A novel autologous-made matrix using hyaline cartilage chips and platelet-rich growth factors for the treatment of full-thickness cartilage or osteochondral defects: Preliminary results

Purpose: To report the clinical, functional, and magnetic resonance imaging (MRI)-based outcomes of a novel autologous-made matrix consisting of hyaline cartilage chips combined with mixed plasma poor rich in platelets clot and plasma rich in growth factors (PRGF) for the treatment of knee full-thickness cartilage or osteochondral defects. Methods: Between July 2015 and January 2018, all patients with full-thickness cartilage or osteochondral defects undergoing this novel cartilage restoration surgical technique were approached for eligibility. Indications for this procedure included traumatic or atraumatic full-thickness knee cartilage defects or osteochondritis dissecans. Patients were included if they had no concomitant use of stem cells, previous ipsilateral cartilage repair procedure, or follow-up was less than 10 months. The outcomes included data on current symptoms, physical exam, patient-reported, and functional outcomes (visual analogue scale (VAS) for pain, Lysholm score, Tegner activity scale, International Knee Documentation Committee (IKDC) subjective form, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Lequesne index, and short form-12 (SF-12)) and the magnetic resonance observation of cartilage repair tissue (MOCART) score. These outcomes were compared to preoperative values, except for the MOCART score. Results: Fifteen patients were included in this preliminary study: mean (standard deviation (SD), range) follow-up 15.9 months (7.2, 10–32), age 26.8 years (12.1, 16–58), and body mass index 23.2 (2.1, 19.3–26.9). There were 14 men (93%) and 1 woman (7%). There was a statistically significant improvement between pre- and postoperative periods for VAS for pain ( p = 0.003), Lysholm score ( p = 0.002), IKDC subjective form ( p = 0.003), WOMAC for pain ( p = 0.005), WOMAC for stiffness ( p = 0.01), WOMAC for function ( p = 0.002), Lequesne Index ( p = 0.002), and SF-12 physical component summary ( p = 0.007). The postoperative mean (SD; range) MOCART score was 70 (12.4; 40–85). Conclusions: The use of this novel cartilage restoration surgical technique provides excellent clinical, functional, and MRI-based outcomes in young, active individuals with full-thickness cartilage or osteochondral defects. Level of evidence: Level IV—Therapeutic case series.

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Allogeneic Umbilical Cord Blood–Derived Mesenchymal Stem Cell Implantation Versus Microfracture for Large, Full-Thickness Cartilage Defects in Older Patients: A Multicenter Randomized Clinical Trial and Extended 5-Year Clinical Follow-up

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120973052 ◽

2021 ◽

Vol 9 (1) ◽

pp. 232596712097305

Author(s):

Hong-Chul Lim ◽

Yong-Beom Park ◽

Chul-Won Ha ◽

Brian J. Cole ◽

Beom-Koo Lee ◽

...

Keyword(s):

Clinical Trial ◽

Adverse Events ◽

Cartilage Repair ◽

Older Patients ◽

Cartilage Defects ◽

Full Thickness ◽

Phase 3 ◽

Randomized Controlled ◽

Cartilage Restoration

Background: There is currently no optimal method for cartilage restoration in large, full-thickness cartilage defects in older patients. Purpose: To determine whether implantation of a composite of allogeneic umbilical cord blood–derived mesenchymal stem cells and 4% hyaluronate (UCB-MSC-HA) will result in reliable cartilage restoration in patients with large, full-thickness cartilage defects and whether any clinical improvements can be maintained up to 5 years postoperatively. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A randomized controlled phase 3 clinical trial was conducted for 48 weeks, and the participants then underwent extended 5-year observational follow-up. Enrolled were patients with large, full-thickness cartilage defects (International Cartilage Repair Society [ICRS] grade 4) in a single compartment of the knee joint, as confirmed by arthroscopy. The defect was treated either with UCB-MSC-HA implantation through mini-arthrotomy or with microfracture. The primary outcome was proportion of participants who improved by ≥1 grade on the ICRS Macroscopic Cartilage Repair Assessment (blinded evaluation) at 48-week arthroscopy. Secondary outcomes included histologic assessment; changes in pain visual analog scale (VAS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and International Knee Documentation Committee (IKDC) score from baseline; and adverse events. Results: Among 114 randomized participants (mean age, 55.9 years; 67% female; body mass index, 26.2 kg/m2), 89 completed the phase 3 clinical trial and 73 were enrolled in the 5-year follow-up study. The mean defect size was 4.9 cm2 in the UCB-MSC-HA group and 4.0 cm2 in the microfracture group ( P = .051). At 48 weeks, improvement by ≥1 ICRS grade was seen in 97.7% of the UCB-MSC-HA group versus 71.7% of the microfracture group ( P = .001); the overall histologic assessment score was also superior in the UCB-MSC-HA group ( P = .036). Improvement in VAS pain, WOMAC, and IKDC scores were not significantly different between the groups at 48 weeks, however the clinical results were significantly better in the UCB-MSC-HA group at 3- to 5-year follow-up ( P < .05). There were no differences between the groups in adverse events. Conclusion: In older patients with symptomatic, large, full-thickness cartilage defects with or without osteoarthritis, UCB-MSC-HA implantation resulted in improved cartilage grade at second-look arthroscopy and provided more improvement in pain and function up to 5 years compared with microfracture. Registration: NCT01041001, NCT01626677 (ClinicalTrials.gov identifier).

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An Injectable Hydrogel Scaffold With Kartogenin-Encapsulated Nanoparticles for Porcine Cartilage Regeneration: A 12-Month Follow-up Study

The American Journal of Sports Medicine ◽

10.1177/0363546520957346 ◽

2020 ◽

Vol 48 (13) ◽

pp. 3233-3244

Author(s):

Wenqiang Yan ◽

Xingquan Xu ◽

Qian Xu ◽

Ziying Sun ◽

Zhongyang Lv ◽

...

Keyword(s):

Cartilage Repair ◽

Subchondral Bone ◽

Therapeutic Efficacy ◽

Tissue Repair ◽

Porcine Model ◽

Hyaline Cartilage ◽

Plga Nanoparticles ◽

Full Thickness ◽

Subchondral Bone Tissue

Background: Treatment of cartilage lesions is clinically challenging. A previous study demonstrated that a hyaluronic acid hydrogel ( m-HA) with kartogenin (KGN)-loaded PLGA nanoparticles ( m-HA+KGN treatment) achieved superior cartilage repair in a rabbit model. However, large animals serve as a bridge to translate animal outcomes into the clinic. Hypotheses: (1) m-HA+KGN treatment could facilitate hyaline cartilage and subchondral bone tissue repair in a porcine model. (2) Defect size and type (full-thickness chondral vs osteochondral) influence the therapeutic efficacy of m-HA+KGN treatment. Study Design: Controlled laboratory study. Methods: 48 minipigs were randomized into 3 treatment groups: m-HA hydrogel with KGN-loaded PLGA nanoparticles ( m-HA+KGN treatment), m-HA hydrogel ( m-HA treatment), and untreated (blank treatment). Full-thickness chondral (6.5 mm or 8.5 mm in diameter) or osteochondral (6.5 mm or 8.5 mm in diameter; 5-mm depth) defects were prepared in the medial femoral condyle. At 6 and 12 months postoperatively, defect repair was assessed by macroscopic appearance, magnetic resonance imaging (MRI), micro–computed tomography (µCT), and histologic and biomechanical tests. Results: The m-HA+KGN group exhibited superior gross and histological healing after evaluation at 6 and 12 months postoperatively. Improved quality of the repaired cartilage demonstrated by MRI and better subchondral bone reconstruction assessed by µCT were observed in the m-HA+KGN group. The m-HA+KGN group showed more hyaline-like cartilage exhibited by histological staining in terms of extracellular matrix, cartilage lacuna, and type II collagen. The biomechanical properties were improved in the m-HA+KGN group. With m-HA+KGN treatment, defects with a diameter of 6.5 mm or full-thickness chondral-type defects possessed significantly higher ICRS macroscopic and histological scores compared with diameter 8.5 mm or osteochondral-type defects. Conclusion: (1) m-HA+KGN treatment facilitated hyaline cartilage and subchondral bone tissue repair in a porcine model at the 12-month follow-up. (2) m-HA+KGN treatment demonstrated better therapeutic efficacy in defects with a diameter of 6.5 mm or full-thickness chondral-type defects. Clinical Relevance: This study verified the efficacy of this innovative KGN release system on cartilage repair. The KGN release system can be injected into defect sites arthroscopically. This convenient and minimally invasive operation holds important prospects for clinical application.

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Medial patellofemoral ligament reconstruction for patellofemoral instability: a new surgical technique

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20212434 ◽

2021 ◽

Vol 7 (4) ◽

pp. 843

Author(s):

Shreekantha K. S. ◽

Mohammed Usman ◽

Deepak Malik ◽

Mahammad Aseem ◽

Mohammad Gous Mulla

Keyword(s):

Surgical Technique ◽

Functional Outcome ◽

Ligament Reconstruction ◽

Medial Patellofemoral Ligament ◽

Patellofemoral Instability ◽

Lysholm Score ◽

Mpfl Reconstruction ◽

Kujala Score ◽

New Surgical Technique

<p class="abstract"><span lang="EN-US">The purpose of this study was to present new surgical technique for MPFL reconstruction. We also describe its functional outcome, complications, and the advantages of the procedure. This study is a prospective analysis of collected data during the period of august 2018 to January 2020. Ten cases of patients with recurrent symptomatic patellar instability and who underwent isolated MPFL reconstruction were included in the study. Kujala scoring and lysholm scoring was done to assess the functional outcome at follow-up. Post-operative dislocation and apprehension were recorded in each case along with any complication. Pre-operative Kujala score was 36.80 which improved to 89.80 postoperatively at the time follow-up. Pre-operative lysholm score was 36.80 which improved to 92.70 postoperatively at the time follow-up. The improvement in Kujala score and Lysholm score was found to be highly significant (p<0.01). We have done a simple technique where MPFL is reconstructed anatomically to restore kinematics and stability. Consistent good results with early rehabilitation can be obtained using the described technique.</span></p>

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A Case of Arthroscopic Treatment of Chondroblastoma-Induced Chondropathy Situated at the Posterior Talus

Journal of the American Podiatric Medical Association ◽

10.7547/20-125 ◽

2021 ◽

Vol 111 (5) ◽

Author(s):

Selcuk Necip Yonter ◽

Lercan Aslan ◽

Ata Can ◽

Tahir Ogut

Keyword(s):

Magnetic Resonance Imaging ◽

Case Report ◽

Magnetic Resonance ◽

Functional Status ◽

Iliac Crest ◽

Osteochondral Defects ◽

Resonance Imaging ◽

Structural Support ◽

Second Year

Chondroblastoma located in the talus is a rare incidence, and due to the weightbearing duty of the talus, the results of local excision may not be favorable. While the volume of the tumor increases, more sophisticated techniques may be undertaken. Cell-free matrix application for extensive osteochondral defects is gaining popularity for its structural support when it is used with microfracture and autograft application. In this case report, we present a patient with 13 × 20 × 8mm–sized chondroblastoma located in the talus. After evaluation of the mass, we performed curettage, iliac crest autograft application, and augmentation with cell-free matrix. After uneventful clinical follow up, we present our patient's postoperative second year magnetic resonance imaging and functional status.

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Autologous Chondrocyte Implantation “Segmental-Sandwich” Technique for Deep Osteochondral Defects in the Knee: Clinical Outcomes and Correlation With Magnetic Resonance Imaging Findings

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119847173 ◽

2019 ◽

Vol 7 (5) ◽

pp. 232596711984717 ◽

Cited By ~ 4

Author(s):

Takahiro Ogura ◽

Gergo Merkely ◽

Tim Bryant ◽

Carl S. Winalski ◽

Tom Minas

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Autologous Chondrocyte Implantation ◽

Osteochondral Defects ◽

Resonance Imaging ◽

Sandwich Technique ◽

Chondrocyte Implantation ◽

The Mean ◽

Autologous Chondrocyte

Background: Symptomatic osteochondral defects are difficult to manage, especially in patients with deep (>8-10 mm) empty defects. The restoration of articular congruence is crucial to avoid the progression to osteoarthritis (OA). Purpose: To describe the autologous chondrocyte implantation (ACI) “segmental-sandwich” technique for restoration of the osteochondral unit and to evaluate midterm outcomes in patients treated with this procedure. Correlations between magnetic resonance imaging (MRI) and radiographic findings with outcomes were assessed. Study Design: Case series; Level of evidence, 4. Methods: Outcomes were evaluated for a consecutive cohort of 15 patients with symptomatic deep (>8 mm) osteochondral lesions who underwent autologous bone grafting plus the ACI segmental-sandwich technique performed by a single surgeon between 2003 and 2011. Patients with a minimum 2-year follow-up were included. All patients completed validated clinical outcome scales and a patient satisfaction survey. The Kellgren-Lawrence (K-L) grade was assessed for the progression to OA. The repair site was evaluated with the MOCART (magnetic resonance observation of cartilage repair tissue) score. Filling and tissue characteristics of the bone defect were analyzed with MRI. Results: All patients (mean age at surgery, 31.0 ± 9.1 years) were available for follow-up (mean follow-up, 7.8 ± 3.0 years; range, 2-15 years). The mean chondral lesion size was 6.0 ± 3.5 cm2 (range, 1.5-13.5 cm2), with a mean bone defect area of 1.7 cm2 (27%-40% of overall surface area treated by ACI) and depth of 1.0 cm. All patients had successful clinical outcomes, and all functional scores improved significantly ( P < .05). Patients reported a very high satisfaction rate (93%). The K-L grade demonstrated no significant progression to OA over a mean follow-up of 4.7 years. For 12 patients with MRI results available, the mean MOCART score at a mean of 3.3 years was 64.2 ± 19.9, with complete or near-complete (≥75% of defect volume) chondral defect filling (83%) and complete integration to adjacent cartilage (83%). Bone defects were completely filled in 83% of patients. Conclusion: The ACI segmental-sandwich technique provides significant functional improvements at midterm follow-up and excellent survival rates. This unique treatment allows for the resurfacing of cartilage defects and the repair of underlying segmental bone lesions.

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Chondral and Osteochondritis Dissecans Lesions Treated by Autologous Chondrocytes Implantation: A Mid- to Long-Term Nonrandomized Comparison

Cartilage ◽

10.1177/1947603520935953 ◽

2020 ◽

pp. 194760352093595

Author(s):

Teemu Paatela ◽

Anna Vasara ◽

Markus Sormaala ◽

Heikki Nurmi ◽

Hannu Kautiainen ◽

...

Keyword(s):

Failure Rate ◽

Osteochondritis Dissecans ◽

Cartilage Lesion ◽

Patient Reported Outcome ◽

Lysholm Score ◽

Full Thickness ◽

Cartilage Lesions ◽

Patient Reported ◽

Chondrocyte Implantation

Objective The aim of this study was to compare the clinical outcome of cartilage repair with autologous chondrocyte implantation (ACI) in patients with osteochondritis dissecans (OCD) lesions and full-thickness cartilage lesions. Design This study included a cohort of 115 consecutive patients with a cartilage lesion of the knee treated with ACI. Of the patients, 35 had an OCD lesion and 80 a full-thickness cartilage lesion. During a follow-up period from 2 to 13 years all treatment failures were identified. The failure rate between OCD lesions and full-thickness cartilage lesions was compared with Kaplan-Meier analysis. Patient-reported outcome was evaluated 2 years postoperatively with the Lysholm score. Results During the follow-up 21 out of 115 patients encountered a treatment failure. The failure rate for full-thickness cartilage lesions was 19.1% and for OCD lesions 43.3% over the 10-year follow-up. Patient-reported outcome improved from baseline to 2 years postoperatively. The improvement from baseline was statistically significant, and the Lysholm score improved more than the minimal clinically important difference. The patient-reported outcome showed no difference between lesion types at 2 years. Conclusions In the presented retrospective study, the failure rate of first-generation ACI was higher in OCD lesions than in large full-thickness cartilage lesions, suggesting that OCD lesions may associate with properties that affect the durability of repair tissue. Future prospective studies are needed to tell us how to best repair OCD lesions with biological tissue engineering.

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Endoscopic Repair of Full-Thickness Abductor Tendon Tears: Surgical Technique and Outcome at Minimum of 1-Year Follow-up

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2013.08.024 ◽

2013 ◽

Vol 29 (12) ◽

pp. 1941-1947 ◽

Cited By ~ 50

Author(s):

Frank McCormick ◽

Kyle Alpaugh ◽

Benedict U. Nwachukwu ◽

Adam B. Yanke ◽

Scott D. Martin

Keyword(s):

Surgical Technique ◽

Full Thickness ◽

Endoscopic Repair ◽

Tendon Tears

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Osteochondral Defects of the Knee treated with Mosaicplasty. Results at Eight Years of Follow-Up

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117s00033 ◽

2017 ◽

Vol 5 (1_suppl) ◽

pp. 2325967117S0003

Author(s):

Juan Pablo Zicaro ◽

Agustin Molina Romoli ◽

Mariano Agustin Revah ◽

Juan Jose Dere ◽

Carlos Yacuzzi ◽

...

Keyword(s):

Femoral Condyle ◽

Functional Results ◽

International Knee Documentation Committee ◽

Lysholm Score ◽

Osteochondral Defects ◽

Main Indication ◽

Surgical Options ◽

The Mean ◽

Articular Cartilage Lesions

Objectives: There are several surgical options described for osteochondral defects of the knee depending on the size, location and condition of subchondral bone. The main indication for a mosaicplasty procedure is a less than 4 cm2 femoral condyle lesion. The purpose of this study was to analyze a series of patients treated with mosaicplasty with average eight years of follow-up. Methods: We retrospectively evaluated sixty-two patients with osteochondral defects of the knee who underwent a mosaicplasty between 2001 and 2014 with a minimum follow-up of 2 years. Patients were evaluated using the Lysholm score, International Knee Documentation Committee Score (IKDC) and Kellgren-Lawrence radiographic scale. Results: The mean Lysholm score was 80.1 and IKDC was 66.7. Forty-two patients had isolated mosaicplasty and 20 patients presented an associated surgical procedure (osteotomy, ACL reconstruction, meniscectomy). There were no significant differences between the Lysholm and IKDC scores in these two groups. Conclusion: We consider that mosaicplasty is a satisfactory procedure with good functional results in patients with focal articular cartilage lesions of the knee.

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