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Nguyen K, Cooperman S, Ng A. Osteochondral Injuries of the Talus. Clin Podiatr Med Surg 2024; 41:437-450. [PMID: 38789163 DOI: 10.1016/j.cpm.2024.01.004] [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] [Indexed: 05/26/2024]
Abstract
Osteochondral lesions of the talus are a common sequelae of trauma and are often associated with ankle sprains and ankle fractures. Because the surface of the talus is composed primarily of hyaline cartilage, the regenerative capacity of these injuries is limited. Therefore, several open and arthroscopic techniques have been described to treat osteochondral injuries of the talus and underlying bone marrow lesions. Throughout this review, these treatment options are discussed along with their indications and currently reported outcomes. A commentary on the authors' preferences among these techniques is also provided.
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Affiliation(s)
- Kevin Nguyen
- Advanced Orthopedic & Sports Medicine Specialists, Denver, CO, USA; Department of Podiatric Surgery, Orthopedic Centers of Colorado, Advanced Orthopedic & Sports Medicine Specialists, 8101 East Lowry Boulevard, Suite 230, Denver, CO 80230, USA.
| | - Steven Cooperman
- Department of Podiatric Surgery, Orthopedic Centers of Colorado, Advanced Orthopedic & Sports Medicine Specialists, 8101 East Lowry Boulevard, Suite 230, Denver, CO 80230, USA; HCA Presbyterian Saint Lukes, Denver, CO, USA
| | - Alan Ng
- Department of Podiatric Surgery, Orthopedic Centers of Colorado, Advanced Orthopedic & Sports Medicine Specialists, 8101 East Lowry Boulevard, Suite 230, Denver, CO 80230, USA
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2
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Alidina S, Luxenburg D, Castro A, Subhawong TK, Ferreira de Souza F. Imaging Review of Different Subchondral Insufficiency Fractures. J Comput Assist Tomogr 2024; 48:663-668. [PMID: 38834938 DOI: 10.1097/rct.0000000000001628] [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: 06/06/2024]
Abstract
ABSTRACT Subchondral fractures are a common cause of joint pain that may ultimately lead to articular collapse and the need for arthroplasty. This type of fracture has been reported at multiple joints throughout the body. While clinical and radiographic resolution can be achieved, progressive bone collapse can occur and lead to a variety of complications. Understanding the pertinent imaging findings can aid in the early evaluation of subchondral fractures and in the prevention of their associated complications.
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Affiliation(s)
- Sameer Alidina
- From the Department of Radiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL
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3
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Villari E, Digennaro V, Panciera A, Ferri R, Benvenuti L, Cesare F. Bone marrow edema of the knee: a narrative review. Arch Orthop Trauma Surg 2024; 144:2305-2316. [PMID: 38642163 PMCID: PMC11093815 DOI: 10.1007/s00402-024-05332-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 04/14/2024] [Indexed: 04/22/2024]
Abstract
Bone marrow edema (BME) is a frequent MRI finding in patients with knee pain. According to the etiology, BME of the knee can be classified into three main categories: ischemic, mechanic, and reactive. The diagnosis may be difficult, because of the specificity of symptoms and the poor radiographic findings. MRI is the gold standard, showing an area of altered signal of the bone with an high signal intensity on fat-suppressed, T2 weighted images, usually in combination with an intermediate or low signal intensity on T1 weighted images. Bone marrow edema tends to be self-limiting and, in most cases, resolves without any consequences in a varying amount of time. However, since it may evolve to complete joint destruction, early diagnosis and correct treatment are crucial to prevent the articular degeneration. Conservative therapy is the first step, with no weight-bearing for 3 to 6 weeks on the affected side, in combination with the administration of anti-inflammatory drugs or painkillers to manage symptoms. In non-responding forms and more advanced stages, minimally invasive preservative surgery can provide significant results, with subchondroplasty and core decompression being the two main procedures available. Knee arthroplasty, both total (TKA) or unicompartmental (UKA), is the only effective option when the degradation of cartilage is diffuse and in patients with subchondral bone collapse.
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Affiliation(s)
- Eleonora Villari
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, Bologna, 40136, Italy.
| | - Vitoantonio Digennaro
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, Bologna, 40136, Italy
| | - Alessandro Panciera
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, Bologna, 40136, Italy
| | - Riccardo Ferri
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, Bologna, 40136, Italy
| | - Lorenzo Benvenuti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, Bologna, 40136, Italy
| | - Faldini Cesare
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, Bologna, 40136, Italy
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Lyu Y, Liu Y, He H, Wang H. Application of Silk-Fibroin-Based Hydrogels in Tissue Engineering. Gels 2023; 9:gels9050431. [PMID: 37233022 DOI: 10.3390/gels9050431] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 05/27/2023] Open
Abstract
Silk fibroin (SF) is an excellent protein-based biomaterial produced by the degumming and purification of silk from cocoons of the Bombyx mori through alkali or enzymatic treatments. SF exhibits excellent biological properties, such as mechanical properties, biocompatibility, biodegradability, bioabsorbability, low immunogenicity, and tunability, making it a versatile material widely applied in biological fields, particularly in tissue engineering. In tissue engineering, SF is often fabricated into hydrogel form, with the advantages of added materials. SF hydrogels have mostly been studied for their use in tissue regeneration by enhancing cell activity at the tissue defect site or counteracting tissue-damage-related factors. This review focuses on SF hydrogels, firstly summarizing the fabrication and properties of SF and SF hydrogels and then detailing the regenerative effects of SF hydrogels as scaffolds in cartilage, bone, skin, cornea, teeth, and eardrum in recent years.
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Affiliation(s)
- Yihan Lyu
- Department of Pharmacology, School of Medicine, Southeast University, Nanjing 210009, China
| | - Yusheng Liu
- Department of Pharmacology, School of Medicine, Southeast University, Nanjing 210009, China
| | - Houzhe He
- Department of Pharmacology, School of Medicine, Southeast University, Nanjing 210009, China
| | - Hongmei Wang
- Department of Pharmacology, School of Medicine, Southeast University, Nanjing 210009, China
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Zhao H, Li H, Xie X, Tang HY, Liu XX, Wen Y, Xiao X, Ye L, Tang YW, Dai GY, He JN, Chen L, Wang Q, Tang DQ, Pan SN. Dual-energy CT virtual non-calcium: an accurate method for detection of knee osteoarthritis-related edema-like marrow signal intensity. Insights Imaging 2023; 14:74. [PMID: 37121955 PMCID: PMC10149542 DOI: 10.1186/s13244-023-01407-8] [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: 07/04/2022] [Accepted: 03/11/2023] [Indexed: 05/02/2023] Open
Abstract
OBJECTIVES To evaluate the performance of a dual-energy computed tomography (DECT) virtual non-calcium (VNCa) technique in the detection of edema-like marrow signal intensity (ELMSI) in patients with knee joint osteoarthritis (OA) compared to magnetic resonance imaging (MRI). METHODS The study received local ethics board approval, and written informed consent was obtained. DECT and MRI were used to examine 28 knees in 24 patients with OA. VNCa images were generated by dual-energy subtraction of calcium. The knee joint was divided into 15 regions for ELMSI grading, performed independently by two musculoskeletal radiologists, with MRI as the reference standard. We also analyzed CT numbers through receiver operating characteristics and calculated cut-off values. RESULTS For the qualitative analysis, we obtained CT sensitivity (Readers 1, 2 = 83.7%, 89.8%), specificity (Readers 1, 2 = 99.5%, 99.5%), positive predictive value (Readers 1, 2 = 95.3%, 95.7%), and negative predictive value (Readers 1, 2 = 97.9%, 98.7%) for ELMSI. The interobserver agreement was excellent (κ = 0.92). The area under the curve for Reader 1 and Reader 2 was 0.961 (95% CI 0.93, 0.99) and 0.992 (95% CI 0.98, 1.00), respectively. CT numbers obtained from the VNCa images were significantly different between regions with and without ELMSI (p < .001). CONCLUSIONS VNCa images have good diagnostic performance for the qualitative and quantitative analysis of knee osteoarthritis-related ELMSI.
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Affiliation(s)
- Heng Zhao
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
- Department of Radiology, Shengjing Hospital of China Medical University, Sanhao Street No. 36, Heping District, Shenyang, 110004, Liaoning, China
| | - Hui Li
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
- Department of Radiology, The First People's Hospital of Zhaoqing City, Zhaoqing, China
| | - Xia Xie
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Hai-Yan Tang
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Xiao-Xin Liu
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Yi Wen
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Xin Xiao
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Lu Ye
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - You-Wei Tang
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Gao-Yue Dai
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Jia-Ni He
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Li Chen
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Qian Wang
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - De-Qiu Tang
- The First Affiliated Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China.
| | - Shi-Nong Pan
- Department of Radiology, Shengjing Hospital of China Medical University, Sanhao Street No. 36, Heping District, Shenyang, 110004, Liaoning, China.
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Meng Z, Xin L, Fan B. SDF-1α promotes subchondral bone sclerosis and aggravates osteoarthritis by regulating the proliferation and osteogenic differentiation of bone marrow mesenchymal stem cells. BMC Musculoskelet Disord 2023; 24:275. [PMID: 37038152 PMCID: PMC10088262 DOI: 10.1186/s12891-023-06366-1] [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: 10/06/2022] [Accepted: 03/24/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Subchondral bone sclerosis is a major feature of osteoarthritis (OA), and bone marrow mesenchymal stem cells (BMSCs) are presumed to play an important role in subchondral bone sclerosis. Accumulating evidence has shown that stromal cell-derived factor-1α (SDF-1α) plays a key role in bone metabolism-related diseases, but its role in OA pathogenesis remains largely unknown. The purpose of this study was to explore the role of SDF-1α expressed on BMSCs in subchondral bone sclerosis in an OA model. METHODS In the present study, C57BL/6J mice were divided into the following three groups: the sham control, destabilization of the medial meniscus (DMM), and AMD3100-treated DMM (DMM + AMD3100) groups. The mice were sacrificed after 2 or 8 weeks, and samples were collected for histological and immunohistochemical analyses. OA severity was assessed by performing hematoxylin and eosin (HE) and safranin O-fast green staining. SDF-1α expression in the OA model was measured using an enzyme-linked immunosorbent assay (ELISA), quantitative real-time polymerase chain reaction (q-PCR), and immunohistochemistry. Micro-CT was used to observe changes in subchondral bone in the OA model. CD44, CD90, RUNX2, and OCN expression in subchondral bone were measured using q-PCR and immunohistochemistry. In vitro, BMSCs were transfected with a recombinant lentivirus expressing SDF-1α, an empty vector (EV), or siRNA-SDF-1α. Western blot analysis, q-PCR, and immunofluorescence staining were used to confirm the successful transfection of BMSCs. The effect of SDF-1α on BMSC proliferation was evaluated by performing a CCK-8 assay and cell cycle analysis. The effect of SDF-1α on the osteogenic differentiation of BMSCs was assessed by performing alkaline phosphatase (ALP) and alizarin red S (ARS) staining. Cyclin D1, RUNX2 and OCN expression were measured using Western blot analysis, q-PCR, and immunofluorescence staining. RESULTS SDF-1α expression in the DMM-induced OA model increased. In the DMM + AMD3100 group, subchondral bone sclerosis was alleviated, OA was effectively relieved, and CD44, CD90, RUNX2, and OCN expression in subchondral bone was decreased. In vitro, high levels of SDF-1α promoted BMSC proliferation and increased osteogenic differentiation. Cyclin D1, RUNX2, and OCN expression increased. CONCLUSION The results of this study reveal a new molecular mechanism underlying the pathogenesis of OA. The targeted regulation of SDF-1α may be clinically effective in suppressing OA progression.
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Affiliation(s)
- Zhiqiang Meng
- Jiaozuo Coal Industry (Group) Co. Ltd, Central Hospital, No. 1 Jiankang Road, Jiefang District, Jiaozuo, 454000, Henan, China
- General Hospital of Ningxia Medical University, Ningxia Medical University, Ningxia, China
| | - Lujun Xin
- Jiaozuo Coal Industry (Group) Co. Ltd, Central Hospital, No. 1 Jiankang Road, Jiefang District, Jiaozuo, 454000, Henan, China
| | - Bosheng Fan
- Jiaozuo Coal Industry (Group) Co. Ltd, Central Hospital, No. 1 Jiankang Road, Jiefang District, Jiaozuo, 454000, Henan, China.
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Chen L, Wei L, Su X, Qin L, Xu Z, Huang X, Chen H, Hu N. Preparation and Characterization of Biomimetic Functional Scaffold with Gradient Structure for Osteochondral Defect Repair. Bioengineering (Basel) 2023; 10:bioengineering10020213. [PMID: 36829707 PMCID: PMC9952804 DOI: 10.3390/bioengineering10020213] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/20/2023] [Accepted: 02/03/2023] [Indexed: 02/08/2023] Open
Abstract
Osteochondral (OC) defects cannot adequately repair themselves due to their sophisticated layered structure and lack of blood supply in cartilage. Although therapeutic interventions are reaching an advanced stage, current clinical therapies to repair defects are in their infancy. Among the possible therapies, OC tissue engineering has shown considerable promise, and multiple approaches utilizing scaffolds, cells, and bioactive factors have been pursued. The most recent trend in OC tissue engineering has been to design gradient scaffolds using different materials and construction strategies (such as bi-layered, multi-layered, and continuous gradient structures) to mimic the physiological and mechanical properties of OC tissues while further enabling OC repair. This review focuses specifically on design and construction strategies for gradient scaffolds and their role in the successful engineering of OC tissues. The current dilemmas in the field of OC defect repair and the efforts of tissue engineering to address these challenges were reviewed. In addition, the advantages and limitations of the typical fabrication techniques for gradient scaffolds were discussed, with examples of recent studies summarizing the future prospects for integrated gradient scaffold construction. This updated and enlightening review could provide insights into our current understanding of gradient scaffolds in OC tissue engineering.
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Affiliation(s)
| | | | | | | | | | - Xiao Huang
- Correspondence: (X.H.); (H.C.); (N.H.); Tel.: +86-023-89011202 (X.H. & H.C. & N.H.)
| | - Hong Chen
- Correspondence: (X.H.); (H.C.); (N.H.); Tel.: +86-023-89011202 (X.H. & H.C. & N.H.)
| | - Ning Hu
- Correspondence: (X.H.); (H.C.); (N.H.); Tel.: +86-023-89011202 (X.H. & H.C. & N.H.)
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Cao Z, Wang H, Chen J, Zhang Y, Mo Q, Zhang P, Wang M, Liu H, Bao X, Sun Y, Zhang W, Yao Q. Silk-based hydrogel incorporated with metal-organic framework nanozymes for enhanced osteochondral regeneration. Bioact Mater 2023; 20:221-242. [PMID: 35702612 PMCID: PMC9163388 DOI: 10.1016/j.bioactmat.2022.05.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/02/2022] [Accepted: 05/19/2022] [Indexed: 11/17/2022] Open
Abstract
Osteochondral defects (OCD) cannot be efficiently repaired due to the unique physical architecture and the pathological microenvironment including enhanced oxidative stress and inflammation. Conventional strategies, such as the control of implant microstructure or the introduction of growth factors, have limited functions failing to manage these complex environments. Here we developed a multifunctional silk-based hydrogel incorporated with metal-organic framework nanozymes (CuTA@SF) to provide a suitable microenvironment for enhanced OCD regeneration. The incorporation of CuTA nanozymes endowed the SF hydrogel with a uniform microstructure and elevated hydrophilicity. In vitro cultivation of mesenchymal stem cells (MSCs) and chondrocytes showed that CuTA@SF hydrogel accelerated cell proliferation and enhanced cell viability, as well as had antioxidant and antibacterial properties. Under the inflammatory environment with the stimulation of IL-1β, CuTA@SF hydrogel still possessed the potential to promote MSC osteogenesis and deposition of cartilage-specific extracellular matrix (ECM). The proteomics analysis further confirmed that CuTA@SF hydrogel promoted cell proliferation and ECM synthesis. In the full-thickness OCD model of rabbit, CuTA@SF hydrogel displayed successfully in situ OCD regeneration, as evidenced by micro-CT, histology (HE, S/O, and toluidine blue staining) and immunohistochemistry (Col I and aggrecan immunostaining). Therefore, CuTA@SF hydrogel is a promising biomaterial targeted at the regeneration of OCD. A multifunctional silk-based hydrogel incorporated with metal-organic framework nanozymes (CuTA@SF) was fabricated. CuTA@SF hydrogel has antioxidant, anti-inflammation and antibacterial capacities. Proteomics analysis confirmed that CuTA@SF hydrogel promoted cell proliferation and ECM synthesis. CuTA@SF hydrogel displayed successful osteochondral regeneration in vivo.
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Affiliation(s)
- Zhicheng Cao
- Department of Orthopaedic Surgery, Institute of Digital Medicine, Nanjing First Hospital, Nanjing Medical University, 210006, Nanjing, China
- School of Medicine, Southeast University, 210009, Nanjing, China
| | - Hongmei Wang
- School of Medicine, Southeast University, 210009, Nanjing, China
- Department of Pharmaceutical Sciences, Binzhou Medical University, 264003, Yantai, Shandong, China
| | - Jialin Chen
- School of Medicine, Southeast University, 210009, Nanjing, China
- Jiangsu Key Laboratory for Biomaterials and Devices, Southeast University, 210096, Nanjing, China
- China Orthopedic Regenerative Medicine Group (CORMed), China
| | - Yanan Zhang
- School of Medicine, Southeast University, 210009, Nanjing, China
| | - Qingyun Mo
- School of Medicine, Southeast University, 210009, Nanjing, China
| | - Po Zhang
- Department of Orthopaedic Surgery, Institute of Digital Medicine, Nanjing First Hospital, Nanjing Medical University, 210006, Nanjing, China
- School of Medicine, Southeast University, 210009, Nanjing, China
| | - Mingyue Wang
- School of Medicine, Southeast University, 210009, Nanjing, China
| | - Haoyang Liu
- School of Medicine, Southeast University, 210009, Nanjing, China
| | - Xueyang Bao
- School of Medicine, Southeast University, 210009, Nanjing, China
| | - Yuzhi Sun
- Department of Orthopaedic Surgery, Institute of Digital Medicine, Nanjing First Hospital, Nanjing Medical University, 210006, Nanjing, China
- School of Medicine, Southeast University, 210009, Nanjing, China
| | - Wei Zhang
- School of Medicine, Southeast University, 210009, Nanjing, China
- Jiangsu Key Laboratory for Biomaterials and Devices, Southeast University, 210096, Nanjing, China
- China Orthopedic Regenerative Medicine Group (CORMed), China
- Corresponding author. School of Medicine, Southeast University, 210009, Nanjing, China.
| | - Qingqiang Yao
- Department of Orthopaedic Surgery, Institute of Digital Medicine, Nanjing First Hospital, Nanjing Medical University, 210006, Nanjing, China
- China Orthopedic Regenerative Medicine Group (CORMed), China
- Corresponding author. Department of Orthopaedic Surgery, Institute of Digital Medicine, Nanjing First Hospital, Nanjing Medical University, 210006, Nanjing, China.
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Pasculli RM, Kenyon CD, Berrigan WA, Mautner K, Hammond K, Jayaram P. Mesenchymal stem cells for subchondral bone marrow lesions: From bench to bedside. Bone Rep 2022; 17:101630. [PMID: 36310763 PMCID: PMC9615138 DOI: 10.1016/j.bonr.2022.101630] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 10/04/2022] [Accepted: 10/19/2022] [Indexed: 11/21/2022] Open
Abstract
Subchondral bone marrow lesions (BMLs) are areas of disease within subchondral bone that appear as T1 hypointense and T2 hyperintense ill-defined areas of bone marrow on magnetic resonance imaging. The most common bone marrow lesions include subchondral lesions related to osteoarthritis, osteochondral defects, and avascular necrosis. Emerging therapies include autologous biologic therapeutics, in particular mesenchymal stem cells (MSCs), to maintain and improve cartilage health; MSCs have become a potential treatment option for BMLs given the unmet need for disease modification. Active areas in the preclinical research of bone marrow lesions include the paracrine function of MSCs in pathways of angiogenesis and inflammation, and the use of bioactive scaffolds to optimize the environment for implanted MSCs by facilitating chondrogenesis and higher bone volumes. A review of the clinical data demonstrates improvements in pain and functional outcomes when patients with knee osteoarthritis were treated with MSCs, suggesting that BM-MSCs can be a safe and effective treatment for patients with painful knee osteoarthritis with or without bone marrow lesions. Preliminary data examining MSCs in osteochondral defects suggest they can be beneficial as a subchondral injection alone, or as a surgical augmentation. In patients with hip avascular necrosis, those with earlier stage disease have improved outcomes when core decompression is augmented with MSCs, whereas patients in later stages post-collapse have equivalent outcomes with or without MSC treatment. While the evidence for the use of MSCs in conditions with associated bone marrow lesions seems promising, there remains a need for continued investigation into this treatment as a viable treatment option. Common BMLs include osteoarthritis, osteochondral defects, and avascular necrosis. Patients with knee osteoarthritis treated with MSCs show improved pain and function. MSCs used as subchondral injection or surgical augmentation in osteochondral defects Improved outcomes of early hip avascular necrosis after core decompression with MSCs Additional preclinical and clinical evidence of MSCs as treatment for BMLs is needed.
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Dallo I, D'Ambrosi R, Szwedowski D, Mobasheri A, Gobbi A. Minimally invasive cell-based therapy for symptomatic bone marrow lesions of the knee: A prospective clinical study at 1 year. Stem Cells Dev 2022; 31:488-497. [PMID: 35072532 DOI: 10.1089/scd.2021.0283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Bone Marrow Lesions (BMLs) are typical findings in magnetic resonance imaging (MRI) present in different pathologies, such as spontaneous insufficiency fractures, osteonecrosis, transient BML syndromes, osteoarthritis, and trauma. The etiology and evolution of BMLs in multiple conditions remain unclear. There is still no gold standard protocol for the treatment of symptomatic BMLs in the knee. The biologic augmentation by Osteo Core Plasty is a new treatment modality showing promising results reducing pain with the aim to stop the progression of the disease. The purpose of this prospective study is to report the clinical outcomes and safety of Osteo Core Plasty for the treatment of symptomatic BMLs in the knee. Fifteen patients with symptomatic BMLs of the knee treated with the Osteo Core Plasty technique were included and followed prospectively for a minimum of 12 months. Each patient was evaluated before the surgery and respectively at 6 and 12 months using the Tegner Score, Marx Score, the International Knee Documentation Committee (IKDC), the Knee Injury and Osteoarthritis Outcome Score (KOOS) divided in pain, activity daily living (ADL) and Quality of Life (QOL) subscale and the Visual Analogue Scale (VAS) for pain. All clinical scores except Tegner and Marx score showed an overall statistically significant improvement through the entire follow-up (p<0.05) and a significant improvement (p<0.05) between each follow-up period (T0 versus T1; T0 versus T2; T1 versus T2). No complications were reported. These preliminary results confirm that biological subchondral bone augmentation by Osteo Core Plasty technique is a safe and effective minimally invasive treatment option for symptomatic BMLs in the knee at 1-year follow-up. There is still a need for high-quality RCTs studies and systematic reviews in the future to enhance further treatment strategies in preventing or treating BMLs of the knee.
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Affiliation(s)
- Ignacio Dallo
- O.A.S.I. Bioresearch Foundation Gobbi NPO, Milan, Milan, Italy.,SportMe Medical Center, Orthopaedic Surgery and Sports Medicine. Unit of Biological Therapies, Seville, Seville, Spain;
| | - Riccardo D'Ambrosi
- IRCCS Istituto Ortopedico Galeazzi, 46767, Orthopaedic Surgery, Milano, Lombardia, Italy;
| | - Dawid Szwedowski
- O.A.S.I.Bioresearch Foundation Gobbi NPO, Orthopaedic Surgery, Milan, Milan, Italy;
| | - Ali Mobasheri
- Oulu University Faculty of Medicine, 60653, Research Unit of Medical Imaging, Physics and Technology, Oulu, Northern Ostrobothnia, Finland, 90014.,State Research Institute Center of Innovative Medicine, 195014, Department of Regenerative Medicine, Vilnius, Vilnius Region, Lithuania, 01102;
| | - Alberto Gobbi
- O.A.S.I. Bioresearch foundation Gobbi NPO, Orthopaedic surgery, Milan, Milan, Italy;
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11
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Yajun W, Jin C, Zhengrong G, Chao F, Yan H, Weizong W, Xiaoqun L, Qirong Z, Huiwen C, Hao Z, Jiawei G, Xinchen Z, Shihao S, Sicheng W, Xiao C, Jiacan S. Betaine Attenuates Osteoarthritis by Inhibiting Osteoclastogenesis and Angiogenesis in Subchondral Bone. Front Pharmacol 2021; 12:723988. [PMID: 34658862 PMCID: PMC8511433 DOI: 10.3389/fphar.2021.723988] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/13/2021] [Indexed: 12/28/2022] Open
Abstract
Osteoarthritis (OA) is the most common type of arthritis with no effective therapy. Subchondral bone and overlying articular cartilage are closely associated and function as “osteo-chondral unit” in the joint. Abnormal mechanical load leads to activated osteoclast activity and increased bone resorption in the subchondral bone, which is implicated in the onset of OA pathogenesis. Thus, inhibiting subchondral bone osteoclast activation could prevent OA onset. Betaine, isolated from the Lycii Radicis Cortex (LRC), has been demonstrated to exert anti-inflammatory, antifibrotic and antiangiogenic properties. Here, we evaluated the effects of betaine on anterior cruciate ligament transection (ACLT)-induced OA mice. We observed that betaine decreased the number of matrix metalloproteinase 13 (MMP-13)-positive and collagen X (Col X)-positive cells, prevented articular cartilage proteoglycan loss and lowered the OARSI score. Betaine decreased the thickness of calcified cartilage and increased the expression level of lubricin. Moreover, betaine normalized uncoupled subchondral bone remodeling as defined by lowered trabecular pattern factor (Tb.pf) and increased subchondral bone plate thickness (SBP). Additionally, aberrant angiogenesis in subchondral bone was blunted by betaine treatment. Mechanistically, we demonstrated that betaine suppressed osteoclastogenesis in vitro by inhibiting reactive oxygen species (ROS) production and subsequent mitogen-activated protein kinase (MAPK) signaling. These data demonstrated that betaine attenuated OA progression by inhibiting hyperactivated osteoclastogenesis and maintaining microarchitecture in subchondral bone.
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Affiliation(s)
- Wang Yajun
- Graduate Management Unit, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Cui Jin
- Department of Orthopedics, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Gu Zhengrong
- Department of Orthopedics, Luodian Hospital, Shanghai, China
| | - Fang Chao
- Graduate Management Unit, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Hu Yan
- Department of Orthopedics, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China.,Institute of Translational Medicine, Shanghai University, Shanghai, China
| | - Weng Weizong
- Department of Orthopedics, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Li Xiaoqun
- Department of Orthopedics, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhou Qirong
- Department of Orthopedics, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Chen Huiwen
- Graduate Management Unit, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhang Hao
- Graduate Management Unit, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Guo Jiawei
- Graduate Management Unit, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhuang Xinchen
- Graduate Management Unit, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Sheng Shihao
- Graduate Management Unit, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Wang Sicheng
- Institute of Translational Medicine, Shanghai University, Shanghai, China.,Department of Orthopedics, Zhongye Hospital, Shanghai, China
| | - Chen Xiao
- Department of Orthopedics, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Su Jiacan
- Department of Orthopedics, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China.,Institute of Translational Medicine, Shanghai University, Shanghai, China.,Shanghai Clinical Research Center for Aging and Medicine, Shanghai, China
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12
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Stem Cells in Autologous Microfragmented Adipose Tissue: Current Perspectives in Osteoarthritis Disease. Int J Mol Sci 2021; 22:ijms221910197. [PMID: 34638538 PMCID: PMC8508703 DOI: 10.3390/ijms221910197] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/09/2021] [Accepted: 09/14/2021] [Indexed: 12/13/2022] Open
Abstract
Osteoarthritis (OA) is a chronic debilitating disorder causing pain and gradual degeneration of weight-bearing joints with detrimental effects on cartilage volume as well as cartilage damage, generating inflammation in the joint structure. The etiology of OA is multifactorial. Currently, therapies are mainly addressing the physical and occupational aspects of osteoarthritis using pharmacologic pain treatment and/or surgery to manage the symptomatology of the disease with no specific regard to disease progression or prevention. Herein, we highlight alternative therapeutics for OA specifically considering innovative and encouraging translational methods with the use of adipose mesenchymal stem cells.
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13
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Song CX, Liu SY, Zhu WT, Xu SY, Ni GX. Excessive mechanical stretch‑mediated osteoblasts promote the catabolism and apoptosis of chondrocytes via the Wnt/β‑catenin signaling pathway. Mol Med Rep 2021; 24:593. [PMID: 34165157 PMCID: PMC8222797 DOI: 10.3892/mmr.2021.12232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 05/05/2021] [Indexed: 02/05/2023] Open
Abstract
Excessive biomechanical loading is considered an important cause of osteoarthritis. Although the mechanical responses of chondrocytes and osteoblasts have been investigated, their communication during mechanical loading and the underlying molecular mechanisms are not yet fully known. The present study investigated the effects of excessive mechanically stretched osteoblasts on the metabolism and apoptosis of chondrocytes, and also assessed the involvement of the Wnt/β‑catenin signaling pathway. In the present study, rat chondrocytes and osteoblasts were subjected to mechanical tensile strain, and an indirect chondrocyte‑osteoblast co‑culture model was established. Reverse transcription‑quantitative PCR and western blotting were performed to determine the expression levels of genes and proteins of interest. An ELISA was performed to investigate the levels of cytokines, including matrix metalloproteinase (MMP) 13, MMP 3, interleukin‑6 (IL‑6) and prostaglandin E2 (PG E2), released from osteoblasts. Flow cytometry was performed to detect the apoptosis of chondrocytes exposed to stretched osteoblast conditioned culture medium. The levels of MMP 13, IL‑6 and PG E2 increased significantly in the supernatants of stretched osteoblasts compared with the un‑stretched group. By contrast, the mRNA expression levels of Collagen 1a and alkaline phosphatase were significantly decreased in osteoblasts subjected to mechanical stretch compared with the un‑stretched group. The mRNA expression level of Collagen 2a was significantly decreased, whereas the expression levels of MMP 13 and a disintegrin and metalloproteinase with thrombospondin‑like motifs 5 were significantly increased in chondrocytes subjected to mechanical stretch compared with the un‑stretched group. In the co‑culture model, the results indicated that excessive mechanically stretched osteoblasts induced the catabolism and apoptosis of chondrocytes, which was partly inhibited by Wnt inhibitor XAV‑939. The results of the present study demonstrated that excessive mechanical stretch led to chondrocyte degradation and inhibited osteoblast osteogenic differentiation; furthermore, excessive mechanically stretched osteoblasts induced the catabolism and apoptosis of chondrocytes via the Wnt/β‑catenin signaling pathway.
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Affiliation(s)
- Cheng-Xian Song
- Department of Orthopedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, P.R. China
| | - Sheng-Yao Liu
- Department of Orthopedics, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510260, P.R. China
| | - Wen-Ting Zhu
- Department of Pharmacy, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, P.R. China
| | - Shao-Yong Xu
- Department of Orthopedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Guo-Xin Ni
- Department of Orthopedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing 100084, P.R. China
- Correspondence to: Professor Guo-Xin Ni, School of Sport Medicine and Rehabilitation, Beijing Sport University, 48 Xinxi Road, Haidian, Beijing 100084, P.R. China, E-mail:
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14
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Zhu T, Xin X, Yang B, Liu C, Kou B, Chen Z, Zhang K. Association Between Clinical Symptoms and Radiographic Features in Late-Stage Knee Osteoarthritis Using a New Radiographic Parameter. PAIN MEDICINE 2021; 22:1539-1547. [PMID: 33527130 DOI: 10.1093/pm/pnab029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE In this study, we proposed a new radiographic parameter, the plateau attrition index (PAI), and the PAI grades (PAIs) to explore the relationship between subchondral attrition of the tibial plateau and symptoms of knee osteoarthritis (OA) in patients with late-stage knee osteoarthritis. METHOD One hundred nineteen patients with late-stage knee osteoarthritis were enrolled. The Kellgren and Lawrence (K/L) grades and hip-knee-ankle (HKA) angle were used to characterize the radiographic features of knee OA. The bone attrition of the tibial plateau was determined by the PAI and PAIs. The symptoms of knee OA were assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), which is composed of the WOMAC pain (WOMP), WOMAC stiffness (WOMS), and WOMAC function (WOMF) subscores. WOMAC pain scores were divided into non-weight-bearing pain (NWBP) and weight-bearing pain (WBP) subcategories. The Pearson correlation coefficient was used to determine the relationship between the PAI, HKA angle, and WOMAC scores. The Spearman rank correlation coefficient was used to evaluate the correlation between the WOMAC score and the PAIs and K/L grades. RESULTS The distribution of the WOMAC scores according to the PAIs was significant (P < .01). A positive correlation was identified between the PAI and the WOMAC, WOMP, WOMF and WBP scores (r = 0.29, 0.34, 0.26 and 0.34, P < .01, respectively). In addition, the PAIs was also significantly correlated with the WOMAC, WOMP, WOMF, and WBP scores (r = 0.37, 0.38, 0.35 and 0.44, P < .01, respectively). CONCLUSIONS The attrition of tibial subchondral bone determined by the new parameter, the plateau attrition index, was correlated with symptoms, especially weight-bearing pain in late-stage knee OA.
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Affiliation(s)
- Tengjiao Zhu
- Peking University Third Hospital, Beijing, China.,Peking University International Hospital, Beijing, China
| | - Xing Xin
- Peking University International Hospital, Beijing, China
| | - Bin Yang
- Peking University International Hospital, Beijing, China
| | - Chen Liu
- Peking University International Hospital, Beijing, China
| | - Bolong Kou
- Peking University International Hospital, Beijing, China.,Peking University People's Hospital, Beijing, China
| | - Zhongqiang Chen
- Peking University Third Hospital, Beijing, China.,Peking University International Hospital, Beijing, China
| | - Ke Zhang
- Peking University Third Hospital, Beijing, China.,Peking University International Hospital, Beijing, China
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15
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Zhao Z, Wang Y, Wang Q, Liang J, Hu W, Zhao S, Li P, Zhu H, Li Z. Radial extracorporeal shockwave promotes subchondral bone stem/progenitor cell self-renewal by activating YAP/TAZ and facilitates cartilage repair in vivo. Stem Cell Res Ther 2021; 12:19. [PMID: 33413606 PMCID: PMC7792202 DOI: 10.1186/s13287-020-02076-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 12/07/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Radial extracorporeal shockwave (r-ESW), an innovative and noninvasive technique, is gaining increasing attention in regenerative medicine due to its mechanobiological effects. Subchondral bone stem/progenitor cells (SCB-SPCs), originating from the pivotal zone of the osteochondral unit, have been shown to have multipotency and self-renewal properties. However, thus far, little information is available regarding the influences of r-ESW on the biological properties of SCB-SPCs and their therapeutic effects in tissue regeneration. METHODS SCB-SPCs were isolated from human knee plateau osteochondral specimens and treated with gradient doses of r-ESW in a suspension stimulation system. The optimized parameters for SCB-SPC self-renewal were screened out by colony-forming unit fibroblast assay (CFU-F). Then, the effects of r-ESW on the proliferation, apoptosis, and multipotency of SCB-SPCs were evaluated. Moreover, the repair efficiency of radial shockwave-preconditioned SCB-SPCs was evaluated in vivo via an osteochondral defect model. Potential mechanisms were explored by western blotting, confocal laser scanning, and high-throughput sequencing. RESULTS The CFU-F data indicate that r-ESW could augment the self-renewal of SCB-SPCs in a dose-dependent manner. The CCK-8 and flow cytometry results showed that the optimized shockwave markedly promoted SCB-SPC proliferation but had no significant influence on cell apoptosis. Radial shockwave exerted no significant influence on osteogenic capacity but strongly suppressed adipogenic ability in the current study. For chondrogenic potentiality, the treated SCB-SPCs were mildly enhanced, while the change was not significant. Importantly, the macroscopic scores and further histological analysis strongly demonstrated that the in vivo therapeutic effects of SCB-SPCs were markedly improved post r-ESW treatment. Further analysis showed that the cartilage-related markers collagen II and proteoglycan were expressed at higher levels compared to their counterpart group. Mechanistic studies suggested that r-ESW treatment strongly increased the expression of YAP and promoted YAP nuclear translocation in SCB-SPCs. More importantly, self-renewal was partially blocked by the YAP-specific inhibitor verteporfin. Moreover, the high-throughput sequencing data indicated that other self-renewal-associated pathways may also be involved in this process. CONCLUSION We found that r-ESW is capable of promoting the self-renewal of SCB-SPCs in vitro by targeting YAP activity and strengthening its repair efficiency in vivo, indicating promising application prospects.
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Affiliation(s)
- Zhidong Zhao
- Chinese People's Liberation Army (PLA) General Hospital, Chinese PLA Medical School, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.,Beijing Institute of Radiation Medicine, No. 27 Taiping Road, Haidian District, Beijing, 100850, China
| | - Yuxing Wang
- Chinese People's Liberation Army (PLA) General Hospital, Chinese PLA Medical School, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.,Beijing Institute of Radiation Medicine, No. 27 Taiping Road, Haidian District, Beijing, 100850, China
| | - Qian Wang
- Chinese People's Liberation Army (PLA) General Hospital, Chinese PLA Medical School, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.,Beijing Institute of Radiation Medicine, No. 27 Taiping Road, Haidian District, Beijing, 100850, China
| | - Jiawu Liang
- Chinese People's Liberation Army (PLA) General Hospital, Chinese PLA Medical School, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.,Beijing Institute of Radiation Medicine, No. 27 Taiping Road, Haidian District, Beijing, 100850, China
| | - Wei Hu
- Chinese People's Liberation Army (PLA) General Hospital, Chinese PLA Medical School, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.,Beijing Institute of Radiation Medicine, No. 27 Taiping Road, Haidian District, Beijing, 100850, China
| | - Sen Zhao
- Chinese People's Liberation Army (PLA) General Hospital, Chinese PLA Medical School, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.,Beijing Institute of Radiation Medicine, No. 27 Taiping Road, Haidian District, Beijing, 100850, China
| | - Peilin Li
- Beijing Institute of Radiation Medicine, No. 27 Taiping Road, Haidian District, Beijing, 100850, China
| | - Heng Zhu
- Beijing Institute of Radiation Medicine, No. 27 Taiping Road, Haidian District, Beijing, 100850, China. .,Graduate School of Anhui Medical University, No. 81 Meishan Road, Shu Shan District, Hefei, 230032, Anhui Province, China.
| | - Zhongli Li
- Chinese People's Liberation Army (PLA) General Hospital, Chinese PLA Medical School, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.
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16
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Szwedowski D, Dallo I, Irlandini E, Gobbi A. Osteo-core Plasty: A Minimally Invasive Approach for Subchondral Bone Marrow Lesions of the Knee. Arthrosc Tech 2020; 9:e1773-e1777. [PMID: 33294339 PMCID: PMC7695615 DOI: 10.1016/j.eats.2020.07.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/22/2020] [Indexed: 02/03/2023] Open
Abstract
"Bone marrow lesion" (BML) is a common term used to describe the presence of fluid in the bone marrow. Although various pathologies can cause BMLs seen on magnetic resonance imaging, in this Technical Note we focus on treating the lesions associated with osteoarthritis in the knee joint. The role of the subchondral bone in transferring loads within the knee joint, as well as in cartilage homeostasis, is well established. In addition, cartilage and subchondral bone are increasingly considered as an osteochondral unit, rather than as 2 separate structures. Knee osteoarthritis, along with insufficiency fracture, is one of the main indications for the treatment of painful BMLs. Nowadays, there is a growing interest in this field, and new approaches are being developed. Our technique can be defined as a surgical procedure aimed directly at pathology within the subchondral bone and is named "osteo-core plasty." It consists of 2 parts: The first is decompression of bone marrow to decrease intraosseous pressure, and the second is administration of bone marrow aspirate concentrate for better healing potential and bone autograft to deliver supportive tissue. It should be noted that the cause of BMLs must be known before this kind of treatment is performed.
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Affiliation(s)
- Dawid Szwedowski
- Address correspondence to Dawid Szwedowski, M.D., Orthopaedic Arthroscopic Surgery International (OASI) Bioresearch Foundation Gobbi NPO, Milan, Italy.
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17
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Schreiner AJ, Stoker AM, Bozynski CC, Kuroki K, Stannard JP, Cook JL. Clinical Application of the Basic Science of Articular Cartilage Pathology and Treatment. J Knee Surg 2020; 33:1056-1068. [PMID: 32583400 DOI: 10.1055/s-0040-1712944] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The joint is an organ with each tissue playing critical roles in health and disease. Intact articular cartilage is an exquisite tissue that withstands incredible biologic and biomechanical demands in allowing movement and function, which is why hyaline cartilage must be maintained within a very narrow range of biochemical composition and morphologic architecture to meet demands while maintaining health and integrity. Unfortunately, insult, injury, and/or aging can initiate a cascade of events that result in erosion, degradation, and loss of articular cartilage such that joint pain and dysfunction ensue. Importantly, articular cartilage pathology affects the health of the entire joint and therefore should not be considered or addressed in isolation. Treating articular cartilage lesions is challenging because left alone, the tissue is incapable of regeneration or highly functional and durable repair. Nonoperative treatments can alleviate symptoms associated with cartilage pathology but are not curative or lasting. Current surgical treatments range from stimulation of intrinsic repair to whole-surface and whole-joint restoration. Unfortunately, there is a relative paucity of prospective, randomized controlled, or well-designed cohort-based clinical trials with respect to cartilage repair and restoration surgeries, such that there is a gap in knowledge that must be addressed to determine optimal treatment strategies for this ubiquitous problem in orthopedic health care. This review article discusses the basic science rationale and principles that influence pathology, symptoms, treatment algorithms, and outcomes associated with articular cartilage defects in the knee.
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Affiliation(s)
- Anna J Schreiner
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,BG Center for Trauma and Reconstructive Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Aaron M Stoker
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Chantelle C Bozynski
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Keiichi Kuroki
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - James P Stannard
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - James L Cook
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
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18
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19
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Liu B, Zhao Y, Zhu T, Gao S, Ye K, Zhou F, Qiu D, Wang X, Tian Y, Qu X. Biphasic Double-Network Hydrogel With Compartmentalized Loading of Bioactive Glass for Osteochondral Defect Repair. Front Bioeng Biotechnol 2020; 8:752. [PMID: 32714919 PMCID: PMC7346869 DOI: 10.3389/fbioe.2020.00752] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 06/12/2020] [Indexed: 12/04/2022] Open
Abstract
Periarticular injury usually causes the defects of superficial cartilage and the underlying subchondral bone. Although some efficacious outcomes have been achieved by the existing therapeutic methods both in clinics and research, like symptomatic treatment, microfracture surgery, and tissue engineering technology, they still present specific disadvantages and complications. To improve this situation, we designed a biphasic (bi-) scaffold aiming to repair the structure of cartilage and subchondral bone synchronously. The scaffold consisted of a superior double-network (DN) hydrogel layer and a lower bioactive glass (BG) reinforced hydrogel layer, and the DN hydrogel included glycol chitosan (GC) and dibenzaldhyde functionalized poly(ethylene oxide) network, and sodium alginate (Alg) and calcium chloride (CaCl2) network. To investigate its effectiveness, we applied this biphasic scaffold to repair osteochondral full-thickness defects in rabbit models. We set up six observation groups in total, including Untreated group, Microfracture group, BG only group, DN gel group, bi-DN gel group, and bi-DN/TGF-β gel group. With a follow-up period of 24 weeks, we evaluated the treatment effects by gross observation, micro-CT scan and histological staining. Besides, we further fulfilled the quantitative analysis of the data from ICRS score, O’Driscoll score and micro-CT parameters. The results revealed that neat GC/Alg DN hydrogel scaffold was only conductive to promoting cartilage regeneration and neat BG scaffold merely showed the excellent ability to reconstruct subchondral bone. While the biphasic scaffold performed better in repairing osteochondral defect synchronously, exhibiting more well-integrated cartilage-like tissue with positive staining of toluidine blue and col II immunohistochemistry, and more dense trabecular bone connecting closely with the surrounding host bone. Therefore, this method possessed the clinical application potential in treating articular injury, osteochondral degeneration, osteochondral necrosis, and sclerosis.
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Affiliation(s)
- Bingchuan Liu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
| | - Yanran Zhao
- Center of Materials Science and Optoelectronics Engineering, College of Materials Science and Opto-Electronic Technology, University of Chinese Academy of Sciences, Beijing, China
| | - Tengjiao Zhu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
| | - Shan Gao
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
| | - Kaifeng Ye
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
| | - Fang Zhou
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
| | - Dong Qiu
- Beijing National Laboratory for Molecular Science, State Key Laboratory of Polymer Physics and Chemistry, CAS Research/Education Center for Excellence in Molecular Sciences, Institute of Chemistry Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Xing Wang
- Beijing National Laboratory for Molecular Science, State Key Laboratory of Polymer Physics and Chemistry, CAS Research/Education Center for Excellence in Molecular Sciences, Institute of Chemistry Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Yun Tian
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
| | - Xiaozhong Qu
- Center of Materials Science and Optoelectronics Engineering, College of Materials Science and Opto-Electronic Technology, University of Chinese Academy of Sciences, Beijing, China
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20
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Abstract
Bone marrow lesions of the knee in patients with osteoarthritis (OA-BML) are an important clinical entity that may explain progressive pain, decreased quality of life, and impaired function. MRI of OA-BMLs demonstrates a region of subchondral bone with hyperintense marrow signal on T2-weighted images. Histopathology retrieval studies have demonstrated that these lesions correlate with microdamage of the trabecular bone, and subsequently, this leads to a vicious cycle of subchondral bone attrition, attempts at repair, pain, and progressive deformity. These lesions have also been linked to accelerated loss of adjacent articular cartilage and increases in the severity of knee pain, prompting patients to seek musculoskeletal care and treatment. Multiple studies have also correlated the presence of an OA-BML with an increased probability of seeking knee arthroplasty. Knowledge of these lesions is important in the context that knee OA is both a cartilage-based and bone-based disease. Further study of OA-BMLs may provide opportunities for early intervention and OA disease-modifying treatments.
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