Biophysical stimulation improves clinical results of matrix-assisted autologous chondrocyte implantation in the treatment of chondral lesions of the knee

Collarile, Marco; Sambri, Andrea; Lullini, Giada; Cadossi, Matteo; Zorzi, Claudio

doi:10.1007/s00167-017-4605-8

Cited by 11 publications

(16 citation statements)

References 34 publications

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“…H&E staining of the graft‐host junction was more intense in PEMF‐treated repairs (Figure 6e,f). It is possible that these modest beneficial results at 3 months may be strengthened with increased duration of PEMF stimulation, as clinical studies of cartilage restoration typically follow‐up for 2 years or longer (Collarile et al, 2018; Osti et al, 2015). It is also possible that a less robust effect was observed in OCA subscores due to minor variations in PEMF orientation introduced by knee flexion and repair location (TG vs. FCL or FCM).…”

Section: Discussionmentioning

confidence: 99%

“…Historically, PEMFs have been used in a clinical setting to treat delayed unions of bone fractures (Becker, Spadaro, & Marino, 1977). More recently, clinical studies of PEMFs have shown improvements in subjective measures of clinical function and pain following anterior cruciate ligament (ACL) reconstruction, bone marrow–derived stem cell transplantation, matrix‐assisted chondrocyte implantation (MACI®), microfracture, and chondroabrasion (Benazzo, Zanon, et al, 2008; Cadossi et al, 2014; Collarile, Sambri, Lullini, Cadossi, & Zorzi, 2018; Osti, Del Buono, & Maffulli, 2015; Zorzi, Dall'Oca, Cadossi, & Setti, 2007). However, while these initial clinical studies were promising, additional preclinical and mechanistic studies are required to support or oppose the regular use of PEMFs as an adjuvant strategy for cartilage repair rather than as a pain management tool (American Academy of Orthopaedic Surgeons Board of Directors, 2013; Bjordal et al, 2007; Gobbi, Lad, Petrera, & Karnatzikos, 2014).…”

Section: Introductionmentioning

confidence: 99%

“…In these studies, clinical stimulation parameters (Collarile et al, 2018; Gobbi et al, 2014; Zorzi et al, 2007) were used to investigate the effect of PEMFs on engineered canine cartilage. A preclinical canine model was selected for its similarities to humans in patellofemoral joint pathology and presentation of pain and discomfort via changes to gait (Bendele, 2001), which allowed both tissue‐level analysis and clinically relevant functional analyses.…”

Section: Introductionmentioning

confidence: 99%

“…Then, a comprehensive analysis of tissue quality and functional outcomes was performed following an in vivo engineered osteochondral allograft or microfracture repair (Study 2). A 3‐month end point was selected to match the normal length of stimulation for clinical pain management (Collarile et al, 2018; Osti et al, 2015; Zorzi et al, 2007) and also capture the effect on expedited graft repair. To the author's knowledge, PEMFs have not previously been investigated as a method for improving engineered cartilage growth and integration, with complementary functional analyses, in a preclinical animal model.…”

Section: Introductionmentioning

confidence: 99%

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Pulsed electromagnetic fields promote repair of focal articular cartilage defects with engineered osteochondral constructs

Stefani

Barbosa

Tan

et al. 2020

Biotech & Bioengineering

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Articular cartilage injuries are a common source of joint pain and dysfunction. We hypothesized that pulsed electromagnetic fields (PEMFs) would improve growth and healing of tissue‐engineered cartilage grafts in a direction‐dependent manner. PEMF stimulation of engineered cartilage constructs was first evaluated in vitro using passaged adult canine chondrocytes embedded in an agarose hydrogel scaffold. PEMF coils oriented parallel to the articular surface induced superior repair stiffness compared to both perpendicular PEMF (p = .026) and control (p = .012). This was correlated with increased glycosaminoglycan deposition in both parallel and perpendicular PEMF orientations compared to control (p = .010 and .028, respectively). Following in vitro optimization, the potential clinical translation of PEMF was evaluated in a preliminary in vivo preclinical adult canine model. Engineered osteochondral constructs (∅ 6 mm × 6 mm thick, devitalized bone base) were cultured to maturity and implanted into focal defects created in the stifle (knee) joint. To assess expedited early repair, animals were assessed after a 3‐month recovery period, with microfracture repairs serving as an additional clinical control. In vivo, PEMF led to a greater likelihood of normal chondrocyte (odds ratio [OR]: 2.5, p = .051) and proteoglycan (OR: 5.0, p = .013) histological scores in engineered constructs. Interestingly, engineered constructs outperformed microfracture in clinical scoring, regardless of PEMF treatment (p < .05). Overall, the studies provided evidence that PEMF stimulation enhanced engineered cartilage growth and repair, demonstrating a potential low‐cost, low‐risk, noninvasive treatment modality for expediting early cartilage repair.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Pulsed electromagnetic fields promote repair of focal articular cartilage defects with engineered osteochondral constructs

Stefani

Barbosa

Tan

et al. 2020

Biotech & Bioengineering

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“…Pulsed signal therapy (PST) is an extension of pulsed electromagnetic field therapy (PEMF) consisting in a patented pulse frequency for bones and soft tissue (PST MOBIL, Bio Magnetic Therapy Systems, Munich, Germany). PST has been used empirically to treat various diseases, including arthrosis of various joints, spine pain syndromes, tendinopathy, sports injuries, and even as an adjunct in rheumatic diseases [Moretti et al, ; Massari et al, ; Collarile et al, ].…”

Section: Introductionmentioning

confidence: 99%

Clinical results of pulsed signal therapy on patellofemoral syndrome with patellar chondropathy

Gobbi

Silva

Demange

et al. 2019

Bioelectromagnetics

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This study was designed to evaluate the effect of pulsed signal therapy (PST) on patellofemoral pain syndrome associated with patellar chondropathy. A prospective randomized double‐blind placebo controlled trial included 25 patients (41 knees) between 20 and 50 years with pain due to isolated patellofemoral syndrome with chondropathy. PST group received nine 60‐min daily sessions of PST treatment. Control group received the same protocol of blinded placebo treatment. The main outcome was change from baseline Kujala score at 3 months. After 3 months, patients in the control group received effective treatment (placebo post‐treatment). All patients were then followed, for up to 12 months. Seventeen knees (5 males and 12 females, mean age 36.7 ± 7.9) received placebo and 24 knees (8 males and 16 females, mean age 35.5 ± 8.9) received PST. By the third month, PST group exhibited a mean change from baseline of 9.63 ± 7.5 Kujala points, compared to 0.53 ± 1.8 in the placebo group (P < 0.001). A significant progressive improvement was seen in the PST group between the 3rd and 6th and between the 6th and 12th month (P < 0.016). Patients initially allocated in the control group also improved at 3 months (P < 0.001) and 6 months (P = 0.005) post‐effective treatment. In conclusion, PST in patellofemoral pain syndrome with chondropathy was effective compared to placebo at 3 months, showing an important improvement of Kujala score. The improvement was progressive and maintained up to 12 months. PST is safe and should be considered as a non‐invasive option for management of this condition. Bioelectromagnetics. 40:83–90, 2019. © 2019 Bioelectromagnetics Society

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Biophysical stimulation of bone and cartilage: state of the art and future perspectives

Massari

Benazzo

Falez

et al. 2019

International Orthopaedics (SICOT)

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Introduction Biophysical stimulation is a non-invasive therapy used in orthopaedic practice to increase and enhance reparative and anabolic activities of tissue. Methods A sistematic web-based search for papers was conducted using the following titles: (1) pulsed electromagnetic field (PEMF), capacitively coupled electrical field (CCEF), low intensity pulsed ultrasound system (LIPUS) and biophysical stimulation; (2) bone cells, bone tissue, fracture, non-union, prosthesis and vertebral fracture; and (3) chondrocyte, synoviocytes, joint chondroprotection, arthroscopy and knee arthroplasty. Results Pre-clinical studies have shown that the site of interaction of biophysical stimuli is the cell membrane. Its effect on bone tissue is to increase proliferation, synthesis and release of growth factors. On articular cells, it creates a strong A 2A and A 3 adenosine-agonist effect inducing an anti-inflammatory and chondroprotective result. In treated animals, it has been shown that the mineralisation rate of newly formed bone is almost doubled, the progression of the osteoarthritic cartilage degeneration is inhibited and quality of cartilage is preserved. Biophysical stimulation has been used in the clinical setting to promote the healing of fractures and non-unions. It has been successfully used on joint pathologies for its beneficial effect on improving function in early OA and after knee surgery to limit the inflammation of periarticular tissues. Discussion The pooled result of the studies in this review revealed the efficacy of biophysical stimulation for bone healing and joint chondroprotection based on proven methodological quality. Conclusion The orthopaedic community has played a central role in the development and understanding of the importance of the physical stimuli. Biophysical stimulation requires care and precision in use if it is to ensure the success expected of it by physicians and patients.

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Biophysical stimulation improves clinical results of matrix-assisted autologous chondrocyte implantation in the treatment of chondral lesions of the knee

Abstract: II.

Cited by 11 publications

References 34 publications

Pulsed electromagnetic fields promote repair of focal articular cartilage defects with engineered osteochondral constructs

Pulsed electromagnetic fields promote repair of focal articular cartilage defects with engineered osteochondral constructs

Clinical results of pulsed signal therapy on patellofemoral syndrome with patellar chondropathy

Biophysical stimulation of bone and cartilage: state of the art and future perspectives

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