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Riedl M, Rupp M, Walter N, Henssler L, Kerschbaum M, Popp D, Vadalà G, Alt V, Docheva D, Pfeifer CG. Practical Relevance of Institutional Guidelines in Translational Large Animal Studies of Cartilage Repair-A Multidisciplinary Survey. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121834. [PMID: 36557037 PMCID: PMC9786804 DOI: 10.3390/medicina58121834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
Background and Objective: Translational large animal models are inevitable to transfer cartilage repair methods into clinical practice. Guidelines for these trials have been published by guiding agencies (FDA, ASTM, EMEA) including recommendations for study descriptors and study outcomes. However, practical adherence to these recommendations is not achieved in all aspects. This study includes an assessment of the recommended aspects regarding practical relevance in large animal models for cartilage repair by professionals in the field. Materials and Methods: In an online based survey, 11 aspects regarding study design and 13 aspects regarding study outcome from previously published guidelines were evaluated (0-10 points, with 10 being most important) by study participants. Additionally, the survey contained questions related to professional experience (years), professional focus (preclinical, clinical, veterinarian, industry) and the preferred translational large animal model for cartilage repair. Results: The total number of survey participants was 37. Rated as most important for study design parameters was lesion size (9.54 pts., SD 0.80) followed by study duration (9.43 pts., SD 1.21); and method of scaffold fixation (9.08 pts., SD 1.30) as well as depth of the lesion (9.03 pts., SD 1.77). The most important aspects of study outcome were considered histology (9.41 pts., SD 0.86) and defect filling (8.97 pts., SD 1.21), while gene expression was judged as the least important (6.11 pts., SD 2.46) outcome. A total of 62.2% of all participants were researchers, 18.9% clinicians, 13.5% veterinarians and 5.4% industry employees. Conclusions: In translational research, recommendations published by guiding agencies receive broad theoretical consensus within the community, including both clinically and preclinically orientated scientists. However, implementation into practical research lacks in major aspects. Ongoing re-evaluation of the guidelines under involvement of all stakeholders and approaches to overcome financial and infrastructural limitations could support the acceptance of the guidance documents and contribute to standardization in the field.
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Affiliation(s)
- Moritz Riedl
- Department of Trauma Surgery, University Regensburg Medical Centre, 93053 Regensburg, Germany
- Laboratory of Experimental Trauma Surgery, University Regensburg Medical Centre, 93053 Regensburg, Germany
- Correspondence:
| | - Markus Rupp
- Department of Trauma Surgery, University Regensburg Medical Centre, 93053 Regensburg, Germany
| | - Nike Walter
- Department of Trauma Surgery, University Regensburg Medical Centre, 93053 Regensburg, Germany
| | - Leopold Henssler
- Department of Trauma Surgery, University Regensburg Medical Centre, 93053 Regensburg, Germany
| | - Maximilian Kerschbaum
- Department of Trauma Surgery, University Regensburg Medical Centre, 93053 Regensburg, Germany
| | - Daniel Popp
- Department of Trauma Surgery, University Regensburg Medical Centre, 93053 Regensburg, Germany
| | - Gianluca Vadalà
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico, University of Rome, 00128 Rome, Italy
| | - Volker Alt
- Department of Trauma Surgery, University Regensburg Medical Centre, 93053 Regensburg, Germany
- Laboratory of Experimental Trauma Surgery, University Regensburg Medical Centre, 93053 Regensburg, Germany
| | - Denitsa Docheva
- Department of Musculoskeletal Tissue Regeneration, Orthopaedic Hospital König-Ludwig-Haus, University of Wuerzburg, 97070 Wuerzburg, Germany
| | - Christian G. Pfeifer
- Department of Trauma Surgery, University Regensburg Medical Centre, 93053 Regensburg, Germany
- Laboratory of Experimental Trauma Surgery, University Regensburg Medical Centre, 93053 Regensburg, Germany
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Changoor A, Suderman RP, Alshaygy I, Fuhrmann A, Akens MK, Safir O, Grynpas MD, Kuzyk PRT. Irregular porous titanium enhances implant stability and bone ingrowth in an intra-articular ovine model. J Orthop Res 2022; 40:2294-2307. [PMID: 35146795 DOI: 10.1002/jor.25272] [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: 03/31/2021] [Revised: 12/02/2021] [Accepted: 01/16/2022] [Indexed: 02/04/2023]
Abstract
Two commercially available porous coatings, Gription and Porocoat, were compared for the first time in a challenging intra-articular, weight-bearing, ovine model. Gription has evolved from Porocoat and has higher porosity, coefficient of friction, and microtextured topography, which are expected to enhance bone ingrowth. Cylindrical implants were press-fit into the weight-bearing regions of ovine femoral condyles and bone ingrowth and fixation strength evaluated 4, 8, and 16 weeks postoperatively. Biomechanical push-out tests were performed on lateral femoral condyles (LFCs) to evaluate the strength of the bone-implant interface. Bone ingrowth was assessed in medial femoral condyles (MFCs) as well as implants retrieved from LFCs following biomechanical testing using backscattered electron microscopy and histology. By 16 weeks, Gription-coated implants exhibited higher force (2455 ± 1362 vs. 1002 ± 1466 N; p = 0.046) and stress (12.60 ± 6.99 vs. 5.14 ± 7.53 MPa; p = 0.046) at failure, and trended towards higher stiffness (11,510 ± 7645 vs. 5010 ± 8374 N/mm; p = 0.061) and modulus of elasticity (591 ± 392 vs. 256 ± 431 MPa; p = 0.061). A strong, positive correlation was detected between bone ingrowth in LFC implants and failure force (r = 0.93, p < 10-13 ). By 16 weeks, bone ingrowth in Gription-coated implants in MFCs was 10.50 ± 6.31% compared to 5.88 ± 2.77% in Porocoat (p = 0.095). Observations of the bone-implant interface, made following push-out testing, showed more bony material consistently adhered to Gription compared to Porocoat at all three time points. Gription provided superior fixation strength and bone ingrowth by 16 weeks.
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Affiliation(s)
- Adele Changoor
- Department of Surgery and Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Lunenfeld Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - R Peter Suderman
- Department of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Ibrahim Alshaygy
- Division of Orthopaedic Surgery, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ariel Fuhrmann
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Orthopedic Surgery, Barzilai Medical Centre, Ashkelon, Israel
| | - Margarete K Akens
- Department of Surgery and Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Oleg Safir
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Marc D Grynpas
- Lunenfeld Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada.,Department of Laboratory Medicine & Pathobiology and Department of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Paul R T Kuzyk
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Flynn C, Hurtig M, Lamoure E, Cummins E, Roati V, Lowerison M, Jeong SY, Oh W, Zur Linden A. Modeling and Staging of Osteoarthritis Progression Using Serial CT Imaging and Arthroscopy. Cartilage 2020; 11:338-347. [PMID: 30079757 PMCID: PMC7298601 DOI: 10.1177/1947603518789997] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The objective of this study was to describe in life methods by which osteoarthritis can be staged in order to time therapeutic interventions that are relevant to osteoarthritis (OA) clinical trials. METHODS Twenty-two sheep underwent arthroscopic meniscal destabilization to induce OA. Serial computed tomography (CT) imaging and arthroscopy were used to monitor osteoarthritis progression at 3-month intervals over 9 months. Eleven sheep received 1 intra-articular injection of hyaluronate 3 months after OA induction and another group of 11 received saline. A linear mixed model was used to define the trajectory of shape change in the medial joint compartment. Ordinal logistic regression was used to investigate the association between morphological changes and sclerosis. RESULTS Three months after meniscal destabilization there were early bipolar chondral lesions in the medial compartment of the knee, as well as osteophytes and bone remodeling. Superficial fissures and cartilage cracks progressed to discrete areas of cartilage thinning and fibrillation on the medial tibial plateau by 6 months that became cartilage erosions by nine months. A linear mixed effect model demonstrated significant change in medial compartment length and width with over time (P < 0.05) for both groups. A significant association between severity of sclerosis and medial compartment morphology was also observed. CONCLUSIONS The induction of osteoarthritic lesions with meniscal release model can be followed using noninvasive and minimally invasive procedures allowing for real-time decisions about redosing therapies, or other changes such as extending trial timelines without sacrificing animals to conduct assessments.
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Affiliation(s)
- Candace Flynn
- Department of Clinical Studies, Ontario
Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Mark Hurtig
- Department of Clinical Studies, Ontario
Veterinary College, University of Guelph, Guelph, Ontario, Canada,Mark Hurtig, Comparative Orthopaedic
Research, Department of Clinical Studies, Ontario Veterinary College, University
of Guelph, 50 McGilvray Street, Guelph, Ontario, N1G 2W1, Canada.
| | - Emma Lamoure
- Department of Clinical Studies, Ontario
Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Erin Cummins
- Department of Clinical Studies, Ontario
Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Valeria Roati
- Department of Clinical Studies, Ontario
Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Mark Lowerison
- Clinical Research Unit, University of
Calgary, Calgary, Alberta, Canada
| | | | - Wonil Oh
- MEDIPOST Co., Ltd., Seoul, Republic of
Korea
| | - Alex Zur Linden
- Department of Clinical Studies, Ontario
Veterinary College, University of Guelph, Guelph, Ontario, Canada
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Hagag U, Tawfiek MG, Brehm W. Systematic arthroscopic investigation of the bovine stifle joint. Vet J 2015; 206:338-48. [PMID: 26549490 DOI: 10.1016/j.tvjl.2015.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 08/29/2015] [Accepted: 09/06/2015] [Indexed: 11/17/2022]
Abstract
The objective of the present study was to establish a protocol for arthroscopic exploration of the bovine stifle joint using craniomedial, caudolateral and caudomedial approaches. An anatomic and arthroscopic study using 26 cadaveric limbs from 13 non-lame adult dairy cows was performed. The craniomedial approach was created between the middle and medial patellar ligaments to investigate the cranial pouches of the stifle joint. The inter-condylar eminence, the proximal aspect of the medial femoral trochlear ridge and the lateral aspect of the lateral femoral condyle were used as starting points for systematic examination of the medial femorotibial, the femoropatellar and the lateral femorotibial joints, respectively. The observed structures were: the suprapatellar pouch, articular surfaces of the patella, femoral trochlear ridges, cruciate ligaments, menisci, and the meniscotibial ligaments. The arthroscopic portal for the caudomedial femorotibial pouch was about 6-8 cm caudal to the medial collateral ligament. The proximal and distal caudolateral femorotibial pouches were explored 3 cm and 1.5 cm caudal to the ipsilateral collateral ligament, respectively. The observed structures were the caudal aspect of femoral condyles, menisci, caudal cruciate ligament, popliteal tendon and the meniscofemoral ligament. Restricted joint size and risk of common peroneal nerve damage were the major limitations for exploration of the caudal femorotibial compartments. The study described the arthroscopic portals and normal intra-articular anatomy of the bovine stifle joint but further investigations are warranted to validate these techniques in clinical cases.
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Affiliation(s)
- U Hagag
- Large Animal Clinic for Surgery, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany; Department of Surgery, Anesthesiology, and Radiology, Faculty of Veterinary Medicine, Beni-Suef University, Beni-Suef 62511, Egypt.
| | - M G Tawfiek
- Department of Anatomy and Embryology, Faculty of Veterinary Medicine, Beni-Suef University, Beni-Suef 62511, Egypt
| | - W Brehm
- Large Animal Clinic for Surgery, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany
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