MaioRegen Osteochondral Substitute for the Treatment of Knee Defects: A Systematic Review of the Literature

D’Ambrosi, Riccardo; Valli, Federico; Luca, Paola De; Ursino, Nicola; Usuelli, Federico Giuseppe

doi:10.3390/jcm8060783

Cited by 41 publications

(38 citation statements)

References 44 publications

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“…The bone-layer of TruFit CB is made of PGA and calcium phosphate, two materials that degrade quickly post-implantation and mechanical failure has resulted in the plug being withdrawn from the market (Fraser et al, 2016 ; Tseng et al, 2020 ). D'Ambrosi et al ( 2019 ), investigated the clinical and radiological efficacy of MaioRegen, a try-layered collagen-based scaffold, in restoring osteochondral knee defects. Despite the promising satisfactory and reliable results at mid-term follow-up, this systematic review revealed that, in terms of clinical improvement at follow-up, MaioRegen is not superior to conservative treatment or other cartilage techniques.…”

Section: Current Clinical Therapiesmentioning

confidence: 99%

Influence of the Mechanical Environment on the Regeneration of Osteochondral Defects

Davis

Roldo

Blunn

et al. 2021

Front. Bioeng. Biotechnol.

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Articular cartilage is a highly specialised connective tissue of diarthrodial joints which provides a smooth, lubricated surface for joint articulation and plays a crucial role in the transmission of loads. In vivo cartilage is subjected to mechanical stimuli that are essential for cartilage development and the maintenance of a chondrocytic phenotype. Cartilage damage caused by traumatic injuries, ageing, or degradative diseases leads to impaired loading resistance and progressive degeneration of both the articular cartilage and the underlying subchondral bone. Since the tissue has limited self-repairing capacity due its avascular nature, restoration of its mechanical properties is still a major challenge. Tissue engineering techniques have the potential to heal osteochondral defects using a combination of stem cells, growth factors, and biomaterials that could produce a biomechanically functional tissue, representative of native hyaline cartilage. However, current clinical approaches fail to repair full-thickness defects that include the underlying subchondral bone. Moreover, when tested in vivo, current tissue-engineered grafts show limited capacity to regenerate the damaged tissue due to poor integration with host cartilage and the failure to retain structural integrity after insertion, resulting in reduced mechanical function. The aim of this review is to examine the optimal characteristics of osteochondral scaffolds. Additionally, an overview on the latest biomaterials potentially able to replicate the natural mechanical environment of articular cartilage and their role in maintaining mechanical cues to drive chondrogenesis will be detailed, as well as the overall mechanical performance of grafts engineered using different technologies.

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Section: Current Clinical Therapiesmentioning

confidence: 99%

Influence of the Mechanical Environment on the Regeneration of Osteochondral Defects

Davis

Roldo

Blunn

et al. 2021

Front. Bioeng. Biotechnol.

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“…Recently, D’Ambrosi et al (2019) published a systematic review on the results of MaioRegen. MaioRegen being a triphasic scaffold aims to closely resemble the osteochondral unit.…”

Section: Clinical Results Of Osteochondral Implantsmentioning

confidence: 99%

Osteochondral Injury, Management and Tissue Engineering Approaches

Jacob

Shimomura

Nakamura

2020

Front. Cell Dev. Biol.

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Osteochondral lesions (OL) are a common clinical problem for orthopedic surgeons worldwide and are associated with multiple clinical scenarios ranging from trauma to osteonecrosis. OL vary from chondral lesions in that they involve the subchondral bone and chondral surface, making their management more complex than an isolated chondral injury. Subchondral bone involvement allows for a natural healing response from the body as marrow elements are able to come into contact with the defect site. However, this repair is inadequate resulting in fibrous scar tissue. The second differentiating feature of OL is that damage to the subchondral bone has deleterious effects on the mechanical strength and nutritive capabilities to the chondral joint surface. The clinical solution must, therefore, address both the articular cartilage as well as the subchondral bone beneath it to restore and preserve joint health. Both cartilage and subchondral bone have distinctive functional requirements and therefore their physical and biological characteristics are very much dissimilar, yet they must work together as one unit for ideal joint functioning. In the past, the obvious solution was autologous graft transfer, where an osteochondral bone plug was harvested from a non-weight bearing portion of the joint and implanted into the defect site. Allografts have been utilized similarly to eliminate the donor site morbidity associated with autologous techniques and overall results have been good but both techniques have their drawbacks and limitations. Tissue engineering has thus been an attractive option to create multiphasic scaffolds and implants. Biphasic and triphasic implants have been under explored and have both a chondral and subchondral component with an interface between the two to deliver an implant which is biocompatible and emulates the osteochondral unit as a whole. It has been a challenge to develop such implants and many manufacturing techniques have been utilized to bring together two unalike materials and combine them with cellular therapies. We summarize the functions of the osteochondral unit and describe the currently available management techniques under study.

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“…The scaffolds have different layers that promote the concurrent restoration of subchondral bone and cartilage. 26,27 Despite extensive preclinical research in the field of biomaterials, only a few osteochondral scaffolds have reached clinical practice, 8,32,45 and in spite of promising results demonstrated in animal models, their regenerative potential in the human setting has thus far shown less favorable outcomes, especially concerning the subchondral bone. The first scaffold available was a bilayered cylindrical implant made of a PLGA copolymer, for which controversial results were demonstrated.…”

Section: Discussionmentioning

confidence: 99%

Aragonite-Based Scaffold for the Treatment of Joint Surface Lesions in Mild to Moderate Osteoarthritic Knees: Results of a 2-Year Multicenter Prospective Study

et al. 2021

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Background: Osteoarthritis (OA) is considered a contraindication to most cartilage repair techniques. Several regenerative approaches have been attempted with the aim of delaying or preventing joint replacement, with controversial results. Currently, there is a paucity of data on the use of single-step techniques, such as cell-free biomimetic scaffolds, for the treatment of joint surface lesions (JSLs) in OA knees. Purpose: To present the 2-year follow-up clinical and radiological outcomes after implantation of a novel, cell-free aragonite-based scaffold for the treatment of JSLs in patients with mild to moderate knee OA in a multicenter prospective study. Study Design: Case series; Level of evidence, 4. Methods: A total of 86 patients, 60 male and 26 female, with a mean age of 37.4 ± 10.0 years, mild to moderate knee OA, and a mean defect size of 3.0 ± 1.7 cm2, were recruited at 8 medical centers according to the following criteria: radiographic mild to moderate knee OA (Kellgren-Lawrence grade 2 or 3); up to 3 treatable chondral/osteochondral defects (International Cartilage Repair Society grades 3 and 4) on the femoral condyles or trochlea; a total defect size ≤7 cm2; and no concurrent knee instability, severe axial malalignment, or systemic arthropathy. All patients were evaluated at baseline and at 6, 12, 18, and 24 months after implantation using the Knee injury and Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee (IKDC) subjective score. Additionally, magnetic resonance imaging (MRI) was performed to assess the amount of cartilage defect filling at the repaired site. Results: Significant improvement on all KOOS subscales was recorded from baseline (Pain: 49.6 ± 13.1; Activities of Daily Living [ADL]: 56.1 ± 18.4; Sport: 22.8 ± 18.8; Quality of Life [QoL]: 23.5 ± 16.5; Symptoms: 55.4 ± 19.9) to the 24 months’ follow-up (Pain: 79.5 ± 21.1 [ P < .001]; ADL: 84.1 ± 21.4 [ P < .001]; Sport: 60.8 ± 31.9 [ P < .001]; QoL: 54.9 ± 30.4 [ P < .001]; Symptoms: 77.7 ± 21.2 [ P < .001]). The IKDC subjective score showed a similar trend and improved from 37.8 ± 14.7 at baseline to 65.8 ± 23.5 at 24 months ( P < .001). MRI showed a significant increase in defect filling over time: up to 78.7% ± 25.3% of surface coverage after 24 months. Treatment failure requiring revision surgery occurred in 8 patients (9.3%). Conclusion: The use of an aragonite-based osteochondral scaffold in patients with JSLs and mild to moderate knee OA provided significant clinical improvement at the 24-month follow-up, as reported by the patients. These findings were associated with good cartilage defect filling, as observed on MRI.

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MaioRegen Osteochondral Substitute for the Treatment of Knee Defects: A Systematic Review of the Literature

Cited by 41 publications

References 44 publications

Influence of the Mechanical Environment on the Regeneration of Osteochondral Defects

Influence of the Mechanical Environment on the Regeneration of Osteochondral Defects

Osteochondral Injury, Management and Tissue Engineering Approaches

Aragonite-Based Scaffold for the Treatment of Joint Surface Lesions in Mild to Moderate Osteoarthritic Knees: Results of a 2-Year Multicenter Prospective Study

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