Comparative efficacy of cartilage repair procedures in the knee: a network meta-analysis

Riboh, Jonathan C.; Cvetanovich, Gregory L.; Cole, Brian J.; Yanke, Adam B.

doi:10.1007/s00167-016-4300-1

Cited by 90 publications

(78 citation statements)

References 44 publications

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“…Clinicians are still seeking a technique that returns damaged cartilage to its original state, although many consider subchondral bone microfracture the standard of care. However, after microfracture, the repaired tissue is composed of fibrous cartilage coupled with poor horizontal integration, which may account for the higher re‐operation rate, long‐term (10 years) when compared with more involved or aggressive procedures of cartilage repair such as osteochondral autograft/allograft and second‐generation autologous chondrocyte transplantation . While these advanced techniques have an improved long‐term outcome, they are not without significant challenges.…”

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confidence: 99%

“…However, after microfracture, the repaired tissue is composed of fibrous cartilage 1,2 coupled with poor horizontal integration, which may account for the higher re-operation rate, long-term (10 years) when compared with more involved or aggressive procedures of cartilage repair such as osteochondral autograft/allograft and second-generation autologous chondrocyte transplantation. 3 While these advanced techniques have an improved long-term outcome, they are not without significant challenges. In this study, we explored ways to improve the repair tissue characteristics as well as the horizontal integration following the microfracture.…”

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confidence: 99%

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Trypsin Pre‐Treatment Combined With Growth Factor Functionalized Self‐Assembling Peptide Hydrogel Improves Cartilage Repair in Rabbit Model

Zanotto

Liebesny

Barrett

et al. 2019

Journal Orthopaedic Research

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The objective of this study was to improve cartilage repair and integration using self‐assembling KLD hydrogel functionalized with platelet‐derived growth factor‐BB and heparin‐binding insulin‐like growth factor‐1 with associated enzymatic trypsin pre‐treatment of the native cartilage. Bilateral osteochondral defects were created at the central portion of the femoral trochlear groove of 48 skeletally mature, white New Zealand rabbits. One limb received a randomly assigned treatment and the contralateral limb served as the control. Treated defects were exposed to trypsin for 2 min and filled with self‐assembling KLD hydrogel only, or associated to growth factors. All control limbs received KLD hydrogel alone or received only trypsin but not hydrogel. Ninety days post‐defect creation, the rabbits were euthanized and magnetic resonance imaging, radiography, macroscopic evaluation, histology, and immunohistochemistry of the joint and repaired tissue were performed. Mixed model analyses of variance were utilized to assess the outcome parameters and individual comparisons were performed using Least Square Means procedure and differences with p‐value < 0.05 were considered significant. Trypsin enzymatic pre‐treatment improved cellular morphology, cluster formation and subchondral bone reconstitution. Platelet‐derived growth factor‐BB improved subchondral bone healing and basal integration. Heparin‐binding insulin‐like growth factor‐1 associated with platelet‐derived growth factor improved tissue and cell morphology. The authors conclude that self‐assembling KLD hydrogel functionalized with platelet‐derived growth factor and heparin‐binding insulin‐like growth factor‐1 with associated enzymatic pre‐treatment of the native cartilage with trypsin resulted in an improvement on the cartilage repair process. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2307–2315, 2019

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confidence: 99%

mentioning

confidence: 99%

Trypsin Pre‐Treatment Combined With Growth Factor Functionalized Self‐Assembling Peptide Hydrogel Improves Cartilage Repair in Rabbit Model

Zanotto

Liebesny

Barrett

et al. 2019

Journal Orthopaedic Research

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“…Zur ACT und anderen Methoden der biologischen Knorpelrekonstruktion im Kniegelenk existieren zahlreiche Studien, darunter solche mit prospektiv randomisiertem Design, Metaanalysen und systematische Reviews sowie Langzeitbeobachtungen bei Erwachsenen und Adoleszenten [2,[61][62][63][64][65][66]. Vor dem Hintergrund der hierzu bestehenden Datenlage, d. h. auch der bestverfügbaren Evidenz, gilt die ACT im Knie, insbesondere matrixgekoppelt, bei Beachtung bestimmter Ein-und Ausschlusskriterien als das derzeit zuverlässigste Verfahren im Langzeitverlauf zur operativen Sanierung klinisch symptomatischer und lokalisiert vollschichtiger Knorpelschäden über 2-4 cm 2 Defektfläche [2,3,67].…”

Section: Bisherige Klinische Ergebnisse Nach Actunclassified

“…Dies weist darauf hin, dass die für das Kniegelenk bekannten biologischen Defizite der MFx auch im Hüftgelenk bestehen. Ähnlich wie in der prospektiven Studie werden im Knie zunächst oft gleichwertige klinische Ergebnisse nach MFx oder MACT beobachtet, die sich erst im weiteren Verlauf signifikant zugunsten der MACT verändern [62,64]. Auch war die Streuung der klinischen Ergebnisse nach MFx nach 1 Jahr in der prospektiven Hüftstudie deutlich größer als die nach MACT [72], was wie in Studien zum Kniegelenk [73] auf eine schlechtere Responderrate nach MFx hindeutet.…”

Section: Bisherige Klinische Ergebnisse Nach Actunclassified

“…Aus klinischen Level-1-und Matched-Pair-Studien, einer Netzwerkmetaanalyse auf höchstem Evidenzniveau und einem systematischen Review prospektiv randomisierter und kontrollierter Studien wurden für ACT-Verfahren der 2. oder 3. Generation im Vergleich zur MFx oder auch Mosaikplastik nach 10 Jahren Verlaufszeit signifikant geringere Reoperations-und Versagensraten und bessere klinische Ergebnisse für das Kniegelenk berichtet (vor allem bei größeren Defekten) [61,63,64,66].…”

Section: Biologische Erkenntnisse Und Allgemeine Aspekte Zu Verschiedunclassified

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Biologische Rekonstruktion lokalisiert vollschichtiger Knorpelschäden des Hüftgelenks: Empfehlungen der Arbeitsgemeinschaft „Klinische Geweberegeneration“ der DGOU und des Hüftkomitees der AGA

et al. 2017

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Symptomatic pre-arthritic deformities such as femoroacetabular impingement (FAI) or hip dysplasia often lead to localised cartilage defects and subsequently to osteoarthritis. The present review of the working group "Clinical Tissue Regeneration" of the German Society of Orthopaedics and Trauma (DGOU) and the hip committee of the AGA (German speaking Society for Arthroscopy and Joint Surgery) provides an overview of current knowledge of the diagnosis and surgical treatment of cartilage defects, in order to infer appropriate therapy recommendations for the hip. Review of FAI and resultant cartilage damage in the hip as reported in published study findings in the literature and discussion of the advantages and disadvantages of different surgical procedures to preserve the joint. Most published studies on the surgical treatment of cartilage damage in the hip report defects caused by cam-type FAI at the acetabulum. Development of these defects can be prevented by timely elimination of the relevant deformities. At present, current full-thickness cartilage defects are mostly treated with bone marrow-stimulating techniques such as microfracture (MFx), with or without a biomaterial, and matrix-assisted autologous chondrocyte transplantation (MACT). Osteochondral autologous transplantation (OAT) is not the treatment of choice for isolated full-thickness chondral defects at the hip, because of the unfavourable risk-benefit profile. Due to the relatively short history of cartilage repair surgery on the hip, the studies available on these procedures have low levels of evidence. However, it is already becoming obvious that the experience gained with the same procedures on the knee can be applied to the hip as well. For example, limited healing and regeneration of chondral defects after MFx can also be observed at the hip joint. The cartilage surface of the acetabulum, where FAI-related chondral lesions appear, is considerably smaller than the weight-bearing cartilage surface of the knee joint. However, as in the knee joint, MACT is the therapy of choice for full-thickness cartilage defects of more than 1.5 - 2 cm. Minimally invasive types of MACT (e.g. injectable chondrocyte implants) should be preferred in the hip joint. In cases where a single-stage procedure is indicated or there are other compelling reasons for not performing a MACT, a bone marrow-stimulating technique in combination with a biomaterial covering is preferable to standard MFx. For treatment of lesions smaller than 1.5 - 2 cm the indication for a single-stage procedure is wider. As with defects in the knee, it is not possible to determine a definite upper age limit for joint-preserving surgery or MACT in the hip, as the chronological age of patients does not necessarily correlate with their biological age or the condition of their joints. Advanced osteoarthritis of the hip is a contraindication for any kind of hip-preserving surgery. Long-term observations and prospective randomised studies like those carried out for other joints are necessary.

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In vitro and in vivo evaluation of 3D constructs engineered with human iPSC‐derived chondrocytes in gelatin methacryloyl hydrogel

Agten

Hoven

Viseu

et al. 2022

Biotech & Bioengineering

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Articular cartilage defects have limited healing potential and, when left untreated, can lead to osteoarthritis. Tissue engineering focuses on regenerating the damaged joint surface, preferably in an early stage. Here, we investigate the regenerative potential of three-dimensional (3D) constructs consisting of human induced pluripotent stem cell (iPSC)-derived chondrocytes in gelatin methacryloyl (GelMA) hydrogel for stable hyaline cartilage production. iPSC-derived chondrocytes are encapsulated in GelMA hydrogel at low (1 × 10 7 ml −1 ) and high (2 × 10 7 ml −1 ) density.In a conventional medium, GelMA hydrogel supports the chondrocyte phenotype, as opposed to cells cultured in 3D in absence of hydrogel. Moreover, encapsulated iPSC-derived chondrocytes preserve their in vivo matrix formation capacity after 21 days in vitro. In differentiation medium, hyaline cartilage-like tissue forms after 21 days, demonstrated by highly sulfated glycosaminoglycans and collagen type II.Matrix deposition is delayed at low encapsulation density, corroborating with lower transcript levels of COL2A1. An ectopic assay in nude mice demonstrates further maturation of the matrix deposited in vitro. Direct ectopic implantation of iPSCderived chondrocyte-laden GelMA, without in vitro priming, also generates hyaline cartilage-like tissue, albeit less mature. Since it is unclear what maturity upon implantation is desired for joint surface regeneration, this is an attractive technology to generate immature and more mature hyaline cartilage-like tissue.

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Comparative efficacy of cartilage repair procedures in the knee: a network meta-analysis

Abstract: Meta-analysis studies, Level I.

Cited by 90 publications

References 44 publications

Trypsin Pre‐Treatment Combined With Growth Factor Functionalized Self‐Assembling Peptide Hydrogel Improves Cartilage Repair in Rabbit Model

Trypsin Pre‐Treatment Combined With Growth Factor Functionalized Self‐Assembling Peptide Hydrogel Improves Cartilage Repair in Rabbit Model

Biologische Rekonstruktion lokalisiert vollschichtiger Knorpelschäden des Hüftgelenks: Empfehlungen der Arbeitsgemeinschaft „Klinische Geweberegeneration“ der DGOU und des Hüftkomitees der AGA

In vitro and in vivo evaluation of 3D constructs engineered with human iPSC‐derived chondrocytes in gelatin methacryloyl hydrogel

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