Clinical experiences with cartilage repair techniques: outcomes, indications, contraindications and rehabilitation

Berta, Ágnes; Duska, Zsófia; Tóth, Ferenc; Hangody, László

doi:10.5606/ehc.2015.19

Cited by 21 publications

(32 citation statements)

References 18 publications

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“…These initial findings suggest that the dSRC method may successfully address the shortcomings of current clinical therapies. OATS, the transfer of osteochondral plugs of non-weight bearing cartilage to a chondral defect, can result in surface irregularities of the lesion due to plug placement [28]. This inadequacy was seen in nearly all plug-filled defects in our study but in very few dSRC-filled injuries.…”

Section: Discussionmentioning

confidence: 81%

Hyaline Articular Matrix Formed by Dynamic Self-Regenerating Cartilage and Hydrogels

Meppelink

Zhao

Griffin

et al. 2016

Tissue Engineering Part A

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Injuries to the articular cartilage surface are challenging to repair because cartilage possesses a limited capacity for self-repair. The outcomes of current clinical procedures aimed to address these injuries are inconsistent and unsatisfactory. We have developed a novel method for generating hyaline articular cartilage to improve the outcome of joint surface repair. A suspension of 10(7) swine chondrocytes was cultured under reciprocating motion for 14 days. The resulting dynamic self-regenerating cartilage (dSRC) was placed in a cartilage ring and capped with fibrin and collagen gel. A control group consisted of chondrocytes encapsulated in fibrin gel. Constructs were implanted subcutaneously in nude mice and harvested after 6 weeks. Gross, histological, immunohistochemical, biochemical, and biomechanical analyses were performed. In swine patellar groove, dSRC was implanted into osteochondral defects capped with collagen gel and compared to defects filled with osteochondral plugs, collagen gel, or left empty after 6 weeks. In mice, the fibrin- and collagen-capped dSRC constructs showed enhanced contiguous cartilage matrix formation over the control of cells encapsulated in fibrin gel. Biochemically, the fibrin and collagen gel dSRC groups were statistically improved in glycosaminoglycan and hydroxyproline content compared to the control. There was no statistical difference in the biomechanical data between the dSRC groups and the control. The swine model also showed contiguous cartilage matrix in the dSRC group but not in the collagen gel and empty defects. These data demonstrate the survivability and successful matrix formation of dSRC under the mechanical forces experienced by normal hyaline cartilage in the knee joint. The results from this study demonstrate that dSRC capped with hydrogels successfully engineers contiguous articular cartilage matrix in both nonload-bearing and load-bearing environments.

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Section: Discussionmentioning

confidence: 81%

Hyaline Articular Matrix Formed by Dynamic Self-Regenerating Cartilage and Hydrogels

Meppelink

Zhao

Griffin

et al. 2016

Tissue Engineering Part A

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“…Clinically used surgical techniques to repair articular cartilage damage, for example, microfracture, drilling, and mosaicplasty, involve the stimulation of bleeding from the subchondral bone plate to access bone marrow-derived mesenchymal stem cells in an effort to stimulate tissue regeneration. 35 Despite the benefits of accessing these cells, short-term exposure of cartilage to blood results in degenerative changes to blood-exposed cartilage. 10 Even rapid clearance of a joint bleed in a canine knee in vivo resulted in reduced proteoglycan synthesis rates in exposed cartilage.…”

Section: Discussionmentioning

confidence: 99%

Ammonium–Chloride–Potassium Lysing Buffer Treatment of Fully Differentiated Cells Increases Cell Purity and Resulting Neotissue Functional Properties

Brown

Athanasiou

2016

Tissue Engineering Part C: Methods

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Juvenile and fetal, primary, fully differentiated cells are widely considered to be ideal cell types for tissue engineering applications. However, their use in tissue engineering may be hindered through contamination by undesirable cell types. These include blood-associated cells as well as unwanted resident cell types found both in healthy and pathologic donor tissues. Ammonium-chloride-potassium (ACK) lysing buffer is used to lyse red blood cells (RBCs) during the isolation of stem cell populations, but has not been explored for the purification of fully differentiated cells. This study sought to investigate the effect of ACK buffer treatment of freshly isolated, fully differentiated cells to increase cell purity and enhance the formation of biofunctional engineered neotissues; this was tested in the well-established cartilage tissue engineering model of the self-assembling process using fetal ovine articular chondrocytes (foACs) and juvenile bovine articular chondrocytes (jbACs). ACK buffer treatment of foACs and jbACs decreased the number of contaminating RBCs by over 60% and additionally reduced the number of apoptotic chondrocytes in the cell isolates. Reducing the number of contaminating RBCs removed cellular detractors to the self-assembling process and eliminated an apoptotic stimulus, thus improving neocartilage homogeneity, chondrocyte distribution, and extracellular matrix deposition within the neotissues. For example, in foAC neocartilage, ACK buffer treatment ultimately led to a 170% increase in compressive aggregate modulus, a 130% increase in shear modulus, an 80% increase in tensile modulus, and a 130% increase in ultimate tensile strength of the neocartilage. This work represents the first time that ACK buffer has been used to purify fully differentiated cells and subsequently increase the functional properties of neotissue.

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“…Mosaicplasty, in particular, involves the implantation of multiple autologous osteochondral plugs that replace damaged cartilage on the joint surface. As described by Berta et al (2015), this technique offers effective management of small and medium-sized focal defects although it does not result in good hyaline cartilage. Allotransplantation is particularly considered for settings that require whole structures such as menisci, large number of cells and/or when other techniques of cartilage repair have failed Gracitelli et al, 2015).…”

Section: R Sommaggio Et Al Barriers To Chondrocyte Xenotransplantationmentioning

confidence: 99%

“…Consequently, limitations associated with cryopreservation or prolonged refrigerated storage have been described. such as reduced viability and metabolism of chondrocytes (Berta et al 2015). In summary, there are also disadvantages for therapies based on chondrocyte/cartilage allotransplantation.…”

Section: R Sommaggio Et Al Barriers To Chondrocyte Xenotransplantationmentioning

confidence: 99%

“…In other studies, the chondrocyte implantation occurred at a slower rate than in osteochondral transplantation and the graft showed an inhomogeneous hyaline appearance (Horas et al, 2003). Other considerations for these techniques include the patient age, the rehabilitation regimens, postoperative joint alignment and surgical history (Berta et al, 2015). The lack of a consistent repair with hyaline cartilage after ACI or MACI has led to the proposal of combination therapy, such as microfracture with MACI (Cucchiarini et al, 2014).…”

Section: Transplantation Of Human Chondrocytesmentioning

confidence: 99%

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Xenotransplantation of pig chondrocytes: therapeutic potential and barriers for cartilage repair

Sommaggio

Uribe‐Herranz²,

Marquina³

et al. 2016

eCM

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Transplantation may be the best option for the repair of many cartilage lesions including early osteoarthritis. Currently, autologous and allogeneic chondrocytes are grafted into cartilage defects to treat selected patients with moderate clinical success. However, their limited use justifies exploring novel therapies for cartilage repair. Xenotransplantation could become a solution by offering high cell availability, quality and genetic engineering capabilities. The rejection process of xenogeneic cartilage is thus being elucidated in order to develop counteractive strategies. Initial studies determined that pig cartilage xenografts are rejected by a slow process comprising humoral and cellular responses in which the galactose α1,3-galactose antigen participates. Since then, our group has identified key mechanisms of the human response to pig chondrocytes (PCs). In particular, human antibody and complement contribute to PC rejection by inducing a pro-inflammatory milieu. Furthermore, PCs express and up-regulate molecules which are functionally relevant for a variety of cellular immune responses (SLA-I, the potent co-stimulatory molecule CD86, and adhesion molecules VCAM-1 and ICAM-1). These participate by triggering a T cell response, as well as supporting a prominent role of the innate immune responses led by natural killer (NK) cells and monocytes/macrophages. Human NK cells lyse PCs by using selected NK activating receptors, whereas human monocytes are activated by PCs to secrete cytokines and chemokines. All this knowledge sets the bases for the development of genetic engineering approaches designed to avert rejection of xenogeneic chondrocytes and leads the way to developing new clinical applications for cartilage repair.

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Clinical experiences with cartilage repair techniques: outcomes, indications, contraindications and rehabilitation

Cited by 21 publications

References 18 publications

Hyaline Articular Matrix Formed by Dynamic Self-Regenerating Cartilage and Hydrogels

Hyaline Articular Matrix Formed by Dynamic Self-Regenerating Cartilage and Hydrogels

Ammonium–Chloride–Potassium Lysing Buffer Treatment of Fully Differentiated Cells Increases Cell Purity and Resulting Neotissue Functional Properties

Xenotransplantation of pig chondrocytes: therapeutic potential and barriers for cartilage repair

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