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Hanna AJ, Campbell MP, Matthews J, Onor G, Perez AR, Tucker B, Freedman KB. Comparative Outcomes of Autologous Chondrocyte Implantation and Osteochondral Allograft Transplantation with Patellar Realignment for Patellar Instability with Associated Cartilage Defects. Arthroscopy 2024:S0749-8063(24)00670-4. [PMID: 39303968 DOI: 10.1016/j.arthro.2024.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 08/26/2024] [Accepted: 08/27/2024] [Indexed: 09/22/2024]
Abstract
PURPOSE The purpose of this study was to determine clinical and functional outcomes in patients treated with autologous chondrocyte implantation (ACI) or osteochondral allograft (OCA) transplantation for chondral defects secondary to patellar instability with concomitant medial patellofemoral ligament (MPFL) reconstruction and tibial tubercle osteotomy (TTO) for patellar realignment. METHODS A retrospective review identified patients who underwent ACI or OCA transplantation with concomitant MPFL reconstruction and TTO . Patients were excluded if they did not have concomitant MPFL reconstruction and TTO, had the presence of other intra-articular pathologies, or failed to complete postoperative subjective outcome evaluations at a minimum of 2 years following surgery. Subjective outcome measures included the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR), International Knee Documentation Committee (IKDC) evaluation, and Short Form Health Survey (SF-12) physical scores, collected a minimum of 2 years after surgery. Defect location, size, complications, and rate of subsequent surgery were determined. RESULTS Eighteen total patients were included in this study. The ACI cohort included 11 patients with 13 total defects that were treated with ACI. The OCA cohort included 7 patients with 10 total defects that were treated with OCA. This was due to a number of patients in either group having multiple cartilage defects. Twenty-three total chondral defects were compared to analyze clinical and functional outcomes following surgical correction (ACI: n=13, OCA: n=10). Five defects were noted on the femoral condyle and 18 on the patellar facets/central ridge. Defects were comparable between groups including, size measured during index-arthroscopy (ACI = 3.34 cm2, 95% CI [2.3 cm2 - 4.4 cm2] vs OCA = 4.03 cm2, 95% CI [3.1 cm2 - 5.0 cm2]; P=.351), Outerbridge classification (ACI = 54.8% grade 4 vs OCA = 60.0% grade 4; P=1.000), and AMADEUS score (ACI = 47.1 vs OCA = 58.6; P=.298). Postoperative outcomes were comparable including revision rate (ACI = 15.4% vs OCA = 10.0%; P=1.000) and 2-year IKDC scores (ACI = 74.2, 95% CI [65.2 - 83.2] vs OCA = 51.2, 95% CI [30.3 - 72.1]; P=.077). ACI did have significantly higher 2-year KOOS JR (85.1, 95% CI [76.9 - 93.3] vs 63.7, 95% CI [49.1 - 78.3]; P=.031) and SF-12 scores (54.1, 95% CI [52.0 - 56.2] vs 42.6, 95% CI [35.8 - 49.4]; P=.007) compared to OCA. CONCLUSION ACI or OCA transplantation for chondral defects with concomitant MPFL reconstruction and TTO can be safely performed in an outpatient setting with functional and clinical outcomes being comparable. LEVEL OF EVIDENCE Retrospective Case Series Study (Level 3).
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Affiliation(s)
- Adeeb J Hanna
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, USA
| | - Michael P Campbell
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, USA
| | - John Matthews
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, USA
| | - Gabriel Onor
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, USA
| | - Andres R Perez
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, USA
| | - Bradford Tucker
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, USA
| | - Kevin B Freedman
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, USA.
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Abed V, Kapp S, Nichols M, Shephard L, Jacobs C, Conley C, Stone AV. Responsiveness of Patient-Reported Outcome Measures After Large Knee Articular Cartilage Transplantation: A Systematic Review and Meta-analysis. Am J Sports Med 2024; 52:2676-2682. [PMID: 38264794 DOI: 10.1177/03635465231196156] [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: 01/25/2024]
Abstract
BACKGROUND Cartilage transplantation is commonly used to treat large (>4 cm2) articular cartilage defects of the knee. The 2 most common transplants are osteochondral allograft transplantation and autologous chondrocyte implantation. Several patient-reported outcome measures (PROMs) have been used to determine the efficacy of treatment, but it is unknown which measures are the most effective. PURPOSE To report the multiple PROMs used after large knee articular cartilage transplantation surgery and to compare the responsiveness between them. STUDY DESIGN Meta-analysis; Level of evidence, 4. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search of the PubMed/MEDLINE and Web of Science databases was performed. A total of 181 articles met inclusion criteria. Patient and study characteristics were extracted, including pre- and postoperative means for PROMs. From the articles that met inclusion criteria for responsiveness analysis (2+ PROMs reported, 1-year minimum follow-up, reported pre- and postoperative means and standard deviations; n = 131), the authors compared the responsiveness between PROM instruments using effect size and relative efficiency (RE) if a PROM could be compared with another in ≥10 articles. RESULTS A total of 10,015 patients (10,093 knees; mean age, 34.8 years; mean body mass index, 26.1) were included in this study. The mean follow-up time was 58.3 months (range, 1.5-247.2 months), imaging findings were reported in 80 articles (44.2%), patient satisfaction was reported in 39 articles (21.5%), and range of motion was reported in 10 articles (5.5%). There were 58 unique PROM instruments identified, with the most used being the International Knee Documentation Committee (IKDC) score (n = 118; 65.2%), followed by Knee injury and Osteoarthritis Outcome Score (KOOS) Pain (n = 58; 32.0%), KOOS Sport and Recreation (n = 58; 32.0%), KOOS Quality of Life (n = 57; 31.5%), KOOS Activities of Daily Living (n = 57; 31.5%), and KOOS Symptoms (n = 57; 31.5%). Overall, IKDC was found to have the greatest effect size (1.68) and the best responsiveness of the other PROMs, which include KOOS Pain (RE, 1.38), KOOS Symptoms (RE, 3.06), KOOS Activities of Daily Living (RE, 1.65), KOOS Sport and Recreation (RE, 1.44), Lysholm (RE, 1.76), and Tegner (RE, 1.56). CONCLUSION The IKDC is the most responsive PROM after large knee articular cartilage transplantation surgery. The IKDC score is recommended for assessing outcomes after cartilage transplantation surgery.
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Affiliation(s)
- Varag Abed
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Sabryn Kapp
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Michael Nichols
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Leah Shephard
- School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Cale Jacobs
- Mass General Brigham Sports Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Caitlin Conley
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Austin V Stone
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
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Soderquist M, Barnes L. Osteochondral allograft transplantation for articular humeral head defect from ballistic trauma. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:540-546. [PMID: 39157227 PMCID: PMC11329011 DOI: 10.1016/j.xrrt.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Affiliation(s)
- Melissa Soderquist
- Temple University Hospital Department of Orthopaedic Surgery and Sports Medicine, Philadelphia, PA, USA
| | - Leslie Barnes
- Temple University Hospital Department of Orthopaedic Surgery and Sports Medicine, Philadelphia, PA, USA
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Triana J, Hughes AJ, Rao N, Li ZI, Moore MR, Garra S, Strauss EJ, Jazrawi LM, Campbell KA, Gonzalez-Lomas G. Comparable Clinical and Functional Outcomes Between Osteochondral Allograft Transplantation and Autologous Chondrocyte Implantation for Articular Cartilage Lesions in the Patellofemoral Joint at a Mean Follow-up of 5 Years. Arthroscopy 2024:S0749-8063(24)00395-5. [PMID: 38844011 DOI: 10.1016/j.arthro.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE To assess clinical outcomes and return to sport (RTS) rates among patients who undergo osteochondral allograft (OCA) transplantation and autologous chondrocyte implantation (ACI) or matrix-induced autologous chondrocyte implantation (MACI), for patellofemoral articular cartilage defects. METHODS A retrospective review of patients who underwent an OCA or ACI/MACI from 2010 to 2020 was conducted. Patient-reported outcomes collected included visual analog scale for pain/satisfaction, Knee Injury and Osteoarthritis Outcome Score (KOOS), and RTS. The percentage of patients that met the patient acceptable symptom state for KOOS was recorded. Logistic regression was used to identify predictors of worse outcomes. RESULTS A total of 95 patients were included (78% follow-up) with ACI or MACI performed in 55 cases (57.9%) and OCA in 40 (42.1%). A tibial tubercle osteotomy was the most common concomitant procedure for OCA (66%) and ACI/MACI (98%). Overall, KOOS pain was significantly poorer in OCA than ACI/MACI (74.7, 95% confidence interval 68.1-81.1 vs 83.6, 95% confidence interval 81.3, 88.4, P = .012), whereas the remaining KOOS subscores were nonsignificantly different (all P > .05). Overall, RTS rate was 54%, with no significant difference in return between OCA or ACI/MACI (52% vs 58%, P = .738). There were 26 (27%) reoperations and 5 (5%) graft failures in the entire group. Increasing age was associated with lower satisfaction in OCA and poorer outcomes in ACI/MACI, whereas larger lesion area was associated with lower satisfaction and poorer outcomes in ACI/MACI. CONCLUSIONS Clinical and functional outcomes were similar in patients who underwent OCA or ACI/MACI for patellofemoral articular cartilage defects at a mean follow-up of 5 years. Patients who received OCA had a greater proportion of degenerative cartilage lesions and, among those with trochlear lesions, reported greater pain at final follow-up than their ACI/MACI counterparts. Overall, increasing age and a larger lesion size were associated with worse patient-reported outcomes. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Jairo Triana
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A..
| | - Andrew J Hughes
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Naina Rao
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Zachary I Li
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Michael R Moore
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Sharif Garra
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Eric J Strauss
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Laith M Jazrawi
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Kirk A Campbell
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Guillem Gonzalez-Lomas
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
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Messaoudi O, Henrionnet C, Courtial EJ, Grossin L, Mainard D, Galois L, Loeuille D, Marquette C, Gillet P, Pinzano A. Increasing Collagen to Bioink Drives Mesenchymal Stromal Cells-Chondrogenesis from Hyaline to Calcified Layers. Tissue Eng Part A 2024; 30:322-332. [PMID: 37885209 DOI: 10.1089/ten.tea.2023.0178] [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: 10/28/2023] Open
Abstract
The bioextrusion of mesenchymal stromal cells (MSCs) directly seeded in a bioink enables the production of three-dimensional (3D) constructs, promoting their chondrogenic differentiation. Our study aimed to evaluate the effect of different type I collagen concentrations in the bioink on MSCs' chondrogenic differentiation. We printed 3D constructs using an alginate, gelatin, and fibrinogen-based bioink cellularized with MSCs, with four different quantities of type I collagen addition (0.0, 0.5, 1.0, and 5.0 mg per bioink syringe). We assessed the influence of the bioprinting process, the bioink composition, and the growth factor (TGF-ꞵ1) on the MSCs' survival rate. We confirmed the biocompatibility of the process and the bioinks' cytocompatibility. We evaluated the chondrogenic effects of TGF-ꞵ1 and collagen addition on the MSCs' chondrogenic properties through macroscopic observation, shrinking ratio, reverse transcription polymerase chain reaction, glycosaminoglycan synthesis, histology, and type II collagen immunohistochemistry. The bioink containing 0.5 mg of collagen produces the richest hyaline-like extracellular matrix, presenting itself as a promising tool to recreate the superficial layer of hyaline cartilage. The bioink containing 5.0 mg of collagen enhances the synthesis of a calcified matrix, making it a good candidate for mimicking the calcified cartilaginous layer. Type I collagen thus allows the dose-dependent design of specific hyaline cartilage layers.
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Affiliation(s)
| | | | - Edwin-Joffrey Courtial
- Plateforme 3D Fab, UMR 5246 CNRS Université de Lyon, INSA, CPE-Lyon, ICBMS, Villeurbanne, France
| | | | - Didier Mainard
- Université de Lorraine, CNRS, IMoPA, Nancy, France
- Department of Orthopedic Surgery, University Hospital of Nancy, Nancy, France
| | - Laurent Galois
- Université de Lorraine, CNRS, IMoPA, Nancy, France
- Department of Orthopedic Surgery, University Hospital of Nancy, Nancy, France
| | - Damien Loeuille
- Université de Lorraine, CNRS, IMoPA, Nancy, France
- Department of Rheumatology and Toxicology & Pharmacovigilance, University Hospital of Nancy, Vandœuvre-Lès-Nancy, France
| | - Christophe Marquette
- Plateforme 3D Fab, UMR 5246 CNRS Université de Lyon, INSA, CPE-Lyon, ICBMS, Villeurbanne, France
| | - Pierre Gillet
- Université de Lorraine, CNRS, IMoPA, Nancy, France
- Department of Pharmacology, Toxicology & Pharmacovigilance, University Hospital of Nancy, Vandœuvre-Lès-Nancy, France
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Guo H, Yan H, Yan H, Liu Y, Zeng C. Comparison of Arthroscopic Microfracture for Osteochondral Lesions of the Talus With and Without Small and Shallow Subchondral Cysts. Foot Ankle Int 2024; 45:383-392. [PMID: 38445607 DOI: 10.1177/10711007241227936] [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: 03/07/2024]
Abstract
BACKGROUND Whether arthroscopic microfracture is effective in treating cystic osteochondral lesions of the talus (OLTs) remains controversial. In this study, outcome parameters in patients with small and shallow subchondral cysts are compared to patients without cysts with the hypothesis that equivalent outcomes may be found after primary microfracture treatment. METHODS From 2018 to 2021, all 50 OLTs treated with arthroscopic microfracture in the authors' hospital were retrospectively reviewed for eligibility. Single unilateral symptomatic lesions were included and divided into the cyst and noncyst groups, whereas kissing lesions and arthritic lesions were excluded. Numeric rating scale (NRS) scores, American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores, Tegner activity level scores, Foot and Ankle Ability Measure (FAAM) scores, and magnetic resonance (MR) imaging results were used to describe outcomes. RESULTS A total of 35 patients were included, 16 in the cyst group and 19 in the noncyst group. The patient characteristics were similar between the 2 groups (P > .05). In the cyst group the average cysts depth was 5.0 ± 1.3 mm. After a mean follow-up duration of 36.2 ± 10.2 months, no significant differences were found between the 2 groups in NRS, AOFAS, FAAM, or Tegner score improvement (P > .05). Three patients (19%) in the cyst group had no NRS score improvement. CONCLUSION OLTs with small and shallow subchondral cysts can be treated with arthroscopic microfracture and achieve similar outcomes as noncystic lesions. A few cystic lesions may not respond to microfracture treatment. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Hao Guo
- Department of Foot and Ankle Surgery, Center for Orthopedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, P.R. China
| | - Haohan Yan
- Department of Foot and Ankle Surgery, Center for Orthopedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, P.R. China
| | - Han Yan
- Department of Foot and Ankle Surgery, Center for Orthopedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, P.R. China
| | - Yijun Liu
- Department of Foot and Ankle Surgery, Center for Orthopedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, P.R. China
| | - Canjun Zeng
- Department of Foot and Ankle Surgery, Center for Orthopedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, P.R. China
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Weishorn J, Tischer T, Niemeyer P, Renkawitz T, Bangert Y. The role of autologous bone grafting in matrix-associated autologous chondrocyte implantation at the knee: Results from the German Cartilage Registry (KnorpelRegister DGOU). Knee Surg Sports Traumatol Arthrosc 2024; 32:929-940. [PMID: 38426599 DOI: 10.1002/ksa.12106] [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: 01/07/2024] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE To investigate whether concomitant autologous bone grafting adversely affects clinical outcome and graft survival after matrix-associated autologous chondrocyte implantation (M-ACI). METHODS The present study examines registry data of patients who underwent M-ACI with or without autologous bone grafting for large-sized chondral or osteochondral defects. Propensity score matching was performed to exclude potential confounders. A total of 215 patients with similar baseline characteristics were identified. Clinical outcome was assessed at the time of surgery and at 6, 12, 24, 36 and 60 months using the Knee Injury and Osteoarthritis Outcome Score (KOOS). KOOS change, clinical response rate, KOOS subcomponents and failure rate were determined. RESULTS Patients treated with M-ACI and autologous bone grafting achieved comparable clinical outcomes compared with M-ACI alone. At 24 months postoperatively, the patient-reported outcome (PRO) of patients treated with M-ACI and autologous bone grafting was even significantly better as measured by KOOS (74.9 ± 18.8 vs. 79.2 ± 15.4; p = 0.043). However, the difference did not exceed the minimal clinically important difference (MCID). In patients with M-ACI and autologous bone grafting, a greater change in KOOS relative to baseline was observed at 6 (9.3 ± 14.7 vs. 15.0 ± 14.7; p = 0.004) and 12 months (12.6 ± 17.2 vs. 17.7 ± 14.6; p = 0.035). Overall, a high clinical response rate was observed in both groups at 24 months (75.8% vs. 82.0%; p = n.s.). The estimated survival at the endpoint of reoperation for any reason was 82.1% (SD 2.8) at 8.4 years for isolated M-ACI and 88.7% (SD 2.4) at 8.2 years for M-ACI with autologous bone grafting (p = 0.039). CONCLUSIONS Even in the challenging cohort of large osteochondral defects, the additional treatment with autologous bone grafting leads to remarkably good clinical outcomes in patients treated with M-ACI. In fact, they tend to benefit more from surgery, have lower revision rates and achieve clinical response rates earlier. Subchondral bone management is critical to the success of M-ACI and should be addressed in the treatment of borderline defects. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Johannes Weishorn
- Department of Orthopaedics, Heidelberg University Hospital, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Thomas Tischer
- Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
- Department of Orthopaecdics, University Medical Center Rostock, Rostock, Germany
| | - Philipp Niemeyer
- OCM Orthopedic Surgery Munich, Munich, Germany
- Clinic for Orthopedics and Trauma Surgery, Albert-Ludwigs-University Freiburg, Freiburg im Breisgau, Germany
| | - Tobias Renkawitz
- Department of Orthopaedics, Heidelberg University Hospital, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Yannic Bangert
- Department of Orthopaedics, Heidelberg University Hospital, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
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Runer A, Ossendorff R, Öttl F, Stadelmann VA, Schneider S, Preiss S, Salzmann GM, Hax J. Autologous minced cartilage repair for chondral and osteochondral lesions of the knee joint demonstrates good postoperative outcomes and low reoperation rates at minimum five-year follow-up. Knee Surg Sports Traumatol Arthrosc 2023; 31:4977-4987. [PMID: 37634136 PMCID: PMC10598129 DOI: 10.1007/s00167-023-07546-1] [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: 03/06/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE Minced cartilage is a one-step, autologous procedure with promising short-term results. The aim of the present study was to evaluate mid-term results in a patient cohort with chondral and osteochondral lesions in the knee joint treated with minced cartilage. METHODS From 2015 through 2016, a total of 34 consecutive patients were treated with a single-step, autologous minced cartilage for knee chondral and osteochondral lesions. Numeric analogue scale (NAS) for pain and knee function were obtained prior to surgery and at 12, 24 and 60 months postoperatively. Secondary outcomes, including Lysholm score, Tegner activity score, and the International Knee Documentation Committee (IKDC) score, were recorded at final follow-up. MRI examinations of patients with unplanned radiological follow-up were analysed using the MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score. RESULTS A total of 28 patients (44.1% females, age at surgery: 29.5 ± 11.5 years) were available at a mean follow-up of 65.5 ± 4.1 months. Mean defect size was 3.5 ± 1.8 cm2. NAS for pain decreased from a median of 7 (range: 2-10) preoperatively to 2 (0-8) postoperatively. NAS knee function improved from a median of 7 (range: 2-10) to 3 (0-7) after five years, respectively. Satisfactory Lysholm (76.5 ± 12.5), IKDC (71.6 ± 14.8) and Tegner activity (4, range 3-9) scores were reported at final follow-up. Of all patients, 21(75%) and 19 (67.9%) reached or exceeded the PASS for the IKDC- and Lysholm score at final follow-up, respectively. The average overall MOCART 2.0 scores for all postoperatively performed MRIs (n = 23) was 62.3 ± 17.4. Four (14.2%) postoperative complications were directly linked to minced cartilage, one (3.5%) of which required revision surgery. CONCLUSION One-step, autologous minced cartilage repair of chondral and osteochondral lesions of the knee without the necessity for subchondral bone treatment demonstrated good patient-reported outcomes, low complication rates, and graft longevity at mid-term follow-up. Minced cartilage represents a viable treatment option to more traditional cartilage repair techniques even in mid-term. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Armin Runer
- Department of Sports Orthopaedics, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Robert Ossendorff
- Department for Orthopaedics and Trauma, University Hospital Bonn, Bonn, Germany
| | - Felix Öttl
- Department of Hip and Knee Surgery, Schulthess Klinik, Zurich, Switzerland
| | | | | | - Stefan Preiss
- Department of Hip and Knee Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Gian M Salzmann
- Department of Hip and Knee Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Jakob Hax
- Department of Hip and Knee Surgery, Schulthess Klinik, Zurich, Switzerland
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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.
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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
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10
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Choi K, Park CY, Choi JS, Kim YJ, Chung S, Lee S, Kim CH, Park SJ. The Effect of the Mechanical Properties of the 3D Printed Gelatin/Hyaluronic Acid Scaffolds on hMSCs Differentiation Towards Chondrogenesis. Tissue Eng Regen Med 2023; 20:593-605. [PMID: 37195569 PMCID: PMC10313889 DOI: 10.1007/s13770-023-00545-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/22/2023] [Accepted: 04/09/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Tissue engineering, including 3D bioprinting, holds great promise as a therapeutic tool for repairing cartilage defects. Mesenchymal stem cells have the potential to treat various fields due to their ability to differentiate into different cell types. The biomimetic substrate, such as scaffolds and hydrogels, is a crucial factor that affects cell behavior, and the mechanical properties of the substrate have been shown to impact differentiation during incubation. In this study, we examine the effect of the mechanical properties of the 3D printed scaffolds, made using different concentrations of cross-linker, on hMSCs differentiation towards chondrogenesis. METHODS The 3D scaffold was fabricated using 3D bioprinting technology with gelatin/hyaluronic acid (HyA) biomaterial ink. Crosslinking was achieved by using different concentrations of 4-(4,6-dimethoxy-1,3,5-triazin-2-yl)-4-methlymorpholinium chloride n-hydrate (DMTMM), allowing for control of the scaffold's mechanical properties. The printability and stability were also evaluated based on the concentration of DMTMM used. The effects of the gelatin/HyA scaffold on chondrogenic differentiation was analyzed by utilizing various concentrations of DMTMM. RESULTS The addition of HyA was found to improve the printability and stability of 3D printed gelatin/HyA scaffolds. The mechanical properties of the 3D gelatin/HyA scaffold could be regulated through the use of different concentrations of DMTMM cross-linker. In particular, the use of 0.25 mM DMTMM for crosslinking the 3D gelatin/HyA scaffold resulted in enhanced chondrocyte differentiation. CONCLUSION The mechanical properties of 3D printed gelatin/HyA scaffolds cross-linked using various concentrations of DMTMM can influence the differentiation of hMSCs into chondrocytes.
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Affiliation(s)
- Kyoung Choi
- Laboratory of Tissue Engineering, Korea Institute of Radiological and Medical Sciences, Seoul, 01812, Republic of Korea
- Program in Biomicro System Technology, Korea University, Seoul, 02841, Republic of Korea
| | - Cho Young Park
- Laboratory of Tissue Engineering, Korea Institute of Radiological and Medical Sciences, Seoul, 01812, Republic of Korea
- Program in Biomicro System Technology, Korea University, Seoul, 02841, Republic of Korea
| | - Jun Shik Choi
- Laboratory of Tissue Engineering, Korea Institute of Radiological and Medical Sciences, Seoul, 01812, Republic of Korea
| | - Young-Jin Kim
- Department of Biomedical Engineering, Catholic University of Daegu, Gyeongsan-Si, 38430, Republic of Korea
| | - Seok Chung
- Program in Biomicro System Technology, Korea University, Seoul, 02841, Republic of Korea
| | - Sanghoon Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Chun-Ho Kim
- Laboratory of Tissue Engineering, Korea Institute of Radiological and Medical Sciences, Seoul, 01812, Republic of Korea.
| | - Sang Jun Park
- Laboratory of Tissue Engineering, Korea Institute of Radiological and Medical Sciences, Seoul, 01812, Republic of Korea.
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11
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Angele P, Zellner J, Schröter S, Flechtenmacher J, Fritz J, Niemeyer P. Biological Reconstruction of Localized Full-Thickness Cartilage Defects of the Knee: A Systematic Review of Level 1 Studies with a Minimum Follow-Up of 5 Years. Cartilage 2022; 13:5-18. [PMID: 36250517 PMCID: PMC9924981 DOI: 10.1177/19476035221129571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the best available mid- to long-term evidence of surgical procedures for the treatment of localized full-thickness cartilage defects of the knee. DESIGN Systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines of Level 1 randomized clinical trials (RCTs), meta-analyses of RCTs and systematic reviews with a minimum follow-up of 5 years. Data extracted included patient demographics, defect characteristics, clinical and radiological outcomes, as well as treatment failures. RESULTS Six RCTs and 3 Level 1 systematic reviews were included. Two RCTs compared microfracture (MFx) to periosteum-covered autologous chondrocyte implantation (ACI-P), 1 to matrix-associated ACI (M-ACI) and 2 to osteochondral autograft transplantation (OAT). One study compared OAT to collagen membrane covered ACI (ACI-C). The 3 Level 1 systematic reviews/meta-analyses assessed the outcome of MFx, OAT, and various ACI methods in RCTs. OAT showed significantly better outcomes compared with MFx. In the 2 RCTs comparing ACI-P and MFx, no significant differences in clinical outcomes were seen, whereas significantly better outcomes were reported for M-ACI versus MFx in 1 study including patients with larger defects (5 cm2), and for ACI-C versus OAT in terms of Cincinnati Score. Higher failure rates were reported for MFx compared with OAT and for OAT compared with ACI-C, while no significant differences in failure rates were observed for ACI-P compared to MFx. CONCLUSION Restorative cartilage procedures (ACI-C or M-ACI and OAT) are associated with better long-term clinical outcomes including lower complication and failure rates when compared with reparative techniques (MFx). Among the restorative procedures, OAT seems to be inferior to ACI especially in larger defects after longer follow-up periods. LEVEL OF EVIDENCE Level I: Systematic review of Level I studies.
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Affiliation(s)
- Peter Angele
- Sporthopaedicum Regensburg, Regensburg,
Germany,Klinik für Unfall- und
Wiederherstellungschirurgie, Universitätsklinikum Regensburg, Regensburg,
Germany,Peter Angele, Sporthopaedicum Regensburg,
Hildegard-von-Bingen-Strasse 1, 93053 Regensburg, Germany.
| | | | - Steffen Schröter
- Abteilung für Unfall- und
Wiederherstellungschirurgie, Jung-Stilling Krankenhaus, Diakonie Klinikum GmbH,
Siegen, Germany
| | | | - Jürgen Fritz
- Orthopädisch Chirurgisches Centrum,
Tübingen, Germany
| | - Philipp Niemeyer
- OCM—Orthopädische Chirurgie München,
München, Germany,Klinik für Orthopädie und
Traumatologie, Universitätsklinikum Freiburg, Freiburg, Germany
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12
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Kaplan DJ, Mojica ES, Ortega PF, Triana J, Strauss EJ, Jazrawi LM, Gonzalez-Lomas G. Posterior tibial tubercle measured by the sagittal TT-TG distance correlates with increased risk for patellofemoral chondral lesions. Knee Surg Sports Traumatol Arthrosc 2022; 30:3733-3741. [PMID: 35513456 DOI: 10.1007/s00167-022-06988-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 04/11/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the variation in tibial tubercle sagittal alignment in patients with and without patellofemoral (PF) cartilage wear. METHODS This was a single-centre, retrospective review of patients that underwent a cartilage restoration procedure for isolated PF cartilage wear from 2014 to 2020. Patients were matched in a 1:2 ratio for age, sex and BMI to partial meniscectomy patients as controls. The sagittal TT-TG (sTT-TG) distance was measured on preoperative axial T2 magnetic resonance imaging (MRI) and was defined as the distance between a point at the nadir of the trochlear cartilage and the most anterior point of the tibial tubercle. RESULTS One hundred and forty patients (47 cartilage restoration, 94 meniscectomy) were included. Mean age, BMI, and height for the total cohort were 34.01 ± 8.7, 26.6 ± 6.4, and 173.0 ± 17.7 respectively, with 78 males (55%) and 63 females (45%). There were no significant differences between groups for age, BMI or sex (n.s). The cartilage restoration group (- 2.5 mm ± 5.9) was found to have a significantly more posterior (negative) sTT-TG compared to the meniscectomy group (1.72 mm ± 6.7) (p < 0.001). Interrater reliability was excellent (ICC = 0.931, p < 0.001). Patients with less than - 3.4 mm sTT-TG were 2.74 times more likely to have a cartilage restoration procedure compared to those with greater than - 3.4 mm (OR 2.7, 95% CI 1.3-5.85). Patients with < - 10 mm posterior translation were 13.7× (CI 1.6-111.1) more likely to have a cartilage restoration procedure. CONCLUSION Patients that underwent isolated cartilage restoration procedures had a significantly more posterior tibial tubercle than partial meniscectomy controls based on the sagittal TT-TG. The more posterior the tubercle, the more likely the patient had a cartilage restoration procedure. Surgeons should consider the sTT-TG measurement in patients presenting with anterior knee pain, particularly patellofemoral lesions. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Daniel J Kaplan
- Department of Orthopaedic Surgery, Division of Sports Medicine, New York University Langone Orthopaedic Hospital, 301 E 17th Street, New York, NY, 10003, USA.
| | - Edward S Mojica
- Department of Orthopaedic Surgery, Division of Sports Medicine, New York University Langone Orthopaedic Hospital, 301 E 17th Street, New York, NY, 10003, USA
| | - Paola F Ortega
- Department of Orthopaedic Surgery, Division of Sports Medicine, New York University Langone Orthopaedic Hospital, 301 E 17th Street, New York, NY, 10003, USA
| | - Jairo Triana
- Department of Orthopaedic Surgery, Division of Sports Medicine, New York University Langone Orthopaedic Hospital, 301 E 17th Street, New York, NY, 10003, USA
| | - Eric J Strauss
- Department of Orthopaedic Surgery, Division of Sports Medicine, New York University Langone Orthopaedic Hospital, 301 E 17th Street, New York, NY, 10003, USA
| | - Laith M Jazrawi
- Department of Orthopaedic Surgery, Division of Sports Medicine, New York University Langone Orthopaedic Hospital, 301 E 17th Street, New York, NY, 10003, USA
| | - Guillem Gonzalez-Lomas
- Department of Orthopaedic Surgery, Division of Sports Medicine, New York University Langone Orthopaedic Hospital, 301 E 17th Street, New York, NY, 10003, USA
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13
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Yokoe T, Tajima T, Yamaguchi N, Morita Y, Chosa E. Fixation of an Osteochondral Lesion of the Femoral Intercondylar Groove Using Autogenous Osteochondral Grafts and Bioabsorbable Pins in a Patient with Open Physes: A Case Report. Medicina (B Aires) 2022; 58:medicina58111528. [PMID: 36363485 PMCID: PMC9695273 DOI: 10.3390/medicina58111528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/17/2022] [Accepted: 10/24/2022] [Indexed: 11/05/2022] Open
Abstract
Osteochondral lesion (OCL) of the patellofemoral (PF) joint is not an uncommon cause of knee pain, and surgery is needed when conservative treatment fails. However, there is a lack of evidence regarding the optimal surgical treatment for OCL of the PF joint. Fixation of OCLs using autogenous osteochondral grafts has been reported to be effective for OCL of the knee. However, in this surgical technique, the biomechanical strength of osteochondral grafts may not be sufficient in patients with open physes due to the specific quality of the cartilage and subchondral bone given their age. There is a lack of studies reporting fixation of the OCL located in the PF joint using autogenous osteochondral grafts. We herein report a case of OCL of the femoral intercondylar groove where autogenous osteochondral grafts augmented with bioabsorbable pins were used to fix the lesion in a 14-year-old patient with open physes. Preoperative MRI revealed a completely detached OCL of the intercondylar groove (36 mm × 20 mm). Although a total of four osteochondral grafts were harvested from the non-weightbearing area of the lateral femoral condyle, cartilage detached from one of the grafts. The quality of the osteochondral grafts was considered to be insufficient for stabilization of the OCL; thus, two bioabsorbable pins were additionally inserted following fixation of the lesion using three osteochondral grafts. After two years of follow-up, postoperative functional scores were favorable without knee pain. The present case suggests that fixation of the OCL using autogenous osteochondral grafts may not be appropriate for young patients with open physes.
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Affiliation(s)
- Takuji Yokoe
- Correspondence: ; Tel.: +81-985-85-0986; Fax: 81-985-84-2931
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14
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Lai WC, Bohlen HL, Fackler NP, Wang D. Osteochondral Allografts in Knee Surgery: Narrative Review of Evidence to Date. Orthop Res Rev 2022; 14:263-274. [PMID: 35979427 PMCID: PMC9377395 DOI: 10.2147/orr.s253761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 08/08/2022] [Indexed: 01/14/2023] Open
Abstract
Knee articular cartilage defects can result in significant pain and loss of function in active patients. Osteochondral allograft (OCA) transplantation offers a single-stage solution to address large chondral and osteochondral defects by resurfacing focal cartilage defects with mature hyaline cartilage. To date, OCA transplantation of the knee has demonstrated excellent clinical outcomes and long-term survivorship. However, significant variability still exists among clinicians with regard to parameters for graft acceptance, surgical technique, and rehabilitation. Technologies to optimize graft viability during storage, improve osseous integration of the allograft, and shorten recovery timelines after surgery continue to evolve. The purpose of this review is to examine the latest evidence on treatment indications, graft storage and surgical technique, patient outcomes and survivorship, and rehabilitation after surgery.
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Affiliation(s)
- Wilson C Lai
- Department of Orthopaedic Surgery, UCI Health, Orange, CA, USA
| | - Hunter L Bohlen
- Department of Orthopaedic Surgery, UCI Health, Orange, CA, USA
| | - Nathan P Fackler
- Department of Orthopaedic Surgery, UCI Health, Orange, CA, USA.,Georgetown University School of Medicine, Washington, DC, USA
| | - Dean Wang
- Department of Orthopaedic Surgery, UCI Health, Orange, CA, USA.,Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
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15
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Chen YC, Liao HJ, Hsu YM, Shen YS, Chang CH. Delivery of Mesenchymal Stem Cell in Dialdehyde Methylcellulose-Succinyl-Chitosan Hydrogel Promotes Chondrogenesis in a Porcine Model. Polymers (Basel) 2022; 14:polym14071474. [PMID: 35406348 PMCID: PMC9002496 DOI: 10.3390/polym14071474] [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: 02/22/2022] [Revised: 03/22/2022] [Accepted: 03/27/2022] [Indexed: 02/04/2023] Open
Abstract
Due to the limitation in the current treatment modalities, such as secondary surgery in ACI and fibrocartilage formation in microfracture surgery, various scaffolds or hydrogels have been developed for cartilage regeneration. In the present study, we used sodium periodate to oxidize methylcellulose and formed dialdehyde methylcellulose (DAC) after dialysis and freeze-drying process, DAC was further mixed with succinyl-chitosan (SUC) to form an DAC-SUC in situ forming hydrogel. The hydrogel is a stiffness, elastic-like and porous hydrogel according to the observation of SEM and rheological analysis. DAC-SUC13 hydrogel possess well cell-compatibility as well as biodegradability. Most bone marrow mesenchymal stem cells (BM-pMSCs) were alive in the hydrogel and possess chondrogenesis potential. According to the results of animal study, we found DAC-SUC13 hydrogel can function as a stem cell carrier to promote glycosaminoglycans and type II collagen synthesis in the osteochondral defects of porcine knee. These findings suggested that DAC-SUC13 hydrogel combined with stem cell is a potential treatment for cartilage defects repair in the future.
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Affiliation(s)
- Yu-Chun Chen
- Department of Chemical Engineering, National United University, Miaoli 360302, Taiwan;
| | - Hsiu-Jung Liao
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan; (H.-J.L.); (Y.-M.H.); (Y.-S.S.)
| | - Yuan-Ming Hsu
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan; (H.-J.L.); (Y.-M.H.); (Y.-S.S.)
| | - Yi-Shan Shen
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan; (H.-J.L.); (Y.-M.H.); (Y.-S.S.)
- Department of Biomedical Engineering, National Taiwan University, Taipei 10617, Taiwan
| | - Chih-Hung Chang
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan; (H.-J.L.); (Y.-M.H.); (Y.-S.S.)
- Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan City 320315, Taiwan
- Correspondence:
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