Cartilage Autografts Research Articles

Particulated Autograft Cartilage Implantation for the Treatment of Osteochondral Lesions of the Talus: A Novel Technique.

Level V.

The role of autologous conchal cartilage in ossiculoplasty during canal wall down mastoidectomy

<p class="abstract"><strong>Background:</strong> This study was done to evaluate the hearing outcome in patients undergoing ossiculoplasty using autograft cartilage in canal wall down surgery for cholesteatoma.</p><p class="abstract"><strong>Methods:</strong> This is a retrospective study. This was conducted in a tertiary care hospital from January 2011 to January 2014. This study included 54 patients who underwent canal wall down mastoidectomy with tympanoplasty during this period. </p><p class="abstract"><strong>Results:</strong> Preoperative and postoperative ABG for short columella were 23.13 dB (±11.21) and 12.66 dB (±8.92) respectively. Preoperative and post-operative ABG for long columella were 36.96 dB (±6.73) and 24.77 dB (±10.36) respectively. This is statistically significant.</p><p><strong>Conclusions:</strong> The use of autologous cartilage in ossiculoplasty during canal wall down mastoidectomy gives excellent hearing gain. It is also a cheaper option which is financially feasible in developing countries.</p>

Cellular viability and outgrowth of cryopreserved particulated adult human allograft cartilage

Event Abstract Back to Event Cellular viability and outgrowth of cryopreserved particulated adult human allograft cartilage Alex Mcnally1, Kurt Sly1, Chris Chapman1, Lee Krengel1 and Steve Lin1 1 Exactech, Inc., Biologics, United States Introduction: Particulated cartilage autograft and fresh osteochondral allograft has been used clinically to treat cartilage defects[1]. However, both these current cartilage repair techniques present drawbacks. Autograft cartilage can cause donor site morbidity and there is a limit to the amount than can be harvested in order to fill a large defect. Fresh osteochondral allograft with fresh living cells has a short shelf-life making it difficult to manage inventory and resulting in tissue being discarded due to limited shelf-life. We propose cryopreservation of allograft cartilage to extend the shelf-life but retain viable and active chondrocytes within particulated cartilage fragments. In this study, we evaluated the viability and bioactivity of cryopreserved human cartilage fragments compared to fresh tissue. Materials and Methods: Human cartilage fragments were harvested from seven adult human condyles (LifeLink Tissue Bank) and sieved between 1-0.1mm. The fragments were then cryopreserved for 12, and 24 weeks. Fresh unfrozen fragments served as a control. A subset of the cartilage fragments at each time point was digested overnight with collagenase to dissociate the tissue and isolate chondrocytes. The viability of the chondrocytes was determined with nucleic acid binding dyes acridine orange (AO) and propidium iodide (PI). Live nucleated cells fluoresce green and the dead nucleated cells fluoresce red. The cellular viability was determined using the Cellometer K2 (Nexcelom). The remaining cartilage fragments were placed in 24-well transwell plates. All fragments were cultured at 37°C, 5% CO2 in complete media consisting of DMEM+GlutaMax (Gibco) supplemented with 10% FBS, 1X antibiotics, and 1X antimycotic for 8 weeks. After 8 weeks the constructs were encased in HistoGel (Thermo Fisher) and collected from the transwells. The constructs were fixed in 10% formalin and embedded in paraffin wax and 5μm sections were prepared. Sections were stained with hematoxylin and eosin (H&E). Results and Discussion: The viability of fresh cartilage was about 92%. The viability of the cryopreserved chondrocytes at 12 and 24 weeks was 84% and 82% respectively and was not significantly different compared to fresh tissue (Figure 1). Fresh cartilage fragments displayed hypercellular regions indicative of chondrocytes outgrowth and fragment fusion after 8 weeks of culture (Figure 2A). The cryopreserved fragments following 12 and 24 weeks of cryopreservation displayed cellular outgrowth and fragment fusion following 8 weeks of culture as well (Figure 2B-C). Conclusion: Several studies have shown that cartilage is a source of chondrocytes which can be used to treat cartilage defects. We investigated a processing technique for adult allograft cartilage which entails particulation and cryopreservation. In this study the cryopreserved fragments maintained high viability and both fresh and cryopreserved human cartilage fragments displayed robust outgrowth. Cryopreservation of adult cartilage with a prolonged shelf-life may provide an attractive alternative for treating cartilage defects. Future studies should evaluate the bioactivity of these fragments in-vivo.

Experimental substantiation of platelet enriched plasma application for stimulation of cartilage autografts regeneration

The objective of this work was to study the influence of platelet enriched plasma on regeneration of cartilage tissue after its mechanical destruction using morphological methods. In the process of study, withdrawal and fragmentation of cartilage tissue sections of both ear conches of rabbits was performed with subsequent reimplantation of the crushed cartilage tissue to the same place in the left ear and crushed cartilage tissue mixed with platelet­enriched plasma obtained from the blood of the same laboratory animal - to the right auricle. After that a cut was made and the peculiarities of regeneration of the cartilage on the 10th, 20th days and after 1, 2 and 3 months after surgery were studied. After that the platelet enriched plasma was injected in the defect site on the right ear conch once a week. The study revealed that in the experimental group in terms of platelet enriched plasma application, regeneration of cartilage tissue occurred more adequately in comparison with the control group, and was accompanied by the acceleration of healing processes, which was expressed in activation of fibroblastic and chondroblastic of programed differentiation.

Osteochondritis Dissecans Treated With Autograft Cartilage Transplantation System (Mosaicplasty): MRI Contribution on Patient Follow-up - Case Report

Articular cartilage injuries may be caused by several mechanisms, including metabolic, genetic, vascular and traumatic events. A single episode of knee trauma or chronic and repetitive mechanical stress overloading the subchondral bone can start the process. The authors report a case of a young male patient with regular exercise routine, diagnosed with osteochondritis dissecans after sudden severe right knee pain. This patient underwent surgical treatment with autograft cartilage transplantation (mosaicplasty). Comparison between initial MRI, one-­‐year and two-­‐year follow-­‐up MRIs was performed. This case report illustrates the importance of the MRI in the evaluation of mosaicplasty treatment for osteochondritis dissecans. We further discuss prognostic factors related to chondral repair and MRI assessment of implant integration.

Intraoperative Autologous Bone Grafting with 3D CAD/CAM

Hypothesis: A subtractive 3D CAD/CAM device can produce accurate bone and cartilage autografts on demand in the operating room. This process can save money by reducing operating room time, and reducing the need for expensive inventories of various shapes, sizes, and types of prosthetic devices. Also, autologous materials are less likely to extrude or cause other complications such as infection. This also can reduce overall costs.

Use of chondral fragments for one stage cartilage repair: A systematic review.

To investigate the state of the art regarding Cartilage Autograft Implantation System (CAIS) or Particulated Juvenile Allograft Cartilage (PJAC). The authors searched the English literature regarding CAIS and PJAC. The search strategy was: (particulated cartilage) OR autologous cartilage fragments. All basic science articles were included. Clinical articles with less than 10 patients treated and less than 6 mo of follow-up were excluded. With these criteria, a total of 17 articles were available for the present review. PJAC and CAIS are relatively novel techniques for cartilage repair. Good basic science evidence was described to support the concept. Although the preliminary clinical reports show encouraging results, clinical data are still limited, especially for CAIS. The indications for both techniques need to be precisely defined (age of the patients, size of the lesion, and involvement of the subchondral bone), together with other debated issues. In conclusion, the authors can state that encouraging preliminary results are available for both techniques. However, further studies are necessary to precisely determine the indications, surgical techniques, and long term outcomes for PJAC and CAIS.

Limited integrative repair capacity of native cartilage autografts within cartilage defects in a sheep model.

The purpose of this study was to investigate integration and cellular outgrowth of native cartilage autografts transplanted into articular cartilage defects. Native cartilage autografts were applied into chondral defects in the femoral condyle of adult sheep. Within the defects, the calcified cartilage layer was either left intact or perforated to induce bone marrow stimulation. Empty defects served as controls. The joints were analyzed after 6 and 26 weeks by macroscopic and histological analysis using the ICRS II Score and Modified O'Driscoll Scores. Non-treated defects did not show any endogenous regenerative response and bone marrow stimulation induced fibrous repair tissue. Transplanted native cartilage grafts only insufficiently integrated with the defect borders. Cell death and loss of proteoglycans were present at the margins of the grafts at 6 weeks, which was only partially restored at 26 weeks. Significant cellular outgrowth from the grafts or defect borders could not be observed. Bonding of the grafts could be improved by additional bone marrow stimulation providing ingrowing cells that formed a fibrous interface predominantly composed of type I collagen. Transplanted native cartilage grafts remain as inert structures within cartilage defects and fail to induce integrative cartilage repair which rather demands additional cells provided by additional bone marrow stimulation.

Saddle-nose deformity repair with microplate-adapted costal cartilage.

Nasal deformities affecting the bone and lower two-thirds of the nose due to the loss of septal height and tip support are defined as "saddle-nose" deformity. Reconstruction of a saddle-nose deformity essentially necessitates structural grafting. This article presents an alternative approach for correction of saddle-nose deformity using a microplate and costal cartilage. The results are compared with those of the previously applied costal cartilage repair methods. Between 2004 and 2013, 16 patients were treated with costal cartilage autografts. Of these 16 patients, 7 were treated with a microplate and costal cartilage autograft combination, 4 were treated with a costal cartilage autograft and Kirschner (K)-wire, and 5 were treated with onlay costal cartilage grafts. The mean follow-up periods were 16 months for group treated with microplate-adapted autologous costal cartilage, 12 months for the group treated with K-wire and autologous costal cartilage, and 16 months for the group treated with onlay costal cartilage. The patients treated with K-wire inserted cartilages and the patients treated onlay dorsal costal cartilages encountered complications such as extrusion of the wire and warping, respectively. The seven patients treated with microplate and dorsal onlay costal cartilage graft did not experience any infection, warping, or extrusion complication. The warping tendency of the costal cartilage autograft can be efficiently prevented without a prominent complication risk by using microplate-adapted costal cartilage grafts. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Endochondral bone tissue engineering: using cartilage to drive vascularized bone regeneration (87.6)

There is a significant unmet clinical need to develop improved strategies to promote vascularized bone regeneration. Current bone graft technologies promote repair through direct osteogenesis by use of auto‐ or allografted bone. Critical failures associated with these therapies include osteonecrosis and poor osseointegration. The long‐term goal of this project is to develop a tissue engineering approach to promote endochondral bone formation, in which bone forms through a cartilage intermediate. Endochondral ossification is the normal mechanism by which long bones form and the majority of fractures heal. By leveraging this normal healing response, we hypothesize we can overcome the clinical problems of osteonecrosis and poor integration to produce a vascularized and integrated bone regenerate. To test this hypothesis, critical sized defects were created in mid‐diaphysis of murine tibia. Defects remained empty, or were filled with a cartilage graft, autograft or allograft bone. Our data show cartilage grafts effectively transformed into vascularized bone and integrated with the host bone to perform statistically better than allografts and equivalent to autografts. To translate this therapy we have developed a biomimetic acrylated hyaluronic acid hydrogel that contains peptide sequences for cell attachment (bone sialoprotein‐derived RGD), heparin for modulation and sequestration of growth factors, and enzymatically degradable MMP‐13 crosslinks. Hypertrophic chondrocytes encapsulated in these scaffolds mineralization during in vitro culture in basal medium. In ongoing work, these scaffolds have been transplanted into a subcutaneous model of osteonecrosis to evaluate the capacity to re‐vitalize bone. This novel approach to bone tissue engineering has the potential to improve clinical outcomes in bone regeneration.Grant Funding Source: Supported by NIH 5F32AR062469 (CSB), MTF Junior Investigator Award (CSB), UCSF CTSI Award (CSB)

Repair of articular cartilage defects in the knee with autologous iliac crest cartilage in a rabbit model

To demonstrate that iliac crest cartilage may be used to repair articular cartilage defects in the knees of rabbits. Full-thickness cartilage defects were created in the medial femoral condyle on both knees of 36 New Zealand white rabbits. The 72 defects were randomly assigned to be repaired with ipsilateral iliac crest cartilage (Group I), osteochondral tissues removed at defect creation (Group II), or no treatment (negative control, Group III). Animals were killed at 6, 12, and 24weeks post-operatively. The repaired tissues were harvested for magnetic resonance imaging (MRI), histological studies (haematoxylin and eosin and immunohistochemical staining), and mechanical testing. At 6weeks, the iliac crest cartilage graft was not yet well integrated with the surrounding articular cartilage, but at 12weeks, the graft deep zone had partial ossification. By 24weeks, the hyaline cartilage-like tissue was completely integrated with the surrounding articular cartilage. Osteochondral autografts showed more rapid healing than Group I at 6weeks and complete healing at 12weeks. Untreated defects were concave or partly filled with fibrous tissue throughout the study. MRI showed that Group I had slower integration with surrounding normal cartilage compared with Group II. The mechanical properties of Group I were significantly lower than those of Group II at 12weeks, but this difference was not significant at 24weeks. Iliac crest cartilage autografts were able to repair knee cartilage defects with hyaline cartilage and showed comparable results with osteochondral autografts in the rabbit model.

耳小骨形成IV型の聴力成績

We evaluated the postoperative hearing results of 33 patients who underwent a type IV tympanoplasty between January 2001 and March 2010 at Tokyo Medical University Hospital. A total of 33 ears in 18 male and 15 female patients were studied with ages ranging from 8 to 77 years. The patients were followed up for at least 6 months after surgery. The surgical techniques were Type IV-c in 32 ears, and IV-i in 1 ear. In the case of a non-inflammatory disease, such as malformation of the middle ear, traumatic lesion of the ossicular chain and congenital cholesteatoma, successful hearing results were attained in 92.9% of the patients. In the case of an inflammatory disease, such as acquired cholesteatoma and otitis media, successful hearing results were attained in 36.8%. The success rate was 87.5%, when an autograft cartilage was used for an ossiculoplasty and 43.8%, when bone was used.

Are bovine pericardium underlay xenograft and butterfly inlay autograft efficient for transcanal tympanoplasty?

To evaluate the success rate and the surgical procedure of two different transcanal myringoplasty techniques using the Tutopatch(®) (Tutogen Medical, Inc., Alachua, FL, USA), a xenograft produced from bovine pericardium or the butterfly, an inlay tragal cartilage autograft. This is a retrospective study. We studied all cases of transcanal myringoplasty with Tutopatch and butterfly, performed by the same surgeon between April 2005 and May 2013. Perforations were secondary to chronic otitis media without cholesteatoma, perforation post ventilation tube or trauma. They were not exceeding one-third of the tympanic membrane surface for the Tutopatch and one quarter for the butterfly. We evaluated the anatomical success rate, complications and postoperative hearing results in both techniques. A total of 106 myringoplasties were performed: 66 with Tutopatch and 40 with butterfly with a mean follow-up of 16.5 and 5.2 months, respectively. Successful closure rates of Tutopatch and butterfly were 75.8% (P < 0.0001) and 85.0% (P < 0.0001), respectively. Myringitis controlled with topical antibiotics treatment occurred in 8 (12.1%) and 5 (12.5%) cases. Eighty percent of patients with Tutopatch had a mean residual air-bone gap within 10 dB, compared to 85.0% in patients with butterfly. When anatomically feasible, a transcanal approach myringoplasty with a Tutopatch(®) graft or butterfly appears to provide good anatomical and functional results. We show that both techniques provide good anatomical and functional results. The butterfly has the advantage to use an autograft, which is surgically easier because it does not require tympanomeatal flap elevation. We recommend the butterfly technique for non-marginal perforation not exceeding one quarter of the tympanic membrane after excision of the perforation edge and Tutopatch for bigger perforation or when standard autografts are not available. Myringitis is the only described complication without specific incidence.

The effect of subcutaneous Insulin-like Growth Factor-1 (IGF-1) injection on rabbit auricular cartilage autograft viability.

Insulin-like Growth Factor-1 (IGF-1) is one of the significant substances affecting the growth and development of cartilage tissue in the body. The aim of this study is to evaluate the possible histopathological effects of local IGF-1 injection on the viability of rabbit auricular cartilage autografts. To this end, the single-piece and sliced cartilage tissues obtained from 20 albino rabbits' auricula were implanted in the subcutaneous pockets created on the back skins of the experimental animals. Every two weeks IGF-1 (10 mg/ml) injections were performed on the autograft implants of one group and normal saline (0.9%) injections were performed on the other group. Experimental animals were sacrificed at the end of the third month. A total of 34 tissue samples obtained after dissection were evaluated and scored histopathologically according to their cartilage viability, environmental reaction, and regenerative activities. The intergroup evaluation carried out for the single-piece and sliced cartilage grafts revealed that there was statistically more cartilage viability and less foreign-body reaction in the IGF-1 group than the normal saline group (p<0.05). While there was a statistically significant difference between the groups for single-piece grafts regarding regenerative activity (p<0.05), there was no significant difference for sliced grafts. The IGF-1 group, however, showed more activity. The results we obtained point out to the fact that IGF-1 increases the tissue viability of the implanted auricular autograft and it suppresses immune modulation effect.

Validation of the Knee Injury and Osteoarthritis Outcome Score Subscales for Patients With Articular Cartilage Lesions of the Knee

Background: The Knee Injury and Osteoarthritis Outcome Score (KOOS) assesses acute and chronic knee injuries or early-onset osteoarthritis in young, active patients. The United States Food and Drug Administration guidelines recommend that patient-reported outcome instruments used to support clinical trial label claims should demonstrate content validity using patient input and have acceptable psychometric properties in the target population. To use the KOOS subscales in safety and efficacy trials assessing new treatments for patients with articular cartilage lesions, additional validation work, using input from patients with articular cartilage lesions, was necessary. Purpose: Qualitative and quantitative evaluations of the KOOS subscales’ validity among patients with articular cartilage lesions were conducted to support their use as clinically meaningful end points in clinical trials. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: For qualitative analysis, cognitive interviews involving concept elicitation and cognitive debriefing with the KOOS items were conducted with 15 participants aged 25 to 52 years. Participants either were candidates for cartilage repair or had undergone cartilage repair 6 months or more before the study. For the quantitative analysis, a psychometric evaluation of the KOOS was conducted with clinical trial data from 54 patients, aged 18 to 55 years, evaluating the Cartilage Autograft Implantation System in the United States (n = 29) and the European Union (n = 25). Data were collected before surgery and at 7 postsurgical visits up to 12 months. Internal consistency and test-retest reliability, construct validity, responsiveness, and estimates of the minimal detectable change (MDC) were assessed. Test-retest reliability was assessed using data from months 2 and 3 on a subset of stable patients. Results: Qualitative research confirmed that concepts measured on the KOOS are important to patients with articular cartilage lesions. Most participants reported the KOOS was comprehensive and appropriate. In the quantitative research, KOOS subscales showed excellent internal consistency reliability (range, .74-.97 at baseline) and test-retest reliability (range, .78-.82). Construct validity results supported hypothesized relationships, with significant correlations (r ≥ .50) in the expected directions. Responsiveness analyses demonstrated excellent sensitivity to change; standardized response means ranged from 0.8 to 1.2, and MDC estimates ranged from 7.4 to 12.1. Conclusion: The study results support the use of the KOOS subscales among patients with articular cartilage lesions.

Antihelical Cartilage Grafts for Reconstruction of Mohs Micrographic Surgery Defects

To illustrate the safety, efficacy, and versatility of the antihelix as the preferred donor site for auricular cartilage autografts in the reconstruction of nasal and auricular Mohs micrographic surgery defects. Retrospective chart review of all cartilage autografts performed at the Medical University of South Carolina for the 5-year period July 1, 2006, to June 30, 2011; 307 auricular cartilage autografts were performed in 297 patients. Each case was reviewed for demographic data, graft donor site, repair type, complications, and revisions. Three hundred five of the grafts (99.3%) were harvested from the antihelix and the remaining two (0.7%) from the conchal bowl. The donor site complication rate was 3%. No patients experienced cosmetic or functional deformity of the donor ear. No patients experienced cartilage graft resorption or infection. Antihelical cartilage grafts can serve as safe, effective, and versatile alternatives to septal, conchal bowl, and costal margin grafts. The authors feel strongly that the antihelix donor site should be favored when harvesting auricular cartilage for its easy accessibility, large dimension that may be harvested without aesthetic penalty, character of graft, and minimal operative morbidity.

Comparative Analysis of the Nail Xenografts With Cartilage Autografts in Eyelid Reconstruction

The tarsal plate is the skeleton support system of the eyelids; therefore, repair during eyelid reconstruction is crucial. Many autogenous graft materials have been proposed for the tarsal reconstruction, such as nasal cartilage, palatal mucosa, upper eyelid tarsus, and auricular cartilage. Nail thickness and shape are similar to the tarsal plate with enough support for the eyelid. It also easily integrates with host tissues. The aim of this experimental study was to macroscopically and histopathologically compare nail xenografts with cartilage autografts when used in eyelid reconstruction in rabbits. In total, 12 New Zealand rabbits were used in the experiment. Full-thickness defect with a 1-cm diameter was created in both upper eyelids. The right upper eyelids were used for cartilage autograft reconstruction, and the left upper eyelids were used for nail xenograft reconstruction. All animals were killed on week 12 after eyelid reconstruction. After the animals were killed, the upper eyelids of the rabbits were resected for macroscopic and histologic analysis. In histologic evaluation, moderate foreign body giant cell formation and moderate histiocytic, neutrophilic, basophilic, and lymphocytic infiltration were observed in both experimental group and control group. In addition, this marked fibrous capsule formation was observed around the nail xenograft, which was absent in the cartilage autograft group. Nail has some advantages such as being cost-effective, being easy to obtain, and having less rejection risk for being composed of dead cells. Nail xenografts can be taken into account instead of cartilage grafts in eyelid reconstruction.

Particulated Articular Cartilage: CAIS and DeNovo NT

Cartilage Autograft Implantation System (CAIS; DePuy/Mitek, Raynham, MA) and DeNovo Natural Tissue (NT; ISTO, St. Louis, MO) are novel treatment options for focal articular cartilage defects in the knee. These methods involve the implantation of particulated articular cartilage from either autograft or juvenile allograft donor, respectively. In the laboratory and in animal models, both CAIS and DeNovo NT have demonstrated the ability of the transplanted cartilage cells to "escape" from the extracellular matrix, migrate, multiply, and form a new hyaline-like cartilage tissue matrix that integrates with the surrounding host tissue. In clinical practice, the technique for both CAIS and DeNovo NT is straightforward, requiring only a single surgery to affect cartilage repair. Clinical experience is limited, with short-term studies demonstrating both procedures to be safe, feasible, and effective, with improvements in subjective patient scores, and with magnetic resonance imaging evidence of good defect fill. While these treatment options appear promising, prospective randomized controlled studies are necessary to refine the indications and contraindications for both CAIS and DeNovo NT.

Nasal reconstruction with costal cartilage autograft in leprosy

Introduction: Leprosy is a chronic granulomatous infection of the skin, mucosa and peripheral nerves, which often leads to gross distortion of the nasal skeleton and consequent formation of a saddle nose deformity. The destruction of the nasal septum and nasal bones by Mycobacterium leprae and subsequent infection is still seen regularly in endemic areas. The reconstruction of the nose has challenged surgeons for centuries, and different procedures have been proposed and developed.

Acquired Cholesteatoma

Reclassification of acquired cholesteatoma into the commonly observed presentations of this condition to provide a simple and clear grouping that indicates the pathology, management, and outcomes of the group cases. Virgin acquired cholesteatoma cases from a single center managed from 1986 to 2008 (515 cases). Cases were managed by transcanal (20%) or intact canal wall techniques. Wall repairs successively used autograft cartilage (transcanal and early intact canal wall mastoidectomy cases), hydroxylapatite plates (1989-2007), or titanium sheeting (2007). Drum repairs used cartilage-perichondrial composite grafts. Assembly techniques were the preferred ossiculoplasty method. Distribution: attic, 41%; pars tensa, 45%; and combined attic-pars tensa, 14%. Unclassifiable cases (n = 14) were excluded. Contralateral disease was present in 15% and effusions in 34% during or after surgery. Cell formation was most extensive in attic disease, least in combined patterns. Ossicular pathology was worse in the collapsed drum cases. Attic cases had the best hearing outcomes but risked recurrent disease, which required precise countermeasures. Overall, the combined pattern group carried the worst prognosis. Compared with previous methods, the clinical classification proved simple, descriptive, and comprehensive. It provides a readily discerned practical basis for clinical management and research purposes.