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.

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 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.

scholarly journals Is T2 mapping reliable in evaluation of native and repair cartilage tissue of the knee?

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Hasan Banitalebi ◽  
Christian Owesen ◽  
Asbjørn Årøen ◽  
Hang Thi Tran ◽  
Tor Åge Myklebust ◽  
...  
Keyword(s):  
T2 Mapping ◽  
Intraclass Correlation ◽  
Cartilage Tissue ◽  
Intraobserver Agreement ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Repair Tissue ◽  
Native Cartilage ◽  
Link Type ◽  
Imaging Plane

Abstract Purpose To evaluate the effect of imaging plane and experience of observers on the reliability of T2 mapping of native and repair cartilage tissue of the knee. Methods Fifteen consecutive patients from two randomised controlled trials (RCTs) were included in this cross-sectional study. Patients with an isolated knee cartilage lesion were randomised to receive either debridement or microfracture (RCT 1) or debridement or autologous chondrocyte implantation (RCT 2). T2 mapping was performed in coronal and sagittal planes two years postoperatively. A musculoskeletal radiologist, a resident of radiology and two orthopaedic surgeons measured the T2 values independently. Intraclass Correlation Coefficient (ICC) with 95% Confidence Intervals was used to calculate the inter- and intraobserver agreement. Results Mean age for the patients was 36.8 ± 11 years, 8 (53%) were men. The overall interobserver agreement varied from poor to good with ICCs in the range of 0.27– 0.76 for native cartilage and 0.00 – 0.90 for repair tissue. The lowest agreement was achieved for evaluations of repair cartilage tissue. The estimated ICCs suggested higher inter- and intraobserver agreement for radiologists. On medial femoral condyles, T2 values were higher for native cartilage on coronal images (p < 0.001) and for repair tissue on sagittal images (p < 0.001). Conclusions The reliability of T2 mapping of articular cartilage is influenced by the imaging plane and the experience of the observers. This influence may be more profound for repair cartilage tissue. This is important to consider when using T2 mapping to measure outcomes after cartilage repair surgery. Trial registration ClinicalTrials.gov, NCT02637505 and NCT02636881, registered December 2015. Level of evidence II, based on prospective data from two RCTs.

scholarly journals Potential predictive value of axial T2 mapping at 3 Tesla MRI in patients with untreated patellar cartilage defects over a mean follow-up of four years

2020 ◽  
Vol 28 (2) ◽  
pp. 215-222 ◽  
Author(s):  
S.R. Apprich ◽  
M.M. Schreiner ◽  
P. Szomolanyi ◽  
G.H. Welsch ◽  
U.K. Koller ◽  
...  
Keyword(s):  
Predictive Value ◽  
T2 Mapping ◽  
3 Tesla ◽  
Cartilage Defects ◽  
Patellar Cartilage ◽  
3 Tesla Mri

scholarly journals Longitudinal T2 Mapping and Texture Feature Analysis in the Detection and Monitoring of Experimental Post-Traumatic Cartilage Degeneration

Life ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 201
Author(s):  
Marc Sebastian Huppertz ◽  
Justus Schock ◽  
Karl Ludger Radke ◽  
Daniel Benjamin Abrar ◽  
Manuel Post ◽  
...  
Keyword(s):  
T2 Mapping ◽  
Energy Levels ◽  
Texture Feature ◽  
Basic Research ◽  
Cartilage Degeneration ◽  
Quantitative Mri ◽  
Degenerative Changes ◽  
Feature Analysis ◽  
Cartilage Defects ◽  
Cartilage Injuries

Background: Traumatic cartilage injuries predispose articulating joints to focal cartilage defects and, eventually, posttraumatic osteoarthritis. Current clinical-standard imaging modalities such as morphologic MRI fail to reliably detect cartilage trauma and to monitor associated posttraumatic degenerative changes with oftentimes severe prognostic implications. Quantitative MRI techniques such as T2 mapping are promising in detecting and monitoring such changes yet lack sufficient validation in controlled basic research contexts. Material and Methods: 35 macroscopically intact cartilage samples obtained from total joint replacements were exposed to standardized injurious impaction with low (0.49 J, n = 14) or high (0.98 J, n = 14) energy levels and imaged before and immediately, 24 h, and 72 h after impaction by T2 mapping. Contrast, homogeneity, energy, and variance were quantified as features of texture on each T2 map. Unimpacted controls (n = 7) and histologic assessment served as reference. Results: As a function of impaction energy and time, absolute T2 values, contrast, and variance were significantly increased, while homogeneity and energy were significantly decreased. Conclusion: T2 mapping and texture feature analysis are sensitive diagnostic means to detect and monitor traumatic impaction injuries of cartilage and associated posttraumatic degenerative changes and may be used to assess cartilage after trauma to identify “cartilage at risk”.

The Use of Particulated Juvenile Allograft Cartilage for the Repair of Porcine Articular Cartilage Defects

2019 ◽  
Vol 47 (10) ◽  
pp. 2308-2315 ◽  
Author(s):  
Yunong Ao ◽  
Zhong Li ◽  
Qi You ◽  
Chengchang Zhang ◽  
Liu Yang ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Statistical Difference ◽  
Fibrous Tissue ◽  
Cartilage Defects ◽  
Control Group ◽  
General View ◽  
Full Thickness ◽  
Femoral Trochlea ◽  
Articular Cartilage Defects ◽  
Experimental Group

Background: The repair of porcine articular cartilage defects by using particulated juvenile allograft cartilage (PJAC) has demonstrated good short-term clinical efficacy, but the repair process and mechanism have not been fully elucidated. Purpose: To study the efficacy of PJAC in repairing full-thickness cartilage defects and to provide an experimental basis for its clinical application. Study Design: Controlled laboratory study. Methods: Thirty Guizhou minipigs were randomly divided into an experimental group and control group. An 8-mm cylindrical full-thickness cartilage defect was created in the femoral trochlea of either knee in all minipigs. The experimental group received the PJAC transplantation (PJAC group; n = 15) and the control group received autologous cartilage chips (ACC group; n = 15). Five minipigs were euthanized at 1, 3, and 6 months in each group to obtain samples, which were evaluated by general view of the knee joint and histomorphometry of the chondral defect area (hematoxylin and eosin, safranin O). International Cartilage Repair Society (ICRS) II semiquantitative evaluation and collagen type II staining immunohistochemistry were also performed. Results: All 30 Guizhou minipigs were followed; there was no infection or incision healing disorder after the operation. At 1 month postoperatively, more hyaline cartilage was found in the ACC group (29.4%) compared with the PJAC group (20.1%) ( P < .05); there was no statistical difference between the 2 groups at 3 and 6 months after operation. The fibrocartilage content in the ACC group was significantly more than that in the PJAC group at 1 and 3 months postoperatively (27.4% vs 18.2% and 49.9% vs 41.1%, respectively; P < .05); significant differences disappeared at 6 months postoperatively. The PJAC group produced more fibrous tissue than the ACC group at 1 and 3 months postoperatively (60.1% vs 40.6% and 38.8% vs 24.4%, respectively; P < .05) but showed no statistical difference at 6 months postoperatively. Regarding the ICRS II scores, those of the ACC group were significantly better than the scores of the PJAC group in some subclasses at 3 and 6 months postoperatively. The positive rates of immunohistochemical staining in the ACC group were higher at 1 and 3 months postoperatively than those in the PJAC group (54.2% vs 37.8% and 46.4% vs 34.4%, respectively; P < .05). The difference was not statistically significant between the 2 groups at 6 months postoperatively. Conclusion: Both PJAC and ACC can produce a good repair effect on cartilage defects. At 1 and 3 months postoperatively, ACC resulted in better outcomes than PJAC, but there was no statistical difference in the repair effect between the 2 techniques at 6 months postoperatively. Clinical Relevance: Based on this animal experiment, further clinical studies are needed to investigate PJAC as a possible alternative first-line treatment for cartilage defects.

Production of Personalized Thyroid Cartilage Scaffold and Histological Analysis

2014 ◽  
Vol 881-883 ◽  
pp. 473-478
Author(s):  
Wei Xia ◽  
Gao Xiang Cao ◽  
Long Cheng Zhang ◽  
Jie Liao ◽  
Jian Min Zeng
Keyword(s):  
Histological Analysis ◽  
In Situ Polymerization ◽  
Thyroid Cartilage ◽  
Biological Properties ◽  
Bone Morphogenetic Protein 2 ◽  
Cartilage Defects ◽  
Organic Additives ◽  
Morphogenetic Protein ◽  
Specimen Density

To meet the bone defect on the personalized needs of implantation, this study presents the manufacture of personalized thyroid cartilage hydroxyapatite (HA) scaffold by the rapid prototyping(RP) technique combined with CT image reconstruction and employs the foaming of suspensions prior to the in situ polymerization of organic monomers contained in the compositions. The organic additives are eliminated at temperatures above 300°C, and sintering is carried out for consolidation of the ceramic matrix. Spherical interconnected cells with sizes ranging from 100μm to 250μm characterize the porous structure, depending on the specimen density. The biological properties of porous personalized scaffolds loaded with bone morphogenetic protein 2 (rhBMP-2) were evaluated, by which a simulated surgical method of thyroid cartilage defects in rabbits and repairing with artificial scaffolds, and compared with rhBMP-2 loaded dense personalized or porous non-personalized scaffolds. The results of the histological analysis and the electronic laryngoscope inspection of airway indicate that rhBMP-2/HA/ porous personalized scaffolds is a promising composite having osteogenic efficient enough for repairing thyroid cartilage defects.

Osseoinduction Evaluation of Hydroxyapatite and Zinc Containing Hydroxyapatite Granules in Rabbits

2011 ◽  
Vol 493-494 ◽  
pp. 252-257 ◽  
Author(s):  
L. Nascimento ◽  
M. Medeiros ◽  
J. Calasans-Maia ◽  
A. Alves ◽  
Antonella M. Rossi ◽  
...  
Keyword(s):  
Histological Analysis ◽  
Bone Matrix ◽  
Fibrous Tissue ◽  
Particle Diameter ◽  
Inflammatory Cells ◽  
Giant Cells ◽  
Multinucleated Giant Cells ◽  
Ethics Commission

This study investigated the osteoinductive potential of granules of stoichiometric hydroxyapatite (HA) and 0.5% zinc containing hydroxyapatite (ZnHA) in intramuscular (IM) site of rabbit’s abdomen. The biomaterials were both used in granular form, with 75% porosity and particle diameter between 450 and 500μm, sintered at 1100°C. Both materials performed adequately on a multiparametric in vitro cytocompatibility assay, indicating their suitability for in vivo testing. After approval by the Ethics Commission on Teaching and Research in Animals, fifteen rabbits were submitted to general anesthesia, incision and tissue dilatation, and a small site was created for HA (right incision) and ZnHA (left incision) intramuscular implantation. The animals were killed after 2, 4 and 12 weeks for biomaterials and surrounding tissues removal. Histological analysis after 2 weeks revealed the presence of granulation tissue surrounding biomaterials with multinucleated giant cells and no newly formed bone for both materials. After 4 weeks there was fibrous tissue involving the material and few inflammatory cells. Following 12 weeks it was observed the presence of connective tissue surrounding the biomaterial, cellularized enough for the two experimental groups, but it was not observed the presence of bone matrix associated with the biomaterials. We conclude that both biomaterials are cytocompatible and did not present the property of osseoinduction after 12 weeks of implantation.

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.

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