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Amirhekmat A, Brown WE, Salinas EY, Hu JC, Athanasiou KA, Wang D. Mechanical Evaluation of Commercially Available Fibrin Sealants for Cartilage Repair. Cartilage 2024; 15:147-155. [PMID: 36974340 DOI: 10.1177/19476035231163273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVE Fibrin sealants are routinely used for intra-articular surgical fixation of cartilage fragments and implants. However, the mechanical properties of fibrin sealants in the context of cartilage repair are unknown. The purpose of this study was to characterize the adhesive and frictional properties of fibrin sealants using an ex vivo model. DESIGN Native bovine cartilage-bone composites were assembled with a single application of Tisseel or Vistaseal. Composites were tested in tension and lap shear. In addition, the coefficient of friction (COF) was measured in a native cartilage annulus model alone and with minced cartilage. Finally, the effect of a double application of fibrin sealant was evaluated. RESULTS There were no significant differences in tensile modulus, ultimate tensile strength (UTS), shear modulus, or ultimate shear strength (USS) between the 2 fibrin sealants. Both fibrin sealants demonstrated a UTS and USS of <8 and <30 kPa, respectively. There were no differences in COF between the sealants when tested alone or with minced cartilage. A double application of fibrin sealant did not alter the mechanical properties compared with a single application of fibrin sealant. CONCLUSIONS Fibrin sealant adhesive properties are not affected by the sealant type studied or the number of applications in a bovine cartilage-bone model. Fibrin sealant tribological properties are not affected by sealant type or the addition of minced cartilage. The adhesive properties of Tisseel and Vistaseal were less than those desired for the in vivo fixation of cartilage repair implants. These findings motivate the development of an improved cartilage-specific adhesive for cartilage repair applications.
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Affiliation(s)
- Arya Amirhekmat
- School of Medicine, University of California, Irvine, Irvine, CA, USA
- Department of Orthopaedic Surgery, University of California, Irvine, Orange, CA, USA
| | - Wendy E Brown
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
| | - Evelia Y Salinas
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
| | - Jerry C Hu
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
| | - Kyriacos A Athanasiou
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
| | - Dean Wang
- School of Medicine, University of California, Irvine, Irvine, CA, USA
- Department of Orthopaedic Surgery, University of California, Irvine, Orange, CA, USA
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
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Haartmans MJJ, Claes BSR, Eijkel GB, Emanuel KS, Tuijthof GJM, Heeren RMA, Emans PJ, Cillero-Pastor B. Matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI-MSI) reveals potential lipid markers between infrapatellar fat pad biopsies of osteoarthritis and cartilage defect patients. Anal Bioanal Chem 2023; 415:5997-6007. [PMID: 37505238 PMCID: PMC10556153 DOI: 10.1007/s00216-023-04871-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023]
Abstract
The incidence of osteoarthritis (OA) has been expected to increase due to an aging population, as well as an increased incidence of intra-articular (osteo-) chondral damage. Lipids have already been shown to be involved in the inflammatory process of OA. This study aims at revealing region-specific lipid profiles of the infrapatellar fat pad (IPFP) of OA or cartilage defect patients by matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI-MSI), which could be used as biomarkers for early OA detection. A higher presence of phospholipids was found in OA patients compared with cartilage defect patients. In addition, a higher abundance of ether-linked phosphatidylethanolamines (PE O-s) containing arachidonic acid was specifically found in OA patients compared with cartilage defect patients. These lipids were mainly found in the connective tissue of the IPFP. Specific lipid species were associated to OA patients compared with cartilage defect patients. PE O-s have been suggested as possible biomarkers for OA. As these were found more abundantly in the connective tissue, the IPFP's intra-tissue heterogeneity might play an important role in biomarker discovery, implying that the amount of fibrous tissue is associated with OA.
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Affiliation(s)
- Mirella J J Haartmans
- Division of Imaging Mass Spectrometry, Maastricht MultiModal Molecular Imaging Institute (M4i), Maastricht University, Maastricht, the Netherlands
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Joint Preserving Clinic, CAPHRI Care and Public Health Research Institute, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Britt S R Claes
- Division of Imaging Mass Spectrometry, Maastricht MultiModal Molecular Imaging Institute (M4i), Maastricht University, Maastricht, the Netherlands
| | - Gert B Eijkel
- Division of Imaging Mass Spectrometry, Maastricht MultiModal Molecular Imaging Institute (M4i), Maastricht University, Maastricht, the Netherlands
| | - Kaj S Emanuel
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Joint Preserving Clinic, CAPHRI Care and Public Health Research Institute, Maastricht University Medical Center+, Maastricht, the Netherlands
- Department of Orthopedic Surgery and Sport Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, the Netherlands
| | - Gabrielle J M Tuijthof
- Biomedical Device Design and Production Technology, Faculty of Engineering Technology, University of Twente, Enschede, the Netherlands
| | - Ron M A Heeren
- Division of Imaging Mass Spectrometry, Maastricht MultiModal Molecular Imaging Institute (M4i), Maastricht University, Maastricht, the Netherlands
| | - Pieter J Emans
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Joint Preserving Clinic, CAPHRI Care and Public Health Research Institute, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Berta Cillero-Pastor
- Division of Imaging Mass Spectrometry, Maastricht MultiModal Molecular Imaging Institute (M4i), Maastricht University, Maastricht, the Netherlands.
- MERLN Institute for Technology-Inspired Regenerative Medicine, Department of Cell Biology-Inspired Tissue Engineering (cBITE), Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, the Netherlands.
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Wodzig M, Peters M, Emanuel K, Van Hugten P, Wijnen W, Jutten L, Boymans T, Loeffen D, Emans P. Minced Autologous Chondral Fragments with Fibrin Glue as a Simple Promising One-Step Cartilage Repair Procedure: A Clinical and MRI Study at 12-Month Follow-Up. Cartilage 2022; 13:19-31. [PMID: 36305343 PMCID: PMC9924984 DOI: 10.1177/19476035221126343] [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] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate early radiological and clinical outcome of autologous minced cartilage treatment as a single-step treatment option in patients with a chondral or osteochondral lesion (OCL) in the knee. DESIGN Eighteen patients with an OCL in the knee were included. Cartilage from healthy-appearing loose bodies and/or the periphery of the defect were minced into small chips and sealed in the defect using fibrin glue. Preoperatively, and at 3 (n = 14) and 12 (n = 18) months follow-up, magnetic resonance imaging (MRI) was performed. The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 score was used to assess the cartilage repair tissue on MRI at 12 months. The International Knee Documentation Score, Knee Injury and Osteoarthritis Outcome Score, EuroQoL-5D, and Visual Analogue Scale pain were collected preoperatively and 12 months after surgery. RESULTS Three months postoperative, MRI showed complete defect filling in 11 out of 14 patients. Mean MOCART 2.0 score at 12 months was 65.0 ± 18.9 with higher scores for lateral femoral chondral lesions compared to medial femoral chondral lesions (75.8 ± 14.3, 52.5 ± 15.8 respectively, P = 0.02). Clinical and statistical significant improvements were observed in the patient-reported outcome measures at 12 months postoperatively compared to preoperatively. CONCLUSION Treatment of OCLs using the autologous minced cartilage procedure resulted in good cartilage repair measured by MOCART 2.0. Clinically relevant improvements were observed in the clinical scores. This study suggests autologous minced cartilage as a promising, single-step treatment for OCLs.
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Affiliation(s)
- M.H.H. Wodzig
- Department of Orthopedic Surgery,
Joint-Preserving Clinic, Maastricht University Medical Center, Maastricht, The
Netherlands,M.H.H. Wodzig, Department of Orthopedic
Surgery, Joint-Preserving Clinic, Maastricht University Medical Center,
Maastricht 6229 HX, The Netherlands.
| | | | - K.S. Emanuel
- Department of Orthopedic Surgery,
Joint-Preserving Clinic, Maastricht University Medical Center, Maastricht, The
Netherlands,Department of Orthopedic Surgery,
Amsterdam UMC, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - P.P.W. Van Hugten
- Department of Orthopedic Surgery,
Joint-Preserving Clinic, Maastricht University Medical Center, Maastricht, The
Netherlands
| | - W. Wijnen
- Department of Orthopedic Surgery,
Joint-Preserving Clinic, Maastricht University Medical Center, Maastricht, The
Netherlands
| | - L.M. Jutten
- Department of Orthopedic Surgery,
Joint-Preserving Clinic, Maastricht University Medical Center, Maastricht, The
Netherlands
| | - T.A. Boymans
- Department of Orthopedic Surgery,
Joint-Preserving Clinic, Maastricht University Medical Center, Maastricht, The
Netherlands
| | - D.V. Loeffen
- Department of Radiology, Maastricht
University Medical Center, Maastricht, The Netherlands
| | - P.J. Emans
- Department of Orthopedic Surgery,
Joint-Preserving Clinic, Maastricht University Medical Center, Maastricht, The
Netherlands
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Koëter M, van Hugten PPW, Emans PJ, Ten Bosch JA. Treatment of a coronal shear injury of the trochlea using a modified hedgehog-based technique through an anterior neurovascular interval approach: A case report. Int J Surg Case Rep 2021; 85:106211. [PMID: 34293656 PMCID: PMC8319752 DOI: 10.1016/j.ijscr.2021.106211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/14/2021] [Accepted: 07/14/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Surgical treatment for dislocated trochlear shear injuries is recommended due to its articular nature. However, the surgical exposure is often limited and large cartilaginous fragments with lack of subchondral bone stock makes a stable fixation technically challenging. Rapid swelling of the traumatized cartilage induces a size misfit between the cartilage of the fragment and the defect site. The use of a "modified hedgehog"-based technique might be a solution in these cases. However, this technique has only been described in chondral shear lesions of the knee. CASE PRESENTATION A fifteen-year-old boy fell out of the still rings during gymnastics at school and suffered trauma to his elbow. A CT-scan of the right elbow showed a coronal shear injury of the trochlea with accompanied lateral condyle fracture of the humerus. The patient was treated throughout an anterior neurovascular approach with a modified hedgehog-based technique with triple fixation by creating an interlocking match of the cartilage, application of fibrin glue and additional screw fixation. CLINICAL DISCUSSION The anterior neurovascular interval approach provides a clear exposure of the fracture site which is useful for anatomic reduction and triple fixation. The subsequent modified hedgehog-based technique has only been described once in children with shear-off chondral fragments of the knee, without additional screw fixation. Adding a screw fixation of the fragment creates some collateral damage to the cartilage and might not be necessary in future cases. CONCLUSION The anterior neurovascular approach seems elegant and provides adequate exposure. Furthermore, a modified hedgehog-based technique delivers a stable triple fixation of the osteochondral fragment.
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Affiliation(s)
- M Koëter
- Departement of Trauma Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - P P W van Hugten
- Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - P J Emans
- Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - J A Ten Bosch
- Departement of Trauma Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
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Ichikawa K, Ogawa H, Matsumoto K, Akiyama H. Osteochondral Peg Fixation for Chondral Fragment of the Knee in Adolescent Patients: A Report of Two Cases. Case Rep Orthop 2021; 2021:9958012. [PMID: 34306786 PMCID: PMC8282393 DOI: 10.1155/2021/9958012] [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: 03/07/2021] [Revised: 06/08/2021] [Accepted: 06/23/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Purely chondral injuries of the knee are relatively rare, and no consensus exists on the appropriate treatment in such cases. We describe two adolescent patients with chondral injury of the knee who were successfully treated by osteochondral peg fixation. Patients, Concerns, and Clinical Findings. In case 1, a 14-year-old boy presented with complaints of right knee pain after landing on his leg while playing basketball. Radiography and computerized tomography revealed no abnormalities. However, magnetic resonance imaging revealed a chondral defect in his lateral femoral condyle and a loose chondral fragment measuring 6.5 cm2. In case 2, a 12-year-old boy presented with complaints of left knee pain after a rotational injury while playing baseball. Similar to case 1, magnetic resonance imaging revealed a chondral defect in his lateral femoral condyle and a loose chondral fragment measuring 3.0 cm2. Primary Diagnosis, Interventions, and Outcomes. The two patients were treated by surgical fixation using osteochondral pegs, which were harvested from the femoral condyle. After a year, postoperative computerized tomography and magnetic resonance imaging showed union of the chondral fragment with the osteochondral pegs and surrounding tissue. In both cases, the Lysholm score was 100 points at the final follow-up more than 2 years after surgery. CONCLUSION The findings reported herein suggest that osteochondral peg fixation is a feasible treatment option for chondral injury of the knee, with satisfactory outcomes.
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Affiliation(s)
- Katsuhiro Ichikawa
- Department of Orthopaedic Surgery, Gifu Prefectural General Medical Center, Noishiki 4-6-1, Gifu, Gifu, Japan
| | - Hiroyasu Ogawa
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital, Hayashi-machi 6-85-1, Ogaki, Gifu, Japan
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu, Gifu, Japan
| | - Kazu Matsumoto
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu, Gifu, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu, Gifu, Japan
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Reconstruction of Large Osteochondral Lesions in the Knee: Focus on Fixation Techniques. Life (Basel) 2021; 11:life11060543. [PMID: 34200546 PMCID: PMC8226590 DOI: 10.3390/life11060543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/28/2021] [Accepted: 06/04/2021] [Indexed: 11/17/2022] Open
Abstract
Large (>3 cm2), focal osteochondral lesions (OCL) may result in poor functional outcomes and early secondary osteoarthritis of the knee. The surgical management of these OCL remains challenging. The treatment strategy must be tailored to various aspects, including lesion-specific (e.g., size, location, chronicity), joint-specific (e.g., instability, limb alignment, meniscal status), and patient-specific factors (e.g., age, activity level, comorbidities). Simple chondroplasty and bone marrow stimulation (BMS) techniques should be reserved for smaller lesions, as they only realize midterm clinical benefits, related to inferior wear characteristics of the induced fibrocartilage (type I collagen). Therefore, much attention has been focused on surgical restoration with hyaline cartilage (type II collagen), based on chondrocyte transplantation and matrix-assisted autologous chondrocyte implantation (MACI). Limited graft availability, staged procedures (MACI), and high treatment costs are limitations of these techniques. However, acute traumatic OCL of the femoral condyles and patellofemoral joint may also be suitable for preservation by surgical fixation. Early detection of the fragment facilitates primary repair with internal fixation. The surgical repair of the articular surface may offer promising clinical and cost-effective benefits as a first-line therapy but remains under-investigated and potentially under-utilized. As a unique characteristic, the fixation technique allows the anatomic restoration of the hyaline articular surface with native cartilage and the repair of the subchondral bone. In this manuscript, we present a case series of large OCL around the knee that were preserved by surgical fixation. Furthermore, various implants and techniques reported for this procedure are reviewed.
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Jacob G, Shimomura K, Nakamura N. Osteochondral Injury, Management and Tissue Engineering Approaches. Front Cell Dev Biol 2020; 8:580868. [PMID: 33251212 PMCID: PMC7673409 DOI: 10.3389/fcell.2020.580868] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/22/2020] [Indexed: 12/13/2022] Open
Abstract
Osteochondral lesions (OL) are a common clinical problem for orthopedic surgeons worldwide and are associated with multiple clinical scenarios ranging from trauma to osteonecrosis. OL vary from chondral lesions in that they involve the subchondral bone and chondral surface, making their management more complex than an isolated chondral injury. Subchondral bone involvement allows for a natural healing response from the body as marrow elements are able to come into contact with the defect site. However, this repair is inadequate resulting in fibrous scar tissue. The second differentiating feature of OL is that damage to the subchondral bone has deleterious effects on the mechanical strength and nutritive capabilities to the chondral joint surface. The clinical solution must, therefore, address both the articular cartilage as well as the subchondral bone beneath it to restore and preserve joint health. Both cartilage and subchondral bone have distinctive functional requirements and therefore their physical and biological characteristics are very much dissimilar, yet they must work together as one unit for ideal joint functioning. In the past, the obvious solution was autologous graft transfer, where an osteochondral bone plug was harvested from a non-weight bearing portion of the joint and implanted into the defect site. Allografts have been utilized similarly to eliminate the donor site morbidity associated with autologous techniques and overall results have been good but both techniques have their drawbacks and limitations. Tissue engineering has thus been an attractive option to create multiphasic scaffolds and implants. Biphasic and triphasic implants have been under explored and have both a chondral and subchondral component with an interface between the two to deliver an implant which is biocompatible and emulates the osteochondral unit as a whole. It has been a challenge to develop such implants and many manufacturing techniques have been utilized to bring together two unalike materials and combine them with cellular therapies. We summarize the functions of the osteochondral unit and describe the currently available management techniques under study.
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Affiliation(s)
- George Jacob
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Orthopedics, Tejasvini Hospital, Mangalore, India
| | - Kazunori Shimomura
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Norimasa Nakamura
- Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan
- Global Center for Medical Engineering and Informatics, Osaka University, Osaka, Japan
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Vogel LA, Fitzsimmons KP, Lee Pace J. Osteochondral Fracture Fixation With Fragment Preserving Suture Technique. Arthrosc Tech 2020; 9:e761-e767. [PMID: 32577349 PMCID: PMC7301336 DOI: 10.1016/j.eats.2020.02.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/04/2020] [Indexed: 02/03/2023] Open
Abstract
Osteochondral fractures are relatively uncommon injuries that typically present after an acute or subacute traumatic injury. Osteochondral fracture fixation is traditionally performed in the acute setting with internal fixation procedures using pins or compression screws through the fragment. Outcomes have generally been good, but cartilage thinning, subchondral remodeling, and tissue reactions can occur after internal fixation through the fragment. This article describes osteochondral fracture fragment fixation with a fragment-preserving technique that does not violate the articular cartilage of the fragment. This technique minimizes risk to articular cartilage that has already sustained injury and also provides superior fixation.
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Affiliation(s)
- Laura A. Vogel
- Department of Orthopaedics, University of Colorado, Aurora, Colorado
| | - Kevin P. Fitzsimmons
- Elite Sports Medicine, Connecticut Children's Medical Center, Farmington, Connecticut, U.S.A
| | - J. Lee Pace
- Elite Sports Medicine, Connecticut Children's Medical Center, Farmington, Connecticut, U.S.A.,Department of Orthopedic Surgery, University of Connecticut School of Medicine, Farmington, Connecticut, U.S.A.,Address correspondence to J. Lee Pace, M.D., Elite Sports Medicine, Connecticut Children's Medical Center, 399 Farmington Ave, Farmington, CT 06032, U.S.A.
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