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The tracheotomy site usually closes spontaneously after decannulation, but in rare cases, it develops into tracheocutaneous fistula. We experienced a case of tracheocutaneous fistula that was successfully treated with the combination of auricular cartilage grafting and sternocleidomastoid muscle flap. In this case, we performed the closure of tracheocutaneous fistula with a view to filling the tissue defect with soft tissue to prevent recurrence. The surgical procedure performed in this case was unique, which to our knowledge, has not been described previously. Herein, we report some findings obtained, together with a literature review. The patient was a 73-year-old male. Starting five months after tracheotomy, the closure of a tracheocutaneous fistula was attempted twice at an otolaryngology clinic, which resulted in recurrence. The patient visited our department with the desire to close the tracheocutaneous fistula. At the initial examination, we found a cutaneous fistula with a diameter of approximately 2 mm on the cranial side of the sternal notch and thinning of the surrounding tissue. Preoperative computed tomography (CT) showed a tracheal defect with a size of approximately 10 mm on the caudal side of the sternal notch. The surgery was performed under general anesthesia 10 months after tracheotomy. The platysma muscle was attached to elevate the skin flap, and the scarring at the cutaneous fistula opening was removed. The cartilage defect was 10×12 mm in size. A piece of cartilage was harvested from the posterior surface of the auricle (navicular fossa) and grafted to the tracheal opening. A part of the left sternocleidomastoid muscle body of the sternal head was dissected from the mandibular side using the sternal attachment site as a stalk and elevated. The muscle flap was rotated, with its tip folded back, doubled over, and fixed on top of the auricular cartilage graft. The platysma muscles were sutured together during which the skin flap suture line was shifted so that the suture line would not coincide with the tracheal fistula site. The course was favorable, with no recurrence for three years. In the closure of a tracheocutaneous fistula, two sides need to be considered: the trachea and the skin. The tracheal defect in the present case was larger than 10 mm in size and thus auricular cartilage grafting was performed. In addition, we filled the tissue defect with the soft tissue of a sternocleidomastoid muscle flap, which was a unique step. The combined use of auricular cartilage grafting and sternocleidomastoid muscle flap was effective for the closure of a refractory tracheocutaneous fistula.
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Synovial mesenchymal stem cells (sMSCs) have great potential for cartilage repair, but their therapeutic design to avoid adverse effects associated with unknown factors remains a challenge. In addition, because long-term preservation is indispensable to maintain high quality levels until implantation, it is necessary to reduce their fluctuations. This study aimed to investigate the properties and feasibility of novel scaffold-free tissue-engineered constructs using serum-free media and to develop long-term preservation methods. sMSCs were cultured in serum-free media, seeded at high density in a monolayer, and finally developed as a sheet-like construct called "gMSC1". The properties of frozen gMSC1 (Fro-gMSC1) were compared with those of refrigerated gMSC1 (Ref-gMSC1) and then examined by their profile. Chondrogenic differentiation potential was analyzed by quantitative real-time polymerase chain reaction and quantification of glycosaminoglycan content. Xenografts into the cartilage defect model in rats were evaluated by histological staining. gMSC1 showed nearly similar properties independent of the preservation conditions. The animal experiment demonstrated that the defect could be filled with cartilage-like tissue with good integration to the adjacent tissue, suggesting that gMSC1 was formed and replaced the cartilage. Furthermore, several chondrogenesis-related factors were significantly secreted inside and outside gMSC1. Morphological analysis of Fro-gMSC1 revealed comparable quality levels to those of fresh gMSC1. Thus, if cryopreserved, gMSC1, with no complicated materials or processes, could have sustained cartilage repair capacity. gMSC1 is a prominent candidate in novel clinical practice for cartilage repair, allowing for large quantities to be manufactured at one time and preserved for a long term by freezing. Supplementary Information: The online version contains supplementary material available at 10.1007/s10616-024-00637-y.
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Cartilage defects caused by joint diseases are difficult to treat clinically. Tissue engineering materials provide a new means to promote the repair of cartilage defects. The purpose of this study is to design a novel scaffold of porous magnesium alloy loaded with icariin and sustained release in order to explore the effect and possible mechanism of this scaffold in repairing SD rat knee articular cartilage defect. We constructed a novel type of icariin/porous magnesium alloy scaffold, observed the structure of the scaffold by electron microscope, detected the drug release of icariin in the scaffold and the biological safety, and established an animal model of cartilage defect in the femoral intercondylar fossa of the knee joint in rats; the scaffold was placed in the defect. After 12 weeks of repair, the rat knee articular cartilage repair was evaluated by gross specimens and micro-CT, HE, safranin O-fast green, and toluidine blue staining combined with the modified Mankin's score. The protein expressions of the Wnt/ß-catenin signaling pathway-related factors (ß-catenin, Wnt5a, Wnt1, sFRP1) and chondrogenic differentiation-related factors (Sox9, Aggrecan, Col2α1) were detected by immunohistochemical staining. We found that the novel scaffold of icariin/porous magnesium alloy can release icariin slowly and has biosafety in rats. Compared with other groups, icariin/porous magnesium alloy can significantly promote the repair of cartilage defects and the expressions of ß-catenin, Wnt5a, Wnt1, Sox9, Aggrecan, and Col2α1 (P < 0.05). This novel scaffold can promote the repair of rat knee cartilage defects, and this process may be achieved by activating the Wnt/ß-catenin signaling pathway.
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Cartilage defects present a significant challenge in orthopedic medicine, often leading to pain and functional impairment. To address this, human amnion, a naturally derived biomaterial, has gained attention for its potential in enhancing cartilage regeneration. This systematic review aims to evaluate the efficacy of human amnion in enhancing cartilage regeneration for full-thickness cartilage defects. An electronic search was conducted on MEDLINE-PubMed, Web of Science (WoS), and the Scopus database up to 27 December 2023 from 2007. A total of 401 articles were identified. After removing 125 duplicates and excluding 271 articles based on predetermined criteria, only 5 articles remained eligible for inclusion in this systematic review. All five eligible articles conducted in vivo studies utilizing rabbits as subjects. Furthermore, analysis of the literature reveals an increasing trend in the frequency of utilizing human amnion for the treatment of cartilage defects. Various forms of human amnion were utilized either alone or seeded with cells prior to implantation. Histological assessments and macroscopic observations indicated usage of human amnion improved cartilage repair outcomes. All studies highlighted the positive results despite using different forms of amnion tissues. This systematic review underscores the promising role of human amnion as a viable option for enhancing cartilage regeneration in full-thickness cartilage defects, thus offering valuable insights for future research and clinical applications in orthopedic tissue engineering.
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Objective: This dextran-tyramine hydrogel is a novel cartilage repair technique, filling focal cartilage defects to provide a cell-free scaffold for subsequent cartilage repair. We aim to asses this techniques' operative feasibility in the knee joint and its ability to maintain position and integrity under expected loading conditions. Method: Seven fresh-frozen human cadaver legs (age range 55-88) were used to create 30 cartilage defects on the medial and lateral femoral condyles dependent of cartilage quality, starting with 1.0 âcm2; augmenting to 1.5 âcm2 and eventually 2.0 âcm2. The defects were operatively filled with the injectable hydrogel scaffold. The knees were subsequently placed on a continues passive motion machine for 30 âmin of non-load bearing movement, mimicking post-operative rehabilitation. High resolution digital photographs documented the hydrogel scaffold after placement and directly after movement. Three independent observers blinded for the moment compared the photographs on outline attachment, area coverage and hydrogel integrity. Results: The operative procedure was uncomplicated in all defects, application of the hydrogel was straightforward and comparable to common cartilage repair techniques. No macroscopic iatrogenic damage was observed. The hydrogel scaffold remained predominately unchanged after non-load bearing movement. Outline attachment, area coverage and hydrogel integrity were unaffected in 87%, 93% and 83% of defects respectively. Larger defects appear to be more affected than smaller defects, although not statistically significant (p â> â0.05). Conclusion: The results of this study show operative feasibility of this cell-free hydrogel scaffold for chondral defects of the knee joint. Sustained outline attachment, area coverage and hydrogel integrity were observed after non-load bearing knee movement.
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Treating bone-cartilage defects is a fundamental clinical problem. The ability of damaged cartilage to self-repair is limited due to its avascularity. Left untreated, these defects can lead to osteoarthritis. Details of osteochondral defect repair are elusive, but animal models indicate healing occurs via an endochondral ossification-like process, similar to that in the growth plate. In the growth plate, the signalling molecules parathyroid hormone-related protein (PTHrP) and Indian Hedgehog (Ihh) form a feedback loop regulating chondrocyte hypertrophy, with Ihh inducing and PTHrP suppressing hypertrophy. To better understand this repair process and to explore the regulatory role of signalling molecules on the regeneration process, we formulate a reaction-diffusion mathematical model of osteochondral defect regeneration after chondrocyte implantation. The drivers of healing are assumed to be chondrocytes and osteoblasts, and their interaction via signalling molecules. We model cell proliferation, migration and chondrocyte hypertrophy, and matrix production and conversion, spatially and temporally. We further model nutrient and signalling molecule diffusion and their interaction with the cells. We consider the PTHrP-Ihh feedback loop as the backbone mechanisms but the model is flexible to incorporate extra signalling mechanisms if needed. Our mathematical model is able to represent repair of osteochondral defects, starting with cartilage formation throughout the defect. This is followed by chondrocyte hypertrophy, matrix calcification and bone formation deep inside the defect, while cartilage at the surface is maintained and eventually separated from the deeper bone by a thin layer of calcified cartilage. The complete process requires around 48 months. A key highlight of the model demonstrates that the PTHrP-Ihh loop alone is insufficient and an extra mechanism is required to initiate chondrocyte hypertrophy, represented by a critical cartilage density. A parameter sensitivity study reveals that the timing of the repair process crucially depends on parameters, such as the critical cartilage density, and those describing the actions of PTHrP to suppress hypertrophy, such as its diffusion coefficient, threshold concentration and degradation rate.
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Condrócitos , Proteínas Hedgehog , Modelos Biológicos , Proteína Relacionada ao Hormônio Paratireóideo , Transdução de Sinais , Condrócitos/metabolismo , Proteína Relacionada ao Hormônio Paratireóideo/metabolismo , Animais , Proteínas Hedgehog/metabolismo , Humanos , Proliferação de Células , Regeneração/fisiologia , Movimento CelularRESUMO
Articular cartilage defects are common injuries of the knee. The defects often progress in size and produce significant clinical symptoms due to the lack of intrinsic repair or regenerative capacity of articular cartilage. With the failure of nonoperative treatment options, surgical treatment is indicated and includes palliative, reparative, and regenerative options. For large defects of the femoral condyles, trochlea, or patella, autologous chondrocyte implantation can provide successful and long-lasting results. Presented is the case of a 37-year-old male with an 18-year follow-up to autologous chondrocyte implantation for extensive left knee articular cartilage defects of the medial and lateral femoral condyles. Recovery from articular cartilage defects is shown through both clinical improvement of the patient and arthroscopic photographs of robust autologous articular cartilage on the medial femoral condyle. This case supports the long-term benefits of autologous chondrocyte implantation as a surgical intervention for large, full-thickness articular cartilage defects of the knee.
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BACKGROUND: The surgical management of large osteochondral lesions of the femoral head in young, active patients remains controversial. Fresh osteochondral allograft (OCA) transplantation can be a highly effective treatment for these lesions in some patients. This study investigated survivorship as well as clinical and radiographic outcomes after fresh OCA transplantation at a minimum 2-year follow-up (mean, 6.6 years; range, 0.6 to 13.7 years). METHODS: A retrospective review of 29 patients who underwent plug OCA transplantation for focal femoral head osteochondral lesions between 2008 and 2021 was performed. 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 osteoarthritis severity. Kaplan-Meier survivorship analyses with 95% confidence intervals (CIs) were performed for the endpoint of conversion to total hip arthroplasty (THA). RESULTS: Overall graft survivorship for included patients was 78.4% (95% CI: 62.9 to 93.9) and 62.7% (95% CI: 39.6 to 85.8) at 5 and 10 years, respectively. There were ten patients (34.5%) who underwent conversion to THA. There was a significant difference using the log-rank test between survival for patients who had a preoperative diagnosis of osteonecrosis (ON) versus those who had other diagnoses (P = .002). The ten-year survival for those who had ON was 41.8% (95% CI: 4.8 to 78.8), and the ten-year survival for diagnoses other than ON was 85.7% (95% CI: 59.8 to 100). The mean mHHS score improved significantly (P < .001) from 48.9 (19 to 84) preoperatively to 77.4 (35 to 100) at the final follow-up. There were twenty patients (69.0%) who had mHHS ≥ 70 at the latest follow-up. Arthritic progression, indicated by an increase in the Kellgren and Lawrence grade, occurred in 7 hips (26.9%). CONCLUSIONS: An OCA transplantation is a viable treatment option for osteochondral defects of the femoral head in young, active patients who have minimal preexisting joint deformity. It may delay the progression of arthritis and the need for THA. Patients who had a preoperative diagnosis of ON had worse clinical outcomes than those who had other diagnoses.
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Aloenxertos , Transplante Ósseo , Cabeça do Fêmur , Humanos , Masculino , Feminino , Adulto , Estudos Retrospectivos , Seguimentos , Cabeça do Fêmur/transplante , Cabeça do Fêmur/cirurgia , Resultado do Tratamento , Pessoa de Meia-Idade , Transplante Ósseo/métodos , Adulto Jovem , Adolescente , Cartilagem Articular/cirurgia , Transplante Homólogo , Artroplastia de Quadril/métodos , Sobrevivência de EnxertoRESUMO
The therapeutic potential of tissue engineering in addressing articular cartilage defects has been a focal point of research for numerous years. Despite its promising outlook, a persistent challenge within this domain is the lack of sufficient functional integration between engineered and natural tissues. This study introduces a novel approach that employs a combination of sulforaphane (SFN) nanoemulsion and tannic acid to enhance cartilage tissue engineering and promote tissue integration in a rat knee cartilage defect model. To substantiate our hypothesis, we conducted a series of in vitro and in vivo experiments. The SFN nanoemulsion was characterized using DLS, zeta potential, and TEM analyses. Subsequently, it was incorporated into a ternary polymer hydrogel composed of chitosan, gelatin, and polyethylene glycol. We evaluated the hydrogel with (H-SFN) and without (H) the SFN nanoemulsion through a comprehensive set of physicochemical, mechanical, and biological analyses. For the in vivo study, nine male Wistar rats were divided into three groups: no implant (Ctrl), H, and H-SFN. After inducing a cartilage defect, the affected area was treated with tannic acid and subsequently implanted with the hydrogels. Four weeks post-implantation, the harvested cartilage underwent histological examination employing H&E, safranin O/fast green, alcian blue, and immunohistochemistry staining techniques. Our results revealed that the SFN nanodroplets had an average diameter of 75 nm and a surface charge of -11.58 mV. Moreover, degradation, swelling rates, hydrophilicity, and elasticity features of the hydrogel incorporating SFN were improved. Histopathological analysis indicated a higher production of GAGs and collagen in the H-SFN group. Furthermore, the H-SFN group exhibited superior cartilage regeneration and tissue integration compared to the Ctrl and H groups. In conclusion, the findings of this study suggest the importance of considering cell protective properties in the fabrication of scaffolds for knee cartilage defects, emphasizing the potential significance of the proposed SFN nanoemulsion and tannic acid approach in advancing the field of cartilage tissue engineering.
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Cartilagem Articular , Quitosana , Emulsões , Gelatina , Hidrogéis , Isotiocianatos , Polietilenoglicóis , Sulfóxidos , Taninos , Engenharia Tecidual , Taninos/química , Taninos/farmacologia , Animais , Quitosana/química , Hidrogéis/química , Hidrogéis/farmacologia , Gelatina/química , Ratos , Cartilagem Articular/efeitos dos fármacos , Isotiocianatos/farmacologia , Isotiocianatos/química , Polietilenoglicóis/química , Masculino , Engenharia Tecidual/métodos , Ratos Wistar , Alicerces Teciduais/química , Nanopartículas/química , PolifenóisRESUMO
PURPOSE: This study aims to compare the mid-term functional outcomes of microfracture and mosaicplasty techniques in talus osteochondral lesions. MATERIALS AND METHODS: This study consists of 47 patients with talus osteochondral lesions who underwent arthroscopic surgery. These patients were divided into two groups: microfracture (28 patients) and mosaicplasty (19 patients). The American Orthopedic Foot and Ankle Society (AOFAS) scoring system was used to evaluate ankle function, and the Visual Analog Scale (VAS) score was used for pain assessment. RESULTS: The mean follow-up period was 26 months (range 10-36 months). It was determined that the mean preoperative AOFAS score of individuals in the mosaicplasty group was 38.84±2.83, and the postoperative AOFAS score was 78.79±3.91. A statistically significant difference was found between the two measurements of AOFAS scores (preoperative and postoperative) in the mosaicplasty group (*t=33.756; p<0.001). The effect size for this difference observed in the mosaicplasty group was determined to be r=0.992 (large). Similarly, a statistically significant difference was found between the two measurements of AOFAS scores (preoperative and postoperative) in the microfracture group (*t=28.152; p<0.001). The effect size for this difference observed in the microfracture group was determined to be r=0.983 (large). CONCLUSION: We believe that both treatment methods have similar positive effects on pain and ankle function. However, larger controlled studies with longer follow-up periods are needed to reach a definitive conclusion.
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Articular cartilage defect is challenged by insufficient regenerative ability of cartilage. Catalpol (CA), the primary active component of Rehmanniae Radix, could exert protective effects against various diseases. However, the impact of CA on the treatment of articular cartilage injuries is still unclear. In this study, full-thickness articular cartilage defect was induced in a mouse model via surgery. The animals were intraperitoneally injected with CA for 4 or 8 weeks. According to the results of macroscopic observation, micro-computed tomography CT (µCT), histological and immunohistochemistry staining, CA treatment could promote mouse cartilage repair, resulting in cartilage regeneration, bone structure improvement and matrix anabolism. Specifically, an increase in the expression of CD90, the marker of mesenchymal stem cells (MSCs), in the cartilage was observed. In addition, we evaluated the migratory and chondrogenic effects of CA on MSCs. Different concentration of CA was added to C3H10 T1/2 cells. The results showed that CA enhanced cell migration and chondrogenesis without affecting proliferation. Collectively, our findings indicate that CA may be effective for the treatment of cartilage defects via stimulation of endogenous MSCs.
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Doenças das Cartilagens , Cartilagem Articular , Glucosídeos Iridoides , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais , Animais , Camundongos , Cartilagem Articular/patologia , Microtomografia por Raio-X , Diferenciação Celular , Doenças das Cartilagens/metabolismo , Transplante de Células-Tronco Mesenquimais/métodos , CondrogêneseRESUMO
Background: While an association between femoroacetabular impingement (FAI) and osteoarthritis (OA) has been reported, the mechanistic differences and transition between the 2 conditions is not fully understood. In FAI, cartilage lesions at the femoral head-neck junction can sometimes be visualized during hip arthroscopy. Purpose/Hypothesis: The purpose of this study was to describe a unique dimpled pattern of superficial fissured cartilage lesions on the femoral head-neck junction at impingement site in patients with FAI syndrome (FAIS) and to evaluate the clinical, histological, and genetic phenotype of this cartilage. We hypothesized that the cartilage lesions may indicate risk for, or predict occurrence of, OA. Study Design: Controlled laboratory study. Methods: Six hips (6 patients; mean age, 34.2 ± 12.9 years; range, 19-54 years) with dimpled or fissured cartilage were included among patients who underwent hip arthroscopy for treatment of FAIS from October 2020 through December 2021. This affected cartilage (dimple-pattern group) and normal cartilage (control group) on the femoral head-neck junction were collected from the same patients and evaluated for histological quantification by Mankin scores and expression of proteins related to cartilage degeneration (eg, matrix metalloproteinase [MMP]-1, MMP-2, MMP-3, MMP-10, and MMP-12, tissue inhibitor of metalloproteinase [TIMP]-1 and TMP-2, aggrecan neopepitope CS846, and hyaluronic acid [HA]) with the use of Milliplex Multiplex Assays. Results: All 6 hips were of the mixed FAI subtype. Preoperatively, 4 of 6 hips had Tönnis grade 1 radiographic changes, which was associated with greater femoral head chondral damage visualized intraoperatively. Mankin scores for the normal cartilage group and the dimple-pattern group were 0.67 ± 0.82 and 3.3 ± 0.82, respectively. Dimple pattern fissured cartilage showed a significant increase in Mankin score (P = .031) and a significant increase in protein expression of CS846 (P = .031) compared with normal cartilage. There were no significant differences in MMPs, TIMPs, or HA levels between the 2 groups. Conclusion: The dimple pattern fissured cartilage, compared to normal cartilage, showed histologically significant cartilage degeneration and a significant increase in protein expression of CS846, a biomarker for early OA. Clinical Relevance: This lesion serves as helpful visual indicator of early degeneration of the cartilage of femoral head-neck junction caused by FAIS.
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OBJECTIVES: Thumb carpometacarpal arthritis has a high incidence. However, the degree of damage to the cartilage has not been accurately assessed. The purpose of this study was to examine the effects of axial traction of the thumb carpometacarpal joint during magnetic resonance imaging (MRI) on the visibility of articular cartilage in patients with thumb carpometacarpal arthritis and to evaluate the articular cartilage defect using MRI findings. MATERIALS AND METHODS: Forty-four patients with thumb carpometacarpal arthritis (14 males, 30 females) and a mean age of 67.3±8.6 years were classified according to Eaton Stages 1, 2, 3, and 4 in 2, 14, 24, and 4 patients, respectively. Axial traction MRI was performed with and without traction (3 kg) using 3-Tesla MRI (Siemens Magnetom Skyra) with a 3D T2* multiecho data imaging combination. The effectiveness of traction was verified using the joint space width before and after traction at five points (central, volar, dorsal, radial, and ulnar margins) and the original articular cartilage outline visibility classification (poor, intermediate, complete). The rate of remaining cartilage on each joint surface was also evaluated. Statistical significance was set at p<0.05 in this study. RESULTS: Joint space width increased significantly at all points with traction (P<0.01). The grade of articular cartilage outline visibility significantly improved from seven intermediate and 37 poor cases to 15 complete, 23 intermediate, and six poor cases (P<0.01). Significantly more articular cartilage remained in Stages 1-2 compared with Stages 3-4 arthritis of both articular surfaces (P<0.01 in first metacarpal, P=0.01 in trapezium). CONCLUSION: Axial traction of the thumb increased the joint space width and improved articular cartilage visibility in the thumb carpometacarpal joint. Our results suggested that axial traction MRI can be used for noninvasive evaluation of articular cartilage defects in patients with thumb carpometacarpal arthritis and aid in selecting the optimal surgical procedure.
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OBJECTIVE: To analyze the prognostic factors for clinical outcomes and cartilage regeneration after the implantation of allogeneic human umbilical cord blood mesenchymal stem cell (hUCB-MSC) for treating large-sized cartilage defects with osteoarthritis. DESIGN: This study is a case-series with multiple subgroup analyses that divides the included patients into multiple subgroups based on various factors. Overall, 47 patients who underwent hUCB-MSC implantation were included. The patient-reported outcomes, magnetic resonance imaging (MRI), and second-look arthroscopy were used to assess the outcomes. RESULTS: Combined realignment surgery significantly correlated with clinical outcomes, particularly pain. No other factors significantly influenced the clinical outcomes in short-term period. Subgroups with large defect sizes or meniscal insufficiency showed significantly poor MRI and arthroscopy outcomes (MRI, P = 0.001, P = 0.001; arthroscopy, P = 0.032, P = 0.042). The logistic regression showed that patients with a 1 cm2 larger defect size were 1.91 times less likely to achieve favorable MRI outcomes (P = 0.017; odds ratio [OR], 1.91). Cut-off value to predict the poor outcome was >5.7 cm2 (area under the curve, 0.756). A cartilage defect size >5.7 cm2 was the major poor prognostic factor for cartilage regeneration on MRI (P = 0.010; OR, 17.46). If the postoperative alignment shifted by 1° opposite to the cartilage defect, it was 1.4 times more likely to achieve favorable MRI outcomes (P = 0.028; OR, 1.4). CONCLUSION: Combining realignment surgery showed a better prognosis for pain improvement. Cartilage defect size, meniscal function, and postoperative alignment are significant prognostic factors for cartilage regeneration. A cartilage defect size >5.7 cm2 was significantly related to poor cartilage regeneration.
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Partial-thickness cartilage defect (PTCD) is a common and formidable clinical challenge without effective therapeutic approaches. The inherent anti-adhesive characteristics of the extracellular matrix within cartilage pose a significant impediment to the integration of cells or biomaterials with the native cartilage during cartilage repair. Here, an injectable photocrosslinked bioadhesive hydrogel, consisting of gelatin methacryloyl (GM), acryloyl-6-aminocaproic acid-g-N-hydroxysuccinimide (AN), and poly(lactic-co-glycolic acid) microspheres loaded with kartogenin (KGN) (abbreviated as GM/AN/KGN hydrogel), is designed to enhance interfacial integration and repair of PTCD. After injected in situ at the irregular defect, a stable and robust hydrogel network is rapidly formed by ultraviolet irradiation, and it can be quickly and tightly adhered to native cartilage through amide bonds. The hydrogel exhibits good adhesion strength up to 27.25 ± 1.22 kPa by lap shear strength experiments. The GM/AN/KGN hydrogel demonstrates good adhesion, low swelling, resistance to fatigue, biocompatibility, and chondrogenesis properties in vitro. A rat model with PTCD exhibits restoration of a smoother surface, stable seamless integration, and abundant aggrecan and type II collagen production. The injectable stable adhesive hydrogel with long-term chondrogenic differentiation capacity shows great potential to facilitate repair of PTCD.
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Anilidas , Condrogênese , Hidrogéis , Ácidos Ftálicos , Ratos , Animais , Hidrogéis/farmacologia , Hidrogéis/química , Preparações de Ação Retardada/farmacologia , CartilagemRESUMO
BACKGROUND: Cartilage transplantation is commonly used to treat large (>4 cm2) articular cartilage defects of the knee. The 2 most common transplants are osteochondral allograft transplantation and autologous chondrocyte implantation. Several patient-reported outcome measures (PROMs) have been used to determine the efficacy of treatment, but it is unknown which measures are the most effective. PURPOSE: To report the multiple PROMs used after large knee articular cartilage transplantation surgery and to compare the responsiveness between them. STUDY DESIGN: Meta-analysis; Level of evidence, 4. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search of the PubMed/MEDLINE and Web of Science databases was performed. A total of 181 articles met inclusion criteria. Patient and study characteristics were extracted, including pre- and postoperative means for PROMs. From the articles that met inclusion criteria for responsiveness analysis (2+ PROMs reported, 1-year minimum follow-up, reported pre- and postoperative means and standard deviations; n = 131), the authors compared the responsiveness between PROM instruments using effect size and relative efficiency (RE) if a PROM could be compared with another in ≥10 articles. RESULTS: A total of 10,015 patients (10,093 knees; mean age, 34.8 years; mean body mass index, 26.1) were included in this study. The mean follow-up time was 58.3 months (range, 1.5-247.2 months), imaging findings were reported in 80 articles (44.2%), patient satisfaction was reported in 39 articles (21.5%), and range of motion was reported in 10 articles (5.5%). There were 58 unique PROM instruments identified, with the most used being the International Knee Documentation Committee (IKDC) score (n = 118; 65.2%), followed by Knee injury and Osteoarthritis Outcome Score (KOOS) Pain (n = 58; 32.0%), KOOS Sport and Recreation (n = 58; 32.0%), KOOS Quality of Life (n = 57; 31.5%), KOOS Activities of Daily Living (n = 57; 31.5%), and KOOS Symptoms (n = 57; 31.5%). Overall, IKDC was found to have the greatest effect size (1.68) and the best responsiveness of the other PROMs, which include KOOS Pain (RE, 1.38), KOOS Symptoms (RE, 3.06), KOOS Activities of Daily Living (RE, 1.65), KOOS Sport and Recreation (RE, 1.44), Lysholm (RE, 1.76), and Tegner (RE, 1.56). CONCLUSION: The IKDC is the most responsive PROM after large knee articular cartilage transplantation surgery. The IKDC score is recommended for assessing outcomes after cartilage transplantation surgery.
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Cartilagem Articular , Articulação do Joelho , Medidas de Resultados Relatados pelo Paciente , Humanos , Cartilagem Articular/cirurgia , Articulação do Joelho/cirurgia , Transplante Autólogo , Traumatismos do Joelho/cirurgiaRESUMO
There has been increasing application of autologous costal chondral/osteochondral transplantation (ACCT/ACOT) and costa-derived chondrocyte implantation (ACCI) for articular cartilage repair over the past three decades. This review presents the major evidence on the properties of costal cartilage and bone and their qualifications as grafts for articular cartilage repair, the major clinical applications, and the risks and strategies for costal chondral/osteochondral graft(s) harvest. First, costal cartilage has many specific properties that help restore the articular surface. Costa, which can provide abundant cartilage and cylindrical corticocancellous bone, preserves permanent chondrocyte and is the largest source of hyaline cartilage. Second, in the past three decades, autologous costal cartilage-derived grafts, including cartilage, osteochondral graft(s), and chondrocyte, have expanded their indications in trauma and orthopaedic therapy from small to large joints, from the upper to lower limbs, and from non-weight-bearing to weight-bearing joints. Third, the rate of donor-site complications of ACCT or ACOT is low, acceptable, and controllable, and some skills and accumulated experience can help reduce the risks of ACCT and ACOT. Costal cartilage-derived autografting is a promising technique and could be an ideal option for articular chondral lesions with or without subchondral cysts. More high-quality clinical studies are urgently needed to help us further understand the clinical value of such technologies.
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Cartilagem Articular , Cartilagem Costal , Procedimentos Ortopédicos , Humanos , Cartilagem Articular/cirurgia , Cartilagem Articular/lesões , Condrócitos/transplante , Transplante AutólogoRESUMO
BACKGROUND: Recently, various types of engineered autologous chondrocyte implantation (ACI) have been developed. Atelocollagen-associated ACI (A-ACI) is the only ACI procedure covered by Japanese Health Insurance since 2013. The indications of the A-ACI are traumatic cartilage defects and osteochondral dissecans (OCD) for knee joints. PURPOSE: To evaluate midterm clinical results after A-ACI for the treatment for full-thickness cartilage defects of the knee. METHODS: Thirteen consecutive patients who underwent A-ACI between 2014 and 2018 had been prospectively enrolled in this study. There were 11 men and 2 women with a mean age of 34 years at the time of surgery. The causes of the cartilage defect were trauma in 10 knees and OCD in 3 knees. The total number of lesions was 15, which were comprised of the medial femoral condyle in 5 knees, the lateral femoral condyle in 5 knees, and the femoral trochlea in 5 knees. The mean size of the lesion was 5.3 cm2. Each knee was clinically and radiologically evaluated preoperatively and postoperatively. RESULTS: The mean Lysholm score improved significantly from 74.0 points to 94.0 points (p = 0.008) and each subscale in Knee injury and Osteoarthritis Outcome Score improved significantly (p < 0.001) at the mean final follow-up period of 51 months (range, 36-84 months). The magnetic resonance observation of cartilage repair tissue 2.0 score at the mean follow-up of 38 months was significantly higher than that at 2 months postoperatively (p = 0.014). According to the International Cartilage Repair Society (ICRS) grading scale, 3 knees were graded as normal, 3 knees as nearly normal, and 1 knee as severely abnormal in second-look arthroscopic evaluation at a mean of 22 months (range, 8-41 months) after A-ACI. CONCLUSION: The present study showed a significant subjective and objective clinical improvement in the A-ACI for large cartilage defects of the knee at a mean follow-up of 51 months (range, 36-84 months).
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Doenças das Cartilagens , Cartilagem Articular , Procedimentos Ortopédicos , Masculino , Humanos , Feminino , Adulto , Condrócitos/transplante , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/cirurgia , Cartilagem Articular/lesões , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Procedimentos Ortopédicos/métodos , Doenças das Cartilagens/diagnóstico por imagem , Doenças das Cartilagens/cirurgia , Transplante Autólogo/métodos , SeguimentosRESUMO
OBJECTIVES: To describe associations between MRI markers with knee symptoms in young adults. METHODS: Knee symptoms were assessed using the WOMAC scale during the Childhood Determinants of Adult Health Knee Cartilage study (CDAH-knee; 2008-2010) and at the 6- to 9-year follow-up (CDAH-3; 2014-2019). Knee MRI scans obtained at baseline were assessed for morphological markers (cartilage volume, cartilage thickness, subchondral bone area) and structural abnormalities [cartilage defects and bone marrow lesions (BMLs)]. Univariable and multivariable (age, sex, BMI adjusted) zero-inflated Poisson (ZIP) regression models were used for analysis. RESULTS: The participants' mean age in CDAH-knee and CDAH-3 were 34.95 (s.d. 2.72) and 43.27 (s.d. 3.28) years, with 49% and 48% females, respectively. Cross-sectionally, there was a weak but significant negative association between medial femorotibial compartment (MFTC) [ratio of the mean (RoM) 0.99971084 (95% CI 0.9995525, 0.99986921), P < 0.001], lateral femorotibial compartment (LFTC) [RoM 0.99982602 (95% CI 0.99969915, 0.9999529), P = 0.007] and patellar cartilage volume [RoM 0.99981722 (95% CI 0.99965326, 0.9999811), P = 0.029] with knee symptoms. Similarly, there was a negative association between patellar cartilage volume [RoM 0.99975523 (95% CI 0.99961427, 0.99989621), P = 0.014], MFTC cartilage thickness [RoM 0.72090775 (95% CI 0.59481806, 0.87372596), P = 0.001] and knee symptoms assessed after 6-9 years. The total bone area was negatively associated with knee symptoms at baseline [RoM 0.9210485 (95% CI 0.8939677, 0.9489496), P < 0.001] and 6-9 years [RoM 0.9588811 (95% CI 0.9313379, 0.9872388), P = 0.005]. The cartilage defects and BMLs were associated with greater knee symptoms at baseline and 6-9 years. CONCLUSION: BMLs and cartilage defects were positively associated with knee symptoms, whereas cartilage volume and thickness at MFTC and total bone area were weakly and negatively associated with knee symptoms. These results suggest that the quantitative and semiquantitative MRI markers can be explored as a marker of clinical progression of OA in young adults.
Assuntos
Doenças Ósseas , Doenças das Cartilagens , Cartilagem Articular , Osteoartrite do Joelho , Feminino , Humanos , Adulto Jovem , Criança , Masculino , Osteoartrite do Joelho/complicações , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Imageamento por Ressonância Magnética , Cartilagem/patologia , Medula Óssea/diagnóstico por imagem , Medula Óssea/patologia , Doenças Ósseas/complicações , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/patologiaRESUMO
BACKGROUND:Cartilage defects are one of the major clinical challenges faced by orthopedic surgeons.Tissue engineering is an interdisciplinary approach that combines knowledge of engineering and cell biology to provide new ideas and approaches for the repair of cartilage defects. OBJECTIVE:To prepare a multi-component composite scaffold based on silk fibroin,gelatin,and chitosan to screen for a three-dimensional porous scaffold suitable for cartilage regeneration by evaluating its physicochemical properties and biological performance. METHODS:Four groups of porous scaffolds were prepared by vacuum freeze-drying method using silk fibroin,gelatin and chitosan as the base materials,namely chitosan/gelatin scaffold,silk fibroin/chitosan scaffold,silk fibroin/gelatin scaffold and silk fibroin/chitosan/gelatin scaffold.The suitable cartilage scaffolds were screened by scanning electron microscopy,X-ray diffractometer,porosity,water absorption and swelling rate,biodegradation rate and mechanical property detection.Then cartilage scaffolds were co-cultured with chondrocytes isolated and extracted from patients with osteoarthritis.The feasibility of porous scaffolds for cartilage injury repair was evaluated in vitro by cell adhesion rate assay,cell live-dead staining and cell activity proliferation assay. RESULTS AND CONCLUSION:(1)All four groups of scaffolds had porous structures.The comprehensive physical performance test results showed that the silk fibroin/gelatin/chitosan scaffold was more in line with the requirements of cartilage defect repair.This scaffold had a pore size of(176.00±53.68)μm,the porosity of(80.15±2.57)%,and water absorption and swelling rate of(3 712±358)%.After immersion in PBS containing lysozyme for 28 days in vitro,the biodegradation rate was(46.87±3.25)%,and it had good mechanical properties.(2)Chondrocytes could adhere well on the silk fibroin/gelatin/chitosan scaffold,and the cell adhesion rate increased with time.CCK8 and live/dead cell double staining results showed that silk fibroin/gelatin/chitosan scaffold had good biocompatibility and low cytotoxicity.(3)The results showed that silk fibroin/gelatin/chitosan scaffold had a highly hydrated 3D structure,suitable pore size and porosity,good biodegradability and superior mechanical properties,which can provide a good reticular skeleton and microenvironment for nutrient transport and chondrocyte attachment and proliferation.