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Ma Y, Lin Q, Wang X, Liu Y, Yu X, Ren Z, Zhang Y, Guo L, Wu X, Zhang X, Li P, Duan W, Wei X. Biomechanical properties of articular cartilage in different regions and sites of the knee joint: acquisition of osteochondral allografts. Cell Tissue Bank 2024; 25:633-648. [PMID: 38319426 PMCID: PMC11143059 DOI: 10.1007/s10561-024-10126-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 01/10/2024] [Indexed: 02/07/2024]
Abstract
Osteochondral allograft (OCA) transplantation involves grafting of natural hyaline cartilage and supporting subchondral bone into the cartilage defect area to restore its biomechanical and tissue structure. However, differences in biomechanical properties and donor-host matching may impair the integration of articular cartilage (AC). This study analyzed the biomechanical properties of the AC in different regions of different sites of the knee joint and provided a novel approach to OCA transplantation. Intact stifle joints from skeletally mature pigs were collected from a local abattoir less than 8 h after slaughter. OCAs were collected from different regions of the joints. The patella and the tibial plateau were divided into medial and lateral regions, while the trochlea and femoral condyle were divided into six regions. The OCAs were analyzed and compared for Young's modulus, the compressive modulus, and cartilage thickness. Young's modulus, cartilage thickness, and compressive modulus of OCA were significantly different in different regions of the joints. A negative correlation was observed between Young's modulus and the proportion of the subchondral bone (r = - 0.4241, P < 0.0001). Cartilage thickness was positively correlated with Young's modulus (r = 0.4473, P < 0.0001) and the compressive modulus (r = 0.3678, P < 0.0001). During OCA transplantation, OCAs should be transplanted in the same regions, or at the closest possible regions to maintain consistency of the biomechanical properties and cartilage thickness of the donor and recipient, to ensure smooth integration with the surrounding tissue. A 7 mm depth achieved a higher Young's modulus, and may represent the ideal length.
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Affiliation(s)
- Yongsheng Ma
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030001, China
| | - Qitai Lin
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030001, China
| | - Xueding Wang
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030001, China
| | - Yang Liu
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030001, China
| | - Xiangyang Yu
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030001, China
| | - Zhiyuan Ren
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030001, China
| | - Yuanyu Zhang
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030001, China
| | - Li Guo
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030001, China
| | - Xiaogang Wu
- Institute of Biomedical Engineering, College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Xiangyu Zhang
- Institute of Biomedical Engineering, College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Pengcui Li
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030001, China
| | - Wangping Duan
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China.
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030001, China.
| | - Xiaochun Wei
- Department of Orthopaedics, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, 030001, Shanxi, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, 030001, China
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2
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Crisol M, Wu K, Congdon B, Skene-Arnold TD, Laouar L, Elliott JAW, Jomha NM. Chondrocyte Viability of Particulated Porcine Articular Cartilage Is Maintained in Tissue Storage After Cryoprotectant Exposure, Vitrification, and Tissue Warming. Cartilage 2024; 15:139-146. [PMID: 37148124 DOI: 10.1177/19476035221118656] [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: 05/07/2023] Open
Abstract
OBJECTIVE Vitrification of articular cartilage (AC) is a promising technique which may enable long-term tissue banking of AC allografts. We previously developed a 2-step, dual-temperature, multi-cryoprotectant agent (CPA) loading protocol to cryopreserve particulated AC (1 mm3 cubes). Furthermore, we also determined that the inclusion of ascorbic acid (AA) effectively mitigates CPA toxicity in cryopreserved AC. Prior to clinical translation, chondrocytes must remain viable after tissue re-warming and before transplantation. However, the effects of short-term hypothermic storage of particulated AC after vitrification and re-warming are not documented. This study evaluated the chondrocyte viability of post-vitrified particulated AC during a 7-day tissue storage period at 4 °C. We hypothesized that porcine particulated AC could be stored for up to 7 days after successful vitrification without significant loss of cell viability, and these results would be enhanced when cartilage is incubated in storage medium supplemented with clinical grade AA. DESIGN Three experimental groups were examined at 5 time points: a fresh control (only incubated in medium), a vitrified - AA group, and a vitrified + AA group (N = 7). RESULTS There was a mild decline in cell viability but both treatment groups maintained a viability of greater than 80% viable cells which is acceptable for clinical translation. CONCLUSION We determined that particulated AC can be stored for up to 7 days after successful vitrification without a clinically significant decline in chondrocyte viability. This information can be used to guide tissue banks regarding the implementation of AC vitrification to increase cartilage allograft availability.
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Affiliation(s)
- Mary Crisol
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Kezhou Wu
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
- Sports Medicine Centre, Department of Orthopedic Surgery, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Barry Congdon
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | | | - Leila Laouar
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Janet A W Elliott
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, AB, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Nadr M Jomha
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
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3
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Merkely G, Leite CB, Farina EM, Gomoll AH, Lattermann C. Harvest Technique Does Affect the Quality of Osteochondral Grafts: Histologic Evaluation Comparing Commercial Standards versus Scalpel Blade Technique. Cartilage 2023; 14:329-337. [PMID: 36484337 PMCID: PMC10601564 DOI: 10.1177/19476035221141420] [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: 06/17/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE While the percentage of viable cells is a major determinant of graft performance during osteochondral allograft (OCA) transplantation, the baseline chondrocyte viability at the periphery of osteochondral plugs is defined at the time of harvest. In this laboratory study, we aimed to determine the optimal technique for OCA plug harvest by evaluating commercial standard techniques compared to sharp blade harvest technique. DESIGN Osteochondral explants were harvested from bovine and human samples using 3 different techniques: (1) standard OATS manual punch device (Osteochondral Autograft Transplant System OATS; Arthrex, Naples, FL), (2) powered trephine device, and (3) fresh scalpel blade. Chondrocyte viability and the dead area at the periphery of the tissue were evaluated by LIVE/DEAD staining. Safranin-O and fast-green were performed for structural evaluation. RESULTS For both bovine and human samples, the dead area at the periphery of the explant was significantly smaller after scalpel blade preparation compared to harvest with OATS (P < 0.001) and powered trephine devices (P < 0.001). In addition, while powered device had a smaller remaining dead area compared to the OATS device (P < 0.001), there was significantly greater tissue loss and peripheral contour change for plugs harvested with the powered trephine device. CONCLUSION Our study demonstrated that OCA plugs harvested with OATS and powered device lead to a significant mechanical injury at the periphery of the explants compared to a scalpel. We propose that the optimal technique for OCA harvest utilizes a combined approach incorporating a scalpel blade/circular scalpel to prepare the chondral surface and a powered trephine to prepare the osseous surface.
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Affiliation(s)
- Gergo Merkely
- Center for Cartilage Repair, Division of Sports Medicine, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Chilan B.G. Leite
- Center for Cartilage Repair, Division of Sports Medicine, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Evan M. Farina
- Center for Cartilage Repair, Division of Sports Medicine, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Christian Lattermann
- Center for Cartilage Repair, Division of Sports Medicine, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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4
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Paul KD, Patel RK, Arguello AM, Kwapisz A, Brabston EW, Stannard JP, Ponce BA, Momaya AM. Variability in the Processing of Fresh Osteochondral Allografts. J Knee Surg 2023; 36:450-455. [PMID: 34600436 DOI: 10.1055/s-0041-1736148] [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] [Indexed: 02/07/2023]
Abstract
The indications for fresh osteochondral allograft continue to increase. As a result, variations in graft processing and preservation methods have emerged. An understanding of these techniques is important when evaluating the optimal protocol for processing fresh osteochondral allografts prior to surgical implantation. The aim of this study is to review the literature and understand various tissue processing protocols of four leading tissue banks in the United States. Donor procurement, serological and microbiological testing, and storage procedures were compared among companies of interest. Similarities between the major tissue banks include donor screening, aseptic processing, and testing for microorganisms. Variability exists between these companies with relation to choice of storage media, antibiotic usage, storage temperature, and graft expiration dates. Potential exists for increased chondrocyte viability and lengthened time-to-expiration of the graft through a protocol of delicate tissue handling, proper choice of storage medium, adding hormones and growth factors like insulin growth factor-1 (IGF-1) to serum-free nutrient media, and storing these grafts closer to physiologic temperatures.
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Affiliation(s)
- Kyle D Paul
- Department of Orthopaedics, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Romil K Patel
- Department of Orthopaedics, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Alexandra M Arguello
- Department of Orthopaedics, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Adam Kwapisz
- Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, Lodz, Lodzkie, Poland
| | - Eugene W Brabston
- Department of Orthopaedics, The University of Alabama at Birmingham, Birmingham, Alabama
| | - James P Stannard
- Department of Orthopaedic Surgery, University of Missouri Columbia, Missouri Orthopaedic Institute, Columbia, Missouri.,Department of Thompson Laboratory for Regenerative Orthopaedics, University of Missouri Columbia, Missouri Orthopaedic Institute, Columbia, Missouri
| | - Brent A Ponce
- Department of Orthopaedics, Hughston Clinic, Columbus, Georgia
| | - Amit M Momaya
- Department of Orthopaedics, The University of Alabama at Birmingham, Birmingham, Alabama
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5
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He J, Wine I, Wu K, Sevick J, Laouar L, Jomha NM, Westover L. Effect of vitrification on mechanical properties of porcine articular cartilage. Proc Inst Mech Eng H 2022; 236:1521-1527. [PMID: 36169308 PMCID: PMC9574425 DOI: 10.1177/09544119221122066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 08/08/2022] [Indexed: 02/05/2023]
Abstract
Articular cartilage (AC) injuries do not heal primarily and large lesions progress to degenerative osteoarthritis. Osteochondral allograft transplantation is an effective surgical treatment but is limited by the lack of donor tissue availability. Fresh allografts can be stored hypothermically up to 28-45 days after which the tissue is no longer viable for transplantation. Vitrification is a method of cryopreservation with the potential to extend the storage time of AC. A specific protocol has been demonstrated to preserve high chondrocyte viability; however, its effect on various mechanical properties of the extracellular matrix (ECM) remains unknown and is the focus of this initial study. Porcine AC was subject to a defined vitrification protocol, using fresh and frozen samples as positive and negative controls, respectively; n = 20 for all three groups. Unconfined compression testing was used to assess mechanical properties of the tissue under rapid load, stress relaxation, and equilibrium conditions. The stress relaxation time constants (modeled with a 2-term Prony series) τ1 and τ2 were significantly lower for frozen (p = 0.014, p < 0.001) and vitrified (p = 0.009, p = 0.003) tissue compared to fresh, with no differences between frozen and vitrified samples (p = 0.848 and 0.105 for τ1 and τ2, respectively). These values indicate that frozen and vitrified samples relaxed more rapidly than fresh, which may suggest altered matrix composition and permeability post-treatment. These results represent the initial study in our experimental path to evaluate differences in mechanical properties of vitrified tissues.
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Affiliation(s)
- Jenny He
- Department of Surgery, University of Alberta, Edmonton, AB,
Canada
| | - Itai Wine
- Department of Civil and Environmental Engineering, University of
Alberta, Edmonton, AB, Canada
| | - Kezhou Wu
- Department of Surgery, University of Alberta, Edmonton, AB,
Canada
- Department of Orthopedic Surgery, First Affiliated Hospital, Shantou
University Medical College, Shantou, Guangdong, China
| | - Johnathan Sevick
- Department of Surgery, University of Alberta, Edmonton, AB,
Canada
| | - Leila Laouar
- Department of Surgery, University of Alberta, Edmonton, AB,
Canada
| | - Nadr M Jomha
- Department of Surgery, University of Alberta, Edmonton, AB,
Canada
| | - Lindsey Westover
- Department of Mechanical Engineering, University of Alberta,
Edmonton, AB, Canada
- Lindsey Westover, Department of Mechanical
Engineering, University of Alberta, 9211 116 Street NW, 10-371 D-ICE Building,
Edmonton, AB T6G 1H9, Canada.
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6
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A Comparative Study Using Fluorescent Confocal Microscopy and Flow Cytometry to Evaluate Chondrocyte Viability in Human Osteochondral Allografts. Bioengineering (Basel) 2022; 9:bioengineering9100515. [DOI: 10.3390/bioengineering9100515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/13/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022] Open
Abstract
The preservation conditions of fresh osteochondral allografts for clinical applications are critical due their objective: to transplant mature hyaline cartilage containing viable chondrocytes, maintaining their metabolic activity and also preserving the structural and functional characteristics of the extracellular matrix. The aim of the present study was to compare fluorescence confocal microscopy and flow cytometry techniques to evaluate the viability of the chondrocytes present in the osteochondral tissue, in order to determine their effectiveness and thus ensure reproducibility and robustness of the analysis. To this end, osteochondral allografts from human cadaveric donors were preserved at 4 °C for 3 weeks in a preservation medium supplemented with antibiotic and antifungal agents. Cell viability of chondrocytes was determined by monitoring the cartilage for 3 weeks of preservation by confocal fluorescence microscopy and flow cytometry, obtaining cell viabilities of 83.7 ± 2.6% and 55.8 ± 7.8% for week three, respectively. The confocal fluorescence microscopy approach is more advantageous and accurate, as it correlates better with actual cell viability values for monitoring osteochondral graft preservation, detecting only the cells that died a natural death associated with the preservation method.
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Malinauskas M, Jankauskaite L, Aukstikalne L, Dabasinskaite L, Rimkunas A, Mickevicius T, Pockevicius A, Krugly E, Martuzevicius D, Ciuzas D, Baniukaitiene O, Usas A. Cartilage regeneration using improved surface electrospun bilayer polycaprolactone scaffolds loaded with transforming growth factor-beta 3 and rabbit muscle-derived stem cells. Front Bioeng Biotechnol 2022; 10:971294. [PMID: 36082160 PMCID: PMC9445302 DOI: 10.3389/fbioe.2022.971294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 07/19/2022] [Indexed: 11/15/2022] Open
Abstract
Polycaprolactone (PCL) has recently received significant attention due to its mechanical strength, low immunogenicity, elasticity, and biodegradability. Therefore, it is perfectly suitable for cartilage tissue engineering. PCL is relatively hydrophobic in nature, so its hydrophilicity needs to be enhanced before its use in scaffolding. In our study, first, we aimed to improve the hydrophilicity properties after the network of the bilayer scaffold was formed by electrospinning. Electrospun bilayer PCL scaffolds were treated with ozone and further loaded with transforming growth factor-beta 3 (TGFβ3). In vitro studies were performed to determine the rabbit muscle-derived stem cells’ (rMDSCs) potential to differentiate into chondrocytes after the cells were seeded onto the scaffolds. Statistically significant results indicated that ozonated (O) scaffolds create a better environment for rMDSCs because collagen-II (Coll2) concentrations at day 21 were higher than non-ozonated (NO) scaffolds. In in vivo studies, we aimed to determine the cartilage regeneration outcomes by macroscopical and microscopical/histological evaluations at 3- and 6-month time-points. The Oswestry Arthroscopy Score (OAS) was the highest at both mentioned time-points using the scaffold loaded with TGFβ3 and rMDSCs. Evaluation of cartilage electromechanical quantitative parameters (QPs) showed significantly better results in cell-treated scaffolds at both 3 and 6 months. Safranin O staining indicated similar results as in macroscopical evaluations—cell-treated scaffolds revealed greater staining with safranin, although an empty defect also showed better results than non-cell-treated scaffolds. The scaffold with chondrocytes represented the best score when the scaffolds were evaluated with the Mankin histological grading scale. However, as in previous in vivo evaluations, cell-treated scaffolds showed better results than non-cell-treated scaffolds. In conclusion, we have investigated that an ozone-treated scaffold containing TGFβ3 with rMDSC is a proper combination and could be a promising scaffold for cartilage regeneration.
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Affiliation(s)
- Mantas Malinauskas
- Institute of Physiology and Pharmacology, Lithuanian University of Health Sciences, Kaunas, Lithuania
- *Correspondence: Mantas Malinauskas,
| | - Lina Jankauskaite
- Institute of Physiology and Pharmacology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Lauryna Aukstikalne
- Institute of Physiology and Pharmacology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Augustinas Rimkunas
- Institute of Physiology and Pharmacology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Tomas Mickevicius
- Institute of Physiology and Pharmacology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Alius Pockevicius
- Department of Veterinary Pathobiology, Veterinary Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Edvinas Krugly
- Faculty of Chemical Technology, Kaunas University of Technology, Kaunas, Lithuania
| | | | - Darius Ciuzas
- Faculty of Chemical Technology, Kaunas University of Technology, Kaunas, Lithuania
| | - Odeta Baniukaitiene
- Faculty of Chemical Technology, Kaunas University of Technology, Kaunas, Lithuania
| | - Arvydas Usas
- Institute of Physiology and Pharmacology, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Ackermann J, Waltenspül M, Merkely G, Germann C, Villefort C, Aufdenblatten C, Fucentese SF. Association of Subchondral Changes With Age and Clinical Outcome in Patients With Osteochondral Fractures in the Knee: MRI Analysis at 1 to 10 Years Postoperatively. Orthop J Sports Med 2022; 10:23259671221113234. [PMID: 35912386 PMCID: PMC9326836 DOI: 10.1177/23259671221113234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/12/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Predictive factors influencing outcomes after surgical fixation of osteochondral fractures (OCFs) in the knee, particularly time between injury and surgery, have not been determined. Purpose: To report imaging and clinical outcomes after OCF fixation and to assess the association between clinical scores and patient characteristics, lesion morphology, and appearance on magnetic resonance imaging (MRI) scans. Study Design: Case series; Level of evidence, 4. Methods: We assessed the clinical and imaging outcomes of 19 patients after screw fixation for OCFs in the knee at a minimum follow-up of 1 year. Patient characteristics, lesion morphology, and time from trauma to surgery were reviewed for each patient. At final follow-up, patients completed a 100-point visual analog scale (VAS) for pain, Tegner activity scale, Knee injury and Osteoarthritis Outcome Score (KOOS), and patient satisfaction survey. Postoperative MRI scans were assessed using the MOCART (magnetic resonance observation of cartilage repair tissue), Osteochondral Allograft MRI Scoring System, and bone marrow edema (BME) size. Results: The mean patient age at surgery was 21.3 ± 11.4 years, and the median time from trauma to surgery was 10 days (range, 0-143 days). The refixed OCF fragment failed in 1 (5.3%) patient on the lateral condyle at 15 months postoperatively. The mean follow-up for the remaining 18 patients was 4.7 ± 3.2 years, and postoperative outcomes were as follows: VAS pain score, 9.5 ± 17.9; Tegner score, 4.8 ± 2.3; KOOS–Pain, 85.9 ± 17.6, KOOS-Symptoms, 76.4 ± 16.1; KOOS–Activities of Daily Living, 90.3 ± 19.0; KOOS–Sport, 74.4 ± 25.4; and KOOS–Quality of Life, 55.9 ± 24.7. Overall, 84.2% were satisfied or very satisfied with outcomes. Patient age was significantly associated with KOOS subscale scores and subchondral imaging parameters including BME and presence of subchondral cysts, which in turn were the only imaging variables linked to clinical outcomes (P < .05). Time from injury to surgery was not correlated with clinical or imaging outcomes. Conclusion: Fixation of OCFs yielded acceptable clinical and imaging outcomes at a mean 5-year follow-up with seemingly little influence of delayed surgical treatment. Postoperative subchondral changes were significantly associated with clinical outcomes and were linked to patient age at surgery.
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Affiliation(s)
- Jakob Ackermann
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,Clinic for Orthopaedics and Traumatology, Department of Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Manuel Waltenspül
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Gergo Merkely
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christoph Germann
- Department of Radiology, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Christina Villefort
- Department of Pediatric Surgery, Division of Trauma and Orthopedic Surgery, University Children's Hospital Zurich, Zurich, Switzerland
| | - Christoph Aufdenblatten
- Department of Pediatric Surgery, Division of Trauma and Orthopedic Surgery, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sandro F Fucentese
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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9
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Tabbaa SM, Guilak F, Sah RL, Bugbee WD. Fresh Osteochondral and Chondral Allograft Preservation and Storage Media: A Systematic Review of the Literature. Am J Sports Med 2022; 50:1702-1716. [PMID: 34310184 DOI: 10.1177/03635465211016832] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Storage procedures and parameters have a significant influence on the health of fresh osteochondral allograft (OCA) cartilage. To date, there is a lack of agreement on the optimal storage conditions for OCAs. PURPOSE To systematically review the literature on (1) experimental designs and reporting of key variables of ex vivo (laboratory) studies, (2) the effects of various storage solutions and conditions on cartilage health ex vivo, and (3) in vivo animal studies and human clinical studies evaluating the effect of fresh OCA storage on osteochondral repair and outcomes. STUDY DESIGN Systematic review; Level of evidence, 5. METHODS A systematic review was performed using the PubMed, Embase, and Cochrane databases. The inclusion criteria were laboratory studies (ex vivo) reporting cartilage health outcomes after prolonged storage (>3 days) of fresh osteochondral or chondral tissue explants and animal studies (in vivo) reporting outcomes of fresh OCA. The inclusion criteria for clinical studies were studies (>5 patients) that analyzed the relationship of storage time or chondrocyte viability at time of implantation to patient outcomes. Frozen, cryopreserved, decellularized, synthetic, or tissue-engineered grafts were excluded. RESULTS A total of 55 peer-reviewed articles met the inclusion criteria. Ex vivo studies reported a spectrum of tissue sources and storage solutions and conditions, although the majority of studies lacked complete reporting of key variables, including storage solution formula and environmental conditions. The effect of various conditions (eg, temperature) and storage solutions on cartilage health were inconsistent. Although 60% of animal models suggest that storage time may influence outcomes and 80% indicate inferior outcomes with frozen OCA as compared with fresh OCA, 75% of clinical studies report no correlation between storage time and outcomes. CONCLUSION Given the variability in experimental designs and lack of reporting across studies, it is still not possible to determine optimal storage conditions, although animal studies suggest that storage time and chondrocyte viability influence osteochondral repair outcomes. A list of recommendations was developed to encourage reporting of key variables, such as media formulation, environmental factors, and methodologies used. High-quality clinical data are needed to investigate the effects of storage and graft health on outcomes.
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Affiliation(s)
- Suzanne M Tabbaa
- University of California, San Francisco, San Francisco, California, USA
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10
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Merkely G, Farina EM, Leite CBG, Ackermann J, Görtz S, Lattermann C, Gomoll AH. Association of Sex Mismatch Between Donor and Recipient With Graft Survivorship at 5 Years After Osteochondral Allograft Transplantation. Am J Sports Med 2022; 50:681-688. [PMID: 35044257 DOI: 10.1177/03635465211068872] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Sex mismatch between donor and recipient has been considered a potential contributor to adverse outcomes after solid organ transplantation. However, the influence of sex mismatching in osteochondral allograft (OCA) transplantation has yet to be determined. PURPOSE To evaluate whether donor-recipient sex mismatching affects graft survival after OCA transplantation. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS In this review of prospectively collected data, patients who underwent OCA transplantation between November 2013 and November 2017 by a single surgeon were analyzed. Cumulative survival was assessed via the Kaplan-Meier method using log-rank tests to compare patients with similar donor groups. Multivariable Cox regression analysis adjusted for patient age, graft size, and body mass index was used to evaluate the influence of donor-recipient sex on graft survival. RESULTS A total of 154 patients were included: 102 (66.2%) who received OCAs from a same-sex donor and 52 (33.8%) who received OCAs from a different-sex donor. At 5-year follow-up, a significantly lower graft survival rate was observed for different-sex donor transplantation in comparison with same-sex donorship (63% vs 92%; P = .01). When correcting for age, graft size, and body mass index, donor-recipient sex-mismatch transplantation demonstrated a 2.9-times greater likelihood to fail at 5 years compared with donor-recipient same-sex transplantation (95% CI, 1.11-7.44; P = .03). A subgroup analysis showed no significant difference in graft survival between the female-to-female and female-to-male groups (91% and 84%, respectively). Conversely, male-to-male transplantation demonstrated a significantly higher cumulative 5-year survival (94%; P = .04), whereas lower survival was found with male-to-female donorship (64%; P = .04). Multivariable Cox regression indicated a 2.6-times higher likelihood of failure for the male-to-female group in comparison with the other groups (95% CI, 1.03-6.69; P = .04). Male-to-male transplantation had a tendency toward decreased likelihood of OCA failure (hazard ratio, 0.33), although without statistical significance (95% CI, 0.11-1.01; P = .052). CONCLUSION Mismatch between donor and recipient sex had a negative effect on OCA survival after transplantation, particularly in those cases when male donor tissue was transplanted into a female recipient.
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Affiliation(s)
- Gergo Merkely
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Evan M Farina
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Chilan B G Leite
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Jakob Ackermann
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Simon Görtz
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christian Lattermann
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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11
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Merkely G, Chisari E, Lola Rosso C, Lattermann C. Do Nonsteroidal Anti-Inflammatory Drugs Have a Deleterious Effect on Cartilage Repair? A Systematic Review. Cartilage 2021; 13:326S-341S. [PMID: 31216865 PMCID: PMC8808836 DOI: 10.1177/1947603519855770] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The purpose of this study was to systematically review the available evidence regarding any plausible deleterious effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on chondrocytes, chondrocyte differentiation, and allograft or autograft incorporation after cartilage repair procedures. DESIGN Three databases (PubMed, Science Direct, and Cochrane Library) were screened for eligible studies: investigating the effects of NSAIDs on chondrocytes, chondrogenic differentiation, or allograft/autograft incorporation. This evaluation included studies of any level of evidence, written in English, reporting clinical or preclinical results, published in peer review journals and dealing with our topic. All articles evaluating the effects of NSAIDs on either osteoarthritic (OA) chondrocyte samples or OA chondrocyte models were excluded. Moreover, articles about bone healing in which allograft or autograft incorporation was not investigated were also excluded. Methodologic quality assessment was performed for in vivo animal studies according to ARRIVE guidelines, and risk of bias of each included study was identified using the ROBINS-I tool. RESULTS Eighteen studies were included in the review: 4 in vitro studies, 13 animal studies, and 1 human study. According to these studies NSAIDs have no detrimental effect on healthy mature chondrocytes; however, these drugs influence chondrocyte differentiation and graft incorporation and therefore may interfere with chondrogenesis and incorporation after transplantation of chondrocytes or osteochondral grafts. CONCLUSION The use of NSAIDs, systemic or local, after cartilage repair procedures should be avoided unless a substantial clinical benefit would otherwise be withheld from the patient. More human studies are needed to analyze the effect of NSAIDs on cartilage repair.
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Affiliation(s)
- Gergo Merkely
- Department of Orthopaedic Surgery,
Division of Sports Medicine, Center for Cartilage Repair, Brigham and Women’s
Hospital, Harvard Medical School, Boston, MA, USA
- Department of Traumatology, Semmelweis
University, Budapest, Hungary
| | - Emanuele Chisari
- Department of General Surgery and
Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University
Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | | | - Christian Lattermann
- Department of Orthopaedic Surgery,
Division of Sports Medicine, Center for Cartilage Repair, Brigham and Women’s
Hospital, Harvard Medical School, Boston, MA, USA
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12
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Hevesi M, Denbeigh JM, Paggi CA, Galeano-Garces C, Bagheri L, Larson AN, Stuart MJ, Saris DBF, van Wijnen AJ, Krych AJ. Fresh Osteochondral Allograft Transplantation in the Knee: A Viability and Histologic Analysis for Optimizing Graft Viability and Expanding Existing Standard Processed Graft Resources Using a Living Donor Cartilage Program. Cartilage 2021; 13:948S-956S. [PMID: 31617404 PMCID: PMC8808912 DOI: 10.1177/1947603519880330] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study aims to (1) determine and validate living cartilage allograft transplantation as a novel source for viable osteochondral allograft (OCA) tissues and (2) perform histologic and viability comparisons of living donor cartilage tissues to currently available clinical-grade standard processed grafts. DESIGN Using healthy cartilage from well-preserved contralateral compartments in 27 patients undergoing total knee arthroplasty (TKA) and 10 clinical-grade OCA specimens obtained immediately following operative implantation, standard and living donor OCA quality was evaluated at the time of harvest and following up to 3 weeks of storage on the basis of macroscopic International Cartilage Repair Society grade, histology, and viability. RESULTS Osteochondral samples demonstrated a consistent decrease in viability and histologic quality over the first 3 weeks of storage at 37°C, supporting the utility of an OCA paradigm shift toward early implantation, as was the clinical standard up until recent adoption of transplantation at 14 to 35 days following donor procurement. Samples from the 10 clinical-grade OCAs, implanted at an average of 23 days following graft harvest demonstrated a mean viable cell density of 45.6% at implantation, significantly lower (P < 0.01) than the 93.6% viability observed in living donor allograft tissues. CONCLUSIONS Osteochondral tissue viability and histologic quality progressively decreases with ex vivo storage, even when kept at physiologic temperatures. Currently available clinical OCAs are stored for 2 to 5 weeks prior to implantation and demonstrate inferior viability to that of fresh osteochondral tissues that can be made available through the use of a living donor cartilage program.
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Affiliation(s)
- Mario Hevesi
- Department of Orthopedic Surgery,
Mayo Clinic, Rochester, MN, USA
| | - Janet M. Denbeigh
- Department of Orthopedic Surgery,
Mayo Clinic, Rochester, MN, USA,Department of Radiation Oncology,
Mayo Clinic, Rochester, MN, USA
| | - Carlo A. Paggi
- Department of Orthopedic Surgery,
Mayo Clinic, Rochester, MN, USA,Department of Regenerative
Medicine, University of Twente, Enschede, Netherlands
| | | | - Leila Bagheri
- Department of Orthopedic Surgery,
Mayo Clinic, Rochester, MN, USA
| | - A. Noelle Larson
- Department of Orthopedic Surgery,
Mayo Clinic, Rochester, MN, USA
| | | | - Daniel B. F. Saris
- Department of Orthopedic Surgery,
Mayo Clinic, Rochester, MN, USA,Department of Regenerative
Medicine, University of Twente, Enschede, Netherlands,Department of Orthopedics,
University Medical Center Utrecht, Utrecht, Netherlands
| | - Andre J. van Wijnen
- Department of Orthopedic Surgery,
Mayo Clinic, Rochester, MN, USA,Andre J. van Wijnen, Department of
Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN
55905, USA.
| | - Aaron J. Krych
- Department of Orthopedic Surgery,
Mayo Clinic, Rochester, MN, USA
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13
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Maciulaitis J, Miskiniene M, Rekštytė S, Bratchikov M, Darinskas A, Simbelyte A, Daunoras G, Laurinaviciene A, Laurinavicius A, Gudas R, Malinauskas M, Maciulaitis R. Osteochondral Repair and Electromechanical Evaluation of Custom 3D Scaffold Microstructured by Direct Laser Writing Lithography. Cartilage 2021; 13:615S-625S. [PMID: 31072136 PMCID: PMC8804810 DOI: 10.1177/1947603519847745] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The objective of this study was to assess a novel 3D microstructured scaffold seeded with allogeneic chondrocytes (cells) in a rabbit osteochondral defect model. DESIGN Direct laser writing lithography in pre-polymers was employed to fabricate custom silicon-zirconium containing hybrid organic-inorganic (HOI) polymer SZ2080 scaffolds of a predefined morphology. Hexagon-pored HOI scaffolds were seeded with chondrocytes (cells), and tissue-engineered cartilage biocompatibility, potency, efficacy, and shelf-life in vitro was assessed by morphological, ELISA (enzyme-linked immunosorbent assay) and PCR (polymerase chain reaction) analysis. Osteochondral defect was created in the weight-bearing area of medial femoral condyle for in vivo study. Polymerized fibrin was added to every defect of 5 experimental groups. Cartilage repair was analyzed after 6 months using macroscopical (Oswestry Arthroscopy Score [OAS]), histological, and electromechanical quantitative potential (QP) scores. Collagen scaffold (CS) was used as a positive comparator for in vitro and in vivo studies. RESULTS Type II collagen gene upregulation and protein secretion was maintained up to 8 days in seeded HOI. In vivo analysis revealed improvement in all scaffold treatment groups. For the first time, electromechanical properties of a cellular-based scaffold were analyzed in a preclinical study. Cell addition did not enhance OAS but improved histological and QP scores in HOI groups. CONCLUSIONS HOI material is biocompatible for up to 8 days in vitro and is supportive of cartilage formation at 6 months in vivo. Electromechanical measurement offers a reliable quality assessment of repaired cartilage.
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Affiliation(s)
- Justinas Maciulaitis
- Institute of Sports, Lithuanian
University of Health Sciences, Kaunas, Lithuania,Justinas Maciulaitis, Institute of Sports,
Lithuanian University of Health Sciences, Tilzes st. 18, 9 House, Kaunas 47181,
Lithuania.
| | - Milda Miskiniene
- Laboratory of Immunology, National
Institute of Cancer, Vilnius, Lithuania
| | - Sima Rekštytė
- Laser Research Center, Faculty of
Physics, Vilnius University, Vilnius, Lithuania
| | - Maksim Bratchikov
- Department of Physiology, Biochemistry,
Microbiology and Laboratory Medicine, Institute of Biomedical Sciences, Faculty of
Medicine, Vilnius University, Vilnius, Lithuania
| | - Adas Darinskas
- Laboratory of Immunology, National
Institute of Cancer, Vilnius, Lithuania
| | - Agne Simbelyte
- National Center of Pathology, Affiliate
of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Gintaras Daunoras
- Non-infectious Disease Department,
Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Aida Laurinaviciene
- National Center of Pathology, Affiliate
of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Arvydas Laurinavicius
- National Center of Pathology, Affiliate
of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Rimtautas Gudas
- Institute of Sports, Lithuanian
University of Health Sciences, Kaunas, Lithuania
| | | | - Romaldas Maciulaitis
- Institute of Physiology and
Pharmacology, Medical Academy, Lithuanian University of Health Sciences, Kaunas,
Lithuania
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14
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Changoor A, Garon M, Quenneville E, Bull SB, Gordon K, Savard P, Buschmann MD, Hurtig MB. Non-invasive Electroarthrography Measures Load-Induced Cartilage Streaming Potentials via Electrodes Placed on Skin Surrounding an Articular Joint. Cartilage 2021; 13:375S-385S. [PMID: 32500724 PMCID: PMC8804767 DOI: 10.1177/1947603520928583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE We aimed to demonstrate that electroarthrography (EAG) measures streaming potentials originating in the cartilage extracellular matrix during load bearing through electrodes adhered to skin surrounding an articular joint. DESIGN Equine metacarpophalangeal joints were subjected to simulated physiological loads while (1) replacing synovial fluid with immersion buffers of different electrolyte concentrations and (2) directly degrading cartilage with trypsin. RESULTS An inverse relationship between ionic strength and EAG coefficient was detected. Compared to native synovial fluid, EAG coefficients increased (P < 0.05) for 5 of 6 electrodes immersed in 0.1X phosphate-buffered saline (PBS) (0.014 M NaCl), decreased (P < 0.05) for 4 of 6 electrodes in 1X PBS (0.14 M NaCl), and decreased (P < 0.05) for all 6 electrodes in 10X PBS (1.4 M NaCl). This relationship corresponds to similar studies where streaming potentials were directly measured on cartilage. EAG coefficients, obtained after trypsin degradation, were reduced (P < 0.05) in 6 of 8, and 7 of 8 electrodes, during simulated standing and walking, respectively. Trypsin degradation was confirmed by direct cartilage assessments. Streaming potentials, measured by directly contacting cartilage, indicated lower cartilage stiffness (P < 10-5). Unconfined compression data revealed reduced Em, representing proteoglycan matrix stiffness (P = 0.005), no change in Ef, representing collagen network stiffness (P = 0.15), and no change in permeability (P = 0.24). Trypsin depleted proteoglycan as observed by both dimethylmethylene blue assay (P = 0.0005) and safranin-O stained histological sections. CONCLUSION These data show that non-invasive EAG detects streaming potentials produced by cartilage during joint compression and has potential to become a diagnostic tool capable of detecting early cartilage degeneration.
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Affiliation(s)
- Adele Changoor
- Lunenfeld-Tanenbaum Research Institute,
Sinai Health System, Toronto, Ontario, Canada
- Department of Surgery and Department of
Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario,
Canada
| | | | | | - Shelley B. Bull
- Lunenfeld-Tanenbaum Research Institute,
Sinai Health System, Toronto, Ontario, Canada
| | - Karen Gordon
- College of Engineering and Physical
Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Pierre Savard
- Biomedical and Electrical Engineering,
École Polytechnique, Montréal, Quebec, Canada
| | | | - Mark B. Hurtig
- Comparative Orthopaedic Research
Laboratory, Department of Clinical Studies, University of Guelph, Guelph, Ontario,
Canada
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15
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Ukai T, Sato M, Wasai S, Takahashi T, Omura H, Watanabe M. Comparison of properties determined using electromechanical assessment (Arthro-BST™) with macroscopic and histological properties in symptomatic human articular cartilage of the hip. Arthritis Res Ther 2021; 23:227. [PMID: 34465392 PMCID: PMC8406846 DOI: 10.1186/s13075-021-02611-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cartilage degeneration is assessed using various methods. Although macroscopic evaluation can directly measure cartilage degeneration, it cannot accurately assess cartilage properties. Histological examination is one of the most accurate methods for evaluating cartilage degeneration. However, it is invasive and requires collection of cartilage tissue. In contrast, the Arthro-BST™ probe can assess cartilage properties noninvasively. This study aimed to evaluate the effectiveness of the Arthro-BST in assessing cartilage degeneration by comparing macroscopic (International Cartilage Repair Society [ICRS] classification) and histological evaluations (modified Mankin score and Osteoarthritis Research Society International [OARSI] histological grade). METHODS Fourteen femoral heads were excised from 13 patients during surgery to treat hip osteoarthritis or femoral fracture. The ICRS score was used for macroscopic evaluation of cartilage degeneration. The Arthro-BST was applied at sites matching the areas of cartilage damage. The sites assessed using the ICRS classification and Arthro-BST were evaluated histologically (modified Mankin score and OARSI histological grade), and these were compared with the Arthro-BST results. RESULTS The ICRS classification identified significant differences between grades 1 and 3 (p < 0.01), between grades 1 and 4 (p < 0.01), between grades 2 and 3 (p < 0.01), and between grades 2 and 4 (p < 0.01). Significant correlations were observed between the Arthro-BST results and the ICRS score, modified Mankin score (structure, cellularity, matrix staining, total score), and OARSI histological grade. CONCLUSIONS In the assessment of hip osteoarthritis, the Arthro-BST results correlated with those of macroscopic and histological evaluations. The Arthro-BST is useful for assessing hip osteoarthritis and may be helpful for noninvasive assessment of cartilage degeneration.
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Affiliation(s)
- Taku Ukai
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Bohseidai, Isehara, Kanagawa, 259-1193, Japan.,Center for Musculoskeletal Innovative Research and Advancement (C-MiRA), Tokai University Graduate School, Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Masato Sato
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Bohseidai, Isehara, Kanagawa, 259-1193, Japan. .,Center for Musculoskeletal Innovative Research and Advancement (C-MiRA), Tokai University Graduate School, Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
| | - Shiho Wasai
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Bohseidai, Isehara, Kanagawa, 259-1193, Japan.,Center for Musculoskeletal Innovative Research and Advancement (C-MiRA), Tokai University Graduate School, Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Takumi Takahashi
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Bohseidai, Isehara, Kanagawa, 259-1193, Japan.,Center for Musculoskeletal Innovative Research and Advancement (C-MiRA), Tokai University Graduate School, Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Haruka Omura
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Bohseidai, Isehara, Kanagawa, 259-1193, Japan.,Center for Musculoskeletal Innovative Research and Advancement (C-MiRA), Tokai University Graduate School, Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Masahiko Watanabe
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Bohseidai, Isehara, Kanagawa, 259-1193, Japan.,Center for Musculoskeletal Innovative Research and Advancement (C-MiRA), Tokai University Graduate School, Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
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16
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Merkely G, Ackermann J, Farina EM, VanArsdale C, Lattermann C, Gomoll AH. Shorter Storage Time Is Strongly Associated With Improved Graft Survivorship at 5 Years After Osteochondral Allograft Transplantation. Am J Sports Med 2020; 48:3170-3176. [PMID: 32941057 DOI: 10.1177/0363546520956311] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Current regulations surrounding the use of osteochondral allografts (OCAs) in the United States require delayed graft release after 14 days to complete infectious disease screening. With a generally accepted expiration time of 28 days in storage, a limited window from 14 to 28 days remains for implantation. Yet, the rates of graft survival and thus optimal time for transplantation within this window remain largely unknown. HYPOTHESIS OCAs transplanted within 19 to 24 days would have lower failure rates at 5 years than those transplanted at 25 to 27 days. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS In this retrospective case series, we analyzed data from patients who underwent OCA transplantation (N = 111) by a single surgeon between February 2014 and December 2016 with at least 2-year follow-up. In total, 56 patients received early transplant grafts (storage time, 19-24 days), and 55 received late transplant grafts (storage time, 25-27 days). Survival analysis with Kaplan-Meier curves was performed using log-rank analysis to compare the groups. Multivariable Cox regression analysis was used to assess the influence of OCA storage duration on graft survival while adjusting for age and defect size. Optimal storage time cutoff associated with graft failure was identified by performing receiver operating characteristic curve analysis and calculating the area under the curve. RESULTS Patients in the late transplant group had a significantly lower rate of graft survival at 5 years postoperatively (70.4%) as compared with patients in the early transplant group (93.1%; P = .027). When correcting for patient age and defect size, late transplant OCAs demonstrated a 3.4-times greater likelihood of failure versus early transplant OCAs. Receiver operating characteristic analysis suggested that OCA transplantation should ideally occur before 25 days of graft storage. CONCLUSION OCA transplantation is a safe and successful treatment option for large osteochondral defects of the knee, with excellent rates of in situ graft survival at 5 years. Prioritizing early transplantation of OCAs to <25 days in storage improves rates of graft survival.
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Affiliation(s)
- Gergo Merkely
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Evan M Farina
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Courtney VanArsdale
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christian Lattermann
- Cartilage Repair Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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17
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Mickevicius T, Pockevicius A, Kucinskas A, Gudas R, Maciulaitis J, Usas A. Nondestructive Assessment of Articular Cartilage Electromechanical Properties after Osteochondral Autologous and Allogeneic Transplantation in a Goat Model. Cartilage 2020; 11:348-357. [PMID: 29998744 PMCID: PMC7298600 DOI: 10.1177/1947603518786543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To determine the applicability of a minimally invasive diagnostic device to evaluate the quality of articular cartilage following autologous (OAT) and allogeneic (OCA) osteochondral graft transplantation in goat model. DESIGN OAT grafts were harvested from lateral femoral condyles (LFCs) and transplanted into osteochondral defects created in medial femoral condyles (MFCs) of contralateral knees. OCA grafts were transplanted into MFC condyles after in vitro storage. Autologous platelet-rich plasma (PRP) was administered intraarticularly after the surgery and at 1 and 2 months postoperatively. OAT and OCA grafts were evaluated macroscopically (Oswestry arthroscopy score [OAS]), electromechanically (quantitative parameter, QP), and histologically (O'Driscoll score, safranin O staining intensity) at 3 and 6 months after transplantation. Results were compared with preoperative graft evaluation. RESULTS Transplanted cartilage deteriorated within 6 months in all groups. Cartilage quality was better retained in OAT group compared with a decline in OCA group. QP and OAS scores were comparable in OAT and OCA groups at 3 months, but superior in OAT group at 6 months, according to all the methods applied. PRP injections significantly improved QP and OAS score at 6 months compared with 3 months in OAT group. QP moderately correlated with OAS, O'Driscoll score, and safranin O staining intensity. CONCLUSIONS Grafts did not retain preoperative quality parameters at 6 months follow-up; however, OAT were superior to OCA grafts. PRP may have a beneficial effect on macroscopic and electromechanical properties of cartilage; however, histological improvement is yet to be proved. Electromechanical diagnostic device enables reliable assessment of transplanted cartilage.
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Affiliation(s)
- Tomas Mickevicius
- Department of Orthopaedics and
Traumatology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics,
Kaunas, Lithuania
| | - Alius Pockevicius
- Pathology Center, Department of
Veterinary Pathobiology, Veterinary Academy, Lithuanian University of Health
Sciences, Kaunas, Lithuania
| | - Audrius Kucinskas
- Biological Research Center Lithuanian
University of Health Sciences, Kaunas, Lithuania
| | - Rimtautas Gudas
- Department of Orthopaedics and
Traumatology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics,
Kaunas, Lithuania,Institute of Sports, Lithuanian
University of Health Sciences, Kaunas, Lithuania
| | - Justinas Maciulaitis
- Department of Orthopaedics and
Traumatology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics,
Kaunas, Lithuania,Institute of Sports, Lithuanian
University of Health Sciences, Kaunas, Lithuania
| | - Arvydas Usas
- Institute of Physiology and
Pharmacology, Lithuanian University of Health Sciences, Kaunas, Lithuania,Arvydas Usas, Institute of Physiology and
Pharmacology, Lithuanian University of Health Sciences, Mickeviciaus 9, Kaunas,
LT-44307, Lithuania.
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18
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Meloni GR, Farran A, Mohanraj B, Guehring H, Cocca R, Rabut E, Mauck RL, Dodge GR. Recombinant human FGF18 preserves depth-dependent mechanical inhomogeneity in articular cartilage. Eur Cell Mater 2019; 38:23-34. [PMID: 31393594 PMCID: PMC7273689 DOI: 10.22203/ecm.v038a03] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Articular cartilage is a specialised tissue that has a relatively homogenous endogenous cell population but a diverse extracellular matrix (ECM), with depth-dependent mechanical properties. Repair of this tissue remains an elusive clinical goal, with biological interventions preferred to arthroplasty in younger patients. Osteochondral transplantation (OCT) has emerged for the treatment of cartilage defects and osteoarthritis. Fresh allografts stored at 4 °C have been utilised, though matrix and cell viability loss remains an issue. To address this, several studies have developed media formulations to maintain cartilage explants in vitro. One promising factor for these applications is sprifermin, a human-recombinant fibroblast growth factor-18, which stimulates chondrocyte proliferation and matrix synthesis and is in clinical trials for the treatment of osteoarthritis. The study hypothesis was that addition of sprifermin during storage would maintain the unique depth-dependent mechanical profile of articular cartilage explants, a feature not often evaluated. Explants were maintained for up to 6 weeks with or without a weekly 24 h exposure to sprifermin (100 ng/mL) and the compressive modulus was assessed. Results showed that sprifermin-treated samples maintained their depth-dependent mechanical profile through 3 weeks, whereas untreated samples lost their mechanical integrity over 1 week of culture. Sprifermin also affected ECM balance by maintaining the levels of extracellular collagen and suppressing matrix metalloproteinase production. These findings support the use of sprifermin as a medium additive for OCT allografts during in vitro storage and present a potential mechanism where sprifermin may impact a functional characteristic of articular cartilage in repair strategies.
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Affiliation(s)
- Gregory R. Meloni
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA
| | - Alexandra Farran
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Bhavana Mohanraj
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA,Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | - Ryan Cocca
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Emilie Rabut
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Robert L. Mauck
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA,Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - George R. Dodge
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA,Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA,Department of Otorhinolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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19
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Jaffe D, Vier D, Royer C. Unipolar allograft reconstruction for post-traumatic avascular necrosis of the distal tibia: A review of the literature, technique, and case series. Foot Ankle Surg 2019; 25:425-433. [PMID: 30321950 DOI: 10.1016/j.fas.2018.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Avascular necrosis of the distal tibial plafond following ankle trauma is an underreported and potentially devastating phenomenon. Beyond conservative treatment options, surgical intervention has been limited to ankle arthrodesis, which sacrifices motion and may have longterm sequellae for adjacent hindfoot joints. Total ankle replacement has been historically contraindicated. Unipolar allograft reconstruction provides an option for joint salvage. We present a literature overview, implantation technique, and two cases utilizing matched unipolar distal tibial allograft. METHODS Two younger patients underwent distal tibia allograft reconstruction for tibial plafond collapse due to post-traumatic avascular necrosis. They were followed to assess for clinical improvement and radiographic graft subsidence. RESULTS Both patients returned to work and activity. One patient had no graft subsidence at four years, but the other patient became symptomatic with graft subsidence at one year. CONCLUSIONS Distal tibia allograft reconstruction can be utilized as a joint salvage surgery for post-traumatic avascular necrosis with collapse of the tibial plafond in younger patients that prefer an alternative to arthrodesis. Results may be mixed and necessitate an engaged, activated patient. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- David Jaffe
- Baylor University Medical Center at Dallas, 3500 Gaston Ave, Dallas, TX 75246, USA.
| | - David Vier
- Baylor University Medical Center at Dallas, 3500 Gaston Ave, Dallas, TX 75246, USA
| | - Christian Royer
- Baylor University Medical Center at Dallas, 3500 Gaston Ave, Dallas, TX 75246, USA
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20
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Mickevicius T, Maciulaitis J, Usas A, Gudas R. Quantitative Arthroscopic Assessment of Articular Cartilage Quality by Means of Cartilage Electromechanical Properties. Arthrosc Tech 2018; 7:e763-e766. [PMID: 30094148 PMCID: PMC6073103 DOI: 10.1016/j.eats.2018.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 08/30/2017] [Indexed: 02/03/2023] Open
Abstract
Arthroscopic surgery has grown rapidly in recent decades. Despite accurately diagnosed clinical cases, the previous pain is retained in some patients after the operation, even though no visible chondral lesions are found during the procedure. A minimally invasive arthroscopic method of measuring articular cartilage electromechanical properties enables rapid and reliable intraoperative articular cartilage quality evaluation.
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Affiliation(s)
- Tomas Mickevicius
- Department of Orthopaedics and Traumatology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
- Institute of Physiology and Pharmacology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Justinas Maciulaitis
- Department of Orthopaedics and Traumatology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
- Institute of Sports, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Arvydas Usas
- Institute of Physiology and Pharmacology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rimtautas Gudas
- Department of Orthopaedics and Traumatology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
- Institute of Sports, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Address correspondence to Rimtautas Gudas, Department of Orthopaedics and Traumatology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Eiveniu Str 2, Kaunas, Lithuania.
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21
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Abstract
BACKGROUND The clinical outcome of fresh allogeneic osteochondral allografts (OCA) is greatly dependent on the number of viable chondrocytes at the time of implantation. The selection and preparation of a suitable recipient can be very time-consuming and the number of tissue donors is greatly limited; therefore, the preservation of high allograft viability before transplantation is a focal point of current research. OBJECTIVE The objective of this review is to give an overview of established storage strategies for OCA and to serve as a decision-making aid for German clinics in the choice of a suitable storage strategy. MATERIAL AND METHODS A search of the literature published between January 2002 and May 2017 was independently performed by two persons with respect to original works on storage strategies of OCA with a focus on storage medium, use of fetal bovine serum, storage temperature and change of medium. A total of 20 suitable studies were selected for this review. RESULTS Based on the current studies a clearly superior storage solution could not be identified; however, storage at 4 °C seems to give better results with respect to cell viability than storage at 37 °C. High chondrocyte viability rates after 28 days of storage were also achieved using media without the addition of fetal bovine serum. CONCLUSION A major difficulty in comparing the relevant studies on storage solutions is that multiple aspects in the study design varied between the studies. Due to this no definite conclusion on what the ideal storage strategy should look like could be drawn. Further studies are needed to conclusively show whether cell culture medium-based storage solutions are truly superior to those based on Ringer-lactate solutions.
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22
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Okeagu CN, Baker EA, Barreras NA, Vaupel ZM, Fortin PT, Baker KC. Review of Mechanical, Processing, and Immunologic Factors Associated With Outcomes of Fresh Osteochondral Allograft Transplantation of the Talus. Foot Ankle Int 2017; 38:808-819. [PMID: 28385038 DOI: 10.1177/1071100717697649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
UNLABELLED Osteochondral lesions of the talus (OLTs) are an increasingly implicated cause of ankle pain and instability. Several treatment methods exist with varying clinical outcomes. Due in part to successful osteochondral allografting (OCA) in other joints, such as the knee and shoulder, OCA has gained popularity as a treatment option, especially in the setting of large lesions. The clinical outcomes of talar OCA have been inconsistent relative to the positive results observed in other joints. Current literature regarding OCA failure focuses mainly on 3 factors: the effect of graft storage conditions on chondrocyte viability, graft/lesion size, and operative technique. Several preclinical studies have demonstrated the ability for bone and cartilage tissue to invoke an immune response, and a limited number of clinical studies have suggested that this response may have the potential to influence outcomes after transplantation. Further research is warranted to investigate the role of immunological mechanisms as an etiology of OCA failure. LEVEL OF EVIDENCE Level V, expert opinion.
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Affiliation(s)
- Chikezie N Okeagu
- 1 Beaumont Health System, Department of Orthopaedic Research, Royal Oak, MI, USA
| | - Erin A Baker
- 1 Beaumont Health System, Department of Orthopaedic Research, Royal Oak, MI, USA
| | - Nicholas A Barreras
- 1 Beaumont Health System, Department of Orthopaedic Research, Royal Oak, MI, USA
| | - Zachary M Vaupel
- 2 Beaumont Health System, Department of Orthopaedic Surgery, Royal Oak, MI, USA
| | - Paul T Fortin
- 2 Beaumont Health System, Department of Orthopaedic Surgery, Royal Oak, MI, USA
| | - Kevin C Baker
- 1 Beaumont Health System, Department of Orthopaedic Research, Royal Oak, MI, USA
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23
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Sim S, Chevrier A, Garon M, Quenneville E, Lavigne P, Yaroshinsky A, Hoemann CD, Buschmann MD. Electromechanical probe and automated indentation maps are sensitive techniques in assessing early degenerated human articular cartilage. J Orthop Res 2017; 35:858-867. [PMID: 27279435 DOI: 10.1002/jor.23330] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 06/02/2016] [Indexed: 02/04/2023]
Abstract
Recent advances in the development of new drugs to halt or even reverse the progression of Osteoarthritis at an early-stage requires new tools to detect early degeneration of articular cartilage. We investigated the ability of an electromechanical probe and an automated indentation technique to characterize entire human articular surfaces for rapid non-destructive discrimination between early degenerated and healthy articular cartilage. Human cadaveric asymptomatic articular surfaces (four pairs of distal femurs and four pairs of tibial plateaus) were used. They were assessed ex vivo: macroscopically, electromechanically, (maps of the electromechanical quantitative parameter, QP, reflecting streaming potentials), mechanically (maps of the instantaneous modulus, IM), and through cartilage thickness. Osteochondral cores were also harvested from healthy and degenerated regions for histological assessment, biochemical analyses, and unconfined compression tests. The macroscopic visual assessment delimited three distinct regions on each articular surface: Region I was macroscopically degenerated, region II was macroscopically normal but adjacent to regions I and III was the remaining normal articular surface. Thus, each extracted core was assigned to one of the three regions. A mixed effect model revealed that only the QP (p < 0.0001) and IM (p < 0.0001) were able to statistically discriminate the three regions. Effect size was higher for QP and IM than other assessments, indicating greater sensitivity to distinguish early degeneration of cartilage. When considering the mapping feature of the QP and IM techniques, it also revealed bilateral symmetry in a moderately similar distribution pattern between bilateral joints. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:858-867, 2017.
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Affiliation(s)
- Sotcheadt Sim
- Department of Chemical Engineering and Institute of Biomedical Engineering, Polytechnique Montreal, P.O. Box 6079, Station Centre-Ville, Montreal, Quebec H3C 3A7, Canada.,Biomomentum Inc., 970 Michelin St., Suite 200, Laval, Quebec H7L 5C1, Canada
| | - Anik Chevrier
- Department of Chemical Engineering and Institute of Biomedical Engineering, Polytechnique Montreal, P.O. Box 6079, Station Centre-Ville, Montreal, Quebec H3C 3A7, Canada
| | - Martin Garon
- Biomomentum Inc., 970 Michelin St., Suite 200, Laval, Quebec H7L 5C1, Canada
| | - Eric Quenneville
- Biomomentum Inc., 970 Michelin St., Suite 200, Laval, Quebec H7L 5C1, Canada
| | - Patrick Lavigne
- Department of Surgery, University of Montreal, P.O. Box 6128, Station Centre-Ville, Quebec H3C 3J7, Canada
| | - Alex Yaroshinsky
- Vital Systems, Inc., 3701 Algonquin Rd, Suite 360 Rolling Meadows, Illinois, 60008
| | - Caroline D Hoemann
- Department of Chemical Engineering and Institute of Biomedical Engineering, Polytechnique Montreal, P.O. Box 6079, Station Centre-Ville, Montreal, Quebec H3C 3A7, Canada.,Groupe de Recherche en Sciences et Technologies Biomédicales, Polytechnique Montreal, P.O. Box 6079, Station Centre-Ville, Montreal, Quebec H3C 3A7, Canada
| | - Michael D Buschmann
- Department of Chemical Engineering and Institute of Biomedical Engineering, Polytechnique Montreal, P.O. Box 6079, Station Centre-Ville, Montreal, Quebec H3C 3A7, Canada.,Groupe de Recherche en Sciences et Technologies Biomédicales, Polytechnique Montreal, P.O. Box 6079, Station Centre-Ville, Montreal, Quebec H3C 3A7, Canada
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