique, patient-reported outcomes, complication rates, failure rates, and survivorship were recorded. RESULTS Fourteen studies yielded 301 knees treated surgically. Patient age ranged from 15 to 74 years. Surgical techniques included 138 autologous chondrocyte implantation (ACI), 156 osteochondral allograft transplantation (OCA), and 7 osteochondral autograft transfer system (OATS). Seven studies reported a concomitant procedure rate that ranged from 0% to 88%. Eight studies reported that both reciprocal lesions received surgical treatment, while 6 studies did not specify. Lesion size ranged from 1 to 41 cm2. All reported postoperative improvements in patient-reported outcomes, but the measures were very heterogeneous. There were no major complications and the rate of minor complications ranged from 0% to 50%. Survivorship ranged from 40% to 100% for OCA, 76% to 95% for ACI, and 100% for the 1 study evaluating OATS. CONCLUSIONS Bipolar cartilage lesions of the knee typically involve a large surface area and are most commonly treated with ACI or OCA, while OATS may be an option for smaller lesions. Improvements in mid-term patient-reported outcomes were reported for all surgical procedures and they can be performed safely with a low rate of major complications.
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Affiliation(s)
- Heath P. Melugin
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA
| | | | | | | | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA
- Aaron J. Krych, Department of Orthopedic
Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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29
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Melugin HP, Bernard CD, Camp CL, Stuart MJ, Saris DB, Nakamura N, Krych AJ. Tibial Plateau Cartilage Lesions: A Systematic Review of Techniques, Outcomes, and Complications. Cartilage 2021; 13:31S-41S. [PMID: 31204491 PMCID: PMC8808855 DOI: 10.1177/1947603519855767] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE The purpose of this systematic review is to determine (1) current reported treatment options for isolated tibial plateau (TP) cartilage lesions, (2) patient reported outcomes following various treatments, and (3) complication rate and survivorship following various treatments. DESIGN A literature search of PubMed, the Cochrane Library, and CINAHL was conducted adhering to PRISMA guidelines. Patients were included if they had TP cartilage lesions treated with surgery. Lesion characteristics, surgical procedure details, patient reported outcomes, complication, and failure rates were collected. RESULTS Thirteen studies yielded 205 knees with TP cartilage lesions treated surgically. Ages ranged from 12 to 77 years. Surgical techniques included 138 treated with osteochondral allograft transplantation (OCA), 37 treated with osteochondral autograft transfer system (OATS), 11 treated with microfracture, 11 treated with an osteochondral scaffold, and 8 treated with autologous chondrocyte implantation (ACI). The patient-reported outcome measures were heterogeneous, but all reported improvements with the notable exception of one study evaluating microfracture. The rate of complications ranged from 0% to 4.6%. Failure rate ranged from 22% to 46% for OCA and 0% to 16% for OATS. No failures were reported for the additional techniques. CONCLUSIONS Various surgical techniques have been utilized for the treatment of TP cartilage lesions. Patient-reported outcome measures were heterogeneous, but improvements were reported following all surgical treatments except for microfracture, which resulted in decreased scores at mid-term follow-up. The complication rate was low for all techniques described. However, the failure rate was higher following unicondylar OCA for salvage treatment of posttraumatic deformities.
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Affiliation(s)
- Heath P. Melugin
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA
| | | | | | | | | | - Norimasa Nakamura
- Department of Orthopaedics, Osaka
University Graduate School of Medicine, Osaka, Japan
| | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA,Aaron J. Krych, Department of Orthopedic
Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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30
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Grande D, Goldstein T, Turek TJ, Hennessy S, Walgenbach AW, Do LHD, Greene D, Stone KR. Osteochondral Autograft Plugs versus Paste Graft: Ex Vivo Morselization Increases Chondral Matrix Production. Cartilage 2021; 13:1058S-1065S. [PMID: 32396463 PMCID: PMC8808900 DOI: 10.1177/1947603520916552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Patients undergoing articular cartilage paste grafting have been shown in studies to have significant improvement in pain and function in long-term follow-ups. We hypothesized that ex vivo impacting of osteochondral autografts results in higher chondrocyte matrix production versus intact osteochondral autograft plugs. DESIGN This institutional review board-approved study characterizes the effects of impacting osteochondral plugs harvested from the intercondylar notch of 16 patients into a paste, leaving one graft intact as a control. Cell viability/proliferation, collagen type I/II, SOX-9, and aggrecan gene expression via qRT-PCR (quantitative reverse transcription-polymerase chain reaction) were analyzed at 24 and 48 hours. Matrix production and cell morphology were evaluated using histology. RESULTS Paste samples from patients (mean age 39.7) with moderate (19%) to severe (81%) cartilage lesions displayed 34% and 80% greater cell proliferation compared to plugs at 24 and 48 hours post processing, respectively (P = 0.015 and P = 0.021). qRT-PCR analysis yielded a significant (P = 0.000) increase of aggrecan, SOX-9, collagen type I and II at both 24 and 48 hours. Histological examination displayed cell division throughout paste samples, with accumulation of aggrecan around multiple chondrocyte lacunae. CONCLUSIONS Paste graft preparation resulted in increased mobility of chondrocytes by matrix disruption without loss of cell viability. The impaction procedure stimulated chondrocyte proliferation resulting in a cellular response to reestablish native extracellular matrix. Analysis of gene expression supports a regenerative process of cartilage tissue formation and contradicts long-held beliefs that impaction trauma leads to immediate cell death. This mechanism of action translates into clinical benefit for patients with moderate to severe cartilage damage.
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Affiliation(s)
- Daniel Grande
- Feinstein Institute for Medical
Research, Manhasset, NY, USA
| | - Todd Goldstein
- Feinstein Institute for Medical
Research, Manhasset, NY, USA
| | | | | | | | | | - David Greene
- Stone Research Foundation, San
Francisco, CA, USA
| | - Kevin R. Stone
- Stone Research Foundation, San
Francisco, CA, USA,The Stone Clinic, San Francisco, CA,
USA,Kevin R. Stone, Stone Research Foundation
for Sports Medicine and Arthritis Research, 3727 Buchanan Street, Suite 310, San
Francisco, CA 94123, USA.
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31
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Marom N, Warner T, Williams RJ. Differences in the Demographics and Preferred Management of Knee Cartilage Injuries in Soccer Players Across FIFA Centers of Excellence. Cartilage 2021; 13:873S-885S. [PMID: 34056956 PMCID: PMC8808837 DOI: 10.1177/19476035211018857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We sought to report on the demographics and epidemiology of knee cartilage injuries and preferred management in soccer players, across FIFA Medical Centers of Excellence (FMCE). DESIGN A descriptive questionnaire focusing on characteristics of knee cartilage injuries and their management in soccer players during the 10-year period prior to the distribution of the questionnaire was sent to all FMCE around the world in September 2019 via an online platform. Voluntary responses from centers were processed and analyzed. Descriptive characteristics were reported using median and interquartile ranges (IQR) for continuous variables and frequencies and percentages (%) for discrete variables. RESULTS A total of 15 centers from 5 continents responded to the questionnaire and reported on a total of 4526 soccer players. Among centers, the median age was 27 years (IQR: 23-38), the median rate of male players was 75% (IQR: 68-90), and the median rate of professional players was 10% (IQR: 5-23). The most common reported etiology for cartilage injury was traumatic (median 40%, IQR: 13-73). The most common nonoperative treatment utilized was physical therapy (median 90%, IQR: 51%-100%) and the most common operative treatment utilized was bone marrow stimulation/micro-fracture (median 40%, IQR: 19-54%). The utilization of other cartilage restoration procedures varied across centers. CONCLUSIONS Our findings highlight different tendencies in the management of these injuries across FMCE and emphasize the need for collaborative efforts focusing on establishing consensus guidelines for the optimal management of these challenging injuries in soccer players.
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Affiliation(s)
- Niv Marom
- Sports Injuries Unit, Department of
Orthopaedic Surgery, Meir Medical Center, Kfar-Saba, Israel,The Faculty of Medicine, Tel Aviv
University, Tel Aviv, Israel,Sports Medicine Institute (FIFA Medical
Center of Excellence), Hospital for Special Surgery, New York, NY, USA,Niv Marom, Sports Injuries Unit, Department
of Orthopaedic Surgery, Meir Medical Center, 59 Tcharnihovsky Street, Kfar-Saba,
4428164, Israel.
| | - Tyler Warner
- Sports Medicine Institute (FIFA Medical
Center of Excellence), Hospital for Special Surgery, New York, NY, USA
| | - Riley J. Williams
- Sports Medicine Institute (FIFA Medical
Center of Excellence), Hospital for Special Surgery, New York, NY, USA
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Melugin HP, Ridley TJ, Bernard CD, Wischmeier D, Farr J, Stuart MJ, Macalena JA, Krych AJ. Prospective Outcomes of Cryopreserved Osteochondral Allograft for Patellofemoral Cartilage Defects at Minimum 2-Year Follow-up. Cartilage 2021; 13:1014S-1021S. [PMID: 32037873 PMCID: PMC8808817 DOI: 10.1177/1947603520903420] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To analyze the clinical outcomes, knee function, and activity level of patients after treatment of full-thickness cartilage defects involving the patellofemoral compartment of the knee with cryopreserved osteochondral allograft. DESIGN Nineteen patients with cartilage defects involving the patellofemoral compartment were treated. The average age was 31 years (range 15-45 years), including 12 females and 7 males. Patients were prospectively followed using validated clinical outcome measures including Veterans RAND 12-item Health Survey (VR-12), International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Tegner activity scale. Graft incorporation was evaluated by magnetic resonance imaging (MRI) or second-look arthroscopy. RESULTS The cartilage defects included the patella (n = 16) and the femoral trochlea (n = 3). Mean VR-12 scores increased from 31.6 to 46.3 (P < 0.01), mean IKDC increased from 40.0 to 69.7 (P < 0.01), mean KOOS increased from 53.9 to 80.2 (P < 0.01), and mean Tegner scores increased from 3.0 to 4.9 (P < 0.01), at average follow-up of 41.9 months (range 24-62 months). Of the 3 patients who underwent second-look arthroscopy, all demonstrated a well-incorporated graft. Mean MOCART score for the 6 patients with follow-up MRI was 62.5 (range 25-85). The reoperation rate was 21.1% and 2 patients (12.5%) experienced progressive patellofemoral osteoarthritis requiring conversion to patellofemoral arthroplasty. CONCLUSION Patients with unipolar cartilage defects involving the patellofemoral compartment of the knee can have positive outcomes at minimum 2-year follow-up after surgical treatment with a cryopreserved osteochondral allograft when concomitant pathology is also addressed, but the reoperation rate is high and bipolar cartilage lesions may increase the failure rate.
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Affiliation(s)
- Heath P. Melugin
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA
| | - Taylor J. Ridley
- Department of Orthopaedic Surgery,
University of Minnesota, Minneapolis, MN, USA
| | | | - Dillen Wischmeier
- Cartilage Restoration Center of Indiana,
OrthoIndy Hospital, Greenwood, IN, USA
| | - Jack Farr
- Cartilage Restoration Center of Indiana,
OrthoIndy Hospital, Greenwood, IN, USA
| | | | - Jeffrey A. Macalena
- Department of Orthopaedic Surgery,
University of Minnesota, Minneapolis, MN, USA
| | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo
Clinic, Rochester, MN, USA,Aaron J. Krych, Department of Orthopedic
Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Guzman AJ, Dela Rueda T, Rayos Del Sol SM, Bryant SA, Jenkins S, Gardner B, McGahan PJ, Chen JL. Arthroscopic Osteochondral Autograft Transfer System Procedure of the Lateral Femoral Condyle with Donor-Site Backfill Using Osteochondral Allograft Plug. Arthrosc Tech 2021; 10:e2683-e2689. [PMID: 35004149 PMCID: PMC8719136 DOI: 10.1016/j.eats.2021.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/06/2021] [Indexed: 02/03/2023] Open
Abstract
The osteochondral autograft transfer system (OATS) procedure is at the forefront of cartilage restoration surgeries of the knee, offering superior return to sport rates and long-term functionality. This technique reports an arthroscopic OATS procedure of the lateral femoral condyle with donor-site backfill using an osteochondral allograft plug. Potential complications from unfilled donor site sockets are eliminated through donor site backfill with an allograft plug.
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Affiliation(s)
- Alvarho J. Guzman
- Address correspondence to Alvarho J. Guzman, B.A., Advanced Orthopaedics and Sports Medicine, 450 Sutter St, Ste 400, San Francisco, CA 94108, U.S.A.
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34
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Xie J, Wang W, Zhao R, Lu W, Chen L, Su W, Zeng M, Hu Y. Fabrication and characterization of microstructure-controllable COL-HA-PVA hydrogels for cartilage repair. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2021; 32:100. [PMID: 34406511 PMCID: PMC8373762 DOI: 10.1007/s10856-021-06577-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 06/14/2021] [Indexed: 05/11/2023]
Abstract
Polyvinyl alcohol (PVA) hydrogel has gained interest in cartilage repair because of its highly swollen, porosity, and viscoelastic properties. However, PVA has some deficiencies, such as its poor biocompatibility and microstructure. This research aimed to design novel hydroxyapatite (HA)-collagen (COL)-PVA hydrogels. COL was added to improve cell biocompatibility, and the microstructure of the hydrogels was controlled by fused deposition modeling (FDM). The feasibility of the COL-HA-PVA hydrogels in cartilage repair was evaluated by in vitro and in vivo experiments. The scanning electron microscopy results showed that the hybrid hydrogels had interconnected macropore structures that contained a COL reticular scaffold. The diameter of the macropore was 1.08-1.85 mm, which corresponds to the diameter of the denatured PVA column. The chondrocytes were then seeded in hydrogels to assess the cell viability and formation of the cartilage matrix. The in vitro results revealed excellent cellular biocompatibility. Osteochondral defects (8 mm in diameter and 8 mm in depth) were created in the femoral trochlear of goats, and the defects were implanted with cell-seeded hydrogels, cell-free hydrogels, or a blank control. The in vivo results showed that the COL-HA-PVA hydrogels effectively repaired cartilage defects, especially the conditions inoculated with chondrocyte in advance. This research suggests that the COL-HA-PVA hydrogels have promising application in cartilage repair.
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Affiliation(s)
- Jie Xie
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wu Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ruibo Zhao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wei Lu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Liang Chen
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Weiping Su
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Min Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Yihe Hu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Identifying Consensus and Open Questions around Assessing or Predicting the Quality and Success of Cartilage Repair: A Delphi Study. SURGERIES 2021. [DOI: 10.3390/surgeries2030029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A range of surgical techniques have been developed for the repair or regeneration of lesioned cartilage in the human knee and a corresponding array of scoring systems have been created to assess their outcomes. The published literature displays a wide range of opinions regarding the factors that influence the success of surgical cartilage repair and which parameters are the most useful for measuring the quality of the repair at follow-up. Our objective was to provide some clarity to the field by collating items that were agreed upon by a panel of experts to be important in these areas. A modified, three-round Delphi consensus study was carried out consisting of one idea-generating focus-group and two subsequent, self-completed questionnaire rounds. In each round, items were assessed for their importance and level of consensus against pre-determined threshold levels. In total, 31 items reached consensus, including a hierarchy of tissues in the joint based on their importance in cartilage repair, markers of repair cartilage quality and the implications of environmental and patient-related factors. Items were stratified into those that can be employed for predicting the success of cartilage repair and those that could be used for assessing the structural quality of the resulting repair cartilage. Items that did not reach consensus represent areas where dissent remains and could, therefore, be used to guide future clinical and fundamental scientific research.
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Mansour O, Raad RB, Hellani AA, Alayane A, Zreik H, Moussa MK. Reconstruction of Tibial Plateau Fracture Malunion in the Setting of a Large Cartilage Defect in an Adolescent: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00057. [PMID: 34329199 DOI: 10.2106/jbjs.cc.20.00868] [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: 11/14/2022]
Abstract
CASE An 18-year-old adolescent boy presented with knee pain and stiffness secondary to tibial plateau valgus malunion and osteochondral defect, 8 months after initial injury/fixation. We opted for a novel technique that reconstructs the convex lateral tibial plateau by using osteotomy and an osteochondral autograft harvested from the lateral aspect of the ipsilateral femoral condyle. CONCLUSION The reported novel reconstruction technique is inexpensive, achievable with routine techniques, and demonstrated a favorable short-term outcome. At 3 years of follow-up, the patient had excellent, asymptomatic, left knee mobility and function with radiographic evidence of mild posttraumatic arthritis despite normal knee alignment.
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Affiliation(s)
- Oussama Mansour
- Department of Orthopedic Surgery, Al Zahraa Hospital, University Medical Center, Beirut, Lebanon
| | - Ryan Bou Raad
- Department of Orthopedic Surgery, Lebanese University, Faculty of Medical Sciences, Beirut, Lebanon
| | - Ali A Hellani
- Department of Orthopedic Surgery, Lebanese University, Faculty of Medical Sciences, Beirut, Lebanon
| | - Ali Alayane
- Department of Orthopedic Surgery, Lebanese University, Faculty of Medical Sciences, Beirut, Lebanon
| | - Hussein Zreik
- Department of Orthopedic Surgery, Al Zahraa Hospital, University Medical Center, Beirut, Lebanon
| | - Mohamad K Moussa
- Department of Orthopedic Surgery, Lebanese University, Faculty of Medical Sciences, Beirut, Lebanon
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Gonçalves AM, Moreira A, Weber A, Williams GR, Costa PF. Osteochondral Tissue Engineering: The Potential of Electrospinning and Additive Manufacturing. Pharmaceutics 2021; 13:983. [PMID: 34209671 PMCID: PMC8309012 DOI: 10.3390/pharmaceutics13070983] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/22/2021] [Accepted: 06/25/2021] [Indexed: 12/14/2022] Open
Abstract
The socioeconomic impact of osteochondral (OC) damage has been increasing steadily over time in the global population, and the promise of tissue engineering in generating biomimetic tissues replicating the physiological OC environment and architecture has been falling short of its projected potential. The most recent advances in OC tissue engineering are summarised in this work, with a focus on electrospun and 3D printed biomaterials combined with stem cells and biochemical stimuli, to identify what is causing this pitfall between the bench and the patients' bedside. Even though significant progress has been achieved in electrospinning, 3D-(bio)printing, and induced pluripotent stem cell (iPSC) technologies, it is still challenging to artificially emulate the OC interface and achieve complete regeneration of bone and cartilage tissues. Their intricate architecture and the need for tight spatiotemporal control of cellular and biochemical cues hinder the attainment of long-term functional integration of tissue-engineered constructs. Moreover, this complexity and the high variability in experimental conditions used in different studies undermine the scalability and reproducibility of prospective regenerative medicine solutions. It is clear that further development of standardised, integrative, and economically viable methods regarding scaffold production, cell selection, and additional biochemical and biomechanical stimulation is likely to be the key to accelerate the clinical translation and fill the gap in OC treatment.
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Affiliation(s)
| | - Anabela Moreira
- BIOFABICS, Rua Alfredo Allen 455, 4200-135 Porto, Portugal; (A.M.G.); (A.M.)
| | - Achim Weber
- Fraunhofer Institute for Interfacial Engineering and Biotechnology IGB, Nobelstrasse 12, 70569 Stuttgart, Germany;
| | - Gareth R. Williams
- UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK;
| | - Pedro F. Costa
- BIOFABICS, Rua Alfredo Allen 455, 4200-135 Porto, Portugal; (A.M.G.); (A.M.)
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Dekker TJ, Aman ZS, DePhillipo NN, Dickens JF, Anz AW, LaPrade RF. Chondral Lesions of the Knee: An Evidence-Based Approach. J Bone Joint Surg Am 2021; 103:629-645. [PMID: 33470591 DOI: 10.2106/jbjs.20.01161] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Management of chondral lesions of the knee is challenging and requires assessment of several factors including the size and location of the lesion, limb alignment and rotation, and the physical and mental health of the individual patient. ➤ There are a multitude of options to address chondral pathologies of the knee that allow individualized treatment for the specific needs and demands of the patient. ➤ Osteochondral autograft transfer remains a durable and predictable graft option in smaller lesions (<2 cm2) in the young and active patient population. ➤ Both mid-term and long-term results for large chondral lesions (≥3 cm2) of the knee have demonstrated favorable results with the use of osteochondral allograft or matrix-associated chondrocyte implantation. ➤ Treatment options for small lesions (<2 cm2) include osteochondral autograft transfer and marrow stimulation and/or microfracture with biologic adjunct, while larger lesions (≥2 cm2) are typically treated with osteochondral allograft transplantation, particulated juvenile articular cartilage, or matrix-associated chondrocyte implantation. ➤ Emerging technologies, such as allograft scaffolds and cryopreserved allograft, are being explored for different graft sources to address complex knee chondral pathology; however, further study is needed.
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Affiliation(s)
- Travis J Dekker
- Division of Orthopaedics, Department of Surgery, Eglin Air Force Base, Eglin, Florida
| | - Zachary S Aman
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Jonathan F Dickens
- Division of Orthopaedics, Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Adam W Anz
- Andrews Research & Education Foundation, Gulf Breeze, Florida
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Optimizing Outcomes in Articulating (Kissing) Patellofemoral Joint Osteochondral Lesions: Case Report and Review of the Literature. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202103000-00010. [PMID: 33986226 DOI: 10.5435/jaaosglobal-d-20-00085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 02/05/2021] [Indexed: 11/18/2022]
Abstract
A 32-year-old woman with bipolar patellofemoral chondral lesions caused by traumatic patella dislocation underwent autologous chondrocyte implantation with concomitant tibial tubercle osteotomy and MPFL reconstruction. At 1- and 2-year follow-ups, the patient had returned to all previous activities with considerable improvement in all patient-reported outcome scores. This is an encouraging treatment option for a historically difficult therapeutic problem.
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Amann E, Amirall A, Franco AR, Poh PSP, Sola Dueñas FJ, Fuentes Estévez G, Leonor IB, Reis RL, Griensven M, Balmayor ER. A Graded, Porous Composite of Natural Biopolymers and Octacalcium Phosphate Guides Osteochondral Differentiation of Stem Cells. Adv Healthc Mater 2021; 10:e2001692. [PMID: 33448144 DOI: 10.1002/adhm.202001692] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/19/2020] [Indexed: 01/08/2023]
Abstract
Lesions involving the osteochondral unit are difficult to treat. Biomimetic scaffolds are previously shown as promising alternative. Such devices often lack multiple functional layers that mimic bone, cartilage, and the interface. In this study, multilayered scaffolds are developed based on the use of natural extracellular matrix (ECM)-like biopolymers. Particular attention is paid to obtain a complex matrix that mimics the native osteochondral transition. Porous, sponge-like chitosan-collagen-octacalcium phosphate (OCP) scaffolds are obtained. Collagen content increases while the amount of OCP particles decreases toward the cartilage layer. The scaffolds are bioactive as a mineral layer is deposited containing hydroxyapatite at the bony side. The scaffolds stimulate proliferation of human adipose-derived mesenchymal stem cells, but the degree of proliferation depends on the cell seeding density. The scaffolds give rise to a zone-specific gene expression. RUNX2, COL1A1, BGLAP, and SPP1 are upregulated in the bony layer of the scaffold. SOX9 is upregulated concomitant with COL2A1 expression in the cartilage zone. Mineralization in presence of the cells is prominent in the bone area with Ca and P steadily increasing over time. These results are encouraging for the fabrication of biomimetic scaffolds using ECM-like materials and featuring gradients that mimic native tissues and their interface.
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Affiliation(s)
- Elisabeth Amann
- Experimental Trauma Surgery Klinikum rechts der Isar Technical University of Munich Munich 81675 Germany
| | - Amisel Amirall
- Biomaterials Center University of Havana Havana 10 400 Cuba
| | - Albina R. Franco
- 3B's Research Group I3Bs‐Research Institute on Biomaterials Biodegradables and Biomimetics University of Minho Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine Avepark Barco Guimarães 4805‐017 Portugal
- ICVS/3B's—PT Government Associate Laboratory Braga Guimarães Portugal
| | - Patrina S. P. Poh
- Experimental Trauma Surgery Klinikum rechts der Isar Technical University of Munich Munich 81675 Germany
- Julius Wolff Institute Charité—Universitätsmedizin Berlin 13353 Berlin Germany
| | | | | | - Isabel B. Leonor
- 3B's Research Group I3Bs‐Research Institute on Biomaterials Biodegradables and Biomimetics University of Minho Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine Avepark Barco Guimarães 4805‐017 Portugal
- ICVS/3B's—PT Government Associate Laboratory Braga Guimarães Portugal
| | - Rui L. Reis
- 3B's Research Group I3Bs‐Research Institute on Biomaterials Biodegradables and Biomimetics University of Minho Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine Avepark Barco Guimarães 4805‐017 Portugal
- ICVS/3B's—PT Government Associate Laboratory Braga Guimarães Portugal
- The Discoveries Centre for Regenerative and Precision Medicine Headquarters at University of Minho Avepark Barco Guimarães 4805‐017 Portugal
| | - Martijn Griensven
- Experimental Trauma Surgery Klinikum rechts der Isar Technical University of Munich Munich 81675 Germany
- Department of Cell Biology‐Inspired Tissue Engineering MERLN Institute for Technology‐Inspired Regenerative Medicine Maastricht University Maastricht 6229 ER The Netherlands
| | - Elizabeth R. Balmayor
- Experimental Trauma Surgery Klinikum rechts der Isar Technical University of Munich Munich 81675 Germany
- Department of Instructive Biomaterials Engineering MERLN Institute for Technology‐Inspired Regenerative Medicine Maastricht University Maastricht 6229 ER The Netherlands
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Focal articular surface replacement of knee lesions after failed cartilage repair using focal metallic implants: A series of 132 cases with 4-year follow-up. Knee 2021; 29:134-141. [PMID: 33610953 DOI: 10.1016/j.knee.2021.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 12/27/2020] [Accepted: 01/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Focal articular lesions of the knee can be treated using several different techniques with generally good results, but failures are difficult to manage. Focal articular surface replacement (FASR) using metal implants could be a promising technique that allows defect geometry matching, congruency restoration and defect propagation prevention. METHODS 132 patients were included who underwent FASR between January 2009 and December 2013. Three different implants were used: 1. HemiCAP®; 2. UniCAP® and 3. HemiCAP® PF Classic for trochlear lesions. Primary outcome parameter was knee function assessed by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score with a 4-year follow-up, secondary outcomes included survivorship and complications. Statistical analyses were performed using GraphPad Prism. RESULTS For all 132 surgeries combined (102 HemiCAP®, 11 UniCAP® and 19 HemiCAP® PF Classic implants), WOMAC scores significantly improved from 6 weeks onward until the end of the study (p < 0.001 for all time points). 4-year survival rate was 97.7%, and a re-operation rate of 12.1% was found. The HemiCAP® group revealed a slower WOMAC improvement in patients aged ≥40 years, combined with a trend towards lower final WOMAC scores and a higher re-operation rate in patients with a BMI ≥ 25. CONCLUSIONS This report shows good to excellent clinical results of FASR as a salvage procedure after failed cartilage repair, with a low re-operation rate and a high survival of 97.7% at 4-year follow-up. Although longer follow-up is required, this could be a valuable treatment option in these challenging cases, without limiting future options for surgical interventions when deemed necessary.
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Characterization of Properties, In Vitro and In Vivo Evaluation of Calcium Phosphate/Amino Acid Cements for Treatment of Osteochondral Defects. MATERIALS 2021; 14:ma14020436. [PMID: 33477289 PMCID: PMC7830446 DOI: 10.3390/ma14020436] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/08/2021] [Accepted: 01/12/2021] [Indexed: 12/13/2022]
Abstract
Novel calcium phosphate cements containing a mixture of four amino acids, glycine, proline, hydroxyproline and either lysine or arginine (CAL, CAK) were characterized and used for treatment of artificial osteochondral defects in knee. It was hypothesized that an enhanced concentration of extracellular collagen amino acids (in complex mixture), in connection with bone cement in defect sites, would support the healing of osteochondral defects with successful formation of hyaline cartilage and subchondral bone. Calcium phosphate cement mixtures were prepared by in situ reaction in a planetary ball mill at aseptic conditions and characterized. It was verified that about 30–60% of amino acids remained adsorbed on hydroxyapatite particles in cements and the addition of amino acids caused around 60% reduction in compressive strength and refinement of hydroxyapatite particles in their microstructure. The significant over-expression of osteogenic genes after the culture of osteoblasts was demonstrated in the cement extracts containing lysine and compared with other cements. The cement pastes were inserted into artificial osteochondral defects in the medial femoral condyle of pigs and, after 3 months post-surgery, tissues were analyzed macroscopically, histologically, immunohistochemically using MRI and X-ray methods. Analysis clearly showed the excellent healing process of artificial osteochondral defects in pigs after treatment with CAL and CAK cements without any inflammation, as well as formation of subchondral bone and hyaline cartilage morphologically and structurally identical to the original tissues. Good integration of the hyaline neocartilage with the surrounding tissue, as well as perfect interconnection between the neocartilage and new subchondral bone tissue, was demonstrated. Tissues were stable after 12 months’ healing.
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Saltzman BM, Redondo ML, Beer A, Cotter EJ, Frank RM, Yanke AB, Cole BJ. Wide Variation in Methodology in Level I and II Studies on Cartilage Repair: A Systematic Review of Available Clinical Trials Comparing Patient Demographics, Treatment Means, and Outcomes Reporting. Cartilage 2021; 12:7-23. [PMID: 30378453 PMCID: PMC7755973 DOI: 10.1177/1947603518809398] [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: 12/31/2022] Open
Abstract
BACKGROUND The management of complex cartilage pathology in young, otherwise healthy patients can be difficult. PURPOSE To determine the nature of the design, endpoints chosen, and rate at which the endpoints were met in published studies and ongoing clinical trials that investigate cartilage repair and restoration procedures. STUDY DESIGN Systematic review. METHODS A systematic review of the publicly available level I/II literature and of the publicly listed clinical trials regarding cartilage repair and restoration procedures for the knee was conducted adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Seventeen published studies and 52 clinical trials were included. Within the 17 published studies, the most common procedure studied was microfracture (MFX) + augmentation (N = 5; 29.4%) and the most common comparison/control group was MFX (N = 10; 58.8%). In total, 13 different cartilage procedure groups were evaluated. For published studies, the most common patient-reported outcome (PRO) measures assessed is the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Visual Analog Scale-Pain (VAS) (N = 10 studies, 58.8% each, respectively). Overall, there are 10 different PROs used among the included studies. Ten studies demonstrate superiority, 5 demonstrate noninferiority, and 2 demonstrate inferiority to the comparison or control groups. For the clinical trials included, the most common procedure studied is MFX + augmentation (N = 16; 30.8%). The most common PRO assessed is KOOS (N = 36 trials; 69.2%), and overall there are 24 different PROs used among the included studies. CONCLUSIONS Recently published studies and clinical trials evaluate a variety of cartilage repair and restoration strategies for the knee, most commonly MFX + augmentation, at various time points of outcome evaluation, with KOOS and VAS scores being used most commonly. MFX remains the most common comparison group for these therapeutic investigations. Most studies demonstrate superiority versus comparison or control groups. Understanding the nature of published and ongoing clinical trials will be helpful in the investigation of emerging technologies required to navigate the regulatory process while studying a relatively narrow population of patients.
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Affiliation(s)
| | | | - Adam Beer
- Rush University Medical Center, Chicago, IL, USA
| | - Eric J. Cotter
- University of Wisconsin Madison School of Medicine and Public Health, Madison, WI, USA
| | | | | | - Brian J. Cole
- Rush University Medical Center, Chicago, IL, USA,Brian J. Cole, Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612-3833, USA.
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Tanaka Y, Nakamura S, Mukai S, Nishitani K, Yamada S, Matsuda S, Nakagawa Y. Domino osteochondral autograft transplantation for osteonecrosis of the knee and femoral head: A case based review. J Orthop Sci 2021; 26:196-199. [PMID: 30055878 DOI: 10.1016/j.jos.2018.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 04/12/2018] [Accepted: 06/07/2018] [Indexed: 02/09/2023]
Affiliation(s)
- Yoshihisa Tanaka
- Department of Orthopaedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Shinichiro Nakamura
- Department of Orthopaedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan.
| | - Shogo Mukai
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Kohei Nishitani
- Department of Orthopaedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Shigeru Yamada
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Yasuaki Nakagawa
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
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Dorcemus DL, Kim HS, Nukavarapu SP. Gradient scaffold with spatial growth factor profile for osteochondral interface engineering. Biomed Mater 2020; 16. [PMID: 33291092 DOI: 10.1088/1748-605x/abd1ba] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/08/2020] [Indexed: 11/11/2022]
Abstract
Osteochondral (OC) matrix design poses a significant engineering challenge due to the complexity involved with bone-cartilage interfaces. To better facilitate the regeneration of OC tissue, we developed and evaluated a biodegradable matrix with uniquely arranged bone and cartilage supporting phases: a poly(lactic-co-glycolic) acid (PLGA) template structure with a porosity gradient along its longitudinal axis uniquely integrated with hyaluronic acid hydrogel. Micro-CT scanning and imaging confirmed the formation of an inverse gradient matrix. Hydroxyapatite was added to the PLGA template which was then plasma-treated to increase hydrophilicity and growth factor affinity. An osteogenic growth factor (bone morphogenetic protein 2; BMP-2) was loaded onto the template scaffold via adsorption, while a chondrogenic growth factor (transforming growth factor beta 1; TGF-β1) was incorporated into the hydrogel phase. Confocal microscopy of the growth factor loaded matrix confirmed the spatial distribution of the two growth factors, with chondrogenic factor confined to the cartilaginous portion and osteogenic factor present throughout the scaffold. We observed spatial differentiation of human mesenchymal stem cells (hMSCs) into cartilage and bone cells in the scaffolds in vitro: cartilaginous regions were marked by increased glycosaminoglycan production, and osteogenesis was seen throughout the graft by alizarin red staining. In a dose-dependent study of BMP-2, hMSC pellet cultures with TGF-β1 and BMP-2 showed synergistic effects on chondrogenesis. These results indicate that development of an inverse gradient matrix can spatially distribute two different growth factors to facilitate chondrogenesis and osteogenesis along different portions of a scaffold, which are key steps needed for formation of an osteochondral interface.
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Affiliation(s)
- Deborah Leonie Dorcemus
- Department of Biomedical Engineering, University of Connecticut, 260 Glenbrook Road, Unit 3247, Storrs, Connecticut, 06269, UNITED STATES
| | - Hyun Sung Kim
- Department of Biomedical Engineering, University of Connecticut, 260 Glenbrook Road, Unit 3247, Storrs, Connecticut, 06269, UNITED STATES
| | - Syam Prasad Nukavarapu
- Department of Biomedical Engineering, University of Connecticut, 260 Glenbrook Road, Unit 3247, Storrs, Connecticut, 06269, UNITED STATES
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Hacken BA, LaPrade MD, Stuart MJ, Saris DBF, Camp CL, Krych AJ. Small Cartilage Defect Management. J Knee Surg 2020; 33:1180-1186. [PMID: 32898908 DOI: 10.1055/s-0040-1716359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cartilage defects in the knee are common resulting in significant pain and morbidity over time. These defects can arise in isolation or concurrently with other associated injuries to the knee. The treatment of small (< 2-3 cm2) cartilage deficiencies has changed as our basic science knowledge of tissue healing has improved. Advancements have led to the development of new and more effective treatment modalities. It is important to address any associated knee injuries and limb malalignment. Surgical options are considered when nonoperative treatment fails. The specific procedure depends on individual patient characteristics, lesion size, and location. Debridement/chondroplasty, microfracture, marrow stimulation plus techniques, fixation of unstable osteochondral fragments, osteochondral autograft transfer, and osteochondral allograft transplantation, all have roles in the treatment of small cartilage defects.
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Affiliation(s)
- Brittney A Hacken
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
| | - Matthew D LaPrade
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
| | - Michael J Stuart
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
| | - Daniel B F Saris
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
| | - Christopher L Camp
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
| | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota
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Mechano-activated biomolecule release in regenerating load-bearing tissue microenvironments. Biomaterials 2020; 265:120255. [PMID: 33099065 DOI: 10.1016/j.biomaterials.2020.120255] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/13/2020] [Accepted: 07/20/2020] [Indexed: 02/07/2023]
Abstract
Although mechanical loads are integral for musculoskeletal tissue homeostasis, overloading and traumatic events can result in tissue injury. Conventional drug delivery approaches for musculoskeletal tissue repair employ localized drug injections. However, rapid drug clearance and inadequate synchronization of molecule provision with healing progression render these methods ineffective. To overcome this, a programmable mechanoresponsive drug delivery system was developed that utilizes the mechanical environment of the tissue during rehabilitation (for example, during cartilage repair) to trigger biomolecule provision. For this, a suite of mechanically-activated microcapsules (MAMCs) with different rupture profiles was generated in a single fabrication batch via osmotic annealing of double emulsions. MAMC physical dimensions were found to dictate mechano-activation in 2D and 3D environments and their stability in vitro and in vivo, demonstrating the tunability of this system. In models of cartilage regeneration, MAMCs did not interfere with tissue growth and activated depending on the mechanical properties of the regenerating tissue. Finally, biologically active anti-inflammatory agents were encapsulated and released from MAMCs, which counteracted degradative cues and prevented the loss of matrix in living tissue environments. This unique technology has tremendous potential for implementation across a wide array of musculoskeletal conditions for enhanced repair of load-bearing tissues.
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Human articular cartilage is orthotropic where microstructure, micromechanics, and chemistry vary with depth and split-line orientation. Osteoarthritis Cartilage 2020; 28:1362-1372. [PMID: 32645403 PMCID: PMC7697147 DOI: 10.1016/j.joca.2020.06.007] [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: 03/31/2020] [Revised: 06/25/2020] [Accepted: 06/27/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Quantitative, micrometer length scale assessment of human articular cartilage is essential to enable progress toward new functional tissue engineering approaches, including utilization of emerging 3D bioprinting technologies, and for improved computational modeling of the osteochondral unit. Thus the objective of this study was to characterize the structural organization, material properties, and chemical composition of human skeletally mature articular cartilage with respect to depth and defined morphological features: normal to the articulating surface, parallel to the split-line, and transverse to the split-line. METHOD Three samples from the lateral femoral condyles of 4 healthy adult donors (55-61 years old) were evaluated via histology, second harmonic generation, microindentation, and Raman spectroscopy. All metrics were evaluated as a function of depth and direction relative to the split-line. RESULTS All donors presented with intact and healthy tissue. Collagen fiber orientation varied significantly between testing directions and with increasing depth from the articular surface. Both compressive and tensile modulus increased significantly with depth and differed across the middle and deep zones and depended on orthogonal direction relative to the split-line. Similarly, matrix components varied with both depth and direction, where chondroitin sulfate steadily increased with depth while collagen prevalence was highest in the surface layer. CONCLUSIONS Microscale measurements of human articular cartilage demonstrate that properties are both depth-dependent and orthotropic and depend on the underlying tissue structure and composition. These findings improve upon existing knowledge establishing more accurate measurements, with greater degree of depth and spatial specificity, as inputs for tissue engineering and computational modeling.
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Frassica MT, Grunlan MA. Perspectives on Synthetic Materials to Guide Tissue Regeneration for Osteochondral Defect Repair. ACS Biomater Sci Eng 2020; 6:4324-4336. [PMID: 33455185 DOI: 10.1021/acsbiomaterials.0c00753] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Regenerative engineering holds the potential to treat clinically pervasive osteochondral defects (OCDs). In a synthetic materials-guided approach, the scaffold's chemical and physical properties alone instruct cellular behavior in order to effect regeneration, referred to herein as "instructive" properties. While this alleviates the costs and off-target risks associated with exogenous growth factors, the scaffold must be potently instructive to achieve tissue growth. Moreover, toward achieving functionality, such a scaffold should also recapitulate the spatial complexity of the osteochondral tissues. Thus, in addition to the regeneration of the articular cartilage and underlying cancellous bone, the complex osteochondral interface, composed of calcified cartilage and subchondral bone, should also be restored. In this Perspective, we highlight recent synthetic-based, instructive osteochondral scaffolds that have leveraged new material chemistries as well as innovative fabrication strategies. In particular, scaffolds with spatially complex chemical and morphological features have been prepared with electrospinning, solvent-casting-particulate-leaching, freeze-drying, and additive manufacturing. While few synthetic scaffolds have advanced to clinical studies to treat OCDs, these recent efforts point to the promising use of the chemical and physical properties of synthetic materials for regeneration of osteochondral tissues.
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Affiliation(s)
- Michael T Frassica
- Department of Biomedical Engineering, Texas A&M University, College Station, Texas 77843-2120, United States
| | - Melissa A Grunlan
- Department of Biomedical Engineering, Texas A&M University, College Station, Texas 77843-2120, United States.,Department of Materials Science & Engineering, Texas A&M University, College Station, Texas 77843-3003, United States.,Department of Chemistry, Texas A&M University, College Station, Texas 77843-3255, United States
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