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Gherghel R, Onu I, Iordan DA, Antohe BA, Rezus II, Alexa O, Macovei LA, Rezus E. A New Approach to Postoperative Rehabilitation following Mosaicplasty and Bone Marrow Aspiration Concentrate (BMAC) Augmentation. Biomedicines 2024; 12:1164. [PMID: 38927371 PMCID: PMC11200487 DOI: 10.3390/biomedicines12061164] [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: 04/18/2024] [Revised: 04/27/2024] [Accepted: 05/22/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Chondral defects in the knee present a significant challenge due to their limited self-healing capacity, often leading to joint degeneration and functional disability. Current treatments, including surgical approaches like mosaicplasty and regenerative therapies such as bone marrow aspirate concentrate (BMAC) augmentation, aim to address these defects and improve patient outcomes. MATERIALS AND METHODS This study conducted a single-center, randomized controlled trial to evaluate the efficacy of different treatment approaches and rehabilitation protocols for chondral defects. Thirty-seven subjects presenting with symptomatic chondral or osteochondral defects (>3 cm2) in the weight-bearing region of the femoral condyle were partitioned into three groups, and underwent mosaicplasty with or without BMAC augmentation, followed by either a 6-week or 12-week rehabilitation program. Group 1 (n = 10) received mosaicplasty combined with BMAC augmentation and engaged in a twelve-week two-phase rehabilitation protocol. Group 2 (n = 15) underwent mosaicplasty alone and participated in the same twelve-week two-phase rehabilitation regimen. Meanwhile, Group 3 (n = 12) underwent mosaicplasty and underwent a shorter six-week one-phase rehabilitation program. Clinical assessments were performed using the visual analog scale (VAS) for pain, goniometry for the knee's range of motion (ROM), manual muscle testing (MMT) for quadricep strength, and the Western Ontario and McMaster University Arthritis Index (WOMAC) for functional evaluation in three test phases. RESULTS Significant differences in WOMAC scale scores were observed between the three groups at the intermediate (F(2, 34) = 5.24, p < 0.010) and final (F(2, 34) = 111, p < 0.000) stages, with post hoc Tukey tests revealing variations shared among all three groups. The between-group analysis of the VAS scale demonstrated no statistically significant difference initially (F(2, 34) = 0.18, p < 0.982), but significant differences emerged following the intermediate (F(2, 34) = 11.40, p < 0.000) and final assessments (F(2, 34) = 59.87, p < 0.000), with post hoc Tukey tests revealing specific group variations, notably between Group 1 and both Group 2 and Group 3, and also between Group 3 and Group 2. The between-group analysis of quadricep muscle strength using MMT scores revealed no statistically significant differences initially (F(2, 34) = 0.376, p < 0.689) or following the intermediate assessment (F(2, 34) = 2.090, p < 0.139). The one-way ANOVA analysis showed no significant difference in the knee ROM initially (F(2, 34) = 1.037, p < 0.366), but significant differences emerged following intermediate (F(2, 34) = 9.38, p < 0.001) and final assessments (F(2, 34) = 11.60, p < 0.000). Post hoc Tukey tests revealed significant differences between Groups 1 and 2, Groups 1 and 3, and Groups 2 and 3 at intermediate and final assessments. CONCLUSIONS The patients who received BMAC augmentation and completed a 12-week rehabilitation protocol had significantly better outcomes in pain relief, knee function, and ROM when compared to those who did not receive BMAC augmentation or those who completed a shorter rehabilitation period. Our findings suggest that combining mosaicplasty with BMAC augmentation and a comprehensive rehabilitation program can lead to superior clinical outcomes for patients with chondral defects in the knee.
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Affiliation(s)
- Robert Gherghel
- Department of Orthopedics and Trauma Surgery, Piatra Neamt Emergency Hospital, 700115 Piatra Neamt, Romania;
- Departments of Orthopedy and Physiotherapy, Medlife-Micromedica Clinic, 610119 Piatra Neamt, Romania
| | - Ilie Onu
- Departments of Orthopedy and Physiotherapy, Medlife-Micromedica Clinic, 610119 Piatra Neamt, Romania
- Department of Biomedical Sciences, Faculty of Medical Bioengineering, University of Medicine and Pharmacy “Grigore T. Popa” Iasi, 700454 Iasi, Romania
- Center of Physical Therapy and Rehabilitation, “Dunărea de Jos” University of Galati, 800008 Galati, Romania;
| | - Daniel Andrei Iordan
- Center of Physical Therapy and Rehabilitation, “Dunărea de Jos” University of Galati, 800008 Galati, Romania;
- Department of Individual Sports and Kinetotherapy, Faculty of Physical Education and Sport, “Dunarea de Jos” University of Galati, 800008 Galati, Romania
| | - Bogdan Alexandru Antohe
- Department of Physical and Occupational Therapy, “Vasile Alecsandri” University of Bacau, 600115 Bacau, Romania;
| | - Ioana-Irina Rezus
- Department of Dermatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania;
| | - Ovidiu Alexa
- Department of Orthopaedic and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania;
| | - Luana Andreea Macovei
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania;
| | - Elena Rezus
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania;
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Mason TW, Gwilt MS, Glover MA, Villa RS, van der List JP, Trasolini NA, Waterman BR. Rates and predictors of reimplantation of matrix-induced autologous chondrocyte implantation following first stage cartilage harvest: A cohort study. Knee 2024; 48:257-264. [PMID: 38788308 DOI: 10.1016/j.knee.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/21/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024]
Abstract
PURPOSE To assess the reimplantation rate and predictors of patients requiring second-staged matrix-induced autologous chondrocyte implantation (MACI) reimplantation after initial first stage cartilage biopsy. METHODS A retrospective review was performed from 2018 to 2022 among patients who underwent only phase I MACI biopsy procedure (biopsy group) or both phase I with transition to phase II implantation of chondrocytes (implantation group) at a single tertiary center. Demographic, qualitative, and quantitative measurements were recorded, and univariate and multivariate regression analysis was performed to assess predictors of ultimately requiring second stage MACI implantation. RESULTS A total of 71 patients (51% female, age 27.7 ± 10.6 years (range 12-50)) were included in this study. Eventually, 25 of 71 patients (35.2%) experienced persistence of symptoms after initial MACI biopsy and other concomitant procedures, requiring second-stage implantation. Univariate analysis showed the implantation group compared to the biopsy group had a greater lesion size (5.2 cm2 ± 3.3 vs. 3.3 cm2 ± 1.4, p = 0.024), a higher proportion patients ≥ 26 years of age (76% vs. 43%, p = 0.009), a medial femoral condyle lesion more commonly (33% vs 11%, p = 0.005), were more often female (72% vs. 39%, p = 0.008), and had less often soft tissue repair at time of biopsy (32% vs. 61%, p = 0.020). Backward multivariate logistic regression analysis revealed that size of the lesion (OR 1.43, p = 0.031) and age ≥ 26 years old at time of biopsy (OR 3.55, p = 0.042) were independent predictors of not responding to initial surgery and requiring implantation surgery. CONCLUSION This study found that 35% of patients undergoing MACI phase I biopsy harvest eventually required autologous implantation. Independent risk factors for progressing to implantation after failed initial surgery were larger defect size and older age. LEVEL OF EVIDENCE III, Cohort Study.
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Affiliation(s)
- Thomas W Mason
- Wake Forest University School of Medicine, Winston-Salem, NC, United States of America.
| | - Matthew S Gwilt
- Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Mark A Glover
- Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Richard S Villa
- Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Jelle P van der List
- Atrium Health Wake Forest Baptist, Department of Orthopaedic Surgery and Rehabilitation, Winston-Salem, NC, United States of America
| | - Nicholas A Trasolini
- Wake Forest University School of Medicine, Winston-Salem, NC, United States of America; Atrium Health Wake Forest Baptist, Department of Orthopaedic Surgery and Rehabilitation, Winston-Salem, NC, United States of America
| | - Brian R Waterman
- Wake Forest University School of Medicine, Winston-Salem, NC, United States of America; Atrium Health Wake Forest Baptist, Department of Orthopaedic Surgery and Rehabilitation, Winston-Salem, NC, United States of America
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Ebert JR, Zheng M, Fallon M, Wood DJ, Janes GC. 10-Year Prospective Clinical and Radiological Evaluation After Matrix-Induced Autologous Chondrocyte Implantation and Comparison of Tibiofemoral and Patellofemoral Graft Outcomes. Am J Sports Med 2024; 52:977-986. [PMID: 38384192 PMCID: PMC10943616 DOI: 10.1177/03635465241227969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/12/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND Long-term outcomes in larger cohorts after matrix-induced autologous chondrocyte implantation (MACI) are required. Furthermore, little is known about the longer-term clinical and radiological outcomes of MACI performed in the tibiofemoral versus patellofemoral knee joint. PURPOSE To present the 10-year clinical and radiological outcomes in patients after MACI and compare outcomes in patients undergoing tibiofemoral versus patellofemoral MACI. STUDY DESIGN Case series; Level of evidence, 4. METHODS Between September 2002 and December 2012, 204 patients who underwent MACI were prospectively registered into a research program and assessed preoperatively and at 2, 5, and 10 years postoperatively. Of these patients, 168 were available for clinical review at 10 years, with 151 (of a total of 182) grafts also assessed via magnetic resonance imaging (MRI). Patients were evaluated using the Knee injury and Osteoarthritis Outcome Score, a visual analog scale for pain frequency and severity, satisfaction, and peak isokinetic knee extensor and flexor strength. Limb symmetry indices (LSIs) were calculated for strength measures. Grafts were scored on MRI scans via the MOCART (magnetic resonance observation of cartilage repair tissue) system, with a focus on tissue infill and an overall MRI graft composite score. RESULTS All patient-reported outcome measures improved (P < .0001) up to 2 years after surgery. Apart from the significant increase (P = .004) in the peak isokinetic knee extensor LSI, no other patient-reported outcome measure or clinical score had changed significantly from 2 to 10 years. At the final follow-up, 92% of patients were satisfied with MACI to provide knee pain relief, with 76% satisfied with their ability to participate in sports. From 2 to 10 years, no significant change was seen for any MRI-based MOCART variable nor the overall MRI composite score. Of the 151 grafts reviewed via MRI at 10 years, 14 (9.3%) had failed, defined by graft delamination or no graft tissue on MRI scan. Furthermore, of the 36 patients (of the prospectively recruited 204) who were not available for longer-term review, 7 had already proceeded to total knee arthroplasty, and 1 patient had undergone secondary MACI at the same medial femoral condylar site because of an earlier graft failure. Therefore, 22 patients (10.8%) essentially had graft failure over the period. At the final follow-up, patients who underwent MACI in the tibiofemoral (vs patellofemoral) joint reported significantly better Knee injury and Osteoarthritis Outcome Score subscale scores for Quality of Life (P = .010) and Sport and Recreation (P < .001), as well as a greater knee extensor strength LSI (P = .002). Even though the tibiofemoral group demonstrated better 10-year MOCART scores for tissue infill (P = .027), there were no other MRI-based differences (P > .05). CONCLUSION This study reports the long-term review of a prospective series of patients undergoing MACI, demonstrating good clinical scores, high levels of patient satisfaction, and acceptable graft survivorship at 10 years. Patients undergoing tibiofemoral (vs patellofemoral) MACI reported better long-term clinical outcomes, despite largely similar MRI-based outcomes.
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Affiliation(s)
- Jay R. Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Crawley, Perth, Western Australia, Australia
- HFRC Rehabilitation Clinic, Nedlands, Perth, Western Australia, Australia
| | - Minghao Zheng
- School of Surgery (Orthopaedics), University of Western Australia, Crawley, Perth, Western Australia, Australia
| | - Michael Fallon
- Perth Radiological Clinic, Subiaco, Perth, Western Australia, Australia
| | - David J. Wood
- School of Surgery (Orthopaedics), University of Western Australia, Crawley, Perth, Western Australia, Australia
| | - Gregory C. Janes
- Perth Orthopaedic and Sports Medicine Centre, West Perth, Perth, Western Australia, Australia
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Niethammer TR, Aurich M, Brucker PU, Faber S, Diemer F, Pietschmann MF, Schoch W, Zinser W, Müller PE. Follow-up Treatment after Cartilage Therapy of the Knee Joint - a Recommendation of the DGOU Clinical Tissue Regeneration Working Group. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024. [PMID: 38224697 DOI: 10.1055/a-2206-7242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
The first follow-up treatment recommendation from the DGOU's Clinical Tissue Regeneration working group dates back to 2012. New scientific evidence and changed framework conditions made it necessary to update the follow-up treatment recommendations after cartilage therapy.As part of a multi-stage member survey, a consensus was reached which, together with the scientific evidence, provides the basis for the present follow-up treatment recommendation.The decisive criterion for follow-up treatment is still the defect localisation. A distinction is made between femorotibial and patellofemoral defects. In addition, further criteria regarding cartilage defects are now also taken into account (stable cartilage edge, location outside the main stress zone) and the different methods of cartilage therapy (e. g. osteochondral transplantation, minced cartilage) are discussed.The present updated recommendation includes different aspects of follow-up treatment, starting with early perioperative management through to sports clearance and resumption of contact sports after cartilage therapy has taken place.
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Affiliation(s)
- Thomas R Niethammer
- Muskuloskelettales Universitätszentrum München (MUM), Klinik für Orthopädie und Unfallchirurgie, Klinikum der Universität München, LMU München, München, Deutschland
| | - Matthias Aurich
- Department für Orthopädie, Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Halle (Saale), Halle, Deutschland
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost, Halle (Saale), Deutschland
| | - Peter U Brucker
- ATOS Klinik München, München, Deutschland
- Biomechanik im Sport, Fakultät für Sport- und Gesundheitswissenschaft, Technische Universität München, München
| | - Svea Faber
- Muskuloskelettales Universitätszentrum München (MUM), Klinik für Orthopädie und Unfallchirurgie, Klinikum der Universität München, LMU München, München, Deutschland
| | | | - Matthias F Pietschmann
- Muskuloskelettales Universitätszentrum München (MUM), Klinik für Orthopädie und Unfallchirurgie, Klinikum der Universität München, LMU München, München, Deutschland
- OrthoPraxis Oberhaching, Oberhaching
| | | | - Wolfgang Zinser
- Orthoexpert, Knittelfeld, Österreich
- Metagil Physikalisches Ambulatorium, Knittelfeld, Österreich
| | - Peter E Müller
- Muskuloskelettales Universitätszentrum München (MUM), Klinik für Orthopädie und Unfallchirurgie, Klinikum der Universität München, LMU München, München, Deutschland
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Kacprzak B, Rosińska K, Siuba-Jarosz N. Hyalofast Cartilage Repair Surgery with a Full Load-Bearing Rehabilitation Program One Day after Operation Reduces the Time for Professional Athletes to Return to Play. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040804. [PMID: 37109762 PMCID: PMC10145501 DOI: 10.3390/medicina59040804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: This study evaluated the effectiveness of Hyalofast cartilage repair surgery with an early, full load-bearing rehabilitation program one day after the operation for reducing the time needed for professional athletes to return to play. Materials and Methods: This prospective study included 49 patients aged between 19 and 38 years who had undergone surgical reconstruction of cartilage using the microfracture technique combined with a Hyalofast scaffold. All patients were active professional athletes. Early rehabilitation was implemented from the first postoperative day, fully loading the operated limb. A clinical evaluation was based on the KOOS and SF-36 questionnaires used during subsequent follow-up visits. All patients underwent magnetic resonance imaging (MRI) to evaluate the effect of the surgery after one year. Results: The clinical results demonstrated a statistically significant improvement in the number of complaints about pain and in the quality of life of the patients, measured in all of the applied scales, with comparisons made between six months or one year post-surgery and pre-surgery. Importantly for athletes, the parameter related to sports and recreation improved from 14 ± 11.1 to 95 ± 7.7 6 months after surgery and to 99.8 ± 1.8 one year after surgery. The overall quality of life score improved from 30 ± 18 to 88 ± 8.8 one year after surgery. Conclusions: These results show that this approach significantly shortened the time needed for the athletes to return to sports at the same level as before the surgery (athletes returned to sports in approximately 2.5-3 months). The mean follow-up time was 19.75 months. This technique can be considered a viable option for the treatment of cartilage injuries in professional athletes, allowing them to return to play more quickly in a safe and healthy way.
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Affiliation(s)
| | - Karolina Rosińska
- Wolf Project Studio Krzysztof Król, ul. Gdańska 79/D01, 90-612 Łódź, Poland
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Schuiringa GH, Pastrama M, Ito K, van Donkelaar CC. Towards a load bearing hydrogel: A proof of principle in the use of osmotic pressure for biomimetic cartilage constructs. J Mech Behav Biomed Mater 2023; 137:105552. [PMID: 36371992 DOI: 10.1016/j.jmbbm.2022.105552] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022]
Abstract
Cartilage defects occur frequently and can lead to osteoarthritis. Hydrogels are a promising regenerative strategy for treating such defects, using their ability of mimicking the native extracellular matrix. However, commonly used hydrogels for tissue regeneration are too soft to resist load-bearing in the joint. To overcome this, an implant is being developed in which the mechanical loadbearing function originates from the osmotic pressure generated by the swelling potential of a charged hydrogel, which is restricted from swelling by a textile spacer fabric. This study aims to quantify the relationship between the swelling potential of the hydrogel and the compressive stiffness of the implant.
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Affiliation(s)
- Gerke H Schuiringa
- Orthopaedic Biomechanics, Dept. Biomedical Engineering, Eindhoven University of Technology, the Netherlands
| | - Maria Pastrama
- Orthopaedic Biomechanics, Dept. Biomedical Engineering, Eindhoven University of Technology, the Netherlands
| | - Keita Ito
- Orthopaedic Biomechanics, Dept. Biomedical Engineering, Eindhoven University of Technology, the Netherlands
| | - Corrinus C van Donkelaar
- Orthopaedic Biomechanics, Dept. Biomedical Engineering, Eindhoven University of Technology, the Netherlands.
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Dhillon J, Fasulo SM, Kraeutler MJ, Belk JW, McCulloch PC, Scillia AJ. The Most Common Rehabilitation Protocol After Matrix-Assisted Autologous Chondrocyte Implantation Is Immediate Partial Weight-Bearing and Continuous Passive Motion. Arthrosc Sports Med Rehabil 2022; 4:e2115-e2123. [PMID: 36579035 PMCID: PMC9791827 DOI: 10.1016/j.asmr.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 09/06/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose To perform a systematic review of postoperative rehabilitation protocols for third-generation autologous chondrocyte implantation (ACI) of the knee joint. Methods A systematic review was performed by searching PubMed, Cochrane Library, and EMBASE to locate randomized controlled trials that described a rehabilitation protocol following third-generation ACI of the knee joint. The search terms used were: "autologous" AND "chondrocyte" AND "randomized". Data extracted from each study included various components of postoperative rehabilitation, such as initial weight-bearing (WB) status and time to full WB, the use of continuous passive motion (CPM), the time to return to sports, and physical therapy (PT) modalities used and the timing of their initiation. Results Twenty-five studies (22 Level I, 3 Level II) met inclusion criteria, including a total of 905 patients undergoing treatment with ACI. The average patient age ranged from 29.1 to 54.8 years, and the mean follow-up time ranged from 3 months to 10.0 years. The average lesion size ranged from 1.9 to 5.8 cm2, and the most common lesion location was the medial femoral condyle (n = 494). Twenty studies allowed partial WB postoperatively with all studies permitting full WB within 12 weeks. Twenty studies used CPM in their rehabilitation protocols and initiated its use within 24 hours postoperatively. Among 10 studies that reported time to return to sport, 9 (90%) allowed return by 12 months. While most protocols used strength training as well as the inclusion of proprioceptive training, there was disagreement on the timing and inclusion of specific PT modalities used during the rehabilitation process. Conclusions Based on the included studies, most rehabilitation protocols for third-generation ACI initiate CPM within 24 hours postoperatively and allow partial WB immediately following surgery with progression to full WB within 12 weeks. There is variation of the PT modalities used as well as the timing of their initiation. Level of Evidence Level II, systematic review of Level I-II studies.
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Affiliation(s)
- Jaydeep Dhillon
- Rocky Vista University College of Osteopathic Medicine, Parker, Colorado U.S.A
| | - Sydney M. Fasulo
- Department of Orthopaedic Surgery, St. Joseph’s University Medical Center, Paterson, New Jersey U.S.A
| | - Matthew J. Kraeutler
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas U.S.A.,Address correspondence to Matthew J. Kraeutler, M.D., Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, 6445 Main St., Suite 2300, Houston, TX 77030.
| | - John W. Belk
- University of Colorado School of Medicine, Aurora, Colorado U.S.A
| | - Patrick C. McCulloch
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas U.S.A
| | - Anthony J. Scillia
- Department of Orthopaedic Surgery, St. Joseph’s University Medical Center, Paterson, New Jersey U.S.A.,Academy Orthopaedics, Wayne, New Jersey, U.S.A
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Esrafilian A, Stenroth L, Mononen ME, Vartiainen P, Tanska P, Karjalainen PA, Suomalainen JS, Arokoski JPA, Saxby DJ, Lloyd DG, Korhonen RK. Towards Tailored Rehabilitation by Implementation of a Novel Musculoskeletal Finite Element Analysis Pipeline. IEEE Trans Neural Syst Rehabil Eng 2022; 30:789-802. [PMID: 35286263 DOI: 10.1109/tnsre.2022.3159685] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Tissue-level mechanics (e.g., stress and strain) are important factors governing tissue remodeling and development of knee osteoarthritis (KOA), and hence, the success of physical rehabilitation. To date, no clinically feasible analysis toolbox has been introduced and used to inform clinical decision making with subject-specific in-depth joint mechanics of different activities. Herein, we utilized a rapid state-of-the-art electromyography-assisted musculoskeletal finite element analysis toolbox with fibril-reinforced poro(visco)elastic cartilages and menisci to investigate knee mechanics in different activities. Tissue mechanical responses, believed to govern collagen damage, cell death, and fixed charge density loss of proteoglycans, were characterized within 15 patients with KOA while various daily activities and rehabilitation exercises were performed. Results showed more inter-participant variation in joint mechanics during rehabilitation exercises compared to daily activities. Accordingly, the devised workflow may be used for designing subject-specific rehabilitation protocols. Further, results showed the potential to tailor rehabilitation exercises, or assess capacity for daily activity modifications, to optimally load knee tissue, especially when mechanically-induced cartilage degeneration and adaptation are of interest.
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Timing of postoperative weightbearing in the treatment of traumatic chondral injuries of the knee in athletes - A systematic review of current concepts in clinical practice. Asia Pac J Sports Med Arthrosc Rehabil Technol 2022; 27:1-8. [PMID: 35155127 PMCID: PMC8803964 DOI: 10.1016/j.asmart.2022.01.001] [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: 08/31/2021] [Revised: 01/01/2022] [Accepted: 01/09/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Surgery aims to stimulate healing and enable a safe return to sport in athletes with symptomatic cartilage lesions of the knee. Timing of postoperative weightbearing is crucial, balancing a stimulation of the healing and avoiding reinjury.To explore current concepts of timing to partial and full weightbearing and rate of return to sport in athletes after articular cartilage surgery of the knee.Systematic Review of studies with level of evidence I-III. METHODS Four databases (Pubmed, Web of Science, Scopus and Embase) were searched using a predetermined keyword strategy. Two independent reviewers screened results according to inclusion and exclusion criteria. Modified Coleman Methodology Score (mCMS) was used for the quality assessment. RESULTS 5294 records were found. Data from ten studies was extracted after duplicate removal, title and abstract screening and full-text evaluation. Eight of the ten studies included a detailed rehabilitation protocol, including 336 out of a total athletic population of 401. 62% began partial weightbearing (PWB) 1-2 weeks postoperatively, while 38% began within 3-4 weeks. The studies that had a later PWB all returned to full weightbearing (FWB) within 6-8 weeks. One study with early PWB returned to early FWB, while the other two returned 10-12 weeks postoperatively. "Return to Sport" (RTS) was the most common reported outcome measure, with most studies reporting RTS at 80% or higher. CONCLUSION There is no clear evidence that the timing of weightbearing (WB) affects the outcome and return to sport in athletes after surgery for focal full-thickness cartilage lesions of the knee. On the other hand, there seems to be no adverse effects in adopting an early WB strategy, currently defined differently by different authors. Further studies directly comparing the timing of WB for specific surgical procedures in athletes and with relevant control groups is recommended. There is a need for a consensus in regard to more exactly defining "early" vs "late" weightbearing in relation to a universal and precisely defined state of healing.
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Ebert JR, Fallon M, Wood DJ, Janes GC. An accelerated 6-week return to full weight bearing after matrix-induced autologous chondrocyte implantation results in good clinical outcomes to 5 years post-surgery. Knee Surg Sports Traumatol Arthrosc 2021; 29:3825-3833. [PMID: 33459833 DOI: 10.1007/s00167-020-06422-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/15/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the mid-term outcomes of an accelerated return to full weight bearing (WB) after matrix-induced autologous chondrocyte implantation (MACI). METHODS This randomized study allocated 35 patients (37 knees) to a 6 week (n = 18) or 8 week (n = 19) return to full WB after MACI. Patients were evaluated pre-operatively and at 1, 2 and minimum 5 years (range 5.5-7 years), using the KOOS, SF-36, visual analogue pain scale, 6-min walk test and active knee range of motion (ROM). Peak isokinetic knee extensor and flexor strength was assessed, with limb symmetry indices (LSIs) calculated. Magnetic resonance imaging (MRI) was undertaken to evaluate the repair tissue, and an MRI composite score was calculated. RESULTS While no group differences (n.s.) were observed, significant improvement was observed for all patient-reported outcome measures (p < 0.05), 6-min walk distance (p = 0.040), active knee flexion (p = 0.002) and extension (p < 0.0001) ROM, and the LSI for peak knee extensor strength (p < 0.0001). At final review, 87.5% (6 weeks) and 82.4% (8 weeks) of patients were satisfied overall. A non-significant decline (n.s.) was observed for the MRI composite score from 1-year post-surgery to final review, with no significant MRI-based differences (n.s.) between groups. At final review, two grafts (6-week n = 1, 8-week n = 1) demonstrated MRI-based graft failure, while an additional patient had progressed toward knee arthroplasty (8.1% failure rate at minimum 5 years). CONCLUSIONS The 6-week return to full WB after MACI provided comparable clinical and MRI-based outcomes beyond 5 years post-surgery, without jeopardizing the graft. This 6-week WB protocol is faster than those previously proposed and studied. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Jay R Ebert
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
- HFRC Rehabilitation Clinic, 117 Stirling Highway, Nedlands, WA, 6009, Australia.
| | - Michael Fallon
- Perth Radiological Clinic, Subiaco, Perth, WA, 6008, Australia
| | - David J Wood
- School of Surgery (Orthopaedics), University of Western Australia, Crawley, Perth, WA, 6009, Australia
| | - Gregory C Janes
- Perth Orthopaedic and Sports Medicine Centre, West Perth, WA, 6005, Australia
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11
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Gupton M, Romanelli D, Johnson J, Meyer B. Multiple Lesion Matrix-Induced Chondrocyte Implantation Procedure in a Collegiate Football Athlete: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00091. [PMID: 34449451 DOI: 10.2106/jbjs.cc.21.00158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 21-year-old male division I collegiate athlete presented for right knee pain, effusion, and mechanical symptoms. The patient was found to have 2.4 × 2-cm medial patellar facet, 1 × 0.8-cm central trochlea, and 2.5 × 3-cm lateral femoral condyle articular cartilage defects on arthroscopy. The patient was treated with a matrix-induced autologous chondrocyte implantation (MACI) procedure for all 3 lesions. At 9 months postoperatively, the patient returned to full American football activities and remains asymptomatic 16 months postoperatively. CONCLUSION Multiple lesions and lesions involving the patellofemoral joint can be treated with a MACI procedure with short-term promising results in high-demand athletes.
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Affiliation(s)
- Marco Gupton
- MountainView Regional Medical Center, Orthopaedic Surgery Residency Program, Las Cruces, New Mexico
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12
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Lyu J, Zhang Y, Zhu W, Li D, Lin W, Chen K, Xia J. Correlation between the subchondral bone marrow lesions and cartilage repair tissue after matrix-associated autologous chondrocyte implantation in the knee: a cross-sectional study. Acta Radiol 2021; 62:1072-1079. [PMID: 33183061 DOI: 10.1177/0284185120969955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The contribution of the subchondral bone in the development and progression of osteoarthritis (OA) has long been recognized, but its role in cartilage repair procedures has only recently attracted more attention. PURPOSE To explore the correlation between the cartilage repair tissue (RT) and the subchondral bone marrow lesions (BMLs) after matrix-associated autologous chondrocyte implantation (MACI) in the knee joint. MATERIAL AND METHODS A total of 30 patients who underwent MACI in the knee from January 2015 to June 2018 and follow-up magnetic resonance imaging (MRI) scan were recruited in this study. The MRI results of cartilage RT were evaluated using T2* relaxation time. Subchondral BMLs were also qualitatively evaluated by use of the two-dimensional proton density-weighted fat-suppressed (2D-PD-FS) and three-dimensional dual-echo steady-state (3D-DESS) sequences. RESULTS The univariate analysis displayed a significant negative correlation between subchondral BMLs and cartilage RT (P < 0.01). In the minimally adjusted model (only age, sex, and body mass index [BMI] adjusted), the results did not show obvious changes (β = -6.54, 95% confidence interval [CI] = -10.99 to -2.09; P = 0.008). After adjustment for the full models (age, sex, BMI, defect size, combined injury, and preoperative duration of symptoms adjusted), the connection was also detected (β = -6.66, 95% CI -11.82 to -1.50; P = 0.019). CONCLUSION After MACI, the subchondral BMLs are significantly correlated with cartilage RT-T2* relaxation time. The role of subchondral bone in cartilage repair procedures should not be underestimated.
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Affiliation(s)
- Jialing Lyu
- Department of Radiology, the First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, Guangdong Province, PR China
| | - Yindi Zhang
- Department of Radiology, the First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, Guangdong Province, PR China
| | - Weimin Zhu
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, Guangdong Province, PR China
| | - Dingfu Li
- Department of Radiology, the First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, Guangdong Province, PR China
| | - Weiqiang Lin
- Department of Radiology, the First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, Guangdong Province, PR China
| | - Kang Chen
- Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, Guangdong Province, PR China
| | - Jun Xia
- Department of Radiology, the First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, Guangdong Province, PR China
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13
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Futrega K, Music E, Robey PG, Gronthos S, Crawford R, Saifzadeh S, Klein TJ, Doran MR. Characterisation of ovine bone marrow-derived stromal cells (oBMSC) and evaluation of chondrogenically induced micro-pellets for cartilage tissue repair in vivo. Stem Cell Res Ther 2021; 12:26. [PMID: 33413652 PMCID: PMC7791713 DOI: 10.1186/s13287-020-02045-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/23/2020] [Indexed: 12/12/2022] Open
Abstract
Abstract Bone marrow stromal cells (BMSC) show promise in cartilage repair, and sheep are the most common large animal pre-clinical model. Objective The objective of this study was to characterise ovine BMSC (oBMSC) in vitro, and to evaluate the capacity of chondrogenic micro-pellets manufactured from oBMSC or ovine articular chondrocytes (oACh) to repair osteochondral defects in sheep. Design oBMSC were characterised for surface marker expression using flow cytometry and evaluated for tri-lineage differentiation capacity. oBMSC micro-pellets were manufactured in a microwell platform, and chondrogenesis was compared at 2%, 5%, and 20% O2. The capacity of cartilage micro-pellets manufactured from oBMSC or oACh to repair osteochondral defects in adult sheep was evaluated in an 8-week pilot study. Results Expanded oBMSC were positive for CD44 and CD146 and negative for CD45. The common adipogenic induction ingredient, 3-Isobutyl-1-methylxanthine (IBMX), was toxic to oBMSC, but adipogenesis could be restored by excluding IBMX from the medium. BMSC chondrogenesis was optimal in a 2% O2 atmosphere. Micro-pellets formed from oBMSC or oACh appeared morphologically similar, but hypertrophic genes were elevated in oBMSC micro-pellets. While oACh micro-pellets formed cartilage-like repair tissue in sheep, oBMSC micro-pellets did not. Conclusion The sensitivity of oBMSC, compared to human BMSC, to IBMX in standard adipogenic assays highlights species-associated differences. Micro-pellets manufactured from oACh were more effective than micro-pellets manufactured from oBMSC in the repair of osteochondral defects in sheep. While oBMSC can be driven to form cartilage-like tissue in vitro, the effective use of these cells in cartilage repair will depend on the successful mitigation of hypertrophy and tissue integration. Supplementary information The online version contains supplementary material available at 10.1186/s13287-020-02045-3.
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Affiliation(s)
- K Futrega
- Centre for Biomedical Technologies (CBT), Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,National Institute of Dental and Craniofacial Research (NIDCR), National Institutes of Health (NIH), Bethesda, Maryland, USA.,Translational Research Institute (TRI), Brisbane, Queensland, Australia
| | - E Music
- Translational Research Institute (TRI), Brisbane, Queensland, Australia.,School of Biomedical Sciences, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - P G Robey
- National Institute of Dental and Craniofacial Research (NIDCR), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - S Gronthos
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - R Crawford
- Centre for Biomedical Technologies (CBT), Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - S Saifzadeh
- Centre for Biomedical Technologies (CBT), Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - T J Klein
- Centre for Biomedical Technologies (CBT), Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - M R Doran
- Centre for Biomedical Technologies (CBT), Queensland University of Technology (QUT), Brisbane, Queensland, Australia. .,National Institute of Dental and Craniofacial Research (NIDCR), National Institutes of Health (NIH), Bethesda, Maryland, USA. .,Translational Research Institute (TRI), Brisbane, Queensland, Australia. .,School of Biomedical Sciences, Queensland University of Technology (QUT), Brisbane, Queensland, Australia. .,Mater Research Institute - University of Queensland (UQ), Translational Research Institute (TRI), Brisbane, Queensland, Australia.
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14
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Crecelius CR, Van Landuyt KJ, Schaal R. Postoperative Management for Articular Cartilage Surgery in the Knee. J Knee Surg 2021; 34:20-29. [PMID: 33111278 DOI: 10.1055/s-0040-1718605] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The postoperative rehabilitation team plays a crucial role in optimizing outcomes after articular cartilage surgery. A comprehensive approach to postoperative physical therapy that considers the type of surgery, location in the knee, concurrent procedures, and patient-specific factors is imperative. While postoperative rehabilitation protocols should be specific to the patient and type of surgery performed and include phased rehabilitation goals and activities, the key principles for postoperative rehabilitation apply across the spectrum of articular cartilage surgeries and patients. These key principles consist of preoperative assessments that include physical, mental, and behavioral components critical to recovery; education and counseling with respect to expectations and compliance; and careful monitoring and adjustments throughout the rehabilitation period based on consistent communication among rehabilitation, surgical, and imaging teams to ensure strict patient compliance with restrictions, activities, and timelines to optimize functional outcomes after surgery.
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Affiliation(s)
- Cory R Crecelius
- Department of Orthopaedic Surgery Physical Therapy, University of Missouri, Columbia, Missouri.,University of Missouri Joint Preservation Center, Columbia, Missouri
| | - Karra J Van Landuyt
- Department of Orthopaedic Surgery Physical Therapy, University of Missouri, Columbia, Missouri
| | - Robert Schaal
- Department of Orthopaedic Surgery Physical Therapy, University of Missouri, Columbia, Missouri
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15
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Stem cell transplantation for the treatment of osteochondral defects of the knee: Operative technique for a single-stage transplantation procedure using bone marrow-derived mesenchymal stem cells. Knee 2021; 28:400-409. [PMID: 32680778 DOI: 10.1016/j.knee.2020.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 04/25/2020] [Accepted: 05/13/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Autologous chondrocyte implantation (ACI) is a NICE-approved technique to regenerate hyaline cartilage in chondral and osteochondral defects (OCDs). The drawbacks of ACI include that it requires a two-stage approach, involves a lengthy rehabilitation process and is expensive. Bone marrow harvest with mesenchymal stem cell transplantation using a single-stage procedure and an accelerated rehabilitation programme has been developed to overcome this. The aim of this paper is to describe the surgical technique for stem cell transplantation of the knee for OCDs with reference to case examples. METHODS The surgical technique for stem cell transplantation of the knee for OCDs is described, with reference to three cases. Magnetic resonance imaging was performed at six months postoperatively. RESULTS The surgical technique is described in this paper. The three patient cases described all improved clinically with reduced pain and improved function at a minimum of six months follow-up. CONCLUSIONS Stem cell transplantation has the potential to produce favourable outcomes for patients with osteochondral defects of the knee. This single-stage approach and accelerated rehabilitation is associated with reduced financial costs. A long-term prospective study of this technique is currently underway at our institution and randomised controlled trials are planned to demonstrate the effectiveness over other techniques.
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16
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Smith JK. Exercise as an Adjuvant to Cartilage Regeneration Therapy. Int J Mol Sci 2020; 21:ijms21249471. [PMID: 33322825 PMCID: PMC7763351 DOI: 10.3390/ijms21249471] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/03/2020] [Accepted: 12/10/2020] [Indexed: 02/06/2023] Open
Abstract
This article provides a brief review of the pathophysiology of osteoarthritis and the ontogeny of chondrocytes and details how physical exercise improves the health of osteoarthritic joints and enhances the potential of autologous chondrocyte implants, matrix-induced autologous chondrocyte implants, and mesenchymal stem cell implants for the successful treatment of damaged articular cartilage and subchondral bone. In response to exercise, articular chondrocytes increase their production of glycosaminoglycans, bone morphogenic proteins, and anti-inflammatory cytokines and decrease their production of proinflammatory cytokines and matrix-degrading metalloproteinases. These changes are associated with improvements in cartilage organization and reductions in cartilage degeneration. Studies in humans indicate that exercise enhances joint recruitment of bone marrow-derived mesenchymal stem cells and upregulates their expression of osteogenic and chondrogenic genes, osteogenic microRNAs, and osteogenic growth factors. Rodent experiments demonstrate that exercise enhances the osteogenic potential of bone marrow-derived mesenchymal stem cells while diminishing their adipogenic potential, and that exercise done after stem cell implantation may benefit stem cell transplant viability. Physical exercise also exerts a beneficial effect on the skeletal system by decreasing immune cell production of osteoclastogenic cytokines interleukin-1β, tumor necrosis factor-α, and interferon-γ, while increasing their production of antiosteoclastogenic cytokines interleukin-10 and transforming growth factor-β. In conclusion, physical exercise done both by bone marrow-derived mesenchymal stem cell donors and recipients and by autologous chondrocyte donor recipients may improve the outcome of osteochondral regeneration therapy and improve skeletal health by downregulating osteoclastogenic cytokine production and upregulating antiosteoclastogenic cytokine production by circulating immune cells.
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Affiliation(s)
- John Kelly Smith
- Departments of Academic Affairs and Biomedical Sciences, James H. Quillen College of Medicine, East Tennessee State University, P.O. Box 70300, Johnson City, TN 37614, USA
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17
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Mechano-activated biomolecule release in regenerating load-bearing tissue microenvironments. Biomaterials 2020; 265:120255. [PMID: 33099065 DOI: 10.1016/j.biomaterials.2020.120255] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/13/2020] [Accepted: 07/20/2020] [Indexed: 02/07/2023]
Abstract
Although mechanical loads are integral for musculoskeletal tissue homeostasis, overloading and traumatic events can result in tissue injury. Conventional drug delivery approaches for musculoskeletal tissue repair employ localized drug injections. However, rapid drug clearance and inadequate synchronization of molecule provision with healing progression render these methods ineffective. To overcome this, a programmable mechanoresponsive drug delivery system was developed that utilizes the mechanical environment of the tissue during rehabilitation (for example, during cartilage repair) to trigger biomolecule provision. For this, a suite of mechanically-activated microcapsules (MAMCs) with different rupture profiles was generated in a single fabrication batch via osmotic annealing of double emulsions. MAMC physical dimensions were found to dictate mechano-activation in 2D and 3D environments and their stability in vitro and in vivo, demonstrating the tunability of this system. In models of cartilage regeneration, MAMCs did not interfere with tissue growth and activated depending on the mechanical properties of the regenerating tissue. Finally, biologically active anti-inflammatory agents were encapsulated and released from MAMCs, which counteracted degradative cues and prevented the loss of matrix in living tissue environments. This unique technology has tremendous potential for implementation across a wide array of musculoskeletal conditions for enhanced repair of load-bearing tissues.
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18
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GIGLIO PEDRONOGUEIRA, LIZIER NELSONFORESTO, LEVY DÉBORA, SOBRADO MARCELFARACO, GOBBI RICCARDOGOMES, PÉCORA JOSÉRICARDO, BYDLOWSKI SERGIOPAULO, DEMANGE MARCOKAWAMURA. AUTOLOGOUS CHONDROCYTE IMPLANTATION IN BRAZIL. ACTA ORTOPEDICA BRASILEIRA 2020; 28:131-136. [PMID: 32536794 PMCID: PMC7269135 DOI: 10.1590/1413-785220202803226503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Objective: To describe the first series of cases of autologous chondrocyte implantation
(ACI) in collagen membrane performed in Brazil. Methods: ACI was performed in 12 knees of 11 patients, aged 32.1 ± 10.9 years, with
5.3 ± 2.6 cm2 full-thickness knee cartilage lesions, with a
six-month minimum follow-up. Two surgical procedures were performed:
arthroscopic cartilage biopsy for isolation and expansion of chondrocytes,
which were seeded onto collagen membrane and implanted in the lesion site;
the characterization of cultured cells and implant was performed using
immunofluorescence for type II collagen (COL2) for cell viability and
electron microscopy of the implant. Clinical safety, KOOS and IKDC scores
and magnetic resonance imaging were evaluated. We used repeated-measures
ANOVA and post-hoc comparisons at α = 5%. Results: COL2 was identified in the cellular cytoplasm, cell viability was higher than
95% and adequate distribution and cell adhesion were found in the membrane.
The median follow-up was 10.9 months (7 to 19). We had two cases of
arthrofibrosis, one of graft hypertrophy and one of superficial infection as
complications, but none compromising clinical improvement. KOOS and IKDC
ranged from 71.2 ± 11.44 and 50.72 ± 14.10, in preoperative period, to 85.0
± 4.4 and 70.5 ± 8.0, at 6 months (p = 0.007 and 0.005). MRI showed
regenerated tissue compatible with hyaline cartilage. Conclusion: ACI in collagen membrane was feasible and safe in a short-term follow-up,
presenting regenerated formation visualized by magnetic resonance imaging
and improved clinical function. Level of evidence IV, Case
series.
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19
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Yodmuang S, Guo H, Brial C, Warren RF, Torzilli PA, Chen T, Maher SA. Effect of interface mechanical discontinuities on scaffold-cartilage integration. J Orthop Res 2019; 37:845-854. [PMID: 30690798 PMCID: PMC6957060 DOI: 10.1002/jor.24238] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/21/2019] [Indexed: 02/04/2023]
Abstract
A consistent lack of lateral integration between scaffolds and adjacent articular cartilage has been exhibited in vitro and in vivo. Given the mismatch in mechanical properties between scaffolds and articular cartilage, the mechanical discontinuity that occurs at the interface has been implicated as a key factor, but remains inadequately studied. Our objective was to investigate how the mechanical environment within a mechanically loaded scaffold-cartilage construct might affect integration. We hypothesized that the magnitude of the mechanical discontinuity at the scaffold-cartilage interface would be related to decreased integration. To test this hypothesis, chondrocyte seeded scaffolds were embedded into cartilage explants, pre-cultured for 14 days, and then mechanically loaded for 28 days at either 1N or 6N of applied load. Constructs were kept either peripherally confined or unconfined throughout the duration of the experiment. Stress, strain, fluid flow, and relative displacements at the cartilage-scaffold interface and within the scaffold were quantified using biphasic, inhomogeneous finite element models (bFEMs). The bFEMs indicated compressive and shear stress discontinuities occurred at the scaffold-cartilage interface for the confined and unconfined groups. The mechanical strength of the scaffold-cartilage interface and scaffold GAG content were higher in the radially confined 1N loaded groups. Multivariate regression analyses identified the strength of the interface prior to the commencement of loading and fluid flow within the scaffold as the main factors associated with scaffold-cartilage integration. Our study suggests a minimum level of scaffold-cartilage integration is needed prior to the commencement of loading, although the exact threshold has yet to be identified. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Supansa Yodmuang
- Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York
| | - Hongqiang Guo
- Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York
| | - Caroline Brial
- Department of Biomechanics, Hospital for Special Surgery, 535 East 70th Street, New York 10021 New York
| | - Russell F. Warren
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York
| | - Peter A. Torzilli
- Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York
| | - Tony Chen
- Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York
| | - Suzanne A. Maher
- Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York,,Department of Biomechanics, Hospital for Special Surgery, 535 East 70th Street, New York 10021 New York
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20
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Stolz B, Grim C, Lutter C, Gelse K, Schell M, Swoboda B, Carl HD, Hotfiel T. Assessing Foot Loads in Continuous Passive Motion (CPM) and Active Knee Joint Motion Devices. SPORTVERLETZUNG-SPORTSCHADEN 2019; 35:18-23. [PMID: 30791084 DOI: 10.1055/a-0648-8699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Continuous passive motion (CPM) and active knee joint motion devices are commonly applied after various surgical procedures. Despite the growing use of active motion devices, there is a paucity of data comparing plantar loads between the different mobilization techniques. The aim of this study was to investigate foot loads during knee joint mobilization in continuous passive and active knee joint motion devices and to compare this data to the physiological load of full weight-bearing. PATIENTS/MATERIAL AND METHODS Fifteen healthy participants (7 women and 8 men, 25 ± 3 years, 66 ± 6 kg, 175 ± 10 cm, BMI 21.9 ± 2) were recruited. Plantar loads were measured via dynamic pedobarography using a continuous passive motion device (ARTROMOT-K1, ORMED GmbH, Freiburg, Germany) and an active motion device (CAMOped, OPED AG, Cham, Switzerland), each with a restricted range of motion of 0-0-90° (ex/flex) and free ROM for the knee joint. For the active motion device, cycles were performed at four different resistance levels (0-III). Data were assessed using the pedar® X system (Novel Inc., Munich, Germany), which monitors loads from the foot-sole interface. Force values were compared between motion devices and normal gait, which served as the reference for conditions of full weight-bearing. P-values of < 0.05 were considered statistically significant. RESULTS Normal gait revealed peak forces of 694 ± 96 N, defined as 100 %. The CPM device produced plantar forces of less than 1.5 N. Using the active motion device in the setting of 0-0-90° produced foot loads of < 1.5 N (resistance 0-II) and 3.4 ± 9.3 N with a resistance of III (p < 0.001). Conditions of free ROM resulted in foot loads of 4.5 ± 4.5 N (resistance 0), 7.7 ± 10.7 N (resistance I), 6.7 ± 10.4 (resistance II) and 6.7 ± 6.9 N with a resistance of III (p < 0.001), corresponding to 0.6 %, 1.1 %, 1.0 % and 1.0 % of full weight-bearing, respectively. CONCLUSION Motion exercises of the knee joint can be performed both with passive and active devices in accordance with strict weight-bearing restrictions, which are often recommended by surgeons. Also, active motion devices can be used when the ankle joint or foot have to be offloaded. Further studies assessing intraarticular joint load conditions have to be performed to confirm the findings obtained in this study.
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Affiliation(s)
- Benedikt Stolz
- Division of Orthopaedic Rheumatology, Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Casper Grim
- Department of Trauma and Orthopaedic Surgery, Klinikum Osnabrück, Germany
| | - Christoph Lutter
- Department of Orthopedic and Trauma Surgery, Sportsorthopedics and Sportsmedicine, Klinikum Bamberg, Germany
| | - Kolja Gelse
- Department of Orthopedic Trauma Surgery, University Hospital Erlangen, Germany
| | - Monika Schell
- Division of Orthopaedic Rheumatology, Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Bernd Swoboda
- Division of Orthopaedic Rheumatology, Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Hans-Dieter Carl
- Department of Orthopaedic and Trauma Surgery, Martha-Maria Hospital, Nuremberg, Germany
| | - Thilo Hotfiel
- Division of Orthopaedic Rheumatology, Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
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21
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Kato Y, Yamada S, Hattori S, Takazawa S, Ohuchi H. Combined autologous chondrocyte implantation and meniscus reconstruction for large chondral defect in the lateral compartment due to discoid lateral meniscus tear: A case report. Regen Ther 2018; 10:64-68. [PMID: 30581898 PMCID: PMC6299147 DOI: 10.1016/j.reth.2018.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/13/2018] [Accepted: 11/16/2018] [Indexed: 01/03/2023] Open
Abstract
Discoid lateral meniscus tear leads to large chondral defect in the lateral compartment of the knee joint. There are few effective treatments for large chondral defect in both the tibial and femoral sides with severe degenerative lateral meniscus. We have developed a combined autologous chondrocyte implantation and meniscus reconstruction technique using hamstring tendon. This technique allows biological reconstruction and avoids knee arthroplasty. Discoid lateral meniscus tear leads to large chondral defect. A combination of autologous chondrocyte implantation and meniscus reconstruction technique using hamstring tendon is introduced. This novel method allows biological reconstruction.
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Affiliation(s)
- Yuki Kato
- Department of Sports Medicine, Kameda Medical Center, Chiba, Japan
| | - Shin Yamada
- Department of Sports Medicine, Kameda Medical Center, Chiba, Japan
| | - Soichi Hattori
- Department of Sports Medicine, Kameda Medical Center, Chiba, Japan
| | - Shuzo Takazawa
- Department of Sports Medicine, Kameda Medical Center, Chiba, Japan
| | - Hiroshi Ohuchi
- Department of Sports Medicine, Kameda Medical Center, Chiba, Japan
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22
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Abstract
BACKGROUND Cartilage defects around the knee joint frequently occur in the region of the medial femoral condyle and the retropatellar cartilage surface. The distinction between local cartilage defects and large area degenerative cartilage lesions is very important for both prognosis and surgical therapy. The size and position of the lesion, the underlying pathomechanism and the age of the patient are very important factors which should be considered in the therapy algorithm for optimal cartilage defect restoration. Important cofactors such as stability, long leg axis and muscle balance should be taken into account. AIM Current procedures for cartilage repair of the knee joint and their results are summarized in this article. In addition, the necessity of precise and comprehensive preoperative clinical and radiological diagnostics is displayed to be able to treat co-pathologies in order to enable a successful repair of the cartilage defect. RESULTS AND CONCLUSIONS Preoperative planning of cartilage-repair techniques usually includes x‑ray images and a magnetic resonance imaging (MRI) examination. If MRI is not available, an arthro-computed tomography could be an alternative. Modern and routinely used procedures for cartilage repair at the knee joint are microfracture, autologous matrix-induced chondrogenesis, autologous chondrocyte transplantation, matrix-induced autologous chondrocyte implantation and osteochondral transplantation. Successful surgical cartilage-repair surgeries require a correct and individualized indication, addressing of copathologies and a standardized rehabilitation that is adapted to the surgical procedure. Evidence-based criteria for an exact time point for the return to sports according to individually operative cartilage repair techniques currently do not exist.
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23
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Zevenbergen L, Smith CR, Van Rossom S, Thelen DG, Famaey N, Vander Sloten J, Jonkers I. Cartilage defect location and stiffness predispose the tibiofemoral joint to aberrant loading conditions during stance phase of gait. PLoS One 2018; 13:e0205842. [PMID: 30325946 PMCID: PMC6191138 DOI: 10.1371/journal.pone.0205842] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 10/02/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The current study quantified the influence of cartilage defect location on the tibiofemoral load distribution during gait. Furthermore, changes in local mechanical stiffness representative for matrix damage or bone ingrowth were investigated. This may provide insights in the mechanical factors contributing to cartilage degeneration in the presence of an articular cartilage defect. METHODS The load distribution following cartilage defects was calculated using a musculoskeletal model that included tibiofemoral and patellofemoral joints with 6 degrees-of-freedom. Circular cartilage defects of 100 mm2 were created at different locations in the tibiofemoral contact geometry. By assigning different mechanical properties to these defect locations, softening and hardening of the tissue were evaluated. RESULTS Results indicate that cartilage defects located at the load-bearing area only affect the load distribution of the involved compartment. Cartilage defects in the central part of the tibia plateau and anterior-central part of the medial femoral condyle present the largest influence on load distribution. Softening at the defect location results in overloading, i.e., increased contact pressure and compressive strains, of the surrounding tissue. In contrast, inside the defect, the contact pressure decreases and the compressive strain increases. Hardening at the defect location presents the opposite results in load distribution compared to softening. Sensitivity analysis reveals that the surrounding contact pressure, contact force and compressive strain alter significantly when the elastic modulus is below 7 MPa or above 18 MPa. CONCLUSION Alterations in local mechanical behavior within the high load bearing area resulted in aberrant loading conditions, thereby potentially affecting the homeostatic balance not only at the defect but also at the tissue surrounding and opposing the defect. Especially, cartilage softening predisposes the tissue to loads that may contribute to accelerated risk of cartilage degeneration and the initiation or progression towards osteoarthritis of the whole compartment.
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Affiliation(s)
- Lianne Zevenbergen
- Department of Movement Sciences, Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium
| | - Colin R. Smith
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Sam Van Rossom
- Department of Movement Sciences, Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium
| | - Darryl G. Thelen
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States of America
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Nele Famaey
- Department of Mechanical Engineering, Biomechanics Section, KU Leuven, Leuven, Belgium
| | - Jos Vander Sloten
- Department of Mechanical Engineering, Biomechanics Section, KU Leuven, Leuven, Belgium
| | - Ilse Jonkers
- Department of Movement Sciences, Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium
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Lin Y, Li T, Xiong Y, Li J, Fu W. [Research progress of rehabilitation after autologous chondrocyte implantation on knee]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:758-763. [PMID: 29905057 PMCID: PMC8414014 DOI: 10.7507/1002-1892.201801034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/30/2018] [Indexed: 02/05/2023]
Abstract
Objective To summarize the research progress of rehabilitation after autologous chondrocyte implantation (ACI). Methods The literature related to basic science and clinical practice about rehabilitation after ACI in recent years was searched, selected, and analyzed. Results Based on the included literature, the progress of the graft maturation consists of proliferation phase (0-6 weeks), transition phase (6-12 weeks), remodeling phase (12-26 weeks), and maturation phase (26 weeks-2 years). To achieve early protection, stimulate the maturation, and promote the graft-bone integrity, rehabilitation protocol ought to be based on the biomechanical properties at different phases. Weight-bearing program, range of motion (ROM), and options or facilities of exercise are importance when considering a rehabilitation program. Conclusion It has been proved that the patients need a program with an increasingly progressive weight-bearing and ROM in principles of rehabilitation after ACI. Specific facilities can be taken at a certain phase. Evidences extracted in the present work are rather low and the high-quality and controlled trials still need to improve the rehabilitation protocol.
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Affiliation(s)
- Yipeng Lin
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Tao Li
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Yan Xiong
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Jian Li
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Weili Fu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
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Mid-term outcome of arthroscopic AMIC for the treatment of articular cartilage defects in the knee joint is equivalent to mini-open procedures. Arch Orthop Trauma Surg 2018; 138:819-825. [PMID: 29356942 DOI: 10.1007/s00402-018-2887-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Indexed: 01/08/2023]
Abstract
INTRODUCTION We present the first retrospective study that compares two various autologous matrix-induced chondrogenesis (AMIC) surgical interventions to repair grade III-IV cartilage defects in the knee. Patients who underwent minimally invasive (arthroscopy) or open (mini-arthrotomy) AMIC were followed up to 2 years to investigate if minimally invasive AMIC is superior to open procedures. MATERIALS AND METHODS Overall n = 50 patients with focal and contained grade III-IV articular cartilage defects in the knee joint were followed in a consecutive cohort study. 20 patients were treated arthroscopically (female 7, male 13; age: mean 38.2 years, range 18-70 years; BMI: mean 27.0, range 18.7-34.7; defect size: mean 3.1 cm2, range 1.0-6.0 cm2), and 30 patients via mini-arthrotomy (female 13, male 17; age: mean 34.4 years, range 14-53 years, BMI: mean 23.9, range 18.4-28.7; defect size: mean 3.4 cm2, range 1.5-12.0 cm2). The primary defect localization was the medial femoral condyle. RESULTS AMIC led to a significant improvement of VAS pain, KOOS and Lysholm scoring for up to 2 years compared to pre-op. Outcome analysis revealed no significant differences between the two different surgical approaches. CONCLUSIONS Our results suggest that mini-open AMIC is equivalent to the arthroscopic procedure. The anticipatory hypothesis that minimally invasive approaches bring greater patient benefit per se could not be confirmed. Therefore, we recommend to perform AMIC where indicated and suggest that the surgeon's personal skills profile guide the choice of surgical approach. LEVEL OF EVIDENCE III.
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Kraeutler MJ, Belk JW, Carver TJ, McCarty EC. Is Delayed Weightbearing After Matrix-Associated Autologous Chondrocyte Implantation in the Knee Associated With Better Outcomes? A Systematic Review of Randomized Controlled Trials. Orthop J Sports Med 2018; 6:2325967118770986. [PMID: 29770344 PMCID: PMC5946627 DOI: 10.1177/2325967118770986] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: Proper rehabilitation after matrix-associated autologous chondrocyte implantation (MACI) is essential to restore a patient’s normal function without overloading the repair site. Purpose: To evaluate the current literature to assess clinical outcomes of MACI in the knee based on postoperative rehabilitation protocols, namely, the time to return to full weightbearing (WB). Study Design: Systematic review; Level of evidence, 1. Methods: A systematic review was performed to locate studies of level 1 evidence comparing the outcomes of patients who underwent MACI with a 6-week, 8-week, or 10/11-week time period to return to full WB. Patient-reported outcomes assessed included the Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner activity scale, Short Form Health Survey–36 (SF-36), and visual analog scale (VAS) for pain frequency and severity. Results: Seven studies met the inclusion criteria, including a total of 136 patients (138 lesions) who underwent MACI. Treatment failure had occurred in 0.0% of patients in the 6-week group, 7.5% in the 8-week group, and 8.3% in the 10/11-week group at a mean follow-up of 2.5 years (P = .46). KOOS, SF-36, and VAS scores in each group improved significantly from preoperatively to follow-up (P < .001). Conclusion: Patients undergoing MACI in the knee can be expected to experience improvement in clinical outcomes with the rehabilitation protocols outlined in this work. No significant differences were seen in failure rates based on the time to return to full WB.
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Affiliation(s)
- Matthew J Kraeutler
- Department of Orthopaedic Surgery, Seton Hall-Hackensack Meridian School of Medicine, South Orange, New Jersey, USA
| | - John W Belk
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Trevor J Carver
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Eric C McCarty
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
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Aae TF, Randsborg PH, Lurås H, Årøen A, Lian ØB. Microfracture is more cost-effective than autologous chondrocyte implantation: a review of level 1 and level 2 studies with 5 year follow-up. Knee Surg Sports Traumatol Arthrosc 2018; 26:1044-1052. [PMID: 29128878 PMCID: PMC5876257 DOI: 10.1007/s00167-017-4802-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 11/08/2017] [Indexed: 02/08/2023]
Abstract
PURPOSE Focal cartilage defects in the knee may have devastating effect on the knee joint, where two of the main surgical treatment options are microfracture and autologous chondrocyte implantation. Comparative studies have failed to establish which method yields the best clinical results. A cost-effectiveness analysis of microfracture and autologous chondrocyte implantation would contribute to the clinical decision process. METHODS A PubMed search identifying level I and level II studies with 5 year follow-up was performed. With the data from these studies, decision trees with associated service provision and costs connected to the two different techniques were designed. In addition to hospital costs, we included costs connected to physiotherapy following surgery. To paint a broader cost picture, we also included indirect costs to the society due to productivity loss caused by work absence. RESULTS Four high-quality studies, with a follow-up of 5 years, met the inclusion criteria. A total of 319 patients were included, 170 undergoing microfracture and 149 autologous chondrocyte implantation. The re-operation rate was 23 (13.5%) following microfracture, and 18 (12.1%) for autologous chondrocyte implantation. Both groups achieved substantially better clinical scores at 5 years compared to baseline. Microfracture was more cost-effective when comparing all clinical scores. CONCLUSION Microfracture is associated with both lower costs and lower cost per point increase in patient reported outcome measures. There is a need of well-designed, high-quality randomized controlled trials before reliable conclusions regarding cost-effectiveness in the long run is possible. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Tommy Frøseth Aae
- Department of Orthopedic Surgery, Kristiansund Hospital, 6518 Kristiansund, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Per-Henrik Randsborg
- Department of Orthopedic Surgery, Akershus University Hospital, 1478 Lørenskog, Norway
| | - Hilde Lurås
- Institute of Clinical Medicine, University of Oslo, Campus Ahus, 1478 Lørenskog, Norway
- Department of Health Services Research, Akershus University Hospital, 1478 Lørenskog, Norway
| | - Asbjørn Årøen
- Department of Orthopedic Surgery, Akershus University Hospital, 1478 Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Campus Ahus, 1478 Lørenskog, Norway
- Oslo Sports Trauma Research Center (OSTRC), Norwegian School of Sports Sciences, postboks 4014 Ullevål Stadion, 0806 Oslo, Norway
| | - Øystein Bjerkestrand Lian
- Department of Orthopedic Surgery, Kristiansund Hospital, 6518 Kristiansund, Norway
- Institute of Neuromedicine, Faculty of Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway
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Lu L, Liu B, Shang X, Zhang Y, Chen W, Liu S, Huang J, Wang A, Guo Q, Lu S. [Construction of tissue engineered cartilage based on acellular cartilage extracellular matrix oriented scaffold and chondrocytes]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:291-297. [PMID: 29806277 DOI: 10.7507/1002-1892.201710095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Objective To observe the feasibility of acellular cartilage extracellular matrix (ACECM) oriented scaffold combined with chondrocytes to construct tissue engineered cartilage. Methods Chondrocytes from the healthy articular cartilage tissue of pig were isolated, cultured, and passaged. The 3rd passage chondrocytes were labeled by PKH26. After MTT demonstrated that PKH26 had no influence on the biological activity of chondrocytes, labeled and unlabeled chondrocytes were seeded on ACECM oriented scaffold and cultivated. The adhesion, growth, and distribution were evaluated by gross observation, inverted microscope, and fluorescence microscope. Scanning electron microscope was used to observe the cellular morphology after cultivation for 3 days. Type Ⅱ collagen immunofluorescent staining was used to check the secretion of extracellular matrix. In addition, the complex of labeled chondrocytes and ACECM oriented scaffold (cell-scaffold complex) was transplanted into the subcutaneous tissue of nude mouse. After transplantation, general physical conditions of nude mouse were observed, and the growth of cell-scaffold complex was observed by molecular fluorescent living imaging system. After 4 weeks, the neotissue was harvested to analyze the properties of articular cartilage tissue by gross morphology and histological staining (Safranin O staining, toluidine blue staining, and typeⅡcollagen immunohistochemical staining). Results After chondrocytes that were mainly polygon and cobblestone like shape were seeded and cultured on ACECM oriented scaffold for 7 days, the neotissue was translucency and tenacious and cells grew along the oriented scaffold well by inverted microscope and fluorescence microscope. In the subcutaneous microenvironment, the cell-scaffold complex was cartilage-like tissue and abundant cartilage extracellular matrix (typeⅡcollagen) was observed by histological staining and typeⅡcollagen immunohistochemical staining. Conclusion ACECM oriented scaffold is benefit to the cell adhesion, proliferation, and oriented growth and successfully constructes the tissue engineered cartilage in nude mouse model, which demonstrates that the ACECM oriented scaffold is promise to be applied in cartilage tissue engineering.
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Affiliation(s)
- Liang Lu
- Department of Orthopedics, Anhui Provincial Hospital, Hefei Anhui, 230001, P.R.China
| | - Bin Liu
- Department of Orthopedics, Anhui Provincial Hospital, Hefei Anhui, 230001, P.R.China
| | - Xifu Shang
- Department of Orthopedics, Anhui Provincial Hospital, Hefei Anhui, 230001, P.R.China
| | - Yu Zhang
- Department of Orthopedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing Jiangsu, 210008, P.R.China;Orthopedics Research Institute, General Hospital of Chinese PLA, Beijing, 100853, P.R.China
| | - Weijian Chen
- Department of Orthopedics, Anhui Provincial Hospital, Hefei Anhui, 230001, P.R.China
| | - Shuyun Liu
- Orthopedics Research Institute, General Hospital of Chinese PLA, Beijing, 100853, P.R.China
| | - Jingxiang Huang
- Orthopedics Research Institute, General Hospital of Chinese PLA, Beijing, 100853, P.R.China
| | - Aiyuan Wang
- Orthopedics Research Institute, General Hospital of Chinese PLA, Beijing, 100853, P.R.China
| | - Quanyi Guo
- Orthopedics Research Institute, General Hospital of Chinese PLA, Beijing, 100853,
| | - Shibi Lu
- Orthopedics Research Institute, General Hospital of Chinese PLA, Beijing, 100853, P.R.China
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Knee Joint Loading in Healthy Adults During Functional Exercises: Implications for Rehabilitation Guidelines. J Orthop Sports Phys Ther 2018; 48:162-173. [PMID: 29308697 DOI: 10.2519/jospt.2018.7459] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Controlled laboratory study. Background The inclusion of specific exercises in rehabilitation after knee injury is currently expert based, as a thorough description of the knee contact forces during different exercises is lacking. Objective To quantify knee loading during frequently used activities such as squats, lunges, single-leg hops, walking stairs, standing up, and gait, and to grade knee joint loading during these activities. Methods Three-dimensional motion-analysis data of 15 healthy adults were acquired during 9 standardized activities used in rehabilitation. Experimental motion data were processed using musculoskeletal modeling to calculate contact and shear forces on the different knee compartments (tibiofemoral and patellofemoral). Using repeated-measures analyses of variance, contact and shear forces were compared between compartments and exercises, whereas muscle and average maximum femoral forces were compared only between exercises. Results With the exception of squats, all therapeutic exercises imposed higher forces to the tibiofemoral joint compared to gait. Likewise, patellofemoral forces were greater during all exercises when compared to gait. Greater compartmental contact forces were accompanied by greater compartmental shear forces. Furthermore, force distribution over the medial and lateral compartments varied between exercises. With increased knee flexion, more force was imposed on the posterior portion of the condyles. Conclusion These results suggest that with careful selection of exercises, forces on an injured zone of the joint can be reduced, as the force distribution differs strongly between exercises. Based on the results, a graded exercise program for progressive knee joint loading during rehabilitation can be conceptualized. J Orthop Sports Phys Ther 2018;48(3):162-173. Epub 6 Jan 2018. doi:10.2519/jospt.2018.7459.
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Krill M, Early N, Everhart JS, Flanigan DC. Autologous Chondrocyte Implantation (ACI) for Knee Cartilage Defects. JBJS Rev 2018; 6:e5. [DOI: 10.2106/jbjs.rvw.17.00078] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Ebert JR, Schneider A, Fallon M, Wood DJ, Janes GC. A Comparison of 2-Year Outcomes in Patients Undergoing Tibiofemoral or Patellofemoral Matrix-Induced Autologous Chondrocyte Implantation. Am J Sports Med 2017; 45:3243-3253. [PMID: 28910133 DOI: 10.1177/0363546517724761] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Matrix-induced autologous chondrocyte implantation (MACI) has demonstrated encouraging clinical results in the treatment of knee chondral defects. However, earlier studies suggested that chondrocyte implantation in the patellofemoral (PF) joint was less effective than in the tibiofemoral (TF) joint. PURPOSE To compare the radiological and clinical outcomes of those undergoing MACI to either the femoral condyles or PF joint. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 194 patients were included in this analysis, including 127 undergoing MACI to the medial (n = 94) and lateral (n = 33) femoral condyle, as well as 67 to the patella (n = 35) or trochlea (n = 32). All patients were evaluated clinically (Knee injury and Osteoarthritis Outcome Score [KOOS], visual analog scale, Short Form-36) before surgery and at 3, 12, and 24 months after surgery, while magnetic resonance imaging (MRI) was undertaken at 3, 12, and 24 months, with the MOCART (magnetic resonance observation of cartilage repair tissue) scoring system employed to evaluate the quality and quantity of repair tissue, as well as an MRI composite score. Patient satisfaction was evaluated. RESULTS No significant group differences ( P > .05) were seen in demographics, defect size, prior injury, or surgical history, while the majority of clinical scores were similar preoperatively. All clinical scores significantly improved over time ( P < .05), with a significant group effect observed for KOOS activities of daily living ( P = .008), quality of life ( P = .008), and sport ( P = .017), reflecting better postoperative scores in the TF group. While the PF group had significantly lower values at baseline for the KOOS activities of daily living and quality of life subscales, it actually displayed a similar net improvement over time compared with the TF group. At 24 months, 93.7% (n = 119) and 91.0% (n = 61) of patients were satisfied with the ability of MACI to relieve their knee pain, 74.0% (n = 94) and 65.7% (n = 44) with their ability to participate in sport, and 90.5% (n = 115) and 83.6% (n = 56) satisfied overall, in the TF and PF groups, respectively. MRI evaluation via the MOCART score revealed a significant time effect ( P < .05) for the MRI composite score and graft infill over the 24-month period. While subchondral lamina scored significantly better ( P = .002) in the TF group, subchondral bone scored significantly worse ( P < .001). At 24 months, the overall MRI composite score was classified as good/excellent in 98 TF patients (77%) and 54 PF patients (81%). CONCLUSION MACI in the PF joint with concurrent correction of PF maltracking if required leads to similar clinical and radiological outcomes compared with MACI on the femoral condyles.
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Affiliation(s)
- Jay R Ebert
- School of Human Sciences, University of Western Australia, Crawley, Perth, Western Australia, Australia
| | - Adrian Schneider
- Perth Orthopaedic and Sports Medicine Centre, West Perth, Western Australia, Australia
| | - Michael Fallon
- Perth Radiological Clinic, Subiaco, Perth, Western Australia, Australia
| | - David J Wood
- School of Surgery (Orthopaedics), University of Western Australia, Crawley, Perth, Western Australia, Australia
| | - Gregory C Janes
- Perth Orthopaedic and Sports Medicine Centre, West Perth, Western Australia, Australia
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Han L, Zhang ZW, Wang BH, Wen ZK. Construction and biocompatibility of a thin type I/II collagen composite scaffold. Cell Tissue Bank 2017; 19:47-59. [PMID: 28808811 DOI: 10.1007/s10561-017-9653-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 08/08/2017] [Indexed: 01/15/2023]
Abstract
Articular cartilage injury is a common type of damage observed in clinical practice. A matrix-induced autologous chondrocyte implant was developed to repair articular cartilage as an advancement on the autologous chondrocyte implant procedure. Here, we establish a thin double layer of collagen as a novel and effective bioscaffold for the regeneration of cartilaginous lesions. We created a collagen membrane with double layers using a cover slip, a cover slip, and the collagen was then freeze-dried under vacuum. Carbodiimide as a crosslinking agent was used to obtain a relatively stable collagen construction. The thickness of the knee joint cartilage from grown rabbits was measured from a frozen section. Both type I and type II collagens were characterized using Sodium dodecylsulfate/polyacrylamide gel electrophoresis (SDS-PAGE) and ultraviolet absorption peaks. The aperture size of the scaffold was observed using a scanning electron microscope (SEM). The degradation of the scaffolds in vitro was tested through digestion using collagenase solution. The mechanical capacity of the scaffolds was assessed under dynamic compression. The influence of the scaffold on chondrocyte proliferation was assessed using the methyl thiazolyl tetrazolium (MTT) colourimetric assay and scanning electron microscopy. The frozen sections of the rabbit femoral condyle showed that the thickness of the weight-bearing area of the articular cartilage was less than 1 mm. The results of the SDS-PAGE and ultraviolet absorption peaks of the collagens were in agreement with the standard photographs in the references. SEM showed that the aperture size of the cross-linked scaffold was 82.14 ± 15.70 μm. The in vitro degradation studies indicated that Carbodiimide cross-linking can effectively enhance the biostability of the scaffolds. The Carbodiimide cross-linking protocol resulted in a mean value for the samples that ranged from 8.72 to 15.95 MPa for the compressive strength. The results of the MTT demonstrated that the scaffold had promoted chondrocyte proliferation and SEM observations showed that the scaffold was a good adhesive and growth material for chondrocytes. Thin type I/II collagen composite scaffold can meet the demands of cartilage tissue engineering and have good biocompatibility.
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Affiliation(s)
- Long Han
- Orthopedics Department, Changzhou Second People's Hospital, Changzhou, 213000, Jiangsu Province, China.
| | - Zhong-Wen Zhang
- Orthopedics 4th Department, General Hospital of Chinese People's Armed Police Forces, Beijing, 100039, China
| | - Bo-He Wang
- Dermatological Department, Children's Hospital of Xuzhou, Xuzhou, 221006, Jiangsu Province, China
| | - Zhen-Kun Wen
- Graduate School, Shaanxi University of Chinese Medicine, Xianyang, 712000, Shaanxi Province, China
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Ebert JR, Fallon M, Wood DJ, Janes GC. A Prospective Clinical and Radiological Evaluation at 5 Years After Arthroscopic Matrix-Induced Autologous Chondrocyte Implantation. Am J Sports Med 2017; 45:59-69. [PMID: 27587741 DOI: 10.1177/0363546516663493] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND While midterm outcomes after matrix-induced autologous chondrocyte implantation (MACI) are encouraging, the procedure permits an arthroscopic approach that may reduce the morbidity of arthrotomy and permit accelerated rehabilitation. HYPOTHESIS A significant improvement in clinical and radiological outcomes after arthroscopic MACI will exist through to 5 years after surgery. STUDY DESIGN Case series; Level of evidence, 4. METHODS We prospectively evaluated the first 31 patients (15 male, 16 female) who underwent MACI via arthroscopic surgery to address symptomatic tibiofemoral chondral lesions. MACI was followed by a structured rehabilitation program in all patients. Clinical scores were administered preoperatively and at 3 and 6 months as well as 1, 2, and 5 years after surgery. These included the Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm knee scale (LKS), Tegner activity scale (TAS), visual analog scale for pain, Short Form-36 Health Survey (SF-36), active knee motion, and 6-minute walk test. Isokinetic dynamometry was used to assess peak knee extension and flexion strength and limb symmetry indices (LSIs) between the operated and nonoperated limbs. High-resolution magnetic resonance imaging (MRI) was performed at 3 months and at 1, 2, and 5 years postoperatively to evaluate graft repair as well as calculate the MRI composite score. RESULTS There was a significant improvement ( P < .05) in all KOOS subscale scores, LKS and TAS scores, the SF-36 physical component score, pain frequency and severity, active knee flexion and extension, and 6-minute walk distance. Isokinetic knee extension strength significantly improved, and all knee extension and flexion LSIs were above 90% (apart from peak knee extension strength at 1 year). At 5 years, 93% of patients were satisfied with MACI to relieve their pain, 90% were satisfied with improving their ability to undertake daily activities, and 80% were satisfied with the improvement in participating in sport. Graft infill ( P = .033) and the MRI composite score ( P = .028) significantly improved over time, with 90% of patients demonstrating good to excellent tissue infill at 5 years. There were 2 graft failures at 5 years after surgery. CONCLUSION The arthroscopically performed MACI technique demonstrated good clinical and radiological outcomes up to 5 years, with high levels of patient satisfaction.
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Affiliation(s)
- Jay R Ebert
- School of Sport Science, Exercise and Health, University of Western Australia, Crawley, Australia
| | | | - David J Wood
- School of Surgery (Orthopaedics), University of Western Australia, Crawley, Australia
| | - Gregory C Janes
- Perth Orthopaedic and Sports Medicine Centre, West Perth, Australia
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How do leg press exercises comply with limited weight bearing? Phys Ther Sport 2016; 22:1-5. [PMID: 27579800 DOI: 10.1016/j.ptsp.2016.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 04/27/2016] [Accepted: 05/02/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To investigate foot loadings in different leg press settings with respect to a possible graduation of weight bearing (WB). DESIGN Case series. SETTINGS Assessing plantar force values by means of dynamic pedobarography taken place in orthopaedic departments' rehab center. PARTICIPANTS 15 healthy students (9 men and 6 women, age 23 ± 2, weight 75 ± 6 kg) were recruited as participants from the medical faculty. MAIN OUTCOME MEASURES Peak force values from normal gait (referred to as 100%) and single and double leg presses (SLP, DLP) with resistances of 10 kg, 20 kg and 40 kg, obtained with pedobarographic insoles. RESULTS Performing DLP produced foot loadings (N) of 37 ± 15 with 10 kg, 91 ± 29 with 20 kg and 203 ± 27 with 40 kg, equal to 5%, 12% and 26% of full WB. SLP result in force values of 195 ± 32 with 10 kg, 308 ± 34 with 20 kg and 516 ± 45 with 40 kg, corresponding to 25%, 40% and 67% baseline. CONCLUSIONS Leg press exercises can be performed in accordance with a given limitation of foot loading. Above mentioned conditions allow a graduation from 5% to 67% of full WB.
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Niemeyer P, Albrecht D, Andereya S, Angele P, Ateschrang A, Aurich M, Baumann M, Bosch U, Erggelet C, Fickert S, Gebhard H, Gelse K, Günther D, Hoburg A, Kasten P, Kolombe T, Madry H, Marlovits S, Meenen NM, Müller PE, Nöth U, Petersen JP, Pietschmann M, Richter W, Rolauffs B, Rhunau K, Schewe B, Steinert A, Steinwachs MR, Welsch GH, Zinser W, Fritz J. Autologous chondrocyte implantation (ACI) for cartilage defects of the knee: A guideline by the working group "Clinical Tissue Regeneration" of the German Society of Orthopaedics and Trauma (DGOU). Knee 2016; 23:426-35. [PMID: 26947215 DOI: 10.1016/j.knee.2016.02.001] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/13/2016] [Accepted: 02/01/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Autologous chondrocyte implantation (ACI) is an established and well-accepted procedure for the treatment of localised full-thickness cartilage defects of the knee. METHODS The present review of the working group "Clinical Tissue Regeneration" of the German Society of Orthopaedics and Trauma (DGOU) describes the biology and function of healthy articular cartilage, the present state of knowledge concerning therapeutic consequences of primary cartilage lesions and the suitable indication for ACI. RESULTS Based on best available scientific evidence, an indication for ACI is given for symptomatic cartilage defects starting from defect sizes of more than three to four square centimetres; in the case of young and active sports patients at 2.5cm(2), while advanced degenerative joint disease needs to be considered as the most important contraindication. CONCLUSION The present review gives a concise overview on important scientific background and the results of clinical studies and discusses the advantages and disadvantages of ACI. LEVEL OF EVIDENCE Non-systematic Review.
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Affiliation(s)
- P Niemeyer
- Department Orthopädie und Traumatologie, Universitätsklinikum Freiburg, Germany.
| | - D Albrecht
- Klinik im Kronprinzenbau, Reutlingen, Germany
| | - S Andereya
- Orthopädie und Unfallchirurgie, Ortho AC, Aachen, Germany
| | - P Angele
- Abteilung für Unfallchirurgie, Universitätsklinikum Regensburg, Germany; Sportopaedicum, Straubing, Berlin, Regensburg, München, Germany
| | - A Ateschrang
- Berufsgenossenschaftliche Unfallklinik Tübingen, Germany
| | - M Aurich
- Kliniken Leipziger Land GmbH, Klinikum Borna, Germany
| | - M Baumann
- Kreiskliniken Esslingen, Klinik f. Unfallchirurgie - Orthopädische Chirurgie, Esslingen, Germany
| | - U Bosch
- Zentrum f. Orthopädische Chirurgie, Sporttraumatologie, INI Hannover, Germany
| | - C Erggelet
- Center of Biologie Joint Repair, Zürich, Switzerland
| | - S Fickert
- Sportopaedicum, Straubing, Berlin, Regensburg, München, Germany
| | - H Gebhard
- Abteilung für Unfallchirurgie, Universitätsklinikum Regensburg, Germany
| | - K Gelse
- Abteilung für Unfallchirurgie, Universitätsklinikum Erlangen, Germany
| | - D Günther
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover (MHH), Germany
| | - A Hoburg
- Universitätsmedizin Berlin-Charite, Klinik für Orthopädie, Unfall u. Wiederherstellungschirurgie, Germany
| | - P Kasten
- Orthopädisch Chirurgisches Centrum, Tübingen, Germany
| | - T Kolombe
- Unfallchirurgie/Orthopädie, DRK Krankenhaus Luckenwalde, Germany
| | - H Madry
- Zentrum für Experimentelle Orthopädie, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - S Marlovits
- Universitätsklinik für Unfallchirurgie, Medizinische Universität Wien und Austrian Cluster for Tissue Regeneration, Austria
| | - N M Meenen
- Sektion Pädiatrische Sportmedizin, Kinderorthopädie, Altonaer Kinderkrankenhaus Hamburg, Germany
| | - P E Müller
- Orthopädische Klinik, Ludwig-Maximiliams-Universität München, Germany
| | - U Nöth
- Evangelisches Waldkrankenhaus Spandau, Klinik f. Orthopädie und Unfallchirurgie, Berlin, Germany
| | - J P Petersen
- Zentrum f. operative Medizin, Klinik für Unfall-, Hand- u. Wiederherstellungschirurgie, Universitätsklinikum Hamburg-Eppendorf, Germany
| | - M Pietschmann
- Orthopädische Klinik, Ludwig-Maximiliams-Universität München, Germany
| | - W Richter
- Forschungszentrum für Experimentelle Orthopädie, Universitätsklinikum Heidelberg, Germany
| | - B Rolauffs
- Berufsgenossenschaftliche Unfallklinik Tübingen, Germany
| | | | - B Schewe
- Orthopädisch Chirurgisches Centrum, Tübingen, Germany
| | - A Steinert
- Orthopädische Klinik, König-Ludwig-Haus, Universität Würzburg, Germany
| | | | | | - W Zinser
- Klinik für Orthopädie und Unfallchirurgie, St. Vinzenz-Hospital Dinslaken, Germany
| | - J Fritz
- Orthopädisch Chirurgisches Centrum, Tübingen, Germany
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Abstract
Biomaterials have played an increasingly prominent role in the success of biomedical devices and in the development of tissue engineering, which seeks to unlock the regenerative potential innate to human tissues/organs in a state of deterioration and to restore or reestablish normal bodily function. Advances in our understanding of regenerative biomaterials and their roles in new tissue formation can potentially open a new frontier in the fast-growing field of regenerative medicine. Taking inspiration from the role and multi-component construction of native extracellular matrices (ECMs) for cell accommodation, the synthetic biomaterials produced today routinely incorporate biologically active components to define an artificial in vivo milieu with complex and dynamic interactions that foster and regulate stem cells, similar to the events occurring in a natural cellular microenvironment. The range and degree of biomaterial sophistication have also dramatically increased as more knowledge has accumulated through materials science, matrix biology and tissue engineering. However, achieving clinical translation and commercial success requires regenerative biomaterials to be not only efficacious and safe but also cost-effective and convenient for use and production. Utilizing biomaterials of human origin as building blocks for therapeutic purposes has provided a facilitated approach that closely mimics the critical aspects of natural tissue with regard to its physical and chemical properties for the orchestration of wound healing and tissue regeneration. In addition to directly using tissue transfers and transplants for repair, new applications of human-derived biomaterials are now focusing on the use of naturally occurring biomacromolecules, decellularized ECM scaffolds and autologous preparations rich in growth factors/non-expanded stem cells to either target acceleration/magnification of the body's own repair capacity or use nature's paradigms to create new tissues for restoration. In particular, there is increasing interest in separating ECMs into simplified functional domains and/or biopolymeric assemblies so that these components/constituents can be discretely exploited and manipulated for the production of bioscaffolds and new biomimetic biomaterials. Here, following an overview of tissue auto-/allo-transplantation, we discuss the recent trends and advances as well as the challenges and future directions in the evolution and application of human-derived biomaterials for reconstructive surgery and tissue engineering. In particular, we focus on an exploration of the structural, mechanical, biochemical and biological information present in native human tissue for bioengineering applications and to provide inspiration for the design of future biomaterials.
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Tian K, Zhong W, Zhang Y, Yin B, Zhang W, Liu H. Microfluidics‑based optimization of neuroleukin‑mediated regulation of articular chondrocyte proliferation. Mol Med Rep 2015; 13:67-74. [PMID: 26573126 PMCID: PMC4686044 DOI: 10.3892/mmr.2015.4540] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 09/14/2015] [Indexed: 12/21/2022] Open
Abstract
Due to the low proliferative and migratory capacities of chondrocytes, cartilage repair remains a challenging clinical problem. Current therapeutic strategies for cartilage repair result in unsatisfactory outcomes. Autologous chondrocyte implantation (ACI) is a cell based therapy that relies on the in vitro expansion of healthy chondrocytes from the patient, during which proliferation-promoting factors are frequently used. Neuroleukin (NLK) is a multifunctional protein that possesses growth factor functions, and its expression has been associated with cartilage development and bone regeneration, however its direct role in chondrocyte proliferation remains to be fully elucidated. In the current study, the role of NLK in chondrocyte proliferation in vitro in addition to its potential to act as an exogenous factor during ACI was investigated. Furthermore, the concentration of NLK for in vitro chondrocyte culture was optimized using a microfluidic device. An NLK concentration of 12.85 ng/ml was observed to provide optimal conditions for the promotion of chondrocyte proliferation. Additionally, NLK stimulation resulted in an increase in type II collagen synthesis by chondrocytes, which is a cartilaginous secretion marker and associated with the phenotype of chondrocytes. Together these data suggest that NLK is able to promote cell proliferation and type II collagen synthesis during in vitro chondrocyte propagation, and thus may serve as an exogenous factor for ACI.
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Affiliation(s)
- Kang Tian
- Department of Orthopaedics, First Affiliated Hospital, Institute of Cancer Stem Cell, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Weiliang Zhong
- Department of Orthopaedics, First Affiliated Hospital, Institute of Cancer Stem Cell, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Yingqiu Zhang
- Department of Orthopaedics, First Affiliated Hospital, Institute of Cancer Stem Cell, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Baosheng Yin
- Department of Orthopaedics, First Affiliated Hospital, Institute of Cancer Stem Cell, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Weiguo Zhang
- Department of Orthopaedics, First Affiliated Hospital, Institute of Cancer Stem Cell, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Han Liu
- Department of Orthopaedics, First Affiliated Hospital, Institute of Cancer Stem Cell, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
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Neuroleukin/Autocrine Motility Factor Receptor Pathway Promotes Proliferation of Articular Chondrocytes through Activation of AKT and Smad2/3. Sci Rep 2015; 5:15101. [PMID: 26459914 PMCID: PMC4602231 DOI: 10.1038/srep15101] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 09/15/2015] [Indexed: 12/12/2022] Open
Abstract
Cartilage defect is an intractable clinical problem. Therapeutic strategies for cartilage repair are far from optimal due to poor proliferation capacity of chondrocytes. Autologous chondrocyte implantation is a cell based therapy that uses in vitro amplified healthy chondrocytes from the patient. However, chondrocyte dedifferentiation during in vitro culture limits its application. Neuroleukin (NLK) is a multifunctional protein that stimulates cell growth and migration, together with its receptor autocrine motility factor receptor (AMFR, also called gp78). We investigated expression of NLK and AMFR/gp78 during cartilage development in vivo and in cultured articular chondrocytes in vitro, and found the pair associates with chondrocyte proliferation and differentiation. While applied to isolated articular chondrocytes, NLK promotes cell proliferation and secretion of type II collagen, a marker of proliferating chondrocytes. Further work demonstrates that NLK up regulates pAKT and pSmad2/3, but down regulates pSmad1/5. In animals, NLK treatment also promotes chondrocyte proliferation while inhibits terminal differentiation, leading to expanded proliferating zone but decreased prehypertrophic and hypertrophic zones in the growth plate region. NLK is therefore a candidate factor that can be applied in the treatment of cartilage defects.
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2014 JOSPT Awards focus on 2 contemporary topics: dry needling and knee articular cartilage defects. J Orthop Sports Phys Ther 2015; 45:151-2. [PMID: 25726696 DOI: 10.2519/jospt.2015.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Mechanostimulation changes the catabolic phenotype of human dedifferentiated osteoarthritic chondrocytes. Knee Surg Sports Traumatol Arthrosc 2015; 23:104-11. [PMID: 25377190 DOI: 10.1007/s00167-014-3412-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 10/27/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The treatment of cartilage defects with matrix-embedded autologous chondrocytes is a promising method to support the repair process and to foster reconstitution of full functionality of the joint. METHODS Human osteoarthritic chondrocytes were harvest from nine different patients (mean ± SD age 68 ± 8 years) who underwent total knee replacement. The chondrocytes were embedded after a precultivation phase into a collagen I hydrogel. Mid-term intermitted mechanostimulation on matrix-embedded dedifferentiated human osteoarthritic chondrocytes was performed by intermittently applying a cyclic sinusoid compression regime for 4 days (cycles of 1 h of sinusoidal stimulation (1 Hz) and 4 h of break; maximum compression 2.5%). Stimulated (Flex) and non-stimulated (No Flex) cell matrix constructs were analysed concerning the expression of genes involved in tissue metabolism, the content of sulphated glycosaminoglycans (sGAG) and the morphology of the chondrocytes. RESULTS Gene expression analysis showed a high significant increase in collagen type II expression (p < 0.001), a significant increase in aggrecan expression (p < 0.04) and a high significant decrease in MMP-13 expression (p < 0.001) under stimulation condition compared with unstimulated controls. No significant changes were found in the gene expression rate of MMP-3. This positive effect of the mechanostimulation was confirmed by the analyses of sGAG. Mechanically stimulated cell-matrix constructs had nearly tripled sGAG content than the non-stimulated control (p < 0.002). In addition, histological examination showed that morphology of chondrocytes was altered from a spindle-shaped to a chondrocyte-characteristic rounded phenotype. CONCLUSION Mid-term intermitted mechanical stimulation in vitro has the potential to improve the cell quality of cell matrix constructs prepared from dedifferentiated osteoarthritic chondrocytes. This observation may extend the inclusion criteria for matrix-assisted autologous chondrocyte implantation (MACI) and confirms the importance of moderate dynamic compression in clinical rehabilitation after MACI.
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Wondrasch B, Risberg MA, Zak L, Marlovits S, Aldrian S. Effect of accelerated weightbearing after matrix-associated autologous chondrocyte implantation on the femoral condyle: a prospective, randomized controlled study presenting MRI-based and clinical outcomes after 5 years. Am J Sports Med 2015; 43:146-53. [PMID: 25378208 DOI: 10.1177/0363546514554910] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Long-term effects of different weightbearing (WB) modalities after matrix-associated autologous chondrocyte implantation (MACI) on changes in knee articular cartilage and clinical outcomes are needed to establish more evidence-based recommendations for postoperative rehabilitation. HYPOTHESIS There will be no differences between accelerated WB compared with delayed WB regarding knee articular cartilage or patient self-reported knee function or activity level 5 years after MACI. Furthermore, significant correlations between magnetic resonance imaging (MRI)-based outcomes and patient-reported outcome measures 5 years postoperatively will exist. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS After MACI, 31 patients (23 male, 8 female) were randomly assigned to the accelerated WB group (AWB group) or to the delayed WB group (DWB group). With the exception of time and increase to full WB, both groups underwent the same rehabilitation program. The AWB group was allowed full WB after 6 weeks and the DWB group after 10 weeks. Assessments were performed 3 months, 2 years, and 5 years postoperatively, but this long-term follow-up study only included changes from 2 to 5 years postoperatively. The magnetic resonance observation of cartilage repair tissue (MOCART) score (primary outcome), the MRI-based variables of bone edema and effusion, the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Tegner scale were included. In addition, the association between MRI-based outcomes and the KOOS at 5 years postoperatively was investigated. RESULTS There was a significant decrease in the MOCART score and a significant increase in bone edema 2 and 5 years postoperatively but no significant group differences. The only significant correlation between the MRI-based variables and the KOOS was found for bone edema and the KOOS subscale of pain (r=-0.435, P<.05) at 5-year follow-up. CONCLUSION There were no significant differences in the MRI-based or clinical outcomes between the AWB group and DWB group 5 years after MACI. While the clinical outcomes remained stable, a decline of the MRI-based findings was observed between 2 and 5 years postoperatively. Furthermore, a significant association between bone edema and pain was found. No occurrence of unintended effects was observed.
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Affiliation(s)
- Barbara Wondrasch
- Norwegian Research Center for Active Rehabilitation, Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway Department of Health and Social Sciences, St Poelten University of Applied Sciences, St Poelten, Austria
| | - May-Arna Risberg
- Department of Health and Social Sciences, St Poelten University of Applied Sciences, St Poelten, Austria
| | - Lukas Zak
- Department of Traumatology, Medical University of Vienna, Vienna, Austria
| | - Stefan Marlovits
- Department of Traumatology, Medical University of Vienna, Vienna, Austria
| | - Silke Aldrian
- Department of Traumatology, Medical University of Vienna, Vienna, Austria
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Zhang Z, Zhong X, Ji H, Tang Z, Bai J, Yao M, Hou J, Zheng M, Wood DJ, Sun J, Zhou SF, Liu A. Matrix-induced autologous chondrocyte implantation for the treatment of chondral defects of the knees in Chinese patients. DRUG DESIGN DEVELOPMENT AND THERAPY 2014; 8:2439-48. [PMID: 25525334 PMCID: PMC4266264 DOI: 10.2147/dddt.s71356] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Articular cartilage injury is the most common type of damage seen in clinical orthopedic practice. The matrix-induced autologous chondrocyte implant (MACI) was developed to repair articular cartilage with an advance on the autologous chondrocyte implant procedure. This study aimed to evaluate whether MACI is a safe and efficacious cartilage repair treatment for patients with knee cartilage lesions. The primary outcomes were the Knee Injury and Osteoarthritis Outcome Score (KOOS) domains and magnetic resonance imaging (MRI) results, compared between baseline and postoperative months 3, 6, 12, and 24. A total of 15 patients (20 knees), with an average age of 33.9 years, had a mean defect size of 4.01 cm(2). By 6-month follow-up, KOOS results demonstrated significant improvements in symptoms and knee-related quality of life. MRI showed significant improvements in four individual graft scoring parameters at 24 months postoperatively. At 24 months, 90% of MACI grafts had filled completely and 10% had good-to-excellent filling of the chondral defect. Most (95%) of the MACI grafts were isointense and 5% were slightly hyperintense. Histologic evaluation at 15 and 24 months showed predominantly hyaline cartilage in newly generated tissue. There were no postoperative complications in any patients and no adverse events related to the MACI operation. This 2-year study has confirmed that MACI is safe and effective with the advantages of a simple technique and significant clinical improvements. Further functional and mechanistic studies with longer follow-up are needed to validate the efficacy and safety of MACI in patients with articular cartilage injuries.
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Affiliation(s)
- Zhongwen Zhang
- Department of Orthopedics, General Hospital of Chinese People's Armed Police Forces (CAPF), Beijing
| | - Xin Zhong
- Department of MRI Center, General Hospital of CAPF, Beijing, People's Republic of China
| | - Huiru Ji
- Department of Orthopedics, General Hospital of Chinese People's Armed Police Forces (CAPF), Beijing
| | - Zibin Tang
- Department of Orthopedics, General Hospital of Chinese People's Armed Police Forces (CAPF), Beijing
| | - Jianpeng Bai
- Department of Orthopedics, General Hospital of Chinese People's Armed Police Forces (CAPF), Beijing
| | - Minmin Yao
- Department of Orthopedics, General Hospital of Chinese People's Armed Police Forces (CAPF), Beijing
| | - Jianlei Hou
- Department of Orthopedics, General Hospital of Chinese People's Armed Police Forces (CAPF), Beijing
| | - Minghao Zheng
- Center for Orthopedic Research, School of Surgery and Pathology, University of Western Australia, Perth, Western Australia, Australia
| | - David J Wood
- Center for Orthopedic Research, School of Surgery and Pathology, University of Western Australia, Perth, Western Australia, Australia
| | - Jiazhi Sun
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, Tampa, FL, USA
| | - Shu-Feng Zhou
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, Tampa, FL, USA ; Guizhou Provincial Key Laboratory for Regenerative Medicine, Stem Cell and Tissue Engineering Research Center and Sino-US Joint Laboratory for Medical Sciences, Guiyang Medical University, Guiyang, Guizhou
| | - Aibing Liu
- Medical Research Center, General Hospital of Chinese People's Armed Police Forces (CAPF), Beijing, People's Republic of China
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Disc cell therapies: critical issues. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23 Suppl 3:S375-84. [PMID: 24509721 DOI: 10.1007/s00586-014-3177-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 12/02/2013] [Accepted: 01/08/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Disc cell therapies, in which cells are injected into the degenerate disc in order to regenerate the matrix and restore function, appear to be an attractive, minimally invasive method of treatment. Interest in this area has stimulated research into disc cell biology in particular. However, other important issues, some of which are discussed here, need to be considered if cell-based therapies are to be brought to the clinic. PURPOSE Firstly, a question which is barely addressed in the literature, is how to identify patients with 'degenerative disc disease' who would benefit from cell therapy. Pain not disc degeneration is the symptom which drives patients to the clinic. Even though there are associations between back pain and disc degeneration, many people with even severely degenerate discs, with herniated discs or with spinal stenosis, are pain-free. It is not possible using currently available techniques to identify whether disc repair or regeneration would remove symptoms or prevent symptoms from occurring in future. Moreover, the repair process in human discs is very slow (years) because of the low cell density which can be supported nutritionally even in healthy human discs. If repair is necessary for relief of symptoms, questions regarding quality of life and rehabilitation during this long process need consideration. Also, some serious technical issues remain. Finding appropriate cell sources and scaffolds have received most attention, but these are not the only issues determining the feasibility of the procedure. There are questions regarding the safety of implanting cells by injection through the annulus whether the nutrient supply to the disc is sufficient to support implanted cells and whether, if cells are able to survive, conditions in a degenerate human disc will allow them to repair the damaged tissue. CONCLUSIONS If cell therapy for treatment of disc-related disorders is to enter the clinic as a routine treatment, investigations must examine the questions related to patient selection and the feasibility of achieving the desired repair in an acceptable time frame. Few diagnostic tests that examine whether cell therapies are likely to succeed are available at present, but definite exclusion criteria would be evidence of major disc fissures, or disturbance of nutrient pathways as measured by post-contrast MRI.
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