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Kolar M, Veber M, Girandon L, Drobnič M. A Biomimetic Osteochondral Scaffold Augmented With Filtered Bone Marrow Aspirate for the Treatment of Joint Surface Lesions in the Knee. Am J Sports Med 2024; 52:1826-1833. [PMID: 38767159 DOI: 10.1177/03635465241247788] [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: 05/22/2024]
Abstract
BACKGROUND Multilayered osteochondral scaffolds are becoming increasingly utilized for the repair of knee joint surface lesions (KJSLs). However, the literature on predictive factors is rather limited. PURPOSE To (1) evaluate the clinical outcomes and safety of a combined single-step approach using a biomimetic collagen-hydroxyapatite scaffold (CHAS) and filtered bone marrow aspirate (fBMA) for the treatment of KJSLs and (2) identify significant predictors of the treatment outcomes. STUDY DESIGN Case series; Level of evidence, 4. METHODS All patients who underwent surgery because of a KJSL (size ≥1.5 cm2; International Cartilage Regeneration & Joint Preservation Society grades 3-4) using the combination above were selected from a hospital registry database (100 patients; minimum 2-year follow-up). Patient characteristics, medical history, knee joint and lesion status, intraoperative details, and cellular parameters of the injected fBMA were collected. The arthroscopic evaluation of chondral and meniscal tissue quality in all knee compartments was performed using the Chondropenia Severity Score. Treatment outcomes were determined clinically using patient-reported outcome measures (Knee Injury and Osteoarthritis Outcome Score, EuroQol-5 Dimensions-3 Levels, EuroQol-Visual Analog Scale, and Tegner Activity Scale) and by assessing the occurrence of serious adverse events and graft failure. Multivariable regression analysis was performed to identify significant predictors of the treatment outcomes. RESULTS At a mean follow-up of 54.2 ± 19.4 months, 78 (87%) patients completed the questionnaires with significant improvements toward the baseline (P < .00625): KOOS Pain subscale from 62 ± 17 to 79 ± 18, KOOS Total score from 57 ± 16 to 70 ± 20, EuroQol-Visual Analog Scale from 61 ± 21 to 76 ± 16, EuroQol-5 Dimensions-3 Levels from 0.57 ± 0.20 to 0.80 ± 0.21, and Tegner Activity Scale from 2.8 ± 1.5 to 3.9 ± 1.9. The graft failure rate was 4%. A longer duration of preoperative symptoms, previous surgery, larger lesions, older age, and female sex were the main negative predictors for the treatment outcomes. The Chondropenia Severity Score and the number of fibroblast colony-forming units in fBMA positively influenced some of the clinical results and safety. CONCLUSION A CHAS augmented with fBMA proved to be an adequate and safe approach for the treatment of KJSLs up to midterm follow-up. Based on the subanalysis of predictive factors, the surgical intervention should be performed in a timely and precise manner to prevent lesion enlargement, deterioration of the general knee cartilage status, and recurrent surgical procedures, especially in older and female patients. When a CHAS is used, the quantity of MSCs seems to play a role in augmentation. REGISTRATION NCT06078072 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Matic Kolar
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | | | - Matej Drobnič
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Chen R, Pye JS, Li J, Little CB, Li JJ. Multiphasic scaffolds for the repair of osteochondral defects: Outcomes of preclinical studies. Bioact Mater 2023; 27:505-545. [PMID: 37180643 PMCID: PMC10173014 DOI: 10.1016/j.bioactmat.2023.04.016] [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: 01/03/2023] [Revised: 03/18/2023] [Accepted: 04/17/2023] [Indexed: 05/16/2023] Open
Abstract
Osteochondral defects are caused by injury to both the articular cartilage and subchondral bone within skeletal joints. They can lead to irreversible joint damage and increase the risk of progression to osteoarthritis. Current treatments for osteochondral injuries are not curative and only target symptoms, highlighting the need for a tissue engineering solution. Scaffold-based approaches can be used to assist osteochondral tissue regeneration, where biomaterials tailored to the properties of cartilage and bone are used to restore the defect and minimise the risk of further joint degeneration. This review captures original research studies published since 2015, on multiphasic scaffolds used to treat osteochondral defects in animal models. These studies used an extensive range of biomaterials for scaffold fabrication, consisting mainly of natural and synthetic polymers. Different methods were used to create multiphasic scaffold designs, including by integrating or fabricating multiple layers, creating gradients, or through the addition of factors such as minerals, growth factors, and cells. The studies used a variety of animals to model osteochondral defects, where rabbits were the most commonly chosen and the vast majority of studies reported small rather than large animal models. The few available clinical studies reporting cell-free scaffolds have shown promising early-stage results in osteochondral repair, but long-term follow-up is necessary to demonstrate consistency in defect restoration. Overall, preclinical studies of multiphasic scaffolds show favourable results in simultaneously regenerating cartilage and bone in animal models of osteochondral defects, suggesting that biomaterials-based tissue engineering strategies may be a promising solution.
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Affiliation(s)
- Rouyan Chen
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, NSW, 2065, Australia
- School of Electrical and Mechanical Engineering, Faculty of Sciences, Engineering and Technology, The University of Adelaide, SA, 5005, Australia
| | - Jasmine Sarah Pye
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, NSW, 2007, Australia
| | - Jiarong Li
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, NSW, 2065, Australia
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, NSW, 2007, Australia
| | - Christopher B. Little
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, NSW, 2065, Australia
- Corresponding author. Raymond Purves Bone and Joint Research Lab, Kolling Institute, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
| | - Jiao Jiao Li
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, NSW, 2065, Australia
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, NSW, 2007, Australia
- Corresponding author. School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, NSW, 2007, Australia.
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Kluyskens L, Debieux P, Wong KL, Krych AJ, Saris DBF. Biomaterials for meniscus and cartilage in knee surgery: state of the art. J ISAKOS 2022; 7:67-77. [PMID: 35543667 DOI: 10.1136/jisakos-2020-000600] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/24/2021] [Accepted: 04/30/2021] [Indexed: 12/11/2022]
Abstract
Meniscus and cartilage injuries of the knee joint lead to cartilage degeneration and osteoarthritis (OA). The research on biomaterials and artificial implants as substitutes in reconstruction and regeneration has become a main international focus in order to solve clinical problems such as irreparable meniscus injury, postmeniscectomy syndrome, osteochondral lesions and generalised chronic OA. In this review, we provide a summary of biomaterials currently used in clinical practice as well as state-of-the-art tissue engineering strategies and technologies that are developed for articular cartilage and meniscus repair and regeneration. The literature was reviewed over the last 5 years on clinically used meniscus and cartilage repair biomaterials, such as Collagen Meniscal Implant, Actifit, NUsurface, TruFit, Agili-C and MaioRegen. There are clinical advantages for these biomaterials and the application of these treatment options should be considered individually. Standardised evaluation protocols are needed for biological and mechanical assessment and comparison between different scaffolds, and long-term randomised independent clinical trials with large study numbers are needed to provide more insight into the use of these biomaterials. Surgeons should become familiar and stay up to date with evolving repair options to improve their armamentarium for meniscal and cartilage defects.
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Affiliation(s)
- Louis Kluyskens
- Orthopedics, AZ Monica Antwerpen, Antwerpen, Belgium; Department of Orthopaedic Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA.
| | - Pedro Debieux
- Department of Orthopedics and Traumatology, Universidade Federal de São Paulo, Sao Paulo, São Paulo, Brazil; Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, Sao Paulo, São Paulo, Brazil
| | - Keng Lin Wong
- Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore; Department of Orthopaedic Surgery, National University of Singapore, Singapore
| | - Aaron J Krych
- Department of Orthopaedic Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Daniel B F Saris
- Department of Orthopaedic Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA; Department of Orthopedic Surgery, University Medical Centre, Utrecht, Netherlands.
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Rosa FM, Fernandes JC, Delisle J, Ranger P, Albano MB, Filho ES. Clinical and quality-of-life outcomes of a combined synthetic scaffold and autogenous tissue graft procedure for articular cartilage repair in the knee. J Orthop Surg Res 2022; 17:112. [PMID: 35184759 PMCID: PMC8859907 DOI: 10.1186/s13018-022-03010-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/09/2022] [Indexed: 11/21/2022] Open
Abstract
Background Injuries to the articular cartilage of the knee often fail to heal properly due to the hypocellular and avascular nature of this tissue. Subsequent disability can limit participation in sports and decrease quality of life. Subchondral bone perforations are used for the treatment of small defects. Filling out the central portion in larger lesions becomes difficult, and scaffolds can be used as adjuvants, providing a matrix onto which the defect can be filled in completely. Also, autogenous cartilage grafts can be combined, acting as an inducer and improving healing quality, all in a single procedure.
Methods This observational study evaluated the clinical and quality-of-life outcomes of patients with articular cartilage lesions of the knee undergoing repair via a microfracture technique combined with a synthetic scaffold and autogenous cartilage graft, with transosseous sutures and fibrin glue fixation, at 12 months of follow-up. Secondarily, it assessed whether combined procedures, previous surgical intervention, traumatic aetiology, lesion location, and age affect outcomes. The sample consisted of adult patients (age 18–66 years) with symptoms consistent with chondral or osteochondral lesions, isolated or multiple, ICRS grade III/IV, 2–12 cm2 in size. Patients with corrected angular deviations or instabilities were included. Those with BMI > 40 kg/m2, prior total or subtotal (> 30%) meniscectomy, second-look procedures, and follow-up < 6 months were excluded. Pain (VAS), physical activity (IKDC), osteoarthritis (WOMAC), and general quality of life (SF-36) were assessed. Results 64 procedures were included, comprising 60 patients. There was significant improvement (P < 0.05) in VAS score (5.92–2.37), IKDC score (33.44–56.33), and modified WOMAC score (53.26–75.93) after surgery. The SF-36 showed significant improvements in the physical and mental domains (30.49–40.23 and 46.43–49.84 respectively; both P < 0.05). Conclusions Combination of microfractures, autogenous crushed cartilage graft, synthetic scaffold, and transosseous sutures with fibrin glue provides secure fixation for treatment of articular cartilage lesions of the knee. At 12-month follow-up, function had improved by 20 points on the IKDC and WOMAC, and quality of life, by 10 points on the SF-36. Age > 45 years had a negative impact on outcomes.
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Sessa A, Romandini I, Andriolo L, Di Martino A, Busacca M, Zaffagnini S, Filardo G. Treatment of Juvenile Knee Osteochondritis Dissecans with a Cell-Free Biomimetic Osteochondral Scaffold: Clinical and MRI Results at Mid-Term Follow-up. Cartilage 2021; 13:1137S-1147S. [PMID: 32909451 PMCID: PMC8808812 DOI: 10.1177/1947603520954500] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE Osteochondral surgical procedures have been described for the treatment of unfixable osteochondritis dissecans (OCD), but only few of them have been studied for juvenile OCD (JOCD) lesions. A cell-free biomimetic osteochondral scaffold showed positive results in adult patients. The aim of this study was to evaluate the results of this scaffold for the treatment of knee JOCD at mid-term follow-up. DESIGN Twenty patients (14 males, 6 females) were included in this study. Mean age was 16.2 ± 1.4 years, average defect size was 3.2 ± 1.8 cm2, and mean symptoms duration was 20.2 ± 17.9 months. After the implantation of the osteochondral collagen-hydroxyapatite scaffold (Maioregen, Fin-Ceramica, Faenza, Italy), patients were evaluated preoperatively and prospectively at 1, 2, and at final mean follow-up of 6 years (range 5-7 years) with International Knee Documentation Committee (IKDC) subjective and objective, Tegner, and EuroQol visual analogue scale (VAS) scores. MRI evaluation was performed with the MOCART 2.0 score. RESULTS All scores showed a significant improvement. IKDC subjective score went from 50.3 ± 17.4 preoperative score to 75.3 ± 14.6 at 1 year (P = 0.002), 80.8 ± 14.6 at 2 years and 85.0 ± 9.3 at 6 years. The Tegner score improved from the preoperative evaluation of 2.6 ± 1.4 to 5.5 ± 2.0 at 6 years (P < 0.0005), although without reaching the level registered before the onset of symptoms. A longer symptoms duration influenced negatively IKDC subjective and Tegner scores up to 2 years (P = 0.003 and P = 0.002, respectively) but did not affect the final outcome. Lesion size did not affect the final result. The MOCART 2.0 score showed a significant improvement between 1-year and final follow-up, but with persisting subchondral alterations. CONCLUSIONS This study demonstrated a clinical improvement stable over time with a high survival rate, although with persisting abnormal MRI findings, especially at subchondral bone level. This procedure can be considered a suitable option for the treatment of young patients affected by knee OCD. Level of evidence. Case series, level IV.
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Affiliation(s)
- Andrea Sessa
- Shoulder and Elbow Surgery, IRCCS
Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Iacopo Romandini
- II Orthopaedic and Traumatologic Clinic,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Andriolo
- II Orthopaedic and Traumatologic Clinic,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy,Luca Andriolo, II Orthopaedic and
Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Di Barbiano, 1/10,
Bologna, 40136, Italy.
| | - Alessandro Di Martino
- II Orthopaedic and Traumatologic Clinic,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maurizio Busacca
- Diagnostic and Interventional Radiology,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- II Orthopaedic and Traumatologic Clinic,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Filardo
- Applied and Translational Research (ATR)
Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Christensen BB, Olesen ML, Hede KTC, Bergholt NL, Foldager CB, Lind M. Particulated Cartilage for Chondral and Osteochondral Repair: A Review. Cartilage 2021; 13:1047S-1057S. [PMID: 32052642 PMCID: PMC8808866 DOI: 10.1177/1947603520904757] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Injuries to articular cartilage have a poor spontaneous repair potential and no gold standard treatment exist. Particulated cartilage, both auto- and allograft, is a promising new treatment method that circumvents the high cost of scaffold- and cell-based treatments. MATERIALS AND METHODS A comprehensive database search on particulated cartilage was performed. RESULTS Fourteen animal studies have found particulated cartilage to be an effective treatment for cartilage injuries. Many studies suggest that juvenile cartilage has increased regenerative potential compared to adult cartilage. Sixteen clinical studies on 4 different treatment methods have been published. (1) CAIS, particulated autologous cartilage in a scaffold, (2) Denovo NT, juvenile human allograft cartilage embedded in fibrin glue, (3) autologous cartilage chips-with and without concomitant bone grafting, and (4) augmented autologous cartilage chips. CONCLUSION Implantation of allogeneic and autologous particulated cartilage provides a low cost and effective treatment alternative to microfracture and autologous chondrocyte implantation. The methods are promising, but large randomized controlled studies are needed.
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Affiliation(s)
- Bjørn Borsøe Christensen
- Department of Orthopedic Surgery,
Horsens Regional Hospital, Denmark,Department of orthopedic surgery, Aarhus
University Hospital, Aarhus, Denmark,Bjørn Borsøe Christensen, Aarhus University
Hospital, Noerrebrogade 44, Building 1A, 1st Floor, Aarhus, 8000, Denmark.
| | | | | | - Natasja Leth Bergholt
- Orthopedic Research Laboratory, Aarhus
University Hospital, Denmark,Comparative medicine, Institute of
clinical medicine, Aarhus University Hospital, Denmark
| | | | - Martin Lind
- Department of orthopedic surgery, Aarhus
University Hospital, Aarhus, Denmark
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Schreiner MM, Raudner M, Marlovits S, Bohndorf K, Weber M, Zalaudek M, Röhrich S, Szomolanyi P, Filardo G, Windhager R, Trattnig S. The MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) 2.0 Knee Score and Atlas. Cartilage 2021; 13:571S-587S. [PMID: 31422674 PMCID: PMC8725373 DOI: 10.1177/1947603519865308] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Since the first introduction of the MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score, significant progress has been made with regard to surgical treatment options for cartilage defects, as well as magnetic resonance imaging (MRI) of such defects. Thus, the aim of this study was to introduce the MOCART 2.0 knee score - an incremental update on the original MOCART score - that incorporates this progression. MATERIALS AND METHODS The volume of cartilage defect filling is now assessed in 25% increments, with hypertrophic filling of up to 150% receiving the same scoring as complete repair. Integration now assesses only the integration to neighboring native cartilage, and the severity of surface irregularities is assessed in reference to cartilage repair length rather than depth. The signal intensity of the repair tissue differentiates normal signal, minor abnormal, or severely abnormal signal alterations. The assessment of the variables "subchondral lamina," "adhesions," and "synovitis" was removed and the points were reallocated to the new variable "bony defect or bony overgrowth." The variable "subchondral bone" was renamed to "subchondral changes" and assesses minor and severe edema-like marrow signal, as well as subchondral cysts or osteonecrosis-like signal. Overall, a MOCART 2.0 knee score ranging from 0 to 100 points may be reached. Four independent readers (two expert readers and two radiology residents with limited experience) assessed the 3 T MRI examinations of 24 patients, who had undergone cartilage repair of a femoral cartilage defect using the new MOCART 2.0 knee score. One of the expert readers and both inexperienced readers performed two readings, separated by a four-week interval. For the inexperienced readers, the first reading was based on the evaluation sheet only. For the second reading, a newly introduced atlas was used as an additional reference. Intrarater and interrater reliability was assessed using intraclass correlation coefficients (ICCs) and weighted kappa statistics. ICCs were interpreted according to Koo and Li; weighted kappa statistics were interpreted according to the criteria of Landis and Koch. RESULTS The overall intrarater (ICC = 0.88, P < 0.001) as well as the interrater (ICC = 0.84, P < 0.001) reliability of the expert readers was almost perfect. Based on the evaluation sheet of the MOCART 2.0 knee score, the overall interrater reliability of the inexperienced readers was poor (ICC = 0.34, P < 0.019) and improved to moderate (ICC = 0.59, P = 0.001) with the use of the atlas. CONCLUSIONS The MOCART 2.0 knee score was updated to account for changes in the past decade and demonstrates almost perfect interrater and intrarater reliability in expert readers. In inexperienced readers, use of the atlas may improve interrater reliability and, thus, increase the comparability of results across studies.
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Affiliation(s)
- Markus M. Schreiner
- Department of Orthopedics and Trauma
Surgery, Medical University of Vienna, Vienna, Austria
| | - Marcus Raudner
- Department of Biomedical Imaging and
Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stefan Marlovits
- Department of Orthopedics and Trauma
Surgery, Medical University of Vienna, Vienna, Austria
| | - Klaus Bohndorf
- Department of Radiology, University
Hospital Halle, Halle, Germany
| | - Michael Weber
- Department of Biomedical Imaging and
Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Martin Zalaudek
- Department of Biomedical Imaging and
Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sebastian Röhrich
- Department of Biomedical Imaging and
Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Pavol Szomolanyi
- Department of Biomedical Imaging and
Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Giuseppe Filardo
- Applied and Translational Research
Center, IRCCS Rizzoli Orthopaedic Institute, Bologna University, Bologna,
Italy
| | - Reinhard Windhager
- Department of Orthopedics and Trauma
Surgery, Medical University of Vienna, Vienna, Austria
| | - Siegfried Trattnig
- Department of Biomedical Imaging and
Image-guided Therapy, Medical University of Vienna, Vienna, Austria,Christian Doppler Laboratory for
Clinical Molecular MR Imaging (MOLIMA), Department of Biomedical Imaging and
Image-Guided Therapy, Medical University of Vienna, Vienna, Austria,Siegfried Trattnig, Christian Doppler
Laboratory for Clinical Molecular MR Imaging (MOLIMA), High Field MR Centre,
Department for Biomedical Imaging and Image-guided Therapy, Medical University
of Vienna, Lazarettgasse 14, 1090 Vienna.
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Ai C, Lee YHD, Tan XH, Tan SHS, Hui JHP, Goh JCH. Osteochondral tissue engineering: Perspectives for clinical application and preclinical development. J Orthop Translat 2021; 30:93-102. [PMID: 34722152 PMCID: PMC8517716 DOI: 10.1016/j.jot.2021.07.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/15/2021] [Accepted: 07/28/2021] [Indexed: 01/17/2023] Open
Abstract
The treatment of osteochondral defects (OCD) remains challenging. Among currently available surgical treatments for OCDs, scaffold-based treatments are promising to regenerate the osteochondral unit. However, there is still no consensus regarding the clinical effectiveness of these scaffold-based therapies for OCDs. Previous reviews have described the gradient physiological characteristics of osteochondral tissue and gradient scaffold design for OCD, tissue engineering strategies, biomaterials, and fabrication technologies. However, the discussion on bridging the gap between the clinical need and preclinical research is still limited, on which we focus in the present review, providing an insight into what is currently lacking in tissue engineering methods that failed to yield satisfactory outcomes, and what is needed to further improve these techniques. Currently available surgical treatments for OCDs are firstly summarized, followed by a comprehensive review on experimental animal studies in recent 5 years on osteochondral tissue engineering. The review will then conclude with what is currently lacking in these animal studies and the recommendations that would help enlighten the community in developing more clinically relevant implants. The translational potential of this article This review is attempting to summarize the lessons from clinical and preclinical failures, providing an insight into what is currently lacking in TE methods that failed to yield satisfactory outcomes, and what is needed to further improve these implants.
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Affiliation(s)
- Chengchong Ai
- Integrative Sciences and Engineering Programme, NUS Graduate School, National University of Singapore, Singapore.,Department of Biomedical Engineering, National University of Singapore, Singapore
| | - Yee Han Dave Lee
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | - Xuan Hao Tan
- Integrative Sciences and Engineering Programme, NUS Graduate School, National University of Singapore, Singapore.,Department of Biomedical Engineering, National University of Singapore, Singapore
| | - Si Heng Sharon Tan
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | - James Hoi Po Hui
- Department of Orthopaedic Surgery, National University Health System, Singapore.,NUS Tissue Engineering Programme, Life Sciences Institute, National University of Singapore, Singapore.,Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - James Cho-Hong Goh
- Integrative Sciences and Engineering Programme, NUS Graduate School, National University of Singapore, Singapore.,Department of Biomedical Engineering, National University of Singapore, Singapore.,NUS Tissue Engineering Programme, Life Sciences Institute, National University of Singapore, Singapore.,Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Bogallo J, Godino Izquierdo M, Dalla-Rosa J, Ramos González L, Arjona Diaz M, Guerado E. Unestable knee osteochondritis dissecans: Arthroscopic fixation with bio-absorbable device. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [DOI: 10.1016/j.recote.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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10
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Iida K, Hashimoto Y, Nishida Y, Yamasaki S, Nakamura H. Evaluation of regenerated cartilage using T2 mapping methods after opening-wedge high tibial osteotomy with microfracture at the cartilage defect: a preliminary study. J Exp Orthop 2021; 8:91. [PMID: 34655391 PMCID: PMC8520536 DOI: 10.1186/s40634-021-00413-3] [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: 06/20/2021] [Accepted: 10/06/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE This study evaluated the regenerated cartilage after opening-wedge high tibial osteotomy (OWHTO) with concomitant microfracture by second-look arthroscopy, Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score and magnetic resonance imaging (MRI) T2 mapping. It was hypothesised that cartilage regeneration can be achieved by HTO, but the quality of regenerated cartilage is not normal cartilage. METHODS OWHTO was performed in eight knees of seven patients (mean age, 57.6 ± 5.2 years). Microfracture for the cartilage defect was performed followed by OWHTO, and second-look arthroscopy was performed at the time of plate removal (14.1 ± 4.5 months after OWHTO). MRI was assessed at three months and one year after surgery. The status of articular cartilage regeneration was assessed by the ICRS grade, MOCART score and T2 value. RESULTS The number of subjects in ICRS grade 1/2/3/4 changed significantly from 0/0/4/4 preoperatively to 0/2/6/0 postoperatively in the medial femoral condyle (MFC) (P < 0.05) and 0/0/0/8 preoperatively to 0/0/7/1 postoperatively in the medial tibial plateau (MTP) (P < 0.05). Mean MOCART scores for MFC and MTP at one year after surgery exhibited significant increases compared with the results at three months after surgery. Mean T2 values for MFC and MTP did not differ at three months and one year after surgery. CONCLUSION The appearance and morphological evaluation by ICRS grade and MOCART score of regenerated cartilage were improved after OWHTO with concomitant microfracture. However, there were no significant qualitative differences in T2 values. This suggests that the regenerated cartilage tissue was likely to be insufficient cartilage. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Ken Iida
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yusuke Hashimoto
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
| | - Yohei Nishida
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shinya Yamasaki
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Boffa A, Solaro L, Poggi A, Andriolo L, Reale D, Di Martino A. Multi-layer cell-free scaffolds for osteochondral defects of the knee: a systematic review and meta-analysis of clinical evidence. J Exp Orthop 2021; 8:56. [PMID: 34331140 PMCID: PMC8324705 DOI: 10.1186/s40634-021-00377-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/23/2021] [Indexed: 01/13/2023] Open
Abstract
Purpose The aim of this study was to analyze the clinical results provided by multi-layer cell-free scaffolds for the treatment of knee osteochondral defects. Methods A systematic review was performed on PubMed, Web of Science, and Cochrane to identify studies evaluating the clinical efficacy of cell-free osteochondral scaffolds for knee lesions. A meta-analysis was performed on articles reporting results of the International Knee Documentation Committee (IKDC) and Tegner scores. The scores were analyzed as improvement from baseline to 1, 2, and ≥ 3 years of follow-up. The modified Coleman Methodology Score was used to assess the study methodology. Results A total of 34 studies (1022 patients) with a mean follow-up of 35 months was included. Only three osteochondral scaffolds have been investigated in clinical trials: while TruFit® has been withdrawn from the market for the questionable results, the analysis of MaioRegen and Agili-C™ provided clinical improvements at 1, 2, and ≥ 3 years of follow-up (all significantly higher than the baseline, p < 0.05), although with a limited recovery of the sport-activity level. A low rate of adverse events and an overall failure rate of 7.0% were observed, but the overall evidence level of the available studies is limited. Conclusions Multi-layer scaffolds may provide clinical benefits for the treatment of knee osteochondral lesions at short- and mid-term follow-up and with a low number of failures, although the sport-activity level obtained seems to be limited. Further research with high-level studies is needed to confirm the role of multi-layer scaffold for the treatment of knee osteochondral lesions.
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Affiliation(s)
- Angelo Boffa
- Clinica Ortopedica E Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1 - 40136, Bologna, Italy
| | - Luca Solaro
- Clinica Ortopedica E Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1 - 40136, Bologna, Italy
| | - Alberto Poggi
- Clinica Ortopedica E Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1 - 40136, Bologna, Italy.
| | - Luca Andriolo
- Clinica Ortopedica E Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1 - 40136, Bologna, Italy
| | - Davide Reale
- Clinica Ortopedica E Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1 - 40136, Bologna, Italy
| | - Alessandro Di Martino
- Clinica Ortopedica E Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1 - 40136, Bologna, Italy
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Bogallo JM, Godino Izquierdo M, Dalla-Rosa J, Ramos González L, Arjona Díaz M, Guerado E. Unestable knee osteochondritis dissecans: arthroscopic fixation with bio-absorbable device. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021; 65:S1888-4415(21)00083-7. [PMID: 34130925 DOI: 10.1016/j.recot.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/28/2020] [Accepted: 01/05/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Knee ostheochondritis dissecans is an osteochondral disease, whose treatment is still debated. The purpose this study was to analyze the patients attached with bioabsorbable nail, assisted by arthroscopy. MATERIAL AND METHOD Analysis was performed using median and interquartile range (P25-P75), with a follow-up of 9 patients (10 knees) operated for stage III osteochondral lesions. After a minimum of 12 months, the KOOS, IKDC, satisfaction questionnaires were evaluated and a MR control was perfomed. RESULTS Bone healing was observed in 80% of patients in the first year, with a delay in union in 20%. The median for age was 15 years. The average follow-up was 5.93 years. All cases were located in the internal condyle. The OCD lesions did not show comminution or necrosis. The 40% of stable lesions, according to preoperative MR, were unestable in arthroscopy and it were attached with internal nail. Two groups of osteochondral lesions were differentiated: juvenile OCD (60%) and adult OCD (40%); all of them were stage III lesions. IKDC questionnaire results were an improvement of 29.5 (22.25, 37.52). In the KOOS questionnaire, an improvement was obtained in symptoms of 18.07, in pain of 29.12, in daily living 25.53, in function (sports, recreational activities) of 35 and in quality of life of 34.42. CONCLUSIONS The bioabsorbable nail is a valid, reproducible option for unestable lesions with lesion integrity, with great improvement in function, quality of life and with few complications.
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Affiliation(s)
- J M Bogallo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Costa del Sol, Marbella, Málaga, España.
| | - M Godino Izquierdo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Costa del Sol, Marbella, Málaga, España
| | - J Dalla-Rosa
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Costa del Sol, Marbella, Málaga, España
| | - L Ramos González
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Costa del Sol, Marbella, Málaga, España
| | - M Arjona Díaz
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Costa del Sol, Marbella, Málaga, España
| | - E Guerado
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Costa del Sol, Marbella, Málaga, España
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Clinical Outcomes of an All-Arthroscopic Technique for Single-Stage Autologous Matrix-Induced Chondrogenesis in the Treatment of Articular Cartilage Lesions of the Knee. Arthrosc Sports Med Rehabil 2020; 2:e353-e359. [PMID: 32875300 PMCID: PMC7451857 DOI: 10.1016/j.asmr.2020.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 05/13/2020] [Indexed: 11/28/2022] Open
Abstract
Purpose The purpose of this study was to determine the clinical efficacy of an all-arthroscopic approach to autologous matrix-induced chondrogenesis (AMIC) for patients with articular cartilage lesions of the knee joint. We hypothesize that an all-arthroscopic, single-stage AMIC using a hyaluron-based cell-free scaffold improves the postoperative clinical scores for patients with isolated articular cartilage lesions of the knee in the early follow-up period. Methods All patients with focal osteochondral lesions of the knee treated with AMIC at our institution from November 2013 to January 2018 were included for analysis. Demographic information, baseline clinical characteristics, perioperative imaging, and follow-up International Knee Documentation Committee (IKDC) scores at 6 and 24 months postoperatively were collected. One-way analysis of variance (ANOVA) with a Bonferroni correction was used to assess for improvement before and after surgery, with statistical significance defined as p < .05. Results A total of 22 patients met the inclusion criteria and were analyzed for this study. Articular cartilage lesions were most commonly found at the center of the medial and lateral femoral condyles. Statistically significant improvements in IKDC scores were seen at the 6- and 24-month follow-up periods (p < .05). Conclusion An all-arthroscopic technique for single-stage autologous matrix-induced chondrogenesis demonstrates significant early clinical improvement for the treatment of articular cartilage lesions of the knee. Level of Evidence 4
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Autologous chondrocytes versus filtered bone marrow mesenchymal stem/stromal cells for knee cartilage repair-a prospective study. INTERNATIONAL ORTHOPAEDICS 2020; 45:931-939. [PMID: 32712785 DOI: 10.1007/s00264-020-04727-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/10/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE To document clinical, radiologic, and cellular data of a prospective patient series treated by a tri-layer collagen-hydroxyapatite biomimetic osteochondral scaffold (CHAS) intra-operatively seeded with cultivated autologous chondrocytes (AC) or with filtered bone marrow stem/stromal cells (fBMSC) to address chronic osteochondral knee lesions. METHODS Thirty-six consecutive patients (15 to 59 years) with chronic osteochondral lesions (1.8-10 cm2) in the condylar or patellofemoral knee surfaces were enrolled. Lesions were covered with CHAS fixed with a fibrin glue. The superficial layer of CHAS was intra-operatively injected with active cells: in initial five patients, ACs were put directly onto dry CHAS (dry-AC); next, eight AC patients had CHAS moistened with cell culture media (media-AC), while the tourniquet was released allowing blood soaking of CHAS in the rest (14 blood-AC, 9 blood-fBMSC). Seventeen (50%) patients required different concomitant procedures. All patients were followed for serious adverse events (SAE) or graft failures; clinical, radiographic, and MRI evaluation was conducted. Cellular data on the injected cells were assessed. RESULTS At a follow-up of 39 months (16-81), 17 patients required an additional surgical intervention: seven graft-related SAE (early post-operative synovitis and/or arthrofibrosis) were registered (3 dry-AC, 3 media-AC, 1 blood-fBMSC). There were two graft failures (1 dry-AC, 1 blood-fBMSC) for secondary reasons. All clinical scores significantly improved from pre- to post-operative values: IKCD subjective 44 to 65; IKDC examination (9/17/5/5) to (20/10/5/1); KOOS (P61/S59/ADL67/Sp32/QoL31) to (P79/S75/ADL84/Sp55/QoL51); Tegner activity scale 3.3 to 4.4. There was evidence of radiographic osteoarthritis progression-Kellgren-Lawrence 1.0 to 1.5. MOCART scores at the final follow-up averaged 71 (10 to 95). Graft-type analysis demonstrated an increased rate of graft-related SAE in dry-AC and media-AC, but their final outcomes were equivalent. Cellular data of AC at the implantation were as follows: cells in suspension 9.2 × 106, viability 95%. In blood-fBMSC group, a cell suspension with 87% viability was injected, which contained 1156 CFU-Fs. CONCLUSION CHAS with intra-operative seeding of active cells, either AC or fBMSC, led to an overall successful outcome for the treatment of chronic osteochondral lesions in the knee. Blood soaking of CHAS in situ before cell seeding significantly decreased early post-operative adverse events, such as synovitis and arthrofibrosis.
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Chou A, Lie D. A Technique Using a Low-Cost, Accessible Cannula to Aid Scaffold Passage in Dry Arthroscopic Cartilage Repair in the Knee. Arthrosc Tech 2020; 9:e775-e782. [PMID: 32577351 PMCID: PMC7301273 DOI: 10.1016/j.eats.2020.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/05/2020] [Indexed: 02/03/2023] Open
Abstract
Although autologous matrix-induced chondrogenesis has grown increasingly popular, it can be technically challenging to place the scaffold within the knee efficiently without extending the arthroscopic incisions. To facilitate arthroscopic placement of the matrix into the knee, we developed a technique that involves fashioning a cannula from a standard 5-mL syringe. This technique enables surgeons to conveniently and efficiently place the matrix through the standard arthroscopic ports at minimal cost.
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Affiliation(s)
- Andrew Chou
- Address correspondence to Department of Orthopaedic Surgery, the Academia, 20 College Road, Singapore 169856.
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Good mid-term outcomes after adipose-derived culture-expanded mesenchymal stem cells implantation in knee focal cartilage defects. Knee Surg Sports Traumatol Arthrosc 2020; 28:502-508. [PMID: 31493012 DOI: 10.1007/s00167-019-05688-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/21/2019] [Indexed: 01/22/2023]
Abstract
PURPOSE The purpose of the present study was to investigate the mid-term outcomes of a single-stage cell-based procedure in patients with knee focal symptomatic cartilage defects using matrix-induced culture-expanded autologous AD-MSCs. It was hypothesised that the increased number of autologous AD-MSCs after culture expansion is a safe and efficient cartilage repair procedure, which improves overtime chondrogenesis in cartilage lesions METHODS: Twenty-five consecutive patients treated for a symptomatic cartilage defect were prospectively followed for 3 years. The median age of patients was 30.5 (range 16-43) with a median BMI of 23.6 kg/m2 (range 19-29) and an average size of the lesion of 3.5 cm2 (range 2-6). All patients underwent a single-stage procedure consisting in filling each defect with autologous culture-expanded mesenchymal stem cells embedded in a trimmed-to-fit commercially available biodegradable matrix. Pre-operative and post-operative evaluation included knee-related clinical and functional evaluation based on objective and subjective scores at 6, 12, 24 and 36 months and MRI evaluation of the repair tissue using the MOCART score at 12 and 24 months. RESULTS Clinical outcomes recorded significant improvements (p < 0.05) at the final follow-up compared with baseline as following: all subcategories of KOOS Score, the IKDC subjective from 40.9 (range 20.7-65.6) to 76.9 (range 42-90.3), Tegner Activity Score from 3 (range 2-4) to 4 (range 3-4), VAS for pain from 6 (range 4-8) to 1 (range 0-3). All patients improve significantly their IKDC objective scores. The MRI findings showed complete filling of the defect and integration to the border zone for 65% of the patients. Two patients underwent post-operative biopsies and the histological analysis demonstrated the presence of hyaline-like tissue. CONCLUSIONS Adipose-derived culture-expanded mesenchymal stem cells were shown to be an efficient and safe single-stage cell-based procedure for symptomatic, full-thickness knee chondral lesions. The findings of the present study demonstrate that all patients presented significant mid-term clinical, functional and radiological improvement. LEVEL OF EVIDENCE IV.
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Perelli S, Molina Romoli AR, Costa-Paz M, Erquicia JI, Gelber PE, Monllau JC. Internal Fixation of Osteochondritis Dissecans of the Knee Leads to Good Long-Term Outcomes and High Degree of Healing without Differences between Fixation Devices. J Clin Med 2019; 8:E1934. [PMID: 31717628 PMCID: PMC6912813 DOI: 10.3390/jcm8111934] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/31/2019] [Accepted: 11/07/2019] [Indexed: 12/26/2022] Open
Abstract
The aim of the present study is to describe results at long-term follow-up of internal fixation of unstable Osteochondritis Dissecans (OCD) achieved with three different fixation devices in skeletally mature knees. A retrospective cohort study was performed at 5 to 19 years follow-up. Patient-reported questionnaires were collected at the final follow-up. Postoperative X-rays and MRIs were evaluated for healing of the lesion and articular degeneration. An arthroscopic second look was performed in 74.3% of the cases. Failures were reported as reintervention to address the osteochondral lesion or poor functional outcomes at the last follow-up. A total of 39 subjects with a median follow-up of 10.7 years were included. Herbert screws were used in 51.2% of the cases, bioabsorbable nails in 25.7% of the cases and cannulated screws in 23.1% of the cases. No differences were observed in terms of the clinical score (International Knee Documentation Committee (IKDC) p = 0.211; Lysholm p = 0.197), radiographic union (p = 0.102) or radiographic degeneration (p = 0.238) between the three different fixation devices. Arthroscopic second look found complete stability of the lesions in all 29 cases evaluated. The mean postoperative Lysholm score was 83 (range = 33-100) and IKDC score was 79 (range = 39-100). Radiographic union was seen in 74% of the cases. Lack of radiographic union was correlated with worst functional scores. A failure rate of 20.5% was found: four reinterventions were performed, and four patients had poor scores at last follow up. This study shows that internal fixation of condylar OCD in skeletally mature patients provides good long-term clinical results and a high degree of healing regardless of the dimensions of the lesion and type of fixation.
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Affiliation(s)
- Simone Perelli
- Institut Català de Traumatologia i Medicina de l’Esport (ICATME)—Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, 08028 Barcelona, Spain; (J.I.E.); (P.E.G.); (J.C.M.)
| | - Agustín Rubén Molina Romoli
- Research Department, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires c1181ach, Argentina;
| | - Matías Costa-Paz
- Department of Knee Arthroscopy, Hospital Italiano de Buenos Aires, Buenos Aires c1181ach, Argentina;
| | - Juan Ignacio Erquicia
- Institut Català de Traumatologia i Medicina de l’Esport (ICATME)—Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, 08028 Barcelona, Spain; (J.I.E.); (P.E.G.); (J.C.M.)
| | - Pablo Eduardo Gelber
- Institut Català de Traumatologia i Medicina de l’Esport (ICATME)—Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, 08028 Barcelona, Spain; (J.I.E.); (P.E.G.); (J.C.M.)
- Department of Orthopaedic Surgery, Hospital de la Sta Creu i Sant Pau, Universitat Autònoma de Barcelona, 08028 Barcelona, Spain
| | - Juan Carlos Monllau
- Institut Català de Traumatologia i Medicina de l’Esport (ICATME)—Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, 08028 Barcelona, Spain; (J.I.E.); (P.E.G.); (J.C.M.)
- Department of Orthopaedic Surgery, Hospital del Mar, Universitat Autònoma de Barcelona, 08028 Barcelona, Spain
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Elkasabgy NA, Mahmoud AA. Fabrication Strategies of Scaffolds for Delivering Active Ingredients for Tissue Engineering. AAPS PharmSciTech 2019; 20:256. [PMID: 31332631 DOI: 10.1208/s12249-019-1470-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/08/2019] [Indexed: 01/28/2023] Open
Abstract
Designing scaffolds with optimum properties is an essential factor for tissue engineering success. They can be seeded with isolated cells or loaded with drugs to stimulate the body ability to repair or regenerate the injured tissues by acting as centers for new tissue formation. Recently, scaffolds gained a significant interest as principal candidates for tissue engineering due to overcoming the autograft or allograft's associated problems. The advancement of the tissue engineering field relies mainly on the introduction of new biomaterials for scaffolds' fabrication. This review presents and criticizes different scaffolds' fabrication techniques with particular emphasis on the fibrous, injectable in situ forming, foam, 3D freeze-dried, 3D printed, and 4D scaffolds. This article highlights on scaffolds' composition which would be beneficial for developing scaffolds that could potentially help to meet the demand for both drug delivery and tissue regeneration.
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Lee OS, Lee SH, Mok SJ, Lee YS. Comparison of the regeneration of cartilage and the clinical outcomes after the open wedge high tibial osteotomy with or without microfracture: a retrospective case control study. BMC Musculoskelet Disord 2019; 20:267. [PMID: 31153367 PMCID: PMC6545202 DOI: 10.1186/s12891-019-2607-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 05/01/2019] [Indexed: 01/22/2023] Open
Abstract
Background It is unclear whether postoperative outcomes are associated with the cartilage regeneration after open wedge high tibial osteotomy (OWHTO) combined with microfracture. The purpose of this study was to evaluate the regeneration of the articular cartilage, radiologic, and clinical outcomes after OWHTO with and without microfracture. Methods Eighty-seven patients who underwent OWHTO from 2014 to 2015 were retrospectively included in this study. Fifty-seven OWHTOs with microfracture on medial femoral condyle (MFC) (group 1) and 30 OWHTOs without microfracture (group 2) were compared at a mean 2-year follow-up. The regeneration of the articular cartilage was evaluated using International Cartilage Repair Society (ICRS) grade on the second-look arthroscopy and the magnetic resonance observation of cartilage repair tissue (MOCART) score on magnetic resonance imaging (MRI). The weight-bearing line (WBL) ratio, hip-knee-ankle (HKA) angle, joint line convergence angle (JLCA) and Ahlbäck grade were evaluated. The clinical outcomes were evaluated using the Western Ontario and McMaster University (WOMAC) scores and the Knee Society (KS). Results The articular cartilage in the MFC were regenerated in 67.8% of group 1 (43/57) and 58.6% of group 2 (16/30), respectively (p = 0.014). However, change of the ICRS grades of the medial tibial plateau, lateral and patellofemoral compartments showed no statistical difference between the groups. Total MOCART score in group 1 was superior to that in the group 2 at postoperative 2 years (41.8 ± 18.6 vs. 31.8 ± 19.8, p = 0.023). Regarding MOCART score, microfracture was only effective in the defect filling and integration to the border zone of the MFC (p < 0.001 and p = 0.035, respectively). Other radiologic and clinical outcomes showed no statistical differences between the groups. Conclusion Microfracture of the MFC during OWHTO only helped the filling of the degenerative cartilage defect and the integration of the cartilage with adjacent cartilage. However, the clinical and radiologic outcome could not be improved by mircrofracture in the OWHTO.
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Affiliation(s)
- O-Sung Lee
- Department of Orthopaedic Surgery, Mediplex Sejong Hospital, Incheon, South Korea
| | - Seung Hoon Lee
- Department of Orthopaedic Surgery, Incheon Metropolitan City Medical Center, Incheon, South Korea
| | - Su Jung Mok
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Bundang Hospital, Seoul, South Korea
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Bundang Hospital, Seoul, South Korea.
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MaioRegen Osteochondral Substitute for the Treatment of Knee Defects: A Systematic Review of the Literature. J Clin Med 2019; 8:jcm8060783. [PMID: 31159439 PMCID: PMC6617307 DOI: 10.3390/jcm8060783] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/19/2019] [Accepted: 05/28/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This study aims to investigate the clinical and radiological efficacy of three-dimensional acellular scaffolds (MaioRegen) in restoring osteochondral knee defects. METHODS MEDLINE, Scopus, CINAHL, Embase, and Cochrane Databases were searched for articles in which patients were treated with MaioRegen for osteochondral knee defects. RESULTS A total of 471 patients were included in the study (mean age 34.07 ± 5.28 years). The treatment involved 500 lesions divided as follows: 202 (40.4%) medial femoral condyles, 107 (21.4%) lateral femoral condyles, 28 (5.6%) tibial plateaus, 46 (9.2%) trochleas, 74 (14.8%) patellas, and 43 (8.6%) unspecified femoral condyles. Mean lesion size was 3.6 ± 0.85 cm2. Only four studies reported a follow-up longer than 24 months. Significant clinical improvement has been reported in almost all studies with further improvement up to 5 years after surgery. A total of 59 complications were reported of which 52 (11.1%) experienced minor complications and 7 (1.48%) major complications. A total of 16 (3.39%) failures were reported. CONCLUSION This systematic review describes the current available evidence for the treatment of osteochondral knee defects with MaioRegen Osteochondral substitute reporting promising satisfactory and reliable results at mid-term follow-up. A low rate of complications and failure was reported, confirming the safety of this scaffold. Considering the low level of evidence of the study included in the review, this data does not support the superiority of the Maioregen in terms of clinical improvement at follow-up compared to conservative treatment or other cartilage techniques.
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Chadli L, Steltzlen C, Beaufils P, Toanen C, Pujol N. Neither significant osteoarthritic changes nor deteriorating subjective outcomes occur after hybrid fixation of osteochondritis dissecans in the young adult. Knee Surg Sports Traumatol Arthrosc 2019; 27:740-744. [PMID: 29916011 DOI: 10.1007/s00167-018-5025-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 06/12/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The goal of the fixation of painful osteochondritis dissecans of the femoral condyles in adults is to integrate the osteochondral fragment and thus achieve a normal hyaline cartilaginous coverage. The addition of a biological process to primary fixation may result in improved fragment integration (hybrid fixation). Osteochondral plugs may fulfil this role. The aim of this study was to evaluate long-term clinical and radiological results after hybrid fixation of unstable osteochondritis dissecans. The hypothesis was that the rate of secondary osteoarthritis would be low. METHODS Nine patients treated by hybrid fixation were retrospectively reviewed at a median follow-up of 10.1 years (range 7-14). The median age at surgery was 21 (range 17-28). Six of them were evaluated as ICRS grade II and three, as ICRS grade III. The mean surface of the lesion was 4.5 cm2. All patients were followed up clinically (IKDC, KOOS, Lysholm) and radiologically [Kellgren-Lawrence score (KL)]. RESULTS During arthroscopic assessment at the time of screw removal (3 months after surgery), the fragments were stable, and autograft plugs were all well integrated. At the most recent follow-up visit, the median IKDC score was 85.8 (range 51.72-100), the KOOS score was 87.7 (52.4-100), and the Lysholm scale score was 89.8 (77-100). In 7 out of 9 patients, radiographs showed a joint space KL grade of 0 or 1. CONCLUSION Hybrid fixation for treating osteochondritis dissecans lesions of the femoral condyles using mechanical and biological fixation provides healing of the osteochondral fragments with good long-term outcomes. No significant osteoarthritic change was seen with this technique at a mid-term follow-up. LEVEL OF EVIDENCE IV-case series.
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Affiliation(s)
- L Chadli
- Orthopedic Department, Centre Hospitalier de Versailles, Le Chesnay, France
| | - C Steltzlen
- Orthopedic Department, Centre Hospitalier de Versailles, Le Chesnay, France
| | - P Beaufils
- Orthopedic Department, Centre Hospitalier de Versailles, Le Chesnay, France
| | - C Toanen
- Orthopedic Department, Centre Hospitalier de Versailles, Le Chesnay, France
| | - N Pujol
- Orthopedic Department, Centre Hospitalier de Versailles, Le Chesnay, France.
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Sofu H, Camurcu Y, Ucpunar H, Ozcan S, Yurten H, Sahin V. Clinical and radiographic outcomes of chitosan-glycerol phosphate/blood implant are similar with hyaluronic acid-based cell-free scaffold in the treatment of focal osteochondral lesions of the knee joint. Knee Surg Sports Traumatol Arthrosc 2019; 27:773-781. [PMID: 30069652 DOI: 10.1007/s00167-018-5079-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 07/25/2018] [Indexed: 01/04/2023]
Abstract
PURPOSE To determine the clinical and radiographic efficacy of chitosan-glycerol phosphate/blood implant versus hyaluronic acid-based cell-free scaffold in patients with focal osteochondral lesion of the knee joint. METHODS Clinical data of 46 patients surgically treated using either chitosan-glycerol phosphate/blood implant (25 patients, Group 1) or hyaluronic acid-based cell-free scaffold (21 patients, Group 2) in combination with microfracture were retrospectively evaluated. All lesions were Outerbridge grade III or IV with a mean lesion size of 3.3 ± 0.7 cm2. The mean follow-up time was 24.4 months. Visual analogue scale (VAS), Lysholm knee score, and Tegner activity scale were the instruments to evaluate the clinical status. Magnetic resonance observation of cartilage repair tissue (MOCART) system was used to analyze the characteristics of repair tissue. RESULTS No significant differences were detected between the groups regarding VAS, Lysholm, and Tegner scores at any time interval during the whole follow-up. The mean post-operative VAS and Lysholm scores at the latest follow-up was significantly better in cases with the lesion size ≤ 3 cm2 in Group 1 (p = 0.001, p < 0.001, respectively). However, no significant differences according to the lesion size were detected in Group 2 (n.s.). Complete repair with the filling of the defect was achieved in 7 (28%) of the knees in Group 1 and it was 7 (33.3%) of the knees in Group 2 according to MOCART system at the latest follow-up. CONCLUSION Single-stage regenerative cartilage surgery using chitosan-glycerol phosphate/blood implant combined to microfracture for focal osteochondral lesions of the knee revealed similar clinical and radiographic outcomes with hyaluronic acid-based cell-free scaffold at short-term follow-up. However, clinical outcomes of hyaluronan scaffold were less sensitive to defect size than chitosan. With the advantages of no hypertrophic repair tissue formation as well as no need to arthrotomy during surgery, chitosan is an effective choice especially in patients with the lesion size ≤ 3 cm2. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hakan Sofu
- Erzincan University Faculty of Medicine, Basbaglar mahallesi No 1, 24030, Erzincan, Turkey.
| | - Yalkin Camurcu
- Erzincan University Faculty of Medicine, Basbaglar mahallesi No 1, 24030, Erzincan, Turkey
| | - Hanifi Ucpunar
- Mengucekgazi Education and Research Hospital, Erzincan, Turkey
| | - Seckin Ozcan
- Erzincan University Faculty of Medicine, Basbaglar mahallesi No 1, 24030, Erzincan, Turkey
| | - Hakan Yurten
- Erzincan University Faculty of Medicine, Basbaglar mahallesi No 1, 24030, Erzincan, Turkey
| | - Vedat Sahin
- Erzincan University Faculty of Medicine, Basbaglar mahallesi No 1, 24030, Erzincan, Turkey
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23
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Ponce MC, Zorzi AR, de Miranda JB, Amstalden EMI. Proposal for a New Histological Scoring System for Cartilage Repair. Clinics (Sao Paulo) 2018; 73:e562. [PMID: 30517286 PMCID: PMC6238816 DOI: 10.6061/clinics/2018/e562] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 08/22/2018] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE This study aimed to develop a new histological scoring system for use in a partial-thickness cartilage repair animal model. Although previous papers have investigated the regeneration of articular cartilage, the good results achieved in small animals have not been replicated in large animal models or humans, possibly because of the frequent use of models with perforation of the subchondral bone plates. Partial-thickness lesions spare the subchondral bone, and this pattern is the most frequent in humans; therefore, new therapies should be tested using this model. However, no specific histological score exists to evaluate partial-thickness model results. METHODS Histological sections from 30 ovine knees were reviewed to develop a new scoring system. The sections were subjected to H&E, Safranin O, and Masson's trichrome staining. RESULTS This paper describes a new scoring tool that is divided into sections in detail: repair of tissue inside the lesion, cartilage around the lesion and degenerative changes at the base of the lesion. Scores range from 0 to 21; a higher score indicates better cartilage repair. DISCUSSION Unlike existing tools, this new scale does not assign points for the positioning of a tidemark; we propose evaluation of the degenerative changes to the subchondral bone and calcified cartilage layer. It is necessary to remove the whole joint to access and study the evolution of the lesion as well as the surrounding tissue. CONCLUSION This article emphasizes the importance of a partial-thickness animal model of cartilage repair and presents a new histological scoring system.
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Affiliation(s)
- Maria Clara Ponce
- Faculdade de Ciencias Medicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, BR
- *Corresponding author. E-mail:
| | - Alessandro Rozim Zorzi
- Departamento de Cirurgia Ortopedica, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, BR
- Departamento de Ortopedia e Reumatologia, Hospital Israelita Albert Einstein, Sao Paulo, SP, BR
| | - João Batista de Miranda
- Departamento de Cirurgia Ortopedica, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, BR
| | - Eliane Maria Ingrid Amstalden
- Departamento de Patologia, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, BR
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24
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Salikhov RZ, Masgutov RF, Chekunov MA, Tazetdinova LG, Masgutova G, Teplov OV, Galimov D, Plakseichuk Y, Yagudin R, Pankov IO, Rizvanov A. The Stromal Vascular Fraction From Fat Tissue in the Treatment of Osteochondral Knee Defect: Case Report. Front Med (Lausanne) 2018; 5:154. [PMID: 29900170 PMCID: PMC5989074 DOI: 10.3389/fmed.2018.00154] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 05/03/2018] [Indexed: 01/13/2023] Open
Abstract
In this study we applied autologous fat tissue stromal vascular fraction (SVF) cells in combination with microfracturing technique in a 36-year-old man with an osteochondral lesion of the medial femoral condyle 8 months after the injury. Cell material was generated by fat tissue liposuction from the anterior abdominal wall with subsequent extraction of the SVF and injected through a mini-arthrotomy portal with subsequent fibrin sealant fixation. The follow-up period was 2 years. Clinical score improved from 23 to 96 according to IKDC and from 10 to 90 according to EQ-VAS at 24 months follow-up. Magnetic resonance imaging (MRI) before the surgery revealed an osteochondral lesion with development of significant trabecular edema that remained unchanged for 6 months despite conservative treatment. MRI 1 and 2 years after the surgery showed the recovery of the damaged cartilage thickness with somewhat uneven structure and a decrease in the trabecular edema of the femoral condyle. The use of SVF cells with fibrin sealant fixation might be a promising approach in the treatment of osteochondral joint lesions. Further studies are required.
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Affiliation(s)
- Ramil Z Salikhov
- Republican Clinical Hospital, Kazan, Russia.,Kazan State Medical Academy, Kazan, Russia
| | - Ruslan F Masgutov
- Republican Clinical Hospital, Kazan, Russia.,Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | | | - Leysan G Tazetdinova
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Galina Masgutova
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | | | - Damir Galimov
- Republican Clinical Hospital, Kazan, Russia.,Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | | | | | | | - Albert Rizvanov
- Republican Clinical Hospital, Kazan, Russia.,Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
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25
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Tissue Engineering Strategies for Osteochondral Repair. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1059:353-371. [PMID: 29736582 DOI: 10.1007/978-3-319-76735-2_16] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Tissue engineering strategies have been pushing forward several fields in the range of biomedical research. The musculoskeletal field is not an exception. In fact, tissue engineering has been a great asset in the development of new treatments for osteochondral lesions. Herein, we overview the recent developments in osteochondral tissue engineering. Currently, the treatments applied in a clinical scenario have shown some drawbacks given the difficulty in regenerating a fully functional hyaline cartilage. Among the different strategies designed for osteochondral regeneration, it is possible to identify cell-free strategies, scaffold-free strategies, and advanced strategies, where different materials are combined with cells. Cell-free strategies consist in the development of scaffolds in the attempt to better fulfill the requirements of the cartilage regeneration process. For that, different structures have been designed, from monolayers to multilayered structures, with the intent to mimic the osteochondral architecture. In the case of scaffold-free strategies, they took advantage on the extracellular matrix produced by cells. The last strategy relies in the development of new biomaterials capable of mimicking the extracellular matrix. This way, the cell growth, proliferation, and differentiation at the lesion site are expedited, exploiting the self-regenerative potential of cells and its interaction with biomolecules. Overall, despite the difficulties associated with each approach, tissue engineering has been proven a valuable tool in the regeneration of osteochondral lesions and together with the latest advances in the field, promises to revolutionize personalized therapies.
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26
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Kon E, Filardo G, Brittberg M, Busacca M, Condello V, Engebretsen L, Marlovits S, Niemeyer P, Platzer P, Posthumus M, Verdonk P, Verdonk R, Victor J, van der Merwe W, Widuchowski W, Zorzi C, Marcacci M. A multilayer biomaterial for osteochondral regeneration shows superiority vs microfractures for the treatment of osteochondral lesions in a multicentre randomized trial at 2 years. Knee Surg Sports Traumatol Arthrosc 2018; 26:2704-2715. [PMID: 28913600 PMCID: PMC6105149 DOI: 10.1007/s00167-017-4707-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/04/2017] [Indexed: 12/03/2022]
Abstract
PURPOSE The increasing awareness on the role of subchondral bone in the etiopathology of articular surface lesions led to the development of osteochondral scaffolds. While safety and promising results have been suggested, there are no trials proving the real potential of the osteochondral regenerative approach. Aim was to assess the benefit provided by a nanostructured collagen-hydroxyapatite (coll-HA) multilayer scaffold for the treatment of chondral and osteochondral knee lesions. METHODS In this multicentre randomized controlled clinical trial, 100 patients affected by symptomatic chondral and osteochondral lesions were treated and evaluated for up to 2 years (51 study group and 49 control group). A biomimetic coll-HA scaffold was studied, and bone marrow stimulation (BMS) was used as reference intervention. Primary efficacy measurement was IKDC subjective score at 2 years. Secondary efficacy measurements were: KOOS, IKDC Knee Examination Form, Tegner and VAS Pain scores evaluated at 6, 12 and 24 months. Tissue regeneration was evaluated with MRI MOCART scoring system at 6, 12 and 24 months. An external independent agency was involved to ensure data correctness and objectiveness. RESULTS A statistically significant improvement of all clinical scores was obtained from basal evaluation to 2-year follow-up in both groups, although no overall statistically significant differences were detected between the two treatments. Conversely, the subgroup of patients affected by deep osteochondral lesions (i.e. Outerbridge grade IV and OCD) showed a statistically significant better IKDC subjective outcome (+12.4 points, p = 0.036) in the coll-HA group. Statistically significant better results were also found for another challenging group: sport active patients (+16.0, p = 0.027). Severe adverse events related to treatment were documented only in three patients in the coll-HA group and in one in the BMS group. The MOCART score showed no statistical difference between the two groups. CONCLUSIONS This study highlighted the safety and potential of a biomimetic implant. While no statistically significant differences were found compared to BMS for chondral lesions, this procedure can be considered a suitable option for the treatment of osteochondral lesions. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Elizaveta Kon
- Humanitas University Department of Biomedical Sciences - Humanitas Clinical and Research Center, Milan, Italy
| | - Giuseppe Filardo
- NABI Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano 1/10, 40136, Bologna, Italy.
| | - Mats Brittberg
- Department of Orthopaedics, Cartilaginous research unit, Goteborg University, Kungsbacka Hospital, Kungsbacka, Sweden
| | | | - Vincenzo Condello
- Dipartimento di Ortopedia, Ospedale Sacro Cuore Don Calabria di Negrar, Verona, Italy
| | - Lars Engebretsen
- Department of orthopaedic surgery, Ullevål Hospital, Oslo University, Oslo, Norway
| | | | - Philipp Niemeyer
- Department of orthopaedic surgery and traumatology, Freiburg University Hospital, Freiburg Im Breisgau, Germany
| | - Patrik Platzer
- Department of traumatology, Medical University of Vienna, Vienna, Austria
| | - Michael Posthumus
- Division of Exercise Science and Sports Medicine, Faculty of Health Sciences, The University of Cape Town, Cape Town, South Africa
| | - Peter Verdonk
- Antwerp Orthopaedic Center, Monica Hospitals, Stevenslei, Deurne, Belgium
| | - Renè Verdonk
- Université Libre de Bruxelles, Brussels, Belgium
| | - Jan Victor
- Department of orthopaedic surgery, Ghent University Hospital, Ghent, Belgium
| | - Willem van der Merwe
- Sport Science Orthopaedic Clinic, Sport Science Institute of South Africa Newlands, Cape Town, South Africa
| | - Wojciech Widuchowski
- Wojewódzki Szpital Chirurgii Urazowej, II Oddział Urazowo-Ortopedyczny, Piekary Śląskie, Polen
| | - Claudio Zorzi
- Dipartimento di Ortopedia, Ospedale Sacro Cuore Don Calabria di Negrar, Verona, Italy
| | - Maurilio Marcacci
- Humanitas University Department of Biomedical Sciences - Humanitas Clinical and Research Center, Milan, Italy
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27
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Sánchez-Téllez DA, Téllez-Jurado L, Rodríguez-Lorenzo LM. Hydrogels for Cartilage Regeneration, from Polysaccharides to Hybrids. Polymers (Basel) 2017; 9:E671. [PMID: 30965974 PMCID: PMC6418920 DOI: 10.3390/polym9120671] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 11/24/2017] [Accepted: 11/29/2017] [Indexed: 12/12/2022] Open
Abstract
The aims of this paper are: (1) to review the current state of the art in the field of cartilage substitution and regeneration; (2) to examine the patented biomaterials being used in preclinical and clinical stages; (3) to explore the potential of polymeric hydrogels for these applications and the reasons that hinder their clinical success. The studies about hydrogels used as potential biomaterials selected for this review are divided into the two major trends in tissue engineering: (1) the use of cell-free biomaterials; and (2) the use of cell seeded biomaterials. Preparation techniques and resulting hydrogel properties are also reviewed. More recent proposals, based on the combination of different polymers and the hybridization process to improve the properties of these materials, are also reviewed. The combination of elements such as scaffolds (cellular solids), matrices (hydrogel-based), growth factors and mechanical stimuli is needed to optimize properties of the required materials in order to facilitate tissue formation, cartilage regeneration and final clinical application. Polymer combinations and hybrids are the most promising materials for this application. Hybrid scaffolds may maximize cell growth and local tissue integration by forming cartilage-like tissue with biomimetic features.
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Affiliation(s)
- Daniela Anahí Sánchez-Téllez
- Instituto Politécnico Nacional-ESIQIE, Depto. Ing. en Metalurgia y Materiales, UPALM-Zacatenco, Mexico City 07738, Mexico.
- Networking Biomedical Research Centre in Bioengineering, Biomaterials and Nanomedicine, Centro de Investigación Biomédica en Red-Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Av. Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain.
| | - Lucía Téllez-Jurado
- Instituto Politécnico Nacional-ESIQIE, Depto. Ing. en Metalurgia y Materiales, UPALM-Zacatenco, Mexico City 07738, Mexico.
| | - Luís María Rodríguez-Lorenzo
- Networking Biomedical Research Centre in Bioengineering, Biomaterials and Nanomedicine, Centro de Investigación Biomédica en Red-Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Av. Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain.
- Department Polymeric Nanomaterials and Biomaterials, ICTP-CSIC, Juan de la Cierva 3, 28006 Madrid, Spain.
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28
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Mirza YH, Oussedik S. Is there a role for stem cells in treating articular injury? Br J Hosp Med (Lond) 2017; 78:372-377. [PMID: 28692374 DOI: 10.12968/hmed.2017.78.7.372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Articular cartilage is a specialized tissue with a high prevalence of injuries. The complex architecture of articular cartilage means that injuries are difficult to treat. The sequelae of such injuries include post-traumatic osteoarthritis. Current treatments include microfracture, microdrilling, osteochondral transplantation and matrix autologous chondral implantation. However, current surgical therapies have a number of disadvantages. Mesenchymal stem cells have been suggested as a potential alternative therapy, with a theoretical ability to regenerate articular cartilage. Research, although positive, is mainly limited to case series, in which the follow up is short to medium term. Stem cells may hold the answer to the age-old problem of articular cartilage injury but more robust evidence is required.
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Affiliation(s)
- Yusuf H Mirza
- Trauma Fellow, Department of Trauma and Orthopaedics, Royal Gwent Hospital, Newport, NP20 2UB
| | - Sam Oussedik
- Consultant Trauma and Orthopaedic Surgeon, Department of Department of Trauma and Orthopaedics, University College Hospital, London
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29
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Kim MS, Koh IJ, Choi YJ, Pak KH, In Y. Collagen Augmentation Improves the Quality of Cartilage Repair After Microfracture in Patients Undergoing High Tibial Osteotomy: A Randomized Controlled Trial. Am J Sports Med 2017; 45:1845-1855. [PMID: 28282221 DOI: 10.1177/0363546517691942] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The quality of cartilage repair after marrow stimulation is unpredictable. To overcome the shortcomings of the microfracture technique, various augmentation techniques have been developed. However, their efficacies remain unclear. HYPOTHESIS The quality of cartilage repair and clinical outcomes would be superior in patients undergoing high tibial osteotomy (HTO) with microfracture and collagen augmentation compared to those undergoing HTO with microfracture alone without collagen augmentation for the treatment of medial compartment osteoarthritis (OA) of the knee. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS Twenty-eight patients undergoing HTO were randomized into 2 groups: microfracture alone (group 1, n = 14) or microfracture with collagen augmentation (group 2, n = 14). At 1 year postoperatively, second-look arthroscopic surgery and biopsy of repaired cartilage were performed at the time of HTO plate removal. Biopsy specimens were graded using the International Cartilage Repair Society Visual Assessment Scale II (ICRS II). In addition, imaging outcomes in terms of the magnetic resonance observation of cartilage repair tissue (MOCART) score were assessed based on magnetic resonance imaging (MRI). Finally, clinical outcomes in terms of the visual analog scale (VAS) for pain score, Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score, and Tegner activity scale score were evaluated. RESULTS The mean ICRS II score in group 2 was significantly higher than that in group 1 (1053.2 vs 885.4, respectively; P = .002). Group 2 showed greater improvement in tissue morphology, cell morphology, surface architecture, middle/deep zone assessment, and overall assessment compared with group 1 ( P < .050 for all comparisons). Imaging outcomes based on the MOCART score were superior in group 2 compared to those in group 1 on MRI at 1 year postoperatively (64.6 vs 45.4, respectively; P = .001). The degree of defect repair was better in group 2 than in group 1 ( P = .040). Clinical outcomes in terms of the VAS for pain score, KOOS, IKDC score, and Tegner activity scale score were improved in both groups without between-group differences ( P > .100 for all comparisons). CONCLUSION The quality of cartilage repair after microfracture with collagen augmentation was superior to that after microfracture alone in patients undergoing HTO. Clinical results after 1 year did not reflect this difference in tissue repair. Therefore, a longer follow-up of the cohort is needed to answer this question.
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Affiliation(s)
- Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Jun Koh
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Jun Choi
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyu Hyung Pak
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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30
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Yucekul A, Ozdil D, Kutlu NH, Erdemli E, Aydin HM, Doral MN. Tri-layered composite plug for the repair of osteochondral defects: in vivo study in sheep. J Tissue Eng 2017; 8:2041731417697500. [PMID: 28694960 PMCID: PMC5496685 DOI: 10.1177/2041731417697500] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 02/12/2017] [Indexed: 01/13/2023] Open
Abstract
Cartilage defects are a source of pain, immobility, and reduced quality of life for patients who have acquired these defects through injury, wear, or disease. The avascular nature of cartilage tissue adds to the complexity of cartilage tissue repair or regeneration efforts. The known limitations of using autografts, allografts, or xenografts further add to this complexity. Autologous chondrocyte implantation or matrix-assisted chondrocyte implantation techniques attempt to introduce cultured cartilage cells to defect areas in the patient, but clinical success with these are impeded by the avascularity of cartilage tissue. Biodegradable, synthetic scaffolds capable of supporting local cells and overcoming the issue of poor vascularization would bypass the issues of current cartilage treatment options. In this study, we propose a biodegradable, tri-layered (poly(glycolic acid) mesh/poly(l-lactic acid)-colorant tidemark layer/collagen Type I and ceramic microparticle-coated poly(l-lactic acid)-poly(ϵ-caprolactone) monolith) osteochondral plug indicated for the repair of cartilage defects. The porous plug allows the continual transport of bone marrow constituents from the subchondral layer to the cartilage defect site for a more effective repair of the area. Assessment of the in vivo performance of the implant was conducted in an ovine model (n = 13). In addition to a control group (no implant), one group received the implant alone (Group A), while another group was supplemented with hyaluronic acid (0.8 mL at 10 mg/mL solution; Group B). Analyses performed on specimens from the in vivo study revealed that the implant achieves cartilage formation within 6 months. No adverse tissue reactions or other complications were reported. Our findings indicate that the porous biocompatible implant seems to be a promising treatment option for the cartilage repair.
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Affiliation(s)
- Altug Yucekul
- Department of Orthopedics and Traumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Deniz Ozdil
- BMT Calsis Health Technologies Co., Ankara, Turkey.,Bioengineering Division, Institute of Science and Engineering, Hacettepe University, Ankara, Turkey
| | | | - Esra Erdemli
- Department of Histology and Embryology, School of Medicine, Ankara University, Ankara, Turkey
| | - Halil Murat Aydin
- Environmental Engineering Department & Bioengineering Division and Centre for Bioengineering, Hacettepe University, Ankara, Turkey
| | - Mahmut Nedim Doral
- Department of Orthopedics and Traumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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31
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Haddad FS. Raising the bar. Bone Joint J 2017; 99-B:417-418. [PMID: 28385927 DOI: 10.1302/0301-620x.99b4.bjj-2017-0322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 03/13/2017] [Indexed: 11/05/2022]
Affiliation(s)
- F S Haddad
- The Bone & Joint Journal, 22 Buckingham Street, London, WC2N 6ET and NIHR University College London Hospitals Biomedical Research Centre, UK
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32
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Haddad FS. In the same vein: looking forward to 2017. Bone Joint J 2017; 99-B:1-2. [PMID: 28053248 DOI: 10.1302/0301-620x.99b1.38084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 12/02/2016] [Indexed: 11/05/2022]
Affiliation(s)
- F S Haddad
- The Bone & Joint Journal, 22 Buckingham Street, London, WC2N 6ET and NIHR University College London Hospitals Biomedical Research Centre, UK
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33
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Sofu H, Kockara N, Oner A, Camurcu Y, Issın A, Sahin V. Results of Hyaluronic Acid-Based Cell-Free Scaffold Application in Combination With Microfracture for the Treatment of Osteochondral Lesions of the Knee: 2-Year Comparative Study. Arthroscopy 2017; 33:209-216. [PMID: 27614391 DOI: 10.1016/j.arthro.2016.06.035] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 06/16/2016] [Accepted: 06/20/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the clinical and radiographic efficacy of hyaluronic acid-based cell-free scaffold applied in combination with microfracture versus microfracture alone in patients with focal osteochondral lesion of the knee joint. METHODS Clinical data of 43 patients between 24 and 55 years of age were evaluated. Hyaluronic acid-based cell-free scaffold was applied in combination with microfracture for 19 knees (group 1), whereas microfracture alone was the surgical intervention for 24 knees (group 2). All lesions were Outerbridge grade III or IV with a mean size of 3.6 ± 1.3 cm2. The mean follow-up time was 25.7 months. Visual analog scale (VAS), Lysholm knee score, and Tegner activity scale were the instruments used to evaluate the clinical status. Magnetic resonance observation of cartilage repair tissue (MOCART) system was used to analyze the characteristics of repair tissue. RESULTS Better VAS and Lysholm scores were detected in group 1 at 12 and 24 months (P = .019 and P = .025). According to the Tegner activity scale, group 1 had also better activity level at the end of 24 months after surgery (P = .020). The mean time from surgery to return to nonimpact sports activities was 7.8 months in group 1, whereas it was 9.2 months in group 2 (P = .013). Complete repair with the filling of the defect was achieved in 7 (36.8%) of the knees in group 1, whereas it was 4 (16.6%) of the knees in group 2 according to the MOCART system at 24 months. CONCLUSIONS Single-stage regenerative cartilage surgery using hyaluronic acid-based cell-free scaffold in combination with microfracture for focal osteochondral lesions of the knee revealed promising clinical outcomes at 24 months of follow-up, but the clinical significance of the differences seen is simply not known. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Hakan Sofu
- Department of Orthopedics, Erzincan University Faculty of Medicine, Erzincan, Turkey.
| | - Nizamettin Kockara
- Department of Orthopedics, Erzincan University Faculty of Medicine, Erzincan, Turkey
| | - Ali Oner
- Erzincan Mengucekgazi Education and Research Hospital, Erzincan, Turkey
| | - Yalkin Camurcu
- Department of Orthopedics, Erzincan University Faculty of Medicine, Erzincan, Turkey
| | - Ahmet Issın
- Department of Orthopedics, Erzincan University Faculty of Medicine, Erzincan, Turkey
| | - Vedat Sahin
- Department of Orthopedics, Erzincan University Faculty of Medicine, Erzincan, Turkey
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Prevalence of Articular Cartilage Lesions and Surgical Clinical Outcomes in Football (Soccer) Players' Knees: A Systematic Review. Arthroscopy 2016; 32:1466-77. [PMID: 27090724 DOI: 10.1016/j.arthro.2016.01.055] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 12/18/2015] [Accepted: 01/21/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To systematize the available scientific literature on the prevalence of articular cartilage and/or osteochondral lesions in football (soccer) players' knees, and overview the surgical procedures and functional outcomes and return to sports. METHODS A comprehensive search using Pubmed, Cochrane Library, SPORTDiscus, and CINAHL databases was carried out until September 30, 2015. All English language studies that assessed the outcomes of a surgical technique for the treatment of articular cartilage lesions in football players' knees, with a minimum follow-up of 12 months, were included. The reference list of the most relevant papers was screened. The main outcomes of interest were the clinical, arthroscopy or imaging primary outcomes and the return to sports rate. The methodological and reporting qualities were assessed according to Coleman methodology score. RESULTS The search provided 485 titles and abstracts. Five studies were eligible for inclusion (mean Coleman score of 37.2 points), comprising a total of 183 football players with a mean age of 25.7 years. A total of 217 articular cartilage and/or osteochondral lesions were reported, where the medial and lateral femoral condyles were the most common sites of lesion. The surgical procedures investigated were mosaicplasty, microfracture, autologous chondrocyte implantation, and chondral debridement. CONCLUSIONS No definitive conclusion could be made in respect to the best current surgical technique for articular cartilage and osteochondral lesions. Microfracture and mosaicplasty can provide a faster return to competition and faster clinical and functional results, whereas autologous chondrocyte implantation and/or matrix-induced autologous chondrocytes implantation procedures can enhance longstanding clinical and functional results. LEVEL OF EVIDENCE Level IV, systematic review of Level III and IV studies.
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Gallo RA, Plakke M, Mosher T, Black KP. Outcomes following impaction bone grafting for treatment of unstable osteochondritis dissecans. Knee 2016; 23:495-500. [PMID: 26947463 DOI: 10.1016/j.knee.2015.11.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 11/06/2015] [Accepted: 11/07/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Many methods have been proposed to treat unstable osteochondritis dissecans (OCD). Our purpose is to report outcomes in a cohort of patients undergoing impaction bone grafting for treatment of knee OCD. METHODS Patients undergoing impaction bone grafting for knee OCD between 1998 and 2011 were contacted and stratified into (a) those who have undergone subsequent surgery on the affected knee and (b) those who have not had revision surgery performed on the affected knee since the impaction bone grafting procedure. For those not undergoing another procedure, physical examination, radiographs, MRI, and functional outcomes (SF12, Tegner, Activity Rating Scale, and IKDC) were obtained. RESULTS Of nine patients (10 knees) undergoing the procedure, seven (eight knees) were available for follow-up. Three had revision surgery. One had debridement due to surface overgrowth and had no symptoms 43months following debridement, while two had osteochondral allograft and autograft procedures at three and 10years after initial surgery, respectively. Four patients did not require a revision surgical procedure at average follow-up of 55.4months (range, 21-116months). All had complete MRI fill of the cartilaginous defect with less than 50% of surface irregularity and redeveloped the tidemark and a heterogeneous cartilaginous surface. Follow-up Tegner, ARS, and SF12-PCS averaged 6.8, 67.5, and 56.6, respectively. All four had good/excellent IKDC results. CONCLUSION Impaction bone grafting can reliably restore osteocartilaginous defect produced by OCD and is a readily available and less-expensive option in treating OCD lesions. Further investigation is necessary to determine the long-term durability of the results. Level IV - Case series.
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Affiliation(s)
- Robert A Gallo
- Bone and Joint Institute, Department of Orthopaedics, Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, 30 Hope Drive, Hershey, PA 17033, United States.
| | - Michael Plakke
- Department of Anesthesia, Duke University Health System, Durham, NC, United States
| | - Timothy Mosher
- Department of Radiology, Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, 30 Hope Drive, Hershey, PA 17033, United States
| | - Kevin P Black
- Bone and Joint Institute, Department of Orthopaedics, Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, 30 Hope Drive, Hershey, PA 17033, United States
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Blanke F, Vogt S. Zellfreie Biomaterialien. ARTHROSKOPIE 2016. [DOI: 10.1007/s00142-016-0067-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Painful chondral defects of the knee are very difficult problems. The incidence of these lesions in the general population is not known since there is likely a high rate of asymptomatic lesions. The rate of lesions found during arthroscopic exam is highly variable, with reports ranging from 11 to 72 % Aroen (Aroen Am J Sports Med 32: 211-5, 2004); Curl(Arthroscopy13: 456-60, 1997); Figueroa(Arthroscopy 23(3):312-5, 2007;); Hjelle(Arthroscopy 18: 730-4, 2002). Examples of current attempts at cartilage restoration include marrow stimulating techniques, ostochondral autografts, osteochondral allografts, and autologous chondrocyte transplantation. Current research in marrow stimulating techniques has been focused on enhancing and guiding the biology of microfracture and other traditional techniques. Modern advances in stem cell biology and biotechnology have provided many avenues for exploration. The purpose of this work is to review current techniques in marrow stimulating techniques as it relates to chondral damage of the knee.
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Affiliation(s)
- M Zain Mirza
- Penn State Hershey Bone and Joint Institute, 30 Hope Drive, Building B, Suite 2400, Hershey, PA, 17033-0850, USA.
| | - Richard D Swenson
- Penn State Hershey Bone and Joint Institute, 30 Hope Drive, Building B, Suite 2400, Hershey, PA, 17033-0850, USA.
| | - Scott A Lynch
- Penn State Hershey Bone and Joint Institute, 30 Hope Drive, Building B, Suite 2400, Hershey, PA, 17033-0850, USA.
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Li X, Ding J, Wang J, Zhuang X, Chen X. Biomimetic biphasic scaffolds for osteochondral defect repair. Regen Biomater 2015; 2:221-8. [PMID: 26816644 PMCID: PMC4669014 DOI: 10.1093/rb/rbv015] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 07/07/2015] [Indexed: 12/27/2022] Open
Abstract
The osteochondral defects caused by vigorous trauma or physical disease are difficult to be managed. Tissue engineering provides a possible option to regenerate the damaged osteochondral tissues. For osteochondral reconstruction, one intact scaffold should be considered to support the regeneration of both cartilage and subchondral bone. Therefore, the biphasic scaffolds with the mimic structures of osteochondral tissues have been developed to close this chasm. A variety of biomimetic bilayer scaffolds fabricated from natural or synthetic polymers, or the ones loading with growth factors, cells, or both of them make great progresses in osteochondral defect repair. In this review, the preparation and in vitro and/or in vivo verification of bioinspired biphasic scaffolds are summarized and discussed, as well as the prospect is predicted.
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Affiliation(s)
- Xuezhou Li
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun 130022, People's Republic of China;; Department of Orthopedics, The Second Hospital of Jilin University, Changchun 130041, People's Republic of China
| | - Jianxun Ding
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun 130022, People's Republic of China
| | - Jincheng Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun 130041, People's Republic of China
| | - Xiuli Zhuang
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun 130022, People's Republic of China
| | - Xuesi Chen
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun 130022, People's Republic of China
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