Microfractures and hydrogel scaffolds in the treatment of osteochondral knee defects: A clinical and histological evaluation.
J Clin Orthop Trauma
; 10(1): 67-75, 2019.
Article
en En
| MEDLINE
| ID: mdl-30705535
BACKGROUND: Osteochondral knee defects (OCD) are often symptomatic, causing pain and functional impairment even in young and active patients. Regenerative surgical options, aiming to stimulate natural cartilage healing, have been recently used as a first line treatment. In this study, a new hydrogel is investigated in its capacity to regenerate the ultra-structural quality of hyaline cartilage when combined with a classical microfracture technique. MATERIAL AND METHODS: Forty-six patients, affected by grade III and IV knee chondropathies, were consecutively treated between 2013 and 2015 with microfractures followed by application of a modern hydrogel in the lesion site. All patients underwent clinical evaluation (WOMAC) pre-operatively, at 6,12 and at 24 months postoperatively: the results were compared with a subsequent, consecutive, matched, control group of 23 patients treated with microfractures alone. In a parallel and separate in-vitro histological study, adipose derived mesenchymal stem cells (ADMSCs) were encapsulated in the hydrogel scaffold, induced to differentiation into chondrocytes, and observed for a 3 weeks period. RESULTS: The initial WOMAC score of 58.6⯱â¯11.0 in the study group was reduced by 88% at 6 months (7.1⯱â¯9.2) and 95% at 24 months (2.9⯱â¯5.9). The "in-vitro" study revealed a histological characterization typical of hyaline cartilage in study group. Separate biopsies performed at 12 months post-op in the study group also revealed type 2 collagen and hyaline-like cartilage in the regenerated tissue. CONCLUSION: Our study demonstrated high patient satisfaction rates after microfractures combined with a modern hydrogel scaffold; histologic evaluation supported the hypothesis of creating an enhanced chondrogenic environment. Microfracture "augmentation" using modern acellular biomaterials, like hydrogels, might improve the clinical outcomes of this classical bone marrow stimulating procedure.
ACI, autologous chondrocyte implantation; AMIC, Autologous Matrix Induced Chondrogenesis; ASCs, adipose mesenchymal stem cells; Arthroscopic; BMI, body mass index; BMS, bone marrow stem cells; BMS, bone marrow stimulation; Cartilage; Hydrogels; Knee; MACI, mixed-assisted chondrocyte implantation; Microfractures; OAT, osteochondral autograft transfer; OCA, Osteochondral allograft transplantation; OCD; OCD, osteochondral defect; Osteochondral defect; PG/GC, polyglucosamine/glucosamine carbonate; Scaffold; WOMAC, (Western Ontario and McMaster Universities Osteoarthritis Index); hASCs, Human adipose-derived stromal/stem cells
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Colección:
01-internacional
Base de datos:
MEDLINE
Idioma:
En
Revista:
J Clin Orthop Trauma
Año:
2019
Tipo del documento:
Article
País de afiliación:
Suiza
Pais de publicación:
India