7 research outputs found
In vitro and in vivo performance of methacrylated gellan gum hydrogel formulations for cartilage repair
Methacrylated gellan gum (GGMA) formulation is proposed as a second‐generation hydrogel for controlled delivery of cartilage‐forming cells into focal chondral lesions, allowing immediate in situ retention of cells and 3D filling of lesion volume, such approach deemed compatible with an arthroscopic procedure. Formulation optimization was carried out in vitro using chondrocytes and adipose mesenchymal stromal/stem cells (ASCs). A proof‐of‐concept in vivo study was conducted using a rabbit model with induced chondral lesions. Outcomes were compared with microfracture or non‐treated control. Three grading scores were used to evaluate tissue repair after 8 weeks by macroscopic, histological and immunohistochemical analysis. Intense collagen type II and low collagen type I gene and protein expression were achieved in vitro by the ASC + GGMA formulation, in light with development of healthy chondral tissue. In vivo, this formulation promoted significantly superior de novo cartilage formation compared with the non‐treated group. Maintenance of chondral height and integration with native tissue was further accomplished. The physicochemical properties of the proposed GGMA hydrogel exhibited highly favorable characteristics and biological performance both in vitro and in vivo, positioning itself as an attractive xeno‐free biomaterial to be used with chondrogenic cells for a cost‐effective treatment of focal chondral lesions
Osteochondral transplantation using autografts from the upper tibio-fibular joint for the treatment of knee cartilage lesions
Purpose Treatment of large cartilage lesions of the knee
in weight-bearing areas is still a controversy and challenging topic. Autologous osteochondral mosaicplasty has
proven to be a valid option for treatment but donor site
morbidity with most frequently used autografts remains a
source of concern. This study aims to assess clinical results
and safety profile of autologous osteochondral graft from
the upper tibio-fibular joint applied to reconstruct symptomatic osteochondral lesions of the knee.
Methods Thirty-one patients (22 men and 9 women) with
grade 4 cartilage lesions in the knee were operated by
mosaicplasty technique using autologous osteochondral
graft from the upper tibio-fibular joint, between 1998 and
2006. Clinical assessment included visual analog scale
(VAS) for pain and Lysholm score. All patients were
evaluated by MRI pre- and post-operatively regarding joint
congruency as good, fair (inferior to 1 mm incongruence),
and poor (incongruence higher than 1 mm registered in any
frame). Donor zone status was evaluated according to
specific protocol considering upper tibio-fibular joint
instability, pain, neurological complications, lateral collateral ligament insufficiency, or ankle complaints.
Results Mean age at surgery was 30.1 years (SD 12.2). In
respect to lesion sites, 22 were located in weight-bearing
area of medial femoral condyle, 7 in lateral femoral condyle, 1 in trochlea, and 1 in patella. Mean follow-up was
110.1 months (SD 23.2). Mean area of lesion was 3.3 cm
2
(SD 1.7), and a variable number of cylinders were used,
mean 2.5 (SD 1.3). Mean VAS score improved from 47.1
(SD 10.1) to 20.0 (SD 11.5); p = 0.00. Similarly, mean
Lysholm score increased from 45.7 (SD 4.5) to 85.3
(SD 7.0); p = 0.00. The level of patient satisfaction was
evaluated, and 28 patients declared to be satisfied/very
satisfied and would do surgery again, while 3 declared as
unsatisfied with the procedure and would not submit to
surgery again. These three patients had lower clinical scores
and kept complaints related to the original problem but
unrelated to donor zone. MRI score significantly improved
at 18–24 months comparing with pre-operative (p = 0.004).
No radiographic or clinical complications related to donor
zone with implication in activity were registered.
Conclusions This work corroborates that mosaicplasty
technique using autologous osteochondral graft from the
upper tibio-fibular joint is effective to treat osteochondral
defects in the knee joint. No relevant complications related
to donor zone were registered
Is superior tibiofibular joint resection necessary in extraarticular knee resection for sarcomas? A systematic review
Knee donor-site morbidity in mosaicplasty - A systematic review
Background: Mosaicplasty has been associated with good short- to long-term results. Nevertheless, the osteochondral harvesting is restricted to the donor-site area available and it may lead to significant donor-site morbidity.
Purpose: Provide an overview of donor-site morbidity associated with harvesting of osteochondral plugs from the knee joint in mosaicplasty procedure.
Methods: Comprehensive search using Pubmed, Cochrane Library, SPORTDiscus and CINAHL databases was carried out through 10th October of 2016. As inclusion criteria, all English-language studies that assessed the knee donor- site morbidity after mosaicplasty were accepted. The outcomes were the description and rate of knee donor-site morbidity, sampleâ s and cartilage defectâ s characterization and mosaicplasty-related features. Correlation between mosaicplasty features and rate of morbidity was performed. The methodological and reporting quality were assessed according to Colemanâ s methodology score.
Results: Twenty-one studies were included, comprising a total of 1726 patients, with 1473 and 268 knee and ankle cartilage defects were included. The defect size ranged from 0.85 cm2 to 4.9 cm2 and most commonly 3 or less plugs (averaging 2.9 to 9.4 mm) were used. Donor-site for osteochondral harvesting included margins of the femoral trochlea (condyles), intercondylar notch, patellofemoral joint and upper tibio-fibular joint. Mean donor-site morbidity was 5.9 % and 19.6 % for knee and ankle mosaicplasty procedures, respectively. Concerning knee-to-knee mosaicplasty procedures, the most common donor-site morbidity complaints were patellofemoral disturbances
(22 %) and crepitation (31 %), and in knee-to-ankle procedures there was a clear tendency for pain or instability during daily living or sports activities (44 %), followed by patellofemoral disturbances, knee stiffness and persistent pain (13 % each). There was no significant correlation between rate of donor-site morbidity and size of the defect, number and size of the plugs (p > 0.05).
Conclusions: Osteochondral harvesting in mosaicplasty often results in considerable donor-site morbidity. The donor-site morbidity for knee-to-ankle (16.9 %) was greater than knee-to-knee (5.9 %) mosaicplasty procedures, without any significant correlation between rate of donor-site morbidity and size of the defect, number and size of the plugs. Lack or imcomplete of donor-site morbidity reporting within the mosaicplasty studies is a concern that should be addressed in future studies.(undefined
Emerging concepts in treating cartilage, osteochondral defects, and osteoarthritis of the knee and ankle
The management and treatment of cartilage lesions, osteochondral defects, and osteoarthritis remain a challenge in orthopedics. Moreover, these entities have different behaviors in different joints, such as the knee and the ankle, which have inherent differences in function, biology, and biomechanics. There has been a huge development on the conservative treatment (new technologies including orthobiologics) as well as on the surgical approach. Some surgical development upraises from technical improvements including advanced arthroscopic techniques but also from increased knowledge arriving from basic science research and tissue engineering and regenerative medicine approaches. This work addresses the state of the art concerning basic science comparing the knee and ankle as well as current options for treatment. Furthermore, the most promising research developments promising new options for the future are discussed.(undefined)info:eu-repo/semantics/publishedVersio