Large Osteochondral Defects Research Articles

The effect of autologous adipose derived mesenchymal stem cell therapy in the treatment of a large osteochondral defect of the knee following unsuccessful surgical intervention of osteochondritis dissecans \u2013 a case study

BackgroundA prospective analysis of the effect of autologous adipose derived mesenchymal stem cell (MSC) therapy in the treatment of an osteochondral defect of the knee with early progressive osteoarthritis following unsuccessful surgical intervention of osteochondritis dissecans (OCD).Case presentationAfter failed conventional management of OCD a patient undergoes intra-articular MSC therapy. Patient outcome measures included the Numeric Pain Rating Scale (NPRS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Structural outcome was assessed using MRI with the novel technique of T2 mapping used to indicate cartilage quality. Following MSC therapy the patient reported improvement in pain and function as measured by NPRS, WOMAC and KOOS. Repeat MRI analysis showed regeneration of cartilage. MRI T2 mapping indicated hyaline like cartilage regrowth.ConclusionIn this report, the use of MSCs, after unsuccessful conventional OCD management, resulted in structural, functional and pain improvement. These results highlight the need to further study the regenerative potential of MSC therapy.Trial registrationAustralian and New Zealand Clinical Trial Registry Number - ACTRN12615000258550 (Date registered 19/03/2015 – retrospectively registered).

Can Competitive Athletes Sustain High-Level Play Following Osteochondral Allograft Transplantation of the Knee?

Objectives:The purpose of this study is to investigate the ability of competitive athletes to remain at a high level of competition following osteochondral allograft transplantation (OCA) of the knee.Methods:A retrospective review was performed to identify all competitive athletes (high school, collegiate, professional) who underwent an isolated femoral condyle OCA between 2004 and 2012. Patient reported outcome (PRO) questionnaires (Lysholm, International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMasters Universities Arthritis Index (WOMAC), Short Form-12 (SF-12), Tegner, and Marx) and custom return-to-sport surveys were administered. All subsequent reoperations were documented.Results:A total of 13 (7 male, 6 female) athletes were identified with an average follow-up of 5.9 ± 2.5 years. Four athletes competed at an intercollegiate level, while 9 played high-level high-school sports. Seven athletes returned to competitive sport (54%) at an average of 7.9 ± 3.5 months, five of whom were returned to pre-injury levels of play. Of the eight athletes who either did not return to sport or failed to sustain their high level of play, the most common reasons cited were a change in life circumstances, such as graduation, or a fear of re-injury (Figure 1). At final follow-up, regardless of return-to-play, all athletes had significant improvements in all PRO scores except for KOOS-Sport, WOMAC-Stiffness, and SF-12 Mental subscales. Tegner Activity scores dropped significantly from pre-injury to final follow-up (8.2 ± 2.4, 4.5 ± 2.1, p < 0.01). There were three reoperations and zero instances of graft failure.Conclusion:OCAs provide acceptable rates of return-to-play and excellent long-term outcomes for high-level athletes with large osteochondral defects. Social factors are three times more likely than persistent pain to prevent return to sport.

Treatment of Large Osteochondral Defects with Spongiosaplasty and Collagen Type I Hydrogel-Based Autologous Chondrocyte Implantation

Treatment of Large Osteochondral Defects with Spongiosaplasty and Collagen Type I Hydrogel-Based Autologous Chondrocyte Implantation

Restoration of a large osteochondral defect of the knee using a composite of umbilical cord blood-derived mesenchymal stem cells and hyaluronic acid hydrogel: a case report with a 5-year follow-up

BackgroundThe treatment of articular cartilage defects is a therapeutic challenge for orthopaedic surgeons. Furthermore, large osteochondral defects needs restoration of the underlying bone for sufficient biomechanical characteristics as well as the overlying cartilage.Case presentationA symptomatic large osteochondral defect in the knee joint was restored using a composite of umbilical cord blood-derived mesenchymal stem cells (UCB-MSCs) 0.5 x 107/ml and 4% hyaluronic acid (HA) hydrogel. Significant improvements in pain and function of the knee joint were identified by the evaluation at 12 months after surgery. A hyaline-like cartilage completely filled the defect and was congruent with the surrounding normal cartilage as revealed by magnetic resonance imaging (MRI), a second-look arthroscopy and histological assessment. The improved clinical outcomes maintained until 5.5 years. MRI also showed the maintenance of the restored bony and cartilaginous tissues.ConclusionThis case report suggests that the composite of allogeneic UCB-MSCs and HA hydrogel can be considered a safe and effective treatment option for large osteochondral defects of the knee.

Repair of osteochondral defects with in vitro engineered cartilage based on autologous bone marrow stromal cells in a swine model

Functional reconstruction of large osteochondral defects is always a major challenge in articular surgery. Some studies have reported the feasibility of repairing articular osteochondral defects using bone marrow stromal cells (BMSCs) and biodegradable scaffolds. However, no significant breakthroughs have been achieved in clinical translation due to the instability of in vivo cartilage regeneration based on direct cell-scaffold construct implantation. To overcome the disadvantages of direct cell-scaffold construct implantation, the current study proposed an in vitro cartilage regeneration strategy, providing relatively mature cartilage-like tissue with superior mechanical properties. Our strategy involved in vitro cartilage engineering, repair of osteochondral defects, and evaluation of in vivo repair efficacy. The results demonstrated that BMSC engineered cartilage in vitro (BEC-vitro) presented a time-depended maturation process. The implantation of BEC-vitro alone could successfully realize tissue-specific repair of osteochondral defects with both cartilage and subchondral bone. Furthermore, the maturity level of BEC-vitro had significant influence on the repaired results. These results indicated that in vitro cartilage regeneration using BMSCs is a promising strategy for functional reconstruction of osteochondral defect, thus promoting the clinical translation of cartilage regeneration techniques incorporating BMSCs.

Evaluation of Bilayer Polycaprolactone Scaffold for Osteochondral Regeneration in Rabbits

Polycaprolactone (PCL) scaffold have been developed as an alternative to natural donor tissue to repair a large osteochondral defect. The objective of this study is to evaluate efficacy and biocompatibility of bilayer PCL scaffold implanted for osteochondral repair in rabbit. Twenty-two male New Zealand White rabbits were used in this animal experiment. Rabbits were divided into three groups. Experimental surgery was carried out under general anesthesia. Osteochondral defects (5 mm diameter and 5 mm deep) were made in the center of the patellar groove using a 5 mm diameter biopsy punch. In group I (3D plotting) and group II (salt-leaching), the scaffold was implanted using the press-fitted technique into the defect. In control group, after osteochondral defect was created, the defect was left without implant. After four and eight weeks, rabbits were sacrificed and the defects were evaluated by macroand microscopical methods. There were not found animal death and severe inflammatory evidence during the experimental periods. There were no significant differences between the experimental groups in gross evaluation. However the group I scored significantly higher than group II at 8 weeks in histological evaluation (P < 0.05). The 3-D plotting PCL scaffold was more suitable method for reconstruction of osteochondral defect than a salt-leaching PCL scaffold.

Treatment of Osteochondral Lesions in the Ankle: A Guideline from the Group "Clinical Tissue Regeneration" of the German Society of Orthopaedics and Traumatology (DGOU)

Background: Osteochondral lesions (OCL) of the ankle are a common cause of ankle pain. Although the precise pathophysiology has not been fully elucidated, it can be assumed that a variety of factors are responsible, mainly including traumatic events such as ankle sprains. Advances in arthroscopy and imaging techniques, in particular magnetic resonance imaging (MRI), have improved the possibilities for the diagnosis of OCLs of the ankle. Moreover, these technologies aim at developing new classification systems and modern treatment strategies. Material and Methods: This article is a review of the literature. Recommendations of the group "Clinical Tissue Regeneration" of the German Society of Orthopaedics and Traumatology (DGOU) for the treatment of OCLs of the ankle are presented. The review gives a concise overview on the results of clinical studies and discusses advantages and disadvantages of different treatment strategies. Results: Non-operative treatment shows good results for selected indications in children and adolescents, especially in early stages of osteochondritis dissecans (OCD). However, surgical treatment is usually indicated in OCLs in adolescents and adults, depending on the size and location of the lesion. Various arthroscopic and open procedures are frequently employed, including reattachment of the fragment, local debridement of the lesion with fragment removal and curettage of the lesion, bone marrow-stimulation by microfracture or microdrilling (antegrade or retrograde), and autologous matrix-induced chondrogenesis (AMIC®) - with or without reconstruction of a subchondral bone defect or cyst by autologous cancellous bone grafting. Isolated subchondral cysts with an intact cartilage surface can be treated by retrograde drilling and possibly additional retrograde bone grafting. For larger defects or as salvage procedure, osteochondral cylinder transplantation (OATS® or Mosaicplasty®) or matrix-induced autologous chondrocyte transplantation (MACT) are recommended. Transplantation of so-called (osteochondral) mega grafts, such as autologous bone grafts or allografts, are used for very large osteochondral defects that cannot be reconstructed otherwise. Implantation of the so-called "small metal implants" - such as HemiCAP Talus® - is reserved for selected cases after failed primary reconstruction. Corrective osteotomies are indicated in accompanying axial malalignments. Conclusions: There are several different treatment strategies for OCLs, but clinical studies are rare and evidence is limited. Therefore, interventional studies, e.g. randomised controlled trials (RCTs), but also observational studies, e.g. based on data of the Cartilage Registry of the German Society of Orthopaedics and Traumatology (www.knorpelregister-dgou.de), are needed and are recommended by the authors.

Porous tantalum biocomposites for osteochondral defect repair: A follow-up study in a sheep model.

ObjectivesWe sought to determine if a durable bilayer implant composed of trabecular metal with autologous periosteum on top would be suitable to reconstitute large osteochondral defects. This design would allow for secure implant fixation, subsequent integration and remodeling.Materials and MethodsAdult sheep were randomly assigned to one of three groups (n = 8/group): 1. trabecular metal/periosteal graft (TMPG), 2. trabecular metal (TM), 3. empty defect (ED). Cartilage and bone healing were assessed macroscopically, biochemically (type II collagen, sulfated glycosaminoglycan (sGAG) and double-stranded DNA (dsDNA) content) and histologically.ResultsAt 16 weeks post-operatively, histological scores amongst treatment groups were not statistically different (TMPG: overall 12.7, cartilage 8.6, bone 4.1; TM: overall 14.2, cartilage 9.5, bone 4.9; ED: overall 13.6, cartilage 9.1, bone 4.5). Metal scaffolds were incorporated into the surrounding bone, both in TM and TMPG. The sGAG yield was lower in the neo-cartilage regions compared with the articular cartilage (AC) controls (TMPG 20.8/AC 39.5, TM 25.6/AC 33.3, ED 32.2/AC 40.2 µg sGAG/1 mg respectively), with statistical significance being achieved for the TMPG group (p < 0.05). Hypercellularity of the neo-cartilage was found in TM and ED, as the dsDNA content was significantly higher (p < 0.05) compared with contralateral AC controls (TM 126.7/AC 71.1, ED 99.3/AC 62.8 ng dsDNA/1 mg). The highest type II collagen content was found in neo-cartilage after TM compared with TMPG and ED (TM 60%/TMPG 40%/ED 39%). Inter-treatment differences were not significant.ConclusionsTM is a highly suitable material for the reconstitution of osseous defects. TM enables excellent bony ingrowth and fast integration. However, combined with autologous periosteum, such a biocomposite failed to promote satisfactory neo-cartilage formation.Cite this article: E. H. Mrosek, H-W. Chung, J. S. Fitzsimmons, S. W. O’Driscoll, G. G. Reinholz, J. C. Schagemann. Porous tantalum biocomposites for osteochondral defect repair: A follow-up study in a sheep model. Bone Joint J 2016;5:403–411. DOI: 10.1302/2046-3758.59.BJR-2016-0070.R1.

Medium-Term Outcomes Using Fresh Osteochondral Allograft Transplantation for Treatment of Large Osteochondral Lesion of the Talus

Category: Ankle Introduction/Purpose: Osteochondral allograft has been proven to be successful surgical option for treatment of large osteochondral defect of the talus. However, there are currently limited literatures reported outcomes of this technique. Methods: Retrospective Chart review with prospectively collected data of 26 patients with 26 ankles who had been diagnosed with large osteochondral lesion of the talus and underwent fresh osteochondral allograft transplantation 2004 and 2011 in single institution. All patients had failure of conservative treatment and minimum follow-up to be included in this study was 1 year (mean 40.9 months, range, 12 to 123 months). Pre- and post-operative pain (Visual Analog Scale (VAS)), SF-36 (PCS and MCS), and Foot Functional Index (FFI) were obtained and compared using Wilcoxon Singed-Ranks test. Results: Twenty-six patients (13 male and 13 female) with mean age of 31.7 years and an average of BMI of 29.0 were included in this study. Complete pre-operative and 1-year post-operative pain (VAS) (n=19/26) and functional outcome scores (SF-36 and FFI)(n=12/26) were collected. The mean pain (VAS) decrease from 6.9/10 to 4.8/10 post-operatively (p = 0.007). The mean SF-36 (PCS and MCS) were 41.3 and 54.7 pre-operatively which improved to 47.2 and 56.0 post-operatively, p = 0.084 and p = 0.875, respectively. The mean FFI (pain, disability, activity limitations, and total score) were 48.0, 48.8, 57.6, and 45.8 pre-operatively which changed to 53.4, 57.6, 68.5, and 54.6 post-operatively (p = 0.674, 0.575, 0.110, and 0.859, respectively). There were 61.8% patient satisfaction with this surgery and 82.7% of the patients will do the surgery again and they will recommend this type of surgery to their friends and family. There were 100% survival rate at 5-year (8 of 8) and 10-year (1 of 1). Conclusion: Osteochondral allograft demonstrated significant relief of pain in medium-term of follow-up as measured with VAS. This procedure was successful for treatment of large osteochondral lesion of the talus.

Fabrication and development of artificial osteochondral constructs based on cancellous bone/hydrogel hybrid scaffold.

Using tissue engineering techniques, an artificial osteochondral construct was successfully fabricated to treat large osteochondral defects. In this study, porcine cancellous bones and chitosan/gelatin hydrogel scaffolds were used as substitutes to mimic bone and cartilage, respectively. The porosity and distribution of pore size in porcine bone was measured and the degradation ratio and swelling ratio for chitosan/gelatin hydrogel scaffolds was also determined in vitro. Surface morphology was analyzed with the scanning electron microscope (SEM). The physicochemical properties and the composition were tested by using an infrared instrument. A double layer composite scaffold was constructed via seeding adipose-derived stem cells (ADSCs) induced to chondrocytes and osteoblasts, followed by inoculation in cancellous bones and hydrogel scaffolds. Cell proliferation was assessed through Dead/Live staining and cellular activity was analyzed with IpWin5 software. Cell growth, adhesion and formation of extracellular matrix in composite scaffolds blank cancellous bones or hydrogel scaffolds were also analyzed. SEM analysis revealed a super porous internal structure of cancellous bone scaffolds and pore size was measured at an average of 410 ± 59 μm while porosity was recorded at 70.6 ± 1.7 %. In the hydrogel scaffold, the average pore size was measured at 117 ± 21 μm and the porosity and swelling rate were recorded at 83.4 ± 0.8 % and 362.0 ± 2.4 %, respectively. Furthermore, the remaining hydrogel weighed 80.76 ± 1.6 % of the original dry weight after hydration in PBS for 6 weeks. In summary, the cancellous bone and hydrogel composite scaffold is a promising biomaterial which shows an essential physical performance and strength with excellent osteochondral tissue interaction in situ. ADSCs are a suitable cell source for osteochondral composite reconstruction. Moreover, the bi-layered scaffold significantly enhanced cell proliferation compared to the cells seeded on either single scaffold. Therefore, a bi-layered composite scaffold is an appropriate candidate for fabrication of osteochondral tissue.

Autologous Chondrocyte Implantation Using a Bilayer Collagen Membrane with Bone Graft and Anteromedialization of the Tibial Tubercle for the Treatment of a Large Osteochondral Defect in the Lateral Knee Trochlea: A Case Report.

Autologous chondrocyte implantation (ACI) is an established technique for the treatment of osteochondral lesions of the knee. For larger lesions with a substantial amount of bone loss, ACI using a bilayer collagen membrane with bone-grafting has been demonstrated to offer good to excellent results in the tibiofemoral joint, but little has been reported on its use in the patellofemoral joint. We report on the 2-year follow-up of this technique of ACI with bone-grafting used for the treatment of a large osteochondral defect in the lateral aspect of the trochlea of the knee in an 18-year-old, active female patient. This case illustrates that ACI with bone-grafting using such a "sandwich" technique can be an effective treatment option for osteochondral lesions of the trochlea in the knee.

Early tissue formation on whole‐area osteochondral defect of rabbit patella by covering with fibroin sponge

Large osteochondral defects have been difficult to repair via tissue engineering treatments due to the lack of a sufficient number of source cells for repairing the defect and to the severe mechanical stresses affecting the replacement tissue. In the present study, whole-area osteochondral defects of rabbit patella were covered and wrapped with a fibroin sponge containing chondrocytes, with or without Green Fluorescent Protein (GFP) transgenic marking, on the surface facing the osteochondral defect. Five of eight osteochondral defects that were covered with the chondrocyte-seeded fibroin sponges showed hyaline cartilage-like repair containing no fibroin fragments at 6 weeks after surgery. The repaired tissue showed a layer formation, which showed intensive safranin-O and toluidine blue staining, and which showed positive type II collagen immunostaining. The average surface coverage of the repaired cartilage was 53%. On average, 48% of the cells in the repaired tissue were derived from GFP transgenic chondrocytes, which had been seeded in the fibroin sponge. The fibroin-sponge covering had the potential to allow the early repair of large osteochondral defects. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 1474-1482, 2016.

Large osteochondral lesions of the femoral condyles: Treatment with fresh frozen and irradiated allograft using the Mega OATS technique

BackgroundThe purpose of this study was to review the clinical results of irradiated fresh frozen osteochondral allografts for large osteochondral defects of the knee using the Mega-OATS technique. MethodsNine patients with a mean age of 32.1±6.6 (18 to 44) underwent Mega-OATS transplantation with irradiated (2.5Mrad), fresh frozen distal femur allograft. Three patients also underwent ACL-reconstruction; one patient a high tibial osteotomy. The underlying indication was osteochondrosis dissecans in four and trauma in five patients. The defect size was 25×25mm in three patients and 30×30 in six patients and the depth ranged from eight to 14mm. All OCD lesions were located on the medial femoral condyle; two of the traumatic lesions were located on the lateral femoral condyle. Clinical outcome was assessed using the Lysholm and IKDC scores. Radiographic incorporation was evaluated using serial radiographs and MR imaging at one year post surgery. All patients were reviewed at three, six, 12, and 24months following surgery. ResultsThe Lysholm (IKDC) score improved significantly (p=0.02 resp. p=0.007) within and between patients during the follow-up period from 40.9 (37) to 90.9 (87.1) at 2years. Radiographic union was observed in all patients at three months; on MR imaging at one year osseous integration was observed in eight patients. Graft subsidence with loss of the overlying cartilage was observed in one and subchondral cystic changes at the implantation side were seen in another patient. ConclusionThe results of this case series suggest that irradiated osteochondral allograft provides significant medium-term clinical improvement in patients treated for large osteochondral lesions of the femoral condyles. Level of evidenceIV, case series

Combination therapy with intra-articular injection of mesenchymal stem cells and articulated joint distraction for repair of a chronic osteochondral defect in the rabbit.

The present study investigated intra-articular injection of bone-marrow-derived mesenchymal stem cells (MSCs) combined with articulated joint distraction as treatment for osteochondral defects. Large osteochondral defects were created in the weight-bearing area of the medial femoral condyle in rabbit knees. Four weeks after defect creation, rabbits were divided into six groups: control group, MSC group, distraction group, distraction + MSC group, temporary distraction group, and temporary distraction + MSC group. Groups with MSC received intra-articular injection of MSCs. Groups with distraction underwent articulated distraction arthroplasty. Groups with temporary distraction discontinued the distraction after 4 weeks. The rabbits were euthanized at 4, 8, and 12 weeks after treatment except temporary distraction groups which were euthanized at only 12 weeks. Histological scores in the distraction + MSC group were significantly better than in the control, MSC group or distraction group at 4 and 8 weeks, but showed no further improvement. At 12 weeks, the temporary distraction + MSC group showed the best results, demonstrating hyaline cartilage repair with regeneration of the osteochondral junction. In conclusion, joint distraction with intra-articular injection of MSCs promotes early cartilage repair, and compressive loading of the repair tissue after temporary distraction stimulates articular cartilage regeneration.

Fresh osteochondral allografts in the knee: only a salvage procedure?

The role of fresh allogeneic osteochondral allograft transplantation (OCA) in the cartilage repair algorithm has been long debated and this procedure is primarily considered as a salvage procedure, to be used when other, simple, techniques have failed. Gracitelli et al. in a retrospective comparison of patients who received OCA as primary treatment or as a salvage procedure, demonstrates that the outcome of this procedure is minimally influenced by a previous failed treatment and that OCA represents an effective solution for both primary and revision surgery of chondral and osteochondral lesions of the knee. In particular, optimal indications for OCA seem to be revision of previously failed bone marrow stimulation techniques with an impaired subchondral bone plate and primary treatment of large osteochondral defects.

Repairing Osteochondral Defects of Critical Size Using Multiple Costal Grafts: An Experimental Study.

Objective:To investigate the feasibility of repairing osteochondral defects of critical size by performing mosaicplasty using multiple sliced costal cartilage grafts, which enables repair of extensively injured knees using grafts from a single rib.Design:Critical osteochondral defects were prepared on the femoral groove of skeletally mature Japanese white rabbits. Costal cartilage grafts from a single rib were harvested and sliced into multiple segments (approximately 3-5 mm in length). The defects were left untreated or repaired by performing mosaicplasty using costal cartilage grafts (with or without a longitudinal cut along the middle). At 4 and 12 weeks after transplantation, International Cartilage Repair Society macroscopic and histological grading was performed.Results:The macroscopic score and visual histological score were significantly higher in the repaired groups than in the untreated group at 4 and 12 weeks after surgery. Histological continuous integration between grafted costal cartilage and host bone was observed in both repaired groups.Conclusions:The findings suggest that costal cartilage might be a useful alternative source for chondral grafting. We were able to repair large osteochondral defects by performing mosaicplasty using multiple sliced costal cartilage grafts from a single rib.

Trasplante con aloinjerto estructural de astrágalo en lesión osteocondral masiva

Large osteochondral defects of the talus present a difficult clinical problem to orthopaedic surgeons. Massive-volume deep cystic lesions are rare. The use of an allograft transplantation offers an alternative in the treatment of these extensive lesions involving the talar dome.We report on the outcome after an osteochondral fresh frozen allograft transplantation in a case of a 53-year old-woman with a massive cystic lesion of the talus.No evidence of resorption or failure of the graft has been observed after 1 year of follow up. Radiological examination shows signs of union and incoroporation of the graft without subchondral collapse or fragmentation. After 1 year se has no pain and she is able to walk independently without assistance.The present case offers a surgical alternative for massive lesions of the talus, that use rigidly fixed ostechondal allograft transplantation. Mid and long term survival of these kind of allografts remains unknown. Despite the good results after one year, worse outcomes or failures can be expected in the future.

Osteochondral Allograft MRI Scoring System (OCAMRISS) in the Knee: Interobserver Agreement and Clinical Application.

Introduction:Osteochondral allograft (OCA) transplantation is a suitable treatment option for large osteochondral defects. Magnetic resonance imaging (MRI) is an objective, reproducible, noninvasive monitoring tool for postoperative assessment after cartilage surgery.Objective:To correlate Osteochondral Allograft MRI Scoring System (OCAMRISS) in patients undergoing OCA transplantation in the knee with clinical outcomes and determine interobserver agreement of this scoring system.Methods:Fifteen patients underwent OCA transplantation in the knee and received a postoperative MRI. Four examiners read each MRI and completed an OCAMRISS. Interobserver agreement and intraclass correlation coefficients (ICCs) were assessed. Clinical outcomes were evaluated. Correlation between the OCAMRISS and clinical outcomes was calculated using Spearman’s correlation coefficients.Results:Interobserver agreement on individual features of the OCAMRISS was superior (κ = 0.81-1.0) in 65% of comparisons, substantial (κ = 0.61-0.8) in 14%, moderate (κ = 0.41-0.6) in 18%, and fair (κ = 0.21-0.4) in 3%. Agreement among readers was very strong for the cartilage, bone, ancillary, and total scores with 96% of comparisons having an ICC >0.80. International Knee Documentation Committee (IKDC) function scores were correlated with OCAMRISS cartilage score (ρ = 0.53, P = 0.044) and total score (ρ = 0.67, P = 0.006). The Knee injury and Osteoarthritis Outcome Score (KOOS) sports/recreation subscale was correlated with OCAMRISS ancillary score (ρ = 0.58, P = 0.049) and total score (ρ = 0.64, P = 0.024). No correlation was observed with subchondral bone features of OCAMRISS and any of the outcome scores.Conclusions:The recently described OCAMRISS is a reproducible grading system for in vivo evaluation after osteochondral allograft transplantation.

The use of autologous adult, allogenic juvenile, and combined juvenile-adult cartilage fragments for the repair of chondral defects.

The goal of the study was to evaluate the repair of chondral lesions treated with combined autologous adult/allogenic juvenile cartilage fragments, compared with isolated adult and isolated juvenile cartilage fragments. Fifty-eight adult (>16week old) and five juvenile (<6week old) New Zealand White female rabbits were used. A large osteochondral defect was created in the center of the femoral trochlea of adult rabbits. The rabbits were divided in four groups: Group 1=untreated defects (controls); Group 2=adult cartilage fragments; Group 3=juvenile cartilage fragments; and Group 4=adult+juvenile cartilage fragments. Killings were performed at 3 and 6months. The defects were evaluated with ICRS macroscopic score, modified O'Driscoll score, and Collagen type II immunostaining. At 3months, Group 4 performed better than Group 1, in terms of modified O'Driscoll score (p=0.001) and Collagen type II immunostaining (p=0.015). At 6months, Group 4 showed higher modified O'Driscoll score (p=0.003) and Collagen type II immunostaining score (p<0.001) than Group 1. Histologically, also Group 3 performed better than Group 1 (p=0.03), and Group 4 performed better than Group 2 (p=0.004). Mixing adult and juvenile cartilage fragments improved cartilage repair in a rabbit model. In the clinical setting, a new "one-stage" procedure combining the two cartilage sources can be hypothesized, with the advantages of improved chondral repair and large defect coverage, because of the use of an off-the-shelf juvenile allograft. Further studies on larger animals and clinical trials are required to confirm these results.

大尺寸关节支架的3D打印及应用

Implantation and long-term failure of artificial joints can cause unrecoverable tissue loss, whereas small-scale biodegradable osteochondral scaffolds can restore the mechanical environment and induce tissue regeneration within articular lesions, thus providing a new therapeutic strategy for repairing large-size defects. However, treatment development has been challenging because of the complex physical structure and mechanical environment of the lesions, and the demanding manufacturing techniques and surgical implantation strategies for multi-material composite scaffolds. This paper presents a novel multi-material osteochondral scaffold, and its bio-manufacturing technique and implantation. To induce tissue growth, PEG (polyethylene glycol), β -TCP ( β -tricalcium phosphate), and PLA (polylactide) biomaterials are selected to develop the new scaffolds. Based on limited radiological image data, techniques for reverse engineering, finite element analysis, and 3D printing are used to establish the cartilage lesion model in a sheep knee joint. Based on the mapping relationship between the scaffold physiological characteristics and joint defect mechanical properties, large-size biomimetic osteochondral scaffolds and their fixations are designed to fasten themselves securely to defects. Experiment results show that scaffold implantation restores the defects initial mechanical environment. Therefore, the proposed large-size osteochondral scaffolds through 3D printing technique is expected to provide a new treatment strategy for repairing large osteochondral defects.