Morphologic Properties of Cartilage Lesions in the Knee Arthroscopically Prepared by the Standard Curette Technique Are Inferior to Lesions Prepared by Specialized Chondrectomy Instruments

2017 ◽  
Vol 46 (4) ◽  
pp. 908-914 ◽  
Author(s):  
Adrian Blasiak ◽  
Graeme P. Whyte ◽  
Adrian Matlak ◽  
Roman Brzóska ◽  
Boguslaw Sadlik
Keyword(s):  
Cartilage Repair ◽  
Group Versus ◽  
Cartilage Lesion ◽  
Cartilage Defects ◽  
Repair Tissue ◽  
Treatment Groups ◽  
Cartilage Lesions ◽  
Morphologic Characteristics ◽  
Wall Profile

Background: Cartilage lesion preparation is an important component to cartilage repair procedures, given the effect of prepared lesion morphology on the formation of durable and well-integrated repair tissue. Purpose: To compare the quality of arthroscopic cartilage lesion debridement performed by (1) the standard curette (SC) technique and (2) specialized chondrectomy (CM) instruments, to provide technical guidance for optimization of cartilage lesion preparation in the setting of arthroscopic cartilage repair. Study Design: Controlled laboratory study. Methods: Articular cartilage lesions of standardized size (8 × 15 mm) were demarcated within the trochlea and femoral condyles of 20 human cadaver knee specimens. Orthopaedic surgeons performed arthroscopic lesion preparation using 2 techniques that consisted of SC preparation and preparation by CM instruments. A histologic comparative analysis was performed within each treatment group and between treatment groups to evaluate the morphology of prepared cartilage defects. Results: The mean angle deviation from perpendicular of the cartilage wall at the front of the prepared cartilage lesions was significantly greater in the SC group versus the CM group (29.8° ± 21.4° vs 7.7° ± 7.6°, P < .001). In lesions prepared via the SC technique, the cartilage walls at the front of the prepared lesions were significantly less perpendicular than the cartilage walls at the rear of the lesions (29.8° ± 21.4° vs 11.0° ± 10.3°, P < .001), whereas lesions prepared by the CM technique demonstrated comparable verticality of surrounding cartilage walls at the front and rear aspects of the lesions (7.7° ± 7.6° vs 9.4° ± 12.3°, P = .827). Depth of lesion debridement was accomplished to the target level by the CM technique in 86% of prepared lesions, compared with 34% of lesions in the SC group. The prepared cartilage wall profile was characterized as the most ideal morphology in 55% of prepared lesions in the CM group, as opposed to 10% in the SC group. Conclusion: Arthroscopic cartilage lesion preparation with SC instruments results in superior perpendicularity of surrounding cartilage walls to subchondral bone and greater consistency of debrided lesion depth, as compared with the standard debridement technique with curettes. Clinical Relevance: Arthroscopic preparation using standard curette technique leads to suboptimal morphologic characteristics of prepared lesions that likely affect the quality of repair tissue, compared to preparation using specialized chondrectomy instruments.

scholarly journals Microfracture Versus Drilling of Articular Cartilage Defects: A Systematic Review of the Basic Science Evidence

2020 ◽  
Vol 8 (8) ◽  
pp. 232596712094531 ◽  
Author(s):  
Matthew J. Kraeutler ◽  
Gianna M. Aliberti ◽  
Anthony J. Scillia ◽  
Eric C. McCarty ◽  
Mary K. Mulcahey
Keyword(s):  
Systematic Review ◽  
Articular Cartilage ◽  
Cartilage Repair ◽  
Basic Science ◽  
Science Studies ◽  
Cartilage Regeneration ◽  
Cartilage Defects ◽  
Repair Tissue ◽  
Marrow Stimulation

Background: Microfracture (MFx) is one of the most common techniques used for the treatment of articular cartilage defects, although recently there has been a trend toward the use of drilling rather than MFx for the treatment of these defects. Purpose: To perform a systematic review of basic science studies to determine the effect of microfracture versus drilling for articular cartilage repair. Study Design: Systematic review. Methods: A systematic review was performed by searching PubMed, the Cochrane Library, and EMBASE to identify basic science studies comparing outcomes of MFx versus drilling. The search phrase used was microfracture AND (drilling OR microdrilling). Inclusion criteria were basic science studies that directly compared the effect of MFx versus drilling on subchondral bone, bone marrow stimulation, and cartilage regeneration. Results: A total of 7 studies met the inclusion criteria and were included in this systematic review. Of these, 4 studies were performed in rabbits, 1 study in sheep, and 2 studies in humans. All of the included studies investigated cartilage repair in the knee. In the animal studies, microfracture produced fractured and compacted bone and led to increased osteocyte necrosis compared with drilling. Deep drilling (6 mm) was superior to both shallow drilling (2 mm) and MFx in terms of increased subchondral hematoma with greater access to marrow stroma, improved cartilage repair, and increased mineralized bone. However, the overall quality of cartilage repair tissue was poor regardless of marrow stimulation technique. In 2 studies that investigated repair tissue after MFx and/or drilling in human patients with osteoarthritis and cartilage defects, the investigators found that cartilage repair tissue did not achieve the quality of normal hyaline articular cartilage. Conclusion: In the limited basic science studies that are available, deep drilling of cartilage defects in the knee resulted in improved biological features compared with MFx, including less damage to the subchondral bone and greater access to marrow stroma. Regardless of marrow stimulation technique, the overall quality of cartilage regeneration was poor and did not achieve the characteristics of native hyaline cartilage. Overall, there is a general lack of basic science literature comparing microfracture versus drilling for focal chondral defects.

scholarly journals Histological Analysis of Cartilage Defects Repaired with an Autologous Human Stem Cell Construct 48 Weeks Postimplantation Reveals Structural Details Not Detected by T2-Mapping MRI

Cartilage ◽  
2021 ◽  
pp. 194760352198942
Author(s):  
Kazunori Shimomura ◽  
Hidetoshi Hamada ◽  
David A. Hart ◽  
Wataru Ando ◽  
Takashi Nishii ◽  
...  
Keyword(s):  
Histological Analysis ◽  
T2 Mapping ◽  
Fibrous Tissue ◽  
Cartilage Lesion ◽  
Cartilage Defects ◽  
Autologous Tissue ◽  
Repair Tissue ◽  
Healthy Cartilage ◽  
Structural Details ◽  
Human Implantation

Objective The aim of this study was to elucidate the efficacy of T2-mapping MRI and correlation with histology for the evaluation of tissue repair quality following the first-in-human implantation of an autologous tissue engineered construct. Design We directly compared the results of T2-mapping MRI of cartilage repair tissue with the histology of a biopsy specimen from the corresponding area at 48 weeks postoperatively in 5 patients who underwent the implantation of a scaffold-free tissue-engineered construct generated from autologous synovial mesenchymal stem cells to repair an isolated cartilage lesion. T2 values and histological scores were compared at each of 2 layers of equally divided halves of the repair tissue (upper and lower zones). Results Histology showed that the repair tissue in the upper zone was dominated by fibrous tissue and the ratio of hyaline-like matrix increased with the depth of the repair tissue. There were significant differences between upper and lower zones in histological scores. Conversely, there were no detectable statistically significant differences in T2 value detected among zones of the repair tissue, but zonal differences were detected in corresponding healthy cartilage. Accordingly, there were no correlations detected between histological scores and T2 values for each repair cartilage zone. Conclusion Discrepancies in the findings between T2 mapping and histology suggest that T2 mapping was limited in ability to detect details in the architecture and composition of the repair cartilage.

scholarly journals A Prospective, Randomized, Open-Label, Multicenter, Phase III Noninferiority Trial to Compare the Clinical Efficacy of Matrix-Associated Autologous Chondrocyte Implantation With Spheroid Technology Versus Arthroscopic Microfracture for Cartilage Defects of the Knee

2019 ◽  
Vol 7 (7) ◽  
pp. 232596711985444 ◽  
Author(s):  
Philipp Niemeyer ◽  
Volker Laute ◽  
Wolfgang Zinser ◽  
Christoph Becher ◽  
Thomas Kolombe ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Cartilage Repair ◽  
Daily Living ◽  
Autologous Chondrocyte Implantation ◽  
Statistical Hypothesis ◽  
Cartilage Defects ◽  
Koos Score ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

Background:Autologous chondrocyte implantation (ACI) and microfracture are established treatments for large, full-thickness cartilage defects, but there is still a need to expand the clinical and health economic knowledge of these procedures.Purpose:To confirm the noninferiority of ACI compared with microfracture.Study Design:Randomized controlled trial; Level of evidence, 2.Methods:Patients were randomized to be treated with matrix-associated ACI using spheroid technology (n = 52) or microfracture (n = 50). Both procedures followed standard methods. Patients were assessed by the Knee injury and Osteoarthritis Outcome Score (KOOS), MOCART (magnetic resonance observation of cartilage repair tissue) scoring system, Bern score, modified Lysholm score, International Cartilage Repair Society (ICRS) rating (histological and immunochemical scoring after rebiopsy 24 months after implantation), and International Knee Documentation Committee (IKDC) examination form. The main assessments were conducted 24 months after study treatment.Results:In the primary intention-to-treat analysis, the overall KOOS score for both ACI and microfracture yielded a statistically significant improvement relative to baseline. According to the between-group analysis, ACI passed the test of noninferiority compared with microfracture; thus, the primary goal of the study was achieved. The KOOS subscores yielded the same qualitative results as the overall KOOS score (ie, for each of these, noninferiority was demonstrated), and in 1 case (Activities of Daily Living subscore), the threshold for superiority was passed. The subgroup analyses did not yield any clear evidence of an association between treatment effect and any of the categories investigated (age, diagnosis, defect localization, sex). A histological analysis of biopsies from 16 patients (ACI: n = 9; microfracture: n = 7) suggested a better quality of repair in the patients treated with ACI.Conclusion:The efficacy of both ACI and microfracture was demonstrated with respect to both functional outcomes and morphological repair. The primary analysis confirmed the statistical hypothesis of the noninferiority of ACI, even for relatively small cartilage defects (1-4 cm2) treated in this study, the indication for which microfracture is generally accepted as the standard of care. ACI showed significant superiority in the KOOS subscores of Activities of Daily Living at 24 months and Knee-related Quality of Life at 12 months.Registration:NCT01222559 ( ClinicalTrials.gov identifier).

First-in-Human Pilot Study of Implantation of a Scaffold-Free Tissue-Engineered Construct Generated From Autologous Synovial Mesenchymal Stem Cells for Repair of Knee Chondral Lesions

2018 ◽  
Vol 46 (10) ◽  
pp. 2384-2393 ◽  
Author(s):  
Kazunori Shimomura ◽  
Yukihiko Yasui ◽  
Kota Koizumi ◽  
Ryota Chijimatsu ◽  
David A. Hart ◽  
...  
Keyword(s):  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Magnetic Resonance ◽  
Cartilage Repair ◽  
Femoral Condyle ◽  
Chondral Lesions ◽  
Repair Tissue ◽  
Biopsy Specimens ◽  
Implantation Procedure

Background: Articular cartilage has limited healing capacity, owing in part to poor vascularity and innervation. Once injured, it cannot be repaired, typically leading to high risk for developing osteoarthritis. Thus, cell-based and/or tissue-engineered approaches have been investigated; however, no approach has yet achieved safety and regenerative repair capacity via a simple implantation procedure. Purpose: To assess the safety and efficacy of using a scaffold-free tissue-engineered construct (TEC) derived from autologous synovial membrane mesenchymal stem cells (MSCs) for effective cartilage repair. Study Design: Case series; Level of evidence, 4. Methods: Five patients with symptomatic knee chondral lesions (1.5-3.0 cm2) on the medial femoral condyle, lateral femoral condyle, or femoral groove were included. Synovial MSCs were isolated from arthroscopic biopsy specimens and cultured to develop a TEC that matched the lesion size. The TECs were then implanted into chondral defects without fixation and assessed up to 24 months postoperatively. The primary outcome was the safety of the procedure. Secondary outcomes were self-assessed clinical scores, arthroscopy, tissue biopsy, and magnetic resonance image–based estimation of morphologic and compositional quality of the repair tissue. Results: No adverse events were recorded, and self-assessed clinical scores for pain, symptoms, activities of daily living, sports activity, and quality of life were significantly improved at 24 months after surgery. Secure defect filling was confirmed by second-look arthroscopy and magnetic resonance imaging in all cases. Histology of biopsy specimens indicated repair tissue approaching the composition and structure of hyaline cartilage. Conclusion: Autologous scaffold-free TEC derived from synovial MSCs may be used for regenerative cartilage repair via a sutureless and simple implantation procedure. Registration: 000008266 (UMIN Clinical Trials Registry number).

No Effect of Platelet-Rich Plasma Injections as an Adjuvant to Autologous Cartilage Chips Implantation for the Treatment of Chondral Defects

Cartilage ◽  
2019 ◽  
pp. 194760351986531 ◽  
Author(s):  
Morten Lykke Olesen ◽  
Bjørn Borsøe Christensen ◽  
Casper Bindzus Foldager ◽  
Kris Chadwick Hede ◽  
Natasja Leth Jørgensen ◽  
...  
Keyword(s):  
Cartilage Repair ◽  
Platelet Rich Plasma ◽  
Fibrous Tissue ◽  
Histological Evaluation ◽  
Full Thickness ◽  
Tissue Quality ◽  
Repair Tissue ◽  
Treatment Groups ◽  
Chondral Defects ◽  
Significant Difference

Background Repair of chondral injuries using cartilage chips has recently demonstrated clinical feasibility. Autologous platelet-rich plasma (PRP) is a potential promising technique for improving healing response during cartilage repair. Purpose To assess the cartilage repair tissue quality after autologous cartilage chips treatment (CC) with and without repeated local injections of PRP for the treatment of full-thickness focal chondral defects of the knee. Materials and Methods Two full-thickness chondral defects (Ø = 6 mm) were created in the medial and lateral trochlea facets of each knee in 6 skeletally mature Göttingen minipigs. The 2 treatment groups were (1) CC with 1 weekly PRP injection for 3 weeks ( n = 12) and (2) CC alone ( n = 12). The animals were euthanized after 6 months. Samples of whole blood and PRP were analyzed for concentrations of platelets and nucleated cells. The composition of the cartilage repair tissue was assessed using gross appearance assessment, histomorphometry, and semiquantitative scoring (ICRS II). Results Histological evaluation demonstrated no significant difference in the content of hyaline cartilage (CC + PRP: 18.7% vs. CC: 19.6%), fibrocartilage (CC + PRP: 48.1% vs. CC: 51.8%), or fibrous tissue (CC + PRP: 22.7% vs. CC: 21.8%) between the treatment groups. Macroscopic evaluation did not demonstrate any difference between groups. Conclusions PRP injections after CC in the treatment of full-thickness cartilage injuries demonstrated no beneficial effects in terms of macroscopic and histologic composition of cartilage repair tissue.

Five-Year Outcome of Characterized Chondrocyte Implantation Versus Microfracture for Symptomatic Cartilage Defects of the Knee

2011 ◽  
Vol 39 (12) ◽  
pp. 2566-2574 ◽  
Author(s):  
Johan Vanlauwe ◽  
Daniel B.F. Saris ◽  
Jan Victor ◽  
Karl Fredrik Almqvist ◽  
Johan Bellemans ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Cartilage Repair ◽  
Clinical Benefit ◽  
Controlled Trial ◽  
Cartilage Lesion ◽  
Cartilage Defects ◽  
Level Of Evidence ◽  
Delayed Treatment ◽  
Chondrocyte Implantation ◽  
Femoral Condyles

Background: Characterized chondrocyte implantation (CCI) results in significantly better early structural tissue regeneration than microfracture (MF), and CCI has a midterm clinical benefit over microfracture. Purpose: This study was undertaken to evaluate the 5-year clinical outcome of CCI in a randomized comparison with MF for the treatment of symptomatic cartilage defects of the femoral condyles of the knee. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Participants aged 18 to 50 years with a symptomatic isolated International Cartilage Repair Society (ICRS) grade III or IV cartilage lesion of the femoral condyles between 1 and 5 cm2 were randomized to either CCI or MF. Clinical outcomes were measured up to 60 months after surgery using the Knee Injury and Osteoarthritis Outcome Score (KOOS). The main outcome parameter was change from baseline in overall KOOS (oKOOS). Adverse events were monitored. Results: Fifty-one participants were treated with CCI and 61 with MF. On average, clinical benefit was maintained through the 60-month follow-up period. The average change from baseline in oKOOS was not different between both groups (least squares [LS] mean ± standard error [SE] 18.84 ± 3.58 for CCI vs 13.21 ± 5.63 for MF; P = .116). Treatment failures were comparable (n = 7 in CCI vs n = 10 in MF), although MF failures tended to occur earlier. Subgroup analysis revealed that CCI resulted in better outcome in participants with time since symptom onset of less than 3 years, which was statistically significant and clinically relevant (change in oKOOS <3 years mean ± SE 25.96 ± 3.45 for CCI vs 15.28 ± 3.17 for MF; P = .026 vs oKOOS >3 years mean ± SE 13.09 ± 4.78 for CCI vs 17.02 ± 4.50 for MF, P = .554). Other subgroup analyses such as age (cutoff 35 years) did not show a difference. Female patients showed more failures irrespective of treatment. Conclusion: At 5 years after treatment, clinical outcomes for CCI and MF were comparable. In the early treatment group, CCI obtained statistically significant and clinically relevant better results than MF. Delayed treatment resulted in less predictable outcomes for CCI. These results provide strong evidence that time since onset of symptoms is an essential variable that should be taken into account in future treatment algorithms for cartilage repair of the knee.

Arthroscopic Evaluation of Radiofrequency Chondroplasty of the Knee

2007 ◽  
Vol 35 (10) ◽  
pp. 1702-1707 ◽  
Author(s):  
Ilya Voloshin ◽  
Kenneth R. Morse ◽  
C. Dain Allred ◽  
Scott A. Bissell ◽  
Michael D. Maloney ◽  
...  
Keyword(s):  
Case Series ◽  
Cartilage Defects ◽  
Long Term Effects ◽  
Level Of Evidence ◽  
Repair Tissue ◽  
Cartilage Lesions ◽  
Complete Filling ◽  
Bipolar Radiofrequency ◽  
Second Look ◽  
Partial Thickness

Background Considerable debate exists over the use of radiofrequency-based chondroplasty to treat partial-thickness chondral defects of the knee. This study used second-look arthroscopy to evaluate cartilage defects previously treated with bipolar radiofrequency—based chondroplasty. Hypothesis Partial-thickness articular cartilage lesions treated with bipolar radiofrequency—based chondroplasty will show no progressive deterioration. Study Design Case series; Level of evidence, 4. Methods One hundred ninety-three consecutive patients underwent bipolar radiofrequency—based chondroplasty over 38 months; 15 (25 defects treated with bipolar radiofrequency—based chondroplasty) underwent repeat arthroscopy for recurrent or new injuries. Time from the initial to repeat arthroscopy ranged from 0.7 to 32.7 months. At both procedures, the location, size, grade, and stability of lesions were evaluated, recorded, and photographed arthroscopically. Results At the initial procedure, 25 lesions treated using bipolar radiofrequency—based chondroplasty ranged from 9 to 625 mm2 (mean, 170.2 ± 131.2 mm2; median, 120 mm2); at second look, lesion size was 9 to 300 mm2 (mean, 107.7 ± 106.7 mm2; median, 100 mm2). At second look, 3 (12%) demonstrated unstable borders with damage in the surrounding cartilage that appeared to be progressive. Eight (32%) lesions were unchanged in size. Eight (32%) demonstrated partial filling with stable repair tissue, and 6 (24%) demonstrated complete filling with stable repair tissue. Lesions in the tibiofemoral compartments showed better response to radiofrequency chondroplasty than did those within the patellofemoral joint (P < .05). Conclusion Only 3 of 25 lesions demonstrated progression. More than 50% showed partial or complete filling of the defect. Bipolar radiofrequency chondroplasty is an effective way to treat partial-thickness cartilage lesions; however, long-term effects of this treatment on cartilage remain unknown.

scholarly journals Human adipose-derived stromal/stem cells expressing doublecortin improve cartilage repair in rabbits and monkeys

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Dongxia Ge ◽  
Michael J. O’Brien ◽  
Felix H. Savoie ◽  
Jeffrey M. Gimble ◽  
Xiying Wu ◽  
...  
Keyword(s):  
Stem Cells ◽  
Cartilage Repair ◽  
Cartilage Tissue ◽  
Cartilage Defects ◽  
Cartilage Lesions ◽  
Tissue Constructs ◽  
Relieve Pain ◽  
Engineered Cartilage ◽  
Stromal Stem Cells

AbstractLocalized cartilage lesions in early osteoarthritis and acute joint injuries are usually treated surgically to restore function and relieve pain. However, a persistent clinical challenge remains in how to repair the cartilage lesions. We expressed doublecortin (DCX) in human adipose-derived stromal/stem cells (hASCs) and engineered hASCs into cartilage tissues using an in vitro 96-well pellet culture system. The cartilage tissue constructs with and without DCX expression were implanted in the knee cartilage defects of rabbits (n = 42) and monkeys (n = 12). Cohorts of animals were euthanized at 6, 12, and 24 months after surgery to evaluate the cartilage repair outcomes. We found that DCX expression in hASCs increased expression of growth differentiation factor 5 (GDF5) and matrilin 2 in the engineered cartilage tissues. The cartilage tissues with DCX expression significantly enhanced cartilage repair as assessed macroscopically and histologically at 6, 12, and 24 months after implantation in the rabbits and 24 months after implantation in the monkeys, compared to the cartilage tissues without DCX expression. These findings suggest that hASCs expressing DCX may be engineered into cartilage tissues that can be used to treat localized cartilage lesions.

scholarly journals Knee MRI Underestimates the Grade of Cartilage Lesions

2021 ◽  
Vol 11 (4) ◽  
pp. 1552
Author(s):  
Przemysław Krakowski ◽  
Robert Karpiński ◽  
Mariusz Jojczuk ◽  
Agata Nogalska ◽  
Józef Jonak
Keyword(s):  
Diagnostic Performance ◽  
Femoral Condyle ◽  
Area Under The Curve ◽  
Cartilage Lesion ◽  
Observer Agreement ◽  
Medial Compartment ◽  
Cartilage Defects ◽  
Anatomical Location ◽  
Cartilage Lesions ◽  
Healthy Cartilage

Purpose: This study was conducted in order to evaluate the clinical utility of MRI in detecting cartilage lesions and its dependence on anatomical location and lesion grade. Methods: A retrospective analysis of MRI reports and arthroscopic findings was performed on 190 consecutive patients treated in one orthopaedic department. MRI protocols were prepared by 18 radiologists from 10 different MRI centers with the use of 1.5 T magnets. The image protocols were selected by reading radiologists. Four hundred and fifty-three chondral lesions in five anatomic locations were identified during this study and graded according to the ICRS classification. Sensitivity, specificity, receiver operating characteristic (ROC), and Bangdiwala’s observer agreement charts were utilized to evaluate the diagnostic performance. Results: Only approximately 30% of MRI showed an adequate cartilage status in all anatomical locations. The sensitivity ranged from 92% in healthy cartilage to 5% in grade I lesions. The specificity differed also grossly depending on the lesion grade, reaching 96.5% in grade four lesions and 38% in healthy cartilage. The medial compartment Bangdiwala’s observer agreement charts show a gross underestimation of cartilage lesions, and the area under the curve (AUC) of ROC surpasses 0.7 only in the medial femoral condyle and patella-femoral joint. Overall, the medial compartment accuracy was significantly higher than the lateral compartment. The MRI showed correspondence of its diagnostic performance with cartilage lesion severity. Conclusion: MRI underestimates the extent of cartilage injury and evaluation of cartilage defects based on MRI should be taken with caution by orthopaedic surgeons in planning surgery. Surgical planning on MRI should take cartilage lesions under consideration, even if no cartilage lesions are reported on the MRI.

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