1
|
Pohl NB, Fitzgerald P, Brush PL, Fletcher DJ, Hornstein J. Late (≥60 years old) and middle adulthood (40-59 years old) patients achieve similar improvement in patient-reported outcomes following ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39324366 DOI: 10.1002/ksa.12491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 09/10/2024] [Accepted: 09/16/2024] [Indexed: 09/27/2024]
Abstract
PURPOSE This study aimed to compare the range of motion (ROM), surgical outcomes, and patient-reported outcome measures (PROMs) following anterior cruciate ligament (ACL) reconstruction outcomes in patients 60 years or older at the time of surgery to 40- to 59-year-old patients. METHODS In this retrospective cohort study from 2015 to 2022, a 3:1 propensity match was performed to match late adulthood patients (≥60 years old) undergoing ACL reconstruction with middle adulthood (40-59 years old) ACL reconstruction patients. Patients were matched based on sex, ACL graft utilized and concomitant procedures performed during ACL reconstruction. Statistical analysis compared demographics, preoperative injury management, surgical outcomes, PROMs, and minimal clinical important difference (MCID) and substantial clinical benefit (SCB) achievement rates for all ACL reconstruction patients included. RESULTS Twenty late adulthood and 60 middle adulthood patients who underwent ACL reconstruction were included in the final cohort. Patients who were 60 years or older experienced no difference in reoperation rate (n.s.), incidence of retears (n.s.) or ROM (n.s.) at 1 year post-operatively. There were also no differences in International Knee Documentation Committee (ΔIKDC) (31.3 ± 19.1 vs. 34.2 ± 18.2, n.s.) or ΔPCS-12 (12.4 ± 9.8 vs. 12.9 ± 10.8, n.s.) scores at 1 year post-operatively. Furthermore, the younger and older patient cohorts demonstrated similar rates of achieving the MCID (80.0% vs. 83.3%, n.s.) and SCB (50.0% vs. 61.7%, n.s.) scores for IKDC. CONCLUSION Patients 60 years or older and 40- to 59-year-old patients demonstrated similar outcomes after undergoing ACL reconstruction with allograft. This study concludes that ACL reconstruction in late adulthood can still be a successful treatment option and should allow surgeons to feel more comfortable when performing indicated surgical intervention for older patients who experience an ACL tear. LEVEL OF EVIDENCE Level III, Therapeutic III, retrospective cohort study.
Collapse
Affiliation(s)
- Nicholas B Pohl
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Patrick Fitzgerald
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Parker L Brush
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Daniel J Fletcher
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Joshua Hornstein
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| |
Collapse
|
2
|
van Hugten PPW, Jeuken RM, Asik EE, Oevering H, Welting TJM, van Donkelaar CC, Thies JC, Emans PJ, Roth AK. In vitro and in vivo evaluation of the osseointegration capacity of a polycarbonate-urethane zirconium-oxide composite material for application in a focal knee resurfacing implant. J Biomed Mater Res A 2024; 112:1424-1435. [PMID: 38465895 DOI: 10.1002/jbm.a.37691] [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: 07/25/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 03/12/2024]
Abstract
Currently available focal knee resurfacing implants (FKRIs) are fully or partially composed of metals, which show a large disparity in elastic modulus relative to bone and cartilage tissue. Although titanium is known for its excellent osseointegration, the application in FKRIs can lead to potential stress-shielding and metal implants can cause degeneration of the opposing articulating cartilage due to the high resulting contact stresses. Furthermore, metal implants do not allow for follow-up using magnetic resonance imaging (MRI).To overcome the drawbacks of using metal based FKRIs, a biomimetic and MRI compatible bi-layered non-resorbable thermoplastic polycarbonate-urethane (PCU)-based FKRI was developed. The objective of this preclinical study was to evaluate the mechanical properties, biocompatibility and osteoconduction of a novel Bionate® 75D - zirconium oxide (B75D-ZrO2) composite material in vitro and the osseointegration of a B75D-ZrO2 composite stem PCU implant in a caprine animal model. The tensile strength and elastic modulus of the B75D-ZrO2 composite were characterized through in vitro mechanical tests under ambient and physiological conditions. In vitro biocompatibility and osteoconductivity were evaluated by exposing human mesenchymal stem cells to the B75D-ZrO2 composite and culturing the cells under osteogenic conditions. Cell activity and mineralization were assessed and compared to Bionate® 75D (B75D) and titanium disks. The in vivo osseointegration of implants containing a B75D-ZrO2 stem was compared to implants with a B75D stem and titanium stem in a caprine large animal model. After a follow-up of 6 months, bone histomorphometry was performed to assess the bone-to-implant contact area (BIC). Mechanical testing showed that the B75D-ZrO2 composite material possesses an elastic modulus in the range of the elastic modulus reported for trabecular bone. The B75D-ZrO2 composite material facilitated cell mediated mineralization to a comparable extent as titanium. A significantly higher bone-to-implant contact (BIC) score was observed in the B75D-ZrO2 implants compared to the B75D implants. The BIC of B75D-ZrO2 implants was not significantly different compared to titanium implants. A biocompatible B75D-ZrO2 composite approximating the elastic modulus of trabecular bone was developed by compounding B75D with zirconium oxide. In vivo evaluation showed an significant increase of osseointegration for B75D-ZrO2 composite stem implants compared to B75D polymer stem PCU implants. The osseointegration of B75D-ZrO2 composite stem PCU implants was not significantly different in comparison to analogous titanium stem metal implants.
Collapse
Affiliation(s)
- Pieter P W van Hugten
- Department of Orthopedic Surgery, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Department of Orthopedic Surgery, Joint Preservation Clinic, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ralph M Jeuken
- Department of Orthopedic Surgery, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Department of Orthopedic Surgery, Joint Preservation Clinic, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Erkan E Asik
- Department of Biomedical Engineering, Orthopaedic Biomechanics, Eindhoven University of Technology, Eindhoven, The Netherlands
- Avalanche Medical BV, Maastricht, The Netherlands
| | | | - Tim J M Welting
- Department of Orthopedic Surgery, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Corrinus C van Donkelaar
- Department of Biomedical Engineering, Orthopaedic Biomechanics, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | - Peter J Emans
- Department of Orthopedic Surgery, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Department of Orthopedic Surgery, Joint Preservation Clinic, Maastricht University Medical Center, Maastricht, The Netherlands
- Avalanche Medical BV, Maastricht, The Netherlands
| | - Alex K Roth
- Department of Orthopedic Surgery, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Avalanche Medical BV, Maastricht, The Netherlands
| |
Collapse
|
3
|
Ren Z, Liu Y, Ma Y, Huang L, Wang X, Lin Q, Xing Y, Yang W, Duan W, Wei X. Treatment of Articular Cartilage Defects: A Descriptive Analysis of Clinical Characteristics and Global Trends Reported from 2001 to 2020. Cartilage 2024; 15:209-218. [PMID: 37853672 PMCID: PMC11418540 DOI: 10.1177/19476035231205695] [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] [Received: 05/30/2023] [Accepted: 08/07/2023] [Indexed: 10/20/2023] Open
Abstract
PURPOSE To evaluate the clinical characteristics and global trends in the surgical treatment of articular cartilage defects. METHODS Studies in English published between January 1, 2001 and December 31, 2020 were retrieved from MEDLINE, WOS, INSPEC, SCIELO, KJD, and RSCI on the "Web of Science." Patient data were extracted, including age, sex, defect location and laterality, duration of follow-up and symptoms, and body mass index (BMI). Data were further stratified according to the surgical method, lesion location, procedural type and geographical area, and time period. A comparative analysis was performed. RESULTS Overall, 443 studies involving 26,854 patients (mean age, 35.25 years; men, 60.5%) were included. The mean lesion size and patient BMI were 3.51 cm2 and 25.61 kg/m2, respectively. Cartilage defects at the knees, talus, and hips affected 20,850 (77.64%), 3,983 (14.83%), and 1,425 (5.31%) patients, respectively. The numbers of patients who underwent autologous chondrocyte implantation, arthroscopic debridement/chondroplasty, osteochondral allograft (OCA), osteochondral autologous transplantation, and microfracture were 7,114 (26.49%), 5,056 (18.83%), 3,942 (14.68%), 3,766 (14.02%), and 2,835 (10.56%), respectively. European patients were the most numerous and youngest. North American patients had the largest defects. The number of patients increased from 305 in 2001 to 3,017 in 2020. In the last 5 years, the frequency of OCAs showed a greatly increasing trend. CONCLUSION Clinical characteristics and global trends in the surgical treatment of articular cartilage defects were revealed. The choice of operation should be based on the patient characteristics and defect location, size, and shape, as well as the patient's preference.
Collapse
Affiliation(s)
- Zhiyuan Ren
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Taiyuan, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Yang Liu
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Taiyuan, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Yongsheng Ma
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Taiyuan, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Lingan Huang
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Xueding Wang
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Taiyuan, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Qitai Lin
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Taiyuan, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Yugang Xing
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Taiyuan, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Wenming Yang
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Taiyuan, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Wangping Duan
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Taiyuan, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Xiaochun Wei
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, China
| |
Collapse
|
4
|
Santos F, Marto-Costa C, Branco AC, Oliveira AS, Galhano Dos Santos R, Salema-Oom M, Diaz RL, Williams S, Colaço R, Figueiredo-Pina C, Serro AP. Tribomechanical Properties of PVA/Nomex ® Composite Hydrogels for Articular Cartilage Repair. Gels 2024; 10:514. [PMID: 39195043 DOI: 10.3390/gels10080514] [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: 06/26/2024] [Revised: 07/18/2024] [Accepted: 07/30/2024] [Indexed: 08/29/2024] Open
Abstract
Due to the increasing prevalence of articular cartilage diseases and limitations faced by current therapeutic methodologies, there is an unmet need for new materials to replace damaged cartilage. In this work, poly(vinyl alcohol) (PVA) hydrogels were reinforced with different amounts of Nomex® (known for its high mechanical toughness, flexibility, and resilience) and sterilized by gamma irradiation. Samples were studied concerning morphology, chemical structure, thermal behavior, water content, wettability, mechanical properties, and rheological and tribological behavior. Overall, it was found that the incorporation of aramid nanostructures improved the hydrogel's mechanical performance, likely due to the reinforcement's intrinsic strength and hydrogen bonding to PVA chains. Additionally, the sterilization of the materials also led to superior mechanical properties, possibly related to the increased crosslinking density through the hydrogen bonding caused by the irradiation. The water content, wettability, and tribological performance of PVA hydrogels were not compromised by either the reinforcement or the sterilization process. The best-performing composite, containing 1.5% wt. of Nomex®, did not induce cytotoxicity in human chondrocytes. Plugs of this hydrogel were inserted in porcine femoral heads and tested in an anatomical hip simulator. No significant changes were observed in the hydrogel or cartilage, demonstrating the material's potential to be used in cartilage replacement.
Collapse
Affiliation(s)
- Francisco Santos
- Centro de Química Estrutural (CQE), Institute of Molecular Sciences, Department of Chemical Engineering, Instituto Superior Técnico, University of Lisbon, Av. Rovisco Pais 1, 1049-001 Lisbon, Portugal
| | - Carolina Marto-Costa
- Centro de Química Estrutural (CQE), Institute of Molecular Sciences, Department of Chemical Engineering, Instituto Superior Técnico, University of Lisbon, Av. Rovisco Pais 1, 1049-001 Lisbon, Portugal
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Monte da Caparica, 2829-511 Almada, Portugal
| | - Ana Catarina Branco
- Centro de Química Estrutural (CQE), Institute of Molecular Sciences, Department of Chemical Engineering, Instituto Superior Técnico, University of Lisbon, Av. Rovisco Pais 1, 1049-001 Lisbon, Portugal
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Monte da Caparica, 2829-511 Almada, Portugal
- Escola Superior de Tecnologia de Setúbal, Instituto Politécnico de Setúbal, 2910-761 Setúbal, Portugal
| | - Andreia Sofia Oliveira
- Centro de Química Estrutural (CQE), Institute of Molecular Sciences, Department of Chemical Engineering, Instituto Superior Técnico, University of Lisbon, Av. Rovisco Pais 1, 1049-001 Lisbon, Portugal
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Monte da Caparica, 2829-511 Almada, Portugal
- Instituto de Engenharia Mecânica (IDMEC), Department of Mechanical Engineering, Instituto Superior Técnico, University of Lisbon, Av. Rovisco Pais 1, 1049-001 Lisbon, Portugal
| | - Rui Galhano Dos Santos
- CERENA-Centre for Natural Resources and the Environment, Instituto Superior Técnico, University of Lisbon, Av. Rovisco Pais, 1049-001 Lisboa, Portugal
| | - Madalena Salema-Oom
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Monte da Caparica, 2829-511 Almada, Portugal
| | - Roberto Leonardo Diaz
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Woodhouse, Leeds LS2 9JT, UK
| | - Sophie Williams
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Woodhouse, Leeds LS2 9JT, UK
| | - Rogério Colaço
- Instituto de Engenharia Mecânica (IDMEC), Department of Mechanical Engineering, Instituto Superior Técnico, University of Lisbon, Av. Rovisco Pais 1, 1049-001 Lisbon, Portugal
| | - Célio Figueiredo-Pina
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Monte da Caparica, 2829-511 Almada, Portugal
- Escola Superior de Tecnologia de Setúbal, Instituto Politécnico de Setúbal, 2910-761 Setúbal, Portugal
- CeFEMA-Center of Physiscs and Engineering of Advanced Materials, Instituto Superior Técnico, University of Lisbon, Av. Rovisco Pais 1, 1049-001 Lisbon, Portugal
| | - Ana Paula Serro
- Centro de Química Estrutural (CQE), Institute of Molecular Sciences, Department of Chemical Engineering, Instituto Superior Técnico, University of Lisbon, Av. Rovisco Pais 1, 1049-001 Lisbon, Portugal
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Monte da Caparica, 2829-511 Almada, Portugal
| |
Collapse
|
5
|
Usuelli FG, Efrima B, Van Dijk N. Personalized Resurfacing for Osteochondral Lesions of the Talus. Foot Ankle Clin 2024; 29:307-319. [PMID: 38679441 DOI: 10.1016/j.fcl.2023.08.001] [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: 05/01/2024]
Abstract
Osteochondral lesions of the talus (OLTs) are the most common cause of chronic deep ankle pain. Joint-preserving surgeries include bone marrow stimulating, chondral transporting, and cellular-based procedures. Each procedure has its advantages and disadvantages. For that reason, a focal metallic inlay was developed as a bridge between biologics and conventional joint arthroplasty. Despite promising initial results, prefabricated implants are associated with unpredictable results. This article describes a novel customized patient-specific metal inlay as a treatment option for OLTs.
Collapse
Affiliation(s)
| | - Ben Efrima
- Ankle and Foot Unit, Humanitas San Pio X Hospital, Via Francesco nava 31, Milan, Italy.
| | - Niek Van Dijk
- Department of Orthopedic Surgery, Amsterdam UMC location AMC, the Netherlands; Head of Ankle Unit, FIFA Medical Centre of Excellence Ripoll-DePrado Sport Clinic Madrid, Spain; Head of Ankle Unit, FIFA Medical Centre of Excellence Clínica do Dragão Porto, Portugal; Casa di Cura, San Rossore, Pisa, Italy
| |
Collapse
|
6
|
Toom DAD, Rieke M, Elbadawi A, Kösters C. 2-year results of middle-aged patients with two-compartment cartilage lesions in one knee treated with two patient specific metal implants. J Exp Orthop 2023; 10:92. [PMID: 37707660 PMCID: PMC10501106 DOI: 10.1186/s40634-023-00648-2] [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: 04/14/2023] [Accepted: 07/28/2023] [Indexed: 09/15/2023] Open
Abstract
PURPOSE Focal chondral lesions of the femur are currently treated with biological repair or arthroplasty. However, some patients are not suitable for either one due to lesion size, age, or prior biological treatment attempts. While singular patient-specific focal mini metal implants already showed good results, the outcomes of bicompartmental implantation of these implants have not been discussed in the literature yet. This study aims to evaluate clinical outcomes of patients who underwent bicompartmental implantation of two patient-specific implants. METHODS This prospective, non-randomized, non-comparative pilot study evaluates results up to two years after bicompartmental implantation of two implants (Episealer Implant, Episurf, Stockholm, Sweden). A damage report is compiled using a special MRI program and patient specific implants are manufactured, including 3D-printed surgical instruments to provide exact placement of the implant. The patients were assessed repeatedly using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Visual Analogue Scale (VAS) for pain during the follow-up. RESULTS The scores were evaluated three, 12, and 24 months after surgery and showed good results. The median in both scores improved from 37.7 for the KOOS5 preoperatively to 69.1 after 24 months and from 69 for the VAS for pain preoperatively to 9 after 24 months. CONCLUSION Overall, for the small study group presented, the early results are promising. With noticeable improvement in KOOS and VAS for pain after two years, patient specific implants appear to become relevant in future standardized treatment of femoral chondral lesions. Especially with bicompartmental implantation, full arthroplasty can be delayed even further. LEVEL OF EVIDENCE IV.
Collapse
|
7
|
Wang X, Ren Z, Liu Y, Ma Y, Huang L, Song W, Lin Q, Zhang Z, Li P, Wei X, Duan W. Characteristics and Clinical Outcomes After Osteochondral Allograft Transplantation for Treating Articular Cartilage Defects: Systematic Review and Single-Arm Meta-analysis of Studies From 2001 to 2020. Orthop J Sports Med 2023; 11:23259671231199418. [PMID: 37745815 PMCID: PMC10515554 DOI: 10.1177/23259671231199418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/03/2023] [Indexed: 09/26/2023] Open
Abstract
Background Osteochondral allograft transplantation (OCA) treats symptomatic focal cartilage defects with satisfactory clinical results. Purpose To comprehensively analyze the characteristics and clinical outcomes of OCA for treating articular cartilage defects. Study Design Systematic review; Level of evidence, 4. Methods We searched Embase, PubMed, Cochrane Database, and Web of Science for studies published between January 1, 2001, and December 31, 2020, on OCA for treating articular cartilage defects. Publication information, patient data, osteochondral allograft storage details, and clinical outcomes were extracted to conduct a comprehensive summative analysis. Results In total, 105 studies involving 5952 patients were included. The annual reported number of patients treated with OCA increased from 69 in 2001 to 1065 in 2020, peaking at 1504 cases in 2018. Most studies (90.1%) were performed in the United States. The mean age at surgery was 34.2 years, and 60.8% of patients were male and had a mean body mass index of 26.7 kg/m2. The mean lesion area was 5.05 cm2, the mean follow-up duration was 54.39 months, the mean graft size was 6.85 cm2, and the number of grafts per patient was 54.7. The failure rate after OCA was 18.8%, and 83.1% of patients reported satisfactory results. Allograft survival rates at 2, 5, 10, 15, 20, and 25 years were 94%, 87.9%, 80%, 73%, 55%, and 59.4%, respectively. OCA was mainly performed on the knee (88.9%). The most common diagnosis in the knee was osteochondritis dissecans (37.9%), and the most common defect location was the medial femoral condyle (52%). The most common concomitant procedures were high tibial osteotomy (28.4%) and meniscal allograft transplantation (24.7%). After OCA failure, 54.7% of patients underwent revision with primary total knee arthroplasty. Conclusion The annual reported number of patients who underwent OCA showed a significant upward trend, especially from 2016 to 2020. Patients receiving OCA were predominantly young male adults with a high body mass index. OCA was more established for knee cartilage than an injury at other sites, and its best indication was osteochondritis dissecans. This analysis demonstrated satisfactory long-term postoperative outcomes.
Collapse
Affiliation(s)
- Xueding Wang
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Zhiyuan Ren
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Yang Liu
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Yongsheng Ma
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Lingan Huang
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Wenjie Song
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Qitai Lin
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Zhipeng Zhang
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Pengcui Li
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Xiaochun Wei
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| | - Wangping Duan
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, Shanxi, China
| |
Collapse
|
8
|
van Tuijn IM, Emanuel KS, van Hugten PPW, Jeuken R, Emans PJ. Prognostic Factors for the Clinical Outcome after Microfracture Treatment of Chondral and Osteochondral Defects in the Knee Joint: A Systematic Review. Cartilage 2023; 14:5-16. [PMID: 36624991 PMCID: PMC10076892 DOI: 10.1177/19476035221147680] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE The objective of this study is to establish which patient and lesion characteristics are related to the clinical outcome after microfracture of cartilage defects in the knee. STUDY DESIGN Systematic review. METHODS After preregistration, PubMed, Embase, and Cochrane were searched for studies that analyzed prognostic factors for the outcome of microfracture treatment in the knee. The criteria for inclusion were outcome measured using Patient-Reported Outcome Measures (PROMs), a clinical study with ≥10 participants receiving microfracture, and a minimal follow-up period of 1 year. RESULTS For none of the investigated prognostic factors, effect size reporting was sufficiently homogeneous to conduct a meta-analysis. However, a majority of the included studies identified higher age, larger lesion size, longer preoperative symptom duration, and previous surgery on the ipsilateral knee, especially meniscectomy and anterior cruciate ligament reconstruction, as factors that are reported to be correlated to a less favorable outcome. A lesion location that does not include the trochlea or the patellofemoral joint and is not weightbearing, a nondegenerative mechanism of injury, and a single lesion were reported as factors that predict a favorable outcome. As to gender, body mass index, preoperative activity level, smoking, and concomitant knee surgery, the included articles were inconclusive or no effect was reported. CONCLUSIONS Several factors correlated with the clinical result after microfracture treatment. However, the information on the effect sizes of the influence on clinical outcome is incomplete due to poor reporting. Large-scale registries or pooling of homogeneous, well-reported data is needed to work toward prognostic models. That would be an important step toward personalized treatment.
Collapse
Affiliation(s)
- Iris M van Tuijn
- Department of Orthopedic Surgery, Joint Preserving Clinic, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Orthopedic Surgery, CAPHRI Care and Public Health Research Institute, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Kaj S Emanuel
- Department of Orthopedic Surgery, Joint Preserving Clinic, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Orthopedic Surgery and Sports Medicine and Amsterdam Movement Sciences, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Pieter P W van Hugten
- Department of Orthopedic Surgery, Joint Preserving Clinic, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Ralph Jeuken
- Department of Orthopedic Surgery, Joint Preserving Clinic, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Pieter J Emans
- Department of Orthopedic Surgery, Joint Preserving Clinic, Maastricht University Medical Center+, Maastricht, The Netherlands
| |
Collapse
|
9
|
Cartilage repair strategies in the knee according to Dutch Orthopedic Surgeons: a survey study. Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04800-6. [PMID: 36810798 PMCID: PMC10374775 DOI: 10.1007/s00402-023-04800-6] [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: 08/01/2022] [Accepted: 01/25/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND This study surveyed Dutch orthopedic surgeons on the management of cartilage defects in the knee and the adherence to the recently updated Dutch knee cartilage repair consensus statement (DCS). METHODS A web-based survey was sent to 192 Dutch knee specialists. RESULTS The response rate was 60%. Microfracture, debridement and osteochondral autografts are performed by the majority, 93%, 70% and 27% of respondents, respectively. Complex techniques are used by < 7%. Microfracture is mainly considered in defects 1-2 cm2 (by > 80%) but also in 2-3 cm2 (by > 40%). Concomitant procedures, e.g., malalignment corrections, are performed by 89%. Twenty-one percent of surgeons treat patients aged 40-60 years. Microfracture, debridement and autologous chondrocyte implantation are not considered to be highly affected by age > 40 years by any of the respondents (0-3%). Moreover, for the middle-aged there is a large spread in treatments considered. In case of loose bodies, the majority (84%) only performs refixation in the presence of attached bone. CONCLUSION Small cartilage defects in ideal patients may be well treated by general orthopedic surgeons. The matter becomes complicated in older patients, or in case of larger defects or malalignment. The current study reveals some knowledge gaps for these more complex patients. Referral to tertiary centers might be indicated, as is stated by the DCS, and this centralization should enhance knee joint preservation. Since the data from present study are subjective, registration of all separate cartilage repair cases should fuel objective analysis of clinical practice and adherence to the DCS in the future.
Collapse
|
10
|
Oliveira AS, Silva JC, Loureiro MV, Marques AC, Kotov NA, Colaço R, Serro AP. Super-Strong Hydrogel Composites Reinforced with PBO Nanofibers for Cartilage Replacement. Macromol Biosci 2023; 23:e2200240. [PMID: 36443994 DOI: 10.1002/mabi.202200240] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 10/28/2022] [Indexed: 11/30/2022]
Abstract
Cartilage replacement materials exhibiting a set of demanding properties such as high water content, high mechanical stiffness, low friction, and excellent biocompatibility are quite difficult to achieve. Here, poly(p-phenylene-2,6-benzobisoxazole) (PBO) nanofibers are combined with polyvinyl alcohol (PVA) to form a super-strong structure with a performance that surpasses the vast majority of previously existing hydrogels. PVA-PBO composites with water contents in the 59-76% range exhibit tensile and compressive moduli reaching 20.3 and 4.5 MPa, respectively, and a coefficient of friction below 0.08. Further, they are biocompatible and support the viability of chondrocytes for 1 week, with significant improvements in cell adhesion, proliferation, and differentiation compared to PVA. The new composites can be safely sterilized by steam heat or gamma radiation without compromising their integrity and overall performance. In addition, they show potential to be used as local delivery platforms for anti-inflammatory drugs. These attractive features make PVA-PBO composites highly competitive engineered materials with remarkable potential for use in the design of load-bearing tissues. Complementary work has also revealed that these composites will be interesting alternatives in other industrial fields where high thermal and mechanical resistance are essential requirements, or which can take advantage of the pH responsiveness functionality.
Collapse
Affiliation(s)
- Andreia S Oliveira
- Centro de Química Estrutural, Institute of Molecular Sciences, and Department of Chemical Engineering, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, Lisbon, 1049-001, Portugal.,Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz, Quinta da Granja, Monte de Caparica, Caparica, 2829-511, Portugal.,Instituto de Engenharia Mecânica and Department of Mechanical Engineering, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, Lisbon, 1049-001, Portugal
| | - João C Silva
- Institute for Bioengineering and Biosciences and Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, Lisbon, 1049-001, Portugal.,Associate Laboratory i4HB-Institute for Health and Bioeconomy, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, Lisbon, 1049-001, Portugal.,Centre for Rapid and Sustainable Product Development, Politécnico de Leiria, Rua de Portugal-Zona Industrial, Marinha Grande, 2430-028, Portugal
| | - Mónica V Loureiro
- Centro de Recursos Naturais e Ambiente, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, Lisbon, 1049-001, Portugal
| | - Ana C Marques
- Centro de Recursos Naturais e Ambiente, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, Lisbon, 1049-001, Portugal
| | - Nicholas A Kotov
- Biointerfaces Institute, Department of Chemical Engineering, and Department of Materials Science and Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Rogério Colaço
- Instituto de Engenharia Mecânica and Department of Mechanical Engineering, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, Lisbon, 1049-001, Portugal
| | - Ana P Serro
- Centro de Química Estrutural, Institute of Molecular Sciences, and Department of Chemical Engineering, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, Lisbon, 1049-001, Portugal.,Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz, Quinta da Granja, Monte de Caparica, Caparica, 2829-511, Portugal
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Grottkau BE, Hui Z, Pang Y. Articular Cartilage Regeneration through Bioassembling Spherical Micro-Cartilage Building Blocks. Cells 2022; 11:cells11203244. [PMID: 36291114 PMCID: PMC9600996 DOI: 10.3390/cells11203244] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/28/2022] [Accepted: 10/09/2022] [Indexed: 11/24/2022] Open
Abstract
Articular cartilage lesions are prevalent and affect one out of seven American adults and many young patients. Cartilage is not capable of regeneration on its own. Existing therapeutic approaches for articular cartilage lesions have limitations. Cartilage tissue engineering is a promising approach for regenerating articular neocartilage. Bioassembly is an emerging technology that uses microtissues or micro-precursor tissues as building blocks to construct a macro-tissue. We summarize and highlight the application of bioassembly technology in regenerating articular cartilage. We discuss the advantages of bioassembly and present two types of building blocks: multiple cellular scaffold-free spheroids and cell-laden polymer or hydrogel microspheres. We present techniques for generating building blocks and bioassembly methods, including bioprinting and non-bioprinting techniques. Using a data set of 5069 articles from the last 28 years of literature, we analyzed seven categories of related research, and the year trends are presented. The limitations and future directions of this technology are also discussed.
Collapse
|
13
|
Abstract
PURPOSE Regular sports activities are associated with multiple physical and psychological health benefits. However, sports also may lead to injuries and the development of osteoarthritis (OA). This systematic review investigated the association between sports activity, sports type, and the risk of developing OA. METHODS A systematic review was performed by assessing studies that have investigated the risk of OA development in sports. Data extracted included general information, study design, number of participants, related body mass index, sports type, and assessment of OA. The methodological quality of the studies was assessed using the Newcastle-Ottawa Scale. RESULTS A total of 63 studies were included in this systematic review. The overall Newcastle-Ottawa Scale score was 6.46±1.44 demonstrating a good methodological quality of the articles included in the present study. A total of 628,036 participants were included, with a mean follow-up of 8.0±8.4 years. The mean age of the included athletes was 45.6±15.8, with a mean body mass index of 24.9±2.3 kg/m 2 . CONCLUSION Football and soccer players seem to be at higher risk for the development of OA, although the injury status of the joint should be considered when assessing the risk of OA. High equipment weight and increased injury risk also put military personnel at a higher risk of OA, although elite dancing leads to more hip labral tears. Femoroacetabular impingement was also often diagnosed in ice-hockey players and ballet dancers.
Collapse
|
14
|
Cruickshank J, Smith J. Next Generation Cartilage Repair and The Pre-Arthroplasty Patient Pre-arthroplasty Artificial Implants Part A: BioPoly. OPER TECHN SPORT MED 2022. [DOI: 10.1016/j.otsm.2022.150964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
15
|
Next Generation Cartilage Repair and the Pre-arthroplasty Patient. Pre-arthroplasty artificial Implants Part B: Metallic. OPER TECHN SPORT MED 2022. [DOI: 10.1016/j.otsm.2022.150965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
16
|
Patchouli Alcohol Inhibits D-Gal Induced Oxidative Stress and Ameliorates the Quality of Aging Cartilage via Activating the Nrf2/HO-1 Pathway in Mice. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:6821170. [PMID: 35720186 PMCID: PMC9200550 DOI: 10.1155/2022/6821170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/07/2022] [Indexed: 12/15/2022]
Abstract
Chondrocytes play an essential role in maintaining the structure and function of articular cartilage. Oxidative stress occurred in chondrocytes accelerates cell senescence and death, which contributes to the development of osteoarthritis (OA). Patchouli alcohol (PA), a kind of sesquiterpene in Pogostemon cablin, processes multiple bioactivities in treatment of many diseases. However, its effects of antisenescence and antioxidation on chondrocytes in a D-gal-induced aging mice model are still obscure. In this study, we found that PA treatment could ameliorate the degradation of cartilage extracellular matrix (ECM) in a D-gal-induced aging mice model. Further analyses through the immunofluorescent staining and western blot revealed that PA inhibited D-gal-induced chondrocyte senescence via the activation of antioxidative system. Besides, the damage caused by D-gal could not be recovered with PA treatment in Nrf2-silencing chondrocytes. In addition, molecular docking analysis between PA and Keap1 further suggested that the mechanism of PA's antisenescence and antioxidation was attributed to the activation of Nrf2/HO-1 pathway. Therefore, our results demonstrated that PA was a promising candidate for preventing the quality loss of aging cartilage through inhibiting oxidative stress-mediated senescence in chondrocytes.
Collapse
|
17
|
Zonal-Layered Chondrocyte Sheets for Repairment of Full-Thickness Articular Cartilage Defect: A Mini-Pig Model. Biomedicines 2021; 9:biomedicines9121806. [PMID: 34944622 PMCID: PMC8698967 DOI: 10.3390/biomedicines9121806] [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: 11/02/2021] [Revised: 11/19/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022] Open
Abstract
The cell sheet technique is a promising approach for tissue engineering, and the present study is aimed to determine a better configuration of cell sheets for cartilage repair. For stratified chondrocyte sheets (S-CS), articular chondrocytes isolated from superficial, middle, and deep zones were stacked accordingly. Heterogeneous chondrocyte sheets (H-CS) were obtained by mixing zonal chondrocytes. The expressions of chondrocytes, cytokine markers, and glycosaminoglycan (GAG) production were assessed in an in vitro assay. The curative effect was investigated in an in vivo porcine osteochondral defect model. The S-CS showed a higher cell viability, proliferation rate, expression of chondrogenic markers, secretion of tissue inhibitor of metalloproteinase, and GAG production level than the H-CS group. The expressions of ECM destruction enzyme and proinflammatory cytokines were lower in the S-CS group. In the mini-pigs articular cartilage defect model, the S-CS group had a higher International Cartilage Repair Society (ICRS) macroscopic score and displayed a zonal structure that more closely resembled the native cartilage than those implanted with the H-CS. Our study demonstrated that the application of the S-CS increased the hyaline cartilage formation and improved the surgical outcome of chondrocyte implication, offering a better tissue engineering strategy for treating articular cartilage defects.
Collapse
|