Evaluation of cartilage reconstruction by means of autologous chondrocyte versus periosteal graft transplantation: an animal study.

BACKGROUND: Autologous chondrocyte transplantation (ACT) has been shown to heal cartilage defects under experimental and clinical conditions. However, the evaluation of successful transplantation still remains arbitrary and further research is required to establish objective criteria of treatment. The aim of the present study was to evaluate the criteria of successful ACT and to compare the results with those obtained following periosteal grafting (PG). MATERIALS AND METHODS: Articular cartilage specimens were taken from the distal femur of 30 adolescent New Zealand rabbits and chondrocytes were obtained by collagenase digestion. The chondrocytes were identified by a functional assay, based on estimating procollagen type II mRNA by reverse-transcribed polymerase chain reaction. The cells cultured in vitro were transplanted under a periosteal flap into a full thickness defect (ICRS III(0)). The quality of the repaired tissue was evaluated macroscopically according to a modified scale of Brittberg et al, and microscopically according to O'Driscoll et al. For comparative purposes animals treated with PG were used. RESULTS: Cultured chondrocytes expressed procollagen type II and, upon transplantation into the defect, produced hyaline cartilage. To evaluate the results of transplantation, two categories of criteria were adopted-macroscopic analysis and microscopic examination. By all adopted criteria the results were significantly better in the ACT group (P < .05) than in the PG group. CONCLUSION: Prior to transplantation, assays for specialized functions of chondrocytes required semiquantitative evaluation of macroscopic and microscopic appearance of the repaired tissue, showing the benefit of autologous chondrocyte versus periosteal graft transplantation.

Articular cartilage repair by means of biodegradable scaffolds.

INTRODUCTION: Articular cartilage has a limited capacity for self-repair; untreated injuries of cartilage may lead to osteoarthritis. In severe cases the only choice a total joint replacement, may be inadequate in young patients. This problem demands new effective methods to reconstruct articular cartilage. The aim of this study was to evaluate the application of collagen matrix for the reconstruction of articular cartilage. MATERIALS AND METHODS: A group of 28 rabbits had a defect penetrating into the subchondral constructed and either filled with collagen scaffold (group I) or remained empty (group II). The results were observed after 4 and 12 weeks. Macroscopic and microscopic evaluations were performed. RESULTS: In the first group we observed the presence of hyalinelike cartilage resembling normal articular cartilage. In the second group fibrous tissue dominated. The surface of regenerated tissue was smooth, intact, and the defect completely filled with regenerated tissue, showing good structural integrity. In the second group, superficial irregularities, disorders of structural integrity, and necrotic features were noticed. CONCLUSIONS: This study showed better results of articular cartilage reconstruction by means of a biodegradable scaffold.

Growth and remodelling of the dysplastic hip after conservative reduction in congenital dislocation.

This study presents the development and remodelling of 78 dysplastic hips treated conservatively. The hip joints were observed from the end of conservative treatment, during growth until maturity, up to the age of 18 years and beyond. We used 9 radiological parameters of hip structure. The parameters described the status of the acetabulum, proximal end of the femur and the joint congruity. The values of these parameters were compared with the norms established for healthy hips. The material was divided into groups with regard to the parameter values. It was found that hip congruity at the age from 2 to 5 years or from 2 to 7 years is the most important factor that determines the development of both the acetabulum and the whole joint. Based on the values of three radiological parameters, describing hip congruity at this period of life, it was found that the remodelling of a dysplastic hip follows one of three definable models. If we attribute the development of a given hip to a given model, then the status of this hip at maturity is predictable. What makes the prediction of the final condition of the hip feasible is the observation of the hip remodelling process from age 2 to 5 or 7 years. This also permits a decision regarding surgery to eliminate any dysplastic elements from the hip during the childs optimal age for operative treatment. (Hip International 2002; 12: 320-33).

[Clinical and radiological evaluation of the hip joints treated operatively due to Perthes disease with incongruence of articular surfaces]. / Ocena kliniczna i radiologiczna stawów biodrowych po leczeniu operacyjnym choroby Perthesa z inkongruencja stawu.

The aim of the study was the clinical and radiological evaluation of the hip joints treated operatively due to Perthes disease with incongruence of articular surfaces. 35 patients (37 hips) treated between 1988-1990 by means of proximal femoral and transpelvic osteotomy were evaluated. Average age of the child at the time of the operation was 7 years 3 months (5-10 years), and at the final examination 15 years (12-19 years). The average follow-up period was 7 years 7 months (5-9 years). At the clinical examination there were 46 percent excellent results (17 hips), 32 percent good (12 hips), and 22 percent fair results (8 hips). Radiological examination showed 19 percent excellent results (7 hips), 35 percent good (13 hips), 5 percent of fair (2 hips), and 41 percent of poor results (15 hips). This study proved that the described operative treatment appeared a useful method in Perthes disease with incongruence of articular surfaces.

[Evaluation of localization and size of subcapital growth plate damage of the proximal femur in the MR image]. / Ocena lokalizacji i wielkosci uszkodzenia podglowowej chrzastki nasadowej kosci udowej w obrazie MR.

A group of 33 hips with avascular necrosis following developmental dislocation of the hip in 24 children was evaluated. The average age of the patients at the time of evaluation was 10 years (age ranging from 4 to 14 years). The study was focused on depiction of the subcapital growth plate of the femur by means of conventional radiography and MRI. On the basis of of the analysis of MR imagesa method of mapping the subcapital growth plate allowing location of the damage site is presented. The method will be useful in planning corrective treatment of the proximal femur e.g. trochanteric epiphysiodesis, corrective osteotomy and future removal of the bone bridges.

The experimental reconstruction of articular cartilage using autogenous periosteal and perichondreal implants.

Injured cartilage has a limited capacity to heal itself. Untreated damage leads to secondary osteoarthritis. There is a need to find a way to reconstruct cartilage in order to prevent secondary osteoarthritis. The aim this study was to evaluate and compare the chondrogenic potential of three different cell materials: perichonrdrial grafts, periosteal grafts and bone marrow in situ. The mesenchemal cells contained in these materials can differentiate in the joint environment into chondrocytes and rebuild articular cartilage.
Forty nine (49) White New Zealand rabbits were used in our experiment. An osteochondrial (full-thickness) defect was created in the joint surface of both ends of the femoral bone. The animals were divided according to the procedure used:
I - cartilage reconstruction by periosteal grat,
II - cartilage reconstruction by perichondrial graft,
III - no graft.
The joint was not immobilized after surgery. Follow-up exams were performed at 4, 8, and 12 weeks. The results were evaluated macroscopically and microscopically.
The results pointed to the chondrogenic potential of periosteum and perichondrium after grafting to cartilage defects. On gross examination the articular surface was found to be reconstructed. Microscopic examination revealed regeneration, with the formation of hyaline-like cartilage. Regenerating tissue was also found in the group without grafts. The structure resembled normal articular cartilage; however, neither the joint surface nor the subchondrial bone were fully reconstructed. No qualitative or quantitative differences were found between the groups treated with periosteal and perichondral grafts.
Our study confirmed that grafts of periosteum or perichondrium have chondrogenic potential, i.e. the ability to generate cartilage tissue whose features are similar to those of the hyaline chondrial tissue in the joint. Both materials have similar chondrogenic potential. The chondrogenic properties of perichondrium and perisostem produce better results in the various categories in comparison to those of bone marrow.

The reconstruction of defects in articular cartilage using autologous chondrocytes.

A defect was artificially created on the joint surface of the distal ends of both femoral bones in 30 rabbits. After digestion of the cartilage fragment, the resulting cells were cultured in vitro and multiplied. The multiplied autologous chondrocytes were implanted at the point of the defect under a periosteum patch in the right knee (group I). The defect in the left knee was covered with periosteum alone (group II). The regenerates obtained in this way were evaluated at 4, 8, and 12 weeks after surgery, macroscopically for even coverage of the surface of the defect and the quantity of regenerate in proportion to the surrounding healthy tissue, microscopically with H + E stain for the nature of the prevalent tissue, integration with the environment, the presence of necrosis, the formation of isogenous groups of cells, and the formation of cracks.
In the macroscopic evaluations at weeks 4, 8, and 12, the presence of regenerate was discovered in group I in approximately the same quantities as in the surrounding cartilage. The group II joints were found to have less satisfactory repair of the lesion.
In the microscopic evaluation, group I was found histologically to have cartilage tissue well integrated with the environment and chondrocytes forming isogenous groups of cells. In group II most of the joints were found to have incomplete or no integration with the surrounding tissue, with necrosis and cracking.
The reconstruction of defects in articular cartilage using autologous chondrocytes and periosteum produced a regenerate macroscopically similar to the surrounding articular cartilage. The results obtained by regeneration of articular cartilage using autologous chondrocyte grafts and periosteum were superior to those obtained with isolated periosteum grafts.

[MR imaging of the subcapital growth plate of the proximal femur]. / Obraz podglowowej chrzastki nasadowej blizszego konca kosci udowej w badaniu MR.

The possibilities of MR imaging of the subcapital growth plate of the proximal femur were evaluated in 36 children with 58 normal hips. The most common presentation of the area of subcapital growth plate on MR images was that of a hypointense band on T1-weighted images and a hyperintense band on sequences using fat saturation. Thinning of the growth plate with age was observed and in the older subjects in this group the growth plate was no longer visible.

[An analysis of the selected parameters of the normal hip joint during growth in magnetic resonance imaging]. / Analiza niektórych parametrów budowy prawidlowego stawu biodrowego w przebiegu jego wzrostu w obrazie rezonansu magnetycznego.

Dynamics of the selected parameters of the normal hip joint during growth has been presented. Fifty-three normal hips in 40 individuals aged 3-17 years were assessed with Magneton Impact MRI. The angles and indices were found on T1 coronal images in Spin Echo or Turbo Spin Echo sequence. Acetabular roof angle of Hilgenreiner, acetabular inclination angle of Sharp, Wiberg angle and Heyman-Herndon index were calculated with both bony and cartilaginous elements regarded. Parameters based on cartilaginous parts of the joint did not change during normal growth, but they do change if calculated with the use of bony landmarks reaching Acartilaginous values by the age of 14-15. The results suggest, that during growth gradual ossification of cartilaginous elements takes place but the proportions remain unchanged. The investigation determines the age of enhanced ossification and the age of its termination.

[Development of the normal infantile hip joints assessed by MRI]. / Badania nad rozwojem dzieciecego prawidlowego stawu biodrowego w obrazie rezonansu magnetycznego.

The paper provides an overview of the time of appearance of the secondary ossification centers and closure of the growth plates of the acetabulum and proximal epiphysis of the femur: the triradiate cartilage, the acetabular roof growth cartilage, the subcapital growth cartilage, the growth cartilage of the major trochanter, the growth cartilage of the minor trochanter. The study is based upon 62 MRI scans of healthy hips in 45 patients aged 3-21. The examined hips showed no pathologic traits--neither in the MRI scan nor in X-ray investigation. In Spin Echo and Turbo Spin Echo sequential imaging all obtained slices were used, on GRADIENT ECHO: FISP 3D, FLASH 2D, and FLASH 3D FAT SAT only chosen slices were included in the study. This way the following results were obtained: the ossification center of the major trochanter appears at the age of 3 in girls and at the age of 6 in boys, while the ossification center of the minor trochanter appears at the age of 6 in both sexes. The times of complete ossification of following growth cartilages were observed: for the triradiate cartilage ossification was observed at age 12-15 in girls and 15-16 in boys; for the cartilage of the acetabular roof ossification was noted at age 12-15 in girls and 15-18 in boys; ossification in the subcapital growth cartilage occurred at age 15-17 in girls and 16-18 in boys; the major trochanter growth cartilage ossifies at age 15-16 in girls and 16-18 in boys; for the minor trochanter ossification of the growth cartilage occurs at age 14-16 in girls and at age 16-18 in boys. The secondary ossification center of the pubic bone appears at age 9-11 in girls and 13-16 in boys and the secondary ossification center of the acetabular roof appears at age 13-17 in girls and boys. This study expand our knowledge on the development of the hip joint and facilitate the assessment of hip pathology.

[The possibility of isolation, culture and storage of articular cartilage cells]. / Mozliwosc izolacji, hodowli i przechowywania komórek chrzastki stawowej.

Lesions of articular cartilage are a common problem and concern millions of people world-wide. A decrease in physical activity and pain symptoms among patients resulting from damage to articular cartilage have prompted research concerning new methods allowing cartilage regeneration. State-of-the-art treatment of articular damage depends very much on genetic engineering techniques. The aim of this paper was to determine the authors' own way of isolation, proliferation and storage of chondrocytes of articular cartilage. The material consisted of 30 rabbits, from which fragments of articular cartilage were taken. The study consisted of the following stages: isolation, chondrocyte proliferation, cell and matrix identification, storage and MTT tests. Matrix digestion was achieved using the following solutions: 0.1% type IA collagenase; 0.025% trypsin, a mixture of collagenase and trypsin. The greatest amount of cells were found after digestion of the basic matter of cartilage by 0.1% solution of type IA collagenase. When ascorbic acid was added to the medium, a 25% increase in cellularity was observed. A cumulation of procollagen mRNA was noted in the isolated cells. After about 21 days the isolated cells formed a multilayer structure, with the space between the cells filled with a substance that showed typical traits for cartilage matrix. Storing the isolated cells for less than 48 hours at room temperature gave a 90% survival rate. Most cells died after less than 12 hours when stored at 4 degrees C. The described method of chondrocyte isolation proved to be effective in preparing material for treatment of articular cartilage lesion.

[Images of growth zones of the femoral head, neck and greater trochanter in MR examination]. / Obraz stref wzrostowych glowy i szyjki kosci udowej oraz kretarza wiekszego w badaniu MR.

The possibilities of MR imaging were evaluated in 36 children with 58 normal hips. The analysed children were divided into 3 groups, basing on age at the time of investigation i.e. children less than 5 years old, age ranging from 5 to 12 years, and over 12 years of age. MRI allowed visualisation of all growth zones of the proximal femur. On T-1 weighted images the growth cartilage of the femoral head, neck, and greater trochanter were of intermediate signal intensity. On sequences using fat saturation and on gradient echo images the cartilage was of high signal intensity. The growth zone of the subtrochanteric cartilage was of low signal intensity on T-1 weighted images and high signal intensity on sequences using fat saturation and on gradient echo images. T-1 weighted images together with FLASH 3D FAT SAT seem to be sufficient for the analysis of the growth zones of the proximal femur.

Avascular necrosis of the proximal femur in developmental dislocation of the hip. Incidence, risk factors, sequelae and MR imaging for diagnosis and prognosis.

Avascular necrosis of the proximal femur still remains the major complication of the treatment for developmental dislocation of the hip. In a three part study I reviewed this problem. Part I analyzed incidence, causes, and risk factors of avascular necrosis. In 105 children with 113 hips who developed avascular necrosis out of 636 consecutive patients with 823 hips treated nonoperatively for developmental dislocation of the hip in the years 1972-1976 the risk factors of avascular necrosis were determined. A method of treatment in most cases was Frejka pillow. Conventional radiographs obtained in AP views during the course of treatment and follow-up were analyzed. Avascular necrosis was found in 14 percent of the hips, classified as mild (49%), moderate (14%), and severe (37%). The differences between mild and severe cases were significant as regards age at the onset of treatment (p 0.006); with higher average age in mild forms, and degree of dislocation (p 0.01) with higher values in severe forms. The older the child was at the onset of treatment, the greater the risk of necrosis, notably if treatment was begun after 6 months of age. However, the incidence of the more severe cases was higher in the group up to 6 month of age. In general, avascular necrosis was more likely to occur in cases with high degree of initial dislocation and the differences between groups with low and high degree of dislocation were significant. In the group with highest initial dislocation the number of both mild and severe forms was high. Part II evaluated the growth and remodeling of the hip joint with avascular necrosis after nonoperative treatment of developmental dislocation on the basis of conventional radiography. An attempt was also made to determine the correlation between the severity of necrosis as seen in conventional radiography and the clinical and radiographic appearance of the hip after completion of growth. Finally the prognostic value of conventional radiography in prediction of deformities of the proximal femur due to necrosis was estimated. 68 patients with 98 involved hips treated exclusively nonoperatively for developmental dislocation of the hip in whom avascular necrosis developed were selected for the study. The average age at the time when the final radiograph was made was 25 (18-36) years and the average follow-up period was 23 (18-35) years. 16 patients (27 hips) were examined twice after completion of growth with the time interval of 10 years, the second examination being at an average age of 30 (26-36) years. In this group also progress of signs and symptoms of degenerative changes in clinical and radiographic examination was noted. To achieve sufficient data necessary to establish indications for further operative treatment in 2 patients also CT examinations with three-dimensional surface reconstruction were performed after physeal closure. Physical examinations were performed in all patients after completion of growth. Radiographs made before the onset of treatment for developmental dislocation of the hip, during treatment, at the child's age of 4-6 years, all obtained until the cessation of growth, and at final assessment, were studied. By physical evaluation 77 hips were rated as excellent or good, being pain free or with only occasional mild pain after walking long distances, with a good range of hip motion and negative Trendelenburg sign. The reasons for 21 fair or poor clinical end-results were pain, mostly with activity, and limp due to pain and abductor weakness. By radiographic evaluation in this group there were 50 hips rated as excellent or good, and 48 hips rated as fair or poor. In 29 hips excellent or good clinical findings at final review contrasted with fair or poor radiographic scores. In no case fair or poor clinical end-result coexisted with excellent radiographic ones. In the group examined twice after completion of growth with the time interval of 10 years no difference in clinical score was found in

[Long-term clinical assessment of the hip joint after conservative treatment for development dislocation complicated by avascular necrosis]. / Odlegla ocean kliniczna stawów biodrowych po leczeniu nieoperacyjnym wrodzonego zwichniecia powiklanego zaburzeniami odzywczymi.

Clinical assessment of 61 hips in 36 adult patients treated in the past nonoperatively due to developmental dislocation of hip and affected with avascular necrosis of the proximal femur has been used as a base to present the fate of these joints. An attempt to relate the of avascular necrosis and clinical symptoms at the termination of growth has been made; clinical and radiographic examinations were compared with each other. At the final evaluation 30 excellent results were found, 20 good, 8 fair, and 3 cases were rated as poor. Clinical symptoms (pain, limp, extremity shortening, Trendelenburg and Duchenne signs) were present chiefly in cases of the most severe avascular necrosis of the femoral head and neck; in majority of patients clinical symptoms were present. Clinical outcome was usually more satisfactory than radiological one. Severity of avascular necrosis and deformity that followed clearly determined final clinical outcome.

Avascular necrosis after nonoperative treatment of developmental hip dislocation. Prognosis in 36 patients followed 17-26 years.

36 children (61 hips) who had nonoperative treatment of developmental hip dislocation with the Frejka pillow and developed avascular necrosis were followed-up for an average of 20 (17-26) years. The radiographic pattern of necrosis was classified into 5 types. At final follow-up after completion of growth, the radiographic outcome was excellent in 11 hips, good in 21, fair in 19, and poor in 10 hips. There was a close correlation between the pattern of necrosis and the outcome: all the poor results were observed in cases with changes also involving the metaphysis.

[Changes in the subcapital growth plate due to avascular necrosis after treatment for congenital hip dislocation in radiologic, tomographic and magnetic resonance examinations]. / Zmiany w chrzastce nasadowej podglowowej w nastepstwie zaburzen odzywczych po leczeniu wrodzonego zwichniecia biodra w badaniu radiologicznym i tomografii rezonansu magnetycznego.

The aim of this investigation was to compare magnetic resonance imaging and radiography in detecting subcapital growth plate changes due to avascular necrosis after treatment for congenital dislocation of the hip. MRI was done in 16 patients (21 hips) aged 8-12 (mean 10 years), treated because of CDH. Radiographs were also done in all cases. Comparison between these two imaging modalities revealed superiority of MRI in both imaging of normal subcapital physis and imaging of its disorders.

[Medial patellar plica of the knee in MR examination and arthroscopy]. / Fald maziowy przysrodkowy stawu kolanowego w badaniu MR i artroskopii.

MRI method of assessment of medio-patellar plica of the knee is presented. The results have been verified arthroscopically. Twenty seven patients have underwent MRI of the knee, arthroscopy followed in 15 cases. MRI revealed the plica in 15 patients, no plica was found in 5 cases and 3 examinations were not conclusive. Arthroscopy confirmed pathology in 9 cases; the plica was also found in one of "not conclusive" cases. MRI rendered 0.7 specificity, 0.9 sensitivity and positive prognostic value was 0.6. MRI proved to be highly sensitive but delivered no means to differentiate symptomatic and asymptomatic plicae.

[Magnetic resonance imaging and arthroscopy in meniscal and ligamentous injuries of the knee]. / Rezonans magnetyczny i artroskopia w uszkodzeniach lakotek i wiezadel krzyzowych stawu kolanowego.

A series of 37 patients after knee injury underwent magnetic resonance imaging, in 21 cases subsequent arthroscopy has been performed. All patients had previous clinical diagnosis of meniscal and/or anterior cruciate injury. The changes within the menisci and anterior cruciate ligament have been confirmed by MRI in 76 per cent and 81 per cent respectively. In conclusion magnetic resonance imaging and arthroscopy are complementary methods in the knee joint diagnostics.

[Remodeling of the hip joint with avascular necrosis during nonoperative treatment of congenital dysplasia, subluxation or dislocation]. / Przebudowa stawów biodrowych z zaburzeniami odzywczymi powstalymi w trakcie nieoperacyjnego leczenia ich wrodzonej dysplazji, podwichniecia i zwichniecia.

Radiological analysis of 61 hips in 32 children served to present natural history of the nonoperatively managed dysplastic hip affected with avascular necrosis of the proximal femur that appeared during treatment. An attempt to establish relationship between the degree of avascular necrosis and radiological state of the hip after growth termination has been made. Ossification disturbances within the femoral neck of some hips and its prognostic value for proximal femur deformity have been assessed. The final radiological assessment revealed 18 per cent excellent results, 34.4 per cent good, 31.2 per cent fair and 16.4 per cent poor results. In hips with changes limited to the femoral head fair and poor results combined constituted less then 25 per cent. If the femoral neck was also involved the percentage amounted to 71. The results accomplished allowed for creating an own prognostic classification of avascular necrosis of the hip.