Cartilage and Bone Serum Biomarkers as Novel Tools for Monitoring Knee Osteochondritis Dissecans Treated with Osteochondral Scaffold.

Elena Gabusi,Cristina Manferdini,Erminia Mariani,Laura Gambari,Elizaveta Kon,Francesca Paolella,Giuseppe Filardo,Gina Lisignoli

doi:10.1155/2018/9275102

Abstract

Knee osteochondritis dissecans (OCD) is a focal disease of the joint characterized by modifications of bone and cartilage tissues. Biomimetic osteochondral scaffolds are used to restore these tissues. The aim of this prognostic prospective cohort study was to evaluate serum biomarkers of cartilage (fragments or propeptide of type II collagen: CTXII, C2C, and CPII) and bone (tartrate-resistant acid phosphatase (TRAP) 5b and osteocalcin (OC)) turnover during follow-up of patients treated with an osteochondral scaffold, to identify which were related to healing outcome and clinical score. We found that cartilage (CPII) and bone (OC) synthetic biomarkers were significantly increased during the first-year follow-up, while the respective degradative markers (CTXII, C2C, and TRAP5b) were not modulated. Only CTXII/CPII and C2C/CPII cartilage ratios were significantly modulated, evidencing a higher remodeling of cartilage compared to bone tissue. Cartilage and bone single biomarkers or ratios at one-year follow-up showed values close to or similar to those of healthy subjects. International Knee Documentation Committee (IKDC) score significantly increased from T0 to T2, while the Tegner score did not. Taking into consideration an IKDC score > 70 as clinical success, we found that all OCD cases with both CPII (> 300 pg/ml) and C2C/CPII (<0.35) presented IKDC scores of clinical success. OCD patients treated with an osteochondral scaffold showed an improvement at one-year follow-up, evidenced by both clinical and serum cartilage biomarkers. These data confirmed that cartilage and bone remodeling took place and showed that systemic biomarkers represent a sensitive tool for monitoring OCD patients during the follow-up.

Highlights

Osteochondritis dissecans (OCD) is a focal idiopathic disease of the joints with unknown etiology, mainly characterized by progressive changes in both cartilage and bone structures
To gain new insight in the evaluation of cartilage and bone remodeling during follow-up after surgical treatment, we evaluated osteochondritis dissecans (OCD) patients treated with a cell-free biomimetic scaffold that simulates the osteochondral anatomy [24]
X-ray and Magnetic Resonance Imaging (MRI) surgical indications were confirmed intraarticularly, and patients were staged as grade 3 OCD lesions, according to the ICRS evaluation package, [https://www .secot.es/uploads/descargas/formacion/escalas valoracion/ ICRS

Summary

Introduction

Osteochondritis dissecans (OCD) is a focal idiopathic disease of the joints with unknown etiology, mainly characterized by progressive changes in both cartilage and bone structures. Different types of surgical procedures (microfractures, osteochondral autograft, debridement, and scaffolds) are used for knee OCD lesions, not suitable of conventional treatment (use of brace; limitation of activities), which are mainly directed to prevent the development of osteoarthritis (OA)[4, 5]. OCD of the knee is divided into juvenile and adult forms depending on the maturity of the distal femoral physis (open or close epiphysis) [3, 6]. To further assess cartilage and bone modifications, different studies have used histological and immunohistochemical analysis on samples collected from patients during surgical treatment [2, 7,8,9]

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Conclusion