Osteochondral repair combining therapeutics implant with mesenchymal stem cells spheroids.

Functional articular cartilage regeneration remains challenging, and it is essential to restore focal osteochondral defects and prevent secondary osteoarthritis. Combining autologous stem cells with therapeutic medical device, we developed a bi-compartmented implant that could promote both articular cartilage and subchondral bone regeneration. The first compartment based on therapeutic collagen associated with bone morphogenetic protein 2, provides structural support and promotes subchondral bone regeneration. The second compartment contains bone marrow-derived mesenchymal stem cell spheroids to support the regeneration of the articular cartilage. Six-month post-implantation, the regenerated articular cartilage surface was 3 times larger than that of untreated animals, and the regeneration of the osteochondral tissue occurred during the formation of hyaline-like cartilage. Our results demonstrate the positive impact of this combined advanced therapy medicinal product, meeting the needs of promising osteochondral regeneration in critical size articular defects in a large animal model combining not only therapeutic implant but also stem cells.

Comparative effectiveness of nonsurgical interventions in the treatment of patients with knee osteoarthritis: A PRISMA-compliant systematic review and network meta-analysis.

BACKGROUND: To find out, based on the available recent randomized controlled trials (RCTs), if the nonsurgical interventions commonly used for knee osteoarthritis patients are valid and quantify their efficiency. METHODS: The database of MEDLINE and EMBASE were searched for RCTs evaluating nonsurgical treatment strategies on patients with mild to moderate knee osteoarthritis. A Bayesian random-effects network meta-analysis was performed. The primary outcome was the mean change from baseline in the Western Ontario and McMaster university (WOMAC) total score at 12 months. Raw mean differences with 95% credibility intervals were calculated. Treatments were ranked by probabilities of each treatment to be the best. RESULTS: Thirteen trials assessed 7 strategies with WOMAC at 12 months: injection of platelet rich plasma (PRP), corticosteroids, mesenchymal stem cells (MSCs), hyaluronic acid, ozone, administration of nonsteroidal anti-inflammatory drugs with or without the association of physiotherapy. For treatment-specific effect size, a greater association with WOMAC decrease was found significantly for MSCs (mean difference, -28.0 [95% CrI, -32.9 to -22.4]) and PRP (mean difference, -19.9 [95% CrI, -24.1 to -15.8]). Rank probabilities among the treatments indicated that MSCs had a much higher probability (P = .91) of being the best treatment compared with other treatments, while PRP ranked as the second-best treatment (P = .89). CONCLUSION: In this systematic review and network meta-analysis, the outcomes of treatments using MSCs and PRP for the management of knee osteoarthritis were associated with long-term improvements in pain and function. More high quality RCTs would be needed to confirm the efficiency of MSCs and PRP for the treatment of patients with knee osteoarthritis.

Computer-assisted total knee arthroplasty: comparative results in a preliminary series of 72 cases.

The aim of this study was to assess the value of navigation in achieving correct positioning of the implants and soft-tissue balance in total knee arthroplasty. We compared the axis alignment achieved in 72 LCS TKA's performed with navigation assistance to a historical cohort of 62 LCS TKA's implanted with the conventional instrumentation. The position of the tibial and femoral implants and the post-operative mechanical axes of the lower limbs were compared in the two series: there was a highly significant improvement in the alignment accuracy in the navigated series (p < 0.0001). There were no outliers in the computer-assisted series whereas 47% of the cases in the conventional series showed deviations of the mechanical axis of the lower limb of more than 2 degrees from neutral alignment. However, the position of the femoral implants in rotation was not improved, suggesting that there may be a need for a more refined technique for rotational alignment of the femur, which was based essentially in the present series on ligament balance in flexion. The height of the joint line was preserved in 89% of the cases, validating the empirical use of the spreader tool prototype used during the study. Navigation eases optimal ligament balancing, by providing information that is used for appropriate release of soft tissue to achieve the proper mechanical axis. No major complication related to the use of navigation was observed. Operation time was lengthened on average by 30 minutes. Long-term studies are necessary to show whether better accuracy in ligament balancing and higher precision in restoration of mechanical axes will improve the functional results and the survival rate of knee arthroplasty.