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Yang H, Yang H, Wang Q, Ji H, Qian T, Qiao Y, Shi J, Cong M. Mesenchymal stem cells and their extracellular vesicles: new therapies for cartilage repair. Front Bioeng Biotechnol 2025; 13:1591400. [PMID: 40343207 PMCID: PMC12058886 DOI: 10.3389/fbioe.2025.1591400] [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: 03/11/2025] [Accepted: 04/08/2025] [Indexed: 05/11/2025] Open
Abstract
Cartilage is crucial for joints, and its damage can lead to pain and functional impairment, causing financial burden to patients. Due to its weak self-repair, cartilage injury control is a research focus. Cartilage injury naturally with age, but mechanical trauma, lifestyle factors and certain genetic abnormalities can increase the likelihood of symptomatic disease progression. Current treatments for cartilage injury include pharmacological and surgical interventions, but these lack the ability to stop the progression of disease and restore the regeneration of the cartilage. Biological therapies have been evaluated but show varying degrees of efficacy in cartilage regeneration long-term. The mesenchymal stem cell (MSC) therapy attracts attention as it is easily harvested and expanded. Once thought to repair via differentiation, MSCs are now known to secrete extracellular vesicles (EVs) paracrinely. These EVs, rich in bioactive molecules, enable cell communication, boost growth factor secretion, regulate the synthesis and degradation of extracellular matrix (ECM), and modulate inflammation, vital for cartilage repair. However, further research and clinical validation are still required for the application of MSC and MSC-EVs. This review highlights the current state of research on the use of MSC and MSC-EVs in the treatment of cartilage injury. It is hoped that the review in this paper will provide valuable references and inspiration for future researchers in therapeutic studies of cartilage repair.
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Affiliation(s)
- Hongwei Yang
- Department of Orthopedics, Affiliated Nantong Hospital 3 of Nantong University, Nantong, China
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education and Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China
| | - Haochen Yang
- School of Medicine, Nantong University, Nantong, China
| | - Qin Wang
- Department of Orthopedics, Affiliated Nantong Hospital 3 of Nantong University, Nantong, China
| | - Hanzhen Ji
- Department of Orthopedics, Affiliated Nantong Hospital 3 of Nantong University, Nantong, China
| | - Tianmei Qian
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education and Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China
- Engineering Research Center of Integration and Application of Digital Learning Technology, Ministry of Education, Beijing, China
| | - Yusen Qiao
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Junfeng Shi
- Department of Orthopedics, Affiliated Nantong Hospital 3 of Nantong University, Nantong, China
| | - Meng Cong
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education and Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China
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Milliron EM, Cavendish PA, Carey J, Barker T, Flanigan DC. Use of MACI (Autologous Cultured Chondrocytes on Porcine Collagen Membrane) in the United States: Expanded Experience over 5,000 Cases. Cartilage 2025:19476035251319404. [PMID: 40202752 PMCID: PMC11982059 DOI: 10.1177/19476035251319404] [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: 07/18/2024] [Revised: 02/18/2025] [Accepted: 01/25/2025] [Indexed: 04/10/2025] Open
Abstract
ObjectiveTo determine whether there are differences in MACI (matrix-induced autologous chondrocyte implantation) treatment in the United States, by comparing cartilage defects and patient characteristics between the initial 1,000 patients treated with the next 5,000MethodsFollowing initial analysis of the first 1,000 consecutive patients treated with MACI, data were collected and analyzed for the subsequent 5,000. Patients were identified by MACI lot number and surgery date. Adverse events were summarized with descriptive statistics. Group differences were assessed with t-tests and chi-square, with significance set at P < 0.05.ResultsFive thousand adults (5,198 knees) were implanted with MACI by 1,130 surgeons. Patient sex (male 49.2%) was evenly split, and the mean age was 33.6 years. Most patients had a single cartilage defect treated, and the mean defect size was 4.4 cm2. The patella was the most treated surface (38.4%), followed by the medial femoral condyle (25.7%). Most patients (85.5%) had concomitant surgical procedures at the time of cartilage biopsy procurement. There were statistically significant differences in the number of patella (P < 0.001), medial femoral condyle (P < 0.001), and "not specified" (P = 0.008) between groups. Mean defect size and mean total defect size were both larger (P < 0.001 and P = 0.009, respectively) in the subsequent 5,000 patients.ConclusionThe utilization of MACI has remained consistent. Patient demographics and concomitant surgical procedures between the first 1,000 MACI patients and subsequent 5,000 MACI patients were comparable. Patellofemoral defects were the most treated in both subsets, and an overall low rate of adverse events was observed.
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Affiliation(s)
- Eric M. Milliron
- Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | | | - James Carey
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Tyler Barker
- Wexner Medical Center, The Ohio State University, Columbus, OH, USA
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Milliron E, Beran MC, DiBartola AC. Editorial Commentary: Osteochondral Allograft of the Knee-Diffuse Edema at 6 Months on Magnetic Resonance Imaging Predicts Failure. Arthroscopy 2024; 40:2453-2454. [PMID: 38395271 DOI: 10.1016/j.arthro.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024]
Abstract
Cartilage defects alter natural function of articular cartilage and can predispose patients to further cartilage wear and eventual osteoarthritis. These injuries present a challenging problem with a multitude of treatment options and lack of consensus on when to employ each. Options include conservative measures (limited weightbearing and immobilization), debridement, microfracture, autologous chondrocyte implantation, and osteochondral autograft and allograft. Indications may be based on defect size, joint alignment, age, activity level, body mass index, and sex. One option, osteochondral allograft (OCA) transplantation, is typically reserved for large and severe defects or revision. With regard to OCA prognosis, older patients, revision cases, patellar defects, and bipolar lesions confer elevated risk of failure, whereas traumatic or idiopathic cases, unipolar lesions, and short duration of symptoms have reported higher levels of satisfaction. Following surgery, the patient with persistent symptoms can present a conundrum. Recent research shows that in such cases, diffuse edema at 6 months on magnetic resonance imaging often predicts ultimate failure, in which case arthroplasty may be required.
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Affiliation(s)
- Eric Milliron
- Ohio State University Wexner Medical Center (E.M.); Nationwide Children's Hospital (M.C.B.)
| | - Matthew C Beran
- Ohio State University Wexner Medical Center (E.M.); Nationwide Children's Hospital (M.C.B.)
| | - Alex C DiBartola
- Ohio State University Wexner Medical Center (E.M.); Nationwide Children's Hospital (M.C.B.)
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Tawy GF, Ojaghi R, McNicholas MJ. Body mass index and sex and their effect on patient-reported outcomes following cartilage repair: an insight from the International Cartilage Regeneration and Joint Preservation Society Patient Registry. JOURNAL OF CARTILAGE & JOINT PRESERVATION 2024; 4:100165. [DOI: 10.1016/j.jcjp.2024.100165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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Amirhekmat A, Brown WE, Salinas EY, Hu JC, Athanasiou KA, Wang D. Mechanical Evaluation of Commercially Available Fibrin Sealants for Cartilage Repair. Cartilage 2024; 15:147-155. [PMID: 36974340 PMCID: PMC11368899 DOI: 10.1177/19476035231163273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVE Fibrin sealants are routinely used for intra-articular surgical fixation of cartilage fragments and implants. However, the mechanical properties of fibrin sealants in the context of cartilage repair are unknown. The purpose of this study was to characterize the adhesive and frictional properties of fibrin sealants using an ex vivo model. DESIGN Native bovine cartilage-bone composites were assembled with a single application of Tisseel or Vistaseal. Composites were tested in tension and lap shear. In addition, the coefficient of friction (COF) was measured in a native cartilage annulus model alone and with minced cartilage. Finally, the effect of a double application of fibrin sealant was evaluated. RESULTS There were no significant differences in tensile modulus, ultimate tensile strength (UTS), shear modulus, or ultimate shear strength (USS) between the 2 fibrin sealants. Both fibrin sealants demonstrated a UTS and USS of <8 and <30 kPa, respectively. There were no differences in COF between the sealants when tested alone or with minced cartilage. A double application of fibrin sealant did not alter the mechanical properties compared with a single application of fibrin sealant. CONCLUSIONS Fibrin sealant adhesive properties are not affected by the sealant type studied or the number of applications in a bovine cartilage-bone model. Fibrin sealant tribological properties are not affected by sealant type or the addition of minced cartilage. The adhesive properties of Tisseel and Vistaseal were less than those desired for the in vivo fixation of cartilage repair implants. These findings motivate the development of an improved cartilage-specific adhesive for cartilage repair applications.
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Affiliation(s)
- Arya Amirhekmat
- School of Medicine, University of California, Irvine, Irvine, CA, USA
- Department of Orthopaedic Surgery, University of California, Irvine, Orange, CA, USA
| | - Wendy E. Brown
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
| | - Evelia Y. Salinas
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
| | - Jerry C. Hu
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
| | | | - Dean Wang
- School of Medicine, University of California, Irvine, Irvine, CA, USA
- Department of Orthopaedic Surgery, University of California, Irvine, Orange, CA, USA
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
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Desai B, Assid E, Jacobs G, Dasgupta A, Williams G, Choate WS, Montgomery S, Godshaw B, Suri M, Jones D. Viable cartilage allograft outperforms existing treatments for focal knee cartilage defects. Knee Surg Sports Traumatol Arthrosc 2024; 32:636-644. [PMID: 38391111 DOI: 10.1002/ksa.12074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/19/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE Viable cartilage allograft (VCA) is a cartilage tissue matrix that contains cryopreserved viable allogeneic cartilage fibres. This study aimed to assess safety and benefits in treating focal knee cartilage defects with VCA. We hypothesized that VCA is a safe single-stage procedure in isolated chondral defects. METHOD In vitro analysis, in vivo studies and a prospective case series were performed. VCA was evaluated in a goat cartilage repair model. Symptomatic International Cartilage Repair Society grade 3/4A lesions of the femoral condyle or patella were implanted with VCA. International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome (KOOS) subscales, Lysholm, Short Form-12, Visual Analog Scale and pain frequency levels were assessed. Radiographic and magnetic resonance imaging (MRI) was performed at regular intervals postoperatively. Data were analysed by statisticians to determine the power and significance of the results. RESULTS The goat study confirmed that VCA is effective for cartilage repair. Twenty patients were implanted; the mean age was 28.1 (16-56), the mean body mass index (BMI) was 27.9 ± 5.6 and the mean follow-up was 24.1 months (range = 12.0-36.0 months). Lesions were in either the femoral condyle (7) or patella (13). Lesion sizes ranged from 1.5 to 6.0 cm2 (mean = 4.58 cm2 ). Outcome scores improved from preoperative baseline (POB): IKDC (78.2), Lysholm (89.0), KOOS: Pain (95.8), Symptoms (86.3), ADL (87.8), Sports (85.0) and QOL (75.0). MRI imaging demonstrated excellent osteochondral allograft assimilation. Second-look arthroscopy (two patients) demonstrated complete fill and incorporation (Brittberg scores 11/12). Functional scores were maintained at 24 (M): IKDC (86.24 ± 17.2), Lysholm (87.23 ± 15.0), KOOS: Pain (91.72 ± 17.3), Symptoms (84.92 ± 16.1), ADLs (93.80 ± 16.1), Sports (84.45 ± 27.7), QOL (81.30 ± 20.8). CONCLUSION VCA is an off-the-shelf, single-stage, conformable allogeneic graft that treats chondral defects with no additional fixation. Preclinical and short-term prospective clinical studies show that VCA can safely treat chondral defects with potential advantages to existing options. LEVEL OF EVIDENCE Level IV study.
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Affiliation(s)
- Bhumit Desai
- Ochsner Medical Center, Department of Orthopaedic Surgery, New Orleans, Louisiana, USA
| | - Eric Assid
- Ochsner Medical Center, Department of Orthopaedic Surgery, New Orleans, Louisiana, USA
- Ochsner Sports Medicine Institute, University of Queensland, Ochsner Clinical School, New Orleans, Louisiana, USA
| | - Graylin Jacobs
- Ochsner Sports Medicine Institute, University of Queensland, Ochsner Clinical School, New Orleans, Louisiana, USA
| | - Anouska Dasgupta
- MTF (Musculoskeletal Transplant Foundation) Biologics, Edison, New Jersey, USA
| | - Gerard Williams
- Howard University Orthopaedic Hospital, Washington, District of Columbia, USA
| | - Walter Stephen Choate
- Ochsner Medical Center, Department of Orthopaedic Surgery, New Orleans, Louisiana, USA
- Ochsner Sports Medicine Institute, University of Queensland, Ochsner Clinical School, New Orleans, Louisiana, USA
| | - Scott Montgomery
- Ochsner Medical Center, Department of Orthopaedic Surgery, New Orleans, Louisiana, USA
- Ochsner Sports Medicine Institute, University of Queensland, Ochsner Clinical School, New Orleans, Louisiana, USA
| | - Brian Godshaw
- Ochsner Medical Center, Department of Orthopaedic Surgery, New Orleans, Louisiana, USA
- Ochsner Sports Medicine Institute, University of Queensland, Ochsner Clinical School, New Orleans, Louisiana, USA
| | - Misty Suri
- Ochsner Medical Center, Department of Orthopaedic Surgery, New Orleans, Louisiana, USA
- Ochsner Sports Medicine Institute, University of Queensland, Ochsner Clinical School, New Orleans, Louisiana, USA
| | - Deryk Jones
- Ochsner Medical Center, Department of Orthopaedic Surgery, New Orleans, Louisiana, USA
- Ochsner Sports Medicine Institute, University of Queensland, Ochsner Clinical School, New Orleans, Louisiana, USA
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Lei T, Tong Z, Zhai X, Zhao Y, Zhu H, Wang L, Wen Z, Song B. Chondroitin Sulfate Improves Mechanical Properties of Gelatin Hydrogel for Cartilage Regeneration in Rats. Adv Biol (Weinh) 2023; 7:e2300249. [PMID: 37635149 DOI: 10.1002/adbi.202300249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/08/2023] [Indexed: 08/29/2023]
Abstract
Cartilage injury is a common disease in daily life. Especially in aging populations, the incidence of osteoarthritis is increasing. However, due to the poor regeneration ability of cartilage, most cartilage injuries cannot be effectively repaired. Even cartilage tissue engineering still faces many problems such as complex composition and poor integration of scaffolds and host tissues. In this study, chondroitin sulfate, one of the main components of extracellular matrix (ECM), is chosen as the main natural component of the material, which can protect cartilage in a variety of ways. Moreover, the results show that the addition of chondroitin sulfate improves the mechanical properties of gelatin methacrylate (GelMA) hydrogel, making it able to effectively bear mechanical loads in vivo. Further, chondroitin sulfate is modified to obtain the oxidized chondroitin sulfate (OCS) containing aldehyde groups via sodium periodate. This special group improves the interface integration and adhesion ability of the hydrogel to host cartilage tissue through schiff base reactions. In summary, GelMA/OCS hydrogel is a promising candidate for cartilage regeneration with good biocompatibility, mechanical properties, tissue integration ability, and excellent cartilage repair ability.
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Affiliation(s)
- Tao Lei
- Department of Orthopaedic Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 32200, China
| | - Zhicheng Tong
- Department of Orthopaedic Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 32200, China
| | - Xinrang Zhai
- School of Chemistry and Chemical Engineering, Nanjing University of Science&Technology, Nanjing, 210094, China
| | - Yushuang Zhao
- School of Chemistry and Chemical Engineering, Nanjing University of Science&Technology, Nanjing, 210094, China
| | - Huangrong Zhu
- Department of Orthopaedic Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 32200, China
| | - Lu Wang
- Department of Pathology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 32200, China
| | - Zhengfa Wen
- Department of Orthopaedic Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 32200, China
| | - Binghua Song
- Department of Orthopaedic Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 32200, China
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Chahla J, Williams BT, Yanke AB, Farr J. The Large Focal Isolated Chondral Lesion. J Knee Surg 2023; 36:368-381. [PMID: 34507359 DOI: 10.1055/s-0041-1735278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Focal chondral defects (FCDs) of the knee can be a debilitating condition that can clinically translate into pain and dysfunction in young patients with high activity demands. Both the understanding of the etiology of FCDs and the surgical management of these chondral defects has exponentially grown in recent years. This is reflected by the number of surgical procedures performed for FCDs, which is now approximately 200,000 annually. This fact is also apparent in the wide variety of available surgical approaches to FCDs. Although simple arthroscopic debridement or microfracture are usually the first line of treatment for smaller lesions, chondral lesions that involve a larger area or depth require restorative procedures such as osteochondral allograft transplantation or other cell-based techniques. Given the prevalence of FCDs and the increased attention on treating these lesions, a comprehensive understanding of management from diagnosis to rehabilitation is imperative for the treating surgeon. This narrative review aims to describe current concepts in the treatment of large FCDs through providing an algorithmic approach to selecting interventions to address these lesions as well as the reported outcomes in the literature.
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Affiliation(s)
- Jorge Chahla
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Brady T Williams
- Department of Orthopedic Surgery, University of Colorado, Aurora, Colorado
| | - Adam B Yanke
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Jack Farr
- Knee Preservation and Cartilage Restoration Center, OrthoIndy, Indianapolis, Indiana
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Herman K, Gobbi A. Evidence-Based Approach to Orthobiologics for Osteoarthritis and Other Joint Disorders. Phys Med Rehabil Clin N Am 2023; 34:71-81. [DOI: 10.1016/j.pmr.2022.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Nanoengineered hydrogels as 3D biomimetic extracellular matrix with injectable and sustained delivery capability for cartilage regeneration. Bioact Mater 2023; 19:487-498. [PMID: 35600973 PMCID: PMC9092603 DOI: 10.1016/j.bioactmat.2022.03.032] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 12/11/2022] Open
Abstract
The regeneration of articular cartilage remains a great challenge due to the difficulty in effectively enhancing spontaneous healing. Recently, the combination of implanted stem cells, suitable biomaterials and bioactive molecules has attracted attention for tissue regeneration. In this study, a novel injectable nanocomposite was rationally designed as a sustained release platform for enhanced cartilage regeneration through integration of a chitosan-based hydrogel, articular cartilage stem cells (ACSCs) and mesoporous SiO2 nanoparticles loaded with anhydroicaritin (AHI). The biocompatible engineered nanocomposite acting as a novel 3D biomimetic extracellular matrix exhibited a remarkable sustained release effect due to the synergistic regulation of the organic hydrogel framework and mesopore channels of inorganic mSiO2 nanoparticles (mSiO2 NPs). Histological assessment and biomechanical tests showed that the nanocomposites exhibited superior performance in inducing ACSCs proliferation and differentiation in vitro and promoting extracellular matrix (ECM) production and cartilage regeneration in vivo. Such a novel multifunctional biocompatible platform was demonstrated to significantly enhance cartilage regeneration based on the sustained release of AHI, an efficient bioactive natural small molecule for ACSCs chondrogenesis, within the hybrid matrix of hydrogel and mSiO2 NPs. Hence, the injectable nanocomposite holds great promise for use as a 3D biomimetic extracellular matrix for tissue regeneration in clinical diagnostics.
The anhydroicaritin (AHI) was identified as a bioactive factor for promoting cartilage repair. The hydrogel was designed to achieve sustained AHI release and optimize the microenvironment of cartilage defect sites. The hydrogel exhibited superior advantages for chondrogenic differentiation and cartilage regeneration. The hydrogel holds a great promise for use as functional scaffold for tissue and organ regeneration in the future.
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Sun D, Liu X, Xu L, Meng Y, Kang H, Li Z. Advances in the Treatment of Partial-Thickness Cartilage Defect. Int J Nanomedicine 2022; 17:6275-6287. [PMID: 36536940 PMCID: PMC9758915 DOI: 10.2147/ijn.s382737] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/23/2022] [Indexed: 04/17/2024] Open
Abstract
Partial-thickness cartilage defects (PTCDs) of the articular surface is the most common problem in cartilage degeneration, and also one of the main pathogenesis of osteoarthritis (OA). Due to the lack of a clear diagnosis, the symptoms are often more severe when full-thickness cartilage defect (FTCDs) is present. In contrast to FTCDs and osteochondral defects (OCDs), PTCDs does not injure the subchondral bone, there is no blood supply and bone marrow exudation, and the nearby microenvironment is unsuitable for stem cells adhesion, which completely loses the ability of self-repair. Some clinical studies have shown that partial-thickness cartilage defects is as harmful as full-thickness cartilage defects. Due to the poor effect of conservative treatment, the destructive surgical treatment is not suitable for the treatment of partial-thickness cartilage defects, and the current tissue engineering strategies are not effective, so it is urgent to develop novel strategies or treatment methods to repair PTCDs. In recent years, with the interdisciplinary development of bioscience, mechanics, material science and engineering, many discoveries have been made in the repair of PTCDs. This article reviews the current status and research progress in the treatment of PTCDs from the aspects of diagnosis and modeling of PTCDs, drug therapy, tissue transplantation repair technology and tissue engineering ("bottom-up").
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Affiliation(s)
- Daming Sun
- Wuhan Sports University, Wuhan, People’s Republic of China
- Department of Orthopedics, Wuhan Third Hospital, Tongren Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Xiangzhong Liu
- Department of Orthopedics, Wuhan Third Hospital, Tongren Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Liangliang Xu
- Wuhan Sports University, Wuhan, People’s Republic of China
| | - Yi Meng
- Wuhan Sports University, Wuhan, People’s Republic of China
| | - Haifei Kang
- Biomedical Materials and Engineering Research Center of Hubei Province, Wuhan University of Technology, Wuhan, People’s Republic of China
| | - Zhanghua Li
- Department of Orthopedics, Wuhan Third Hospital, Tongren Hospital of Wuhan University, Wuhan, People’s Republic of China
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The Biomimetics of Mg 2+-Concentration-Resolved Microenvironment for Bone and Cartilage Repairing Materials Design. Biomimetics (Basel) 2022; 7:biomimetics7040227. [PMID: 36546928 PMCID: PMC9775637 DOI: 10.3390/biomimetics7040227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/28/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
With the increase in population aging, the tendency of osteochondral injury will be accelerated, and repairing materials are increasingly needed for the optimization of the regenerative processes in bone and cartilage recovery. The local environment of the injury sites and the deficiency of Mg2+ retards the repairing period via inhibiting the progenitor osteogenesis and chondrogenesis cells’ recruitment, proliferation, and differentiation, which results in the sluggish progress in the osteochondral repairing materials design. In this article, we elucidate the Mg2+-concentration specified effect on the cell proliferation, osteochondral gene expression, and differentiation of modeling chondrocytes (extracted from New Zealand white rabbit) and osteoblasts (MC3T3-E1). The concentration of Mg2+ in the culture medium affects the proliferation, chondrogenesis, and osteogenesis: (i) Appropriate concentrations of Mg2+ promote the proliferation of chondrocytes (1.25−10.0 mM) and MC3T3-E1 cells (2.5−30.0 mM); (ii) the optimal concentration of Mg2+ that promotes the gene expression of noncalcified cartilage is 15 mM, calcified cartilage 10 mM, and subchondral bone 5 mM, respectively; (iii) overdosed Mg2+ leads to the inhibition of cell activity for either chondrocytes (>20 mM) or osteoblasts (>30 mM). The biomimetic elucidation for orchestrating the allocation of gradient concentration of Mg2+ in accordance of the physiological condition is crucial for designing the accurate microenvironment in osteochondral injury defects for optimization of bone and cartilage repairing materials in the future.
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Wodzig M, Peters M, Emanuel K, Van Hugten P, Wijnen W, Jutten L, Boymans T, Loeffen D, Emans P. Minced Autologous Chondral Fragments with Fibrin Glue as a Simple Promising One-Step Cartilage Repair Procedure: A Clinical and MRI Study at 12-Month Follow-Up. Cartilage 2022; 13:19-31. [PMID: 36305343 PMCID: PMC9924984 DOI: 10.1177/19476035221126343] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate early radiological and clinical outcome of autologous minced cartilage treatment as a single-step treatment option in patients with a chondral or osteochondral lesion (OCL) in the knee. DESIGN Eighteen patients with an OCL in the knee were included. Cartilage from healthy-appearing loose bodies and/or the periphery of the defect were minced into small chips and sealed in the defect using fibrin glue. Preoperatively, and at 3 (n = 14) and 12 (n = 18) months follow-up, magnetic resonance imaging (MRI) was performed. The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 score was used to assess the cartilage repair tissue on MRI at 12 months. The International Knee Documentation Score, Knee Injury and Osteoarthritis Outcome Score, EuroQoL-5D, and Visual Analogue Scale pain were collected preoperatively and 12 months after surgery. RESULTS Three months postoperative, MRI showed complete defect filling in 11 out of 14 patients. Mean MOCART 2.0 score at 12 months was 65.0 ± 18.9 with higher scores for lateral femoral chondral lesions compared to medial femoral chondral lesions (75.8 ± 14.3, 52.5 ± 15.8 respectively, P = 0.02). Clinical and statistical significant improvements were observed in the patient-reported outcome measures at 12 months postoperatively compared to preoperatively. CONCLUSION Treatment of OCLs using the autologous minced cartilage procedure resulted in good cartilage repair measured by MOCART 2.0. Clinically relevant improvements were observed in the clinical scores. This study suggests autologous minced cartilage as a promising, single-step treatment for OCLs.
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Affiliation(s)
- M.H.H. Wodzig
- Department of Orthopedic Surgery,
Joint-Preserving Clinic, Maastricht University Medical Center, Maastricht, The
Netherlands,M.H.H. Wodzig, Department of Orthopedic
Surgery, Joint-Preserving Clinic, Maastricht University Medical Center,
Maastricht 6229 HX, The Netherlands.
| | | | - K.S. Emanuel
- Department of Orthopedic Surgery,
Joint-Preserving Clinic, Maastricht University Medical Center, Maastricht, The
Netherlands,Department of Orthopedic Surgery,
Amsterdam UMC, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - P.P.W. Van Hugten
- Department of Orthopedic Surgery,
Joint-Preserving Clinic, Maastricht University Medical Center, Maastricht, The
Netherlands
| | - W. Wijnen
- Department of Orthopedic Surgery,
Joint-Preserving Clinic, Maastricht University Medical Center, Maastricht, The
Netherlands
| | - L.M. Jutten
- Department of Orthopedic Surgery,
Joint-Preserving Clinic, Maastricht University Medical Center, Maastricht, The
Netherlands
| | - T.A. Boymans
- Department of Orthopedic Surgery,
Joint-Preserving Clinic, Maastricht University Medical Center, Maastricht, The
Netherlands
| | - D.V. Loeffen
- Department of Radiology, Maastricht
University Medical Center, Maastricht, The Netherlands
| | - P.J. Emans
- Department of Orthopedic Surgery,
Joint-Preserving Clinic, Maastricht University Medical Center, Maastricht, The
Netherlands
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14
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Luo TD, Beck EC, Trammell AP, Koulopoulos MW, Edge CC, Marquez-Lara A, Al'Khafaji IM, Schallmo MS, Stubbs AJ. Hip Arthroscopic Microfracture Augmented With Platelet-Rich Plasma-Infused Micronized Cartilage Allograft Significantly Improves Functional Outcomes. Arthroscopy 2022; 38:2819-2826.e1. [PMID: 35247511 DOI: 10.1016/j.arthro.2022.02.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 02/18/2022] [Accepted: 02/20/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate functional outcomes and survivorship in patients at 1 year after undergoing arthroscopic microfracture augmented with hyaline allograft for symptomatic chondral defects of the hip. METHODS Consecutive patients with and without prior hip procedures presenting with Outerbridge grade IV chondral lesion of the acetabulum or femoral head were prospectively followed. Patients underwent hip microfracture augmented with hyaline allograft suspended in autologous platelet-rich plasma between October 2016 and April 2018. Extent of cartilage degeneration was quantified using the chondromalacia severity index (CMI). Patient functional scores, including Tegner, Hip Outcome Score-Activities of Daily Living (HOS-ADL), Sport-Specific Subscale (HOS-SSS), modified Harris Hip Score (mHHS), and Nonarthritic Hip Score (NAHS) were collected preoperatively and at minimum 1-year postoperatively. Minimal clinically important difference (MCID) was analyzed. Statistical significance was established at P < .05. Pearson's coefficient analysis was performed to identify preoperative variables correlated with clinical outcomes. RESULTS Fifty-seven patients (86.4%) had minimum 1-year follow-up and were included in the final analysis, with a mean age and body mass index (BMI) of 38.3 ± 9.1 years and 27.7 ± 4.9 kg/m2, respectively. Comparison of baseline and postoperative score averages demonstrated significant improvements in Tegner scores (3.7 ± 2.9 vs 5.1 ± 2.6; P = .003), HOS-ADL (63.3 ± 16.4 vs 89.1 ± 14.5; P < .001), HOS-SSS (40.8 ± 20.4 vs 79.5 ± 21.6; P < .001), mHHS (61.5 ± 16.2 vs 87.0 ± 17.7; P < .001), and NAHS (56.6 ± 14.9 vs 78.7 ± 18.3; P < .001). The percentage of patients who achieved MCID for HOS-ADL, HOS-SSS, mHHS, and NAHS were 89.8%, 83.0%, 75.6%, and 81.6%, respectively. Overall, 91.8% of patients met the threshold for achieving MCID in at least one outcome score. Of the 57 patients, 5 (8.8%) failed clinically, with 1 (1.8%) undergoing revision surgery and 4 (6.9%) undergoing conversion to total hip arthroplasty. There was a direct correlation between preoperative alpha angle and postoperative HOS-ADL. Femoral chondral lesion size and CMI inversely correlated with postoperative HOS-ADL. CONCLUSIONS Treatment of hip chondral defects with microfracture and hyaline allograft augmentation demonstrated excellent survivorship and significantly improved patient report outcomes at 1 year. LEVEL OF EVIDENCE IV, retrospective case series.
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Affiliation(s)
- T David Luo
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Edward C Beck
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Amy P Trammell
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Michael W Koulopoulos
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Carl C Edge
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Alejandro Marquez-Lara
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Ian M Al'Khafaji
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Michael S Schallmo
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Allston J Stubbs
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A.
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15
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Zhao G, Jiang H. Beneficial effects of Aucubin on restoration of rabbits with cartilage defect. Cell Tissue Bank 2022; 23:887-897. [PMID: 35384569 DOI: 10.1007/s10561-022-10004-w] [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: 01/24/2022] [Accepted: 03/17/2022] [Indexed: 11/02/2022]
Abstract
Osteochondral grafts are suitable materials for repair of articular cartilage defect and plastic and reconstructive surgery. In our study, osteochondral allografts from rabbits were preserved in vitro for 28 days, and chondrocyte death, degradation of collagen and proteoglycan, morphological alterations, and inflammatory reaction were observed in the grafts. Supplementing of Aucubin with 10 or 20 μM in the preservation solution inhibited chondrocyte death, matrix degradation, pathological alterations and inflammation in allografts preserved in vitro, compared with that preserved in standard preservation solution. In addition, after transplantation of 20 μM Aucubin-treated allografts, the osteochondral repair and regeneration of rabbits with knee joint defect were accelerated. In conclusion, Aucubin was beneficial for maintaining chondrocyte viability and normal morphology, and inhibiting inflammatory occurrence in rabbit osteochondral grafts preserved in vitro, and facilitated osteochondral repair and regeneration of rabbits with knee defect. These findings might provide novel insights for preservation of grafts for clinical articular cartilage repair and plastic surgery.
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Affiliation(s)
- Gaofeng Zhao
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33, Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Haiyue Jiang
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33, Badachu Road, Shijingshan District, Beijing, 100144, China.
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16
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Mestriner AB, Ackermann J, Merkely G, Galvão PHSAF, Ambra LFM, Gomoll AH. Etiology of Cartilage Lesions Does Not Affect Clinical Outcomes of Patellofemoral Autologous Chondrocyte Implantation. Cartilage 2021; 13:1298S-1305S. [PMID: 34286619 PMCID: PMC8808922 DOI: 10.1177/19476035211030991] [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] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the relationship between cartilage lesion etiology and clinical outcomes after second-generation autologous chondrocyte implantation (ACI) in the patellofemoral joint (PFJ) with a minimum of 2 years' follow-up. METHODS A retrospective review of all patients that underwent ACI in the PFJ by a single surgeon was performed. Seventy-two patients with a mean follow-up of 4.2 ± 2.0 years were enrolled in this study and were stratified into 3 groups based on the etiology of PFJ cartilage lesions: patellar dislocation (group 1; n = 23); nontraumatic lesions, including chondromalacia, osteochondritis dissecans, and degenerative defects (group 2; n = 28); and other posttraumatic lesions besides patellar dislocations (group 3; n = 21). Patient's mean age was 29.6 ± 8.7 years. Patients in group 1 were significantly younger (25.4 ± 7.9 years) than group 2 (31.7 ± 9.6 years; P = 0.025) and group 3 (31.5 ± 6.6 years; P = 0.05). Body mass index averaged 26.2 ± 4.3 kg/m2, with a significant difference between group 1 (24.4 ± 3.2 kg/m2) and group 3 (28.7 ± 4.5 kg/m2; P = 0.005). A clinical comparison was established between groups based on patient-reported outcome measures (PROMs) and failure rates. RESULTS Neither pre- nor postoperative PROMs differed between groups (P > 0.05). No difference was seen in survivorship between groups (95.7% vs. 82.2% vs. 90.5%, P > 0.05). CONCLUSION Cartilage lesion etiology did not influence clinical outcome in this retrospective study after second generation ACI in the PFJ. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Alexandre Barbieri Mestriner
- Universidade Federal de São
Paulo–Escola Paulista de Medicina, São Paulo, Brazil,Cartilage Repair Center, Brigham and
Women’s Hospital, Harvard Medical Center, Boston, MA, USA,Alexandre Barbieri Mestriner, 334 Jorge
Chammas Street, Apartment 18, Sao Paulo, SP, 04016-070, Brazil.
| | - Jakob Ackermann
- Sports Medicine Center, Massachusetts
General Hospital, Boston, MA, USA,Balgrist University Hospital, Zurich,
Switzerland
| | - Gergo Merkely
- Cartilage Repair Center, Brigham and
Women’s Hospital, Harvard Medical Center, Boston, MA, USA,Department of Traumatology, Semmelweis
University, Budapest, Hungary
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17
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Steinwachs MR, Gille J, Volz M, Anders S, Jakob R, De Girolamo L, Volpi P, Schiavone-Panni A, Scheffler S, Reiss E, Wittmann U. Systematic Review and Meta-Analysis of the Clinical Evidence on the Use of Autologous Matrix-Induced Chondrogenesis in the Knee. Cartilage 2021; 13:42S-56S. [PMID: 31508990 PMCID: PMC8808829 DOI: 10.1177/1947603519870846] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE A systematic review and meta-analysis of Autologous Matrix-Induced Chondrogenesis (AMIC®) outcomes for grade III/IV chondral and osteochondral lesions of the knee treated with Chondro-Gide®. DESIGN Studies with a minimum follow-up of 1 year providing clinical results of AMIC repair in the knee were included based on PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Methodological quality was assessed by the modified Coleman Methodology Score (mCMS). The meta-analysis was comparing pain VAS (Visual Analog Scale), Lysholm score, and IKDC score (International Knee Documentation Committee) between baseline and follow-up after 1 or 2 years and after >3 years. RESULTS Twelve studies (375 patients) were included. The mCMS demonstrated a suboptimal study design (ranking between 52 and 80). The mean age was 36.2 years (14-70 years). The mean defect size was 4.24 cm2 (0.8-22 cm2). The results from the random effects model indicated a clinically significant (P < 0.05) improvement of pain VAS from baseline to follow-up at year 1 to 2 of -4.02(confidence interval -4.37; -3.67), still significant after 3 years. Lysholm score at year 1 or 2 improved significantly and remained highly significant after 3 years. IKDC score showed highly significant improvement of 32.61 between 1 and 2 years versus baseline values maintained after 3 years. CONCLUSIONS The AMIC procedure significantly improved the clinical status and functional scoring versus preoperative values. Evidence was obtained in a non-selected patient population, corresponding to real-life treatment of knee chondral and osteochondral defects. The evidence is sufficient to recommend AMIC in this indication.
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Affiliation(s)
- Matthias R. Steinwachs
- SportClinic Zurich Hirslanden Clinic,
Zurich, Switzerland,M.R. Steinwachs, MD, SportClinic Zurich
Hirslanden Clinic, Witellikerstrasse, 40, Zurich, 8032, Switzerland.
| | - Justus Gille
- University of Schleswig-Holstein, Campus
Luebeck, Luebeck, Germany
| | | | | | | | | | | | | | | | | | - Udo Wittmann
- Consult AG Statistical Services,
Zurich, Switzerland
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18
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Yildiz E, Ersen A, Yener E, Comunoglu N, Sen C. The Effect of Intraarticular Insulin on Chondral Defect Repair. Cartilage 2021; 13:684S-691S. [PMID: 32613847 PMCID: PMC8804716 DOI: 10.1177/1947603520938462] [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] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The aim of this study is to evaluate the effects of intraarticular insulin on the treatment of chondral defects. DESIGN Twenty-four mature New Zealand rabbits were randomly divided into 3 groups as control (Group 1), microfracture (Group 2), and microfracture and insulin (Group 3). Four-millimeter full-thickness cartilage defects were created to the weight-bearing surface on the medial femoral condyles of each rabbit. In the first group, any additional interventions were not performed. Microfracture was performed on defects in groups 2 and 3. Additionally, 10 IU of insulin glargine was administrated into the knee joints of the third group. Three months after surgery, the knee joints were harvested and cartilage quality was assessed according to Wakitani and ICRS (International Cartilage Repair Society) scores histopathologically. Insulin injections were performed into the knees of 2 additional rabbits without creating a cartilage defect to evaluate the potential adverse effects of insulin on healthy cartilage (Group 4). RESULTS The total ICRS and Wakitani scores of the insulin group were found to be significantly lower than the microfracture group but similar to the control group. No negative effects of insulin on healthy cartilage were detected. Intraarticular insulin after surgery has led to a statistically significant decrease in systemic blood sugar levels whereas the decrease observed after administration to intact tissues was not statistically significant. CONCLUSIONS Insulin had a negative influence on the quality of cartilage regeneration and had no effect on healthy cartilage. Intraarticular insulin administration does not cause significant systemic effects in intact tissue.
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Affiliation(s)
- Eren Yildiz
- Department of Orthopaedics, Hatay State
Hospital, Antakya, Turkey
| | - Ali Ersen
- Department of Orthopaedics, School of
Medicine, Istanbul University, Istanbul, Turkey
| | - Emre Yener
- Department of Pathology, Mehmet Akif
Inan Training and Research Hospital, School of Medicine, University of Health
Sciences, Şanlıurfa, Turkey
| | - Nil Comunoglu
- Department of Pathology, School of
Medicine, Cerrahpasa University, Istanbul, Turkey
| | - Cengiz Sen
- Department of Orthopaedics, School of
Medicine, Istanbul University, Istanbul, Turkey
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19
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Everhart JS, Vajapey S, Kirven JC, Abouljoud MM, DiBartola AC, Wright B, Flanigan DC. Symptom Chronicity and Tobacco Use: Differences in Athletic and Nonathletic Candidates for Cartilage Surgery. Cartilage 2021; 12:448-455. [PMID: 31088145 PMCID: PMC8461163 DOI: 10.1177/1947603519847729] [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] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To determine whether there are differences in symptomatic knee cartilage defects and rates of tobacco use among age-matched athletes versus nonathletes undergoing initial arthroscopic knee surgery who meet demographic and radiographic criteria for cartilage restoration surgery. DESIGN Age-matched athletes (n = 186) and nonathletes (n = 159) age 40 or less with a body mass index (BMI) of 35 kg/m2 or less (mean 26.8 SD 4.1) and <50% joint space narrowing on weight-bearing radiographs were included. All patients had a symptomatic Outerbridge grade 2 or higher cartilage defect visualized during knee arthroscopy. Relationship between athletic status and chronicity of knee symptoms prior to surgery and tobacco use status, cartilage defect Outerbridge grade, size, and location at time of surgery were characterized. RESULTS Nonathletes were more likely to smoke (P < 0.001) and had higher BMI (P = 0.005). Duration of symptoms prior to surgery was shorter among athletes (P < 0.001). Grade 4 defects were equally prevalent (P = 0.96) as were multicompartment grade 3-4 lesions (P = 0.12). Mean grade 3-4 defect size was similar in lateral (P = 0.96) and medial compartments (P = 0.82). There was a trend toward larger anterior compartment defects in nonathletes (P = 0.07). CONCLUSIONS Among age-matched athletes and nonathletes with symptomatic cartilage defects who meet demographic criteria for cartilage restoration, nonathletes were more likely to smoke and have a longer duration of symptoms prior to treatment. Athletes tended to present earlier but with similar size defects compared to nonathletes, supporting accelerated treatment of defects in athletes and caution toward allowing continued athletic participation in patients with known cartilage defects.
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Affiliation(s)
- Joshua S. Everhart
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sravya Vajapey
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - James C. Kirven
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Moneer M. Abouljoud
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Alex C. DiBartola
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Brennan Wright
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - David C. Flanigan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA,David C. Flanigan, Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr, Columbus, OH 43202, USA.
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20
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Huddleston HP, Urita A, Cregar WM, Wolfson TM, Cole BJ, Inoue N, Yanke AB. Overlapping Allografts Provide Superior and More Reliable Surface Topography Matching Than Oblong Allografts: A Computer-Simulated Model Study. Am J Sports Med 2021; 49:1505-1511. [PMID: 33831318 DOI: 10.1177/03635465211003074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteochondral allograft transplantation is 1 treatment option for focal articular cartilage defects of the knee. Large irregular defects, which can be treated using an oblong allograft or multiple overlapping allografts, increase the procedure's technical complexity and may provide suboptimal cartilage and subchondral surface matching between donor grafts and recipient sites. PURPOSE To quantify and compare cartilage and subchondral surface topography mismatch and cartilage step-off for oblong and overlapping allografts using a 3-dimensional simulation model. STUDY DESIGN Controlled laboratory study. METHODS Human cadaveric medial femoral hemicondyles (n = 12) underwent computed tomography and were segmented into cartilage and bone components using 3-dimensional reconstruction and modeling software. Segments were then exported into point-cloud models. Modeled defect sizes of 17 × 30 mm were created on each recipient hemicondyle. There were 2 types of donor allografts from each condyle utilized: overlapping and oblong. Grafts were virtually harvested and implanted to optimally align with the defect to provide minimal cartilage surface topography mismatch. Least mean squares distances were used to measure cartilage and subchondral surface topography mismatch and cartilage step-off. RESULTS Cartilage and subchondral topography mismatch for the overlapping allograft group was 0.27 ± 0.02 mm and 0.80 ± 0.19 mm, respectively. In comparison, the oblong allograft group had significantly increased cartilage (0.62 ± 0.43 mm; P < .001) and subchondral (1.49 ± 1.10 mm; P < .001) mismatch. Cartilage step-off was also found to be significantly increased in the oblong group compared with the overlapping group (P < .001). In addition, overlapping allografts more reliably provided a significantly higher percentage of clinically acceptable (0.5- and 1-mm thresholds) cartilage surface topography matching (overlapping: 100% for both 0.5 and 1 mm; oblong: 90% for 1 mm and 56% for 0.5 mm; P < .001) and cartilage step-off (overlapping: 100% for both 0.5 and 1 mm; oblong: 86% for 1 mm and 12% for 0.5 mm; P < .001). CONCLUSION This computer simulation study demonstrated improved topography matching and decreased cartilage step-off with overlapping osteochondral allografts compared with oblong osteochondral allografts when using grafts from donors that were not matched to the recipient condyle by size or radius of curvature. These findings suggest that overlapping allografts may be superior in treating large, irregular osteochondral defects involving the femoral condyles with regard to technique. CLINICAL RELEVANCE This study suggests that overlapping allografts may provide superior articular cartilage surface topography matching compared with oblong allografts and do so in a more reliable fashion. Surgeons may consider overlapping allografts over oblong allografts because of the increased ease of topography matching during placement.
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Affiliation(s)
| | - Atsushi Urita
- Rush University Medical Center, Chicago, Illinois, USA
| | | | | | - Brian J Cole
- Rush University Medical Center, Chicago, Illinois, USA
| | - Nozomu Inoue
- Rush University Medical Center, Chicago, Illinois, USA
| | - Adam B Yanke
- Rush University Medical Center, Chicago, Illinois, USA
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21
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Ross JR, Clohisy JC, Bedi A, Zaltz I. Why Does Hip Arthroscopy Fail? Indications and PEARLS for Revision Success. Sports Med Arthrosc Rev 2021; 29:44-51. [PMID: 33395230 DOI: 10.1097/jsa.0000000000000300] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The surgical treatment of femoroacetabular impingement has been shown to have successful early and mid-term clinical outcomes. Despite these favorable clinical outcomes that have been published in the literature, there is a subgroup of patients that present with continued or recurrent symptoms after surgical treatment. Not only has there been an increase in the number of hip arthroscopy procedures, but also there has been a corresponding increase in the number of revision hip arthroscopy and hip preservation surgeries. Previous studies have reported residual deformity to be the most common reason for revision hip arthroscopy. However, chondral, labral, and capsular considerations also are important when addressing patients not only in the primary but also, the revision setting. In this review, we outline the evaluation and treatment of the patient that presents with continued hip and groin pain after undergoing a hip.
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Affiliation(s)
- James R Ross
- BocaCare Orthopedics-Boca Raton Regional Hospital, Florida Atlantic University College of Medicine, Boca Raton, FL
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | | | - Ira Zaltz
- Department of Pediatric Orthopaedics, William Beaumont Hospital, Royal Oak, MI
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22
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Totlis T, Marín Fermín T, Kalifis G, Terzidis I, Maffulli N, Papakostas E. Arthroscopic debridement for focal articular cartilage lesions of the knee: A systematic review. Surgeon 2021; 19:356-364. [PMID: 33423921 DOI: 10.1016/j.surge.2020.11.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/15/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE OF THE STUDY Arthroscopic debridement, the most commonly applied surgical technique for focal cartilage lesions in the knee, is not included in most treatment algorithms because of discouraging results in the management of osteoarthritis of the knee. The present systematic review evaluates the outcome of arthroscopic cartilage debridement as the primary treatment of focal knee chondral lesions in adults, and defines its indications and role as the primary treatment of focal knee chondral lesions. METHODS Two independent investigators searched PubMed, Cochrane CENTRAL, and Virtual Health Library databases using the terms "knee", "cartilage", "chondral", "lesions", "injury", "damage", "debridement", "chondroplasty", "chondrectomy", alone and in combination. Clinical studies evaluating the effect of mechanical cartilage debridement in adults with symptomatic focal cartilage lesions in the knee joint regardless of the defect size and depth were included. We excluded studies if patients had a concomitant ligament or meniscus injury, and/or had additional debridement with monopolar radiofrequency energy. MAIN FINDINGS Available studies suggest good to excellent short and medium-term functional outcomes (KOOS, LKSS, Tegner scale) for focal cartilage lesions treated with debridement regardless of the defect size and depth. Data are lacking comparing cartilage debridement versus other cartilage repair techniques. CONCLUSIONS Arthroscopic debridement of focal articular cartilage lesions of the knee is associated with good to excellent short and medium-term postoperative outcomes, especially in terms of functional improvement. Arthroscopic debridement may be considered in the primary treatment of focal cartilage injuries regardless of the defect size and depth. However, available studies are limited and the level of evidence is low.
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Affiliation(s)
- Trifon Totlis
- Thessaloniki Minimally Invasive Surgery (TheMIS) Orthopaedic Center, St. Luke's Hospital, 55236, Thessaloniki, Greece.
| | - Theodorakys Marín Fermín
- Thessaloniki Minimally Invasive Surgery (TheMIS) Orthopaedic Center, St. Luke's Hospital, 55236, Thessaloniki, Greece; Department of Traumatology, Hospital Periférico de Coche, Intercomunal avenue at Zea street, 1090, Coche, Caracas, Venezuela.
| | - Giorgos Kalifis
- Thessaloniki Minimally Invasive Surgery (TheMIS) Orthopaedic Center, St. Luke's Hospital, 55236, Thessaloniki, Greece; Department of Orthopaedic Surgery and Musculoskeletal Trauma, General University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece.
| | - Ioannis Terzidis
- Thessaloniki Minimally Invasive Surgery (TheMIS) Orthopaedic Center, St. Luke's Hospital, 55236, Thessaloniki, Greece.
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Via Salvator Allende, 84081, Salerno, Italy; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England, UK; Institute of Science and Technology in Medicine, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, England, UK.
| | - Emmanouil Papakostas
- Aspetar Orthopedic and Sports Medicine Hospital, Sports City Street, 29222, Doha, Qatar.
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23
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Schreiner AJ, Stoker AM, Bozynski CC, Kuroki K, Stannard JP, Cook JL. Clinical Application of the Basic Science of Articular Cartilage Pathology and Treatment. J Knee Surg 2020; 33:1056-1068. [PMID: 32583400 DOI: 10.1055/s-0040-1712944] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The joint is an organ with each tissue playing critical roles in health and disease. Intact articular cartilage is an exquisite tissue that withstands incredible biologic and biomechanical demands in allowing movement and function, which is why hyaline cartilage must be maintained within a very narrow range of biochemical composition and morphologic architecture to meet demands while maintaining health and integrity. Unfortunately, insult, injury, and/or aging can initiate a cascade of events that result in erosion, degradation, and loss of articular cartilage such that joint pain and dysfunction ensue. Importantly, articular cartilage pathology affects the health of the entire joint and therefore should not be considered or addressed in isolation. Treating articular cartilage lesions is challenging because left alone, the tissue is incapable of regeneration or highly functional and durable repair. Nonoperative treatments can alleviate symptoms associated with cartilage pathology but are not curative or lasting. Current surgical treatments range from stimulation of intrinsic repair to whole-surface and whole-joint restoration. Unfortunately, there is a relative paucity of prospective, randomized controlled, or well-designed cohort-based clinical trials with respect to cartilage repair and restoration surgeries, such that there is a gap in knowledge that must be addressed to determine optimal treatment strategies for this ubiquitous problem in orthopedic health care. This review article discusses the basic science rationale and principles that influence pathology, symptoms, treatment algorithms, and outcomes associated with articular cartilage defects in the knee.
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Affiliation(s)
- Anna J Schreiner
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,BG Center for Trauma and Reconstructive Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Aaron M Stoker
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Chantelle C Bozynski
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Keiichi Kuroki
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - James P Stannard
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - James L Cook
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
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Yamamoto A, Levine BD, Padron M, Chung CB. Is There a Role for Cartilage Imaging in Athletes? Semin Musculoskelet Radiol 2020; 24:246-255. [PMID: 32987423 DOI: 10.1055/s-0040-1708818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article reviews implications for cartilage imaging in athletes in the setting of (1) acute chondral injury diagnosis, (2) evaluation and follow-up of conservative and surgical therapy, and (3) evaluation of cartilage as a surrogate for meniscal function and joint stability. Focal knee cartilage defects are common in athletic populations. Athletes with articular cartilage injury may initially be able to return to sport with conservative therapy; however, a reduction of athletic ability and progression to osteoarthritis is expected in athletes with untreated severe chondral injury. For diagnostic and pre- and postsurgical evaluation purposes, morphological magnetic resonance (MR) assessment of the articular cartilage with high-resolution protocols is crucial. Although not widely implemented for clinical use, compositional MR techniques have great potential for monitoring the development and progression of biochemical and microstructural changes in cartilage extracellular matrix before gross morphological changes occur.
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Affiliation(s)
- Asako Yamamoto
- Department of Radiology, University of California, San Diego, California
| | - Benjamin D Levine
- Department of Radiology, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Mario Padron
- Department of Radiology, Clínica Cemtro, Madrid, Spain
| | - Christine B Chung
- Department of Radiology, VA San Diego Healthcare System and University of California, San Diego, La Jolla, California
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25
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Orth P, Gao L, Madry H. Microfracture for cartilage repair in the knee: a systematic review of the contemporary literature. Knee Surg Sports Traumatol Arthrosc 2020; 28:670-706. [PMID: 30659314 DOI: 10.1007/s00167-019-05359-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 01/11/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE To systematically review and evaluate novel clinical data following microfracture treatment of knee articular cartilage defects. METHODS A systematic review was performed by searching PubMed, ScienceDirect, and Cochrane Library databases for clinical trials on microfracture treatment, published between 2013 and 2018. Titles, abstracts, and articles were reviewed, and data concerning patient demographics, study design, pre-, intra-, and postoperative findings were extracted. PRISMA guidelines were applied. The methodological quality of the included studies was analyzed by the modified Coleman Methodology Score (CMS), and aggregate data were generated. RESULTS Eighteen studies including 1830 defects (1759 patients) were included. Of them, 8 (59% of patients) were cohort studies without a comparison group. Overall study quality was moderate (mean total CMS: 64 points), mainly due to low patient numbers, short follow-up periods, lack of control groups and structural repair tissue evaluation, and inhomogeneity in outcome parameters. Microfracture treatment of full-thickness articular cartilage defects (3.4 ± 2.1 cm2) was performed at 43.4 ± 68.0 months of symptom duration. Postoperative assessment at 79.5 ± 27.2 months revealed failure rates of 11-27% within 5 years and 6-32% at 10 years. Imaging analysis was conducted in 10 studies, second-look arthroscopies were reported twice (n = 205 patients) and revealed well integrated fibrocartilaginous repair tissue. CONCLUSIONS Microfracture provides good function and pain relief at the mid-term and clinically largely satisfying results thereafter. Standardized, high-quality future study designs will better refine optimal indications for microfracture in the context of cartilage repair strategies. LEVEL OF EVIDENCE This systematic review is based on studies with levels of evidence ranging between I and IV (see results section and Table). Therefore, and according to this journals Instructions for Authors (SYSTEMATIC REVIEWS AND META-ANALYSES are assigned a level of evidence equivalent to the lowest level of evidence used from the manuscripts analysed), level of evidence is IV.
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Affiliation(s)
- Patrick Orth
- Center of Experimental Orthopaedics, Saarland University, Kirrberger Strasse 100, Building 37, 66421, Homburg, Germany.,Department of Orthopaedic Surgery, Saarland University Medical Center, Kirrberger Strasse 100, Building 37, 66421, Homburg, Germany
| | - Liang Gao
- Center of Experimental Orthopaedics, Saarland University, Kirrberger Strasse 100, Building 37, 66421, Homburg, Germany
| | - Henning Madry
- Center of Experimental Orthopaedics, Saarland University, Kirrberger Strasse 100, Building 37, 66421, Homburg, Germany. .,Department of Orthopaedic Surgery, Saarland University Medical Center, Kirrberger Strasse 100, Building 37, 66421, Homburg, Germany.
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26
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Gaul F, Bugbee WD. Applications for osteochondral allografts. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-019-00337-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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27
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Systematic Review of Patient Outcomes and Associated Predictors After Microfracture in the Patellofemoral Joint. J Am Acad Orthop Surg Glob Res Rev 2019; 3:JAAOSGlobal-D-19-00151. [PMID: 31875194 PMCID: PMC6903815 DOI: 10.5435/jaaosglobal-d-19-00151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We summarized the clinical outcomes and predictors of clinical outcomes after microfracture for chondral lesions in the patellofemoral joint (PFJ).
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28
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Gaul F, Bugbee WD. Einsatzmöglichkeiten osteochondraler Allografts. ARTHROSKOPIE 2019. [DOI: 10.1007/s00142-019-00320-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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29
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Parameters identifying the risk of treatment failure after cartilage repair: a proposed treatment algorithm and pilot study. CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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30
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Martín AR, Patel JM, Zlotnick HM, Carey JL, Mauck RL. Emerging therapies for cartilage regeneration in currently excluded 'red knee' populations. NPJ Regen Med 2019; 4:12. [PMID: 31231546 PMCID: PMC6542813 DOI: 10.1038/s41536-019-0074-7] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 04/29/2019] [Indexed: 12/13/2022] Open
Abstract
The field of articular cartilage repair has made significant advances in recent decades; yet current therapies are generally not evaluated or tested, at the time of pivotal trial, in patients with a variety of common comorbidities. To that end, we systematically reviewed cartilage repair clinical trials to identify common exclusion criteria and reviewed the literature to identify emerging regenerative approaches that are poised to overcome these current exclusion criteria. The term “knee cartilage repair” was searched on clinicaltrials.gov. Of the 60 trials identified on initial search, 33 were further examined to extract exclusion criteria. Criteria excluded by more than half of the trials were identified in order to focus discussion on emerging regenerative strategies that might address these concerns. These criteria included age (<18 or >55 years old), small defects (<1 cm2), large defects (>8 cm2), multiple defect (>2 lesions), BMI >35, meniscectomy (>50%), bilateral knee pathology, ligamentous instability, arthritis, malalignment, prior repair, kissing lesions, neurologic disease of lower extremities, inflammation, infection, endocrine or metabolic disease, drug or alcohol abuse, pregnancy, and history of cancer. Finally, we describe emerging tissue engineering and regenerative approaches that might foster cartilage repair in these challenging environments. The identified criteria exclude a majority of the affected population from treatment, and thus greater focus must be placed on these emerging cartilage regeneration techniques to treat patients with the challenging “red knee”.
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Affiliation(s)
- Anthony R Martín
- 1McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 USA.,2Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA 19104 USA
| | - Jay M Patel
- 1McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 USA.,2Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA 19104 USA
| | - Hannah M Zlotnick
- 1McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 USA.,2Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA 19104 USA.,3Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - James L Carey
- 1McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Robert L Mauck
- 1McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 USA.,2Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA 19104 USA.,3Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA 19104 USA
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31
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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: 15] [Impact Index Per Article: 2.1] [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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32
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Sommerfeldt MF, Magnussen RA, Hewett TE, Kaeding CC, Flanigan DC. Microfracture of Articular Cartilage. JBJS Rev 2018; 4:01874474-201606000-00006. [PMID: 27486725 DOI: 10.2106/jbjs.rvw.15.00005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Microfracture is a treatment option for symptomatic, full-thickness cartilage defects. Microfracture is most likely to be successful when performed in nonobese patients under the age of thirty years for small (<2 to 4-cm2) femoral condylar defects that have been symptomatic for a short time (less than twelve to twenty-four months). Microfracture has acceptable short-term clinical results, but results can be expected to decline over time. Long-term studies that compare microfracture with advanced cartilage restoration techniques are required to ascertain whether these newer techniques provide longer-lasting results.
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Affiliation(s)
- Mark F Sommerfeldt
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
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34
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Mei XY, Alshaygy IS, Safir OA, Gross AE, Kuzyk PR. Fresh Osteochondral Allograft Transplantation for Treatment of Large Cartilage Defects of the Femoral Head: A Minimum Two-Year Follow-Up Study of Twenty-Two Patients. J Arthroplasty 2018; 33:2050-2056. [PMID: 29573913 DOI: 10.1016/j.arth.2018.02.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/18/2018] [Accepted: 02/01/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Controversy remains over the surgical management of large osteochondral lesions of the femoral head in young, active patients. The purpose of this study is to assess midterm clinical and radiographic outcomes after fresh osteochondral allograft transplantation (OAT) for large femoral head lesions at minimum 2-year follow-up. METHODS A retrospective review of prospectively collected data was performed for 22 patients under the age of 50 years with defined femoral head osteochondral lesions who underwent fresh OAT between 2008 and 2015. Patients were assessed clinically using the modified Harris Hip Score (mHHS) preoperatively and at each follow-up visit. Postoperative radiographs were evaluated for graft integrity and Kellgren & Lawrence Grade for osteoarthritis severity. Complications and reoperation were assessed by chart review. Kaplan-Meier survivorship analyses with 95% confidence intervals were performed for the end point of conversion to total hip arthroplasty. RESULTS At a mean follow-up of 68.8 months (26-113), the mean mHHS improved significantly (P < .001) from 48.9 (19-84) to 77.4 (35-98). Sixteen of 22 patients (72.7%) had an mHHS ≥70 at the latest follow-up. Arthritic progression, as indicated by an increase in the Kellgren & Lawrence Grade, occurred in 4 of 22 hips (18.2%). Five patients (22.7%) underwent conversion to total hip arthroplasty. Graft survivorship was 86.4 ± 7.3% at 2 years, 78.5 ± 10.0% at 5 years, and 67.3 ± 13.5% at 9 years. CONCLUSION Fresh OAT may be a viable treatment option for osteochondral defects of the femoral head in young, active patients with minimal preexisting joint deformity.
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Affiliation(s)
- Xin Y Mei
- Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - Ibrahim S Alshaygy
- Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - Oleg A Safir
- Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - Allan E Gross
- Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - Paul R Kuzyk
- Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, Canada
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35
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Tírico LEP, McCauley JC, Pulido PA, Bugbee WD. Lesion Size Does Not Predict Outcomes in Fresh Osteochondral Allograft Transplantation. Am J Sports Med 2018; 46:900-907. [PMID: 29360386 DOI: 10.1177/0363546517746106] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cartilage repair algorithms use lesion size to choose surgical techniques when selecting a cartilage repair procedure. The association of fresh osteochondral allograft (OCA) size with graft survivorship and subjective patient outcomes is still unknown. PURPOSE To determine if lesion size (absolute or relative) affects outcomes after OCA transplantation. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The study included 156 knees in 143 patients who underwent OCA transplantation from 1998 to 2014 for isolated femoral condyle lesions. The mean age was 29.6 ± 11.4 years, and 62.9% were male. The majority of patients (62.2%) presented for cartilage repair because of osteochondritis dissecans. The mean graft area, used as a surrogate for absolute size of the lesion, was 6.4 cm2 (range, 2.3-11.5 cm2). The relative size of the lesion was calculated as the tibial width ratio (TWR; ratio of graft area to tibial width) and affected femoral condyle ratio (AFCR; ratio of graft area to affected femoral condyle width) using preoperative radiographs. All patients had a minimum follow-up of 2 years. Further surgical procedures were documented, and graft failure was defined as revision OCA transplantation or conversion to arthroplasty. International Knee Documentation Committee (IKDC) pain, function, and total scores were obtained. Satisfaction with OCA transplantation was assessed. RESULTS The mean follow-up among patients with grafts remaining in situ was 6.0 years (range, 1.9-16.5 years). The OCA failure rate was 5.8%. Overall survivorship of the graft was 97.2% at 5 years and 93.5% at 10 years. No difference in postoperative outcomes between groups was found in absolute or relative size. Change in IKDC scores (from preoperative to latest follow-up) was greater for knees with large lesions compared to knees with small lesions, among all measurement methods. Overall satisfaction with the results of OCA transplantation was 89.8%. CONCLUSION The size of the lesion, either absolute or relative, does not influence outcomes after OCA transplantation for isolated femoral condyle lesions of the knee.
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Affiliation(s)
- Luis E P Tírico
- Shiley Center for Orthopaedic Research & Education, Scripps Clinic, La Jolla, California, USA
| | - Julie C McCauley
- Shiley Center for Orthopaedic Research & Education, Scripps Clinic, La Jolla, California, USA
| | - Pamela A Pulido
- Shiley Center for Orthopaedic Research & Education, Scripps Clinic, La Jolla, California, USA
| | - William D Bugbee
- Shiley Center for Orthopaedic Research & Education, Scripps Clinic, La Jolla, California, USA.,Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA
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36
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Mistry H, Connock M, Pink J, Shyangdan D, Clar C, Royle P, Court R, Biant LC, Metcalfe A, Waugh N. Autologous chondrocyte implantation in the knee: systematic review and economic evaluation. Health Technol Assess 2018; 21:1-294. [PMID: 28244303 DOI: 10.3310/hta21060] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The surfaces of the bones in the knee are covered with articular cartilage, a rubber-like substance that is very smooth, allowing frictionless movement in the joint and acting as a shock absorber. The cells that form the cartilage are called chondrocytes. Natural cartilage is called hyaline cartilage. Articular cartilage has very little capacity for self-repair, so damage may be permanent. Various methods have been used to try to repair cartilage. Autologous chondrocyte implantation (ACI) involves laboratory culture of cartilage-producing cells from the knee and then implanting them into the chondral defect. OBJECTIVE To assess the clinical effectiveness and cost-effectiveness of ACI in chondral defects in the knee, compared with microfracture (MF). DATA SOURCES A broad search was done in MEDLINE, EMBASE, The Cochrane Library, NHS Economic Evaluation Database and Web of Science, for studies published since the last Health Technology Assessment review. REVIEW METHODS Systematic review of recent reviews, trials, long-term observational studies and economic evaluations of the use of ACI and MF for repairing symptomatic articular cartilage defects of the knee. A new economic model was constructed. Submissions from two manufacturers and the ACTIVE (Autologous Chondrocyte Transplantation/Implantation Versus Existing Treatment) trial group were reviewed. Survival analysis was based on long-term observational studies. RESULTS Four randomised controlled trials (RCTs) published since the last appraisal provided evidence on the efficacy of ACI. The SUMMIT (Superiority of Matrix-induced autologous chondrocyte implant versus Microfracture for Treatment of symptomatic articular cartilage defects) trial compared matrix-applied chondrocyte implantation (MACI®) against MF. The TIG/ACT/01/2000 (TIG/ACT) trial compared ACI with characterised chondrocytes against MF. The ACTIVE trial compared several forms of ACI against standard treatments, mainly MF. In the SUMMIT trial, improvements in knee injury and osteoarthritis outcome scores (KOOSs), and the proportion of responders, were greater in the MACI group than in the MF group. In the TIG/ACT trial there was improvement in the KOOS at 60 months, but no difference between ACI and MF overall. Patients with onset of symptoms < 3 years' duration did better with ACI. Results from ACTIVE have not yet been published. Survival analysis suggests that long-term results are better with ACI than with MF. Economic modelling suggested that ACI was cost-effective compared with MF across a range of scenarios. LIMITATIONS The main limitation is the lack of RCT data beyond 5 years of follow-up. A second is that the techniques of ACI are evolving, so long-term data come from trials using forms of ACI that are now superseded. In the modelling, we therefore assumed that durability of cartilage repair as seen in studies of older forms of ACI could be applied in modelling of newer forms. A third is that the high list prices of chondrocytes are reduced by confidential discounting. The main research needs are for longer-term follow-up and for trials of the next generation of ACI. CONCLUSIONS The evidence base for ACI has improved since the last appraisal by the National Institute for Health and Care Excellence. In most analyses, the incremental cost-effectiveness ratios for ACI compared with MF appear to be within a range usually considered acceptable. Research is needed into long-term results of new forms of ACI. STUDY REGISTRATION This study is registered as PROSPERO CRD42014013083. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Hema Mistry
- Warwick Evidence, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Martin Connock
- Warwick Evidence, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Joshua Pink
- Warwick Evidence, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Deepson Shyangdan
- Warwick Evidence, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Christine Clar
- Warwick Evidence, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Pamela Royle
- Warwick Evidence, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Rachel Court
- Warwick Evidence, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Leela C Biant
- Department of Trauma and Orthopaedic Surgery, University of Manchester, Manchester, UK
| | - Andrew Metcalfe
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Norman Waugh
- Warwick Evidence, Division of Health Sciences, University of Warwick, Coventry, UK
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37
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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: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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38
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Huwe LW, Brown WE, Hu JC, Athanasiou KA. Characterization of costal cartilage and its suitability as a cell source for articular cartilage tissue engineering. J Tissue Eng Regen Med 2018; 12:1163-1176. [PMID: 29286211 DOI: 10.1002/term.2630] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 11/23/2017] [Accepted: 12/11/2017] [Indexed: 12/16/2022]
Abstract
Costal cartilage is a promising donor source of chondrocytes to alleviate cell scarcity in articular cartilage tissue engineering. Limited knowledge exists, however, on costal cartilage characteristics. This study describes the characterization of costal cartilage and articular cartilage properties and compares neocartilage engineered with costal chondrocytes to native articular cartilage, all within a sheep model. Specifically, we (a) quantitatively characterized the properties of costal cartilage in comparison to patellofemoral articular cartilage, and (b) evaluated the quality of neocartilage derived from costal chondrocytes for potential use in articular cartilage regeneration. Ovine costal and articular cartilages from various topographical locations were characterized mechanically, biochemically, and histologically. Costal cartilage was stiffer in compression but softer and weaker in tension than articular cartilage. These differences were attributed to high amounts of glycosaminoglycans and mineralization and a low amount of collagen in costal cartilage. Compared to articular cartilage, costal cartilage was more densely populated with chondrocytes, rendering it an excellent chondrocyte source. In terms of tissue engineering, using the self-assembling process, costal chondrocytes formed articular cartilage-like neocartilage. Quantitatively compared via a functionality index, neocartilage achieved 55% of the medial condyle cartilage mechanical and biochemical properties. This characterization study highlighted the differences between costal and articular cartilages in native forms and demonstrated that costal cartilage is a valuable source of chondrocytes suitable for articular cartilage regeneration strategies.
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Affiliation(s)
| | - Wendy E Brown
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
| | - Jerry C Hu
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
| | - Kyriacos A Athanasiou
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
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39
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Danna NR, Beutel BG, Ramme AJ, Kirsch T, Kennedy OD, Strauss E. The Effect of Growth Hormone on Chondral Defect Repair. Cartilage 2018; 9:63-70. [PMID: 29219025 PMCID: PMC5724667 DOI: 10.1177/1947603516678973] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective Focal chondral defects alter joint mechanics and cause pain and debilitation. Microfracture is a surgical technique used to treat such defects. This technique involves penetration of subchondral bone to release progenitor cells and growth factors from the marrow to promote cartilage regeneration. Often this results in fibrocartilage formation rather than structured hyaline cartilage. Some reports have suggested use of growth hormone (GH) with microfracture to augment cartilage regeneration. Our objective was to test whether intra-articular (IA) GH in conjunction with microfracture, improves cartilage repair in a rabbit chondral defect model. We hypothesized that GH would exhibit a dose-dependent improvement in regeneration. Design Sixteen New Zealand white rabbits received bilateral femoral chondral defects and standardized microfracture repair. One group of animals ( n = 8) received low-dose GH by IA injection in the left knee, and the other group ( n = 8) received high-dose GH in the same manner. All animals received IA injection of saline in the contralateral knee as control. Serum assays, macroscopic grading, and histological analyses were used to assess any improvements in cartilage repair. Results Peripheral serum GH was not elevated postoperatively ( P = 0.21). There was no improvement in macroscopic grading scores among either of the GH dosages ( P = 0.83). Scoring of safranin-O-stained sections showed no improvement in cartilage regeneration and some evidence of increased bone formation in the GH-treated knees. Conclusions Treatment with either low- or high-dose IA GH does not appear to enhance short-term repair in a rabbit chondral defect model.
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Affiliation(s)
- Natalie R. Danna
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Bryan G. Beutel
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Austin J. Ramme
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Thorsten Kirsch
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Oran D. Kennedy
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Eric Strauss
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, USA,Eric Strauss, MD, Department of Orthopaedic Surgery, New York University School of Medicine, 301 E 17th Street, New York, NY 10003, USA.
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Huwe LW, Brown WE, Hu JC, Athanasiou KA. Characterization of costal cartilage and its suitability as a cell source for articular cartilage tissue engineering. J Tissue Eng Regen Med 2017. [PMID: 29286211 DOI: 10.1002/term.2630.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Costal cartilage is a promising donor source of chondrocytes to alleviate cell scarcity in articular cartilage tissue engineering. Limited knowledge exists, however, on costal cartilage characteristics. This study describes the characterization of costal cartilage and articular cartilage properties and compares neocartilage engineered with costal chondrocytes to native articular cartilage, all within a sheep model. Specifically, we (a) quantitatively characterized the properties of costal cartilage in comparison to patellofemoral articular cartilage, and (b) evaluated the quality of neocartilage derived from costal chondrocytes for potential use in articular cartilage regeneration. Ovine costal and articular cartilages from various topographical locations were characterized mechanically, biochemically, and histologically. Costal cartilage was stiffer in compression but softer and weaker in tension than articular cartilage. These differences were attributed to high amounts of glycosaminoglycans and mineralization and a low amount of collagen in costal cartilage. Compared to articular cartilage, costal cartilage was more densely populated with chondrocytes, rendering it an excellent chondrocyte source. In terms of tissue engineering, using the self-assembling process, costal chondrocytes formed articular cartilage-like neocartilage. Quantitatively compared via a functionality index, neocartilage achieved 55% of the medial condyle cartilage mechanical and biochemical properties. This characterization study highlighted the differences between costal and articular cartilages in native forms and demonstrated that costal cartilage is a valuable source of chondrocytes suitable for articular cartilage regeneration strategies.
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Affiliation(s)
| | - Wendy E Brown
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
| | - Jerry C Hu
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
| | - Kyriacos A Athanasiou
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
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Autologous and micro-fragmented adipose tissue for the treatment of diffuse degenerative knee osteoarthritis. J Exp Orthop 2017; 4:33. [PMID: 28975547 PMCID: PMC5626678 DOI: 10.1186/s40634-017-0108-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 09/27/2017] [Indexed: 01/10/2023] Open
Abstract
Background Chondral lesions of the knee represent a challenge for the orthopaedic surgeon. Several treatments have been proposed with variable success rate. Recently, new therapeutic approaches, such as the use of mesenchymal stem cells, have shown promising results. The adipose tissue is a good source of these naturally occurring regenerative cells, due to its abundance and easy access. In addition, it can be used to provide cushioning and filling of structural defects. The 1-year safety and outcome of a single intra-articular injection of autologous and micro-fragmented adipose tissue in 30 patients affected by diffuse degenerative chondral lesions was evaluated. Methods Micro-fragmented adipose tissue was obtained using a minimal manipulation technique in a closed system. The safety of the procedure was evaluated by recording type and incidence of any adverse event. The clinical outcomes were determined using the KOOS, IKDC-subjective, Tegner Lysholm Knee, and VAS pain scales taken pre-operatively and at 12 months follow-up. A level of at least 10 points of improvement in the scores has been selected as cut-off representing a clinically significant difference. Results No relevant complications nor clinical worsening were recorded. A total median improvement of 20 points has been observed in IKDC-subjective and total KOOS, and a higher percentage of success was found in VAS pain and Tegner Lysholm Knee, where the total median improvement was 24 and 31 points, respectively. Conclusion The results of this study show the safety and feasibility of using autologous and micro-fragmented adipose tissue in patients affected by diffuse degenerative chondral lesions. The technique is safe, minimally invasive, simple, one-step, with low percentage of complications, and compliant with the regulatory panorama. Electronic supplementary material The online version of this article (10.1186/s40634-017-0108-2) contains supplementary material, which is available to authorized users.
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Osteochondral transplantation with a dynamic external fixator is useful treatment for traumatic osteochondral defect of the finger. A case report. J Orthop Sci 2017; 22:958-961. [PMID: 26850922 DOI: 10.1016/j.jos.2015.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 12/03/2015] [Accepted: 12/23/2015] [Indexed: 11/21/2022]
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Abstract
CONTEXT Hip arthroscopy is gaining popularity within the field of orthopaedic surgery. The development and innovation of hip-specific arthroscopic instrumentation and improved techniques has resulted in improved access to the hip joint and ability to treat various hip pathologies. EVIDENCE ACQUISITION Electronic databases, including PubMed and MEDLINE, were queried for articles relating to hip arthroscopy indications (1930-2017). STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 4. RESULTS Initially used as a technique for loose body removal, drainage/debridement of septic arthritis, and treatment of pediatric hip disorders, hip arthroscopy is currently used to treat various hip conditions. The recognition of femoroacetabular impingement (FAI) as a source of hip pain in young adults has rapidly expanded hip arthroscopy by applying the principles of osseous correction that were previously described and demonstrated via an open surgical dislocation approach. Hip pathologies can be divided into central compartment, peripheral compartment, peritrochanteric space, and subgluteal space disorders. CONCLUSION Although hip arthroscopy is a minimally invasive procedure that may offer decreased morbidity, diminished risk of neurovascular injury, and shorter recovery periods compared with traditional open exposures to the hip, it is important to understand the appropriate patient selection and indications.
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Affiliation(s)
- James R. Ross
- Boca Care Orthopedics, Deerfield Beach, Florida
- Florida Atlantic University College of Medicine, Boca Raton, Florida
| | - Christopher M. Larson
- Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics, Edina, Minnesota
| | - Asheesh Bedi
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
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Flanigan DC, Carey JL, Brophy RH, Graham WC, DiBartola AC, Hamilton D, Nagaraja HN, Lattermann C. Interrater and Intrarater Reliability of Arthroscopic Measurements of Articular Cartilage Defects in the Knee. J Bone Joint Surg Am 2017. [PMID: 28632586 DOI: 10.2106/jbjs.16.01132] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cartilage lesions of the knee are difficult to treat. Lesion size is a critical factor in treatment algorithms, and the accurate, reproducible sizing of lesions is important. In this study, we evaluated the interrater and intrarater reliability of, and correlations in relation to, various arthroscopic sizing techniques. METHODS Five lesions were created in each of 10 cadaveric knees (International Cartilage Repair Society grade 3C). Three orthopaedic surgeons used 4 techniques (visualization and use of a 3-mm probe, a simple metal ruler, and a sliding metallic ruler tool) to estimate lesion size. Repeated-measures data were analyzed using a mixed-effect linear model. The differences between observed and gold-standard (plastic mold) values were used as the response. Intraclass and interclass correlation coefficient (ICC) values for intrarater and interrater reliability were computed, as were overall correlation coefficients between measurements and gold standards. RESULTS The mean lesion size was 2.37 cm (range, 0.36 to 6.02 cm). Rater, lesion location and size, and measurement method all affected the cartilage defect measurements. Surgeons underestimated lesion size, and measurements of larger lesions had a higher percentage of error compared with those of smaller lesions. When compared with plastic molds of lesions, 60.5% of surgeon measurements underestimated lesion size. Overall, the correlation between measurements and gold standards was strongest for the simple metal ruler method and weakest for the visualization method. CONCLUSIONS Several factors may influence arthroscopic estimation of cartilage lesion size: the lesion location, measurement tool, surgeon, and defect size itself. The intrarater and interrater reliability was moderate to good using a 3-mm probe, sliding metallic ruler tool, or simple metal ruler and was fair to moderate using visualization only. CLINICAL RELEVANCE There is a need for more accurate methods of determining the size of articular cartilage lesions.
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Affiliation(s)
- David C Flanigan
- 1Division of Sports Medicine Cartilage Repair Center, Department of Orthopaedics (D.C.F., W.C.G., and A.C.D.), Division of Biostatistics, College of Public Health (H.N.N.), and Wexner Medical Center (D.C.F. and A.C.D.), The Ohio State University, Columbus, Ohio 2Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 3Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri 4OrthoCarolina, Pineville, North Carolina 5University of Kentucky, Lexington, Kentucky
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Yabumoto H, Nakagawa Y, Mukai S, Saji T, Nakamura T. Surgical Technique and Clinical Outcomes of Retrograde Osteochondral Autograft Transfer for Osteochondral Lesions of the Tibial Plateau. Arthroscopy 2017; 33:1241-1247. [PMID: 28325693 DOI: 10.1016/j.arthro.2017.01.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 12/27/2016] [Accepted: 01/05/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To present the surgical technique, clinical outcomes, and poor prognostic factors of arthroscopic retrograde osteochondral autograft transfer of the tibial plateau. METHODS Twelve patients (6 men, 6 women; mean age, 38.7 years) with tibial plateau osteochondral lesions underwent surgery. The primary diseases were osteonecrosis in 4 cases, cartilage injuries in 6, and postfractures of the tibial plateau in 2. Clinical outcomes were evaluated preoperatively and postoperatively according to the International Knee Documentation Committee score and the Japanese Orthopaedic Association score. The International Cartilage Repair Society score was recorded in 7 cases who underwent second-look arthroscopies postoperatively. Statistical analyses were performed to identify prognostic factors associated with the clinical outcomes. RESULTS The mean International Knee Documentation Committee and Japanese Orthopaedic Association scores were both significantly improved from 39.0 (range, 13.0-57.1) to 72.4 (range, 33.3-100) (P = .0022) and from 65.8 (range, 30.0-85.0) to 85.8 (range, 50.0-100) (P = .0022 < .05), respectively. In 2 cases, secondary operations were performed because of knee pain (1 varus osteotomy of the femur and 1 total knee replacement). The mean International Cartilage Repair Society scores were significantly worse in the 2 cases who required a secondary operation (3.5; abnormal) than in the 5 cases who did not (10.6; nearly normal). The secondary operation rate was significantly higher in cases with lesion size ≥400 mm2 than in those <400 mm2 (Fisher's exact test; P = .046). CONCLUSIONS Most clinical scores improved significantly postoperatively. The results indicate that arthroscopic retrograde osteochondral autograft transfer is an effective procedure to achieve sufficient cartilage congruity for osteochondral lesions of the tibial plateau <400 mm2 in size. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Hiromitsu Yabumoto
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Fukakusa, Fushimi-ku, Kyoto, Japan.
| | - Yasuaki Nakagawa
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Fukakusa, Fushimi-ku, Kyoto, Japan
| | - Shogo Mukai
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Fukakusa, Fushimi-ku, Kyoto, Japan
| | - Takahiko Saji
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Fukakusa, Fushimi-ku, Kyoto, Japan
| | - Takashi Nakamura
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Fukakusa, Fushimi-ku, Kyoto, Japan
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Usuelli FG, Maccario C, Ursino C, Serra N, D'Ambrosi R. The Impact of Weight on Arthroscopic Osteochondral Talar Reconstruction. Foot Ankle Int 2017; 38:612-620. [PMID: 28379733 DOI: 10.1177/1071100717695349] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of the study was to assess the functional and radiologic outcomes after AT-AMIC (arthroscopic talus autologous matrix-induced chondrogenesis) in 2 weight groups of patients with osteochondral lesions of the talus (OLTs): patients with BMI <25 (Healthy Weight Group [HG]) and with BMI ≥25 (Overweight Group [OG]). METHODS Thirty-seven patients were evaluated. HG was composed of 21 patients (BMI = 21.90 ± 1.94), whereas OG consisted of 16 patients (BMI = 27.41 ± 1.98). All patients were treated with AT-AMIC repair for OLTs. Magnetic resonance imaging (MRI), computed tomography (CT), Visual Analgoue Scale (VAS) for pain, American Orthopaedic Foot & Ankle Society (AOFAS) Ankle and Hindfoot score and Short-Form Health Survey (SF-12) were administered preoperatively (T0) and at 6 (T1), 12 (T2), and 24 (T3) months postoperatively. RESULTS In both groups, we found a significant difference for clinical and radiologic parameters with analysis of variance for repeated measures through 4 time points ( P < .001). In HG, AOFAS increased at every follow-up ( P < .05), whereas in OG, AOFAS improved only between T2 and T3 ( P = .0104). In OG we found a significant difference comparing CT and MRI at each follow-up; in HG this difference was found only at T0 ( P < .0001) and T1 ( P = .0492). Finally, OG presented a significantly larger lesion measured with MRI at T0 ( P = .033). CONCLUSIONS OLTs in overweight patients were characterized by a larger preoperative size. At final follow-up, both groups showed a significant clinical improvement. AT-AMIC can be considered a safe and reliable procedure, regardless of weight, with a significant improvement also in quality of life. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
| | - Camilla Maccario
- 1 IRCCS Istituto Ortopedico Galeazzi, UO CASCO, Piede e Caviglia, Milan, Italy
- 2 Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | | | - Nicola Serra
- 4 Seconda Università degli Studi di Napoli, Naples, Italy
| | - Riccardo D'Ambrosi
- 1 IRCCS Istituto Ortopedico Galeazzi, UO CASCO, Piede e Caviglia, Milan, Italy
- 2 Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
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Pareek A, Reardon PJ, Macalena JA, Levy BA, Stuart MJ, Williams RJ, Krych AJ. Osteochondral Autograft Transfer Versus Microfracture in the Knee: A Meta-analysis of Prospective Comparative Studies at Midterm. Arthroscopy 2016; 32:2118-2130. [PMID: 27487736 DOI: 10.1016/j.arthro.2016.05.038] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 05/24/2016] [Accepted: 05/26/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare microfracture (MFX) and osteochondral autograft transfer (OAT) surgical techniques to determine (1) postoperative activity level, (2) subjective patient outcomes, (3) failure rates, and (4) assess if any lesion characteristics favored one technique over the other. METHODS A comprehensive review of literature was performed of all studies comparing MFX and OAT. Studies included were all prospective studies that reported on activity-based outcome measures such as Tegner activity scores and subjective outcomes such as the International Knee Documentation Committee score. Failure rates, as determined by the publishing authors, were recorded for each study. Meta-analyses were conducted using a random-effects model. Paired standardized mean differences (Hedges's g to account for small sample bias) were used for continuous outcome measures, and risk ratios (Mantel-Haenszel method for small sample bias) for dichotomous outcome measures. RESULTS Six prospective studies satisfied the eligibility criteria and included 249 patients (186 male, 120 female) with an average age of 26.4 years and follow-up of 67.2 months. Tegner scores were superior in patients treated with OAT compared with MFX (ΔOAT-MFX for pre-post scores = 0.94 Tegner points, standardized mean difference [SMD] = 0.469, P = .005). Failure rates of MFX were higher than OAT (OAT = 11%, MFX = 32%, risk ratio = 2.42, P < .036). OAT was superior to MFX at 3 years in relation to subjective outcome scores (SMD = 0.404, P = .008). When assessing OAT lesions larger than 3 cm2, OAT was superior to MFX with respect to activity level (SMD = 0.506, P = .001). CONCLUSIONS OAT may achieve higher activity levels and lower risk of failure when compared with MFX for cartilage lesions greater than 3 cm2 in the knee, although there was no significant difference for lesions less than 3 cm2 at midterm. However, because of variability in patient-specific factors such as age, preinjury activity level, lesion location and size, the superiority of OAT over MFX cannot be generalized to all patient populations and therefore requires individualized patient care. LEVEL OF EVIDENCE Level II, meta-analysis of Level I and II studies.
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Affiliation(s)
- Ayoosh Pareek
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Patrick J Reardon
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Jeffrey A Macalena
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Bruce A Levy
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Michael J Stuart
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Riley J Williams
- Department of Orthopedic Surgery, Institute for Cartilage Repair, Hospital for Special Surgery, New York, New York, U.S.A
| | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A..
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Aae TF, Randsborg PH, Breen AB, Visnes H, Vindfeld S, Sivertsen EA, Løken S, Brinchmann J, Hanvold HA, Årøen A. Norwegican Cartilage Project - a study protocol for a double-blinded randomized controlled trial comparing arthroscopic microfracture with arthroscopic debridement in focal cartilage defects in the knee. BMC Musculoskelet Disord 2016; 17:292. [PMID: 27422025 PMCID: PMC4947343 DOI: 10.1186/s12891-016-1156-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 07/02/2016] [Indexed: 01/30/2023] Open
Abstract
Background Focal lesions to the articular cartilage in the knee might have demolishing consequences to the knee. There exists a wide range of possible surgical procedures targeting these injuries, however no significant differences have been found between these procedures. This may support that the improvement is a result of rehabilitation, and not the surgery itself. Arthroscopic microfracture (MF) treatment has gained popularity, and has become the treatment of choice in patients with knee cartilage defects globally. In this study we want to increase knowledge, both clinical and economic, about arthroscopic microfracture (AF) compared to arthroscopic debridement (AD) and physical rehabilitation both in the short run, and in the long run. Methods/Design To compare arthroscopic microfracture with arthroscopic debridement and physiotherapy for the treatment of focal cartilage lesions in the knee, a long-term, double-blinded, randomized controlled multicenter trial will be conducted. A total of 114 men and non-pregnant women with a symptomatic focal full thickness cartilage lesion in the knee less than 2 cm2 will be included in the study. The two treatment allocations will receive identical rehabilitation, which is made up of 3 phases: accommodation, rehabilitation and return to activity. Follow up is 24 months, where all will be invited to participate in late follow ups after 5 and 10 years. The Knee Injury and Osteoarthritis Outcome Score (KOOS) knee-related quality of life (QoL) subscore is the primary endpoint. Clinical parameters, questionnaires and radiologic modalities (Magnetic Resonance Imaging (MRI) and x-ray) will be used as secondary endpoints. Discussion This is an ongoing multicenter study with a high level of evidence to compare arthroscopic microfracture with arthroscopic debridement and physiotherapy for the treatment of isolated symptomatic full thickness cartilage lesions in the knee joint. Trial registration ClinicalTrials.gov ID: NCT02637505 (December 15, 2015).
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Affiliation(s)
- Tommy Frøseth Aae
- Department of Orthopedic Surgery, Kristiansund Hospital, Kristiansund, Norway.
| | - Per-Henrik Randsborg
- Department of Orthopedic Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Anne Berg Breen
- Department of Orthopedic Surgery, Ålesund Hospital, Ålesund, Norway
| | - Håvard Visnes
- Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Søren Vindfeld
- Department of Orthopedic Surgery, Haraldsplass Deaconess Hospital, Deaconess, Norway
| | | | - Sverre Løken
- Department of Orthopedics, Oslo University Hospital, Oslo, Norway
| | - Jan Brinchmann
- Department of Immunology and Norwegian Center for Stem Cell Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | - Asbjørn Årøen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Oslo Sports Trauma Research Centre, Norwegian School of Sport Sciences, Oslo, Norway
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de Windt TS, Sorel JC, Vonk LA, Kip MMA, Ijzerman MJ, Saris DBF. Early health economic modelling of single-stage cartilage repair. Guiding implementation of technologies in regenerative medicine. J Tissue Eng Regen Med 2016; 11:2950-2959. [DOI: 10.1002/term.2197] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 12/24/2015] [Accepted: 03/14/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Tommy S. de Windt
- Department of Orthopaedics; University Medical Centre Utrecht; Utrecht the Netherlands
| | - Juliette C. Sorel
- Department of Orthopaedics; University Medical Centre Utrecht; Utrecht the Netherlands
| | - Lucienne A. Vonk
- Department of Orthopaedics; University Medical Centre Utrecht; Utrecht the Netherlands
| | - Michelle M. A. Kip
- Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine; University of Twente; Enschede the Netherlands
| | - Maarten J. Ijzerman
- Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine; University of Twente; Enschede the Netherlands
| | - Daniel B. F. Saris
- Department of Orthopaedics; University Medical Centre Utrecht; Utrecht the Netherlands
- MIRA Institute for Biotechnology and Technical Medicine; University of Twente; Enschede the Netherlands
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Marquez-Lara A, Mannava S, Howse EA, Stone AV, Stubbs AJ. Arthroscopic Management of Hip Chondral Defects: A Systematic Review of the Literature. Arthroscopy 2016; 32:1435-43. [PMID: 27117866 DOI: 10.1016/j.arthro.2016.01.058] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 01/18/2016] [Accepted: 01/21/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To critically evaluate the evidence for arthroscopic management of chondral defects in the hip through a systematic literature review. METHODS A systematic literature review was performed to identify all articles addressing the arthroscopic management of chondral defects about the hip. Case reports, open techniques, and those associated with osteonecrosis were excluded. Articles were assessed for sample size, location, severity, and size of chondral defects, and the surgical technique. Associated injuries, follow-up duration (months), and functional outcomes were recorded. Study cohorts were defined by a surgical technique (debridement v microfracture v autologous chondrocyte transplantation [ACT]). Statistical analysis was performed with a χ(2) test and analysis of variance with post hoc pairwise analysis for categorical and continuous data, respectively, with significance defined as P < .05. RESULTS The literature search identified 269 articles, of which 12 clinical studies met inclusion criteria for this analysis. After pooling the data, there were 579 (64.7%) debridements, 279 (31.2%) microfracture, and 37 (4.1%) ACT performed. Patients were followed for an average of 27.1 months (range: 5 to 72 months). All lesions treated with either a microfracture or ACT were high grade (Outerbridge 3 to 4). However, lesion size was significantly larger in ACT-treated patients compared with those who underwent microfracture (357.3 ± 96.0 mm(2)v 149.5 ± 20.7 mm(2); P = .020). All cohorts showed significant improvement in functional outcomes after hip arthroscopy (P < .001). CONCLUSIONS This systematic review showed that arthroscopic debridement, microfracture, and ACT are associated with equivalent improvement in clinical outcomes in patients with high-grade chondral defects in the hip in the short- and midterm follow-up. In addition, although there were no differences in patient characteristics and demographics based on the surgical technique, we confirmed the hypothesis that lesion size varied significantly between arthroscopic techniques, and that the decision to use one technique over another may be determined by the size of the defect. Therefore, lesion size is likely to influence the development of hip- and technique-specific indications, and may also represent a useful metric for success of surgical intervention. LEVEL OF EVIDENCE Level IV, systematic review of Level III and IV studies.
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Affiliation(s)
- Alejandro Marquez-Lara
- Department of Orthopaedic Surgery, Division of Sports Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston Salem, North Carolina, U.S.A
| | - Sandeep Mannava
- Department of Orthopaedic Surgery, Division of Sports Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston Salem, North Carolina, U.S.A
| | - Elizabeth A Howse
- Department of Emergency Medicine, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, California, U.S.A
| | - Austin V Stone
- Department of Orthopaedic Surgery, Division of Sports Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston Salem, North Carolina, U.S.A
| | - Allston J Stubbs
- Department of Orthopaedic Surgery, Division of Sports Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston Salem, North Carolina, U.S.A..
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