The use of autologous mesenchymal stem cells for knee cartilage repair

Purpose. The present study aims to evaluate the efficacy of matrix-induced adipose-derived mesenchymal stem cells (AD-MSCs) for cartilage repair of focal, full-thickness, symptomatic chondral knee lesions.Materials and Methods. Twenty-five consecutive patients were initially treated for symptomatic full-thickness chondral defects of the knee and then prospectively followed for three years. All patients underwent a single-stage procedure consisting in filling each defect with autologous culture-expanded mesenchymal stem cells embedded in a trimmed-to-fit commercially available biodegradable matrix. Knee-related function was evaluated based on objective and subjective assessment tools using two self-reported questionnaires the KOOS and the IKDC, the objective form of IKDC, the Tegner activity level, the Visual Analogue Scale for pain. MRI data were analysed based on the MOCART scoring system.Results. The data analysis recorded a constantly increased statistically significant improvement in all the values of the KOOS subgroups as well as of the IKDC score post-operatively (p<0.05). Equally, the VAS score for pain and the IKDC objective evaluation were improved significantly as well (p<0.05). The Tegner activity score was also increased with statistically significant difference (p<0.05), nevertheless its initial decrease. The MRI findings demonstrate a complete filling of the defect and a complete integration to border zone in 65% of the patients. All patients were found with subchondral laminar changes. No treatment-related adverse events or complications were reported.Conclusions. Matrix-induced adipose-derived mesenchymal stem cells implantation is an effective and safe single-staged cell-based procedure to manage full-thickness focal chondral lesions of the knee. Our findings demonstrate that all patients presented significant clinical and functional improvement at 3 years follow-up. The MRI aspects of the repair tissue continue to progress during the first two years after the surgery.Σκοπός. Σκοπός της παρούσας μελέτης, είναι να αξιολογήσει την ασφάλεια και την αποτελεσματικότητα των αυτόλογων μεσεγχυματικών κυττάρων από λιπώδη ιστό, που εμποτισμένα σε βιοδιασπώμενο ικρίωμα χρησιμοποιούνται στην αποκατάσταση των συμπτωματικών χόνδρινων βλαβών του γόνατος.Υλικό και Μέθοδος. Εικοσιπέντε ασθενείς αντιμετωπίστηκαν για ολικού πάχους, συμπτωματικές, εστιακές χόνδρινες βλάβες του γόνατος και στη συνέχεια παρακολουθήθηκαν προοπτικά για τρία χρόνια. Όλοι οι ασθενείς υποβλήθηκαν σε βιολογική θεραπεία ενός χρόνου κατά την οποία το χόνδρινο έλλειμμα καλύφθηκε από καλλιεργημένα αυτόλογα μεσεγχυματικά κύτταρα του λιπώδους ιστού, εμποτισμένα σε βιοδιασπώμενο ικρίωμα. Για την μετεγχειρητική αξιολόγηση των ασθενών χρησιμοποιήθηκαν υποκειμενικά και αντικειμενικά κριτήρια, όπως η κλινική εξέταση βάση του πρωτοκόλλου παρακολούθησης IKDC, τα ερωτηματολόγια KOOS και IKDC, το επίπεδο δραστηριότητας Tegner και η οπτική αναλογική κλίμακα πόνου. Για την αξιολόγηση των MRI χρησιμοποιήθηκε η κλίμακα MOCART. Αποτελέσματα. Από την ανάλυση των αποτελεσμάτων διαπιστώθηκε, μετεγχειρητικά, μία στατιστικά σημαντική βελτίωση όλων των τιμών των υποκατηγοριών του KOOS καθώς και του IKDC (p<0.05). Αντίστοιχα, τόσο η οπτική αναλογική κλίμακα του πόνου όσο και η κλινική αξιολόγηση IKDC παρουσίασαν και αυτές στατιστικά σημαντική βελτίωση (p<0.05). Το επίπεδο δραστηριότητας Tegner, βελτιώθηκε επίσης με στατιστικά σημαντική σχέση (p<0.05), παρά την αρχική μείωση της τιμής του. Οι μαγνητικές τομογραφίες έδειξαν πλήρη πλήρωση του ελλείμματος και πλήρη ενσωμάτωση με τη γειτνιάζουσα περιοχή στο 65% των ασθενών. Σε όλους τους ασθενείς παρατηρήθηκαν αλλοιώσεις στο υποχόνδριο έλασμα. Δεν παρατηρήθηκαν ανεπιθύμητες ενέργειες ή επιπλοκές.Συμπεράσματα. Τα μεσεγχυματικά κύτταρα του λιπώδους ιστού, αποτελούν μία αποτελεσματική και ασφαλή βιολογική θεραπεία σε ένα χειρουργικό χρόνο για την αντιμετώπιση των ολικού πάχους, συμπτωματικών χόνδρινων βλαβών του γόνατος, παρέχοντας στατιστικά σημαντική κλινική και λειτουργική βελτίωση των ασθενών στα τρία χρόνια παρακολούθησης. Η απεικόνιση του επιδιορθωμένου ιστού στις MRI παρουσιάζει μία συνεχή βελτίωση στα δύο χρόνια από την επέμβαση

Current concepts in natural history of meniscal injury and future options in meniscus healing: Orthobiologics

SCOPUS: ch.binfo:eu-repo/semantics/publishe

Segmental meniscal replacement

Meniscal damage results in higher peak stress on the articular cartilage and leads to cartilage degeneration and osteoarthritis. Thus, in recent years there has been an increasing tendency to “save the meniscus” and to repair meniscal defects. However, this is not always possible and restoring meniscal function using scaffolds fulfills this gap. This approach requires the physical presence of an artificial meniscus to allow successful migration and colonization with precursor cells and vessels that lead to the development of organized meniscal tissue. Two meniscal scaffolds are currently available; 1 composed of aliphatic polyurethane named Actifit (Orteq Sports Medicine, Ltd.), and one based on collagen type I fibers called Collagen Meniscus Implant (Stryker Kalamazoo). Both provide an effective and safe solution to treat symptomatic patients with segmental meniscus mid-substance defects. Indeed, recent studies have demonstrated their ability to significantly improve patient satisfaction and clinical evaluation in the mid- to long-term. As such, these approaches hold great promise as a meniscus preservation option to facilitate long-term knee health

Reliability of patient specific instrumentation in total knee arthroplasty

The aim of this study was to compare the precision between Patient Specific Instrumentation (PSI) and Conventional Instrumentation (CI) as determined intra-operatively by a pinless navigation system. Eighty patients were included in this prospective comparative study and they were divided into two homogeneous groups. We defined an original score from 6 to 30 points to evaluate the accuracy of the position of the cutting guides. This score is based on 6 objective criteria. The analysis indicated that PSI was not superior to conventional instrumentation in the overall score (p = 0.949). Moreover, no statistically significant difference was observed for any individual criteria of our score.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Satisfactory outcomes of patellar tendon reconstruction using achilles’ tendon allograft with bone block after infected total knee arthroplasty

Abstract Purpose Extensor mechanism disruption is an uncommon and devastating complication after total knee arthroplasty. It negatively affects patients’ quality of life and leads to significant functional limitations and the inability to stand and walk. The purpose of the present study was to evaluate the outcomes of the extensor mechanism reconstruction using Achilles’ tendon allograft after infected total knee arthroplasty. It was hypothesized that it is a safe procedure and that patients will present good clinical and functional results. Methods Ten patients treated for infra‐patellar extensor mechanism disruption after infected total knee arthroplasty were prospectively followed for two years. The mean age of patients was 70.8 (range 55–85), with a median BMI of 28.72 ± 2.2 kg/m2. All patients underwent reconstruction using a fresh frozen Achilles tendon allograft. Preoperative and postoperative evaluation included knee‐related clinical and functional assessment based on objective and subjective scores, including the knee flexion, the extension lag, the Knee Society Score (KSS) clinical and functional, and the visual analog scale (VAS) for pain at 12 and 24 months. Radiological evaluation was also performed using the Caton‐Deschamps index. Reported complications were also recorded. Results Clinical and functional outcomes recorded significant improvements (p < 0.05) at the final follow‐up compared with baseline as follows: Knee flexion was improved from 66° ± 4.8 to 99.7° ± 3.9, and the extension lag was decreased from 28.3° ± 4.4 to 9° ± 2.7. The mean KSS clinical and functional were also improved from 22.6 ± 7.9 to 73.4 ± 3.9 and from 10 ± 13.8 to 55 ± 13.8, respectively. The VAS for pain was decreased from 8.1 ± 1.2 to 1.9 ± 1.2. The Caton‐Deschamps index demonstrated a tendency to patella Alta. Two treatment failures were recorded, one patellar dislocation and one re‐rupture revised to arthrodesis. Conclusions Extensor mechanism reconstruction using Achilles’ tendon allograft after infected total knee arthroplasty is an efficient and safe procedure for infra‐patellar disruption. The present study’s findings demonstrate that most of the patients (80%) presented significant clinical and functional improvement at two‐year follow‐up

Sonographic and radiographic evaluation of the extensor tendons in early postoperative period after total knee arthroplasty

Objective: To prospectively assess the early changes in the quadriceps and patellar tendons before and after total knee arthroplasty using ultrasound, shear wave elastography, and X-rays. Materials and methods: Radiographs, ultrasound, and shear wave elastography were performed on 23 patients (16 women; aged 51–85, mean 66 ± 9 years) before and after surgery at 6 weeks and on 11 patients at 3 months. Patellar position and patellar tendon lengths were evaluated by radiography; joint effusion or synovitis, quadriceps and patellar tendon lengths, and thicknesses, echogenicity, vascularity, and stiffness were assessed with ultrasound and shear wave elastography. Results: In the early postoperative period, 87% of the patients had joint effusion, and 43% had signs of synovitis. There was a significant thickening of the quadriceps tendon in 51.5% (p <.0001) and of the patellar tendon in 93.8% (p <.0001) of patients with a significant shortening of the patellar tendon in 7.8% (p <.0001). A hypoechoic defect on the medial aspect of the quadriceps tendon was found in 87% of the patients. There was a significant increase in Young’s modulus in the quadriceps tendon (p =.0006) but not in the patellar tendon. Conclusion: The following should not be considered to be pathological findings at early postoperative imaging: joint effusion, synovitis, increasing of stiffness and thickening of quadriceps tendons by more than 50%, thickening of patellar tendon by more than 90%, focal defect through the medial aspect of the quadriceps tendon, and shortening of the patellar tendon by 8%.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Matrix-Induced Adipose-Derived Mesenchymal Stem Cells Implantation for Knee Articular Cartilage Repair. Two Years Follow-up.

Objective. The aim of this study was to evaluate the efficacy of cartilage repair using matrix-induced adipose-derived mesenchymal stem cells (MSCs) for focal chondral knee lesions.Materials and Methods. Twenty consecutive patients treated for symptomatic full-thickness chondral defects were prospectively followed for two years. All patients underwent a single-stage procedure consisting in filling each defect with autologous culture-expanded mesenchymal stem cells embedded in a trimmed-to-fit commercially available biodegradable matrix. Knee-related function was evaluated based on subjective scores given by two self-reported questionnaires (KOOS and IKDC).  Results. The data analysis recorded significant improvements (p&lt;0.001) in all the values. The mean preoperative scores in the subscales of KOOS, as well as in the IKDC subjective score were constantly increased during the follow-up period with statistical significant differences at 6, 12 and 24 months review.Conclusions. Matrix-induced adipose-derived mesenchymal stem cells implantation is an efficient and safe single-staged cell-based procedure to manage full-thickness focal chondral lesions of the knee. 

Stem cells for the treatment of early to moderate osteoarthritis of the knee: a systematic review

Abstract Purpose Mesenchymal stem cells (MSCs) present a valuable treatment option for knee osteoarthritis with promising results. The purpose of the present study was to systematically review the clinical and functional outcomes following mesenchymal stem cell application focusing on early to moderate knee osteoarthritis. Methods A systematic search was done using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines in Pubmed, Scopus, Web of Science, and Cochrane Library databases. All Studies published between 2017 and March 2023 on patients treated with single mesenchymal stem cell injection for Kellgren‐Lawrence grade I—III knee osteoarthritis reported on clinical and functional outcomes were included. Results Twelve articles comprising 539 patients and 576 knees treated with a single intraarticular injection of MSCs for knee osteoarthritis were included in the current systematic review. In eligible studies, the reported outcomes were improved concerning patient‐reported outcomes measures, knee function, pain relief, and quality of patient's life. Conclusion Based on high‐level evidence studies, single intraarticular injection of MSCs is a safe, reliable, and effective treatment option for Kellgren‐Lawrence grade I—III knee osteoarthritis. However, the lack of homogeneity in the included studies and the variance in MSCs sources and preparations should be noted. Level of evidence III

Effects of press-fit biphasic (collagen and HA/βTCP) scaffold with cell-based therapy on cartilage and subchondral bone repair knee defect in rabbits.

Human spontaneous osteonecrosis of the knee (SPONK) is still challenging as the current treatments do not allow the production of hyaline cartilage tissue. The aim of the present study was to explore the therapeutic potential of cartilage regeneration using a new biphasic scaffold (type I collagen/hydroxyapatite) previously loaded or not with concentrated bone marrow cells. Female rabbits were operated of one knee to create articular lesions of the trochlea (three holes of 4 × 4mm). The holes were left empty in the control group or were filled with the scaffold alone or the scaffold previously loaded with concentrated bone marrow cells. After two months, rabbits were sacrificed and the structure of the newly formed tissues were evaluated by macroscopic, MRI, and immunohistochemistry analyses. Macroscopic and MRI evaluation of the knees did not show differences between the three groups (p > 0.05). However, histological analysis demonstrated that a higher O'Driscoll score was obtained in the two groups treated with the scaffold, as compared to the control group (p  0.05) but subchondral bone repair was significantly thicker in scaffold-treated groups than in the control group (1 mm for the control group vs 2.1 and 2.6 mm for scaffold groups). Furthermore, we observed that scaffolds previously loaded with concentrated bone marrow were more reabsorbed (p < 0.05). The use of a biphasic scaffold previously loaded with concentrated bone marrow significantly improves cartilage lesion healing

Locking plates versus retrograde intramedullary nails in the treatment of periprosthetic supracondylar knee fractures. A retrospective multicenter comparative study

Introduction: Biomechanical studies demonstrated the superiority of retrograde supracondylar intramedullary nails (RIN) against locking plates (LP) for the treatment of periprosthetic supracondylar femoral fractures (PSFs); however, clinical results are still conflicting. This study aimed to compare LP and RIN, as well as, cemented and uncemented nails in the treatment of PSFs regarding fracture healing, complications and functional results. Materials and methods: A retrospective multicenter analysis of 60 PSFs classified as Rorabeck type I or II was performed. Thirty-one cases were treated with LP while in 29 cases RIN were used. Out of the latter, 14 had nailed cementoplasty, while 15 an uncemented nail. Results: The two groups were comparable concerning gender, ASA score, operated side, follow-up time, fracture type and mechanism of injury. The LP was significantly younger than the RIN group. Forty-six cases had fracture union at an average of six months, 11 were healed between seven and twelve months (delayed unions), and three developed non-unions. There was no significant difference in the median union time between RIN and LP groups (six vs five months, p = 0.707) or cemented and uncemented nailing groups (5.5 vs six months, p = 0.354). The RIN group had fewer delayed unions or non-unions than LP group; however, not reaching significance (4 vs 10, p = 0.190). Complications were fewer but non-significantly different between cemented and uncemented nails (one vs five, p = 0.481). The mean postoperative flexion was comparable between RIN and LP groups (99.1° vs 94.9°, p = 0.547) or cemented and uncemented nails (102° vs 96.3°, p = 0.4). The mean Oxford Knee Score did not differ between LP and RIN groups (30.8 vs 31.3, p = 0.93) as well as between cemented and uncemented nails (31.5 vs 30.6, p = 0.801). Discussion: PSFs with good bone stock can be treated equally with LP or RIN. Nails demonstrated advantages concerning the fracture healing potential. Orthopaedic surgeons need to be trained in both treatment options to manage PSFs. Cemented nails may increase stability and healing capacity in elderly osteoporotic patients; however, further studies are needed.SCOPUS: ar.jinfo:eu-repo/semantics/publishe