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1

Osteochondral tissue engineering.  

PubMed

Osteochondral defects (i.e., defects which affect both the articular cartilage and underlying subchondral bone) are often associated with mechanical instability of the joint, and therefore with the risk of inducing osteoarthritic degenerative changes. Current surgical limits in the treatment of complex joint lesions could be overcome by grafting osteochondral composite tissues, engineered by combining the patient's own cells with three-dimensional (3D) porous biomaterials of pre-defined size and shape. Various strategies have been reported for the engineering of osteochondral composites, which result from the use of one or more cell types cultured into single-component or composite scaffolds in a broad spectrum of compositions and biomechanical properties. The variety of concepts and models proposed by different groups for the generation of osteochondral grafts reflects that understanding of the requirements to restore a normal joint function is still poor. In order to introduce the use of engineered osteochondral composites in the routine clinical practice, it will be necessary to comprehensively address a number of critical issues, including those related to the size and shape of the graft to be generated, the cell type(s) and properties of the scaffold(s) to be used, the potential physical conditioning to be applied, the degree of functionality required, and the strategy for a cost-effective manufacturing. The progress made in material science, cell biology, mechanobiology and bioreactor technology will be key to support advances in this challenging field. PMID:16730354

Martin, Ivan; Miot, Sylvie; Barbero, Andrea; Jakob, Marcel; Wendt, David

2007-01-01

2

Osteochondral Allograft of the Talus  

PubMed Central

Osteochondral lesions of the talus are being recognized as an increasingly common injury. They are most commonly located postero-medially or antero-laterally, while centrally located lesions are uncommon. Large osteochondral lesions have significant biomechanical consequences and often require resurfacing with osteochondral autograft transfer, mosaicplasty, autologous chondrocyte implantation (or similar methods) or osteochondral allograft transplantation. Allograft procedures have become popular due to inherent advantages over other resurfacing techniques. Cartilage viability is one of the most important factors for successful clinical outcomes after transplantation of osteochondral allografts and is related to storage length and intra-operative factors. While there is abundant literature about osteochondral allograft transplantation in the knee, there are few papers about this procedure in the talus. Failure of non-operative management, initial debridement, curettage or microfractures are an indication for resurfacing. Patients should have a functional ankle motion, closed growth plates, absence of cartilage lesions on the tibial side. This paper reviews the published literature about osteochondral allograft transplantation of the talus focusing on indications, pre-operative planning, surgical approaches, postoperative management, results and complications of this procedure. PMID:25328456

Bisicchia, Salvatore; Rosso, Federica; Amendola, Annunziato

2014-01-01

3

[Osteochondral lesions of the talus].  

PubMed

Osteochondral lesions occur either as osteochondral fractures (so called flake fractures) or osteochondritis dissecans. Both types of lesions are caused in the most of the cases by an adequate trauma. The injury is sustained during inversion of the ankle. If the foot is dorsiflexed, an anterolateral lesion will result from shearing forces by the fibula. If the inversed foot is plantar flexed and followed by rotation of the tibia on the talus, a postero-medial lesion will result from compression of the medial talar dome by the tibia, secondary to spiralling and shortening of the collateral ligaments. The diagnosis is suspected with the most common complaints of the patients to pain on weight bearing or during sports, swelling, crepitus, giving way or locking ankle after an inversion injury. In case of negative standard X-rays and doubtful clinical findings tomograms in the AP and lateral views or even a scintigraphy of both ankles ar indicated. 15 patients with osteochondral lesions were treated, 7 with an antero-lateral transchondral fracture and 8 with a poster-medial osteochondritis dissecans. The lesions were classified after Berndt and Harty and differentiated between type I-IV. 13 patients have been operated, 4 by arthroscopy. The mean follow-up time of the clinical and radiographic examination was 1 year. The results were evaluated by a point score system. 7 patients (46.6%) had good, 5 (33.3%) a fair and 3 (20%) a poor result.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2727716

Biedert, R

1989-04-01

4

Treatment of talar osteochondral lesions using local osteochondral graft.  

PubMed

Twelve patients with an osteochondral lesion of the talus were treated with excision of the lesions and local osteochondral autogenous grafting. The lesion was accessed through a replaceable bone block removed from the anterior tibial plafond. The graft was harvested from the medial or lateral talar articular facet on the same side of the lesion. The average age of the patients was 41 years and duration of symptoms was 90 months (ave.). There were six males and six females with the right talus involved in eight and the left in four patients. Graft sizes ranged from four to eight millimeters in diameter. There was a significant improvement in the AOFAS score from 64.4 (ave.) pre-operatively to 90.8 (ave.) postoperatively (p<0.0001), at a follow-up of 25.3 months (ave.). The AOFAS score was slightly higher in patients under 40 years of age and in those without pre-existing joint arthritis. All patients were very satisfied with the procedure. Arthroscopy performed in two patients at six and 12 months following surgery showed good graft incorporation. No complications occurred at the donor site or the site of bone block removal on the distal tibia. The results show that stage III and IV talar osteochondral lesions can be accessed successfully excising a tibial bone block and using local autogenous osteochondral graft harvested from the ipsilateral talar articular facet. PMID:12199381

Sammarco, G James; Makwana, Nilesh K

2002-08-01

5

Patellar dislocation and osteochondral fractures.  

PubMed

Follow-up study of nine patients with patellar dislocation in combination with osteochondral fractures. Three of these patients with special problems in relation to knee pathology are discussed in detail. This group of knee injuries is often overlooked because of frequent spontaneous reposition. Etiology, diagnosis and treatment are discussed. Arthroscopy is recommended to visualize chondral defects. Results are presented in combination with follow-up. Four patients still complain of instability of the knee after surgery. Reconstruction is the treatment of choice. The kind of fixation depends on the size of the osteochondral fragment, and consists of either screws or fibrin, in future possibly resorbable pins. Continuous passive motion is to be recommended after operation. Factors predisposing to recurrence are an indication for correction. PMID:3774187

ten Thije, J H; Frima, A J

1986-10-01

6

Osteochondritis dissecans of the talus  

PubMed Central

Osteochondritis dissecans (OCD) is an acquired idiopathic lesion of subchondral bone that can produce delamination and sequestration with or without articular cartilage involvement and instability. The cause of OCD is still debated: the most recognized etiology is the occurrence of repetitive micro-traumas associated with vascular impairment, causing progressive ankle pain and dysfunction in skeletally immature and young adult patients. Ankle OCD is classically located in the medial part of the talus, while lateral and posterior involvement is less frequent. Diagnosis of OCD, based on MRI findings, is quite straightforward; MRI examination can also be very useful for dating the defect and obtaining information about the associated bone bruise. Osteochondritis dissecans, if not recognized and treated appropriately, may lead to secondary osteoarthritis with pain and functional limitation. Surgical treatment is mandatory especially in young patients with unstable cartilage fragments. There are various surgical options: fixation, microfracture, or substitution using autologous chondrocyte implantation techniques.

ZANON, GIACOMO; DI VICO, GIOVANNI; MARULLO, MATTEO

2014-01-01

7

Drilling techniques for osteochondritis dissecans.  

PubMed

Although the advanced stages of osteochondritis dissecans remain challenging to treat, most early-stage lesions in skeletally immature patients, if managed appropriately, can be stimulated to heal. For stable lesions that do not demonstrate adequate healing with nonoperative measures, such as activity modification, weight-bearing protection, or bracing, drilling of the subchondral bone has emerged as the gold standard of management. Several techniques of drilling exist, including transarticular drilling, retroarticular drilling, and notch drilling. Although each technique has been shown to be effective in small retrospective studies, higher-powered prospective comparative studies are needed to better elucidate their relative advantages and disadvantages. PMID:24698045

Heyworth, Benton E; Edmonds, Eric W; Murnaghan, M Lucas; Kocher, Mininder S

2014-04-01

8

Genetics Home Reference: Familial osteochondritis dissecans  

MedlinePLUS

... Other characteristic features of familial osteochondritis dissecans include short stature and development of a joint disorder called osteoarthritis ... in life after the bone has stopped growing. Short stature is not associated with this form of the ...

9

Osteochondral lesions in pediatric and adolescent patients.  

PubMed

Osteochondral lesions are acquired, potentially reversible injuries of the subchondral bone with or without associated articular cartilage involvement. Injury results in delamination and potential sequestration of the affected bone. Although an association with mechanical and traumatic factors has been established, the etiology remains poorly understood. These lesions commonly occur in the knee; articular surfaces of the elbow, ankle, hip, and shoulder are also affected. Osteochondral lesions are relatively common in children and adolescents, and the incidence is increasing. Prognosis of these lesions depends on stability, location, and size of the lesion.Imaging has an essential role in the diagnosis, staging, and management of osteochondral lesions. Many of these lesions are first diagnosed by plain film. MRI adds value by identifying unstable lesions that require surgical intervention. This review focuses on the clinical and imaging features of osteochondral lesions of the knee, elbow, and ankle. Imaging criteria for staging and management are also reviewed. PMID:25350829

Ghahremani, Shahnaz; Griggs, Rachel; Hall, Theodore; Motamedi, Kambiz; Boechat, M Ines

2014-11-01

10

Osteochondritis dissecans of the knee  

PubMed Central

Osteochondritis dissecans (OCD) of the knee is a common cause of knee pain and dysfunction among skeletally immature and young adult patients. OCD is increasingly frequently seen in pediatric, adolescent and young adult athletes. If it is not recognized and treated appropriately, it can lead to secondary osteoarthritis with pain and functional limitation. Stable lesions in skeletally immature patients should initially be managed non-operatively. Unstable juvenile lesions and stable juvenile lesions that fail to heal with non-operative treatment require a surgical treatment. By contrast, adult OCD of the knee rarely responds to conservative measures because of limited healing potential. Operative treatment depends on the lesion stage, and there exist several surgical options. PMID:25606539

ZANON, GIACOMO; DI VICO, GIOVANNI; MARULLO, MATTEO

2014-01-01

11

Strategies for osteochondral repair: Focus on scaffolds.  

PubMed

Interest in osteochondral repair has been increasing with the growing number of sports-related injuries, accident traumas, and congenital diseases and disorders. Although therapeutic interventions are entering an advanced stage, current surgical procedures are still in their infancy. Unlike other tissues, the osteochondral zone shows a high level of gradient and interfacial tissue organization between bone and cartilage, and thus has unique characteristics related to the ability to resist mechanical compression and restoration. Among the possible therapies, tissue engineering of osteochondral tissues has shown considerable promise where multiple approaches of utilizing cells, scaffolds, and signaling molecules have been pursued. This review focuses particularly on the importance of scaffold design and its role in the success of osteochondral tissue engineering. Biphasic and gradient composition with proper pore configurations are the basic design consideration for scaffolds. Surface modification is an essential technique to improve the scaffold function associated with cell regulation or delivery of signaling molecules. The use of functional scaffolds with a controllable delivery strategy of multiple signaling molecules is also considered a promising therapeutic approach. In this review, we updated the recent advances in scaffolding approaches for osteochondral tissue engineering. PMID:25343021

Seo, Seog-Jin; Mahapatra, Chinmaya; Singh, Rajendra K; Knowles, Jonathan C; Kim, Hae-Won

2014-01-01

12

Approaches to preserve human osteochondral allografts.  

PubMed

Osteochondral defects may progress to osteoarthritis. Many attempts have been developed to overcome this issue, including osteochondral autografts and allografts. The goal of this study was to develop a new protocol for storage of human osteochondral allografts. Osteochondral plugs were randomly allocated in the following groups: control, immediate freezing up to -70 °C, cooling at 4 °C, and storage at 37 °C. Samples from the cooling at 4 °C and storage at 37 °C groups were stored in tubes containing medium plus human albumin and analyzed after 1, 3, and 14 days. The frozen groups' samples were cryopreserved for 1 year in cryotubes containing medium only (FM), medium plus human albumin (FA), and medium plus human albumin and glucose (FG) and were then analyzed. Analysis involved histological study with hematoxylin-eosin and Safranin O and a modified Live/Dead assay. In samples stored both at 37 and 4 °C, analysis showed statistically significant higher cellular mortality at 14 days compared to 1 and 3 days, but mortality in the 4 °C group was lower. In the freezing protocols, the FA group showed less cellular mortality than the FM and FG groups. Cooling at 4 °C offers better preservation capacity than storage at 37 °C, but both offer the capacity for preservation for 14 days. Adding human albumin to the storage medium is useful in reducing cellular mortality in samples frozen for 1 year. PMID:25479814

de Sousa, Eduardo Branco; Aguiar, Diego Pinheiro; Barcelos, José Fernando Marques; Duarte, Maria Eugênia Leite; Olej, Beni

2014-12-01

13

Osteochondritis of the Distal Tibial Epiphysis  

PubMed Central

Osteochondritis of the distal tibial epiphysis is a very rare entity. 9 cases have been described in 7 articles and 8 other cases have been mentioned in textbooks. This paper describes the 10th case of osteochondritis of the distal tibial epiphysis and summarizes the clinical and radiological presentations of the 9 other cases. The etiology of this entity is well debated in the literature. We believe that it results from a vascular abnormality in the distal tibial epiphysis associated with a mechanical stress (trauma, excessive overload, etc.). Since it is a self-limited disease, the prognosis is good and the younger the patient is the better the prognosis will be. In general, this entity responds well to conservative treatment. PMID:23193412

EL Hajj, Firass; Sebaaly, Amer; Kharrat, Khalil; Ghanem, Ismat

2012-01-01

14

Osteochondral defects in the ankle: why painful?  

PubMed Central

Osteochondral defects of the ankle can either heal and remain asymptomatic or progress to deep ankle pain on weight bearing and formation of subchondral bone cysts. The development of a symptomatic OD depends on various factors, including the damage and insufficient repair of the subchondral bone plate. The ankle joint has a high congruency. During loading, compressed cartilage forces its water into the microfractured subchondral bone, leading to a localized high increased flow and pressure of fluid in the subchondral bone. This will result in local osteolysis and can explain the slow development of a subchondral cyst. The pain does not arise from the cartilage lesion, but is most probably caused by repetitive high fluid pressure during walking, which results in stimulation of the highly innervated subchondral bone underneath the cartilage defect. Understanding the natural history of osteochondral defects could lead to the development of strategies for preventing progressive joint damage. PMID:20151110

Reilingh, Mikel L.; Zengerink, Maartje; van Bergen, Christiaan J. A.

2010-01-01

15

Bipolar fresh osteochondral allograft of the shoulder  

PubMed Central

Purpose to describe an original technique and preliminary results of bipolar fresh osteochondral allograft implantation for the treatment of end-stage glenohumeral osteoarthritis. Methods three patients underwent bipolar fresh osteochondral allograft implantation to the shoulder. Clinical and radiographical evaluations were carried out periodically through to final follow-up. Results constant Score increased from 38.3 ± 2.9 pre-operatively to 78.7 ± 16.2 at 12 months, 72.3 ±15.3 at 24 months, and 59.3 ± 22.0 at 34 months. Arthritis and partial reabsorption of the implanted surfaces were evident radiographically. Conclusions the clinical results obtained in these patients seem to support the applicability of bipolar fresh osteochondral allograft implantation in the shoulder in subjects with severe post-traumatic arthritis and intact rotator cuff. The development of arthritis of the implanted surfaces, while not impacting the clinical result, is a cause of concern. Level of evidence level IV, therapeutic case series.

GIANNINI, SANDRO; SEBASTIANI, ELISA; SHEHU, ALBA; BALDASSARRI, MATTEO; MARALDI, SUSANNA; VANNINI, FRANCESCA

2013-01-01

16

Treatment principles for osteochondral lesions in foot and ankle.  

PubMed

Osteochondral lesion of the talus (OLT) is a broad term used to describe an injury or abnormality of the talar articular cartilage and adjacent bone. A variety of terms have been used to refer to this clinical entity, including osteochondritis dissecans (OCD), osteochondral fracture and osteochondral defect. Whether OLT is a precursor to more generalised arthrosis of the ankle remains unclear, but the condition is often symptomatic enough to warrant treatment. In more than one third of cases, conservative treatment is unsuccessful, and surgery is indicated. There is a wide variety of treatment strategies for osteochondral defects of the ankle, with new techniques that have substantially increased over the last decade. The common treatment strategies of symptomatic osteochondral lesions include nonsurgical treatment, with rest, cast immobilisation and use of nonsteroidal anti-inflammatory drugs (NSAIDs). Surgical options are lesion excision, excision and curettage, excision combined with curettage and microfracturing, filling the defect with autogenous cancellous bone graft, antegrade (transmalleolar) drilling, retrograde drilling, fixation and techniques such as osteochondral transplantation [osteochondral autograft transfer system (OATS)] and autologous chondrocyte implantation (ACI). Furthermore, smaller lesions are symptomatic and when left untreated, OCDs can progress; current treatment strategies have not solved this problem. The target of these treatment strategies is to relieve symptoms and improve function. Publications on the efficacy of these treatment strategies vary. In most cases, several treatment options are viable, and the choice of treatment is based on defect type and size and preferences of the treating clinician. PMID:23982639

Badekas, Thanos; Takvorian, Maria; Souras, Nikolaos

2013-09-01

17

Recent progress in interfacial tissue engineering approaches for osteochondral defects.  

PubMed

This review provides a brief synopsis of the anatomy and physiology of the osteochondral interface, scaffold-based and non-scaffold based approaches for engineering both tissues independently as well as recent developments in the manufacture of gradient constructs. Novel manufacturing techniques and nanotechnology will be discussed with potential application in osteochondral interfacial tissue engineering. PMID:22677924

Castro, Nathan J; Hacking, S Adam; Zhang, Lijie Grace

2012-08-01

18

Arthroscopic management of osteochondritis dissecans of the first metatarsal head.  

PubMed

Osteochondritis dissecans of the first metatarsal head can be painfully disabling in the adolescent. It may be the forerunner of adolescent and adult hallux rigidus. Arthroscopic surgical treatment of this osteochondritis dissecans lesion is technically feasible. The case reported here suggests that arthroscopic treatment, at an early stage, can render a patient symptom-free and allow a return to full activity. PMID:3355642

Bartlett, D H

1988-01-01

19

A computer assisted surgical technique for retrograde autologous osteochondral grafting in talar osteochondritis dissecans (OCD): a cadaveric study  

Microsoft Academic Search

This study describes a new method for the treatment of osteochondritis dissecans (OCD) in the medial talar dome. Ten cadaveric lower extremities were used to develop and evaluate a retrograde osteochondral grafting technique applying computer-assisted surgery. With the help of a computed tomography (CT)-based navigation system, a guide wire was placed from the lateral talar process into the posteromedial talar

Christian Hoser; Oliver Bichler; Reto Bale; Ralph Rosenberger; Michael Rieger; Peter Kovacs; Thomas Lang; Christian Fink

2004-01-01

20

Treatment of osteochondral injuries with platelet gel  

PubMed Central

OBJECTIVES: Treatments for injured articular cartilage have not advanced to the point that efficient regeneration is possible. However, there has been an increase in the use of platelet-rich plasma for the treatment of several orthopedic disorders, including chondral injuries. Our hypothesis is that the treatment of chondral injuries with platelet gel results in higher-quality repair tissue after 180 days compared with chondral injuries not treated with gel. METHODS: A controlled experimental laboratory study was performed on 30 male rabbits to evaluate osteochondral injury repair after treatment with or without platelet gel. Osteochondral injuries were surgically induced in both knees of each rabbit at the medial femoral condyle. The left knee injury was filled with the platelet gel, and the right knee was not treated. Microscopic analysis of both knee samples was performed after 180 days using a histological grading scale. RESULTS: The only histological evaluation criterion that was not significantly different between treatments was metachromasia. The group that was treated with platelet gel exhibited superior results in all other criteria (cell morphology, surface regularity, chondral thickness and repair tissue integration) and in the total score. CONCLUSION: The repair tissue was histologically superior after 180 days in the study group treated with platelet gel compared with the group of untreated injuries. PMID:25518022

Danieli, Marcus Vinicius; da Rosa Pereira, Hamilton; de Sá Carneiro, Carlos Augusto; Felisbino, Sérgio Luiz; Deffune, Elenice

2014-01-01

21

Hydrogels for Osteochondral Repair Based on Photocrosslinkable Carbamate Dendrimers  

E-print Network

Hydrogels for Osteochondral Repair Based on Photocrosslinkable Carbamate Dendrimers Lovorka) (PEG) were synthesized divergently in high yields using ester and carbamate forming reactions. Aqueous modulus of the 10% formulations, a low swelling ratio, and contained carbamate linkages, which are more

22

Internal Fixation of Juvenile Osteochondritis Dissecans Lesions of the Knee  

Microsoft Academic Search

Background: Operative techniques for the management of juvenile osteochondritis dissecans lesions of the knee include drilling, internal fixation, fragment removal, and chondral resurfacing.Purpose: To evaluate the functional and radiographic outcome of internal fixation of juvenile osteochondritis dissecans lesions of the knee.Study Design: Case series; Level of evidence, 4.Methods: The study design was a retrospective case series. Twenty-six knees in 24

Mininder S. Kocher; Joseph J. Czarnecki; Jason S. Andersen; Lyle J. Micheli

2007-01-01

23

Refixation of osteochondral fractures by ultrasound-activated, resorbable pins  

PubMed Central

Objectives Osteochondral injuries, if not treated adequately, often lead to severe osteoarthritis. Possible treatment options include refixation of the fragment or replacement therapies such as Pridie drilling, microfracture or osteochondral grafts, all of which have certain disadvantages. Only refixation of the fragment can produce a smooth and resilient joint surface. The aim of this study was the evaluation of an ultrasound-activated bioresorbable pin for the refixation of osteochondral fragments under physiological conditions. Methods In 16 Merino sheep, specific osteochondral fragments of the medial femoral condyle were produced and refixed with one of conventional bioresorbable pins, titanium screws or ultrasound-activated pins. Macro- and microscopic scoring was undertaken after three months. Results The healing ratio with ultrasound-activated pins was higher than with conventional pins. No negative heat effect on cartilage has been shown. Conclusion As the material is bioresorbable, no further surgery is required to remove the implant. MRI imaging is not compromised, as it is with implanted screws. The use of bioresorbable pins using ultrasound is a promising technology for the refixation of osteochondral fractures. PMID:23610699

Neumann, H.; Schulz, A. P.; Gille, J.; Klinger, M.; Jürgens, C.; Reimers, N.; Kienast, B.

2013-01-01

24

Fluoroquinolone Use in a Child Associated with Development of Osteochondritis Dissecans  

PubMed Central

SUMMARY Several etiological theories have been proposed for the development of osteochondritis dissecans. Cartilage toxicity after fluoroquinolone use has been well documented in vitro. We present a case report of a 10-year-old child who underwent a prolonged 18-month course of ciprofloxacin therapy for chronic urinary tract infections. This patient later developed an osteochondritis dissecans lesion of the medial femoral condyle. We hypothesize that the fluoroquinolone therapy disrupted normal endochondral ossification, resulting in development of osteochondritis dissecans. The etiology of osteochondritis dissecans is still unclear, and this case describes an association between fluoroquinolone use and osteochondritis dissecans development. PMID:25228675

Jacobs, John; Shea, Kevin; Oxford, Julia; Carey, James

2014-01-01

25

Case reports: pediatric PCL insufficiency from tibial insertion osteochondral avulsions.  

PubMed

Posterior cruciate ligament (PCL) insertion-site osteochondral avulsions in children, particularly from the tibia, are not commonly seen by orthopaedic surgeons. Because of the rarity of these injuries, careful attention to the specific physical examination and imaging findings seen with these injuries is necessary so that the proper diagnosis can be made. Osteochondral avulsions of the PCL can be missed on plain radiographs in skeletally immature patients, and therefore magnetic resonance imaging is necessary for proper diagnosis. With this knowledge, clinicians can formulate treatment plans which can return their patients to activities while avoiding potential morbidity resulting from missed diagnoses or improper treatment. We report two rare cases of PCL insufficiency stemming from tibial insertion osteochondral avulsions. Both patients underwent subsequent open reduction and internal fixation of the avulsion using two different fixation methods (bioabsorbable anchors versus cannulated screw and washer) and have returned to full sporting activities. PMID:18648903

Pandya, Nirav K; Janik, Luke; Chan, Gilbert; Wells, Lawrence

2008-11-01

26

The knee: internal fixation techniques for osteochondritis dissecans.  

PubMed

For the athlete with a newly diagnosed osteochondritis dissecans of the knee, the first step in formulating a treatment plan is determining the stability of the lesion. When the lesion is found to be unstable but salvageable, several methods for fixation are available. Fixation of osteochondritis dissecans in the athletic population has been described and each has its own advantages and disadvantages. Determining the most appropriate method for fixation depends on several variables and should include the athlete's level of play, sport, and overall goals. PMID:24698046

Grimm, Nathan L; Ewing, Christopher K; Ganley, Theodore J

2014-04-01

27

Additive manufacturing for in situ repair of osteochondral defects  

Microsoft Academic Search

Tissue engineering holds great promise for injury repair and replacement of defective body parts. While a number of techniques exist for creating living biological constructs in vitro, none have been demonstrated for in situ repair. Using novel geometric feedback-based approaches and through development of appropriate printing-material combinations, we demonstrate the in situ repair of both chondral and osteochondral defects that

Daniel L. Cohen; Jeffrey I. Lipton; Lawrence J. Bonassar; Hod Lipson

2010-01-01

28

Treatment algorithm for osteochondritis dissecans of the knee.  

PubMed

The authors' preferred treatment algorithm for osteochondritis dissecans (OCD) of the knee is based on skeletal maturity, OCD lesion stability, and OCD lesion salvageability. For unstable yet salvageable OCD lesions, the senior author's preferred treatment is fixation with bone grafting. For unstable and unsalvageable OCD lesions, the senior author's preferred treatment is autologous chondrocyte implantation with bone grafting. PMID:25435043

Carey, James L; Grimm, Nathan L

2015-01-01

29

Three-dimensional osteochondral microtissue to model pathogenesis of osteoarthritis  

PubMed Central

Osteoarthritis (OA), the most prevalent form of arthritis, affects up to 15% of the adult population and is principally characterized by degeneration of the articular cartilage component of the joint, often with accompanying subchondral bone lesions. Understanding the mechanisms underlying the pathogenesis of OA is important for the rational development of disease-modifying OA drugs. While most studies on OA have focused on the investigation of either the cartilage or the bone component of the articular joint, the osteochondral complex represents a more physiologically relevant target because the disease ultimately is a disorder of osteochondral integrity and function. In our current investigation, we are constructing an in vitro three-dimensional microsystem that models the structure and biology of the osteochondral complex of the articular joint. Osteogenic and chondrogenic tissue components are produced using adult human mesenchymal stem cells derived from bone marrow and adipose seeded within biomaterial scaffolds photostereolithographically fabricated with defined internal architecture. A three-dimensional-printed, perfusion-ready container platform with dimensions to fit into a 96-well culture plate format is designed to house and maintain the osteochondral microsystem that has the following features: an anatomic cartilage/bone biphasic structure with a functional interface; all tissue components derived from a single adult mesenchymal stem cell source to eliminate possible age/tissue-type incompatibility; individual compartments to constitute separate microenvironment for the synovial and osseous components; accessible individual compartments that may be controlled and regulated via the introduction of bioactive agents or candidate effector cells, and tissue/medium sampling and compositional assays; and compatibility with the application of mechanical load and perturbation. The consequences of mechanical injury, exposure to inflammatory cytokines, and compromised bone quality on degenerative changes in the cartilage component are examined in the osteochondral microsystem as a first step towards its eventual application as an improved and high-throughput in vitro model for prediction of efficacy, safety, bioavailability, and toxicology outcomes for candidate disease-modifying OA drugs. PMID:24564995

2013-01-01

30

Osteochondral Lesion of the Bilateral Femoral Heads in a Young Athletic Patient  

PubMed Central

Osteochondral lesions of the femoral head are uncommon and few studies have reported their imaging findings. Since joints are at risk of early degeneration after osteochondral damage, timely recognition is important. Osteochondral lesions of femoral head may often be necessary to differentiate from avascular necrosis. Here, we report a case of osteochondral lesions on bilateral femoral heads. This lesion manifested as subchondral cysts in initial radiographs, which led to further evaluation by computed tomography arthrography and magnetic resonance imaging, which revealed overlying cartilage defects. PMID:25469091

Lee, Jung Eun; Park, Ji Seon; Cho, Yoon Je; Yoon, So Hee; Park, So Young; Jin, Wook; Lee, Kyung Ryeol

2014-01-01

31

Fluoro-Free navigated retrograde drilling of osteochondral lesions  

Microsoft Academic Search

Purpose  Retrograde drilling of osteochondral lesions (OCLs) is a recommended, but demanding operative approach for revascularization\\u000a of lesions in stage 1–3 according to Berndt and Harty after failed conservative treatment. The gold standard of intraoperative\\u000a driller guidance is fluoroscopic control. Limitations are a 2D visualization of a 3D procedure and sometimes limited view\\u000a of the OCL in fluoroscopy, leading to increased

Florian Gras; Ivan Marintschev; David M. Kahler; Kajetan Klos; Thomas Mückley; Gunther O. Hofmann

2011-01-01

32

Technique: Osteochondral Grafting of Capitate Chondrosis in PRC  

PubMed Central

Background Proximal row carpectomy (PRC) is a useful treatment option for wrist arthritis, but the operation is contraindicated when there is arthritis of the capitate head. We describe a technique that involves resurfacing of a capitate that has focal chondrosis, using an osteochondral graft harvested from the resected carpal bones. Materials and Methods PRC patients who had a focal area of capitate chondrosis underwent osteochondral grafting of the capitate. Pre- and postoperative pain level, employment status, motion, grip strength, and Modified Mayo Wrist Scores (MMWS) were assessed. Postoperative Disability of the Arm, Shoulder, and Hand (DASH) scores were also calculated. Description of Technique The articular surface of the capitate is assessed for need for grafting. The proximal row is resected with the lunate removed intact. The arthritic area is prepared. The graft is taken from the lunate and placed in the prepared site of the capitate. Results Eight patients (average age of 53 years) were followed for 18 months. Pain: Preoperatively, moderate to severe in 7 patients; postoperatively, mild to no pain in 7 patients. Motion: Preoperative, 84° (74% of the contralateral side); postoperative 75° (66%). Grip Strength: Preoperative, 29 kg (62%); postoperative, 34 kg (71%). Mayo Wrist Score: Preoperative, 51 (poor); postoperative, 68 (fair). Average postoperative DASH score was 19.5. Follow-up radiographs showed that 75% of patients had mild to no degeneration. Conclusions Osteochondral grafting in PRC offers satisfactory results in terms of pain relief, return to work, motion, and grip strength. Level of Evidence Therapeutic IV, Case series PMID:24436818

Tang, Peter; Imbriglia, Joseph E.

2013-01-01

33

Technique: Osteochondral Grafting of Capitate Chondrosis in PRC.  

PubMed

Background Proximal row carpectomy (PRC) is a useful treatment option for wrist arthritis, but the operation is contraindicated when there is arthritis of the capitate head. We describe a technique that involves resurfacing of a capitate that has focal chondrosis, using an osteochondral graft harvested from the resected carpal bones. Materials and Methods PRC patients who had a focal area of capitate chondrosis underwent osteochondral grafting of the capitate. Pre- and postoperative pain level, employment status, motion, grip strength, and Modified Mayo Wrist Scores (MMWS) were assessed. Postoperative Disability of the Arm, Shoulder, and Hand (DASH) scores were also calculated. Description of Technique The articular surface of the capitate is assessed for need for grafting. The proximal row is resected with the lunate removed intact. The arthritic area is prepared. The graft is taken from the lunate and placed in the prepared site of the capitate. Results Eight patients (average age of 53 years) were followed for 18 months. Pain: Preoperatively, moderate to severe in 7 patients; postoperatively, mild to no pain in 7 patients. Motion: Preoperative, 84° (74% of the contralateral side); postoperative 75° (66%). Grip Strength: Preoperative, 29 kg (62%); postoperative, 34 kg (71%). Mayo Wrist Score: Preoperative, 51 (poor); postoperative, 68 (fair). Average postoperative DASH score was 19.5. Follow-up radiographs showed that 75% of patients had mild to no degeneration. Conclusions Osteochondral grafting in PRC offers satisfactory results in terms of pain relief, return to work, motion, and grip strength. Level of Evidence Therapeutic IV, Case series. PMID:24436818

Tang, Peter; Imbriglia, Joseph E

2013-08-01

34

Management of recurrent multiple osteochondral lesions of the talus (OCLT) in a young active patient  

PubMed Central

Management of recurrent osteochondral lesion of talus in a young active male is a challenging problem. We present one such case of recurrent talar osteochondral lesions treated by Autologous Matrix Induced Chondrogenesis (AMIC). Patient had a good functional outcome at short-term follow up. We also describe the technique and review the literature regarding this novel technique.

Syed, Farhan; Nunag, Perrico; Pillai, Anand

2014-01-01

35

Functional and Radiographic Outcome of Juvenile Osteochondritis Dissecans of the Knee Treated with Transarticular Arthroscopic Drilling  

Microsoft Academic Search

Management of juvenile osteochondritis dissecans is controversial. The purpose of this study was to evaluate the functional and radiographic outcomes of transarticular arthroscopic drilling for isolated stable, juvenile osteochondritis dissecans lesions of the medial femoral condyle with an intact articular surface after 6 months of nonoperative management had failed. We reviewed 30 affected knees in 23 skeletally immature patients (mean

Mininder S. Kocher; Lyle J. Micheli; Moshe Yaniv; David Zurakowski; Andrew Ames; Anthony A. Adrignolo

2001-01-01

36

Extraarticular Drilling for Stable Osteochondritis Dissecans in the Skeletally Immature Knee  

Microsoft Academic Search

Background: Osteochondritis dissecans of the knee is an increas- ingly frequent diagnosis in the skeletally immature, in whom it is known as juvenile osteochondritis dissecans (JOCD). Although many stable lesions heal with nonoperative treatment, surgical management may be necessary when this treatment fails. Our objective is to determine if extraarticular drilling is an effective treatment for JOCD. Methods: Patients who

Laurie D. Donaldson; Edward M. Wojtys

37

Bioactive Stratified Polymer Ceramic-Hydrogel Scaffold for Integrative Osteochondral Repair  

E-print Network

of polylactide- co-glycolide (PLGA) and 45S5 bioactive glass (BG) was fabricated and optimized for chondrocyte. Keywords--Osteochondral, Tissue engineering, Bioactive glass, Interface, Hydrogel, MicrosphereBioactive Stratified Polymer Ceramic-Hydrogel Scaffold for Integrative Osteochondral Repair JIE

Lu, Helen H.

38

Arthroscopic osteochondral autograft transplantation for chondral lesion of the tibial plateau of the knee.  

PubMed

Arthroscopic osteochondral autograft transplantation is often used to treat chondral/osteochondral lesions of the femoral condyle of the knee. However, arthroscopic autologous osteochondral grafting to the tibial plateau has not been reported. We report the surgical technique and the clinical course of a patient who underwent engraftment by this method. A 26-year-old man developed symptoms of pain and catching in his knee. Arthroscopy revealed a deep chondral lesion, 10 x 15 mm in size, down to the subchondral bone on the posterocentral area of the lateral tibial plateau. The injured cartilage was debrided using a curette and an abrader until normal healthy cartilage bordered the debrided defect. An osteochondral plug, 10 mm in diameter and 20 mm long, the chondral surface of which was orientated 25 degrees obliquely, was harvested from the most peripheral and proximal part of the lateral patellar groove. A bony hole was created in the center of the defect through the tibia using a core reamer. The osteochondral plug was inserted from the tibial window through the bony hole. To enhance the stability of the osteochondral fragment, bioactive ceramic fillers were used to fill the space below the plug. A second-look arthroscopy 10 months after surgery showed that the grafted osteochondral plug was well adapted and integrated into the surrounding cartilage on the lateral tibial plateau. PMID:11447556

Matsusue, Y; Kotake, T; Nakagawa, Y; Nakamura, T

2001-07-01

39

Osteochondritis dissecans of the medial femoral condyle associated with malformation of the menisci.  

PubMed

Osteochondritis dissecans is a form of osteochondrosis limited to the articular epiphysis and the relationship of osteochondritis dissecans and discoid lateral meniscus has been clearly identified. This article presents a 10-year-old boy with osteochondritis dissecans of the medial femoral condyle associated with hypoplastic medial and partial deficient lateral menisci. The patient presented with activity-related pain and intermittent swellings of his left knee for 2 months without any evidence of significant knee trauma. Magnetic resonance imaging revealed anomalous medial meniscus mimicking displaced bucket-handle tear and partially deficient lateral meniscus with osteochondritis dissecans at the lateral aspect of medial femoral condyle without any significant bone loss with a non-dislocated fragment. Arthroscopy of the knee revealed an incomplete separated osteochondral flap with partial discontinuity that was unstable on probing on the lateral aspect of the medial femoral condyle. The medial meniscus was hypoplastic without a body and only the meniscal rim could be seen. The lateral meniscus had an anomalous vertical insertion of the posterior horn, normal body, but an absent anterior horn. The anterior cruciate ligament was intact, but looked like a peacock's tail. Arthroscopic fixation of the chondral lesion was performed. At 30-months follow-up, the boy had no limitation in his daily and sports activity. The present case is the first description of congenital anomaly of the both menisci and osteochondritis dissecans together. Meniscal or ligamentous anomalies of the knee may be associated with osteochondritis dissecans. PMID:19292299

Beyzadeoglu, Tahsin; Gokce, Alper; Bekler, Halil

2008-05-01

40

Bone Marrow Aspiration Concentrate and Platelet Rich Plasma for Osteochondral Repair in a Porcine Osteochondral Defect Model  

PubMed Central

Background Bone marrow aspiration concentrate (BMAC) may possess a high potency for cartilage and osseous defect healing because it contains stem cells and multiple growth factors. Alternatively, platelet rich plasma (PRP), which contains a cocktail of multiple growth factors released from enriched activated thrombocytes may potentially stimulate the mesenchymal stem cells (MSCs) in bone marrow to proliferate and differentiate. Methods A critical size osteochondral defect (10×6 mm) in both medial femoral condyles was created in 14 Goettinger mini-pigs. All animals were randomized into the following four groups: biphasic scaffold alone (TRUFIT BGS, Smith & Nephew, USA), scaffold with PRP, scaffold with BMAC and scaffold in combination with BMAC and PRP. After 26 weeks all animals were euthanized and histological slides were cut, stained and evaluated using a histological score and immunohistochemistry. Results The thrombocyte number was significantly increased (p?=?0.049) in PRP compared to whole blood. In addition the concentration of the measured growth factors in PRP such as BMP-2, BMP-7, VEGF, TGF-?1 and PDGF were significantly increased when compared to whole blood (p<0.05). In the defects of the therapy groups areas of chondrogenic tissue were present, which stained blue with toluidine blue and positively for collagen type II. Adding BMAC or PRP in a biphasic scaffold led to a significant improvement of the histological score compared to the control group, but the combination of BMAC and PRP did not further enhance the histological score. Conclusions The clinical application of BMAC or PRP in osteochondral defect healing is attractive because of their autologous origin and cost-effectiveness. Adding either PRP or BMAC to a biphasic scaffold led to a significantly better healing of osteochondral defects compared with the control group. However, the combination of both therapies did not further enhance healing. PMID:23951201

Betsch, Marcel; Schneppendahl, Johannes; Thuns, Simon; Herten, Monika; Sager, Martin; Jungbluth, Pascal; Hakimi, Mohssen; Wild, Michael

2013-01-01

41

MR imaging of osteochondral grafts and autologous chondrocyte implantation  

PubMed Central

Surgical articular cartilage repair therapies for cartilage defects such as osteochondral autograft transfer, autologous chondrocyte implantation (ACI) or matrix associated autologous chondrocyte transplantation (MACT) are becoming more common. MRI has become the method of choice for non-invasive follow-up of patients after cartilage repair surgery. It should be performed with cartilage sensitive sequences, including fat-suppressed proton density-weighted T2 fast spin-echo (PD/T2-FSE) and three-dimensional gradient-echo (3D GRE) sequences, which provide good signal-to-noise and contrast-to-noise ratios. A thorough magnetic resonance (MR)-based assessment of cartilage repair tissue includes evaluations of defect filling, the surface and structure of repair tissue, the signal intensity of repair tissue and the subchondral bone status. Furthermore, in osteochondral autografts surface congruity, osseous incorporation and the donor site should be assessed. High spatial resolution is mandatory and can be achieved either by using a surface coil with a 1.5-T scanner or with a knee coil at 3 T; it is particularly important for assessing graft morphology and integration. Moreover, MR imaging facilitates assessment of complications including periosteal hypertrophy, delamination, adhesions, surface incongruence and reactive changes such as effusions and synovitis. Ongoing developments include isotropic 3D sequences, for improved morphological analysis, and in vivo biochemical imaging such as dGEMRIC, T2 mapping and diffusion-weighted imaging, which make functional analysis of cartilage possible. PMID:16802126

Millington, S. A.; Szomolanyi, P.; Marlovits, S.

2006-01-01

42

A functional agarose-hydroxyapatite scaffold for osteochondral interface regeneration  

PubMed Central

Regeneration of the osteochondral interface is critical for integrative and functional cartilage repair. This study focuses on the design and optimization of a hydrogel-ceramic composite scaffold of agarose and hydroxyapatite (HA) for calcified cartilage formation. The first study objective was to compare the effects of HA on non-hypertrophic and hypertrophic chondrocytes cultured in the composite scaffold. Specifically, cell growth, biosynthesis, hypertrophy, and scaffold mechanical properties were evaluated. Next, the ceramic phase of the scaffold was optimized in terms of particle size (200 nm vs. 25 µm) and dose (0–6 w/v%). It was observed that while deep zone chondrocyte (DZC) biosynthesis and hypertrophy remained unaffected, hypertrophic chondrocytes measured higher matrix deposition and mineralization potential with the addition of HA. Most importantly, higher matrix content translated into significant increases in both compressive and shear mechanical properties. While cell hypertrophy was independent of ceramic size, matrix deposition was higher only with the addition of micron-sized ceramic particles. In addition, the highest matrix content, mechanical properties and mineralization potential were found in scaffolds with 3% micro-HA, which approximates both the mineral aggregate size and content of the native interface. These results demonstrate that the biomimetic hydrogel-ceramic composite is optimal for calcified cartilage formation and is a promising design strategy for osteochondral interface regeneration. PMID:22531222

Khanarian, Nora T.; Haney, Nora M.; Burga, Rachel A.; Lu, Helen H.

2013-01-01

43

The osteochondral dilemma: review of current management and future trends.  

PubMed

The management of articular cartilage defects remains challenging and controversial. Hyaline cartilage has limited capacity for self-repair and post-injury cartilage is predominantly replaced by fibrocartilage through healing from the subchondral bone. Fibrocartilage lacks the key properties that characterize hyaline cartilage such as capacity for compression, hydrodynamic permeability and smoothness of the articular surface. Many reports relate compromised function associated with repaired cartilage and loss of function of the articular surface. Novel methods have been proposed with the key aim to regenerate hyaline cartilage for repair of osteochondral defects. Over the past decade, with many exciting developments in tissue engineering and regenerative cell-based technologies, we are now able to consider new combinatorial approaches to overcome the problems associated with osteochondral injuries and damage. In this review, the currently accepted surgical approaches are reviewed and considered; debridement, marrow stimulation, whole tissue transplantation and cellular repair. More recent products, which employ tissue engineering approaches to enhance the traditional methods of repair, are discussed. Future trends must not only focus on recreating the composition of articular cartilage, but more importantly recapitulate the nano-structure of articular cartilage to improve the functional strength and integration of repair tissue. PMID:23458285

Ye, Ken; Di Bella, Claudia; Myers, Damian E; Choong, Peter F M

2014-04-01

44

Autologous osteochondral transplantation using the diamond bone-cutting system (DBCS): 6-12 years' follow-up of 35 patients with osteochondral defects at the knee joint.  

PubMed

Thirty-five patients with severe osteochondral defects were treated by autologous osteochondral transplantation between 1986 and 1992. The majority of patients (27) suffered from osteochondrosis dissecans, while 8 patients presented with posttraumatic osteochondral defects. The grafts were harvested with a diamond bone cutter from the posterior part of the medial or lateral femoral condyle. In 29 patients the lesion was located at the lateral part of the medial femoral condyle, in 3 it was at the lateral femoral condyle, and in 3 at the patella. Twenty-nine patients could be examined at the follow-up between 6 and 12 years later (mean follow up 8.1 years). Using the standard cartilage evaluation form, the transplanted knees of 12 patients were graded as normal (grade I), 14 knees were nearly normal (grade II), while 3 patients presented with an abnormal result (grade III). All 3 of them had a varus malalignment and refused a high tibial correction osteotomy against our advice. No patient was assessed as severely abnormal (grade IV). The majority of patients improved their activity level and the functional status of the joint. Twelve patients developed new radiological signs of osteoarthrosis with a decrease in the radiological score of Kellgren and Lawrence by about one stage. We conclude that autologous osteochondral transplantation with the diamond bone-cutting system is an effective method in the treatment of severe osteochondral defects. PMID:11409552

Laprell, H; Petersen, W

2001-05-01

45

Fresh-frozen osteochondral allograft reconstruction of a giant cell tumor of the talus.  

PubMed

The use of fresh-frozen osteochondral allografts has been reported for the treatment of talar fractures, osteochondral lesions, and tumors of the calcaneus. Currently, we are unaware of any reports in the literature addressing the use of fresh-frozen osteochondral allograft for the treatment of giant cell tumors in the talus. We report our attempt to eradicate an aggressive giant cell tumor of the talus while minimizing morbidity and loss of function via reconstruction with a fresh-frozen osteochondral allograft. This is the first report in the literature to propose such a treatment option for giant cell tumors in the talus. The patient was informed that a report of this case would be submitted for publication. PMID:17466239

Schoenfeld, Andrew J; Leeson, Mark C; Grossman, Jordan P

2007-01-01

46

Prevalence of osteochondritis among preparatory and primary school children in an Egyptian governorate.  

PubMed

Epiphyseal osteochondritis is a localized disorder in childhood. Vascular insufficiency is thought to be the most significant etiologic factor. This study had been carried on Primary and Preparatory school children in Zagazig City and surrounding villages in Sharkia Governorate, Egypt. Total number of studied children were 16,060, 7,380 males, 8,680 females. The mean age was 11.41 ± 1.99. Our results showed that the prevalence of osteochondritis was 21:10,000. Distribution of Sever's and Osgood-Shlatter diseases were significantly high compared with other osteochondritis. Regarding the sex distribution, osteochondritis was frequent in males. Our results showed that there was history of trauma especially in Sever's and Osgood-Schlatter diseases. PMID:21553279

Abou El-Soud, Amany M; Gaballa, Hala A; Ali, Manal Abdo

2012-08-01

47

Chondrocyte Death and Cartilage Degradation After Autologous Osteochondral Transplantation Surgery in a Rabbit Model  

Microsoft Academic Search

Background: Autologous osteochondral transplantation surgery requires an impact force on the graft that may cause chondrocyte death and matrix degradation. This study attempted to determine the degree to which this occurs in a rabbit model shortly after the procedure.Hypothesis: Impaction of a press-fit autologous osteochondral graft in vivo results in chondrocyte necrosis, apoptosis, and matrix degradation at early time points.Study

Lawrence V. Gulotta; Jonas R. Rudzki; David Kovacevic; Christopher C. T. Chen; Dejan Milentijevic; Riley J. Williams

2009-01-01

48

Chondrogenesis of mesenchymal stem cells in an osteochondral environment is mediated by the subchondral bone.  

PubMed

In articular cartilage repair, cells that will be responsible for the formation of repair tissue are often exposed to an osteochondral environment. To study cartilage repair mechanisms in vitro, we have recently developed a bovine osteochondral biopsy culture model in which cartilage defects can be simulated reproducibly. Using this model, we now aimed at studying the chondrogenic potential of human bone marrow-derived mesenchymal stem cells (hBMSCs) in an osteochondral environment. In contrast to standard in vitro chondrogenesis, it was found that supplementing transforming growth factor beta (TGF?) to culture medium was not required to induce chondrogenesis of hBMSCs in an osteochondral environment. hBMSC culture in defects created in osteochondral biopsies or in bone-only biopsies resulted in comparable levels of cartilage-related gene expression, whereas culture in cartilage-only biopsies did not induce chondrogenesis. Subcutaneous implantation in nude mice of osteochondral biopsies containing hBMSCs in osteochondral defects resulted in the formation of more cartilaginous tissue than hBMSCs in chondral defects. The subchondral bone secreted TGF?; however, the observed results could not be attributed to TGF?, as either capturing TGF? with an antibody or blocking the canonical TGF? signaling pathway did not result in significant changes in cartilage-related gene expression of hBMSCs in the osteochondral culture model. Inhibition of BMP signaling did not prevent chondrogenesis. In conclusion, we demonstrate that chondrogenesis of hBMSCs is induced by factors secreted from the bone. We have strong indications that this is not solely mediated by members of the TGF? family but other, yet unknown, factors originating from the subchondral bone appeared to play a key role. PMID:23980750

de Vries-van Melle, Marloes L; Narcisi, Roberto; Kops, Nicole; Koevoet, Wendy J L M; Bos, P Koen; Murphy, J Mary; Verhaar, Jan A N; van der Kraan, Peter M; van Osch, Gerjo J V M

2014-01-01

49

Arthroscopic Delivery of Cancellous Tibial Autograft for Unstable Osteochondral Lesions in the Adolescent Knee  

PubMed Central

The appropriate surgical technique for the treatment of unstable osteochondral lesions of the knee remains unclear and had been traditionally described with an open arthrotomy. Administration of bone grafting material in the knee may be performed for a variety of pathologic conditions, including unstable osteochondritis dissecans, traumatic osteochondral defects, or subchondral fracture nonunion, or for preparation of residual tunnels during revision anterior cruciate ligament reconstruction. Although various grafting materials have been described in the literature, cancellous autograft remains the gold standard for treatment safety and efficacy. We describe a successful technique for arthroscopic delivery of autogenous bone graft during fixation of unstable osteochondral lesions of the knee. When the indication for grafting is established, cancellous autograft is harvested from the proximal tibia, undergoes morcellation, and is soaked in bone marrow aspirate obtained through the harvest window. The bone graft is then packed into a modified tuberculin syringe. After arthroscopic preparation of the unstable osteochondral fragment and the respective donor surface, the tuberculin syringe is placed through a standard arthroscopy portal and the bone graft is introduced into the defect under direct visualization, followed by an appropriate osteochondral fixation technique. PMID:25126499

Espinoza, Chris; Ellis, Henry B.; Wilson, Philip

2014-01-01

50

Arthroscopic delivery of cancellous tibial autograft for unstable osteochondral lesions in the adolescent knee.  

PubMed

The appropriate surgical technique for the treatment of unstable osteochondral lesions of the knee remains unclear and had been traditionally described with an open arthrotomy. Administration of bone grafting material in the knee may be performed for a variety of pathologic conditions, including unstable osteochondritis dissecans, traumatic osteochondral defects, or subchondral fracture nonunion, or for preparation of residual tunnels during revision anterior cruciate ligament reconstruction. Although various grafting materials have been described in the literature, cancellous autograft remains the gold standard for treatment safety and efficacy. We describe a successful technique for arthroscopic delivery of autogenous bone graft during fixation of unstable osteochondral lesions of the knee. When the indication for grafting is established, cancellous autograft is harvested from the proximal tibia, undergoes morcellation, and is soaked in bone marrow aspirate obtained through the harvest window. The bone graft is then packed into a modified tuberculin syringe. After arthroscopic preparation of the unstable osteochondral fragment and the respective donor surface, the tuberculin syringe is placed through a standard arthroscopy portal and the bone graft is introduced into the defect under direct visualization, followed by an appropriate osteochondral fixation technique. PMID:25126499

Espinoza, Chris; Ellis, Henry B; Wilson, Philip

2014-06-01

51

Additive manufacturing for in situ repair of osteochondral defects.  

PubMed

Tissue engineering holds great promise for injury repair and replacement of defective body parts. While a number of techniques exist for creating living biological constructs in vitro, none have been demonstrated for in situ repair. Using novel geometric feedback-based approaches and through development of appropriate printing-material combinations, we demonstrate the in situ repair of both chondral and osteochondral defects that mimic naturally occurring pathologies. A calf femur was mounted in a custom jig and held within a robocasting-based additive manufacturing (AM) system. Two defects were induced: one a cartilage-only representation of a grade IV chondral lesion and the other a two-material bone and cartilage fracture of the femoral condyle. Alginate hydrogel was used for the repair of cartilage; a novel formulation of demineralized bone matrix was used for bone repair. Repair prints for both defects had mean surface errors less than 0.1 mm. For the chondral defect, 42.8+/-2.6% of the surface points had errors that were within a clinically acceptable error range; however, with 1 mm path planning shift, an estimated approximately 75% of surface points could likely fall within the benchmark envelope. For the osteochondral defect, 83.6+/-2.7% of surface points had errors that were within clinically acceptable limits. In addition to implications for minimally invasive AM-based clinical treatments, these proof-of-concept prints are some of the only in situ demonstrations to-date, wherein the substrate geometry was unknown a priori. The work presented herein demonstrates in situ AM, suggests potential biomedical applications and also explores in situ-specific issues, including geometric feedback, material selection and novel path planning techniques. PMID:20823507

Cohen, Daniel L; Lipton, Jeffrey I; Bonassar, Lawrence J; Lipson, Hod

2010-09-01

52

Repairing the Osteochondral Defect in Goat with the Tissue-Engineered Osteochondral Graft Preconstructed in a Double-Chamber Stirring Bioreactor  

PubMed Central

To investigate the reparative efficacy of tissue-engineered osteochondral (TEO) graft for repairing the osteochondral defect in goat, we designed a double-chamber stirring bioreactor to construct the bone and cartilage composites simultaneously in one ?-TCP scaffold and observed the reparative effect in vivo. The osteochondral defects were created in goats and all the animals were divided into 3 groups randomly. In groups A, the defect was treated with the TEO which was cultured with mechanical stimulation of stir; in group B, the defect was treated with TEO which was cultured without mechanical stimulation of stir; in groups C, the defect was treated without TEO. At 12 weeks and 24 weeks after operation, the reparative effects in different groups were assessed and compared. The results indicated that the reparative effect of the TEO cultured in the bioreactor was better than the control group, and mechanical stimulation of stir could further improve the reparative effect. We provided a feasible and effective method to construct the TEO for treatment of osteochondral defect using autologous BMSCs and the double-chamber bioreactor. PMID:25061604

Pei, Yang; Fan, Jun-jun; Zhang, Xiao-qiang; Zhang, Zhi-yong; Yu, Min

2014-01-01

53

Osteochondritis Dissecans of the Knee: Experiences at The Children's Hospital of Philadelphia and a Review of Literature  

Microsoft Academic Search

Osteochondritis dissecans is a condition primarily found in the knee, elbow, and ankle, which affects subchondral bone and potentially the overlying articular cartilage. Although the etiology is not certain, possible causative factors include repetitive microtrauma, ischemia, genetic and endocrine factors, and anoma- lies of ossification. The etiology, presentation, and management is age-dependent, as osteochondral lesions have a much greater po-

STEPHAN G. PILL; THEODORE J. GANLEY; JOHN M. FLYNN; R. ALDEN MILAM; PAUL J. KING; JOHN R. GREGG

2001-01-01

54

The Impact of Compact Layer in Biphasic Scaffold on Osteochondral Tissue Engineering  

PubMed Central

The structure of an osteochondral biphasic scaffold is required to mimic native tissue, which owns a calcified layer associated with mechanical and separation function. The two phases of biphasic scaffold should possess efficient integration to provide chondrocytes and osteocytes with an independent living environment. In this study, a novel biphasic scaffold composed of a bony phase, chondral phase and compact layer was developed. The compact layer-free biphasic scaffold taken as control group was also fabricated. The purpose of current study was to evaluate the impact of the compact layer in the biphasic scaffold. Bony and chondral phases were seeded with autogeneic osteoblast- or chondrocyte-induced bone marrow stromal cells (BMSCs), respectively. The biphasic scaffolds-cells constructs were then implanted into osteochondral defects of rabbits’ knees, and the regenerated osteochondral tissue was evaluated at 3 and 6 months after surgery. Anti-tensile and anti-shear properties of the compact layer-containing biphasic scaffold were significantly higher than those of the compact layer-free biphasic scaffold in vitro. Furthermore, in vivo studies revealed superior macroscopic scores, glycosaminoglycan (GAG) and collagen content, micro tomograph imaging results, and histological properties of regenerated tissue in the compact layer-containing biphasic scaffold compared to the control group. These results indicated that the compact layer could significantly enhance the biomechanical properties of biphasic scaffold in vitro and regeneration of osteochondral tissue in vivo, and thus represented a promising approach to osteochondral tissue engineering. PMID:23382984

Cheng, Jian-Hua; Zhou, Wei; Xiong, Zhuo; Mu, Yun-Jing; Liu, Jian

2013-01-01

55

Arthroscopic Particulated Juvenile Cartilage Allograft Transplantation for the Treatment of Osteochondral Lesions of the Talus  

PubMed Central

Several options exist for the treatment of osteochondral lesions of the talus. Particulated juvenile cartilage allograft transplantation (PJCAT) has become a viable treatment modality for osteochondral lesions of the talus that are not amenable to microfracture or for which microfracture has failed. Arthroscopic placement of this type of graft obviates the need for osteotomy or plafondplasty and does not prevent additional procedures from being performed through an anterior approach. Special instrumentation and setup are not required to perform this procedure. Our arthroscopic technique for placement of particulated juvenile cartilage into osteochondral lesions of the talus is described. Case series and outcomes after arthroscopic ankle PJCAT are currently not reported within the literature; however, it is believed that the outcomes are at least similar to those of open ankle PJCAT. PMID:25264516

Adams, Samuel B.; Demetracopoulos, Constantine A.; Parekh, Selene G.; Easley, Mark E.; Robbins, Justin

2014-01-01

56

Hydrogen Supplementation of Preservation Solution Improves Viability of Osteochondral Grafts  

PubMed Central

Allogenic osteochondral tissue (OCT) is used for the treatment of large cartilage defects. Typically, OCTs collected during the disease-screening period are preserved at 4°C; however, the gradual reduction in cell viability during cold preservation adversely affects transplantation outcomes. Therefore, improved storage methods that maintain the cell viability of OCTs are needed to increase the availability of high-quality OCTs and improve treatment outcomes. Here, we evaluated whether long-term hydrogen delivery to preservation solution improved the viability of rat OCTs during cold preservation. Hydrogen-supplemented Dulbecco's Modified Eagles Medium (DMEM) and University of Wisconsin (UW) solution both significantly improved the cell viability of OCTs during preservation at 4°C for 21 days compared to nonsupplemented media. However, the long-term cold preservation of OCTs in DMEM containing hydrogen was associated with the most optimal maintenance of chondrocytes with respect to viability and morphology. Our findings demonstrate that OCTs preserved in DMEM supplemented with hydrogen are a promising material for the repair of large cartilage defects in the clinical setting. PMID:25506061

Yamada, Takuya; Onuma, Kenji; Kuzuno, Jun; Ujihira, Masanobu; Kurokawa, Ryosuke; Sakai, Rina; Takaso, Masashi

2014-01-01

57

Repair of osteochondral lesions in the knee by chondrocyte implantation using the MACI ® technique  

Microsoft Academic Search

Purpose  Matrix-associated autologous chondrocyte implantation (MACI®) is an innovative therapeutic option for the treatment of chondral and osteochondral lesions of the knee.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Fifty-three patients (54 knees) with MRI-documented osteochondral lesions were treated with MACI®. A clinical assessment was performed using VAS score, Lysholm score, and Tegner activity level after an average follow-up\\u000a of 27 months (SD: 2.3). MRI scans were performed 12

Alberto Ventura; Antonio Memeo; Enrico Borgo; Clara Terzaghi; Claudio Legnani; Walter Albisetti

58

Chondroblastoma of the Knee Treated with Resection and Osteochondral Allograft Reconstruction  

PubMed Central

Case. This case report describes the operative management of 16-year-old male with a symptomatic chondroblastoma of the distal femur with breach of the chondral surface. Following appropriate imaging and core needle biopsy, the diagnosis was confirmed histologically. The patient then underwent intralesional curettage and osteochondral allograft reconstruction of the defect. At one-year follow-up the patient was pain-free and has obtained excellent range of motion. There is radiographic evidence of allograft incorporation and no evidence of local recurrence. Conclusion. Osteochondral allograft reconstruction is an effective option following marginal resection and curettage of chondroblastoma involving the chondral surface of the distal femur.

Fitzgerald, Judd; Broehm, Cory; Treme, Gehron

2014-01-01

59

Osteochondritis dissecans and Osgood Schlatter disease in a family with Stickler syndrome  

Microsoft Academic Search

PURPOSE: Stickler syndrome is among the most common autosomal dominant connective tissue disorders but is often unrecognised and therefore not diagnosed by clinicians. Despite much speculation, the cause of osteochondrosis in general and osteochondritis dissecans (OCD) and Osgood Schlatter syndrome (OSS) in particular remain unclear. Etiological understanding is essential. We describe a pair of family subjects presented with OCD and

Ali Al Kaissi; Klaus Klaushofer; Franz Grill

2009-01-01

60

Biofabrication of Osteochondral Tissue Equivalents by Printing Topologically Defined, Cell-Laden Hydrogel Scaffolds  

PubMed Central

Osteochondral defects are prone to induce osteoarthritic degenerative changes. Many tissue-engineering approaches that aim to generate osteochondral implants suffer from poor tissue formation and compromised integration. This illustrates the need for further improvement of heterogeneous tissue constructs. Engineering of these structures is expected to profit from strategies addressing the complexity of tissue organization and the simultaneous use of multiple cell types. Moreover, this enables the investigation of the effects of three-dimensional (3D) organization and architecture on tissue function. In the present study, we characterize the use of a 3D fiber deposition (3DF) technique for the fabrication of cell-laden, heterogeneous hydrogel constructs for potential use as osteochondral grafts. Changing fiber spacing or angle of fiber deposition yielded scaffolds of varying porosity and elastic modulus. We encapsulated and printed fluorescently labeled human chondrocytes and osteogenic progenitors in alginate hydrogel yielding scaffolds of 1×2?cm with different parts for both cell types. Cell viability remained high throughout the printing process, and cells remained in their compartment of the printed scaffold for the whole culture period. Moreover, distinctive tissue formation was observed, both in vitro after 3 weeks and in vivo (6 weeks subcutaneously in immunodeficient mice), at different locations within one construct. These results demonstrate the possibility of manufacturing viable centimeter-scaled structured tissues by the 3DF technique, which could potentially be used for the repair of osteochondral defects. PMID:21854293

Fedorovich, Natalja E.; Schuurman, Wouter; Wijnberg, Hans M.; Prins, Henk-Jan; van Weeren, P. René; Malda, Jos; Dhert, Wouter J.A.

2012-01-01

61

Orderly osteochondral regeneration in a sheep model using a novel nano-composite multilayered biomaterial.  

PubMed

The objective of this article was to investigate the safety and regenerative potential of a newly developed biomimetic scaffold when applied to osteochondral defects in an animal model. A new multilayer gradient nano-composite scaffold was obtained by nucleating collagen fibrils with hydroxyapatite nanoparticles. In the femoral condyles of 12 sheep, 24 osteochondral lesions were created. Animals were randomized into three treatment groups: scaffold alone, scaffold colonized in vitro with autologous chondrocytes and empty defects. Six months after surgery, the animals were sacrificed and the lesions were histologically evaluated. Histologic and gross evaluation of specimens showed good integration of the chondral surface in all groups except for the control group. Significantly better bone regeneration was observed both in the group receiving the scaffold alone and in the group with scaffold loaded with autologous chondrocytes. No difference in cartilage surface reconstruction and osteochondral defect filling was noted between cell-seeded and cell-free groups. In the control group, no bone or cartilage defect healing occurred, and the defects were filled with fibrous tissue. Quantitative macroscopic and histological score evaluations confirmed the qualitative trends observed. The results of the present study showed that this novel osteochondral scaffold is safe and easy to use, and may represent a suitable matrix to direct and coordinate the process of bone and hyaline-like cartilage regeneration. The comparable regeneration process observed with or without autologous chondrocytes suggests that the main mode of action of the scaffold is based on the recruitment of local cells. PMID:19623663

Kon, Elizaveta; Delcogliano, Marco; Filardo, Giuseppe; Fini, Milena; Giavaresi, Gianluca; Francioli, Silvia; Martin, Ivan; Pressato, Daniele; Arcangeli, Elena; Quarto, Rodolfo; Sandri, Monica; Marcacci, Maurillo

2010-01-01

62

Radially oriented collagen scaffold with SDF-1 promotes osteochondral repair by facilitating cell homing.  

PubMed

The migration of cells from the side and the bottom of the defect is important in osteochondral defect healing. Here, we designed a novel collagen scaffold that possessed channels in both the horizontal and the vertical directions, along with stromal cell-derived factor-1 (SDF-1) to enhance osteochondral regeneration by facilitating cell homing. Firstly we fabricated the radially oriented and random collagen scaffolds, then tested their properties. The radially oriented collagen scaffold had better mechanical properties than the random scaffold, but both supported cell proliferation well. Then we measured the migration of BMSCs in the scaffolds in vitro. The radially oriented collagen scaffold effectively promoted their migration, and this effect was further facilitated by addition of SDF-1. Moreover, we created osteochondral defects in rabbits, and implanted them with random or oriented collagen scaffolds with or without SDF-1, and evaluated cartilage and subchondral bone regeneration at 6 and 12 weeks after surgery. Cartilage regeneration with both the radially oriented scaffold and SDF-1 effectively promoted repair of the cartilage defect. Our results confirmed that the implantation of the radially oriented channel collagen scaffold with SDF-1 could be a promising strategy for osteochondral repair. PMID:25477178

Chen, Pengfei; Tao, Jiadong; Zhu, Shouan; Cai, Youzhi; Mao, Qijiang; Yu, Dongsheng; Dai, Jun; Ouyang, HongWei

2015-01-01

63

Potential pitfall in the microfracturing technique during the arthroscopic treatment of an osteochondral lesion  

Microsoft Academic Search

Debridement and bone marrow stimulation of the subchondral bone is currently considered to be the primary surgical treatment of most osteochondral lesions of the talus. Different methods of bone marrow stimulation are used, including drilling, abrasion, and microfracturing. The latter has gained recent popularity. In this technical note we describe a potential pitfall in the microfracturing technique. The microfracture awl

Bergen van C. J. A; Leeuw de P. A. J; Dijk van C. N

2009-01-01

64

Development of Novel Three-Dimensional Printed Scaffolds for Osteochondral Regeneration.  

PubMed

As modern medicine advances, various methodologies are being explored and developed in order to treat severe osteochondral defects in joints. However, it is still very challenging to cure the osteochondral defects due to their poor inherent regenerative capacity, complex stratified architecture, and disparate biomechanical properties. The objective of this study is to create novel three-dimensional (3D) printed osteochondral scaffolds with both excellent interfacial mechanical properties and biocompatibility for facilitating human bone marrow mesenchymal stem cell (MSC) growth and chondrogenic differentiation. For this purpose, we designed and 3D printed a series of innovative bi-phasic 3D models that mimic the osteochondral region of articulate joints. Our mechanical testing results showed that our bi-phasic scaffolds with key structures have enhanced mechanical characteristics in compression (a maximum Young's modulus of 31?MPa) and shear (a maximum fracture strength of 5768?N/mm(2)) when compared with homogenous designs. These results are also correlated with numerical simulation. In order to improve their biocompatibility, the scaffolds' surfaces were further modified with acetylated collagen (one of the main components in osteochondral extracellular matrix). MSC proliferation results demonstrated that incorporation of a collagen, along with biomimetically designed micro-features, can greatly enhance MSC growth after 5 days in vitro. Two weeks' chondrogenic differentiation results showed that our novel scaffolds (dubbed "key" scaffolds), both with and without surface collagen modification, displayed enhanced chondrogenesis (e.g., 130%, 114%, and 236% increases in glycosaminoglycan, type II collagen deposition, and total protein content on collagen-modified key scaffolds when compared with homogeneous controls). PMID:25088966

Holmes, Benjamin; Zhu, Wei; Li, Jiaoyan; Lee, James D; Zhang, Lijie Grace

2014-09-12

65

Dual growth factor delivery from bilayered, biodegradable hydrogel composites for spatially-guided osteochondral tissue repair.  

PubMed

The present work investigated the use of biodegradable hydrogel composite scaffolds, based on the macromer oligo(poly(ethylene glycol) fumarate) (OPF), to deliver growth factors for the repair of osteochondral tissue in a rabbit model. In particular, bilayered OPF composites were used to mimic the structural layers of the osteochondral unit, and insulin-like growth factor-1 (IGF-1) and bone morphogenetic protein-2 (BMP-2) were loaded into gelatin microparticles and embedded within the OPF hydrogel matrix in a spatially controlled manner. Three different scaffold formulations were implanted in a medial femoral condyle osteochondral defect: 1) IGF-1 in the chondral layer, 2) BMP-2 in the subchondral layer, and 3) IGF-1 and BMP-2 in their respective separate layers. The quantity and quality of osteochondral repair was evaluated at 6 and 12 weeks with histological scoring and micro-computed tomography (micro-CT). While histological scoring results at 6 weeks showed no differences between experimental groups, micro-CT analysis revealed that the delivery of BMP-2 alone increased the number of bony trabecular islets formed, an indication of early bone formation, over that of IGF-1 delivery alone. At 12 weeks post-implantation, minimal differences were detected between the three groups for cartilage repair. However, the dual delivery of IGF-1 and BMP-2 had a higher proportion of subchondral bone repair, greater bone growth at the defect margins, and lower bone specific surface than the single delivery of IGF-1. These results suggest that the delivery of BMP-2 enhances subchondral bone formation and that, while the dual delivery of IGF-1 and BMP-2 in separate layers does not improve cartilage repair under the conditions studied, they may synergistically enhance the degree of subchondral bone formation. Overall, bilayered OPF hydrogel composites demonstrate potential as spatially-guided, multiple growth factor release vehicles for osteochondral tissue repair. PMID:25047629

Lu, Steven; Lam, Johnny; Trachtenberg, Jordan E; Lee, Esther J; Seyednejad, Hajar; van den Beucken, Jeroen J J P; Tabata, Yasuhiko; Wong, Mark E; Jansen, John A; Mikos, Antonios G; Kasper, F Kurtis

2014-10-01

66

A novel injectable hydrogel in combination with a surgical sealant in a rat knee osteochondral defect model  

Microsoft Academic Search

Osteochondral defects are frequent, painful, debilitating and expensive to treat, often resulting in poor results. The goal\\u000a of the present study was to synthesize and characterize a novel biocompatible and biodegradable hydrogel comprised of poly(ethylene\\u000a glycol), gelatin, and genipin, and examine the hydrogel as an injectable biomaterial in combination with a cyanoacrylate-based\\u000a surgical sealant for cartilage repair. An osteochondral knee

Natasa D. Miljkovic; Yen-Chih Lin; Mario Cherubino; Danielle Minteer; Kacey G. Marra

2009-01-01

67

Chronic posttraumatic cartilage lesion of the knee treated with an acellular osteochondral-regenerating implant: case history with rehabilitation guidelines.  

PubMed

Osteochondral defects are often symptomatic and lead to deranged joint function. The spontaneous healing capacity of osteochondral defects is limited. In this case study, use of an acellular scaffold capable of induction of mesenchymal stem-cell migration is described. This scaffold was used on an Outerbridge grade IV medical condylar defect measuring ~2 cm2. At 24 mo follow-up, the articular surface appeared restored by MRI, and the patient returned to sports. PMID:24231791

Kon, Elizaveta; Drobnic, Matej; Davidson, Phil A; Levy, Andrew; Zaslav, Ken R; Robinson, Dror

2014-08-01

68

Arthroscopic Anatomic Humeral Head Reconstruction With Osteochondral Allograft Transplantation for Large Hill-Sachs Lesions  

PubMed Central

Anatomic reconstruction of the humeral head with osteochondral allograft has been reported as a solution for large Hill-Sachs lesions with or without glenoid bone loss. However, to date, varying techniques have been used. This technical note describes an arthroscopic reconstruction technique using fresh-frozen, side- and size-matched osteochondral humeral head allograft. Allograft plugs are press fit into the defect without internal fixation and seated flush with the surrounding articular surface. This technique restores the native articular contour of the humeral head without compromising shoulder range of motion. Potential benefits of this all-arthroscopic approach include minimal trauma to the soft tissue and articular surface without the need for hardware or staged reoperation. PMID:24266001

Snir, Nimrod; Wolfson, Theodore S.; Hamula, Mathew J.; Gyftopoulos, Soterios; Meislin, Robert J.

2013-01-01

69

Treatment of a Lateral Tibial Plateau Osteochondritis Dissecans Lesion With Subchondral Injection of Calcium Phosphate  

PubMed Central

Osteochondritis dissecans lesions occur frequently in children and adolescents. Treatment can be challenging and depends on the status of the articular cartilage and subchondral bone. Injection of calcium phosphate bone substitute into the area of subchondral bone edema (Subchondroplasty; Knee Creations, West Chester, PA) may be an option. We present a case of a lateral tibial plateau osteochondritis dissecans lesion treated with subchondral injection of nanocrystalline calcium phosphate. Preoperative magnetic resonance imaging is used to determine the area of subchondral edema, and intraoperative fluoroscopy is used to localize this area with the injection cannula. Calcium phosphate is injected by use of a series of syringes until the appropriate fill is obtained. Treatment of concomitant cartilage defects may also be carried out at this time. PMID:24265997

Abrams, Geoffrey D.; Alentorn-Geli, Eduard; Harris, Joshua D.; Cole, Brian J.

2013-01-01

70

Prevalence of osteochondritis among preparatory and primary school children in an Egyptian governorate  

Microsoft Academic Search

Epiphyseal osteochondritis is a localized disorder in childhood. Vascular insufficiency is thought to be the most significant\\u000a etiologic factor. This study had been carried on Primary and Preparatory school children in Zagazig City and surrounding villages\\u000a in Sharkia Governorate, Egypt. Total number of studied children were 16,060, 7,380 males, 8,680 females. The mean age was\\u000a 11.41 ± 1.99. Our results showed that

Amany M. Abou El-Soud; Hala A. Gaballa; Manal Abdo Ali

71

[Refixation of osteochondral fragments using absorbable implants. First results of a retrospective study].  

PubMed

An osteochondral lesion in a weight bearing joint causes therapeutic problems. Surgical therapy focuses on the restoration of the articular surface, unlimited motion of the joint and prevention of cartilaginous degeneration. A causal therapy to prevent posttraumatic osteoarthritis is the fixation of osteochondral fragments. Various absorbable implants for the purpose of refixation are available, but only a few have proved to be biocompatible. This retrospective study presents the preliminary results after refixation of osteochondral fragments of the ankle and knee joints. We used self-reinforced absorbable pins, nails and screws made of polylactide acid. The results for 15 patients with 17 fractures of 16 joints were evaluated. All patients were scored by the Tegner-activity-level, the McDermott-score and the DGKKT-score, and 13 of them were monitored by postoperative magnetic resonance imaging (MRI). The follow-up extended for an average of 14.3 months (range: 4-43 months). The clinical results for all patients were good (McDermott-score: Ø 89 points, DGKKT-score: Ø 78.8 points, Tegner: pre-op vs post-op=Ø 4.6 vs Ø 5.1) and the surgical therapy proved to be successful. The MRI showed the complete incorporation and vitality of the fragment as well as a congruence of the joint surface. The clinical course and the MRI gave little reference to an inflammatory reaction due to the implants that complicated the course of two patients. These results indicate that absorbable implants made of polylactide acid are biocompatible and effective in the fixation of osteochondral fragments. PMID:12883805

Fuchs, M; Vosshenrich, R; Dumont, C; Stürmer, K M

2003-06-01

72

Evaluation of novel in situ synthesized nano-hydroxyapatite/collagen/alginate hydrogels for osteochondral tissue engineering.  

PubMed

Collagen hydrogel has been widely used for osteochondral repair, but its mechanical properties cannot meet the requirements of clinical application. Previous studies have shown that the addition of either polysaccharide or inorganic particles could reinforce the polymer matrix. However, their synergic effects on collagen-based hydrogel have seldom been studied, and the potential application of triple-phased composite gel in osteochondral regeneration has not been reported. In this study, nano-hydroxyapatite (nano-HA) reinforced collagen-alginate hydrogel (nHCA) was prepared by the in situ synthesis of nano-HA in collagen gel followed by the addition of alginate and Ca(2+). The properties of triple-phased nHCA hydrogel were studied and compared with pure collagen and biphasic gels, and the triple-phased composite of collagen-alginate-HA gels showed a superiority in not only mechanical but also biological features, as evidenced by the enhanced tensile and compressive modulus, higher cell viability, faster cell proliferation and upregulated hyaline cartilage markers. In addition, it was found that the synthesis process could also affect the properties of the triple-phased composite, compared to blend-mixing HCA. The in situ-synthesized nHCA hydrogel showed an enhanced tensile modulus, as well as enhanced biological features compared with HCA. Our study demonstrated that the nHCA composite hydrogel holds promise in osteochondral regeneration. The addition of alginate and nano-HA contribute to the increase in both mechanical and biological properties. This study may provide a valuable reference for the design of an appropriate composite scaffold for osteochondral tissue engineering. PMID:25358331

Zheng, Li; Jiang, Xianfang; Chen, Xuening; Fan, Hongsong; Zhang, Xingdong

2014-12-01

73

A volleyball player with bilateral knee osteochondritis dissecans treated with extracorporeal shock wave therapy  

Microsoft Academic Search

We present a case report of a 14-year-old Caucasian sport woman affected by bilateral and symmetrical knee osteochondritis\\u000a dissecans (OCD) addressed to surgery, in which extracorporeal shock wave therapy determined complete healing. Shock wave is\\u000a a longitudinal acoustic wave traveling with the speed of ultrasound through the water of the body tissue. Recently, this therapy\\u000a has been used in the

Biagio Moretti; Angela Notarnicola; Lorenzo Moretti; Paola Giordano; Vittorio Patella

2009-01-01

74

Percutaneous CT-Guided Treatment of Osteochondritis Dissecans of the Sacroiliac Joint  

SciTech Connect

Osteochondritis dissecans (OCD) is a joint disorder that affects the articular cartilage and subchondral bone, most commonly at the knee. OCD of the sacroiliac joint is extremely rare. Management of OCD remains controversial, and surgery is often needed, especially when conservative treatment fails. We present a rare case of OCD involving the left sacroiliac joint successfully treated by percutaneous computed tomography-guided retrograde drilling and debridement.

Becce, Fabio, E-mail: fabio.becce@chuv.ch [University of Lausanne, Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois (Switzerland); Mouhsine, Elyazid [Clinique Hirslanden Bois-Cerf, Department of Orthopaedic Surgery (Switzerland); Mosimann, Pascal John; Anaye, Anass [University of Lausanne, Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois (Switzerland); Letovanec, Igor [University Institute of Pathology, Centre Hospitalier Universitaire Vaudois (Switzerland); Theumann, Nicolas [University of Lausanne, Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois (Switzerland)

2012-08-15

75

Does Subchondral Bone Affect the Fate of Osteochondral Allografts During Storage?  

Microsoft Academic Search

Background: Osteochondral allografts currently are hypothermically stored for a minimum of 14 days to a maximum of 28 days before surgical implantation, making storage conditions increasingly important. Previous studies have suggested that graft deterioration during storage may result from degradative factors and residual marrow elements in the subchondral bone.Hypothesis: Allografts stored with large bone-to-cartilage ratios will be compromised after prolonged

Andrew T. Pennock; Catherine M. Robertson; Ferdinand Wagner; Frederick L. Harwood; William D. Bugbee; David Amiel

2006-01-01

76

Traumatic Osteochondral Injury of the Femoral Head Treated by Mosaicplasty: A Report of Two Cases  

Microsoft Academic Search

The increased risk of symptomatic progression towards osteoarthritis after chondral damage has led to the development of multiple\\u000a treatment options for cartilage repair. These procedures have evolved from arthroscopic lavage and debridement, to marrow\\u000a stimulation techniques, and more recently, to osteochondral autograft and allograft transplants, and autogenous chondrocyte\\u000a implantation. The success of mosaicplasty procedures in the knee has led to

Denis Nam; Michael K. Shindle; Robert L. Buly; Bryan T. Kelly; Dean G. Lorich

2010-01-01

77

Potential pitfall in the microfracturing technique during the arthroscopic treatment of an osteochondral lesion  

Microsoft Academic Search

Debridement and bone marrow stimulation of the subchondral bone is currently considered to be the primary surgical treatment\\u000a of most osteochondral lesions of the talus. Different methods of bone marrow stimulation are used, including drilling, abrasion,\\u000a and microfracturing. The latter has gained recent popularity. In this technical note we describe a potential pitfall in the\\u000a microfracturing technique. The microfracture awl

Christiaan J. A. van Bergen; Peter A. J. de Leeuw; C. Niek van Dijk

2009-01-01

78

A novel, visible light-induced, rapidly cross-linkable gelatin scaffold for osteochondral tissue engineering  

PubMed Central

Osteochondral injuries remain difficult to repair. We developed a novel photo-cross-linkable furfurylamine-conjugated gelatin (gelatin-FA). Gelatin-FA was rapidly cross-linked by visible light with Rose Bengal, a light sensitizer, and was kept gelled for 3 weeks submerged in saline at 37°C. When bone marrow-derived stromal cells (BMSCs) were suspended in gelatin-FA with 0.05% Rose Bengal, approximately 87% of the cells were viable in the hydrogel at 24?h after photo-cross-linking, and the chondrogenic differentiation of BMSCs was maintained for up to 3 weeks. BMP4 fusion protein with a collagen binding domain (CBD) was retained in the hydrogels at higher levels than unmodified BMP4. Gelatin-FA was subsequently employed as a scaffold for BMSCs and CBD-BMP4 in a rabbit osteochondral defect model. In both cases, the defect was repaired with articular cartilage-like tissue and regenerated subchondral bone. This novel, photo-cross-linkable gelatin appears to be a promising scaffold for the treatment of osteochondral injury. PMID:24662725

Mazaki, Tetsuro; Shiozaki, Yasuyuki; Yamane, Kentaro; Yoshida, Aki; Nakamura, Mariko; Yoshida, Yasuhiro; Zhou, Di; Kitajima, Takashi; Tanaka, Masato; Ito, Yoshihiro; Ozaki, Toshifumi; Matsukawa, Akihiro

2014-01-01

79

Osteochondral tissue regeneration through polymeric delivery of DNA encoding for the SOX trio and RUNX2.  

PubMed

Native osteochondral repair is often inadequate owing to the inherent properties of the tissue, and current clinical repair strategies can result in healing with a limited lifespan and donor site morbidity. This work investigates the use of polymeric gene therapy to address this problem by delivering DNA encoding for transcription factors complexed with the branched poly(ethylenimine)-hyaluronic acid (bPEI-HA) delivery vector via a porous oligo[poly(ethylene glycol) fumarate] hydrogel scaffold. To evaluate the potential of this approach, a bilayered scaffold mimicking native osteochondral tissue organization was loaded with DNA/bPEI-HA complexes. Next, bilayered implants either unloaded or loaded in a spatial fashion with bPEI-HA and DNA encoding for either Runt-related transcription factor 2 (RUNX2) or SRY (sex determining region Y)-box 5, 6, and 9 (the SOX trio), to generate bone and cartilage tissues respectively, were fabricated and implanted in a rat osteochondral defect. At 6weeks post-implantation, micro-computed tomography analysis and histological scoring were performed on the explants to evaluate the quality and quantity of tissue repair in each group. The incorporation of DNA encoding for RUNX2 in the bone layer of these scaffolds significantly increased bone growth. Additionally, a spatially loaded combination of RUNX2 and SOX trio DNA loading significantly improved healing relative to empty hydrogels or either factor alone. Finally, the results of this study suggest that subchondral bone formation is necessary for correct cartilage healing. PMID:24854956

Needham, Clark J; Shah, Sarita R; Dahlin, Rebecca L; Kinard, Lucas A; Lam, Johnny; Watson, Brendan M; Lu, Steven; Kasper, F Kurtis; Mikos, Antonios G

2014-10-01

80

Juvenile Osteochondritis Dissecans in a 13-year-old male athlete: A case report  

PubMed Central

Objective: To present the clinical management of juvenile osteochondritis dissecans (OCD) of the knee and highlight the importance of a timely diagnosis to optimize the time needed for less invasive, non-operative therapy. Clinical Features: A 13-year-old provincial level male soccer player presenting with recurrent anterior knee pain despite ongoing manual therapy. Intervention and Outcome: A multidisciplinary, non-operative treatment approach was utilized to promote natural healing of the osteochondral lesion. The plan of management consisted of patient education, activity modification, manual therapy, passive modalities and rehabilitation, while being overseen by an orthopaedic surgeon. Conclusions: Considering the serious consequences of misdiagnosing osteochondritis dissecans, such as the potential for future joint instability and accelerated joint degeneration, a high degree of suspicion should be considered with young individuals presenting with nonspecific, recurrent knee pain. A narrative review of the literature is provided to allow practitioners to apply current best practices to appropriately manage juvenile OCD and become more cognizant of the common knee differential diagnoses in the young athletic population. PMID:25550663

D’Angelo, Kevin; Kim, Peter; Murnaghan, M. Lucas

2014-01-01

81

Current strategies in multiphasic scaffold design for osteochondral tissue engineering: A review.  

PubMed

The repair of osteochondral defects requires a tissue engineering approach that aims at mimicking the physiological properties and structure of two different tissues (cartilage and bone) using specifically designed scaffold-cell constructs. Biphasic and triphasic approaches utilize two or three different architectures, materials, or composites to produce a multilayered construct. This article gives an overview of some of the current strategies in multiphasic/gradient-based scaffold architectures and compositions for tissue engineering of osteochondral defects. In addition, the application of finite element analysis (FEA) in scaffold design and simulation of in vitro and in vivo cell growth outcomes has been briefly covered. FEA-based approaches can potentially be coupled with computer-assisted fabrication systems for controlled deposition and additive manufacturing of the simulated patterns. Finally, a summary of the existing challenges associated with the repair of osteochondral defects as well as some recommendations for future directions have been brought up in the concluding section of this article. © 2014 Wiley Periodicals, Inc. J Biomed Mater Res Part A, 2014. PMID:25345589

Yousefi, Azizeh-Mitra; Hoque, Md Enamul; Prasad, Rangabhatala G S V; Uth, Nicholas

2014-10-23

82

A novel, visible light-induced, rapidly cross-linkable gelatin scaffold for osteochondral tissue engineering.  

PubMed

Osteochondral injuries remain difficult to repair. We developed a novel photo-cross-linkable furfurylamine-conjugated gelatin (gelatin-FA). Gelatin-FA was rapidly cross-linked by visible light with Rose Bengal, a light sensitizer, and was kept gelled for 3 weeks submerged in saline at 37°C. When bone marrow-derived stromal cells (BMSCs) were suspended in gelatin-FA with 0.05% Rose Bengal, approximately 87% of the cells were viable in the hydrogel at 24?h after photo-cross-linking, and the chondrogenic differentiation of BMSCs was maintained for up to 3 weeks. BMP4 fusion protein with a collagen binding domain (CBD) was retained in the hydrogels at higher levels than unmodified BMP4. Gelatin-FA was subsequently employed as a scaffold for BMSCs and CBD-BMP4 in a rabbit osteochondral defect model. In both cases, the defect was repaired with articular cartilage-like tissue and regenerated subchondral bone. This novel, photo-cross-linkable gelatin appears to be a promising scaffold for the treatment of osteochondral injury. PMID:24662725

Mazaki, Tetsuro; Shiozaki, Yasuyuki; Yamane, Kentaro; Yoshida, Aki; Nakamura, Mariko; Yoshida, Yasuhiro; Zhou, Di; Kitajima, Takashi; Tanaka, Masato; Ito, Yoshihiro; Ozaki, Toshifumi; Matsukawa, Akihiro

2014-01-01

83

Osteochondrosis in the horse. I. A clinical and radiologic investigation of osteochondritis dissecans of the knee and hock joint.  

PubMed

The clinical and radiologic features of osteochondritis dissecans in the knee and hock joint of horses are described. The material includes 91 horses, of which 43 had the lesion in one or both knee joints, and 48 in one or both hock joints. It was found that osteochondritis dissecans of the knee joint was more common than the one in the hock joint in thoroughbreds and halfbreds, while the lesion in the hock joint was most common in standardbred trotters. In the knee the lesion was most often located to the lateral trochlear ridge. In the hock joint the predilection site was the intermediate ridge of the tibia. The lesions were of obvious clinical importance and the knee joint was usually more severely affected than the hock joint. Prognosis was also more guarded in horses with knee joint involvement, regardless whether or not surgical treatment was instituted. Arthrotomy and removal of fragments in the osteochondral defects or of loose bodies was the standard surgical procedure. It was felt that this treatment improved prognosis somewhat, particularly in the horses with hock joint lesions. It was found that there are many similarities between osteochondritis dissecans in horses and in pigs and dogs. However, further investigation is needed to shed more light on etiology and pathogenesis and on the nature of osteochondritis dissecans in the horse. PMID:233593

Strömberg, B; Rejnö, S

1978-01-01

84

Millicurrent stimulation of human articular chondrocytes cultivated in a collagen type-I gel and of human osteochondral explants  

PubMed Central

Background Here we investigate the effect of millicurrent treatment on human chondrocytes cultivated in a collagen gel matrix and on human osteochondral explants. Methods Human chondrocytes from osteoarthritic knee joints were enzymatically released and transferred into a collagen type-I gel. Osteochondral explants and cell-seeded gel samples were cultivated in-vitro for three weeks. Samples of the verum groups were stimulated every two days by millicurrent treatment (3 mA, sinusoidal signal of 312 Hz amplitude modulated by two super-imposed signals of 0.28 Hz), while control samples remained unaffected. After recovery, collagen type-I, type-II, aggrecan, interleukin-1?, IL-6, TNF? and MMP13 were examined by immunohistochemistry and by real time PCR. Results With regard to the immunostainings 3 D gel samples and osteochondral explants did not show any differences between treatment and control group. The expression of all investigated genes of the 3 D gel samples was elevated following millicurrent treatment. While osteochondral explant gene expression of col-I, col-II and Il-1? was nearly unaffected, aggrecan gene expression was elevated. Following millicurrent treatment, IL-6, TNF?, and MMP13 gene expression decreased. In general, the standard deviations of the gene expression data were high, resulting in rarely significant results. Conclusions We conclude that millicurrent stimulation of human osteoarthritic chondrocytes cultivated in a 3 D collagen gel and of osteochondral explants directly influences cell metabolism. PMID:20691044

2010-01-01

85

Mechanical effects of surgical procedures on osteochondral grafts elucidated by osmotic loading and real-time ultrasound  

PubMed Central

Introduction Osteochondral grafts have become popular for treating small, isolated and full-thickness cartilage lesions. It is recommended that a slightly oversized, rather than an exact-sized, osteochondral plug is transplanted to achieve a tight fit. Consequently, impacting forces are required to insert the osteochondral plug into the recipient site. However, it remains controversial whether these impacting forces affect the biomechanical condition of the grafted articular cartilage. The present study aimed to investigate the mechanical effects of osteochondral plug implantation using osmotic loading and real-time ultrasound. Methods A full-thickness cylindrical osteochondral defect (diameter, 3.5 mm; depth, 5 mm) was created in the lateral lower quarter of the patella. Using graft-harvesting instruments, an osteochondral plug (diameter, 3.5 mm as exact-size or 4.5 mm as oversize; depth, 5 mm) was harvested from the lateral upper quarter of the patella and transplanted into the defect. Intact patella was used as a control. The samples were monitored by real-time ultrasound during sequential changes of the bathing solution from 0.15 M to 2 M saline (shrinkage phase) and back to 0.15 M saline (swelling phase). For cartilage sample assessment, three indices were selected, namely the change in amplitude from the cartilage surface (amplitude recovery rate: ARR) and the maximum echo shifts from the cartilage surface and the cartilage-bone interface. Results The ARR is closely related to the cartilage surface integrity, while the echo shifts from the cartilage surface and the cartilage-bone interface are closely related to tissue deformation and NaCl diffusion, respectively. The ARR values of the oversized plugs were significantly lower than those of the control and exact-sized plugs. Regarding the maximum echo shifts from the cartilage surface and the cartilage-bone interface, no significant differences were observed among the three groups. Conclusions These findings demonstrated that osmotic loading and real-time ultrasound were able to assess the mechanical condition of cartilage plugs after osteochondral grafting. In particular, the ARR was able to detect damage to the superficial collagen network in a non-destructive manner. Therefore, osmotic loading and real-time ultrasound are promising as minimally invasive methods for evaluating cartilage damage in the superficial zone after trauma or impact loading for osteochondral grafting. PMID:19725961

2009-01-01

86

OSTEOCHONDRAL INTERFACE REGENERATION OF THE RABBIT KNEE WITH MACROSCOPIC GRADIENTS OF BIOACTIVE SIGNALS  

PubMed Central

To date, most interfacial tissue engineering approaches have utilized stratified designs, in which there are two or more discrete layers comprising the interface. Continuously-graded interfacial designs, where there is no discrete transition from one tissue type to another, are gaining attention as an alternative to stratified designs. Given that osteochondral regeneration holds the potential to enhance cartilage regeneration by leveraging the healing capacity of the underlying bone, we endeavored to introduce a continuously graded approach to osteochondral regeneration. The purpose of this study was thus to evaluate the performance of a novel gradient-based scaffolding approach to regenerate osteochondral defects in the New Zealand White rabbit femoral condyle. Bioactive plugs were constructed from poly(d,l-lactic-co-glycolic acid) (PLGA) microspheres with a continuous gradient transition between cartilage-promoting and bone-promoting growth factors. At six and 12 weeks of healing, results suggested that the implants provided support for the neo-synthesized tissue, and the gradient in bioactive signaling may have been beneficial for bone and cartilage regeneration compared to the blank control implant, as evidenced by histology. In addition, the effects of pre-seeding gradient scaffolds with umbilical cord mesenchymal stromal cells (UCMSCs) from the Wharton’s jelly of New Zealand White rabbits were evaluated. Results indicated that there may be regenerative benefits to pre-localizing UCMSCs within scaffold interiors. The inclusion of bioactive factors in a gradient-based scaffolding design is a promising new treatment strategy for defect repair in the femoral condyle. PMID:22009693

Dormer, Nathan H.; Singh, Milind; Zhao, Liang; Mohan, Neethu; Berkland, Cory J.; Detamore, Michael S.

2011-01-01

87

Long-term results of arthroscopic excision of unstable osteochondral lesions of the lateral femoral condyle.  

PubMed

The purpose of this study was to evaluate the long-term functional and radiological outcomes of arthroscopic removal of unstable osteochondral lesions with subchondral drilling in the lateral femoral condyle. We reviewed the outcome of 23 patients (28 knees) with stage III or IV osteochondritis dissecans lesions of the lateral femoral condyle at a mean follow-up of 14 years (10 to 19). The functional clinical outcomes were assessed using the Lysholm score, which improved from a mean of 38.1 (SD 3.5) pre-operatively to a mean of 87.3 (SD 5.4) at the most recent review (p = 0.034), and the Tegner activity score, which improved from a pre-operative median of 2 (0 to 3) to a median of 5 (3 to 7) at final follow-up (p = 0.021). The radiological degenerative changes were evaluated according to Tapper and Hoover's classification and when compared with the pre-operative findings, one knee had grade 1, 22 knees had grade 2 and five knees had grade 3 degenerative changes. The overall outcomes were assessed using Hughston's rating scale, where 19 knees were rated as good, four as fair and five as poor. We found radiological evidence of degenerative changes in the third or fourth decade of life at a mean of 14 years after arthroscopic excision of the loose body and subchondral drilling for an unstable osteochondral lesion of the lateral femoral condyle. Clinical and functional results were more satisfactory. PMID:22323683

Lim, H-C; Bae, J-H; Park, Y-E; Park, Y-H; Park, J-H; Park, J-W; Suh, D-H

2012-02-01

88

Hydrogels for Osteochondral Repair Based on Photo-crosslinkable Carbamate Dendrimers  

PubMed Central

First generation, photo-crosslinkable dendrimers consisting of natural metabolites (i.e. succinic acid, glycerol, and ?-alanine) and non-immunogenic poly(ethylene glycol) (PEG) were synthesized divergently in high yields using ester and carbamate forming reactions. Aqueous solutions of these dendrimers were photo-crosslinked with an eosin-based photo-initiator to afford hydrogels. The hydrogels displayed a range of mechanical properties based on their structure, generation size, and concentration in solution. All of the hydrogels showed minimal swelling characteristics. The dendrimer solutions were then photo-crosslinked in situ in an ex vivo rabbit osteochondral defect (3 mm diameter and 10 mm depth), and the resulting hydrogels were subjected to physiologically relevant dynamic loads. Magnetic resonance imaging (MRI) showed the hydrogels to be fixated in the defect site after the repetitive loading regimen. The ([G1]-PGLBA-MA)2-PEG hydrogel was chosen for the 6 month pilot in vivo rabbit study because this hydrogel scaffold could be prepared at low polymer weight (10wt%) and possessed the largest compressive modulus of the 10% formulations, a low swelling ratio, and contained carbamate linkages which are more hydrolytically stable than the ester linkages. The hydrogel treated osteochondral defects showed good attachment in the defect site and histological analysis showed the presence of collagen II and glycosaminoglycans (GAGs) in the treated defects. By contrast, the contralateral unfilled defects showed poor healing and negligible GAG or collagen II production. Good mechanical properties, low swelling, good attachment to the defect site, and positive in vivo results illustrate the potential of these dendrimer-based hydrogels as scaffolds for osteochondral defect repair. PMID:18800810

Degoricija, Lovorka; Bansal, Prashant N.; Söntjens, Serge H. M.; Joshi, Neel; Takahashi, Masaya; Snyder, Brian; Grinstaff, Mark W.

2009-01-01

89

Osteochondral Repair by a Novel Interconnecting Collagen-Hydroxyapatite Substitute: A Large-Animal Study.  

PubMed

A novel three-dimensional bicomponent substitute made of collagen type I and hydroxyapatite was tested for the repair of osteochondral lesions in a swine model. This scaffold was assembled by a newly developed method that guarantees the strict integration between the organic and the inorganic parts, mimicking the biological tissue between the chondral and the osseous phase. Thirty-six osteochondral lesions were created in the trochlea of six pigs; in each pig, two lesions were treated with scaffolds seeded with autologous chondrocytes (cell+group), two lesions were treated with unseeded scaffolds (cell- group), and the two remaining lesions were left untreated (untreated group). After 3 months, the animals were sacrificed and the newly formed tissue was analyzed to evaluate the degree of maturation. The International Cartilage Repair Society (ICRS) macroscopic assessment showed significantly higher scores in the cell- and untreated groups when compared with the cell+ group. Histological evaluation showed the presence of repaired tissue, with fibroblast-like and hyaline-like areas in all groups; however, with respect to the other groups, the cell- group showed significantly higher values in the ICRS II histological scores for "cell morphology" and for the "surface/superficial assessment." While the scaffold seeded with autologous chondrocytes promoted the formation of a reparative tissue with high cellularity but low glycosaminoglycans (GAG) production, on the contrary, the reparative tissue observed with the unseeded scaffold presented lower cellularity but higher and uniform GAG distribution. Finally, in the lesions treated with scaffolds, the immunohistochemical analysis showed the presence of collagen type II in the peripheral part of the defect, indicating tissue maturation due to the migration of local cells from the surroundings. This study showed that the novel osteochondral scaffold was easy to handle for surgical implantation and was stable within the site of lesion; at the end of the experimental time, all implants were well integrated with the surrounding tissue and no signs of synovitis were observed. The quality of the reparative tissue seemed to be superior for the lesions treated with the unseeded scaffolds, indicating the promising potential of this novel biomaterial for use in a one-stage procedure for osteochondral repair. PMID:25316498

Sosio, Corrado; Di Giancamillo, Alessia; Deponti, Daniela; Gervaso, Francesca; Scalera, Francesca; Melato, Marco; Campagnol, Marino; Boschetti, Federica; Nonis, Alessandro; Domeneghini, Cinzia; Sannino, Alessandro; Peretti, Giuseppe Michele

2014-11-21

90

A review of arthroscopic classification systems for osteochondritis dissecans of the knee.  

PubMed

Multiple systems for classifying osteochondritis dissecans (OCD) of the knee have been reported. These existing classification systems have some similar characteristics, such as stable lesion/intact articular cartilage and presence of a loose body. However, variations are found in the number of stages and specific lesion characteristics assessed. Currently, no system has been universally accepted. A future classification system should be developed that reconciles the discrepancies among the current systems and provides a clear, consistent, and reliable method for classifying OCD lesions of the knee during arthroscopy. PMID:25435042

Jacobs, John C; Archibald-Seiffer, Noah; Grimm, Nathan L; Carey, James L; Shea, Kevin G

2015-01-01

91

The “Cup-Shaped” Technique for Uncontained Osteochondral Lesion of the Talus  

PubMed Central

The arthroscopic bone marrow stimulation technique is defined as the first-line procedure for an osteochondral lesion of the talus. The containment of the lesion has been reported as 1 of the prognostic factors for clinical outcomes of arthroscopic bone marrow stimulation. It was surmised that lesions without a stable rim lose the protective border, thereby making stable formation of fibrocartilage less likely. The purpose of the cup-shaped technique is to improve the stability of blood clots after arthroscopic bone marrow stimulation in an uncontained lesion. The geometry of the lesion changes from “uncontained” to “contained like,” which improves the stability of the blood clots. PMID:24400180

Yoshimura, Ichiro; Hagio, Tomonobu; Naito, Masatoshi

2013-01-01

92

The effect of interface microstructure on interfacial shear strength for osteochondral scaffolds based on biomimetic design and 3D printing.  

PubMed

Interface integration between chondral phase and osseous phase is crucial in engineered osteochondral scaffolds. However, the integration was poorly understood and commonly failed to meet the need of osteochondral scaffolds. In this paper, a biphasic polyethylene glycol (PEG)/?-tricalcium phosphate (?-TCP) scaffold with enhanced interfacial integration was developed. The chondral phase was a PEG hydrogel. The osseous phase was a ?-TCP ceramic scaffold. The PEG hydrogel was directly cured on the ceramic interface layer by layer to fabricate osteochondral scaffolds by 3D printing technology. Meanwhile, a series of interface structure were designed with different interface pore area percentages (0/10/20/30/40/50/60%), and interfacial shear test was applied for interface structure optimization (n=6 samples/group). The interfacial shear strength of 30% pore area group was nearly three folds improved compared with that of 0% pore area percentage group, and more than fifty folds improved compared with that of traditional integration (5.91±0.59 kPa). In conclusion, the biomimetic PEG/?-TCP scaffolds with interface structure enhanced integration show promising potential application for osteochondral tissue engineering. PMID:25491954

Zhang, Weijie; Lian, Qin; Li, Dichen; Wang, Kunzheng; Hao, Dingjun; Bian, Weiguo; Jin, Zhongmin

2015-01-01

93

Lapidus arthrodesis plus osteochondral autograft transplantation in the management of hallux rigidus with an elevated first ray.  

PubMed

The range of joint-sparing treatments for advanced hallux rigidus is still very limited. The authors describe an osteochondral autograft transplantation technique combined with Lapidus arthrodesis as a novel method of obtaining a relatively symptom-free first metatarsophalangeal joint function in patients with hallux rigidus and first-ray elevation. PMID:24379451

Klos, Kajetan; Simons, Paul

2014-04-01

94

Osteochondral regeneration using an oriented nanofiber yarn-collagen type I/hyaluronate hybrid/TCP biphasic scaffold.  

PubMed

Osteochondral defects affect both the articular cartilage and the underlying subchondral bone, but poor osteochondral regeneration is still a daunting challenge. Although the tissue engineering technology provides a promising approach for osteochondral repair, an ideal biphasic scaffold is in high demand with regards to proper biomechanical strength. In this study, an oriented poly(l-lacticacid)-co-poly(?-caprolactone) P(LLA-CL)/collagen type I(Col-I) nanofiber yarn mesh, fabricated by dynamic liquid electrospinning served as a skeleton for a freeze-dried Col-I/Hhyaluronate (HA) chondral phase (SPONGE) to enhance the mechanical strength of the scaffold. In vitro results show that the Yarn Col-I/HA hybrid scaffold (Yarn-CH) can allow the cell infiltration like sponge scaffolds. Using porous beta-tricalcium phosphate (TCP) as the osseous phase, the Yarn-CH/TCP biphasic scaffold was then assembled by freeze drying. After combination of bone marrow mesenchymal stem cells, the biphasic complex was successfully used to repair the osteochondral defects in a rabbit model with greatly improved repairing scores and compressive modulus. © 2014 Wiley Periodicals, Inc. J Biomed Mater Res Part A, 2014. PMID:24771686

Liu, Shen; Wu, Jinglei; Liu, Xudong; Chen, Desheng; Bowlin, Gary L; Cao, Lei; Lu, Jianxi; Li, Fengfeng; Mo, Xiumei; Fan, Cunyi

2014-04-25

95

A comparative study on collagen type I and hyaluronic acid dependent cell behavior for osteochondral tissue bioprinting.  

PubMed

Bioprinting is a promising technique for engineering composite tissues, such as osteochondral tissues. In this study, as a first step toward bioprinting-based osteochondral tissue regeneration, we systematically examined the behavior of chondrocytes and osteoblasts to hyaluronic acid (HA) and type I collagen (Col-1) hydrogels. First, we demonstrated that cells on hydrogels that were comprised of major native tissue extracellular matrix (ECM) components (i.e. chondrocytes on HA hydrogels and osteoblasts on Col-1 hydrogels) exhibited better proliferation and cell function than cells on non-native ECM hydrogels (i.e., chondrocytes on Col-1 hydrogels and osteoblasts on HA hydrogels). In addition, cells located near their native ECM hydrogels migrated towards them. Finally, we bioprinted three-dimensional (3D) osteochondral tissue-mimetic structures composed of two compartments, osteoblast-encapsulated Col-1 hydrogels and chondrocyte-encapsulated HA hydrogels, and found viability and functions of each cell type were well maintained within the 3D structures up to 14 days in vitro. These results suggest that with proper choice of hydrogel materials, bioprinting-based approaches can be successfully applied for osteochondral tissue regeneration. PMID:24758832

Park, Ju Young; Choi, Jong-Cheol; Shim, Jin-Hyung; Lee, Jung-Seob; Park, Hyoungjun; Kim, Sung Won; Doh, Junsang; Cho, Dong-Woo

2014-09-01

96

The Role of Erythropoietin and Bone Marrow Concentrate in the Treatment of Osteochondral Defects in Mini-Pigs  

PubMed Central

Background All available treatment options for osteochondral and chondral defects do not restore hyaline cartilage and are limited to decreasing associated pain, and maintaining or improving joint function. The purpose of this study was to evaluate the potential of erythropoietin (EPO) in combination with bone marrow aspiration concentrate (BMAC) in the treatment of osteochondral defects of mini-pigs. Methods 14 Goettinger mini-pigs, in which a 6×10 mm osteochondral defect in the medial femoral condyle of both knee joints was created, were randomized into four groups: biphasic scaffold alone, scaffold with EPO, scaffold with BMAC and scaffold in combination with EPO and BMAC. After 26 weeks all animals were euthanized and histological slides were evaluated using a modified ÓDriscoll Score. Results In the therapy groups, areas of chondrogenic tissue that contained collagen II were present. Adding EPO (p?=?0.245) or BMAC (p?=?0.099) alone to the scaffold led to a non-significant increase in the score compared to the control group. However, the combination of EPO and BMAC in the implanted scaffold showed a significant improvement (p?=?0.02) in the histological score. Conclusion The results of our study show that in mini-pigs, the combination of EPO and BMAC leads to an enhanced osteochondral healing. However, additional research is necessary to further improve the repair tissue and to define the role of MSCs and EPO in cartilage repair. PMID:24676029

Betsch, Marcel; Thelen, Simon; Santak, Laila; Herten, Monika; Jungbluth, Pascal; Miersch, Daniel; Hakimi, Mohssen; Wild, Michael

2014-01-01

97

Behavior of Transplanted Bone Marrow-derived GFP Mesenchymal Cells in Osteochondral Defect as a Simulation of Autologous Transplantation  

Microsoft Academic Search

To elucidate the behavior of autologously transplanted mesenchymal cells in osteochondral defects, we followed transplanted cells using green fluorescent protein (GFP) transgenic rats, in which all cells express GFP signals in their cytoplasm and nuclei as transplantation donors. Bone marrow-derived mesenchymal cells, which contain mesenchymal stem cells (MSCs), were obtained from transgenic rats. Then, dense mesenchymal cell masses created by

Yasushi Oshima; Nobuyoshi Watanabe; Ken-ichi Matsuda; Shinro Takai; Mitsuhiro Kawata; Toshikazu Kubo

2005-01-01

98

Repair of articular cartilage in rabbit osteochondral defects promoted by extracorporeal shock wave therapy  

NASA Astrophysics Data System (ADS)

This study investigated the stimulative effect of extracorporeal shock wave therapy (ESWT) on the articular cartilage regeneration in the rabbit osteochondral defect model for the first time. An osteochondral defect, 3 mm in diameter and 3 mm in depth, was drilled in the patellar groove at the distal end of each femur in 24 mature New Zealand rabbits. The right patellar defects received 500 impulses of shock waves of 1.2 { mJ}/{mm}2 (at 14 kV) at 1 week after surgery and were designated as the experimental samples; the left patellar defects served as control. At 4, 8, and 12 weeks after ESWT, cartilage repair was evaluated macroscopically and histologically using a semiquantitative grading scale. The total scores of the macroscopic evaluation at 4, 8, and 12 weeks in the experimental group were superior to those in the control group (statistical significance level P < 0.05 ). As to the total scores of the histologic evaluation, the experimental group showed a tendency toward a better recovery than the control group at 4 weeks (0.05 < P < 0.1 ). At 8 and 12 weeks the differences between the experimental and control groups became mild and had no significance on statistical analysis. These findings suggested that regeneration of articular cartilage defects might be promoted by ESWT, especially at the early stage. The easy and safe ESWT is potentially viable for clinical application.

Chu, C.-H.; Yen, Y.-S.; Chen, P.-L.; Wen, C.-Y.

2014-05-01

99

Isobutyl 2-cyanoacrylate as an osseous adhesive in the repair of osteochondral fractures.  

PubMed

An in vivo evaluation of isobutyl 2-cyanoacrylate as an osseous adhesive was done in an effort to answer two questions: Used in limited amounts, can this monomer maintain the reduction of an unstable intra-articular osteochondral fracture while allowing for fracture healing around the sites of adhesive placement? Used in limited amounts, in this monomer toxic to adjacent viable bone? Osteochondral fractures were created in 32 dog knees. In 16 knees, the fracture reduction was secured with three small drops of adhesive placed around the periphery of the fracture surface. In 16 control knees no adhesive was used. Eighty-one percent of the fractures in the adhesive-treated group united compared to 56% of the control group. Although the difference in number of fractures that healed in the two groups is not definitely statistically significant and no conclusion was drawn as to effectiveness of the adhesive, osseous healing was noted to proceed around the sites of adhesive placement and the monomer appeared nontoxic to adjacent bone. PMID:6826572

Harper, M C; Ralston, M

1983-01-01

100

Retro-articular drilling and bone grafting of juvenile knee osteochondritis dissecans: a technical description.  

PubMed

The goal of the surgery in stable juvenile osteochondritis dissecans (OCD) is to promote revascularization and reossification of the osteochondral fragment by creating channels, linking the subchondral bone to the OCD lesion. Retro-articular and trans-articular drilling of OCD lesions has up to a 33 % failure rate based on complete radiographic healing. Healing may be improved with the delivery of pluripotent mesenchymal stem cells into the lesion. We describe a technically simple procedure for retro-articular drilling with the addition of percutaneous iliac crest bone graft placement for stable juvenile OCD lesions of the knee. By using a bone marrow biopsy needle, the bone grafting can be performed in a reproducible manner and in shorter time than in previously described techniques. The proposed technique represents a promising adjunct for the management of stable juvenile OCD lesions that fail to heal after 3-6 months of non-operative treatment and for non-displaced, unstable OCD lesions that undergo internal fixation. PMID:23328989

Lykissas, Marios G; Wall, Eric J; Nathan, Senthil

2014-02-01

101

Improved Visualization of the 70° Arthroscope in the Treatment of Talar Osteochondral Defects  

PubMed Central

Osteochondral defects (OCDs) of the talus are a common cause of residual pain after ankle injuries. When conservative treatment fails, arthroscopic debridement combined with drilling/microfracturing of the lesion (bone marrow stimulation [BMS] procedures) has been shown to provide good to excellent outcomes. Not uncommonly, talar OCDs involve the borders of the talar dome. These uncontained lesions are sometimes difficult to visualize with the 30° arthroscope, with potential negative effect on the clinical outcome of an arthroscopic BMS procedure. The use of the 70° arthroscope has been described for a multitude of common knee, shoulder, elbow, and hip procedures. The purpose of this article is to show the usefulness of the 70° arthroscope in arthroscopic BMS procedures, pointing out which kinds of talar OCDs can benefit most from its use. PMID:23875138

Spennacchio, Pietro; Randelli, Pietro; Arrigoni, Paolo; van Dijk, Niek

2013-01-01

102

A novel computer navigation system for retrograde drilling of osteochondral lesions.  

PubMed

Osteochondritis dissecans (OCD) represents an important clinical entity in orthopedic sports medicine. Once surgical intervention is required, retrograde drilling for OCD lesions remains technically challenging. A novel electromagnetic navigation system was developed to be a radiation-free navigation tool providing spatiotemporal real-time information to the surgeon without the need for a stationary patient tracker and without relevant setup and calibration times. The novel system was tested for arthroscopically assisted retrograde drilling of cadaveric OCD lesions of the knee and talus and compared with the gold standard fluoroscopy-guided retrograde drilling procedure in a controlled laboratory study setup. The novel method considerably improves on the standard operating procedure in terms of safety, operation time, and radiation exposure and will be available for further surgical indications. PMID:25370876

Hoffmann, Michael; Schroeder, Malte; Rueger, Johannes M

2014-12-01

103

Snapping popliteus tendon within an osteochondritis dissecans lesion: an unusual case of lateral knee pain.  

PubMed

The popliteus muscle is an important structure in the posterior knee, coursing from the distal lateral femoral condyle to the posterior tibia, and it initiates knee flexion, protects the lateral meniscus, and resists tibial external rotation. Abnormalities in the lateral femoral condyle may result in impaired tracking of the popliteus tendon over the lateral femoral condyle, causing pain and a snapping sensation. We report a case of a snapping popliteus tendon caused by an osteochondral defect of the lateral femoral condyle. We obtained a thorough medical history, performed a detailed physical examination, and performed diagnostic ultrasonography to accurately diagnose the condition. The patient underwent open popliteus tenotomy and tibial tenodesis with excellent results and full return to activity. Any abnormality of the lateral femoral condyle may predispose patients to snapping popliteus tendon and we believe early diagnosis utilizing ultrasonography imaging and surgical intervention may benefit these patients significantly. PMID:25251535

Shukla, Dave R; Levy, Bruce A; Kuzma, Scott A; Stuart, Michael J

2014-09-01

104

Osteochondritis dissecans and Osgood Schlatter disease in a family with Stickler syndrome  

PubMed Central

Purpose Stickler syndrome is among the most common autosomal dominant connective tissue disorders but is often unrecognised and therefore not diagnosed by clinicians. Despite much speculation, the cause of osteochondrosis in general and osteochondritis dissecans (OCD) and Osgood Schlatter syndrome (OSS) in particular remain unclear. Etiological understanding is essential. We describe a pair of family subjects presented with OCD and OSS as a symptom complex rather than a diagnosis. Methods Detailed clinical and radiographic examinations were undertaken with emphasis on the role of MRI imaging. Magnetic resonance imaging may allow early prediction of articular lesion healing potential in patients with Stickler syndrome. Results The phenotype of Stickler syndrome can be diverse and therefore misleading. The expectation that the full clinical criteria of any given genetic disorder such as Stickler syndrome will always be present can easily lead to an underestimation of these serious inheritable disorders. We report here two family subjects, a male proband and his aunt (paternal sister), both presented with the major features of Stickler syndrome. Tall stature with marfanoid habitus, astigmatism/congenital vitreous abnormality and submucus cleft palate/cleft uvula, and enlarged painful joints with early onset osteoarthritis. Osteochondritis dissecans (OCD) and Osgood Schlatter syndrome (OSS) were the predominating joint abnormalities. Conclusion We observed that the nature of the articular and physeal abnormalities was consistent with a localised manifestation of a more generalised epiphyseal dysplasia affecting the weight-bearing joints. In these two patients, OCD and OSS appeared to be the predominant pathologic musculoskeletal consequences of an underlying Stickler's syndrome. It is empirical to consider generalised epiphyseal dysplasia as a major underlying causation that might drastically affect the weight-bearing joints. PMID:19193224

Al Kaissi, Ali; Klaushofer, Klaus; Grill, Franz

2009-01-01

105

Treatment of osteochondritis dissecans of the knee with a biomimetic scaffold. A prospective multicenter study  

PubMed Central

Purpose the aim of the present study was to evaluate the clinical outcome of the treatment of osteochondritis dissecans (OCD) of the knee with a type-I collagen-hydroxyapatite nanostructural biomimetic osteochondral scaffold. Methods twenty-three patients affected by symptomatic knee OCD of the femoral condyles, grade 3 or 4 of the International Cartilage Repair Society (ICRS) scale, underwent biomimetic scaffold implantation. The site of the defect was the medial femoral condyle in 14 patients, whereas in 9 patients the lateral femoral condyle was involved. The average size of the defects was 3.5±1.43 cm2. All patients were clinically evaluated using the ICRS subjective score, the IKDC objective score, the EQ-VAS and the Tegner Activity Score. Minimum follow-up was two years. MRI was performed at 12 and 24 months after surgery and then every 12 months thereafter. Results the ICRS subjective score improved from the baseline value of 50.93±20.6 to 76.44±18.03 at the 12 months (p<0.0005) and 82.23± 17.36 at the two-year follow-up (p<0.0005). The IKDC objective score confirmed the results. The EQ-VAS showed a significant improvement from 3.15±1.09 to 8.15±1.04 (p<0.0005) at two years of follow-up. The Tegner Activity Score improvement was statistically significant (p<0.0005). Conclusions biomimetic scaffold implantation was a good procedure for treating grade 3 and 4 OCD, in which other classic techniques are burdened by different limitations. This open one-step surgery gave promising stable results at short-term follow-up. Level of evidence Level IV, therapeutic case series. PMID:25606552

DELCOGLIANO, MARCO; MENGHI, AMERIGO; PLACELLA, GIACOMO; SPEZIALI, ANDREA; CERULLI, GIULIANO; CARIMATI, GIULIA; PASQUALOTTO, STEFANO; BERRUTO, MASSIMO

2014-01-01

106

Effect of betamethasone and exercise on equine carpal joints with osteochondral fragments.  

PubMed

Osteochondral fragments were created arthroscopically on the distal aspect of both radial carpal bones in 12 horses. On day 14 after surgery, one middle carpal joint of each horse was injected with 2.5 mL Betavet Soluspan (3.9 mg betamethasone sodium phosphate and 12 mg betamethasone acetate per milliliter) and the contralateral joint was injected with 2.5 mL saline as a control. Intra-articular treatments were repeated on day 35. On day 17, six horses began exercising 5 days per week on a high-speed treadmill. The other six horses were kept in box stalls throughout the study as nonexercised controls. On day 56, all horses were examined clinically and radiographically and then were euthanatized. Samples were obtained for histological, histochemical, and biochemical evaluation. Mild lameness was observed in five of the six exercised horses at day 56; four horses were lame in the control limb and one horse was lame in the treated limb. Of the five nonexercised horses evaluated for lameness, two were lame in the control limb, two were lame in the treated limb, and one was lame in both the control and the treated limb. No differences were noted on radiographs or palpation of steroid treated limbs versus control limbs. Firm reattachment of the osteochondral fragment to the radial carpal bone occurred in all but three joints. Gross cartilage damage was not different between steroid-treated joints and joints injected with saline. Histologically, there were no significant detrimental effects of beta-methasone with or without exercise, but there was a tendency for more pathological change in treated joints. No significant difference in the water content or uronic acid concentration was detected between treated and control joints. Intra-articular betamethasone administration in this carpal chip model was not associated with any significant detrimental effects in either rested or exercised horses. PMID:7839595

Foland, J W; McIlwraith, C W; Trotter, G W; Powers, B E; Lamar, C H

1994-01-01

107

Platelet autologous growth factors decrease the osteochondral regeneration capability of a collagen-hydroxyapatite scaffold in a sheep model  

PubMed Central

Background Current research aims to develop innovative approaches to improve chondral and osteochondral regeneration. The objective of this study was to investigate the regenerative potential of platelet-rich plasma (PRP) to enhance the repair process of a collagen-hydroxyapatite scaffold in osteochondral defects in a sheep model. Methods PRP was added to a new, multi-layer gradient, nanocomposite scaffold that was obtained by nucleating collagen fibrils with hydroxyapatite nanoparticles. Twenty-four osteochondral lesions were created in sheep femoral condyles. The animals were randomised to three treatment groups: scaffold, scaffold loaded with autologous PRP, and empty defect (control). The animals were sacrificed and evaluated six months after surgery. Results Gross evaluation and histology of the specimens showed good integration of the chondral surface in both treatment groups. Significantly better bone regeneration and cartilage surface reconstruction were observed in the group treated with the scaffold alone. Incomplete bone regeneration and irregular cartilage surface integration were observed in the group treated with the scaffold where PRP was added. In the control group, no bone and cartilage defect healing occurred; defects were filled with fibrous tissue. Quantitative macroscopic and histological score evaluations confirmed the qualitative trends observed. Conclusions The hydroxyapatite-collagen scaffold enhanced osteochondral lesion repair, but the combination with platelet growth factors did not have an additive effect; on the contrary, PRP administration had a negative effect on the results obtained by disturbing the regenerative process. In the scaffold + PRP group, highly amorphous cartilaginous repair tissue and poorly spatially organised underlying bone tissue were found. PMID:20875101

2010-01-01

108

A Novel Imaging Method for Osteochondral Lesions of the Talus—Comparison of SPECT-CT With MRI  

Microsoft Academic Search

Background: Magnetic resonance imaging (MRI) is the current standard in noninvasive diagnostics of osteochondral lesions (OCLs) of the talus. Single-photon emission computed tomography–computed tomography (SPECT-CT) is a new technique that displays different imaging qualities. The influence of the aforementioned diagnostic information on treatment decision making in talar OCLs is not known.Purpose: The aim of the study was to evaluate SPECT-CT

André Leumann; Victor Valderrabano; Christian Plaass; Helmut Rasch; Ueli Studler; Beat Hintermann; Geert I. Pagenstert

2011-01-01

109

Effect of tenascin-C on the repair of full-thickness osteochondral defects of articular cartilage in rabbits.  

PubMed

The purpose of this study was to examine the effect of tenascin-C (TNC) on the repair of full-thickness osteochondral defects of articular cartilage in vivo. We used a gellan-gellan-sulfate sponge (Gellan-GS) to maintain a TNC-rich environment in the cartilage defects. We implanted Gellan-GS soaked in PBS only (Group 1), Gellan-GS soaked in 10?µg/ml of TNC (Group 2), and Gellan-GS soaked in 100?µg/ml of TNC (Group 3) into a full-thickness osteochondral defect of the patellar groove of rabbits. The defect area was examined grossly and histologically 4-12 weeks after surgery. Sections of synovium were also immunohistochemically investigated. Histologically as well as macroscopically, the defects in Group 2 showed better repair than the other groups at 8 and 12 weeks after surgery. Inflammation of the synovium tended to diminish over time in all groups, and the degree of synovitis was the same for all three groups at each time point. In conclusion, Gellan-GS soaked in TNC can be used as a novel scaffold for the repair of articular cartilage defects. This study also indicates that TNC promotes the repair of full-thickness osteochondral defects in vivo. This article is protected by copyright. All rights reserved. PMID:25428773

Ikemura, Shigeto; Hasegawa, Masahiro; Iino, Takahiro; Miyamoto, Keiichi; Imanaka-Yoshida, Kyoko; Yoshida, Toshimichi; Sudo, Akihiro

2014-11-26

110

Enhanced repair of large osteochondral defects using a combination of artificial cartilage and basic fibroblast growth factor.  

PubMed

The purpose of this study was to examine the efficacy of a combination of artificial cartilage and basic fibroblast growth factor (bFGF) for the repair of large osteochondral defects. The artificial cartilage was a three-dimensional fabric (3-DF) composed of an ultra-high molecular weight polyethylene fiber with a triaxial three-dimensional structure. We implanted 3-DF impregnated with type I collagen gel containing 500 ng of bFGF (bFGF-treated group) or 3-DF impregnated with type I collagen gel alone (non-treated group) into a large full-thickness osteochondral defect (6 x 6 x 3 mm) of the patellar groove of rabbits. The defect area was examined grossly, histologically and biomechanically 4-48 weeks after surgery. Bone ingrowth into and around the 3-DF was evaluated with micro-computed tomography (micro-CT). Addition of bFGF to the 3-DF greatly accelerated cartilage formation on the articular surface and subchondral bone formation into and around the 3-DF, and improved biomechanical properties. These findings suggest that a combination of artificial cartilage and bFGF is clinically useful in cases involving large osteochondral defects. PMID:15683654

Fukuda, Aki; Kato, Ko; Hasegawa, Masahiro; Hirata, Hitoshi; Sudo, Akihiro; Okazaki, Kenshi; Tsuta, Kaoru; Shikinami, Yasuo; Uchida, Atsumasa

2005-07-01

111

Reconstruction of Osteochondral Defects by Combined Bone Grafting and a Bilayer Collagen Membrane as a Sandwich Technique  

PubMed Central

Treatment of osteochondral lesions of the knee remains a major challenge in orthopedic surgery. Recently established procedures like autologous chondrocyte implantation or matrix-associated chondrocyte implantation yield good results, but include the disadvantage of two-step procedures. The purpose of this study was to evaluate the clinical and magnetic resonance imaging outcome of repairs of osteochondral defects of the knee by a combined procedure of bone grafting and covering with a bilayer collagen membrane in a sandwich technique. Seven male patients with a mean age of 42 (range 30-55) years and symptomatic focal osteochondral lesions of the knee grade IV according to the International Cartilage Repair Society classification were included. The mean diameter of defects was 28.6 (range 15-40) mm. Results were evaluated at a minimum of 24 months after surgery by International Knee Documentation Committee score, Lysholm-score, visual analogue scale, and magnetic resonance imaging with specific cartilage sequences, evaluating the ICRS score and the Magnetic Observation of Cartilage Repair Tissue (MOCART) score. All patients judged the operation as successful. Among the patients available for the long-term follow-up, mean visual analogue scale value was 1.3 (range 0-3) out of 10 points. Mean International Knee Documentation Committee score was 80.8 (range 63.2-88.5) out of 100 points. Mean Lysholm score was 85 (range 55-95) out of 100 points. None of the patients had to be reoperated until today. Evaluation of magnetic resonance imaging using the MOCART score revealed a good correlation to the clinical outcome. This is the first study reporting results after reconstruction of osteochondral defects of the knee joint by bone grafting and a bilayer collagen membrane. This new method offers the advantage of a one-step-procedure and yields both good clinical and magnetic resonance findings. We conclude that this procedure can be a valuable tool to improve joint function after osteochondral defects, trauma, and in joints with local arthritic lesions. PMID:24416480

Petri, Maximilian; Ettinger, Max; von Falck, Christian; Hawi, Nael; Jagodzinski, Michael; Haasper, Carl

2013-01-01

112

Refixation of Osteochondral Fractures by an Ultrasound-Activated Pin System – An Ovine In Vivo Examination Using CT and Scanning Electron Microscope  

PubMed Central

Background: Osteochondral injuries, if not treated appropriately, often lead to severe osteoarthritis of the affected joint. Without refixation of the osteochondral fragment, human cartilage only repairs these defects imperfectly. All existing refixation systems for chondral defects have disadvantages, for instance bad MRI quality in the postoperative follow-up or low anchoring forces. To address the problem of reduced stability in resorbable implants, ultrasound-activated pins were developed. By ultrasound-activated melting of the tip of these implants a higher anchoring is assumed. Aim of the study was to investigate, if ultrasound-activated pins can provide a secure refixation of osteochondral fractures comparing to conventional screw and conventional, resorbable pin osteosynthesis. CT scans and scanning electron microscopy should proovegood refixation results with no further tissue damage by the melting of the ultrasound-activated pins in comparison to conventional osteosynthesis. Methods: Femoral osteochondral fragments in sheep were refixated with ultrasound-activated pins (SonicPin™), Ethipins® and screws (Asnis™). The quality of the refixated fragments was examined after three month of full weight bearing by CT scans and scanning electron microscopy of the cartilage surface. Results: The CT examination found almost no statistically significant difference in the quality of refixation between the three different implants used. Concerning the CT morphology, ultrasound-activated pins demonstrated at least the same quality in refixation of osteochondral fragments as conventional resorbable pins or screws. The scanning electron microscopy showed no major surface damage by the three implants, especially any postulated cartilage damage induced by the heat of the ultrasound-activated pin. The screws protruded above the cartilage surface, which may affect the opposingtibial surface. Conclusion: Using CT scans and scanning electron microscopy, the SonicPin™, the Ethipin® and screws were at least equivalent in refixation quality of osteochondral fragments. PMID:25674184

H, Neumann; A.P, Schulz; S, Breer; A, Unger; B, Kienast

2015-01-01

113

OSTEOCHONDRAL INTERFACE REGENERATION OF THE RABBIT MANDIBULAR CONDYLE WITH BIOACTIVE SIGNAL GRADIENTS  

PubMed Central

PURPOSE Tissue engineering solutions focused on the temporomandibular joint (TMJ) have expanded in number and variety over the past decade to address the treatment of TMJ disorders. The existing literature on approaches for healing small defects in the TMJ condylar cartilage and subchondral bone, however, is sparse. The purpose of this study was thus to evaluate the performance of a novel gradient-based scaffolding approach to regenerate osteochondral defects in the rabbit mandibular condyle. MATERIALS AND METHODS Miniature bioactive plugs for regeneration of small mandibular condylar defects in New Zealand White rabbits were fabricated. The plugs were constructed from poly(D,L-lactic-co-glycolic acid) (PLGA) microspheres with a gradient transition between cartilage-promoting and bone-promoting growth factors. RESULTS At six weeks of healing, results suggested that the implants provided support for the neo-synthesized tissue as evidenced by histology and 9.4T magnetic resonance imaging. CONCLUSION The inclusion of bioactive factors in a gradient-based scaffolding design is a promising new treatment strategy for focal defect repair in the TMJ. PMID:21470747

Dormer, Nathan H.; Busaidy, Kamal; Berkland, Cory J.; Detamore, Michael S.

2011-01-01

114

Computational biomechanics of articular cartilage of human knee joint: effect of osteochondral defects.  

PubMed

Articular cartilage and its supporting bone functional conditions are tightly coupled as injuries of either adversely affects joint mechanical environment. The objective of this study was set to quantitatively investigate the extent of alterations in the mechanical environment of cartilage and knee joint in presence of commonly observed osteochondral defects. An existing validated finite element model of a knee joint was used to construct a refined model of the tibial lateral compartment including proximal tibial bony structures. The response was computed under compression forces up to 2000 N while simulating localized bone damage, cartilage-bone horizontal split, bone overgrowth and absence of deep vertical collagen fibrils. Localized tibial bone damage increased overall joint compliance and substantially altered pattern and magnitude of contact pressures and cartilage strains in both tibia and femur. These alterations were further exacerbated when bone damage was combined with base cartilage split and absence of deep vertical collagen fibrils. Local bone boss markedly changed contact pressures and strain patterns in neighbouring cartilage. Bone bruise/fracture and overgrowth adversely perturbed the homeostatic balance in the mechanical environment of articulate cartilage surrounding and opposing the lesion as well as the joint compliance. As such, they potentially contribute to the initiation and development of post-traumatic osteoarthritis. PMID:19660759

Shirazi, R; Shirazi-Adl, A

2009-11-13

115

Osteochondral repair in the rabbit model utilizing bilayered, degradable oligo(poly(ethylene glycol) fumarate) hydrogel scaffolds.  

PubMed

In this study, hydrogel scaffolds, based on the polymer oligo(poly(ethylene glycol) fumarate) (OPF), were implanted into osteochondral defects in the rabbit model. Scaffolds consisted of two layers-a bottom, bone forming layer and a top, cartilage forming layer. Three scaffold formulations were implanted to assess how material composition and transforming growth factor-beta1 (TGF-beta1) loading affected osteochondral repair. Critical histological evaluation and scoring of the quantity and quality of tissue in the chondral and subchondral regions of defects was performed at 4 and 14 weeks. At both time points, no evidence of prolonged inflammation was observed, and healthy tissue was seen to infiltrate the defect area. The quality of this tissue improved over time with hyaline cartilage filling the chondral region and a mixture of trabecular and compact bone filling the subchondral region at 14 weeks. A promising degree of Safranin O staining and chondrocyte organization was observed in the newly formed surface tissue, while the underlying subchondral bone was completely integrated with the surrounding bone at 14 weeks. Material composition within the bottom, bone-forming layer did not appear to affect the rate of scaffold degradation or tissue filling. However, no bone upgrowth into the chondral region was observed with any scaffold formulation. TGF-beta1 loading in the top layer of scaffolds appeared to exert some therapeutic affect on tissue quality, but further studies are necessary for scaffold optimization. Yet, the excellent tissue filling and integration resulting from osteochondral implantation of these OPF-based scaffolds demonstrates their potential in cartilage repair strategies. PMID:16052490

Holland, Theresa A; Bodde, Esther W H; Baggett, L Scott; Tabata, Yasuhiko; Mikos, Antonios G; Jansen, John A

2005-10-01

116

Osteochondral reconstruction of a non-weight-bearing joint using a high-density porous polyethylene implant.  

PubMed

Currently, there is no reliable reconstructive modality allowing anatomic resurfacing of traumatic digital osteochondral articular defects. The purpose of the present study is to demonstrate the utility of Medpor, a high-density porous polyethylene (HDPP) scaffold biomaterial that can (1) be readily contoured to fit any joint defect, (2) permit stable internal fixation, and (3) permit osteocyte and chondrocyte ingrowth and subsequent articular cartilage resurfacing necessary to restore joint congruity. HDPP has gained wide acceptance for use in craniofacial and skeletal reconstruction and augmentation. An avian non-weight-bearing joint model was designed to study the role of the HDPP implant in small joint reconstruction. An osteochondral defect was created with a 5-mm circular punch in the humeral articular surface of both glenohumeral joints of 32 adult White Leghorn chickens. In each animal, one defect was press-fitted with a correspondingly sized HDPP implant (HDPP implant group); the contralateral defect was filled with the original osteochondral plug (isograft group) or left unrepaired (control group). At 2 weeks, and 1, 3, and 6 months,joints from each group were harvested and evaluated. Over the 6-month study period, joints in the control group demonstrated healing with dense collagenous scar tissue leaving residual defects at the articular surfaces and significant degenerative disease of the glenohumeral joints radiographically. Joints in the isograft group demonstrated near-complete resorption with some preservation of the cartilaginous cap but overall depression of the articular surface and significant degenerative joint disease. Joints in the HDPP implant group demonstrated stable fixation by highly mineralized bony trabecular ingrowth, preservation of the articular contour of the humeral head, and no evidence of significant degenerative joint disease. These findings indicate a potential role for this high-density porous polyethylene implant in the reconstruction of small joint articular and osseous defects. PMID:11129184

Weinzweig, J; Pantaloni, M; Spangenberger, A; Marler, J; Zienowicz, R J

2000-12-01

117

Development of a Comprehensive Osteochondral Allograft MRI Scoring System (OCAMRISS) with Histopathologic, Micro-Computed Tomography, and Biomechanical Validation  

PubMed Central

Objective To describe and apply a semi-quantitative MRI scoring system for multi-feature analysis of cartilage defect repair in the knee by osteochondral allografts, and to correlate this scoring system with histopathologic, micro-computed tomography (?CT), and biomechanical reference standards using a goat repair model. Design Fourteen adult goats had two osteochondral allografts implanted into each knee: one in the medial femoral condyle (MFC) and one in the lateral trochlea (LT). At 12 months, goats were euthanized and MRI was performed. Two blinded radiologists independently rated nine primary features for each graft, including cartilage signal, fill, edge integration, surface congruity, calcified cartilage integrity, subchondral bone plate congruity, subchondral bone marrow signal, osseous integration, and presence of cystic changes. Four ancillary features of the joint were also evaluated, including opposing cartilage, meniscal tears, synovitis, and fat-pad scarring. Comparison was made with histological and ?CT reference standards as well as biomechanical measures. Interobserver agreement and agreement with reference standards was assessed. Cohen’s kappa, Spearman’s correlation, and Kruskal-Wallis tests were used as appropriate. Results There was substantial agreement (?>0.6, p<0.001) for each MRI feature and with comparison against reference standards, except for cartilage edge integration (?=0.6). There was a strong positive correlation between MRI and reference standard scores (?=0.86, p<0.01). OCAMRISS was sensitive to differences in outcomes between the types of allografts. Conclusions We have described a comprehensive MRI scoring system for osteochondral allografts and have validated this scoring system with histopathologic and ?CT reference standards as well as biomechanical indentation testing. PMID:24489999

Chang, Eric Y.; Pallante-Kichura, Andrea L.; Bae, Won C.; Du, Jiang; Statum, Sheronda; Wolfson, Tanya; Gamst, Anthony C.; Cory, Esther; Amiel, David; Bugbee, William D.; Sah, Robert L.; Chung, Christine B.

2014-01-01

118

Viscoelastic and biomechanical properties of osteochondral tissue constructs generated from graded polycaprolactone and beta-tricalcium phosphate composites.  

PubMed

The complex micro-/nanostructure of native cartilage-to-bone insertion exhibits gradations in extracellular matrix components, leading to variations in the viscoelastic and biomechanical properties along its thickness to allow for smooth transition of loads under physiological movements. Engineering a realistic tissue for osteochondral interface would, therefore, depend on the ability to develop scaffolds with properly graded physical and chemical properties to facilitate the mimicry of the complex elegance of native tissue. In this study, polycaprolactone nanofiber scaffolds with spatially controlled concentrations of beta-tricalcium phosphate nanoparticles were fabricated using twin-screw extrusion-electrospinning process and seeded with MC3T3-E1 cells to form osteochondral tissue constructs. The objective of the study was to evaluate the linear viscoelastic and compressive properties of the native bovine osteochondral tissue and the tissue constructs formed in terms of their small-amplitude oscillatory shear, unconfined compression, and stress relaxation behavior. The native tissue, engineered tissue constructs, and unseeded scaffolds exhibited linear viscoelastic behavior for strain amplitudes less than 0.1%. Both native tissue and engineered tissue constructs demonstrated qualitatively similar gel-like behavior as determined using linear viscoelastic material functions. The normal stresses in compression determined at 10% strain for the unseeded scaffold, the tissue constructs cultured for four weeks, and the native tissue were 0.87+/-0.08 kPa, 3.59+/-0.34 kPa, and 210.80+/-8.93 kPa, respectively. Viscoelastic and biomechanical properties of the engineered tissue constructs were observed to increase with culture time reflecting the development of a tissuelike structure. These experimental findings suggest that viscoelastic material functions of the tissue constructs can provide valuable inputs for the stages of in vitro tissue development. PMID:20815647

Erisken, Cevat; Kalyon, Dilhan M; Wang, Hongjun

2010-09-01

119

Subchondral insufficiency fracture of the second metatatarsal head in an elderly woman treated with autologous osteochondral transplantation.  

PubMed

Freiberg's infraction is a rare disorder that arises mostly in adolescent athletes. We describe a 77-year-old woman with the collapse of second metatarsal head with similar clinical appearance to Freiberg's infraction. Radiological findings at initial visit of our hospital were normal. Her condition was obscure and magnetic resonance imaging showed the subchondral insufficiency fracture with bone marrow edema to the second metatarsal head. Despite the conservative treatment, the second metatarsal head collapsed. She was surgically treated with an osteochondral autograft without complications relating surgery. Furthermore, the histological findings showed that the site of collapse was considered to be secondary lesions resulting from the subchondral insufficiency fracture. PMID:17680255

Tsujii, Masaya; Hasegawa, Masahiro; Hirata, Hitoshi; Uchida, Atsumasa

2008-07-01

120

Bioactive Glass 13-93 as a Subchondral Substrate for Tissue-engineered Osteochondral Constructs: A Pilot Study  

Microsoft Academic Search

Background  Replacement of diseased areas of the joint with tissue-engineered osteochondral grafts has shown potential in the treatment\\u000a of osteoarthritis. Bioactive glasses are candidates for the osseous analog of these grafts.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purposes  (1) Does Bioactive Glass 13-93 (BG 13-93) as a subchondral substrate improve collagen and glycosaminoglycan production in\\u000a a tissue-engineered cartilage layer? (2) Does BG 13-93 as a culture medium supplement

Prakash Jayabalan; Andrea R. Tan; Mohammed N. Rahaman; B. Sonny Bal; Clark T. Hung; James L. Cook

121

Evaluation of chitosan-GP hydrogel biocompatibility in osteochondral defects: an experimental approach  

PubMed Central

Background Articular cartilage, because of its avascular nature, has little capacity for spontaneous healing, and tissue engineering approaches, employing different biomaterials and cells, are under development. Among the investigated biomaterials are the chitosan-based hydrogels. Although thoroughly studied in other mammalian species, studies are scarce in equines. So, the aim of the present study was to investigate the biocompatibility of chitosan-GP in horse joints submitted to high mechanical loads. Results An osteochondral defect was created by arthroscopy in the medial surface of lateral trochlea of talus of left or right leg, randomly selected, from six healthy geldings. The defect was filled up with chitosan-GP. The contralateral joint received an identical defect with no implant. The chondral fragment removed to produce the defect was collected, processed and used as the “Initial” sample (normal cartilage) for histology, immunohistochemistry, and metabolic labelling of PGs. After 180 days, the repair tissues were collected, and also analyzed. At the end of the experiment (180 days after lesion), the total number of cells per field in repair tissues was equal to control, and macrophages and polymorphonuclear cells were not detected, suggesting that no significant inflammation was present. These cells were able to synthesize type II collagen and proteoglycans (PGs). Nevertheless, the cell population in these tissues, both in presence of chitosan-GP and in untreated controls, were heterogeneous, with a lower proportion of type II collagen-positives cells and some with a fibroblastic aspect. Moreover, the PGs synthesized in repair tissues formed in presence or absence of chitosan-GP were similar to those of normal cartilage. However, the chitosan-GP treated tissue had an disorganized appearance, and blood vessels were present. Conclusions Implanted chitosan-GP did not evoke an important inflammatory reaction, and permitted cell growth. These cells were able to synthesize type II collagen and PGs similar to those synthesized in normal cartilage and in healing tissue without implant, indicating its chondrocyte nature. PMID:25160583

2014-01-01

122

Loss of jab1 in osteochondral progenitor cells severely impairs embryonic limb development in mice.  

PubMed

The transcriptional cofactor Jab1 controls cell proliferation, apoptosis, and differentiation in diverse developmental processes by regulating the activity of various transcription factors. To determine the role of Jab1 during early limb development, we developed a novel Jab1(flox/flox) ; Prx1-Cre conditional Knockout (cKO) mutant mouse model in which Jab1 was deleted in the osteochondral progenitor cells of the limb buds. Jab1 cKO mutant mice displayed drastically shortened limbs at birth. The short-limb defect became apparent in Jab1 cKO mutants at E15.5 and increasingly worsened thereafter. By E18.5, Jab1 cKO mutant mice exhibited significantly shorter limbs with: very few hypertrophic chondrocytes, disorganized chondrocyte columns, much smaller primary ossification centers, and significantly increased apoptosis. Real-time RT-PCR analysis showed decreased expression of Sox9, Col2a1, Ihh, and Col10a1 in Jab1 cKO mutant long bones, indicating impaired chondrogenesis. Furthermore, in a micromass culture model of early limb mesenchyme cells, alcian blue staining showed a significant decrease in chondrogenesis in Jab1 cKO limb bud cells. The expression of Sox9 and its downstream targets Col2a1 and Aggrecan, as well as BMP signaling downstream targets, Noggin, Id1, and Ihh, were significantly decreased in Jab1 cKO micromass cultures. Moreover, over-expression of SOX9 in Jab1 cKO micromass cultures partially restored Col2a1and Aggrecan expression. Jab1-deficient micromass cultures also exhibited decreased BMP signaling response and reduced BMP-specific reporter activity ex vivo. In summary, our study demonstrates that Jab1 is an essential regulator of early embryonic limb development in vivo, likely in part by co-activating Sox9 and BMP signaling. PMID:24604556

Bashur, Lindsay A; Chen, Dongxing; Chen, Zhijun; Liang, Bojian; Pardi, Ruggero; Murakami, Shunichi; Zhou, Guang

2014-11-01

123

In vitro chondrogenesis and in vivo repair of osteochondral defect with human induced pluripotent stem cells.  

PubMed

The purpose of this study was to investigate the chondrogenic features of human induced pluripotent stem cells (hiPSCs) and examine the differences in the chondrogenesis between hiPSCs and human bone marrow-derived MSCs (hBMMSCs). Embryoid bodies (EBs) were formed from undifferentiated hiPSCs. After EBs were dissociated into single cells, chondrogenic culture was performed in pellets and alginate hydrogel. Chondro-induced hiPSCs were implanted in osteochondral defects created on the patellar groove of immunosuppressed rats and evaluated after 12 weeks. The ESC markers NANOG, SSEA4 and OCT3/4 disappeared while the mesodermal marker BMP-4 appeared in chondro-induced hiPSCs. After 21 days of culture, greater glycosaminoglycan contents and better chondrocytic features including lacuna and abundant matrix formation were observed from chondro-induced hiPSCs compared to chondro-induced hBMMSCs. The expression of chondrogenic markers including SOX-9, type II collagen, and aggrecan in chondro-induced hiPSCs was comparable to or greater than chondro-induced hBMMSCs. A remarkably low level of hypertrophic and osteogenic markers including type X collagen, type I collagen and Runx-2 was noted in chondro-induced hiPSCs compared to chondro-induced hBMMSCs. hiPSCs had significantly greater methylation of several CpG sites in COL10A1 promoter than hBMMSCs in either undifferentiated or chondro-induced state, suggesting an epigenetic cause of the difference in hypertrophy. The defects implanted with chondro-induced hiPSCs showed a significantly better quality of cartilage repair than the control defects, and the majority of cells in the regenerated cartilage consisted of implanted hiPSCs. PMID:24462354

Ko, Ji-Yun; Kim, Kyung-Il; Park, Siyeon; Im, Gun-Il

2014-04-01

124

Association between intraarticular cytokine levels and clinical parameters of osteochondritis dissecans in the ankle  

PubMed Central

Background Reliable data about in vivo regulation of cytokines in osteochondritis dissecans (OCD) of the ankle are still missing. Disease-specific regulation patterns were hypothesized. Methods 28 patients with a mean age of 30.7?±?14.8 years undergoing an arthroscopy of the ankle because of OCD were prospectively included in a clinical trial. Lavage fluids were analyzed by ELISA for levels of aggrecan, BMP-2, BMP-7, IGF-1, IGF-1R, bFGF, endoglin, MMP-13, and IL-1?. Additionally, clinical parameters and scores (FFI, CFSS, AOFAS) were evaluated and supplemented by the Kellgren Lawrence Score (KLS) for conventional X-rays and the Ankle Osteoarthritis Scoring System (AOSS) for MRI. Results Grading of OCD lesions statistically significant increased with age and was higher in case of previously performed operations (p?

2014-01-01

125

Outcomes are favorable after arthroscopic treatment of osteochondritis dissecans of the talus.  

PubMed

Arthroscopic treatment of osteochondritis dissecans (OCD) of the talus has resulted in outcomes as good as, or better than, those after arthrotomy. We noted a lack of prospective studies investigating the outcomes of arthroscopic treatment. As such, we conducted a prospective study investigating the functional outcomes, pain scores, patient satisfaction, and expectation scores of patients undergoing arthroscopic treatment of OCD of the talus, hypothesizing that these patients would have good outcomes and satisfaction. A total of 61 patients underwent arthroscopic chondroplasty, removal of loose bodies, and microfracture for OCD of the talus and completed ?1 year of follow-up. We evaluated patients pre- and postoperatively at 6 and 12 months using the Ankle-Hindfoot score, visual analog scale for pain, and Medical Outcomes Study short-form 36 questionnaires. We also evaluated the patients' expectations and satisfaction. The mean Ankle-Hindfoot score improved significantly from 53.0 ± 14.3 points preoperatively to 77.8 ± 19.1 at 6 months and 83.1 ± 18.3 at 12 months after arthroscopic treatment (p < .001). The overall scores at the final follow-up visit were excellent for 30 (49%), good for 6 (10%), fair for 18 (30%), and poor for 7 (11%). The patients also experienced significant improvement in the visual analog scale score and physical component score of the short-form 36 questionnaire (p < .001). Of the 61 patients, 67% had their expectations fulfilled and 74% were satisfied with their surgery at 12 months of follow-up. Arthroscopic treatment of OCD of the talus continues to be a successful procedure to alleviate pain and loss of function. It is also associated with improvements to quality of life and good patient satisfaction. PMID:25441271

Goh, Graham Seow Hng; Bin Abd Razak, Hamid Rahmatullah; Mitra, Amit Kanta

2015-01-01

126

[Osteochondritis Dissecans of the Talus with Hindfoot Malalignment - Autologous Matrix-Induced Chondrogenesis with Lateral Calcaneal Distraction Osteotomy in an Internationally Successful Young Female Ski Racer.  

PubMed

Background: Osteochondritis dissecans of the talus (ODT) describes a special entity of osteochondral lesions of the talus (OLT). In the case of an advanced stage or failure of conservative treatment, a wide variety of surgical treatment strategies for osteochondral defects of the ankle have been described. In most cases, the ODT leads to a loss in sports time and competition. Material and Methods: In the following case report we describe a case dealing with a young alpine ski racer who competes in international races. An osteochondritis dissecans of the talus was observed and led to pain and loss of sports function. We decided for an operative treatment with an autologous matrix-associated chondrogenesis (AMIC). In addition to the AMIC we performed a lateral calcaneal distraction osteotomy, based on the findings of a flatfoot in order to correct the hindfoot malalignment. Results: At an early time pain relief could be detected. Step by step, the presented ski racer could increase the intensity of training sessions. Based on the findings in the MRI at the follow-up, an integrated repair tissue could be detected. Conclusions: The following case report describes a positive course after an autologous matrix-associated chondrogenesis (AMIC) combined with a lateral calcaneal distraction osteotomy. At this time the athlete is reintegrated in elite sports and takes part in the normal training programmes. PMID:25211309

Hotfiel, T; Engelhardt, M

2014-09-11

127

The effect of cartilage and bone density of mushroom-shaped, photooxidized, osteochondral transplants: an experimental study on graft performance in sheep using transplants originating from different species  

Microsoft Academic Search

BACKGROUND: Differences in overall performance of osteochondral photooxidized grafts were studied in accordance of their species origin and a new, more rigorous cleansing procedure using alcohol during preparation. METHODS: Photooxidized mushroom-shaped grafts of bovine, ovine, human and equine origin were implanted in the femoral condyles of 32 sheep (condyles: n = 64). No viable chondrocytes were present at the time

Anja C Waselau; Daniel Nadler; Jessika MV Müller; Katalin Zlinszky; Monika Hilbe; Jörg A Auer; Brigitte von Rechenberg

2005-01-01

128

Evaluation of the activity of intraarticular hyaluronic acid in the repair of experimentally induced osteochondral defects of the stifle joint in dogs  

Microsoft Academic Search

The present study examined the results of using hyaluronic acid with autogenetic cancellous grafts in the treatment of experimentally induced osteochondral defects in the stifle joints of dogs. In this study, 10 mature dogs of different breeds, weights and of both sexes were used. General anesthesia and usual operation proce- dures were followed. A 10 mm deep defect was created

A. Sagliyan; E. Karabulut; E. Unsaldi; I. Yaman

129

Cartilage repair and subchondral bone migration using 3D printing osteochondral composites: a one-year-period study in rabbit trochlea.  

PubMed

Increasing evidences show that subchondral bone may play a significant role in the repair or progression of cartilage damage in situ. However, the exact change of subchondral bone during osteochondral repair is still poorly understood. In this paper, biphasic osteochondral composite scaffolds were fabricated by 3D printing technology using PEG hydrogel and ?-TCP ceramic and then implanted in rabbit trochlea within a critical size defect model. Animals were euthanized at 1, 2, 4, 8, 16, 24, and 52 weeks after implantation. Histological results showed that hyaline-like cartilage formed along with white smooth surface and invisible margin at 24 weeks postoperatively, typical tidemark formation at 52 weeks. The repaired subchondral bone formed from 16 to 52 weeks in a "flow like" manner from surrounding bone to the defect center gradually. Statistical analysis illustrated that both subchondral bone volume and migration area percentage were highly correlated with the gross appearance Wayne score of repaired cartilage. Therefore, subchondral bone migration is related to cartilage repair for critical size osteochondral defects. Furthermore, the subchondral bone remodeling proceeds in a "flow like" manner and repaired cartilage with tidemark implies that the biphasic PEG/?-TCP composites fabricated by 3D printing provides a feasible strategy for osteochondral tissue engineering application. PMID:25177697

Zhang, Weijie; Lian, Qin; Li, Dichen; Wang, Kunzheng; Hao, Dingjun; Bian, Weiguo; He, Jiankang; Jin, Zhongmin

2014-01-01

130

Cartilage Repair and Subchondral Bone Migration Using 3D Printing Osteochondral Composites: A One-Year-Period Study in Rabbit Trochlea  

PubMed Central

Increasing evidences show that subchondral bone may play a significant role in the repair or progression of cartilage damage in situ. However, the exact change of subchondral bone during osteochondral repair is still poorly understood. In this paper, biphasic osteochondral composite scaffolds were fabricated by 3D printing technology using PEG hydrogel and ?-TCP ceramic and then implanted in rabbit trochlea within a critical size defect model. Animals were euthanized at 1, 2, 4, 8, 16, 24, and 52 weeks after implantation. Histological results showed that hyaline-like cartilage formed along with white smooth surface and invisible margin at 24 weeks postoperatively, typical tidemark formation at 52 weeks. The repaired subchondral bone formed from 16 to 52 weeks in a “flow like” manner from surrounding bone to the defect center gradually. Statistical analysis illustrated that both subchondral bone volume and migration area percentage were highly correlated with the gross appearance Wayne score of repaired cartilage. Therefore, subchondral bone migration is related to cartilage repair for critical size osteochondral defects. Furthermore, the subchondral bone remodeling proceeds in a “flow like” manner and repaired cartilage with tidemark implies that the biphasic PEG/?-TCP composites fabricated by 3D printing provides a feasible strategy for osteochondral tissue engineering application. PMID:25177697

Li, Dichen; Wang, Kunzheng; Hao, Dingjun; Bian, Weiguo; He, Jiankang; Jin, Zhongmin

2014-01-01

131

An anti-inflammatory cell-free collagen/resveratrol scaffold for repairing osteochondral defects in rabbits.  

PubMed

Inflammatory factor overexpression is the major cause of cartilage and osteochondral damage. Resveratrol (Res) is known for its anti-inflammatory, antioxidant and immunmodulatory properties. However, these effects are hampered by its water insolubility and rapid metabolism in vivo. To optimize its therapeutic efficacy in this study, Res was grafted to polyacrylic acid (PAA, 1000Da) to obtain a macromolecular drug, PAA-Res, which was then incorporated into atelocollagen (Coll) hydrogels to fabricate anti-inflammatory cell-free (Coll/Res) scaffolds with improved mechanical strengths. The Coll/Res scaffolds demonstrated the ability to capture diphenylpicrylhydrazyl free radicals. Both pure Coll and Coll/Res scaffolds could maintain their original shape for 6weeks in phosphate buffered saline. The scaffolds were degraded by collagenase over several days, and the degradation rate was slowed down by Res loading. The Coll and Coll/Res scaffolds with excellent cytocompatibility were shown to promote the proliferation and maintain the normal phenotype of the seeded chondrocytes and bone marrow stromal stem cells (BMSCs). In addition, the Coll/Res scaffold exhibited the capacity to protect the chondrocytes and BMSCs against reactive oxygen species. The acellular Coll/Res scaffolds were transplanted into the rabbit osteochondral defects. After implantation for 2, 4 and 6weeks, the samples were retrieved for quantitative real-time polymerase chain reaction, and the inflammatory related genes interleukin-1?, matrix metalloproteinases-13, COX-2 and bone and cartilage related genes SOX-9, aggrecan, Coll II and Coll I were determined. Compared with the untreated defects, the inflammatory related genes were down-regulated and those bone and cartilage related genes were up-regulated by filling the defect with an anti-inflammatory scaffold. After 12weeks, the osteochondral defects were completely repaired by the Coll/Res scaffold, and the neo-cartilage integrated well with its surrounding tissue and subchondral bone. Immunohistochemical and glycosaminoglycan staining confirmed the distribution of Coll II and glycosaminoglycans in the regenerated cartilage. The anti-inflammatory acellular Coll/Res scaffolds are convenient to administer in vivo, holding a greater potential for future clinical applications. PMID:25169257

Wang, Wei; Sun, Liang; Zhang, Pengfei; Song, Junfei; Liu, Wenguang

2014-12-01

132

Knee Osteochondritis Dissecans Treated by the AO Hook Fixation System: A Four Year Follow-Up of an Alternative Technique  

PubMed Central

Surgical fixation is recommended for stable osteochondritis dissecans (OCD) lesions that have failed nonoperative management and for all unstable lesions. In this study we set out to describe and evaluate an alternative method of surgical fixation for such lesions. Five knees with unstable OCD lesions in four male adolescent patients with open physes were treated with the AO Hook Fixation System. The outcome was evaluated both clinically and with three separate outcome systems (IKDC 2000, KOOS, Lysholm) at one and a mean four year follow-up. We demonstrated excellent clinical results in all patients. At four years, all scoring systems demonstrated statistically significant improvement when compared to the preoperative status. Our study suggests that the AO Hook Fixation System is an alternative method of surgical intervention with comparable medium term results with other existing modes of fixation and the added biomechanical advantage of the absence of distracting forces during hardware removal. PMID:25067976

Pengas, Ioannis P; Assiotis, Angelos; Kokkinakis, Michail; Khan, Wasim S; Meyers, Paul; Arbuthnot, James; Mcnicholas, Michael J

2014-01-01

133

Lateral compartment osteoarthritis of the knee after meniscectomy treated by the transplantation of tissue-engineered cartilage and osteochondral plug.  

PubMed

Management of osteoarthritis of the knee after meniscectomy has been challenging, especially for young patients, because articular cartilage has very poor healing capacity because of its lack of vessels, nerve supply, and isolation from systemic regulation. Osteoarthritic lesions often involve both femoral and tibial cartilage, requiring treatments for both lesions. We report the case of a 14-year-old girl with lateral compartment osteoarthritis of the knee after a total meniscectomy of the discoid meniscus, who was successfully treated by the transplantation of both tissue-engineered cartilage made ex vivo for a femoral lesion and an autologous osteochondral plug for a tibial lesion. We treated both femoral and tibial cartilage defects simultaneously with this procedure. We confirmed cartilaginous regeneration in both femoral and tibial lesions at second-look arthroscopy. This procedure is one option to prevent further development of osteoarthritis in young patients. PMID:16399469

Adachi, Nobuo; Ochi, Mitsuo; Deie, Masataka; Ito, Yohei; Izuta, Yasunori

2006-01-01

134

Rehabilitation and return-to-sports activity after debridement and bone marrow stimulation of osteochondral talar defects.  

PubMed

An osteochondral defect (OD) is a lesion involving the articular cartilage and the underlying subchondral bone. ODs of the talus can severely impact on the quality of life of patients, who are usually young and athletic. The primary treatment for ODs that are too small for fixation, consists of arthroscopic debridement and bone marrow stimulation. This article delineates levels of activity, determines times for return to activity and reviews the factors that affect rehabilitation after arthroscopic debridement and bone marrow stimulation of a talar OD. Articles for review were obtained from a search of the MEDLINE database up to January 2012 using the search headings 'osteochondral defects', 'bone marrow stimulation', 'sports/activity', 'rehabilitation', various other related factors and 'talus'. English-, Dutch- and German-language studies were evaluated.The review revealed that there is no consensus in the existing literature about rehabilitation times or return-to-sports activity times, after treatment with bone marrow stimulation of ODs in the talus. Furthermore, scant research has been conducted on these issues. The literature also showed that potential factors that aid rehabilitation could include youth, lower body mass index, smaller OD size, mobilization and treatment with growth factors, platelet-rich plasma, biphosphonates, hyaluronic acid and pulse electromagnetic fields. However, most studies have been conducted in vitro or on animals. We propose a scheme, whereby return-to-sports activity is divided into four phases of increasing intensity: walking, jogging, return to non-contact sports (running without swerving) and return to contact sports (running with swerving and collision). We also recommend that research, conducted on actual sportsmen, of recovery times after treatment of talar ODs is warranted. PMID:22963224

van Eekeren, Inge C M; Reilingh, Mikel L; van Dijk, C Niek

2012-10-01

135

Short-term load bearing capacity of osteochondral autografts implanted by the mosaicplasty technique: an in vitro porcine model.  

PubMed

Articular surface congruency and graft stability are considered essential factors in the success of osteochondral grafting; however, quantitative measures of short-term load bearing capacity of grafts implanted by the mosaicplasty technique have not been reported. The purpose of this study was to develop a live tissue in vitro model to examine short-term fixation strength of mosaicplasty autografts immediately after and 1 week following graft implantation. Cylindrical osteochondral autografts were implanted in vitro by the mosaicplasty technique on five pairs of porcine femoral condyles within one and a half hours of animal sacrifice. Immediately following the surgical procedure, graft push-in and pull-out strength tests as well as indentation tests to determine modulus of the surrounding cancellous bone were performed on half of the specimens from the distal femurs of each animal. The remaining specimens, matched for location in the contralateral leg, were incubated in culture medium for 7 days prior to performing the same set of mechanical tests. Averaged push-in and pull-out graft fixation strength decreased 44% from 135.7 to 75.5N over the 7-day period, while no change in modulus was detected in the surrounding cancellous bone. These in vitro results demonstrate a substantial deterioration of short-term fixation strength of mosaicplasty grafts from the immediate post-operative state. Such a reduction in short-term graft load bearing capacity may pose a threat to the surgically established articular surface congruency and blood vessels formed during the early stages of the healing response. PMID:12831747

Whiteside, R A; Bryant, J T; Jakob, R P; Mainil-Varlet, P; Wyss, U P

2003-08-01

136

Bioprinting of a mechanically enhanced three-dimensional dual cell-laden construct for osteochondral tissue engineering using a multi-head tissue\\/organ building system  

Microsoft Academic Search

The aim of this study was to build a mechanically enhanced three-dimensional (3D) bioprinted construct containing two different cell types for osteochondral tissue regeneration. Recently, the production of 3D cell-laden structures using various scaffold-free cell printing technologies has opened up new possibilities. However, ideal 3D complex tissues or organs have not yet been printed because gel-state hydrogels have been used

Jin-Hyung Shim; Jung-Seob Lee; Jong Young Kim; Dong-Woo Cho

2012-01-01

137

Arthroscopic Treatment of Osteochondral Lesions of the Ankle With Matrix-Associated Chondrocyte ImplantationEarly Clinical and Magnetic Resonance Imaging Results  

Microsoft Academic Search

Background: Conventional autologous chondrocyte transplantation in the ankle often requires tibial or fibular osteotomies with potential morbidity for the patient. Advances in biotechnology and surgical techniques have resulted in the development of matrix-associated chondrocyte implantation (MACI). As the chondrocyte-loaded scaffold can be applied arthroscopically, this procedure is especially useful for the treatment of osteochondral defects in the ankle.Hypothesis: Arthroscopic MACI

Matthias Aurich; Harvinder S. Bedi; Peter J. Smith; Bernd Rolauffs; Thomas Mückley; James Clayton; Mark Blackney

2011-01-01

138

Bioprinting of a mechanically enhanced three-dimensional dual cell-laden construct for osteochondral tissue engineering using a multi-head tissue/organ building system  

NASA Astrophysics Data System (ADS)

The aim of this study was to build a mechanically enhanced three-dimensional (3D) bioprinted construct containing two different cell types for osteochondral tissue regeneration. Recently, the production of 3D cell-laden structures using various scaffold-free cell printing technologies has opened up new possibilities. However, ideal 3D complex tissues or organs have not yet been printed because gel-state hydrogels have been used as the principal material and are unable to maintain the desired 3D structure due to their poor mechanical strength. In this study, thermoplastic biomaterial polycaprolactone (PCL), which shows relatively high mechanical properties as compared with hydrogel, was used as a framework for enhancing the mechanical stability of the bioprinted construct. Two different alginate solutions were then infused into the previously prepared framework consisting of PCL to create the 3D construct for osteochondral printing. For this work, a multi-head tissue/organ building system (MtoBS), which was particularly designed to dispense thermoplastic biomaterial and hydrogel having completely different rheology properties, was newly developed and used to bioprint osteochondral tissue. It was confirmed that the line width, position and volume control of PCL and alginate solutions were adjustable in the MtoBS. Most importantly, dual cell-laden 3D constructs consisting of osteoblasts and chondrocytes were successfully fabricated. Further, the separately dispensed osteoblasts and chondrocytes not only retained their initial position and viability, but also proliferated up to 7 days after being dispensed.

Shim, Jin-Hyung; Lee, Jung-Seob; Kim, Jong Young; Cho, Dong-Woo

2012-08-01

139

Arthroscopic removal of axial osteochondral fragments of the plantar/palmar proximal aspect of the proximal phalanx in horses: 119 cases (1988-1992).  

PubMed

Medical records from 119 horses that had undergone arthroscopic surgery for removal of axial osteochondral fragments of the palmar/plantar proximal aspect of the proximal phalanx were reviewed. Standardbred racehorses represented 109 (92%) of those affected. Ninety-three (78%) of the horses were < 3 years old. Gender distribution was consistent with that of the equine hospital population. Fragments most commonly were observed in the hind limbs (155/164; 95%), specifically, on the medial aspect of the left hind limb (72/164; 44%). Bilateral fragmentation occurred in 21 of 119 (18%) horses, and 15 of 119 (13%) horses had fragments in the medial and lateral aspect within the same joint. Fifteen (13%) horses had a concurrent osteochondritis dissecans lesion on the distal intermediate ridge of the tibia, and 30 of 119 (25%) had radiographic signs of osteoarthritis involving the centrodistal (distal intertarsal) and tarsometatarsal articulations. In 55 of 87 (63%) racehorses and in 100% of the 9 nonracehorses, performance returned to preoperative levels after surgery. Fragment numbers or distribution, concurrent osteochondritis dissecans lesions of the distal intermediate ridge of the tibia, or tarsal osteoarthritis were not significantly associated with outcome. Abnormal surgical findings, consisting of articular cartilage fibrillation or synovial proliferation, were significantly (P < 0.0001) associated with adverse outcome; these findings were documented in 31% of the 32 horses without successful outcome and in only 2% of the 55 horses with successful outcomes. PMID:7744667

Fortier, L A; Foerner, J J; Nixon, A J

1995-01-01

140

Osteochondral Avulsion Fracture of the Femoral Origin of the Anterior Cruciate Ligament in an 11-Year-Old Child  

PubMed Central

Although tibial end avulsions of the anterior cruciate ligament are relatively common in clinical practice, avulsions of the femoral end of this ligament are by comparison rare. We present the case of an 11-year-old boy with a bony avulsion injury, which was presumed to have arisen from the tibial insertion of the anterior cruciate ligament but turned out instead to be an osteochondral avulsion fracture of the femoral origin. This unexpected finding that was not detected during preoperative workup resulted in the first attempt at surgical fixation being aborted. The need for a second planned definitive fixation procedure emphasises the importance of combining a thorough history and examination in association with appropriate imaging in the patient workup. The patient's definitive operative treatment and outcome are described. Although rare, surgeons (and emergency room doctors) treating such patients should include femoral end avulsion injuries of the anterior cruciate ligament in the differential diagnosis of a child presenting with an acute haemarthrosis of the knee. Furthermore, once diagnosed, early onward referral to an experienced knee surgeon is advocated. PMID:22666266

Pai, Sunil Kumar; Aslam Pervez, Nayef; Radcliffe, Graham

2012-01-01

141

99m-Technetium phosphate compound joint scintigraphy in the management of juvenile osteochondritis dissecans of the femoral condyles.  

PubMed

The known sensitivity of joint scintigraphy in following the course of fracture healing caused the authors to believe that this radiologic technique might be valuable in the management of osteochondritis dissecans (OCD). Accordingly, 99mTc-diphosphonate joint scintigraphy was used on 18 patients with OCD of the knee. The average age was 13 1/2 years. The scintigrams were repeated at 6-week intervals until healing had occurred. When the diagnosis of OCD was established by standard roentgenograms and joint scintigraphy, the patients were placed on an activity restriction program, attempting to reach a symptom-free level. The patients were followed for an average of 18 months. Ninety-five scans were categorized according to their level of scintigraphic activity. This led to a discrete four-part scintigraphic classification that is indicative of the extent of healing or progression of this condition, and precedes changes seen on standard x-rays by months. Joint scintigraphy also rules out anomalies of ossification in the diagnosis of OCD since an anomaly should have a normal scintigraphic appearance. We have concluded that joint scintigraphy is valuable in the management of OCD because of its superior sensitivity to changes in the activity of the lesion. As experience is gained with this technique, those cases that should be prophylactically surgically stabilized may be indicated. PMID:6638247

Cahill, B R; Berg, B C

1983-01-01

142

Reconstruction of a large osteochondral lesion of the distal tibia with an iliac crest graft and autologous matrix-induced chondrogenesis (AMIC): a case report.  

PubMed

Isolated osteochondral lesions (OCL) of the distal tibia are rare and lack clear treatment guidelines. With the case we present here, we suggest a novel surgical approach and report the successful use of autologous matrix-induced chondrogenesis-aided reconstruction for OCL of the distal tibia. A 29-year-old male patient complained about persisting pain of the left ankle joint and a restricted activity level 12 months after an ankle sprain. Imaging revealed edema of the subchondral bone and thinning of the cartilage above the osseous defect at the lateral distal tibia. The OCL was debrided followed by microfracturing of the underlying sclerotic bone. A cancellous bone plug was harvested from the iliac crest and impacted into the defect. A collagen matrix was then fixed on the defect. After 12 months, the patient was free of pain and returned to full activity. Conventional radiographs at 1 year showed successful osseous integration of the plug and a nearly anatomic shape of the tibial joint line. Delayed gadolinium-enhanced MRI of cartilage scans at 36 months showed an intact cartilage layer over the defect and glycosaminoglycan content, indicating hyaline-like cartilage repair. This case demonstrates autologous matrix-induced chondrogenesis-aided reconstruction of large osteochondral lesions of distal tibia to be a promising treatment method. Our aim was to describe the case of a patient with a large isolated osteochondral lesion of the distal tibia treated by a novel operative technique using cancellous bone from the iliac crest and a collagen I/III matrix. PMID:22770901

Miska, Matthias; Wiewiorski, Martin; Valderrabano, Victor

2012-01-01

143

The promotion of osteochondral repair by combined intra-articular injection of parathyroid hormone-related protein and implantation of a bi-layer collagen-silk scaffold.  

PubMed

The repair of osteochondral defects can be enhanced with scaffolds but is often accompanied with undesirable terminal differentiation of bone marrow-derived mesenchymal stem cells (BMSCs). Parathyroid hormone-related protein (PTHrP) has been shown to inhibit aberrant differentiation, but administration at inappropriate time points would have adverse effects on chondrogenesis. This study aims to develop an effective tissue engineering strategy by combining PTHrP and collagen-silk scaffold for osteochondral defect repair. The underlying mechanisms of the synergistic effect of combining PTHrP administration with collagen-silk scaffold implantation for rabbit knee joint osteochondral defect repair were investigated. In vitro studies showed that PTHrP treatment significantly reduced Alizarin Red staining and expression of terminal differentiation-related markers. This is achieved in part through blocking activation of the canonical Wnt/?-catenin signaling pathway. For the in vivo repair study, intra-articular injection of PTHrP was carried out at three different time windows (4-6, 7-9 and 10-12 weeks) together with implantation of a bi-layer collagen-silk scaffold. Defects treated with PTHrP at the 4-6 weeks time window exhibited better regeneration (reconstitution of cartilage and subchondral bone) with minimal terminal differentiation (hypertrophy, ossification and matrix degradation), as well as enhanced chondrogenesis (cell shape, Col2 and GAG accumulation) compared with treatment at other time windows. Furthermore, the timing of PTHrP administration also influenced PTHrP receptor expression, thus affecting the treatment outcome. Our results demonstrated that intra-articular injection of PTHrP at 4-6 weeks post-injury together with collagen-silk scaffold implantation is an effective strategy for inhibiting terminal differentiation and enhancing chondrogenesis, thus improving cartilage repair and regeneration in a rabbit model. PMID:23702148

Zhang, Wei; Chen, Jialin; Tao, Jiadong; Hu, Changchang; Chen, Longkun; Zhao, Hongshi; Xu, Guowei; Heng, Boon C; Ouyang, Hong Wei

2013-08-01

144

Effect of Self-assembling Peptide, Chondrogenic Factors, and Bone Marrow Derived Stromal Cells on Osteochondral Repair  

PubMed Central

Objective The goal of this study was to test the ability of an injectable self-assembling peptide (KLD) hydrogel with or without chondrogenic factors (CF) and allogeneic bone marrow stromal cells (BMSCs) to stimulate cartilage regeneration in a full-thickness, critically-sized, rabbit cartilage defect model in vivo. We used CF treatments to test the hypotheses that CF would stimulate chondrogenesis and matrix production by cells migrating into acellular KLD (KLD+CF) or by BMSCs delivered in KLD (KLD+CF+BMSCs). Design Three groups were tested against contralateral untreated controls: KLD, KLD+CF, and KLD+CF+BMSCs, n=6–7. TGF-?1, dexamethasone, and IGF-1 were used as chondrogenic factors (CF) pre-mixed with KLD and BMSCs before injection. Evaluations included gross, histological, immunohistochemical and radiographic analyses. Results KLD without CF or BMSCs showed the greatest repair after 12 weeks with significantly higher Safranin-O, collagen II immunostaining, and cumulative histology scores than untreated contralateral controls. KLD+CF resulted in significantly higher aggrecan immunostaining than untreated contralateral controls. Including allogeneic BMSCs+CF markedly reduced the quality of repair and increased osteophyte formation compared to KLD alone. Conclusions These data show that KLD can fill full-thickness osteochondral defects in situ and improve cartilage repair as shown by Safranin-O, collagen II immunostaining, and cumulative histology. In this small animal model, the full-thickness critically-sized defect provided access to the marrow, similar in concept to abrasion arthroplasty or spongialization in large animal models, and suggests that combining KLD with these techniques may improve current practice. PMID:20851201

Miller, Rachel E.; Grodzinsky, Alan J.; Vanderploeg, Eric J.; Lee, Christina; Ferris, Dora J.; Barrett, Myra F.; Kisiday, John D.; Frisbie, David D.

2010-01-01

145

Programmed Application of Transforming Growth Factor ?3 and Rac1 Inhibitor NSC23766 Committed Hyaline Cartilage Differentiation of Adipose-Derived Stem Cells for Osteochondral Defect Repair.  

PubMed

Hyaline cartilage differentiation is always the challenge with application of stem cells for joint repair. Transforming growth factors (TGFs) and bone morphogenetic proteins can initiate cartilage differentiation but often lead to hypertrophy and calcification, related to abnormal Rac1 activity. In this study, we developed a strategy of programmed application of TGF?3 and Rac1 inhibitor NSC23766 to commit the hyaline cartilage differentiation of adipose-derived stem cells (ADSCs) for joint cartilage repair. ADSCs were isolated and cultured in a micromass and pellet culture model to evaluate chondrogenic and hypertrophic differentiation. The function of Rac1 was investigated with constitutively active Rac1 mutant and dominant negative Rac1 mutant. The efficacy of ADSCs with programmed application of TGF?3 and Rac1 inhibitor for cartilage repair was studied in a rat model of osteochondral defects. The results showed that TGF?3 promoted ADSCs chondro-lineage differentiation and that NSC23766 prevented ADSC-derived chondrocytes from hypertrophy in vitro. The combination of ADSCs, TGF?3, and NSC23766 promoted quality osteochondral defect repair in rats with much less chondrocytes hypertrophy and significantly higher International Cartilage Repair Society macroscopic and microscopic scores. The findings have illustrated that programmed application of TGF?3 and Rac1 inhibitor NSC23766 can commit ADSCs to chondro-lineage differentiation and improve the efficacy of ADSCs for cartilage defect repair. These findings suggest a promising stem cell-based strategy for articular cartilage repair. PMID:25154784

Zhu, Shouan; Chen, Pengfei; Wu, Yan; Xiong, Si; Sun, Heng; Xia, Qingqing; Shi, Libing; Liu, Huanhuan; Ouyang, Hong Wei

2014-10-01

146

Controlled Release Strategies for Bone, Cartilage, and Osteochondral Engineering—Part II: Challenges on the Evolution from Single to Multiple Bioactive Factor Delivery  

PubMed Central

The development of controlled release systems for the regeneration of bone, cartilage, and osteochondral interface is one of the hot topics in the field of tissue engineering and regenerative medicine. However, the majority of the developed systems consider only the release of a single growth factor, which is a limiting step for the success of the therapy. More recent studies have been focused on the design and tailoring of appropriate combinations of bioactive factors to match the desired goals regarding tissue regeneration. In fact, considering the complexity of extracellular matrix and the diversity of growth factors and cytokines involved in each biological response, it is expected that an appropriate combination of bioactive factors could lead to more successful outcomes in tissue regeneration. In this review, the evolution on the development of dual and multiple bioactive factor release systems for bone, cartilage, and osteochondral interface is overviewed, specifically the relevance of parameters such as dosage and spatiotemporal distribution of bioactive factors. A comprehensive collection of studies focused on the delivery of bioactive factors is also presented while highlighting the increasing impact of platelet-rich plasma as an autologous source of multiple growth factors. PMID:23249320

Santo, Vítor E.; Mano, João F.; Reis, Rui L.

2013-01-01

147

Repair of large osteochondral defects in a beagle model with a novel type I collagen/glycosaminoglycan-porous titanium biphasic scaffold.  

PubMed

The limited repair potential of articular cartilage, which hardly heals after injury or debilitating osteoarthritis, is a clinical challenge. The aim of this work was to develop a novel type I collagen (Col)/glycosaminoglycan (GAGs)-porous titanium biphasic scaffold (CGT) and verify its ability to repair osteochondral defects in an animal model with bone marrow stem cells (bMSCs) in the chondral phase. The biphasic scaffold was composed of Col/GAGs as chondral phasic and porous titanium as subchondral phasic. Twenty-four full-thickness defects through the articular cartilage and into the subchondral bone were prepared by drilling into the surface of the femoral patellar groove. Animals were assigned to one of the three groups: 1) CGT with bMSCs (CGTM), 2) only CGT, and 3) no implantation (control). The defect areas were examined grossly, histologically and by micro-CT. The most satisfied cartilage repairing result was in the CGTM group, while CGT alone was better than the control group. Abundant subchondral bone formation was observed in the CGTM and CGT groups but not the control group. Our findings demonstrate that a composite based on a novel biphasic scaffold combined with bMSCs shows a high potential to repair large osteochondral defects in a canine model. PMID:23910301

Duan, Xin; Zhu, Xiangdong; Dong, Xingxing; Yang, Jing; Huang, Fuguo; Cen, Shiqiang; Leung, Frankie; Fan, Hongsong; Xiang, Zhou

2013-10-01

148

Controlled Release Strategies for Bone, Cartilage, and Osteochondral Engineering—Part I: Recapitulation of Native Tissue Healing and Variables for the Design of Delivery Systems  

PubMed Central

The potential of growth factors to stimulate tissue healing through the enhancement of cell proliferation, migration, and differentiation is undeniable. However, critical parameters on the design of adequate carriers, such as uncontrolled spatiotemporal presence of bioactive factors, inadequate release profiles, and supraphysiological dosages of growth factors, have impaired the translation of these systems onto clinical practice. This review describes the healing cascades for bone, cartilage, and osteochondral interface, highlighting the role of specific growth factors for triggering the reactions leading to tissue regeneration. Critical criteria on the design of carriers for controlled release of bioactive factors are also reported, focusing on the need to provide a spatiotemporal control over the delivery and presentation of these molecules. PMID:23268651

Santo, Vítor E.; Mano, João F.; Reis, Rui L.

2013-01-01

149

Intra-articular administration of hyaluronic acid increases the volume of the hyaline cartilage regenerated in a large osteochondral defect by implantation of a double-network gel.  

PubMed

Implantation of PAMPS/PDMAAm double-network (DN) gel can induce hyaline cartilage regeneration in the osteochondral defect. However, it is a problem that the volume of the regenerated cartilage tissue is gradually reduced at 12 weeks. This study investigated whether intra-articular administration of hyaluronic acid (HA) increases the volume of the cartilage regenerated with the DN gel at 12 weeks. A total of 48 rabbits were used in this study. A cylindrical osteochondral defect created in the bilateral femoral trochlea was treated with DN gel (Group DN) or left without any implantation (Group C). In both Groups, we injected 1.0 mL of HA in the left knee, and 1.0 mL of saline solution in the right knee. Quantitative histological evaluations were performed at 2, 4, and 12 weeks, and PCR analysis was performed at 2 and 4 weeks after surgery. In Group DN, the proteoglycan-rich area was significantly greater in the HA-injected knees than in the saline-injected knees at 12 weeks (P = 0.0247), and expression of type 2 collagen, aggrecan, and Sox9 mRNAs was significantly greater in the HA-injected knees than in the saline-injected knees at 2 weeks (P = 0.0475, P = 0.0257, P = 0.0222, respectively). The intra-articular administration of HA significantly enhanced these gene expression at 2 weeks and significantly increased the volume of the hyaline cartilage regenerated by implantation of a DN gel at 12 weeks. This information is important to develop an additional method to increase the volume of the hyaline cartilage tissue in a potential cartilage regeneration strategy using the DN gel. PMID:24394983

Fukui, Takaaki; Kitamura, Nobuto; Kurokawa, Takayuki; Yokota, Masashi; Kondo, Eiji; Gong, Jian Ping; Yasuda, Kazunori

2014-04-01

150

The use of osteochondral allograft with bone marrow-derived mesenchymal cells and hinge joint distraction in the treatment of post-collapse stage of osteonecrosis of the femoral head.  

PubMed

Osteonecrosis of the femoral head is an entity which occurs mainly in young and active patients aged between 20 and 50. The success of hip joint preserving treatments ranges from 15% to 50% depending on the stage and amount of osteonecrotic lesion. Total hip replacement is indicated in late post-collapse hips but it has unsatisfactory survival because of the wear and osteolysis in young and active patients. Osteochondral allografts have been reported in the treatment of large articular lesions with defects in underlying bone in knee, talus and shoulder. By combining osteoconductive properties of osteochondral allograft with osteogenic abilities of bone marrow-derived mesenchymal cells it has a potential to be an alternative to an autologous graft. The adjunct of hinged joint distraction should minimize stresses in subchondral bone to promote creeping substitution and prevent femoral head collapse. Unlike current treatment modalities, it would provide both structural support and allow bony and articular substitution. PMID:25081504

Gagala, J; Tarczynska, M; Gaweda, K; Matuszewski, L

2014-09-01

151

Bilayered silk/silk-nanoCaP scaffolds for osteochondral tissue engineering: In vitro and in vivo assessment of biological performance.  

PubMed

Novel porous bilayered scaffolds, fully integrating a silk fibroin (SF) layer and a silk-nano calcium phosphate (silk-nanoCaP) layer for osteochondral defect (OCD) regeneration, were developed. Homogeneous porosity distribution was achieved in the scaffolds, with calcium phosphate phase only retained in the silk-nanoCaP layer. The scaffold presented compressive moduli of 0.4MPa in the wet state. Rabbit bone marrow mesenchymal stromal cells (RBMSCs) were cultured on the scaffolds, and good adhesion and proliferation were observed. The silk-nanoCaP layer showed a higher alkaline phosphatase level than the silk layer in osteogenic conditions. Subcutaneous implantation in rabbits demonstrated weak inflammation. In a rabbit knee critical size OCD model, the scaffolds firmly integrated into the host tissue. Histological and immunohistochemical analysis showed that collagen II positive cartilage and glycosaminoglycan regeneration presented in the silk layer, and de novo bone ingrowths and vessel formation were observed in the silk-nanoCaP layer. These bilayered scaffolds can therefore be promising candidates for OCD regeneration. PMID:25449920

Yan, Le-Ping; Silva-Correia, Joana; Oliveira, Mariana B; Vilela, Carlos; Pereira, Hélder; Sousa, Rui A; Mano, João F; Oliveira, Ana L; Oliveira, Joaquim M; Reis, Rui L

2015-01-15

152

The effect of cartilage and bone density of mushroom-shaped, photooxidized, osteochondral transplants: an experimental study on graft performance in sheep using transplants originating from different species  

PubMed Central

Background Differences in overall performance of osteochondral photooxidized grafts were studied in accordance of their species origin and a new, more rigorous cleansing procedure using alcohol during preparation. Methods Photooxidized mushroom-shaped grafts of bovine, ovine, human and equine origin were implanted in the femoral condyles of 32 sheep (condyles: n = 64). No viable chondrocytes were present at the time of implantation. Grafts were evaluated at 6 months using plastic embedded sections of non-decalcified bone and cartilage specimens. Graft incorporation, the formation of cyst-like lesions at the base of the cartilage junction as well as cartilage morphology was studied qualitatively, semi-quantitatively using a score system and quantitatively by performing histomorphometrical measurements of percentage of bone and fibrous tissue of the original defects. For statistical analysis a factorial analysis of variance (ANOVA- test) was applied. Results Differences of graft performance were found according to species origin and cleansing process during graft preparation. According to the score system cartilage surface integrity was best for equine grafts, as well as dislocation or mechanical stability. The equine grafts showed the highest percentage for bone and lowest for fibrous tissue, resp. cystic lesions. The new, more rigorous cleansing process decreased cartilage persistence and overall graft performance. Conclusion Performance of grafts from equine origin was better compared to bovine, ovine and human grafts. The exact reason for this difference was not proven in the current study, but could be related to differences in density of cartilage and subchondral bone between species. PMID:16356173

Waselau, Anja C; Nadler, Daniel; Müller, Jessika MV; Zlinszky, Katalin; Hilbe, Monika; Auer, Jörg A; von Rechenberg, Brigitte

2005-01-01

153

Type IX collagen gene mutations can result in multiple epiphyseal dysplasia that is associated with osteochondritis dissecans and a mild myopathy  

PubMed Central

Multiple epiphyseal dysplasia (MED) is a clinically variable and genetically heterogeneous disease that is characterized by mild short stature and early onset osteoarthritis. Autosomal dominant forms are caused by mutations in the genes that encode type IX collagen, cartilage oligomeric matrix protein, and matrilin-3: COL9A1, COL9A2, COL9A3, COMP, and MATN3, respectively. Splicing mutations have been identified in all three genes encoding type IX collagen and are restricted to specific exons encoding an equivalent region of the COL3 domain in all three ?(IX) chains. MED has been associated with mild myopathy in some families, in particular one family with a COL9A3 mutation and two families with C-terminal COMP mutations. In this study we have identified COL9A2 mutations in two families with MED that also have osteochondritis dissecans and mild myopathy. This study therefore extends the range of gene-mutations that can cause MED-related myopathy. © 2010 Wiley-Liss, Inc. PMID:20358595

Jackson, Gail C; Marcus-Soekarman, Dominique; Stolte-Dijkstra, Irene; Verrips, Aad; Taylor, Jacqueline A; Briggs, Michael D

2010-01-01

154

Improved quality of cartilage repair by bone marrow mesenchymal stem cells for treatment of an osteochondral defect in a cynomolgus macaque model.  

PubMed

Background and purpose - Integration of repaired cartilage with surrounding native cartilage is a major challenge for successful tissue-engineering strategies of cartilage repair. We investigated whether incorporation of mesenchymal stem cells (MSCs) into the collagen scaffold improves integration and repair of cartilage defects in a cynomolgus macaque model. Methods - Cynomolgus macaque bone marrow-derived MSCs were isolated and incorporated into type-I collagen gel. Full-thickness osteochondral defects (3 mm in diameter, 5 mm in depth) were created in the patellar groove of 36 knees of 18 macaques and were either left untreated (null group, n = 12), had collagen gel alone inserted (gel group, n = 12), or had collagen gel incorporating MSCs inserted (MSC group, n = 12). After 6, 12, and 24 weeks, the cartilage integration and tissue response were evaluated macroscopically and histologically (4 null, 4 gel, and 4 MSC knees at each time point). Results - The gel group showed most cartilage-rich reparative tissue covering the defect, owing to formation of excessive cartilage extruding though the insufficient subchondral bone. Despite the fact that a lower amount of new cartilage was produced, the MSC group had better-quality cartilage with regular surface, seamless integration with neighboring naïve cartilage, and reconstruction of trabecular subchondral bone. Interpretation - Even with intensive investigation, MSC-based cell therapy has not yet been established in experimental cartilage repair. Our model using cynomolgus macaques had optimized conditions, and the method using MSCs is superior to other experimental settings, allowing the possibility that the procedure might be introduced to future clinical practice. PMID:25175660

Araki, Susumu; Imai, Shinji; Ishigaki, Hirohito; Mimura, Tomohiro; Nishizawa, Kazuya; Ueba, Hiroaki; Kumagai, Kousuke; Kubo, Mitsuhiko; Mori, Kanji; Ogasawara, Kazumasa; Matsusue, Yoshitaka

2015-02-01

155

Bone Cysts After Osteochondral Allograft Repair of Cartilage Defects in Goats Suggest Abnormal Interaction Between Subchondral Bone and Overlying Synovial Joint Tissues  

PubMed Central

The efficacy of osteochondral allografts (OCA) may be affected by osseous support of the articular cartilage, and thus affected by bone healing and remodeling in the OCA and surrounding host. Bone cysts, and their communication pathways, may be present in various locations after OCA insertion and reflect distinct pathogenic mechanisms. Previously, we analyzed the effect of OCA storage (FRESH, 4°C/14d, 4°C/28d, FROZEN) on cartilage quality in fifteen adult goats after 12 months in vivo. The objectives of this study were to further analyze OCA and contralateral non-operated (Non-Op) CONTROLS from the medial femoral condyle to (1) determine the effect of OCA storage on local subchondral (ScB) and trabecular (TB) bone structure, (2) characterize the location and structure of bone cysts and channels, and (3) assess the relationship between cartilage and bone properties. (1) Overall bone structure after OCA was altered compared to Non-Op, with OCA samples displaying bone cysts, ScB channels, and ScB roughening. ScB BV/TV in FROZEN OCA was lower than Non-Op and other OCA. TB BV/TV in FRESH, 4°C/14d, and 4°C/28d OCA did not vary compared to Non-Op, but BS/TV was lower. (2) OCA contained “basal” cysts, localized to deeper regions, some “subchondral” cysts, localized near the bone-cartilage interface, and some ScB channels. TB surrounding basal cysts exhibited higher BV/TV than Non-Op. (3) Basal cysts occurred (a) in isolation, (b) with subchondral cysts and ScB channels, (c) with ScB channels, or (d) with subchondral cysts, ScB channels, and ScB erosion. Deterioration of cartilage gross morphology was strongly associated with abnormal ?CT bone structure. Evidence of cartilage-bone communication following OCA repair may favor fluid intrusion as a mechanism for subchondral cyst formation, while bone resorption at the graft-host interface without affecting overall bone and cartilage structure may favor bony contusion mechanism for basal cyst formation. These findings suggest that cysts occurring after OCA may result from aberrant mechanobiology due to (1) altered compartmentalization that normally separates overlying cartilage and subchondral bone, either from distinct ScB channels or more general ScB plate deterioration, and (2) bone resorption at the basal graft-host interface. PMID:23958821

Pallante-Kichura, Andrea L.; Cory, Esther; Bugbee, William D.; Sah, Robert L.

2013-01-01

156

Influence of the gel thickness on in vivo hyaline cartilage regeneration induced by double-network gel implanted at the bottom of a large osteochondral defect: Short-term results  

PubMed Central

Background A double-network (DN) gel, which is composed of poly(2-acrylamido-2-methylpropanesulfonic acid) and poly(N,N’-dimethyl acrylamide), can induce hyaline cartilage regeneration in vivo in a large osteochondral defect. The purpose of this study was to clarify the influence of the thickness of the implanted DN gel on the induction ability of hyaline cartilage regeneration. Methods Thirty-eight mature rabbits were used in this study. We created an osteochondral defect having a diameter of 4.3-mm in the patellofemoral joint. The knees were randomly divided into 4 groups (Group I: 0.5-mm thick gel, Group II: 1.0-mm thick gel, Group III: 5.0-mm thick gel, and Group IV: untreated control). Animals in each group were further divided into 3 sub-groups depending on the gel implant position (2.0-, 3.0-, or 4.0-mm depth from the articular surface) in the defect. The regenerated tissues were evaluated with the Wayne’s gross and histological grading scales and real time PCR analysis of the cartilage marker genes at 4 weeks. Results According to the total Wayne’s score, when the depth of the final vacant space was set at 2.0 mm, the scores in Groups I, II, and III were significantly greater than that Group IV (p?

2013-01-01

157

Osteochondral Interface Tissue Engineering using Macroscopic Gradients of Physicochemical Signals  

E-print Network

The field of tissue engineering has continually been described as "cells, signals, and scaffolds." The current thesis work describes the evaluation of a continuously-graded microsphere-based scaffold technology for the regeneration...

Dormer, Nathan Henry

2011-04-25

158

Harnessing Cell–Biomaterial Interactions for Osteochondral Tissue Regeneration  

PubMed Central

Articular cartilage that is damaged or diseased often requires surgical intervention to repair the tissue; therefore, tissue engineering strategies have been developed to aid in cartilage regeneration. Tissue engineering approaches often require the integration of cells, biomaterials, and growth factors to direct and support tissue formation. A variety of cell types have been isolated from adipose, bone marrow, muscle, and skin tissue to promote cartilage regeneration. The interaction of cells with each other and with their surrounding environment has been shown to play a key role in cartilage engineering. In tissue engineering approaches, biomaterials are commonly used to provide an initial framework for cell recruitment and proliferation and tissue formation. Modifications of the properties of biomaterials, such as creating sites for cell binding, altering their physicochemical characteristics, and regulating the delivery of growth factors, can have a significant influence on chondrogenesis. Overall, the goal is to completely restore healthy cartilage within an articular cartilage defect. This chapter aims to provide information about the importance of cell–biomaterial interactions for the chondrogenic differentiation of various cell populations that can eventually produce functional cartilage matrix that is indicative of healthy cartilage tissue. PMID:21975954

Kim, Kyobum; Yoon, Diana M.; Mikos, Antonios G.

2013-01-01

159

Osteochondral Tissue Engineering for the TMJ Condyle Using a Novel Gradient Scaffold  

E-print Network

Table 3.4: Gradient-based implant design approaches .. .......................................... 232 Table 3.5: Concentration/surface density gradients of peptides and proteins .. ....... 233 Table 3.6: Methods to create peptides and proteins... The organization of the remaining chapters is as follows: Chapters 2 and 3 serve to provide background information, where the literature pertinent to the subsequent chapters is comprehensively reviewed. In Chapter 2, a review of the biomechanical properties...

Singh, Milind

2008-10-22

160

Journal of Biomechanics 36 (2003) 18531864 Anatomically shaped osteochondral constructs for  

E-print Network

integrated with trabecular bone, no adverse diffusion limitation effects were observed. Anatomically shaped (Ahsan et al., 1999; Harper, 1988), enzymatic treatments (Caplan et al., 1997), laser solder welding

Lu, Helen H.

161

Subchondral pre-solidified chitosan/blood implants elicit reproducible early osteochondral  

E-print Network

: In this study we evaluated a novel approach to guide the bone marrow-driven articular cartilage repair response in skeletally aged rabbits. We hypothesized that dispersed chitosan particles implanted close to the bone marrow attracted neutrophils, osteoclasts and abundant bone marrow-derived stromal cells, stimulated bone

Buschmann, Michael

162

Evaluating osteochondral defect repair potential of autologous rabbit bone marrow cells on type II collagen scaffold  

Microsoft Academic Search

The feasibility of using genipin cross-linked type II collagen scaffold with rabbit bone marrow mesenchymal stem cells (RBMSCs)\\u000a to repair cartilage defect was herein studied. Induction of RBMSCs into chondrocytic phenotype on type II collagen scaffold\\u000a in vitro was conducted using TGF-? 3 containing medium. After 3-weeks of induction, chondrocytic behavior, including marker\\u000a genes expression and specific extracellular matrix (ECM)

Wei-Chuan Chen; Chao-Ling Yao; Yu-Hong Wei; I-Ming Chu

2011-01-01

163

Imaging of acute injuries of the articular surfaces (chondral, osteochondral and subchondral fractures)  

Microsoft Academic Search

Fractures involving the articulating surfaces of bone are a common cause of chronic disability after joint injury. Acute fractures\\u000a of the articular surface typically run parallel to the surface and are confined to the cartilage and\\/or the immediate subchondral\\u000a cancellous bone. They should be distinguished from vertical or oblique bone fractures with intra-articular extension. This\\u000a article reviews the mechanism of

Klaus Bohndorf

1999-01-01

164

Disease-specific clinical problems associated with the subchondral bone  

Microsoft Academic Search

The subchondral bone is involved in a variety of diseases affecting both the articular cartilage and bone. Osteochondral defects\\u000a in distinct locations and of variable sizes are the final results of different etiologies. These include traumatic osteochondral\\u000a defects, osteochondritis dissecans, osteonecrosis, and osteoarthritis. Traumatic osteochondral defects are caused by osteochondral\\u000a fractures, separating an osteochondral fragment that includes articular cartilage and

Dietrich Pape; Giuseppe Filardo; Elisaveta Kon; C. Niek van Dijk; Henning Madry

2010-01-01

165

Genetics of osteochondral disease and its relationship with meat quality and quantity, growth, and feed conversion traits in pigs.  

PubMed

The main objective of this research was to estimate heritabilities of seven osteochondrosis (OC) lesions in station-tested pigs and their genetic and phenotypic correlations with four meat quality (MQ) traits, the percentage of premium cuts (PPC), daily weight gain (DWG), and feed conversion ratio (FCR). Observed OC lesions were on the head of humerus (HK), condylus medialis humeri (CMH), condylus lateralis humeri (CLH), radius and ulna proximal (RUP), distal epiphyseal cartilage of ulna (DEU), head of femur (FK), and condylus medialis femoris (CMF). Meat quality traits were i.m. fat (IMF), muscle pH at 1 h after slaughter (pH1), muscle pH at 30 h after slaughter (pH30), and light reflectance on muscle (H30). The data set comprised 2,710 animals, of which 1,291 animals had OC records. All traits were analyzed by multiple-trait linear mixed model, with the animal's genetic and common litter effects as random. Fixed effects in the model varied between traits. Each OC lesion was further analyzed by a univariate generalized linear mixed model or, equivalently, "threshold models," assuming logistic, probit (normal), and Poisson distributions of the underlying "liability" to the disease. For OC lesions, estimates of heritability were low on the original "incidence" scale (0.06 for HK to 0.16 for CLH) and moderate to high on the liability scale (0.08 to 0.42). Genetic correlations (r(g)) between OC lesions and most MQ traits and PPC were generally unfavorable. Significant r(g) were -0.44 for DWG-CMH, 0.31 for DWG-CMF, 0.40 for FCR-HK, 0.21 for PPC-CLH, 0.32 for PPC-RUP, 0.30 for PPC-CMF, -0.54 for pH1-CLH, 0.47 for pH1-DEU, -0.34 for pH30-CMH, 0.58 for pH30-DEU, -0.50 for H30-HK, -0.31 for H30-DEU, and 0.31 for H30-CMF. Genetic susceptibilities to some OC lesions within the front leg were positively related to each other (r(g) range = 0.57 to 0.69), but r(g) between front and hind leg OC lesions were mostly negative (range = -0.21 to -0.40). Estimated h2 was 0.60 for PPC, and ranged from 0.12 to 0.66 for MQ traits, 0.28 for DWG, and 0.42 for FCR. Genetic correlations among meat quality and quantity traits ranged from -0.66 to 0.37. This is the first study to report genetic and phenotypic correlations between OC lesions and several meat quality and quantity traits in pigs. These findings will be useful to pig industry, especially in designing breeding programs for robust pigs. PMID:15542457

Kadarmideen, H N; Schwörer, D; Ilahi, H; Malek, M; Hofer, A

2004-11-01

166

Disease-specific clinical problems associated with the subchondral bone.  

PubMed

The subchondral bone is involved in a variety of diseases affecting both the articular cartilage and bone. Osteochondral defects in distinct locations and of variable sizes are the final results of different etiologies. These include traumatic osteochondral defects, osteochondritis dissecans, osteonecrosis, and osteoarthritis. Traumatic osteochondral defects are caused by osteochondral fractures, separating an osteochondral fragment that includes articular cartilage and both subchondral and trabecular bone from the joint surface. In osteochondritis dissecans, the disease originates in the subchondral bone and secondarily affects the articular cartilage. Location, stage, size, and depth of osteochondral lesions play a role in the treatment of traumatic osteochondral defects and osteochondritis dissecans. Surgical options include fragment refixation, transplantation of osteochondral autografts, or bone restoration by impacted cancellous bone grafts combined with autologous chondrocyte transplantation. An insufficiency fracture of the subchondral bone may be the initiating factor of what was formerly believed to be a spontaneous osteonecrosis of the knee (SPONK). Recent histopathological studies suggest that each stage of SPONK reflects different types of bone repair reactions following a fracture of the subchondral bone plate. Osteoarthritis is a disease that does affect not only the articular cartilage, but also the subchondral bone. Reconstructive surgical techniques aim at preserving joint function, inducing fibrocartilaginous repair, and at correcting malalignment. This review summarizes the current status of the clinical treatment of traumatic osteochondral defects, osteochondritis dissecans, osteonecrosis, and osteoarthritis as they affect the subchondral bone region and its adjacent structures. PMID:20151111

Pape, Dietrich; Filardo, Giuseppe; Kon, Elisaveta; van Dijk, C Niek; Madry, Henning

2010-04-01

167

A novel osteochondral composite consisting of a self-assembling peptide hydrogel and 3D printed polycaprolactone scaffold : potential for articular cartilage repair  

E-print Network

Degenerative diseases, such as osteoarthritis, and traumatic injuries are both prominent causes of cartilage defects. Due to its avascular nature, adult human cartilage displays limited capacity for regeneration. Current ...

Saatchi, Sanaz, 1980-

2004-01-01

168

Penetrating Blast Injury to the Knee of a United States Soldier Treated with Allograft Mosaicplasty  

Microsoft Academic Search

Objective: This is the first report of successful allograft mosaicplasty treatment of a large osteochondral lesion of the knee caused by a blast fragment sustained during combat operations. The patient was able to return to active duty following rehabilitation. Methods: An active-duty infantryman sustained an osteochondral lesion of the medial femoral condyle caused by a metallic fragment of an explosively

Maj. Josef K. Eichinger; Eric M. Bluman; Col. Edward D. Arrington

2011-01-01

169

Overview of cartilage biology and new trends in cartilage stimulation.  

PubMed

This article reviews the basics of articular cartilage biology, which provide a necessary foundation for understanding the evolving field of articular cartilage injury and repair. The currently popular treatment options for osteochondral injury (microfracture, osteochondral autograft transfer system, osteochondral allograft, autologous chondrocyte implantation, and the use of scaffolds with autologous chondrocyte implantation) document the significant advances made in this area in the past 2 decades. Integration of newly available information and technology derived from advances in molecular biology and tissue engineering holds even greater promise for continued advances in optimal management of this challenging problem. PMID:23465945

Triche, Rachel; Mandelbaum, Bert R

2013-03-01

170

MRI of Cartilage: Pathological Findings  

Microsoft Academic Search

\\u000a The most important clinical indications for magnetic resonance imaging (MRI) are assessment of cartilage in osteoarthritis\\u000a (OA), chronic or acute osteochondral injury including sports injuries, osteochondritis dissecans, chondromalacia patellae,\\u000a and inflammatory arthropathies (in particular before invasive therapy). In addition dedicated cartilage imaging is required\\u000a after invasive cartilage repair procedures or conservative therapies, including pharmacological therapies, to monitor treatment\\u000a effect. MR

Thomas M. Link

171

Epidemiology and imaging of the subchondral bone in articular cartilage repair  

Microsoft Academic Search

Articular cartilage and the subchondral bone act as a functional unit. Following trauma, osteochondritis dissecans, osteonecrosis\\u000a or osteoarthritis, this intimate connection may become disrupted. Osteochondral defects—the type of defects that extend into\\u000a the subchondral bone—account for about 5% of all articular cartilage lesions. They are very often caused by trauma, in about\\u000a one-third of the cases by osteoarthritis and rarely

Jacques Menetrey; Florence Unno-Veith; Henning Madry; Iwan Van Breuseghem

2010-01-01

172

Nutraceutical Therapies for Degenerative Joint Diseases: A Critical Review  

Microsoft Academic Search

There is growing recognition of the importance of nutritional factors in the maintenance of bone and joint health, and that nutritional imbalance combined with endocrine abnormalities may be involved in the pathogenesis of osteoarthritis (OA) and osteochondritis dissecans (OCD). Despite this, dietary programs have played a secondary role in the management of these connective tissue disorders. Articular cartilage is critically

Robert Goggs; Anne Vaughan-Thomas; Peter D. Clegg; Stuart D. Carter; John F. Innes; Ali Mobasheri; Mehdi Shakibaei; Wolfgang Schwab; Carolyn A. Bondy

2005-01-01

173

Cartilage repair techniques of the talus: An update  

PubMed Central

Symptomatic chondral or osteochondral defects of the talus reduce the quality of life of many patients. Although their pathomechanism is well understood, it is well known that different aetiologic factors play a role in their origin. Additionally, it is well recognised that the talar articular cartilage strongly differs from that in the knee. Despite this fact, many recommendations for the management of talar cartilage defects are based on approaches that were developed for the knee. Conservative treatment seems to work best in paediatric and adolescent patients with osteochondritis dissecans. However, depending on the size of the lesions, surgical approaches are necessary to treat many of these defects. Bone marrow stimulation techniques may achieve good results in small lesions. Large lesions may be treated by open procedures such as osteochondral autograft transfer or allograft transplantation. Autologous chondrocyte transplantation, as a restorative procedure, is well investigated in the knee and has been applied in the talus with increasing popularity and promising results but the evidence to date is poor. The goals of the current article are to summarise the different options for treating chondral and osteochondral defects of the talus and review the available literature. PMID:25035819

Baums, Mike H; Schultz, Wolfgang; Kostuj, Tanja; Klinger, Hans-Michael

2014-01-01

174

New developments in osteoarthritis. Posttraumatic osteoarthritis: pathogenesis and pharmacological treatment options  

Microsoft Academic Search

Joint trauma can lead to a spectrum of acute lesions, including osteochondral fractures, ligament or meniscus tears and damage to the articular cartilage. This is often associated with intraarticular bleeding and causes posttraumatic joint inflammation. Although the acute symptoms resolve and some of the lesions can be surgically repaired, joint injury triggers a chronic remodeling process in cartilage and other

Martin K Lotz

2010-01-01

175

Hip Arthroscopic Management for Femoral Head Fractures and Posterior Acetabular Wall Fractures (Pipkin Type IV)  

PubMed Central

Femoral head fractures associated with acetabular fractures are usually treated by an open method. After a closed reduction of a hip dislocation, open reduction and internal fixation of acetabular fractures usually depend on the type of acetabular fracture. Acetabular fractures associated with femoral head fractures, torn labrums, or osteochondral fractures are often managed simultaneously by a posterior approach. The patient in this study was referred to us because of pain and limited motion after open reduction and internal fixation of an acetabular fracture. Postoperative computed tomography showed remnant osteochondral fragments located in the cotyloid fossa. Using hip arthroscopy, we found a torn labrum and multiple osteochondral fragments in the cotyloid fossa. The avulsed torn labrum was reattached with 2 anchors through the midanterior portal. Osteochondral fragments were curetted and removed. This article reviews the treatment of the torn labrum and multiple fragments after acetabular fracture reduction. The patient recovered immediately and had a satisfactory outcome. We conclude that hip arthroscopy is a valuable option for treating femoral head fracture dislocations associated with acetabular fractures. PMID:24265988

Park, Myung-Sik; Yoon, Sun-Jung; Choi, Seung-Min

2013-01-01

176

Tibiofemoral joint contact forces in sheep  

Microsoft Academic Search

Although the sheep has become a standard model for understanding the mechanical conditions that occur after injury and investigating surgical treatments such as osteochondral defect healing and ligament reconstruction, no study has yet evaluated the contact forces that occur in the sheep tibio-femoral joint in vivo. In this study, bone pins, together with reflective markers, were used to measure the

William R. Taylor; Rainald M. Ehrig; Markus O. Heller; Hanna Schell; Petra Seebeck; Georg N. Duda

2006-01-01

177

Comparative study of elbow disorders in young high-performance gymnasts.  

PubMed

The study aimed to investigate the prognosis of osteochondral affection (e.g., osteochondritis dissecans (OCD), cartilage lesions, fractures and bone edema in the elbows of high-performance gymnasts (n=30) compared to prognosis results with athletes not undergoing excessive stress on the upper extremity (n=29). The study also tested a novel isotropic 3D-FSE-sequence (CUBE) technique as an early diagnostic modality. Standard protocol was used to conduct the MRI examinations, which were then compared to results from the CUBE - sequence. The gymnast group (p=0.012) presented a significantly higher prevalence of complaints in the elbow joint compared to the other athlete group. Furthermore, osteochondral lesions in MRIs appeared more frequently in the group of gymnasts (n=10, 33%, p=0.033), including 7 cases (23%) of OCD. In the control athlete group 2 asymptomatic cases of OCD and one case of bone edema were detected. The MRI investigation with the CUBE - sequence showed similar results as the standard MRI protocol in terms of the diagnosis sensitivity. The current study indicates that juvenile gymnasts are at a higher risk for osteochondral lesions of the elbow than athletes without excessive stress on the upper extremities. PMID:24863726

Dexel, J; Marschner, K; Beck, H; Platzek, I; Wasnik, S; Schuler, M; Nasreddin, A; Kasten, P

2014-10-01

178

Articular cartilage repair using a resorbable matrix scaffold.  

PubMed

The creation of cartilage repair tissue relies on the implantation or neosynthesis of cartilage matrix elements. One cartilage repair strategy involves the implantation of bioabsorbable matrices that immediately fill a chondral or osteochondral defect. Such matrices support the local migration of chondrogenic or osteogenic cells that ultimately synthesize new ground substance. One such matrix scaffold, a synthetic resorbable biphasic implant (TruFit Plug; Smith & Nephew, San Antonio, TX), is a promising device for the treatment of osteochondral voids. The implant is intended to serve as a scaffold for native marrow elements and matrix ingrowth in chondral defect repair. The device is a resorbable tissue regeneration scaffold made predominantly from polylactide-coglycolide copolymer, calcium sulfate, and polyglycolide. It is approved in Europe for the treatment of acute focal articular cartilage or osteochondral defects but is approved by the US Food and Drug Administration only for backfill of osteochondral autograft sites. Preclinical studies demonstrated restoration of hyaline-like cartilage in a goat model with subchondral bony incorporation at 12 months. Early clinical results of patients enrolled in the Hospital for Special Surgery Cartilage Registry have been favorable, with a good safety profile. PMID:18399610

Williams, Riley J; Gamradt, Seth C

2008-01-01

179

[Treatment of a partial avascular necrosis of a metacarpal head (Morbus Mauclaire Dieterich's Disease) utilizing the ostechondral autograft transfer system (OATS) technique].  

PubMed

The OATS (osteochondral autograft transfer system) is a standardized technique for the treatment of aseptic osteonecrosis of the knee and ankle. We show the first use and successful course of the OAT System for the treatment of a partial aseptic necrosis of a metacarpal head. PMID:22382907

Braun, B J; Brandenburg, L-O; Braun, C

2012-01-01

180

Mineral density and penetration strength of the subchondral bone plate of the talar dome: high correlation and specific distribution patterns.  

PubMed

The subchondral bone plate plays an important role in stabilizing the osteochondral joint unit and in the pathomechanism of osteochondral lesions and osteoarthritis. The objective of the present study was to measure the mineral density distribution and subchondral bone plate penetration strength of the talar dome joint facet to display and compare the specific distribution patterns. Ten cadaver specimens were used for computed tomography (CT) scans, from which densitograms were derived using CT-osteoabsorptiometry, and for mechanical indentation testing from which the penetration strength was obtained. Our results showed 2 different distribution patterns for mineral density and penetration strength. Of the 10 specimens, 6 (60%) showed bicentric maxima (anteromedially and anterolaterally), and 4 (40%) showed a monocentric maximum (either anteromedially or anterolaterally). A highly significant correlation (p < .0001) for both methods confirmed that the mineral density relied on local load characteristics. In conclusion, the biomechanical properties of the subchondral bone plate of the talar dome joint facet showed specific distribution patterns. CT-osteoabsorptiometry is a reliable method to display the mineral density distribution noninvasively. We recommend CT-osteoabsorptiometry for noninvasive analysis of the biomechanical properties of the subchondral bone plate in osteochondral joint reconstruction and the prevention and treatment of osteoarthritis and osteochondral lesions. PMID:25451205

Leumann, André; Valderrabano, Victor; Hoechel, Sebastian; Göpfert, Beat; Müller-Gerbl, Magdalena

2015-01-01

181

Arthroscopic Distal Clavicular Autograft for Treating Shoulder Instability With Glenoid Bone Loss  

PubMed Central

Glenoid bone loss is a significant risk factor for failure after arthroscopic shoulder stabilization. Multiple options are available to reconstruct this bone loss, including coracoid transfer, iliac crest bone graft, and osteoarticular allograft. Each technique has strengths and weaknesses. Coracoid grafts are limited to anterior augmentation and, along with iliac crest, do not provide an osteochondral reconstruction. Osteochondral allografts do provide a cartilage source but are challenged by the potential for graft rejection, infection, cost, and availability. We describe the use of a distal clavicular osteochondral autograft for bony augmentation in cases of glenohumeral instability with significant bone loss. This graft has the advantages of being readily available and cost-effective, it provides an autologous osteochondral transplant with minimal donor-site morbidity, and it can be used in both anterior and posterior bone loss cases. The rationale and technical aspects of arthroscopic performance will be discussed. Clinical studies are warranted to determine the outcomes of the use of the distal clavicle as a graft in shoulder instability. PMID:25264509

Tokish, John M.; Fitzpatrick, Kelly; Cook, Jay B.; Mallon, William J.

2014-01-01

182

Drilling and microfracture lead to different bone structure and necrosis during bone-marrow stimulation for cartilage repair  

Microsoft Academic Search

Bone marrow stimulation is performed using several surgical techniques that have not been systematically compared or optimized for a desired cartilage repair outcome. In this study, we investigated acute osteochondral characteristics following microfracture and comparing to drilling in a mature rabbit model of cartilage repair. Microfracture holes were made to a depth of 2 mm and drill holes to either

Hongmei Chen; Jun Sun; Caroline D. Hoemann; Viorica Lascau-Coman; Wei Ouyang; Marc D. McKee; Matthew S. Shive; Michael D. Buschmann

2009-01-01

183

Retrograde cartilage transplantation on the proximal and distal tibia.  

PubMed

The authors, with experience with more than 400 osteochondral autograft transplantation (OATS) cases since 1996, report a new technique of a retrograde osteochondral autograft transplantation for the treatment of isolated osteochondral lesions of the proximal and the distal tibia started in 1999. We treated 5 patients, 3 who presented with painful traumatic chondral defects in the central weight-bearing portion of the tibial plateau (1 in the medial and 2 in the lateral compartment), and 2 who presented with painful chondral lesions on the distal tibia. An anterior cruciate ligament (ACL) drill guide positioned in the center of the defect was used to accurately prepare the cartilage surface, in one case arthroscopically and in 4 cases through an open incision. A guide-wire was introduced and drilled through the tibia, and a cannulated reamer equal to the diameter of the defect was advanced. An osteochondral cylinder was harvested from the non-weight-bearing zone of the femoral trochlea at the angle that corresponded to the angle on the ACL drill guide. The autograft was inserted in a retrograde fashion from the cortical window into the tibial tunnel to be flush with the articular surface in press-fit technique. The remaining tunnel defect between the cortical window on the tibia and the distal aspect of the autograft was filled with a cancellous bony cylinder and secured with a diagonal bioabsorbable screw. A concomitant varus deformity with the lesion on the medial tibial plateau was corrected in the same surgery using a high tibial osteotomy to relieve stress on the graft. Patients were followed up for 6 to 35 months. A complete healing of the grafts was seen in control magnetic resonance images (MRIs). All patients were satisfied with the surgery. Control arthroscopies showed the osteochondral cylinders well integrated and flush with the articular surface. PMID:14716283

Ueblacker, Peter; Burkart, Andreas; Imhoff, Andreas Balthasar

2004-01-01

184

Continuous passive motion following cartilage surgery: does a common protocol exist?  

PubMed

Continuous passive motion (CPM) devices have the potential to improve the histological content as well as the rate and volume of chondrogenesis in repair tissue following chondral injury. However, clinical evidence is lacking to support broad implementation of CPM following cartilage restoration procedures. We searched PubMed, CINAHL, SPORTDiscus, and Cochrane for such terms as knee, continuous passive motion, CPM, ACI, ACT, autologous chondrocyte implantation, autologous chondrocyte transplantation, microfracture, marrow-stimulation technique, mosaicplasty, osteochondral autograft, and osteochondral allograft. Inclusion criteria were all English-language studies of human subjects, evidence levels I to IV, reporting the use of CPM following cartilage repair or restoration surgery in the knee. One hundred and seven studies met inclusion criteria. Sixty-three studies reported the use of CPM following autologous chondrocyte implantation; 28 reported the use of CPM following microfracture; 13 reported the use of CPM following osteochondral autograft; and 15 reported the use of CPM following osteochondral allograft (several studies reported > 1 type of cartilage procedure, which explains why the sum of all studies reporting a particular procedure [119] is greater than the number of studies included in the review [107]). Of the 5723 patients included, 60.8% were treated with autologous chondrocyte implantation, 23.1% were treated with microfracture, 6.4% were treated with osteochondral autograft, and 9.7% were treated with osteochondral allograft. Of the 6612 total defects, 5043 (76.3%) were tibiofemoral and 1569 (23.7%) were patellofemoral. Most reports of CPM use after cartilage restoration procedures did not include specific information on how it was implemented. Overall, the description of CPM protocols in published knee articular cartilage surgery studies was disappointing. The majority of studies did not describe common variables such as the duration of CPM therapy, the initiation of CPM therapy, and the initial range of motion used. The most commonly prescribed parameters within a CPM regimen are initiated on the first postoperative day, with an initial range-of-motion of 0 to 30 degrees and a frequency of 1 cycle per minute, and for 6 to 8 hours daily over 6 weeks. The lack of consistent standardized reporting of postoperative CPM protocols provides an impetus to researchers and clinicians to more clearly define and describe their use following knee articular surgery. PMID:24231597

Karnes, Jonathan M; Harris, Joshua D; Griesser, Michael J; Flanigan, David C

2013-11-01

185

Imaging pediatric sports injuries: lower extremity.  

PubMed

Injuries to pediatric athletes, which are becoming increasingly common, take the form of acute injuries and chronic overuse injuries. Acute injuries of the lower extremity include avulsions of the pelvic apophyses, muscle-tendon injuries, transient dislocation of the patella, ankle sprains, and acute tears of the anterior cruciate ligament and menisci. Magnetic resonance (MR) imaging of the latter 2 injuries should approach the accuracy of MR imaging of the adult knee. Chronic overuse injuries of the lower extremity in this age group include stress fractures, which are most common in the tibia; ankle impingement syndromes; osteochondritis dissecans of the knee and osteochondral lesions of the talus; and traction apophysitis, most commonly presenting as Osgood-Schlatter disease and Sinding-Larsen-Johannson disease, affecting the patellar tendon. Imaging findings of all these lesions are characteristic, and allow radiologists to assist their clinical colleagues in diagnosing and treating pediatric athletic injuries. PMID:21094407

Davis, Kirkland W

2010-11-01

186

Outcomes in orthopedics and traumatology: translating research into practice  

PubMed Central

Clinical research is focused in generating evidence that is feasible to be applicable to practitioners. However, translating research-focused evidence into practice may be challenging and often misleading. This article aims is to pinpoint these challenges and suggest some methodological safeguards, taking platelet-rich plasma therapies and knee osteochondral injuries as examples. Studies and systematic reviews involving the following concepts will be investigated: clinically relevant outcomes, systematic errors on sample calculation, internal and external validity. Relevant studies on platelet-rich plasma for muscle-tendon lesions and updates on osteochondral lesions treatment were included in this analysis. Authors and clinicians should consider these concepts for the implementation and application of dissemination of the best evidence. Research results should be challenged by a weighted analysis of its methodological soundness and applicability. Level of Evidence V, Therapeutic Studies - Investigating the Results of Treatment.

de Moraes, Vinícius Ynoe; Ferrari, Paula Martins de Oliveira; Gracitelli, Guilherme Conforto; Faloppa, Flávio; Belloti, João Carlos

2014-01-01

187

Subchondral nacre implant in the articular zone of the sheep's knee: a pilot study.  

PubMed

The present study was designed to analyze the intra-articular behaviour of nacre, when implanted in the subchondral bone area in the sheep knee. We implanted nacre blocks in sheep's trochlea by replacing the half of the femoral trochlea (nacre group). For comparison we used complete cartilage resection (resection group) down to the subchondral bone. In the "nacre group", implants were well tolerated without any synovial inflammation. In addition, we observed centripetal regrowth of new cartilage after 3 months. In the "resection group", no chondral regrowth was observed, but, in contrast, a thin layer of fibrous tissue was formed. After 6 months, a new tissue covered the nacre implant formed by an osteochondral regrowth. Nacre, as a subchondral implant, exerts benefic potential for osteochondral repair. PMID:22785366

Rousseau, Marthe; Delattre, Olivier; Gillet, Pierre; Lopez, Evelyne

2012-01-01

188

Oral hyaluronan gel reduces post operative tarsocrural effusion in the yearling Thoroughbred  

Microsoft Academic Search

Summary Reasons for performing study: Hyaluronan (HA) has been used to treat joint disease via intra-articular, i.v. and oral administration. The efficacy of intra-articular and i.v. use has been evaluated but the oral route has yet to be examined. Objectives: To determine the effect of oral hyaluronan gel on joint effusion following arthroscopic surgery for osteochondritis dissecans (OCD) of the

B. J. BERGIN; S. W. PIERCE; L. R. BRAMLAGE; A. STROMBERG

2010-01-01

189

Sensitivity of Indentation Testing to Step-Off Edges and Interface Integrity in Cartilage Repair  

Microsoft Academic Search

Step-off edges and tissue interfaces are prevalent in cartilage injury such as after intra-articular fracture and reduction, and in focal defects and surgical repair procedures such as osteochondral graft implantation. It would be useful to assess the function of injured or donor tissues near such step-off edges and the extent of integration at material interfaces. The objective of this study

Won C. Bae; Amanda W. Law; David Amiel; Robert L. Sah

2004-01-01

190

Radiographic changes in Thoroughbred yearlings in South Africa.  

PubMed

This study involves the evaluation of pre-purchase radiographic studies of South African Thoroughbred yearlings. Radiographic changes were recorded and compared with similar international studies. The study differs from other studies in that a lower prevalence of pedal osteitis (1.26%), dorsal osteochondral fragmentation of the metatarsophalangeal joint (1.60%), distal metacarpal sagittal ridge changes (15.7%), ulnar carpal bone lucencies (8.33%), carpal osteophytes (1.19%), distal intertarsal and tarsometatarsal joint radiographic changes (9.92%), tarsal osteochondrosis lesions (4.40%) and stifle osteochondrosis lesions (0.4%) was found. The prevalence of dorsal osteochondral fragments in the metacarpophalangeal joint was similar to other studies (1.60%). A higher prevalence of vascular channels as well as irregular borders and lucencies was evident in the proximal sesamoid bones. There was a higher prevalence of palmar metacarpophalangeal and plantar metatarsophalangeal osteochondral fragments (2% and 7.10% respectively). Palmar metacarpal disease, metacarpal supracondylar lysis, proximal sesamoid bone fractures and carpal osteochondral fragmentation were absent in the current study. Additional findings recorded in the current study were proximal interphalangeal joint hyperextension (left front 15.13%, right front 18.91%), the solar angle (right front 2.38 degrees, left front 2.79 degrees), the prevalence of carpal bone 1 (30.95%) and carpal bone 5 (1.59%). Management, nutrition and genetics in the various groups of Thoroughbred yearlings should be further investigated in order to explain the reasons for the differences recorded in the current study. PMID:22616432

Furniss, C; Carstens, A; van den Berg, S S

2011-12-01

191

Receptor tyrosine kinase inhibition causes simultaneous bone loss and excess bone formation within growing bone in rats  

SciTech Connect

During postnatal skeletal growth, adaptation to mechanical loading leads to cellular activities at the growth plate. It has recently become evident that bone forming and bone resorbing cells are affected by the receptor tyrosine kinase (RTK) inhibitor imatinib mesylate (STI571, Gleevec (registered)) . Imatinib targets PDGF, ABL-related gene, c-Abl, c-Kit and c-Fms receptors, many of which have multiple functions in the bone microenvironment. We therefore studied the effects of imatinib in growing bone. Young rats were exposed to imatinib (150 mg/kg on postnatal days 5-7, or 100 mg/kg on postnatal days 5-13), and the effects of RTK inhibition on bone physiology were studied after 8 and 70 days (3-day treatment), or after 14 days (9-day treatment). X-ray imaging, computer tomography, histomorphometry, RNA analysis and immunohistochemistry were used to evaluate bone modeling and remodeling in vivo. Imatinib treatment eliminated osteoclasts from the metaphyseal osteochondral junction at 8 and 14 days. This led to a resorption arrest at the growth plate, but also increased bone apposition by osteoblasts, thus resulting in local osteopetrosis at the osteochondral junction. The impaired bone remodelation observed on day 8 remained significant until adulthood. Within the same bone, increased osteoclast activity, leading to bone loss, was observed at distal bone trabeculae on days 8 and 14. Peripheral quantitative computer tomography (pQCT) and micro-CT analysis confirmed that, at the osteochondral junction, imatinib shifted the balance from bone resorption towards bone formation, thereby altering bone modeling. At distal trabecular bone, in turn, the balance was turned towards bone resorption, leading to bone loss. - Research Highlights: > 3-Day imatinib treatment. > Causes growth plate anomalies in young rats. > Causes biomechanical changes and significant bone loss at distal trabecular bone. > Results in loss of osteoclasts at osteochondral junction.

Nurmio, Mirja, E-mail: Mirja.Nurmio@utu.fi [Department of Physiology, University of Turku (Finland); Department of Pediatrics, University of Turku (Finland); Joki, Henna, E-mail: Henna.Joki@utu.fi [Department of Cell Biology and Anatomy, University of Turku (Finland); Kallio, Jenny, E-mail: Jenny.Kallio@utu.fi [Department of Physiology, University of Turku (Finland); Maeaettae, Jorma A., E-mail: jorma.maatta@utu.fi [Department of Cell Biology and Anatomy, University of Turku (Finland); Department of Turku Center for Disease Modeling, University of Turku (Finland); Vaeaenaenen, H. Kalervo, E-mail: kalervo.vaananen@utu.fi [Department of Cell Biology and Anatomy, University of Turku (Finland); Toppari, Jorma, E-mail: Jorma.Toppari@utu.fi [Department of Physiology, University of Turku (Finland); Department of Pediatrics, University of Turku (Finland); Jahnukainen, Kirsi, E-mail: Kirsi.Jahnukainen@utu.fi [Pediatric Endocrinology Unit, Department of Woman and Child Health, Karolinska Institutet and University Hospital, Stockholm (Sweden); Division of Hematology-Oncology and Stem Cell Transplantation, Hospital for Children and Adolescents, Helsinki (Finland); Laitala-Leinonen, Tiina, E-mail: tilale@utu.fi [Department of Cell Biology and Anatomy, University of Turku (Finland)

2011-08-01

192

Biomaterials for Tissue Engineering  

PubMed Central

Biomaterials serve as an integral component of tissue engineering. They are designed to provide architectural framework reminiscent of native extracellular matrix in order to encourage cell growth and eventual tissue regeneration. Bone and cartilage represent two distinct tissues with varying compositional and mechanical properties. Despite these differences, both meet at the osteochondral interface. This article presents an overview of current biomaterials employed in bone and cartilage applications, discusses some design considerations, and alludes to future prospects within this field of research. PMID:23820768

Lee, Esther J.; Kasper, F. Kurtis; Mikos, Antonios G.

2013-01-01

193

Autologous Chondrocyte Implantation: Current Surgery and Rehabilitation  

Microsoft Academic Search

RIEGGER-KRUGH, C. L., E. C. MCCARTY, M. S. ROBINSON, and D. A. WEGZYN. Autologous Chondrocyte Implantation: Current Surgery and Rehabilitation. Med. Sci. Sports Exerc., Vol. 40, No. 2, pp. 206-214, 2008. Autologous chondrocyte implantation (ACI) is a treatment option for full-thickness chondral, or osteochondral injuries that are painful, debilitating, and progressive. Goals of surgery and rehabilitation include replacement of damaged

CHERYL L. RIEGGER-KRUGH; ERIC C. MCCARTY; MITCHEL S. ROBINSON; DAVID A. WEGZYN

2008-01-01

194

The subchondral bone in articular cartilage repair: current problems in the surgical management  

Microsoft Academic Search

As the understanding of interactions between articular cartilage and subchondral bone continues to evolve, increased attention\\u000a is being directed at treatment options for the entire osteochondral unit, rather than focusing on the articular surface only.\\u000a It is becoming apparent that without support from an intact subchondral bed, any treatment of the surface chondral lesion\\u000a is likely to fail. This article

Andreas H. Gomoll; Henning Madry; Gunnar Knutsen; Niek van Dijk; Romain Seil; Mats Brittberg; Elizaveta Kon

2010-01-01

195

Stem cell-coated titanium implants for the partial joint resurfacing of the knee  

Microsoft Academic Search

The goal of the present study was to evaluate the partial surface replacement of the knee with stem cell-coated titanium implants and to provide a basis for a successful treatment of large osteochondral defects.Mesenchymal stem cells (MSCs) were isolated from bone marrow aspirates of adult sheep. Round titanium implants with a diameter of 2×7.3mm were seeded with autologous MSC and

Karl-Heinz Frosch; Anja Drengk; Petra Krause; Volker Viereck; Nicolai Miosge; Carola Werner; Detlev Schild; Ewa K. Stürmer; Klaus M. Stürmer

2006-01-01

196

One-step bone marrow-derived cell transplantation in talarosteochondral lesions: mid-term results  

PubMed Central

Purpose to verify the capability of scaffold-supported bone marrow-derived cells to be used in the repair of osteochondral lesions of the talus. Methods using a device to concentrate bone marrow-derived cells, a scaffold (collagen powder or hyaluronic acid membrane) for cell support and platelet gel, a one-step arthroscopic technique was developed for cartilage repair. In a prospective clinical study, we investigated the ability of this technique to repair talar osteochondral lesions in 64 patients. The mean follow-up was 53 months. Clinical results were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) scale score. We also considered the influence of scaffold type, lesion area, previous surgery, and lesion depth. Results the mean preoperative AOFAS scale score was 65.2 ± 13.9. The clinical results peaked at 24 months, before declining gradually to settle at a score of around 80 at the maximum follow-up of 72 months. Conclusions the use of bone marrow-derived cells supported by scaffolds to repair osteochondral lesions of the talus resulted in significant clinical improvement, which was maintained over time. Level of Evidence level IV, therapeutic case series.

BUDA, ROBERTO; VANNINI, FRANCESCA; CAVALLO, MARCO; BALDASSARRI, MATTEO; NATALI, SIMONE; CASTAGNINI, FRANCESCO; GIANNINI, SANDRO

2013-01-01

197

Biofabrication of tissue constructs by 3D bioprinting of cell-laden microcarriers.  

PubMed

Bioprinting allows the fabrication of living constructs with custom-made architectures by spatially controlled deposition of multiple bioinks. This is important for the generation of tissue, such as osteochondral tissue, which displays a zonal composition in the cartilage domain supported by the underlying subchondral bone. Challenges in fabricating functional grafts of clinically relevant size include the incorporation of cues to guide specific cell differentiation and the generation of sufficient cells, which is hard to obtain with conventional cell culture techniques. A novel strategy to address these demands is to combine bioprinting with microcarrier technology. This technology allows for the extensive expansion of cells, while they form multi-cellular aggregates, and their phenotype can be controlled. In this work, living constructs were fabricated via bioprinting of cell-laden microcarriers. Mesenchymal stromal cell (MSC)-laden polylactic acid microcarriers, obtained via static culture or spinner flask expansion, were encapsulated in gelatin methacrylamide-gellan gum bioinks, and the printability of the composite material was studied. This bioprinting approach allowed for the fabrication of constructs with high cell concentration and viability. Microcarrier encapsulation improved the compressive modulus of the hydrogel constructs, facilitated cell adhesion, and supported osteogenic differentiation and bone matrix deposition by MSCs. Bilayered osteochondral models were fabricated using microcarrier-laden bioink for the bone compartment. These findings underscore the potential of this new microcarrier-based biofabrication approach for bone and osteochondral constructs. PMID:25048797

Levato, Riccardo; Visser, Jetze; Planell, Josep A; Engel, Elisabeth; Malda, Jos; Mateos-Timoneda, Miguel A

2014-09-01

198

Stem cell- and growth factor-based regenerative therapies for avascular necrosis of the femoral head.  

PubMed

Avascular necrosis (AVN) of the femoral head is a debilitating disease of multifactorial genesis, predominately affects young patients, and often leads to the development of secondary osteoarthritis. The evolving field of regenerative medicine offers promising treatment strategies using cells, biomaterial scaffolds, and bioactive factors, which might improve clinical outcome. Early stages of AVN with preserved structural integrity of the subchondral plate are accessible to retrograde surgical procedures, such as core decompression to reduce the intraosseous pressure and to induce bone remodeling. The additive application of concentrated bone marrow aspirates, ex vivo expanded mesenchymal stem cells, and osteogenic or angiogenic growth factors (or both) holds great potential to improve bone regeneration. In contrast, advanced stages of AVN with collapsed subchondral bone require an osteochondral reconstruction to preserve the physiological joint function. Analogously to strategies for osteochondral reconstruction in the knee, anterograde surgical techniques, such as osteochondral transplantation (mosaicplasty), matrix-based autologous chondrocyte implantation, or the use of acellular scaffolds alone, might preserve joint function and reduce the need for hip replacement. This review summarizes recent experimental accomplishments and initial clinical findings in the field of regenerative medicine which apply cells, growth factors, and matrices to address the clinical problem of AVN. PMID:22356811

Rackwitz, Lars; Eden, Lars; Reppenhagen, Stephan; Reichert, Johannes C; Jakob, Franz; Walles, Heike; Pullig, Oliver; Tuan, Rocky S; Rudert, Maximilian; Nöth, Ulrich

2012-01-01

199

Cartilage tissue engineering on the surface of a novel gelatin-calcium-phosphate biphasic scaffold in a double-chamber bioreactor.  

PubMed

Tissue engineering is a new approach to articular cartilage repair; however, the integration of the engineered cartilage into the host subchondral bone is a major problem in osteochondral injury. The aim of the present work, therefore, was to make a tissue-engineered osteochondral construct from a novel biphasic scaffold in a newly designed double-chamber bioreactor. This bioreactor was designed to coculture chondrocytes and osteoblasts simultaneously. The aim of this study was to prove that engineered cartilage could be formed with the use of this biphasic scaffold. The scaffold was constructed from gelatin and a calcium-phosphate block made from calcined bovine bone. The cartilage part of the scaffold had a uniform pore size of about 180 microm and approximate porosity of 75%, with the trabecular pattern preserved in the bony part of the scaffold. The biphasic scaffolds were seeded with porcine chondrocytes and cultured in a double-chamber bioreactor for 2 or 4 weeks. The chondrocytes were homogeneously distributed in the gelatin part of the scaffold, and secretion of the extracellular matrix was demonstrated histologically. The chondrocytes retained their phenotype after 4 weeks of culture, as proven immunohistochemically. After 4 weeks of culture, hyaline-like cartilage with lacuna formation could be clearly seen in the gelatin scaffold on the surface of the calcium phosphate. The results show that this biphasic scaffold can support cartilage formation on a calcium-phosphate surface in a double-chamber bioreactor, and it seems reasonable to suggest that there is potential for further application in osteochondral tissue engineering. PMID:15386400

Chang, Chih-Hung; Lin, Feng-Huei; Lin, Chien-Cheng; Chou, Cheng-Hung; Liu, Hwa-Chang

2004-11-15

200

Incorporation of bioactive polyvinylpyrrolidone-iodine within bilayered collagen scaffolds enhances the differentiation and subchondral osteogenesis of mesenchymal stem cells.  

PubMed

Polyvinylpyrrolidone-iodine (Povidone-iodine, PVP-I) is widely used as an antiseptic agent for lavation during joint surgery; however, the biological effects of PVP-I on cells from joint tissue are unknown. This study examined the biocompatibility and biological effects of PVP-I on cells from joint tissue, with the aim of optimizing cell-scaffold based joint repair. Cells from joint tissue, including cartilage derived progenitor cells (CPC), subchondral bone derived osteoblast and bone marrow derived mesenchymal stem cells (BM-MSC) were isolated. The concentration-dependent effects of PVP-I on cell proliferation, migration and differentiation were evaluated. Additionally, the efficacy and mechanism of a PVP-I loaded bilayer collagen scaffold for osteochondral defect repair was investigated in a rabbit model. A micromolar concentration of PVP-I was found not to affect cell proliferation, CPC migration or extracellular matrix production. Interestingly, micromolar concentrations of PVP-I promote osteogenic differentiation of BM-MSC, as evidenced by up-regulation of RUNX2 and Osteocalcin gene expression, as well as increased mineralization on the three-dimensional scaffold. PVP-I treatment of collagen scaffolds significantly increased fibronectin binding onto the scaffold surface and collagen type I protein synthesis of cultured BM-MSC. Implantation of PVP-I treated collagen scaffolds into rabbit osteochondral defect significantly enhanced subchondral bone regeneration at 6 weeks post-surgery compared with the scaffold alone (subchondral bone histological score of 8.80±1.64 vs. 3.8±2.19, p<0.05). The biocompatibility and pro-osteogenic activity of PVP-I on the cells from joint tissue and the enhanced subchondral bone formation in PVP-I treated scaffolds would thus indicate the potential of PVP-I for osteochondral defect repair. PMID:23707501

Jiang, Yangzi; Chen, Longkun; Zhang, Shufang; Tong, Tong; Zhang, Wei; Liu, Wanlu; Xu, Guowei; Tuan, Rocky S; Heng, Boon Chin; Crawford, Ross; Xiao, Yin; Ouyang, Hong Wei

2013-09-01

201

Overuse injuries in youth sports.  

PubMed

Although youth sports participation is beneficial on many levels, it is also associated with an increased risk of injury. Risk factors for injury in children and adolescents include the presence of growth cartilage, existence of muscle imbalance, and pressure to compete despite pain and fatigue. Overuse injuries, such as patellofemoral pain, Osgood-Schlatter disease, calcaneal apophysitis, Little League elbow, Little League shoulder, spondylolysis, and osteochondritis dissecans, are common injuries in organized sports. However, proper education, supervision, and training can help reduce the risk of these injuries and facilitate early intervention. PMID:20631469

Stein, Cynthia J; Micheli, Lyle J

2010-06-01

202

Musculoskeletal injuries in adolescents.  

PubMed

This article reviews the anatomy of the physis and the most common classification of injuries or fractures through the physis. The common apophyseal injuries of Osgood-Schlatter, Severs disease and iliac apophysitis, are reviewed in addition to a review of the most common osteochondritides, including Panner's disease and Osteochondritis Dessicans of the femur and talus. An understanding of these is key to diagnosis and treatment of adolescent musculoskeletal injuries. This article also reviews slipped capital femoral epiphysis, little leaguer's elbow, anterior cruciate and collateral ligament injuries, patella problems, ankle sprains and several common fractures in children. PMID:9469924

Kaeding, C C; Whitehead, R

1998-03-01

203

Glued periosteal grafts in the knee.  

PubMed

Periosteal grafting was performed in 4 patients with osteochondritis dissecans of the medial femoral condyle and 1 patient with osteonecrosis of the lateral femoral condyle following prednisone therapy. The lesions were drilled out deep into the cancellous bone. The periosteal graft was taken from the medial facet of the tibia and fixed to the excavated bony defect by the tissue glue Fibrinkleber Human Immuno (Tisseel). The patients were followed clinically, by arthroscopic examination and by radiography at 3, 6, and 12 months. After 1 year the borderline between the new and surrounding cartilage was hardly visible. PMID:3879088

Niedermann, B; Boe, S; Lauritzen, J; Rubak, J M

1985-12-01

204

Effect of Implantation Accuracy on Ankle Contact Mechanics with a Metallic Focal Resurfacing Implant  

PubMed Central

Background: Talar osteochondral defects can lead to joint degeneration. Focal resurfacing with a metallic implant has shown promise in other joints. We studied the effect of implantation accuracy on ankle contact mechanics after focal resurfacing of a defect in the talar dome. Methods: Static loading of seven cadaver ankles was performed before and after creation of a 15-mm-diameter osteochondral defect on the talar dome, and joint contact stresses were measured. The defect was then resurfaced with a metallic implant, with use of a custom implant-bone interface fixture that allowed fine control (in 0.25-mm steps) of implantation height. Stress measurements were repeated at heights of –0.5 to +0.5 mm relative to an as-implanted reference. Finite element analysis was used to determine the effect of implant height, post axis rotation, and valgus/varus tilt over a motion duty cycle. Results: With the untreated defect, there was a 20% reduction in contact area and a 40% increase in peak contact stress, as well as a shift in the location of the most highly loaded region, as compared with the values in the intact condition. Resurfacing led to recovery of 90% of the contact area that had been measured in the intact specimen, but the peak contact stresses remained elevated. With the implant 0.25 mm proud, peak contact stress was 220% of that in the intact specimen. The results of the finite element analyses agreed closely with those of the experiments and additionally showed substantial variations in defect influences on contact stresses across the motion arc. Talar internal/external rotations also differed for the unfilled defect. Focal implant resurfacing substantially restored kinematics but did not restore the stresses to the levels in the intact specimens. Conclusions: Focal resurfacing with a metallic implant appears to have the potential to restore normal joint mechanics in ankles with a large talar osteochondral defect. However, contact stresses were found to be highly sensitive to implant positioning. Clinical Relevance: Resurfacing a talar osteochondral defect with an implant that restores the joint contour, that provides immediate stability, and that reproduces normal joint mechanics, without requiring biological potential, offers advantages over existing resurfacing techniques; however, restoration of normal joint mechanics is highly dependent on precise surgical implantation. PMID:20516325

Anderson, Donald D.; Tochigi, Yuki; Rudert, M. James; Vaseenon, Tanawat; Brown, Thomas D.; Amendola, Annunziato

2010-01-01

205

Surgical hip dislocation: techniques for success.  

PubMed

Surgical hip dislocation (SHD) is a versatile approach used to address both intra-articular and extra-articular pathology around the hip joint in both pediatric and adult patients. It allows anterior dislocation of the femoral head for direct visualization of the hip joint while preserving femoral head vascularity and minimizing trauma to the abductor musculature. Previously described indications for SHD include femoroacetabular impingement, deformity resulting from Legg-Calve-Perthes disease, slipped capital femoral epiphysis, periarticular trauma, benign lesions of the hip joint, and osteochondral lesions. In this review, we will describe current surgical techniques, indications, and clinical outcomes for SHD. PMID:25207733

Ricciardi, Benjamin F; Sink, Ernest L

2014-01-01

206

Human Periosteum Is a Source of Cells for Orthopaedic Tissue Engineering: A Pilot Study  

Microsoft Academic Search

Background  Periosteal cells are important in embryogenesis, fracture healing, and cartilage repair and could provide cells for osteochondral\\u000a tissue engineering.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purpose  We determined whether a population of cells isolated from human periosteal tissue contains cells with a mesenchymal stem cell\\u000a (MSC) phenotype and whether these cells can be expanded in culture and used to form tissue in vitro.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  We obtained periosteal tissue

Michael D. Ball; Ian C. Bonzani; Melissa J. Bovis; Andrew Williams; Molly M. Stevens

207

Secondary synovial osteochondromatosis of the ankle in a child.  

PubMed

We describe a case of a large intra-articular ossifying mass of the ankle joint in a 12-year-old boy who sustained a severe ankle twisting injury at 6 years of age. The mass is presumed to be the result of secondary synovial osteochondromatosis originated from a fractured osteochondral fragment of the medial tubercle of the posterior process of the talus. The mass could be differentiated from os trigonum syndrome, Trevor disease and primary synovial osteochondromatosis based on its location, size and radiologic and histological features. PMID:23860637

Song, Mi Hyun; Cheon, Jung-Eun; Moon, Kyung Chul; Lee, Dong Yeon; Choi, In Ho

2013-12-01

208

MR imaging of the hip: osseous lesions.  

PubMed

Because of the exquisite soft tissue contrast resolution of MR imaging combined with recent technologic developments, a variety of conditions involving the hip joint and adjacent bony structures can be well evaluated using MR imaging, with or without contrast material. Among the different conditions, hip trauma and avascular necrosis are the most frequent indications. Other entities for which MR imaging has proven its usefulness include subchondral fractures, osteochondritis dissecans, transient osteoporosis, bone tumors, inflammatory and infectious processes, and a variety of bone marrow disorders. PMID:16275575

Beltran, Javier; Opsha, Oleg

2005-11-01

209

Transient serum exposure regimes to support dual differentiation of human mesenchymal stem cells.  

PubMed

Human mesenchymal stem cells (MSCs), which can generate both osteoblasts and chondrocytes, represent an ideal resource for orthopaedic repair using tissue-engineering approaches. One major difficulty for the development of osteochondral constructs using undifferentiated MSCs is that serum is typically used in culture protocols to promote differentiation of the osteogenic component, whereas existing chondrogenic differentiation protocols rely on the use of serum-free conditions. In order to define conditions which could be compatible with both chondrogenic and osteogenic differentiation in a single bioreactor, we have analysed the efficiency of new biphasic differentiation regimes based on transient serum exposure followed by serum-free treatment. MSC differentiation was assessed either in serum-free medium or with a range of transient exposure to serum, and compared to continuous serum-containing treatment. Although osteogenic differentation was not supported in the complete absence of serum, marker expression and extensive mineralization analyses established that 5 days of transient exposure triggered a level of differentiation comparable to that observed when serum was present throughout. This initial phase of serum exposure was further shown to support the successful chondrogenic differentiation of MSCs, comparable to controls maintained in serum-free conditions throughout. This study indicates that a culture based on temporal serum exposure followed by serum-free treatment is compatible with both osteogenic and chondrogenic differentiation of MSCs. These results will allow the development of novel strategies for osteochondral tissue engineering approaches using MSCs for regenerative medicine. PMID:23161724

France, L A; Scotchford, C A; Grant, D M; Rashidi, H; Popov, A A; Sottile, V

2014-08-01

210

Elbow injuries.  

PubMed

The elbow is a commonly injured joint, yet physicians may be less comfortable treating injuries to the elbow compared with knee and shoulder injuries. Common injuries involving the elbow are tendinosis, instability, tendon ruptures, osteochondritis dissecans, and fractures. Tendinosis is a common overuse injury and may occur on the lateral, medial, or infrequently, the posterior side of the elbow. Injury to the medial or lateral ulnar collateral ligaments may result in instability. Repetitive trauma from overuse is the most common etiologic factor in athletes. Distal biceps and triceps tendon injuries may result in elbow disability in active individuals. Partial tears are more difficult to diagnose than complete ruptures. Osteochondritis dissecans of capitellum affects adolescents involved in overhead throwing athletics. Fractures about the elbow most commonly involve the radial head in adults, and the distal humerus in children. Athletes are prone to elbow injuries resulting from both overuse and acute trauma. Our purpose is to describe the diagnosis and treatment of these common elbow injuries in athletes of all ages. PMID:11845021

Kandemir, Utku; Fu, Freddie H; McMahon, Patrick J

2002-03-01

211

Multiple osteochondroses of bilateral knee joints.  

PubMed

We experienced a patient with a combination of multiple osteochondroses: Blount's disease, bipartite patella, and Sinding-Larsen-Johansson disease in the left knee, and a combination of bipartite patella and Osgood-Schlatter disease in the right knee. The patient was a healthy, active 12-year-old boy with bilateral knee pain. He had been diagnosed with Blount's disease of the left tibia at 2 years of age, and had been treated with open wedge osteotomy. He was diagnosed with bilateral bipartite patellae at the age of 9 years, and was diagnosed with Osgood-Schlatter disease in the right knee and Sinding-Larsen-Johansson disease in the left knee at 10 years of age. The second growth spurt was observed during this period. At 11 years of age, he was diagnosed with an osteochondral fracture of the left lateral femoral condyle and was observed without surgery. This patient showed the sequential appearance of an ossification disorder, probably due to the abnormal response of enchondral ossification to mechanical stress. Overuse in this growth period may have played a role in the development of these osteochondroses. The osteochondral fracture was probably caused by a disruption at one of the weakest parts of the developing skeleton, between the ossification center and the overlying cartilage in the background of an ossification disorder. PMID:11484125

Segawa, H; Omori, G; Koga, Y

2001-01-01

212

The amelioration of cartilage degeneration by ADAMTS-5 inhibitor delivered in a hyaluronic acid hydrogel.  

PubMed

Degradation of proteoglycan is the key early event in the development of osteoarthritis (OA). The aggrecanase ADAMTS-5 has been identified as the major enzyme responsible for the degradation and thus is an attractive therapeutic target for OA. However, currently there is no report on using an ADAMTS-5 inhibition strategy for OA treatment. The present study aimed to investigate the synergic effect of combining an ADAMTS-5 inhibitor (114810) with a hyaluronic acid hydrogel (HAX) for OA therapeutics. Two OA models were induced by surgically creating an osteochondral defect or removing the anterior cruciate ligament (ACL) in Sprague-Dawley rats. Human OA cartilage was obtained from total joint replacement patients. Both human and rat OA cartilage showed marked proteoglycan loss with significantly increased ADAMTS-5 expression. The effectiveness of ADAMTS-5 inhibition by 114810 was confirmed by a cartilage explants assay in vitro, which showed that the 114810 halted the aggrecanase-mediated (374)ARGS neoepitope released from aggrecan induced by IL-1? stimulation. The in vivo effect of ADAMTS-5 inhibition was assessed by the articular injection of HAX with 114810 into OA knee joints. Evaluated eight weeks after injection, 114810 with HAX significantly promoted the in vivo cartilage healing in the osteochondral defect model, and prevented the progression of degenerative changes in the ACL model. Our results confirmed that ADAMTS-5 is an effective target for OA treatment, and the intra-articular injection of an ADAMTS-5 inhibitor within HAX gel could be a promising strategy for OA treatment. PMID:24424207

Chen, Pengfei; Zhu, Shouan; Wang, Yanyan; Mu, Qin; Wu, Yan; Xia, Qingqing; Zhang, Xiaolei; Sun, Heng; Tao, Jiadong; Hu, Hu; Lu, Ping; Ouyang, Hongwei

2014-03-01

213

Isolation, culture, and osteogenic/chondrogenic differentiation of bone marrow-derived mesenchymal stem cells.  

PubMed

Musculoskeletal disorders, as non-healing fractures and large bone defects, articular cartilage and subchondral bone injuries, often result in lifelong chronic pain and compromised quality of life. Although generally a natural process, failure of large bone defects to heal such as after complex fractures, resection of tumours, infections, or revisions of joint replacements remains a critical challenge that requires more appropriate solutions as those currently available. In addition, regeneration of chondral and osteochondral defects continues to be a challenge until to date. A profound understanding of the underlying mechanisms of endogenous regeneration is a prerequisite for successful bone and cartilage regeneration. Presently, one of the most promising therapeutic approaches is cell-based tissue engineering which provides a healthy population of cells to the injured site. Use of differentiated cells has severe limitations; an excellent alternative would be the application of adult marrow stromal cells/mesenchymal stem cells (MSC) which possess extensive proliferation potential and proven capability to differentiate along the osteochondral pathway. The process of osteo-/chondrogenesis can be mimicked in vitro by inducing osteo-chondroprogenitor stem cells to undergo osteogenesis and chondrogenesis through exposure of osteo-/chondrogenic favourable microenvironmental, mechanical, and nutritional conditions. This chapter provides comprehensive protocols for the isolation, expansion, and osteo-/chondrogenic differentiation of adult bone marrow-derived MSC. PMID:22610563

Grässel, Susanne; Stöckl, Sabine; Jenei-Lanzl, Zsuzsa

2012-01-01

214

Erosion of the medial compartment of the canine elbow: occurrence, diagnosis and currently available treatment options.  

PubMed

Erosion of the medial compartment of the elbow joint refers to full thickness cartilage loss with exposure of the subchondral bone (modified Outerbridge grades 4-5) of the medial part of the humeral condyle (MHC) and the corresponding ulnar contact area. This finding may appear in the absence of an osteochondral fragment or a cartilage flap, or in combination with fragmentation of the medial coronoid process (MCP) or osteochondritis dissecans (OCD) of the MHC. With regard to the prognosis, it is important to diagnose these severe erosions. Imaging of cartilage lesions by means of radiography, ultrasonography, computed tomography or magnetic resonance imaging is challenging in dogs. In contrast, direct arthroscopic inspection provides detailed information about the cartilage. The treatment of these severe erosions is difficult because of the limited regenerative capacity of cartilage and presumed mechanical or physical triggering factors. Several conservative and surgical treatment methods have been proposed to treat elbows with severe cartilage defects. However, due to irreversible loss of cartilage, the prognosis in these cases remains guarded. PMID:25396224

Coppieters, E; Gielen, I; Verhoeven, G; Van Vynckt, D; Van Ryssen, B

2015-01-12

215

Delayed presentation of a loose body in undisplaced paediatric talar neck fracture  

PubMed Central

Fractures of the talus are rare in children. A high index of suspicion is needed to avoid missing such an injury, which is not an uncommon occurrence especially with undisplaced fractures. We present an unusual case of an undisplaced talar neck fracture in a five-year-old child leading to a delayed presentation of a symptomatic osteochondral loose body in the ankle joint. To our knowledge there are no reports in the literature of osteochondral loose bodies occurring in conjunction with an associated undisplaced talar neck fracture in either children or adults. The loose body was removed using anterior ankle arthroscopy. The child had an uneventful post operative recovery and regained full range of movement and function of his ankle joint and was discharged at one year follow-up. We aim to highlight the need to have a low threshold to further evaluate symptomatic children after fracture healing of an undisplaced talar neck fracture for a possible associated loose body in the ankle joint. PMID:25035846

Patel, Vishal; Bloch, Benjamin; Johnson, Nicholas; Mangwani, Jitendra

2014-01-01

216

Evolution of radiological findings detected in the limbs of 321 young horses between the ages of 6 and 18 months.  

PubMed

The objective of this study was to evaluate the spontaneous evolution of radiological findings (RF) indicative of juvenile osteochondral conditions (JOCC) in a field study. A radiographic survey was performed at the age of 6 and 18months in 321 young horses from three breeds (French Trotter Standardbred, Selle-Français Warmblood and Thoroughbred). Each RF identified at 6months was re-evaluated at 18months, and classified as (1) disappeared, (2) improved, (3) stable, (4) deteriorated or (5) new when it was not identified at 6months. Only 32.3% of all RF identified at the age of 6months were stable, while at 18months 46.6% had disappeared and 38.7% were new radiological abnormalities. Evolution of RF varied according to the joint involved and the type of lesion. In the stifle, 85.7% of the RF of osteochondral fragmentation (OCF) of the lateral ridge of the femoral trochlea regressed (disappeared or improved). In the hock, 53.1% of the RF of OCD of the intermediate ridge of the tibial cochlea were stable. In the fetlock, dorsal and plantar OCF were frequently observed as new radiological abnormalities at 18months (51% of the dorsal RF and 45.8% of the plantar). As many lesions develop or change after 6months, a definitive radiographic assessment of the JOCC status is more reliable at 18months. Knowing the spontaneous healing capacity of some lesions is useful in helping to decide the appropriate management. PMID:23660154

Jacquet, S; Robert, C; Valette, J-P; Denoix, J-M

2013-07-01

217

Bioengineering a Multicomponent Spinal Motion Segment Construct-A 3D Model for Complex Tissue Engineering.  

PubMed

Intervertebral disc degeneration is an important clinical problem but existing treatments have significant drawbacks. The ability to bioengineer the entire spinal motion segment (SMS) offers hope for better motion preservation strategies but is extremely challenging. Here, fabrication of a multicomponent SMS construct with complex hierarchical organization from mesenchymal stem cells and collagen-based biomaterials, using a module-based integrative approach, is reported. The construct consists of two osteochondral subunits, a nucleus pulposus (NP-)-like core and a multi-lamellae annulus fibrosus (AF-)-like component. Chondrogenic medium is crucial for stabilizing the osteochondral subunits, which are shown to allow passive nutrient diffusion, while cyclic compression is necessary for better fiber matrix organization. Cells adhere, survive, and interact with the NP-like core. Cyclic torsional loading stimulates cell alignment in the AF-like lamellae and the number of lamellae affects the mechanical properties of the construct. This work represents an important milestone in SMS tissue engineering and provides a 3D model for studying tissue maturation and functional remodeling. PMID:24846571

Chik, Tsz Kit; Chooi, Wai Hon; Li, Yuk Yin; Ho, Fu Chak; Cheng, Hiu Wa; Choy, Tsz Hang; Sze, Kam Yim; Luk, Keith Kei Dip; Cheung, Kenneth Man Chi; Chan, Barbara Pui

2014-05-20

218

Lateral subtalar dislocation associated with bimalleolar fracture: case report and literature review.  

PubMed

Subtalar dislocation is an uncommon injury that affects the talocalcaneal and talonavicular joints, with the tibiotalar and calcaneocuboid joints remaining intact. The 4 types of subtalar dislocation are medial, lateral, anterior, and posterior, although the latter 2 are rare. These injuries-especially lateral dislocation-occur as a result of high-energy trauma. Medial dislocation is the most common type, and lateral dislocation is associated with osteochondral fractures of the talus and calcaneus, as well as with open injuries; hence, its worse prognosis. We report the case of a 62-year-old woman diagnosed with lateral subtalar dislocation accompanied by an ipsilateral bimalleolar fracture after a fall downstairs. She underwent emergency reduction of the dislocation under sedation. Surgical treatment of the bimalleolar fracture was delayed 9 days to avoid cutaneous complications. This is the first report of a subtalar dislocation accompanied by a bimalleolar fracture. PMID:21621435

Conesa, Xavier; Barro, Víctor; Barastegui, David; Batalla, Lledó; Tomás, Jordi; Molero, Vicente

2011-01-01

219

Giant cell tumor of the talar neck.  

PubMed

We describe a patient with a giant cell tumor in the talar head and neck of the left foot who was diagnosed as having osteochondritis dissecans and treated with arthroscopic drilling in this same location 3 years earlier. Giant cell tumors can be confused with several conditions, including giant cell reparative granulomas, brown tumors, and aneurysmal bone cysts. Giant cell tumors of bone typically occur in the epiphysis of long bones, including the distal femur and proximal tibia. They are uncommonly found in the small bones of the foot or ankle, and talar involvement is rare. Despite this rarity, the radiographic appearance and clinical signs of talar lesions should be considered in the differential diagnosis of nontraumatic conditions in the foot. PMID:17507533

Selek, Hakan; Ozer, Hamza; Turanli, Sacit; Erdem, Ozlem

2007-01-01

220

Allograft Replacement for Absent Native Tissue  

PubMed Central

Context: Structural instability due to poor soft tissue quality often requires augmentation. Allografts are important biological substitutes that are used for the symptomatic patient in the reconstruction of deficient ligaments, tendons, menisci, and osteochondral defects. Interest in the clinical application of allografts has arisen from the demand to obtain stable anatomy with restoration of function and protection against additional injury, particularly for high-demand patients who participate in sports. Traditionally, allografts were employed to reinforce weakened tissue. However, they can also be employed to substitute deficient or functionally absent tissue, particularly in the sports medicine setting. Objective: This article presents a series of 6 cases that utilized allografts to restore functionally deficient anatomic architecture, rather than just simply augmenting the degenerated or damaged native tissue. Detailed discussions are presented of the use of allografts as a successful treatment strategy to replace functionally weakened tissue, often after failed primary repairs. PMID:24427387

Chaudhury, Salma; Wanivenhaus, Florian; Fox, Alice J.; Warren, Russell F.; Doyle, Maureen; Rodeo, Scott A.

2013-01-01

221

Current indications for and the technique of wrist arthroscopy.  

PubMed

Since its introduction more than 30 years ago, wrist arthroscopy has become an essential diagnostic and therapeutic tool in hand surgery. This procedure minimizes exposures and allows access to otherwise remotely located anatomic regions with minimal morbidity. Advances in anatomic understanding and wrist scope technology have standardized the procedure and expanded indications. Current applications are diagnostic staging of various wrist pathologies where arthroscopy allows for a direct, magnified, and tactile-assisted examination. This includes injuries to the triangular fibrocartilage complex (TFCC), osteochondral lesion of the carpus, and dynamic assessment of carpal instability and radiocarpal arthritis. Therapeutic applications have continued to expand and include arthroscopic-assisted fracture reductions, treatment of radiocarpal synovitis and arthritis, TFCC repairs, and arthroscopic management of soft tissue pathologies such as ganglion excisions and release of contractures. PMID:24754550

Wagner, Jennifer; Ipaktchi, Kyros; Livermore, Meryl; Banegas, Rodrigo

2014-04-01

222

Topographic Analysis of the Glenoid and Proximal Medial Tibial Articular Surfaces – A Search for the Ideal Match for Glenoid Resurfacing  

PubMed Central

Background Current knowledge of the appropriate site of osteochondral allograft harvest to match glenoid morphology for the purposes of glenoid resurfacing is lacking. This has led to difficulty with adequately restoring the geometry of the glenoid using current available techniques. The purpose of this study was to quantify the articular surface topography of the glenoid and medial tibial plateau via 3-dimensional (3D) modeling to determine if the medial tibial articular surface provides an anatomic topographic match to the articular surface of the glenoid. Hypothesis We hypothesized that the medial tibial plateau will provide a suitable osteochondral harvest site due to its concavity and anatomic similarity to the glenoid. Study Design Descriptive Laboratory Study Materials and Methods Computed tomography (CT) was performed on four cadaveric proximal tibias and four scapulae, allowing for 16 glenoid-tibial comparative combinations. 3D CT models were created and exported into point cloud models. A local coordinate map of the glenoid and medial tibial plateau articular surfaces was created. Two zones of the medial tibial articular surface (anterior and posterior) were quantified. The glenoid articular surface was defined as a best-fit circle of the glenoid articular surface maintaining a two millimeter bony rim. This surface was virtually placed on a point on the tibial articular surface in 3D space. The tibial surface was segmented and its 3D surface orientation was determined with respect to its surface. 3D orientation of the glenoid surface was reoriented so that the direction of the glenoid surface matched that of the tibial surface. The least distances between the point-clouds on the glenoid and tibial surfaces were calculated. The glenoid surface was rotated 360 degrees in one-degree increments and the mean least distance was determined at each rotating angle. Results When the centroid of the glenoid surface was placed on the medial tibial articular surface, it covered approximately two-thirds of the anterior or posterior tibial surfaces. Overall, the mean least distance difference in articular congruity of all 16 glenoid-medial tibial surface combinations was 0.74 mm (standard deviation; ± 0.13 mm). The mean least distance difference of the anterior and posterior two-thirds of the medial tibial articular surface was 0.72 mm (± 0.13 mm) and 0.76 mm (± 0.16 mm), respectively. There was no significant difference between and the anterior and posterior two-thirds of the tibia with regard to topographic match of the glenoid (p=0.187). Conclusion We describe a novel methodology to quantify the topography of the tibial and glenoid articular surfaces. The findings suggest that the medial tibial articular surface provides an appropriate anatomic match to the glenoid articular surface. Both the anterior and posterior two-thirds of the medial tibial articular surface can serve as potential sites for osteochondral graft harvest. This methodology can be applied to future studies evaluating the ideal sites of graft harvest to treat zonal glenoid bone wear and/or loss. Clinical Relevance This study provides evidence of a near anatomic topographic match between the medial tibial plateau and glenoid articular surfaces, which has direct clinical application for future biologic osteochondral glenoid resurfacing. This concept has not been described in the literature to date. PMID:23857887

Gupta, Anil K.; Forsythe, Bryan; Lee, Andrew S.; Harris, Joshua D.; McCormick, Frank; Abrams, Geoffrey D.; Verma, Nikhil N.; Romeo, Anthony A.; Inoue, Nozomu; Cole, Brian J.

2014-01-01

223

Detection of avascular necrosis in adults by single photon emission computed tomography  

SciTech Connect

Twenty-one adult patients with the clinical diagnosis of avascular necrosis (AVN) of the femoral head were examined with planar bone scintigraphy (high resolution collimator) and single photon emission computed tomography (SPECT). The duration of hip pain ranged from 1 day to 18 months. Risk factors (including steroids, renal transplantation, alcoholism, and trauma) were present in 17 cases. A final diagnosis of AVN (20 hips), osteochondral facture, or stress fracture, was established for 17 patients. The 4 remaining patients, who were radiographically normal and did not complain of pain 3 months later, were thought to have no significant bone pathology. SPECT and planar bone scintigraphy were reported as positive for AVN only if a photopenic bony defect could be identified. In particular, uniformly increased activity throughout the femoral head was not considered to be diagnostic of AVN. The authors conclude that by identifying a photopenic defect which is not evident on planar bone scintigraphy, SPECT can contribute to accurate diagnosis of AVN.

Collier, B.D.; Johnston, R.P.; Carrera, G.; Isitman, A.T.; Hellman, R.S.; Zielonka, J.S.

1984-01-01

224

Brief communication: a case of congenital syphilis during the colonial period in Mexico City.  

PubMed

Congenital syphilis has been diagnosed very seldom in ancient populations. The case that we examined comes from San Jeronimo's Church (17th and 18th centuries AD; Mexico City). Coffin 43 contained an incomplete skeleton of an approximately 2-year-old infant. The pathological lesions of this skeleton include bilateral osteochondritis, diaphyseal osteomyelitis, and osteitis and/or periostitis on the long bones. The radiographic appearance depicts symmetrical osteomyelitic foci, particularly at the proximal extremity of both tibiae (Wimberger's sign). The skull exhibits hydrocephaly and periosteal changes on the vault, and the unerupted upper incisors evince dental hypoplasia and other pathological alterations reminiscent of Hutchinson's incisors. All these features strongly suggest a case of early congenital syphilis. PMID:7653507

Mansilla, J; Pijoan, C M

1995-06-01

225

Hip Arthroscopy for Synovial Chondromatosis: Tips and Tricks  

PubMed Central

Hip arthroscopy is an important diagnostic and therapeutic tool in the management of synovial chondromatosis. Removal of osteochondral fragments (OCFs) from the central and peripheral compartments is crucial for the relief of mechanical symptoms and subsequent joint destruction. Direct access to the central compartment is often limited because of the ball-and-socket morphology and limitation of traction. We present our surgical technique for removing OCFs and a new method for the removal of a large loose body using a nitinol stone retrieval basket. The technique facilitates removal of difficult-to-access fragments from the central compartment. Moreover, this technique allows removal of far-medial OCFs from the peripheral compartment.

Rath, Ehud; Amar, Eyal; Doron, Ran; Matsuda, Dean K.

2014-01-01

226

MR imaging of the paediatric foot and ankle.  

PubMed

Radiography is the mainstay for initial evaluation of paediatric foot and ankle pathology. MRI is the preferred exam for further characterisation of the majority of these conditions. The modality features high sensitivity and specificity for this purpose with few exceptions. Findings on MRI will often dictate patient referral and further management, and are frequently required for surgical planning. This article will provide an overview of a variety of pathologies that afflict the foot and ankle in children. These include tarsal coalition, osteochondral lesions, osteonecrosis, osteochondroses, stress fractures, osteomyelitis, inflammatory arthritis, neoplasms of bone and soft tissue, and foreign bodies. Their respective imaging manifestations on MRI are the focus of the paper. Technical parameters and marrow signal variation are also discussed. PMID:23478926

Iyer, Ramesh S; Thapa, Mahesh M

2013-03-01

227

New developments in osteoarthritis. Posttraumatic osteoarthritis: pathogenesis and pharmacological treatment options  

PubMed Central

Joint trauma can lead to a spectrum of acute lesions, including osteochondral fractures, ligament or meniscus tears and damage to the articular cartilage. This is often associated with intraarticular bleeding and causes posttraumatic joint inflammation. Although the acute symptoms resolve and some of the lesions can be surgically repaired, joint injury triggers a chronic remodeling process in cartilage and other joint tissues that ultimately manifests as osteoarthritis in a majority of cases. The objective of the present review is to summarize information on pathogenetic mechanisms involved in the acute and chronic consequences of joint trauma and discuss potential pharmacological interventions. The focus of the review is on the early events that follow joint trauma since therapies for posttraumatic joint inflammation are not available and this represents a unique window of opportunity to limit chronic consequences. PMID:20602810

2010-01-01

228

Feet injuries in rock climbers  

PubMed Central

While injuries of the upper extremity are widely discussed in rock climbers, reports about the lower extremity are rare. Nevertheless almost 50 percent of acute injuries involve the leg and feet. Acute injuries are either caused by ground falls or rock hit trauma during a fall. Most frequently strains, contusions and fractures of the calcaneus and talus. More rare injuries, as e.g., osteochondral lesions of the talus demand a highly specialized care and case presentations with combined iliac crest graft and matrix associated autologous chondrocyte transplantation are given in this review. The chronic use of tight climbing shoes leads to overstrain injuries also. As the tight fit of the shoes changes the biomechanics of the foot an increased stress load is applied to the fore-foot. Thus chronic conditions as subungual hematoma, callosity and pain resolve. Also a high incidence of hallux valgus and hallux rigidus is described. PMID:24147257

Schöffl, Volker; Küpper, Thomas

2013-01-01

229

New perspectives in the treatment of cartilage damage. Poly(ethylene glycol) diacrylate (PEGDA) scaffold. A review.  

PubMed

This review was conducted as a complementary study to our review "Current concepts in the treatment of cartilage damage. A review", in this same Journal, on promising new strategies in the treatment of cartilage defects. The established treatments such as osteochondral implants, bone marrow stimulation techniques and chondrogeneic cell implantations, besides advantages, have drawbacks that have led to seek new strategies such as scaffold materials. Matrix-associated chondrocyte implantation, hyaluronan-based scaffolds, tissue-engineered collagen matrices seeded with autologous chondrocytes and encapsulation of autologous chondrocytes in poly(ethylene glycol) diacrylate (PEGDA) seem to be less invasive and have a good performance. In this review we describe benefits and disadvantages of the new procedures of cartilage regeneration by scaffolding materials such as PEGDA. PMID:25338410

Musumeci, Giuseppe; Loreto, Carla; Castorina, Sergio; Imbesi, Rosa; Leonardi, Rosalia; Castrogiovanni, Paola

2013-01-01

230

A conceptually new type of bio-hybrid scaffold for bone regeneration  

NASA Astrophysics Data System (ADS)

Magnetic bio-hybrid porous scaffolds have been synthesized, nucleating nano-apatite in situ on self-assembling collagen, in the presence of magnetite nano-particles. The magnetic phase acted as a sort of cross-linking agent for the collagen, inducing a chemico-physical-mechanical stabilization of the material and allowing us to control the porosity network of the scaffold. Gradients of bio-mineralization and magnetization were also developed for osteochondral application. The good potentiality of the material as a biomedical device, able to offer assistance to bone regeneration through scaffold reloading with specific factors guided by an external magnetic field, has been preliminarily investigated. Up to now the proof of this concept has been realized through in vitro assessments.

Tampieri, A.; Landi, E.; Valentini, F.; Sandri, M.; D'Alessandro, T.; Dediu, V.; Marcacci, M.

2011-01-01

231

Feet injuries in rock climbers.  

PubMed

While injuries of the upper extremity are widely discussed in rock climbers, reports about the lower extremity are rare. Nevertheless almost 50 percent of acute injuries involve the leg and feet. Acute injuries are either caused by ground falls or rock hit trauma during a fall. Most frequently strains, contusions and fractures of the calcaneus and talus. More rare injuries, as e.g., osteochondral lesions of the talus demand a highly specialized care and case presentations with combined iliac crest graft and matrix associated autologous chondrocyte transplantation are given in this review. The chronic use of tight climbing shoes leads to overstrain injuries also. As the tight fit of the shoes changes the biomechanics of the foot an increased stress load is applied to the fore-foot. Thus chronic conditions as subungual hematoma, callosity and pain resolve. Also a high incidence of hallux valgus and hallux rigidus is described. PMID:24147257

Schöffl, Volker; Küpper, Thomas

2013-01-01

232

Joint-preserving surgical options for management of chondral injuries of the hip.  

PubMed

Management of injuries to the articular cartilage is complex and challenging; it becomes especially problematic in weight-bearing joints such as the hip. Several causes of articular cartilage damage have been described, including trauma, labral tears, and femoroacetabular impingement, among others. Because articular cartilage has little capacity for healing, nonsurgical management options are limited. Surgical options include total hip arthroplasty, microfracture, articular cartilage repair, autologous chondrocyte implantation, mosaicplasty, and osteochondral allograft transplantation. Advances in hip arthroscopy have broadened the spectrum of tools available for diagnosis and management of chondral damage. However, the literature is still not sufficiently robust to draw firm conclusions regarding best practices for chondral defects. Additional research is needed to expand our knowledge of and develop guidelines for management of chondral injuries of the hip. PMID:24382879

El Bitar, Youssef F; Lindner, Dror; Jackson, Timothy J; Domb, Benjamin G

2014-01-01

233

Subtalar dislocation secondary to a low energy injury.  

PubMed

An 18-year-old young man presented with an ankle injury, after landing on a supinated right foot following jumping while playing football. A plain X-ray revealed a medial subtalar dislocation. Despite obvious ankle deformity, the surrounding skin remained intact. Closed reduction of the subtalar joint was successfully performed under general anaesthesia in theatre. A CT of the ankle, after reduction, demonstrated a non-displaced fracture of the neck of the talus; no osteochondral defect was observed. This was successfully managed conservatively, with immobilisation of the ankle, in a non-weight bearing cast for 6?weeks. This case highlights that subtalar dislocation may follow a low-energy mechanism and that such injuries can be managed without open reduction. PMID:25650063

McKeag, Philip; Lyske, Jonathan; Reaney, Jonathan; Thompson, Neville

2015-01-01

234

[Soft tissue balancing in valgus gonarthrosis].  

PubMed

Implanting a condylar knee in patients with valgus deformity is challenging both for the surgeon and in terms of clinical instrumentation. Valgus deformity - defined as an anatomic angle >10 degrees - consists of a bony and a soft tissue component. Frequently, the lateral femoral condyle is hypoplastic and can create a secondary osteochondral lesion on the tibial plateau. Concomitantly, there is a soft tissue contracture of the lateral side with an elongation of the medial collateral ligament. Correction of the deformity and restoration of anatomic alignment should be achieved to maximize the longevity of the replaced components. Soft tissue balancing is crucial for successful treatment. This is achieved if a symmetrical flexion and extension gap together with a centralized patella position is obtained. We describe our surgical approach to address valgus deformities in primary total knee arthroplasty with special emphasize on a stepwise release of tight lateral capsular and ligamentous structures controlled by a knee balancer. PMID:17563870

Pape, D; Kohn, D

2007-07-01

235

[Bone bruises of the knee].  

PubMed

Bone bruises represent a spectrum of occult bone lesions around the knee, which can only be detected by magnetic resonance imaging. These lesions can be isolated or are usually associated with other soft tissue injuries of the knee. These occult lesions are mostly associated with anterior cruciate ligament (ACL) injuries and are typically located in the lateral femoral condyle and the posterolateral tibial plateau. The location of the lesion may provide information on the mechanism of injury and associated soft tissue injuries. Bone bruises are less severe after low-energy trauma and most of these lesions usually regress within a short period. However, in lesions due to high-energy trauma like ACL injuries, healing may take years and those especially located close to the subchondral bone have the risk of associated osteochondral sequelae. Bone bruises may be responsible for the late degenerative changes of the knee after an ACL injury. PMID:18180591

Gönç, U?ur; Kayaalp, Asim; Irgit, Kaan

2007-01-01

236

Excision of posterolateral talar dome lesions through a medial transmalleolar approach.  

PubMed

Posterolateral osteochondral fractures of the talus are rare. Although arthroscopy is becoming an increasingly important method of evaluating and treating lesions of the ankle, these techniques may not always be feasible, especially for posterolateral lesions. Classic treatment of displaced or symptomatic chronic lesions is excision, usually with a distal fibular osteotomy and turndown procedure. Subsequent removal of the syndesmosis screw is required. The surgical dissection of the distal fibula is extensive and devascularizing. An alternate technique for debriding posterolateral talar dome lesions through a medial transmalleolar approach is described. Exposure of the lateral talar dome is sufficient to allow debridement and curettage of the lesion. Anatomic rigid fixation of the medial malleolus allows for rapid healing of the osteotomy site and immediate ankle rehabilitation. For those ankle lesions that are not accessible to arthroscopy or an anterolateral arthrotomy, this approach is preferable to the distal fibular osteotomy and turndown. PMID:2731827

Ove, P N; Bosse, M J; Reinert, C M

1989-02-01

237

Management of cartilage defects in the shoulder.  

PubMed

Articular cartilage lesions of the glenohumeral joint are an especially difficult clinical problem to manage, particularly in the younger, more active patient. Left untreated, these lesions may progress in the long-term, leading to further pain and disability. While shoulder arthroplasty remains a viable option in older patients with glenohumeral arthritis, concerns over component longevity and loosening in younger patients make it less attractive in that age group. Arthroscopic joint debridement with loose body removal, often with capsular release, has been successful in select, more sedentary patients. More recent techniques, including autologous chondrocyte implantation (ACI), osteochondral grafting (allograft versus autograft), interpositional arthroplasty, and microfracture surgery, have been evaluated for use in the shoulder. These procedures have experienced success in weight bearing joints, including the knee and ankle. Despite the good clinical results in the shoulder with short-term follow-up reported in some small series, the treatment of chondral injuries in the glenohumeral joint remains a challenging problem. PMID:22628177

Depalma, Anthony A; Gruson, Konrad I

2012-09-01

238

Arthroscopy in acute trauma of the knee joint.  

PubMed

Even in massive hemarthrosis, arthroscopy of the acutely injured knee joint can be performed. The procedure is indicated in all cases where clinical findings and radiography cannot establish a clear diagnosis or a clear indication for operation. Hemarthrosis of unknown origin should be investigated in every case. An additional indication for arthroscopy is planned arthroscopic operation. In a series of 1000 arthroscopies, the examination was performed in 76 patients in the acute stage after trauma. In most knee joints several injuries were found; the most frequent being tears of the menisci, cartilage lesions, ruptures of the anterior cruciate ligament and tears of the joint capsule. 24 cases were treated by arthroscopic operation: 13 partial meniscectomies were performed in acute blocking of the knee and in 8 cases a detached chondral or osteochondral fragment was removed. 29 cases required arthrotomy. Post-operative morbidity of arthroscopic operation is surprisingly low. Patients were not hospitalized for diagnostic or operative arthroscopy. PMID:7428734

Glinz, W; Segantini, P; Kägi, P

1980-11-01

239

Nanofibrous hollow microspheres self-assembled from star-shaped polymers as injectable cell carriers for knee repair  

PubMed Central

Biomaterials play pivotal roles in engineering tissue regeneration and repair. To regenerate irregular shaped defects, injectable cell carriers are desirable. Here, we report the development of self-assembled nanofibrous hollow microspheres from star-shaped biodegradable polymers as an injectable cell carrier for tissue regeneration. The nanofibrous hollow microspheres were shown to efficiently accommodate cells and enhance cartilage regeneration over control microspheres. The nanofibrous hollow microspheres also supported a significantly larger amount and higher quality cartilage regeneration over the chondrocytes alone group in an ectopic implantation model. In a critical-size rabbit osteochondral defect repair model, the nanofibrous hollow microspheres/chondrocytes group achieved substantially better cartilage repair and integration compared to the chondrocytes alone group that simulates the clinically available autologous chondrocyte implantation (ACI) procedure. These results indicate that the nanofibrous hollow microspheres are an excellent cell carrier for cartilage regeneration and are worthy of further investigation towards the aimed clinical application. PMID:21499313

Liu, Xiaohua; Jin, Xiaobing; Ma, Peter X.

2011-01-01

240

Gene Modification of Mesenchymal Stem Cells and Articular Chondrocytes to Enhance Chondrogenesis  

PubMed Central

Current cell based treatment for articular cartilage and osteochondral defects are hampered by issues such as cellular dedifferentiation and hypertrophy of the resident or transplanted cells. The reduced expression of chondrogenic signalling molecules and transcription factors is a major contributing factor to changes in cell phenotype. Gene modification of chondrocytes may be one approach to redirect cells to their primary phenotype and recent advances in nonviral and viral gene delivery technologies have enabled the expression of these lost factors at high efficiency and specificity to regain chondrocyte function. This review focuses on the various candidate genes that encode signalling molecules and transcription factors that are specific for the enhancement of the chondrogenic phenotype and also how epigenetic regulators of chondrogenesis in the form of microRNA may also play an important role. PMID:24963479

2014-01-01

241

Modulation of chondrocyte functions and stiffness-dependent cartilage repair using an injectable enzymatically crosslinked hydrogel with tunable mechanical properties.  

PubMed

We developed an injectable hydrogel system to evaluate the effect of hydrogel stiffness on chondrocyte cellular functions in a three-dimensional (3D) environment and its subsequent influence on ectopic cartilage formation and early-stage osteochondral defect repair in a rabbit model. The hydrogels, composed of gelatin-hydroxyphenylpropionic acid (Gtn-HPA) conjugate, were formed using oxidative coupling of HPA moieties catalyzed by hydrogen peroxide (H2O2) and horseradish peroxidase (HRP). The storage modulus (G') of the hydrogels, which was tunable by changing the H2O2 and Gtn-HPA concentrations, ranged from 570 Pa to 2750 Pa. It was found that the cellular functions of chondrocytes encapsulated in hydrogels, including cell proliferation, biosynthesis of collagen and sulfated glycosaminoglycans (sGAG), as well as gene expression of type I (Col-I) and type II collagen (Col-II), were strongly affected by the stiffness of the hydrogels. Of note, chondrocytes cultured within the Gtn-HPA hydrogel of medium stiffness (G' = 1000 Pa) produced highest level of sGAG production, as well as highest ratio of Col-II to Col-I gene expression among the Gtn-HPA hydrogels of different stiffness. Consistent with the results from in vitro and in vivo ectopic cartilage formation, osteochondral defect repair in a rabbit model showed stiffness-dependent tissue repair, with defects implanted with chondrocytes in hydrogels of medium stiffness having markedly more hyaline cartilage formation, smoother surface and better integration with adjacent cartilage, compared to defects treated with hydrogels of low or high stiffness. These results suggest that the tunable stiffness of Gtn-HPA hydrogels modulates chondrocyte cellular functions, and has a dramatic impact on cartilage tissue histogenesis and repair. PMID:24333028

Wang, Li-Shan; Du, Chan; Toh, Wei Seong; Wan, Andrew C A; Gao, Shu Jun; Kurisawa, Motoichi

2014-02-01

242

Morphological MRI and T2 mapping of cartilage repair tissue after mosaicplasty with tissue-engineered cartilage in a pig model  

PubMed Central

Abstract The aim of this study was to evaluate the efficacy of mosaicplasty with tissue-engineered cartilage for the treatment of osteochondral defects in a pig model with advanced MR technique. Eight adolescent miniature pigs were used. The right knee underwent mosaicplasty with tissue-engineered cartilage for treatment of focal osteochondral defects, while the left knee was repaired via single mosaicplasty as controls. At 6, 12, 18 and 26 weeks after surgery, repair tissue was evaluated by magnetic resonance imaging (MRI) with the cartilage repair tissue (MOCART) scoring system and T2 mapping. Then, the results of MRI for 26 weeks were compared with findings of macroscopic and histologic studies. The MOCART scores showed that the repaired tissue of the tissue-engineered cartilage group was statistically better than that of controls (P < 0.001). A significant correlation was found between macroscopic and MOCART scores (P < 0.001). Comparable mean T2 values were found between adjacent cartilage and repair tissue in the experimental group (P > 0.05). For zonal T2 value evaluation, there were no significant zonal T2 differences for repair tissue in controls (P > 0.05). For the experimental group, zonal T2 variation was found in repair tissue (P < 0.05). MRI, macroscopy and histology showed better repair results and bony incorporation in mosaicplasty with the tissue-engineered cartilage group than those of the single mosaicplasty group. Mosaicplasty with the tissue-engineered cartilage is a promising approach to repair osteochodndral defects. Morphological MRI and T2 mapping provide a non-invasive method for monitoring the maturation and integration of cartilage repair tissue in vivo. PMID:25050115

Chen, Qichun; Zuo, Qiang; Hu, Qianqian; Feng, Yang; Cui, Weiding; Fan, Weimin; Zou, Yuefen

2014-01-01

243

Sequelae of Perthes Disease  

PubMed Central

Background Sequelae of Perthes disease commonly manifests as complex hip pathomorphology including coxa magna, coxa brevis, and acetabular dysplasia. These abnormalities contribute to femoroacetabular impingement and early osteoarthritis. This report describes our experience with correction of the proximal femoral deformity associated with Perthes disease via surgical dislocation, osteochondroplasty (SDO), trochanteric advancement, and treatment of intra-articular chondrolabral injury. Methods Between January 2003 and January 2009, 14 patients with Perthes disease (4 female and 10 male patients) with an average age of 19.6 years (range 14 – 28) were treated with SDO and trochanteric advancement. One patient had a subsequent staged periacetabular osteotomy to improve acetabular coverage. Patient histories, physical exams, operative findings, and pre and postoperative radiographs were evaluated. Results Operative findings demonstrated 6 acetabular cartilage lesions, 6 labral lesions, and 4 femoral osteochondritis dissecans (OCD) lesions treated with autografts. Mean center trochanteric distance improved from ?20 mm to ?1 mm. 4/14 hips deteriorated 1 Tönnis grade and 1/14 hips 2 grades. The Harris hip scores improved from an average of 62 preoperatively (range 51–72) to 95 postoperatively (range 93–97) versus 71 (range 65–76) to 88.6 (range 63–100) in the hips without OCD lesions. There was no statistically significant difference in the age, pre or postoperative HHS between the OCD and non-OCD groups. Mean follow up was 45 months. There were no major perioperative complications and all patients in both groups have their native hip to date. Conclusions The typical adult sequelae of Perthes disease predispose the hip to the development of chondrolabral injury and poor clinical function. Treatment with SDO and trochanteric advancement reduces impingement, improves hip biomechanics and allows treatment of intra-articular pathology. The described approach is associated with clinical improvement without major perioperative complication. Additionally, we have found a high rate of OCD lesions of the femoral head in Perthes hips undergoing surgical dislocation. Osteochondral autograft transfer from the resected femoral head-neck junction been found in the 4 patients treated thus far to be safe and effective with comparable clinical and radiographic outcomes to those hips without OCD lesions. PMID:21102198

ANDERSON, Lucas A.; ERICKSON, Jill A.; SEVERSON, Erik; PETERS, Christopher L.

2010-01-01

244

Simultaneous regeneration of full-thickness cartilage and subchondral bone defects in vivo using a three-dimensional scaffold-free autologous construct derived from high-density bone marrow-derived mesenchymal stem cells.  

PubMed

BackgroundIn recent years, several methods have been developed for repairing full-thickness cartilage defects by tissue engineering using mesenchymal stem cells. Most of these use scaffolds to achieve sufficient thickness. However, considering the potential influence of scaffolds on the surrounding microenvironment, as well as immunological issues, it is desirable to develop a scaffold-free technique. In this study, we developed a novel technique, a scaffold-free autologous construct derived from bone marrow-derived mesenchymal stem cells (BM-MSCs), and successfully use this technique to regenerate cartilage and subchondral bone to repair an osteochondral defect in rabbit knees.MethodsBM-MSCs were isolated from bone marrow liquid aspirated from the iliac crest of rabbits. After expansion in culture dishes and re-suspension in 96-well plates, the cells spontaneously aggregated into a spheroid-like structure. The spheroids were loaded into a tube-shaped Teflon mold with a 5-mm height and maintained under air-liquid interface conditions. These loaded spheroids fused with each other, resulting in a cylinder-shaped construct made of fused cells that conformed to the inner shape of the mold. The construct was implanted into an osteochondral defect in rabbit knees and histologically analyzed 24 and 52 weeks after implantation using Wakitani¿s scoring system.ResultsBoth bone and cartilage were regenerated, maintaining a constant thickness of cartilage. The mean histological score was 10¿±¿1.7 in the 24-week group and 9.7¿±¿0.6 in the 52-week group. There was no significant difference between the 24- and 52-week groups in either parameter of the score, indicating that no deterioration of the repaired tissue occurred during the intervening period.ConclusionsUsing our novel technique, which employs a three-dimensional scaffold-free autologous construct derived from BM-MSCs, we successfully achieved simultaneous regeneration of bone and cartilage for up to 1 year in vivo. This method has potential for clinical use as a safe and effective method for repairing bone and cartilage defects. PMID:25312099

Ishihara, Kohei; Nakayama, Koichi; Akieda, Shizuka; Matsuda, Shuichi; Iwamoto, Yukihide

2014-10-14

245

Customized biomimetic scaffolds created by indirect three-dimensional printing for tissue engineering  

PubMed Central

Three-dimensional printing (3DP) is a rapid prototyping (RP) technique that can create complex 3D structures by inkjet printing of a liquid binder onto powder biomaterials for tissue engineering scaffolds. Direct fabrication of scaffolds from 3DP, however, imposes a limitation on material choices by manufacturing processes. In this study, we report an indirect 3DP approach wherein a positive replica of desired shapes was printed using gelatin particles, and the final scaffold was directly produced from the printed mold. To create patient-specific scaffolds that match precisely to a patient’s external contours, we integrated our indirect 3DP technique with imaging technologies and successfully created custom scaffolds mimicking human mandibular condyle using polycaprolactone (PCL) and chitosan (CH) for potential osteochondral tissue engineering. To test the ability of the technique to precisely control the internal morphology of the scaffolds, we created orthogonal interconnected channels within the scaffolds using computer-aided-design (CAD) models. Because very few biomaterials are truly osteoinductive, we modified inert 3D printed materials with bioactive apatite coating. The feasibility of these scaffolds to support cell growth was investigated using bone marrow stromal cells (BMSC). The BMSCs showed good viability in the scaffolds, and the apatite-coating further enhanced cellular spreading and proliferation. This technique may be valuable for complex scaffold fabrication. PMID:24060622

Lee, Ju-Yeon; Choi, Bogyu; Wu, Benjamin; Lee, Min

2013-01-01

246

Customized biomimetic scaffolds created by indirect three-dimensional printing for tissue engineering.  

PubMed

Three-dimensional printing (3DP) is a rapid prototyping technique that can create complex 3D structures by inkjet printing of a liquid binder onto powder biomaterials for tissue engineering scaffolds. Direct fabrication of scaffolds from 3DP, however, imposes a limitation on material choices by manufacturing processes. In this study, we report an indirect 3DP approach wherein a positive replica of desired shapes was printed using gelatin particles, and the final scaffold was directly produced from the printed mold. To create patient-specific scaffolds that match precisely to a patient's external contours, we integrated our indirect 3DP technique with imaging technologies and successfully created custom scaffolds mimicking human mandibular condyle using polycaprolactone and chitosan for potential osteochondral tissue engineering. To test the ability of the technique to precisely control the internal morphology of the scaffolds, we created orthogonal interconnected channels within the scaffolds using computer-aided-design models. Because very few biomaterials are truly osteoinductive, we modified inert 3D printed materials with bioactive apatite coating. The feasibility of these scaffolds to support cell growth was investigated using bone marrow stromal cells (BMSC). The BMSCs showed good viability in the scaffolds, and the apatite coating further enhanced cellular spreading and proliferation. This technique may be valuable for complex scaffold fabrication. PMID:24060622

Lee, Ju-Yeon; Choi, Bogyu; Wu, Benjamin; Lee, Min

2013-12-01

247

How reliable is MRI in diagnosing cartilaginous lesions in patients with first and recurrent lateral patellar dislocations?  

PubMed Central

Background Lateral dislocation of the patella (LPD) leads to cartilaginous injuries, which have been reported to be associated with retropatellar complaints and the development of patellofemoral osteoarthritis. Therefore, the purpose of this study was to determine the reliability of MRI for cartilage diagnostics after a first and recurrent LPD. Methods After an average of 4.7 days following an acute LPD, 40 patients (21 with first LPDs and 19 with recurrent LPDs) underwent standardized 1.5 Tesla MRI (sagittal T1-TSE, coronal STIR-TSE, transversal fat-suppressed PD-TSE, sagittal fat-suppressed PD-TSE). MRI grading was compared to arthroscopic assessment of the cartilage. Results Sensitivities and positive predictive values for grade 3 and 4 lesions were markedly higher in the patient group with first LPDs compared to the group with recurrent LPDs. Similarly, intra- and inter-observer agreement yielded higher kappa values in patients with first LPDs compared to those with recurrent LPDs. All grade 4 lesions affecting the subchondral bone (osteochondral defects), such as a fissuring or erosion, were correctly assessed on MRI. Conclusions This study demonstrated a comparatively good diagnostic performance for MRI in the evaluation of first and recurrent LPDs, and we therefore recommend MRI for the cartilage assessment after a LPD. PMID:20602779

2010-01-01

248

Intraosseous Infiltration of Platelet-Rich Plasma for Severe Knee Osteoarthritis  

PubMed Central

We describe a new technique of platelet-rich plasma (PRP) infiltration for the treatment of severe knee osteoarthritis. PRP intra-articular infiltration is a promising treatment for knee osteoarthritis, but it still has some limitations in high-degree osteoarthritis. Diagnosis of osteoarthritis is based on clinical and radiographic findings, and patients with grade III or IV knee tibiofemoral osteoarthritis based on the Ahlbäck scale are considered candidates for this technique. The technique consists of performing intraosseous infiltration of PRP into the subchondral bone, which acts on this tissue and consequently on cartilage-bone communication. Although the intraosseous injection hinders the conventional knee intra-articular infiltration, it allows an extension of the range of action of the PRP, which acts directly on the subchondral bone, which is involved in the progression of osteoarthritis. Thus this technique involves a new administration of PRP that can delay knee arthroplasty; moreover, it can be applied for not only severe osteoarthritis but also other pathologies in which the subchondral bone is critical in the etiology, such as necrosis and osteochondral lesions. PMID:25685680

Sánchez, Mikel; Fiz, Nicolás; Guadilla, Jorge; Padilla, Sabino; Anitua, Eduardo; Sánchez, Pello; Delgado, Diego

2014-01-01

249

Matrix assisted autologous chondrocyte transplantation for cartilage treatment  

PubMed Central

Objectives Matrix-assisted autologous chondrocyte transplantation (MACT) has been developed and applied in the clinical practice in the last decade to overcome most of the disadvantages of the first generation procedures. The purpose of this systematic review is to document and analyse the available literature on the results of MACT in the treatment of chondral and osteochondral lesions of the knee. Methods All studies published in English addressing MACT procedures were identified, including those that fulfilled the following criteria: 1) level I-IV evidence, 2) measures of functional or clinical outcome, 3) outcome related to cartilage lesions of the knee cartilage. Results The literature analysis showed a progressively increasing number of articles per year. A total of 51 articles were selected: three randomised studies, ten comparative studies, 33 case series and five case reports. Several scaffolds have been developed and studied, with good results reported at short to medium follow-up. Conclusions MACT procedures are a therapeutic option for the treatment of chondral lesions that can offer a positive outcome over time for specific patient categories, but high-level studies are lacking. Systematic long-term evaluation of these techniques and randomised controlled trials are necessary to confirm the potential of this treatment approach, especially when comparing against less ambitious traditional treatments. PMID:23610698

Kon, E.; Filardo, G.; Di Matteo, B.; Perdisa, F.; Marcacci, M.

2013-01-01

250

Changes in the extracellular matrix on the surface of sintered bovine bone implanted in the femur of a rabbit: an immunohistochemical study.  

PubMed

The interface of implanted True Bone Ceramics (TBC; sintered bovine bone; Koken, Tokyo, Japan) was examined. In the primary experiment, TBC was implanted into the bone marrow of a rabbit's femur. The extracellular matrices (types I, II, and III collagens and fibronectin) of decalcified specimens collected 1-48 weeks postoperatively were immunohistochemically examined. Undecalcified sections collected 6 weeks postoperatively were used for line analyses of calcium and phosphorus, by a scanning electron microscope-electron probe microanalysis (SEM-EPMA) method. In a secondary experiment, TBC was implanted into an osteochondral defect of a femoral condyle, harvested 1-12 weeks postoperatively, and decalcified to examine the extracellular matrices at the interface. In the bone marrow in the early phase, TBC had absorbed quantities of fibronectin. Immature bone (containing both types I and III collagens) in direct apposition to the ceramic surface had matured (containing type I collagen alone) in the TBC pores. SEM-EPMA revealed the continuity of high levels of calcium and phosphorus at the TBC-bone interface. In the secondary experiment, enchondral ossification or fibrous tissue formation was observed near the articular surface. However, in the subchondral layer, direct bone formation was observed in the TBC pores. It was concluded that TBC has excellent bioactivity for inducing maturation of new bone matrix on porous surfaces. PMID:9654554

Hashizume, H; Tamaki, T; Oura, H; Minamide, A

1998-01-01

251

Human telomerase reverse transcriptase and glucose-regulated protein 78 increase the life span of articular chondrocytes and their repair potential  

PubMed Central

Background Like all mammalian cells, normal adult chondrocytes have a limited replicative life span, which decreases with age. To facilitate the therapeutic use of chondrocytes from older donors, a method is needed to prolong their life span. Methods We transfected chondrocytes with hTERT or GRP78 and cultured them in a 3-dimensional atelocollagen honeycomb-shaped scaffold with a membrane seal. Then, we measured the amount of nuclear DNA and glycosaminoglycans (GAGs) and the expression level of type II collagen as markers of cell proliferation and extracellular matrix formation, respectively, in these cultures. In addition, we allografted this tissue-engineered cartilage into osteochondral defects in old rabbits to assess their repair activity in vivo. Results Our results showed different degrees of differentiation in terms of GAG content between chondrocytes from old and young rabbits. Chondrocytes that were cotransfected with hTERT and GRP78 showed higher cellular proliferation and expression of type II collagen than those of nontransfected chondrocytes, regardless of the age of the cartilage donor. In addition, the in vitro growth rates of hTERT- or GRP78-transfected chondrocytes were higher than those of nontransfected chondrocytes, regardless of donor age. In vivo, the tissue-engineered cartilage implants exhibited strong repairing activity, maintained a chondrocyte-specific phenotype, and produced extracellular matrix components. Conclusions Focal gene delivery to aged articular chondrocytes exhibited strong repairing activity and may be therapeutically useful for articular cartilage regeneration. PMID:22472071

2012-01-01

252

Early tissue response to citric acid-based micro- and nanocomposites  

PubMed Central

Composites based on calcium phosphates and biodegradable polymers are desirable for orthopaedic applications due to their potential to mimic bone. Herein, we describe the fabrication, characterization, and in vivo response of novel citric acid-based microcomposites and nanocomposites. Poly(1,8-octanediol-co-citrate) (POC) was mixed with increasing amounts of HA nanoparticles or microparticles (up to 60 wt%), and the morphology and mechanical properties of the resulting composites were assessed. To investigate tissue response, nanocomposites, microcomposites, POC, and poly(L-lactide) (PLL) were implanted in osteochondral defects in rabbits and harvested at 6 weeks for histological evaluation. SEM confirmed increased surface roughness of microcomposites relative to nanocomposites. The mechanical properties of both types of composites increased with increasing amounts of HA (8–328 MPa), although nanocomposites with 60 wt.% HA displayed the highest strength and stiffness. Based on tissue-implant interfacial assessments, all implants integrated well with the surrounding bone and cartilage with no evidence of inflammation. Both nanocomposites and microcomposites supported bone remodeling; however, nanocomposites induced more trabecular bone formation at the tissue-implant interface. The mechanical properties of citric acid-based composites are within the range of human trabecular bone (1–1524 MPa, 211±78 MPa mean modulus) and tissue response was dependent on the size and content of HA, providing new perspectives of design and fabrication criteria for orthopaedic devices such as interference screws and fixation pins. PMID:20949482

Chung, Eun Ji; Qiu, Hongjin; Kodali, Pradeep; Yang, Scott; Sprague, Stuart M.; Hwong, James; Koh, Jason; Ameer, Guillermo A.

2010-01-01

253

Prostaglandin E2 receptor type 2-selective agonist prevents the degeneration of articular cartilage in rabbit knees with traumatic instability  

PubMed Central

Introduction Osteoarthritis (OA) is a common cause of disability in older adults. We have previously reported that an agonist for subtypes EP2 of the prostaglandin E2 receptor (an EP2 agonist) promotes the regeneration of chondral and osteochondral defects. The purpose of the current study is to analyze the effect of this agonist on articular cartilage in a model of traumatic degeneration. Methods The model of traumatic degeneration was established through transection of the anterior cruciate ligament and partial resection of the medial meniscus of the rabbits. Rabbits were divided into 5 groups; G-S (sham operation), G-C (no further treatment), G-0, G-80, and G-400 (single intra-articular administration of gelatin hydrogel containing 0, 80, and 400 ?g of the specific EP2 agonist, ONO-8815Ly, respectively). Degeneration of the articular cartilage was evaluated at 2 or 12 weeks after the operation. Results ONO-8815Ly prevented cartilage degeneration at 2 weeks, which was associated with the inhibition of matrix metalloproteinase-13 (MMP-13) expression. The effect of ONO-8815Ly failed to last, and no effects were observed at 12 weeks after the operation. Conclusions Stimulation of prostaglandin E2 (PGE2) via EP2 prevents degeneration of the articular cartilage during the early stages. With a system to deliver it long term, the EP2 agonist could be a new therapeutic tool for OA. PMID:21914215

2011-01-01

254

The present state of treatments for articular cartilage defects in the knee  

PubMed Central

INTRODUCTION Chondral and osteochondral lesions of the knee are notoriously difficult to treat due to the poor healing capacity of articular cartilage and the hostile environment of moving joints, ultimately causing disabling pain and early osteoarthritis. There are many different reconstructive techniques used currently but few are proven to be of value. However, some have been shown to produce a better repair with hyaline-like cartilage rather than fibrocartilage. METHODS A systematic search of all available online databases including PubMed, MEDLINE® and Embase™ was undertaken using several keywords. All the multiple treatment options and methods available were considered. These were summarised and the evidence for and against them was scrutinised. RESULTS A total of 460 articles were identified after cross-referencing the database searches using the keywords. These revealed that autologous and matrix assisted chondrocyte implantation demonstrated both ‘good to excellent’ histological results and significant improvement in clinical outcomes. CONCLUSIONS Autologous and matrix assisted chondrocyte implantation have been shown to treat symptomatic lesions successfully with significant histological and clinical improvement. There is, however, still a need for further randomised clinical trials, perfecting the type of scaffold and the use of adjuncts such as growth factors. A list of recommendations for treatment and the potential future trends of managing these lesions are given. PMID:22943326

Perera, JR; Gikas, PD; Bentley, G

2012-01-01

255

FREQUENCY CONTENT OF CARTILAGE IMPACT FORCE SIGNAL REFLECTS ACUTE HISTOLOGIC STRUCTURAL DAMAGE  

PubMed Central

Objective The objective of this study was to determine if acute cartilage impact damage could be predicted by a quantification of the frequency content of the impact force signal. Design Osteochondral specimens excised from bovine lateral tibial plateaus were impacted with one of six impact energies. Each impact force signal underwent frequency analysis, with the amount of higher-frequency content (percent of frequency spectrum above 1 KHz) being registered. Specimens were histologically evaluated to assess acute structural damage (articular surface cracking and cartilage crushing) resulting from the impact. Results Acute histologic structural damage to the cartilage had higher concordance with the high-frequency content measure than with other mechanical impact measures (delivered impact energy, impact maximum stress, and impact maximum stress rate of change). Conclusions This result suggests that the frequency content of an impact force signal, specifically the proportion of higher-frequency components, can be used as a quick surrogate measure for acute structural cartilage injury. Taking advantage of this relationship could reduce the time and expense of histological processing needed to morphologically assess cartilage damage, especially for purposes of initial screening when evaluating new impaction protocols. PMID:24015324

Heiner, Anneliese D.; Martin, James A.; McKinley, Todd O.; Goetz, Jessica E.; Thedens, Daniel R.; Brown, Thomas D.

2013-01-01

256

Interactions between structural and chemical biomimetism in synthetic stem cell niches.  

PubMed

Advancements in understanding stem cell functions and differentiation are of key importance for the clinical success of stem-cell-based therapies. 3D structural niches fabricated by two-photon polymerization are a powerful platform for controlling stem cell growth and differentiation. In this paper, we investigate the possibility of further controlling stem cell fate by tuning the mechanical properties of such niches through coating with thin layers of biomimetic hyaluronan-based and gelatin-based hydrogels. We first assess the biocompatibility of chemical coatings and then study the interactions between structural and chemical biomimetism on the response of MSCs in terms of proliferation and differentiation. We observed a clear effect of the hydrogel coating on otherwise identical 3D scaffolds. In particular, in gelatin-coated niches we observed a stronger metabolic activity and commitment toward the osteo-chondral lineage with respect to hyaluronan-coated niches. Conversely, a reduction in the homing effect was observed in all the coated niches, especially in gelatin-coated niches. This study demonstrates the feasibility of controlling independently different mechanical cues, in bioengineered stem cell niches, i.e. the 3D scaffold geometry and the surface stiffness. This will allow, on the one hand, understanding their specific role in stem cell proliferation and differentiation and, on the other hand, finely tuning their synergistic effect. PMID:25594262

Nava, Michele M; Raimondi, Manuela T; Credi, Caterina; De Marco, Carmela; Turri, Stefano; Cerullo, Giulio; Osellame, Roberto

2015-01-01

257

In vitro assessment of biomaterial-induced remodeling of subchondral and cancellous bone for the early intervention of joint degeneration with focus on the spinal disc  

NASA Astrophysics Data System (ADS)

Osteoarthritis-associated pain of the spinal disc, knee, and hip derives from degeneration of cartilagenous tissues in these joints. Traditional therapies have focused on these cartilage (and disc specific nucleus pulposus) changes as a means of treatment through tissue grafting, regenerative synthetic implants, non-regenerative space filling implants, arthroplasty, and arthrodesis. Although such approaches may seem apparent upon initial consideration of joint degeneration, tissue pathology has shown changes in the underlying bone and vascular bed precede the onset of cartilaginous changes. It is hypothesized that these changes precedent joint degeneration and as such may provide a route for early prevention. The current work proposes an injectable biomaterial-based therapy within these subchondral and cancellous bone regions as a means of preventing or reversing osteoarthritis. Two human concentrated platelet releasate-containing alginate hydrogel/beta-tricalcium phosphate composites have been developed for this potential biomaterial application. The undertaking of assessing these materials through bench-, in vitro, and ex vivo work is described herein. These studies showed the capability of the biomaterials to initiate a wound healing response in monocytes, angiogenic and differentiation behavior in immature endothelial cells, and early osteochondral differentiation in mesenchymal stem cells. These cellular activities are associated with fracture healing and endochondral bone formation, demonstrating the potential of the biomaterials to induce osseous and vascular tissue remodeling underlying osteoarthritic joints as a novel therapy for a disease with rapidly growing healthcare costs.

McCanless, Jonathan D.

258

Characterization of mesenchymal stem cells isolated from the rabbit fetal liver.  

PubMed

Physiological attributes of mesenchymal stem cells (MSCs) including straightforward manipulation, multilineage differentiation, immunoregulation, and tropism for injury settings render them ideal therapeutic agents for tissue repair/regeneration. Nevertheless, further studies in suitable animal models of disease are needed to translate the potential of MSCs into clinical applications. We report here the isolation and preliminary characterization of MSCs from fetal rabbit liver (fl-MSCs). Compared with MSCs isolated from adult rabbit bone marrow, fl-MSCs had superior growth rate, clonogenic capability, and plastic adherence owing to their developmental immaturity. Both cytochemical staining and mRNA expression analysis of fl-MSCs confirmed mesodermal lineage differentiation into adipocytes, osteocytes, and chondrocytes. Moreover, fl-MSCs were capable to prevent lymphocyte proliferation both in a 2-way MLC and upon phytohemagglutinin (PHA) stimulation. In contrast, fl-MSCs co-cultured with allogeneic lymphocytes induced proliferation of the latter. Relatedly, although freshly isolated fl-MSCs did express neither major histocompatibility complex (MHC) class I/II nor CD80/CD86, all these immune synapse components were induced upon in vitro culture. Furthermore, fl-MSCs became efficiently transduced for long-term transgene expression with a retroviral vector. Thus, the special biological qualities of fl-MSCs endow them as model candidate vehicles/agents for gene/cell therapy strategies applied to a variety of rabbit models of injury, such as osteochondral lesions. PMID:20148649

Moreno, Rafael; Martínez-González, Itziar; Rosal, Marta; Farwati, Abduljalil; Gratacós, Eduard; Aran, Josep M

2010-10-01

259

Ferumoxytol: a new, clinically applicable label for stem-cell tracking in arthritic joints with MRI  

PubMed Central

Aim To develop a clinically applicable MRI technique for tracking stem cells in matrix-associated stem-cell implants, using the US FDA-approved iron supplement ferumoxytol. Materials & methods Ferumoxytol-labeling of adipose-derived stem cells (ADSCs) was optimized in vitro. A total of 11 rats with osteochondral defects of both femurs were implanted with ferumoxytol- or ferumoxides-labeled or unlabeled ADSCs, and underwent MRI up to 4 weeks post matrix-associated stem-cell implant. The signal-to-noise ratio of different matrix-associated stem-cell implant was compared with t-tests and correlated with histopathology. Results An incubation concentration of 500 µg iron/ml ferumoxytol and 10 µg/ml protamine sulfate led to significant cellular iron uptake, T2 signal effects and unimpaired ADSC viability. In vivo, ferumoxytol-and ferumoxides-labeled ADSCs demonstrated significantly lower signal-to-noise ratio values compared with unlabeled controls (p < 0.01). Histopathology confirmed engraftment of labeled ADSCs, with slow dilution of the iron label over time. Conclusion Ferumoxytol can be used for in vivo tracking of stem cells with MRI. PMID:23534832

Khurana, Aman; Nejadnik, Hossein; Chapelin, Fanny; Lenkov, Olga; Gawande, Rakhee; Lee, Sungmin; Gupta, Sandeep N; Aflakian, Nooshin; Derugin, Nikita; Messing, Solomon; Lin, Guiting; Lue, Tom F; Pisani, Laura; Daldrup-Link, Heike E

2013-01-01

260

Closed medial total subtalar joint dislocation without ankle fracture: a case report  

PubMed Central

Introduction Total subtalar dislocation without fracture of the ankle is a rare clinical entity; it is usually due to a traumatic high-energy mechanism. Standard treatment is successful closed reduction under general anesthesia followed by non-weight bearing and ankle immobilization with a below-knee cast for 6 weeks. Case presentation We present the case of a 30-year-old Moroccan woman who was involved in a road traffic accident. She subsequently received a radiological assessment that objectified a total subtalar dislocation without fracture of her ankle. She was immediately admitted to the operating theater where an immediate reduction was performed under sedation, and immobilization in a plaster boot was adopted for 8 weeks. The management of this traumatic lesion is discussed in the light of the literature. Conclusions Medial subtalar dislocation is a rare dislocation and is not commonly seen as a sports injury because it requires transfer of a large amount of kinetic energy. The weaker talocalcaneal and talonavicular ligaments often bear the brunt of the energy and are more commonly disrupted, compared to the relatively stronger calcaneonavicular ligament. Urgent reduction is important, and closed reduction under general anesthesia is usually successful, often facilitated by keeping the knee in flexion to relax the gastrocnemius muscle. Long-term sequelae include talar avascular necrosis and osteochondral fracture, as well as chronic instability and pain. PMID:25240955

2014-01-01

261

Treatment of Lateral Knee Pain Using Soft Tissue Mobilization in Four Female Triathletes  

PubMed Central

Study Design Prospective case series. Background These case reports present results of the treatment of lateral knee pain in four female amateur triathletes. The athletes were referred to the author’s clinic with either a diagnosis of iliotibial band friction syndrome or patellofemoral pain syndrome, all four having symptoms for longer than seven months. Changes in training routines were identified as the possible cause of the overuse injuries that eventually developed into chronic conditions. Intervention Treatment involved soft tissue mobilization of the musculotendinous structures on the lateral aspect of the knee. Results At four weeks, three of the athletes improved 9 to 19 points on the Lower Extremity Functional Scale, 3 to 5 points on the Global Rating of Change Scale, and demonstrated improvement in hamstring and iliotibial band flexibility. At eight weeks the Global Rating of Change for these three athletes was a 7 (“a very great deal better”) and they had returned to triathlon training with no complaints of lateral knee pain. One athlete did not respond to treatment and eventually underwent arthroscopic surgery for debridement of a lateral meniscus tear. Conclusions After ruling out common causes for lateral knee pain such as lateral meniscus tear, lateral collateral ligament sprain, patellofemoral dysfunction, osteochondral injury, biceps femoris tendonitis, iliotibial band friction syndrome or osteoarthritis, soft tissue restriction should be considered a potential source of dysfunction. In some cases soft tissue restriction is overlooked; athletes go undiagnosed and are limited from sports participation. PMID:25184012

Winslow, John

2014-01-01

262

Endochondral bone formation in gelatin methacrylamide hydrogel with embedded cartilage-derived matrix particles.  

PubMed

The natural process of endochondral bone formation in the growing skeletal system is increasingly inspiring the field of bone tissue engineering. However, in order to create relevant-size bone grafts, a cell carrier is required that ensures a high diffusion rate and facilitates matrix formation, balanced by its degradation. Therefore, we set out to engineer endochondral bone in gelatin methacrylamide (GelMA) hydrogels with embedded multipotent stromal cells (MSCs) and cartilage-derived matrix (CDM) particles. CDM particles were found to stimulate the formation of a cartilage template by MSCs in the GelMA hydrogel in vitro. In a subcutaneous rat model, this template was subsequently remodeled into mineralized bone tissue, including bone-marrow cavities. The GelMA was almost fully degraded during this process. There was no significant difference in the degree of calcification in GelMA with or without CDM particles: 42.5 ± 2.5% vs. 39.5 ± 8.3% (mean ± standard deviation), respectively. Interestingly, in an osteochondral setting, the presence of chondrocytes in one half of the constructs fully impeded bone formation in the other half by MSCs. This work offers a new avenue for the engineering of relevant-size bone grafts, by the formation of endochondral bone within a degradable hydrogel. PMID:25453948

Visser, Jetze; Gawlitta, Debby; Benders, Kim E M; Toma, Selynda M H; Pouran, Behdad; van Weeren, P René; Dhert, Wouter J A; Malda, Jos

2015-01-01

263

Subchondral bone in osteoarthritis: insight into risk factors and microstructural changes  

PubMed Central

Osteoarthritis (OA) is a major cause of disability in the adult population. As a progressive degenerative joint disorder, OA is characterized by cartilage damage, changes in the subchondral bone, osteophyte formation, muscle weakness, and inflammation of the synovium tissue and tendon. Although OA has long been viewed as a primary disorder of articular cartilage, subchondral bone is attracting increasing attention. It is commonly reported to play a vital role in the pathogenesis of OA. Subchondral bone sclerosis, together with progressive cartilage degradation, is widely considered as a hallmark of OA. Despite the increase in bone volume fraction, subchondral bone is hypomineralized, due to abnormal bone remodeling. Some histopathological changes in the subchondral bone have also been detected, including microdamage, bone marrow edema-like lesions and bone cysts. This review summarizes basic features of the osteochondral junction, which comprises subchondral bone and articular cartilage. Importantly, we discuss risk factors influencing subchondral bone integrity. We also focus on the microarchitectural and histopathological changes of subchondral bone in OA, and provide an overview of their potential contribution to the progression of OA. A hypothetical model for the pathogenesis of OA is proposed. PMID:24321104

2013-01-01

264

Mesenchymal stem cells as a potent cell source for articular cartilage regeneration  

PubMed Central

Since articular cartilage possesses only a weak capacity for repair, its regeneration potential is considered one of the most important challenges for orthopedic surgeons. The treatment options, such as marrow stimulation techniques, fail to induce a repair tissue with the same functional and mechanical properties of native hyaline cartilage. Osteochondral transplantation is considered an effective treatment option but is associated with some disadvantages, including donor-site morbidity, tissue supply limitation, unsuitable mechanical properties and thickness of the obtained tissue. Although autologous chondrocyte implantation results in reasonable repair, it requires a two-step surgical procedure. Moreover, chondrocytes expanded in culture gradually undergo dedifferentiation, so lose morphological features and specialized functions. In the search for alternative cells, scientists have found mesenchymal stem cells (MSCs) to be an appropriate cellular material for articular cartilage repair. These cells were originally isolated from bone marrow samples and further investigations have revealed the presence of the cells in many other tissues. Furthermore, chondrogenic differentiation is an inherent property of MSCs noticed at the time of the cell discovery. MSCs are known to exhibit homing potential to the damaged site at which they differentiate into the tissue cells or secrete a wide spectrum of bioactive factors with regenerative properties. Moreover, these cells possess a considerable immunomodulatory potential that make them the general donor for therapeutic applications. All of these topics will be discussed in this review. PMID:25126383

Baghaban Eslaminejad, Mohamadreza; Malakooty Poor, Elham

2014-01-01

265

Chondrogenesis of Infrapatellar Fat Pad Derived Adipose Stem Cells in 3D Printed Chitosan Scaffold  

PubMed Central

Infrapatellar fat pad adipose stem cells (IPFP-ASCs) have been shown to harbor chondrogenic potential. When combined with 3D polymeric structures, the stem cells provide a source of stem cells to engineer 3D tissues for cartilage repair. In this study, we have shown human IPFP-ASCs seeded onto 3D printed chitosan scaffolds can undergo chondrogenesis using TGF?3 and BMP6. By week 4, a pearlescent, cartilage-like matrix had formed that penetrated the top layers of the chitosan scaffold forming a ‘cap’ on the scaffold. Chondrocytic morphology showed typical cells encased in extracellular matrix which stained positively with toluidine blue. Immunohistochemistry demonstrated positive staining for collagen type II and cartilage proteoglycans, as well as collagen type I. Real time PCR analysis showed up-regulation of collagen type II, aggrecan and SOX9 genes when IPFP-ASCs were stimulated by TGF?3 and BMP6. Thus, IPFP-ASCs can successfully undergo chondrogenesis using TGF?3 and BMP6 and the cartilage-like tissue that forms on the surface of 3D-printed chitosan scaffold may prove useful as an osteochondral graft. PMID:24918443

Ye, Ken; Felimban, Raed; Traianedes, Kathy; Moulton, Simon E.; Wallace, Gordon G.; Chung, Johnson; Quigley, Anita; Choong, Peter F. M.; Myers, Damian E.

2014-01-01

266

FGF upregulates osteopontin in epiphyseal growth plate chondrocytes: implications for endochondral ossification.  

PubMed

Fibroblast growth factor receptor 3 (FGFR3) signaling pathways are essential for normal longitudinal bone growth. Mutations in this receptor lead to various human growth disorders, including Achondroplasia, disproportionately short-limbed dwarfism, characterized by narrowing of the hypertrophic region of the epiphyseal growth plates. Here we find that FGF9, a preferred ligand for FGFR3 rapidly induces the upregulation and secretion of the matrix resident phosphoprotein, osteopontin (OPN) in cultured chicken chondrocytes. This effect was observed as early as two hours post stimulation and at FGF9 concentrations as low as 1.25 ng/ml at both mRNA and protein levels. OPN expression is known to be associated with chondrocyte and osteoblast differentiation and osteoclast activation. Unexpectedly, FGF9 induced OPN was accompanied by inhibition of differentiation and increased proliferation of the treated chondrocytes. Moreover, FGF9 stimulated OPN expression irrespective of the differentiation stage of the cells or culture conditions. In situ hybridization analysis of epiphyseal growth plates from chicken or mice homozygous for the Achondroplasia, G369C/mFGFR3 mutation demonstrated co-localization of OPN expression and osteoclast activity, as evidenced by tartarate resistant acid phosphatase positive cells in the osteochondral junction. We propose that FGF signaling directly activates OPN expression independent of chondrocytes differentiation. This may enhance the recruitment and activation of osteoclasts, and increase in cartilage resorption and remodeling in the chondro-osseus border. PMID:16253490

Weizmann, S; Tong, A; Reich, A; Genina, O; Yayon, A; Monsonego-Ornan, E

2005-12-01

267

The optimal combination of cartilage source and apparatus for long-term in vitro chondrocyte viability analysis.  

PubMed

Most studies of long-term chondrocytes survival were for tissue banks. They showed a gradual reduction in the viable chondrocytes percentage as a function of time and ambient temperature, but the samples were harvested under optimal conditions. The aim of our study was to determine the most reliable combination of cartilage source and assay for the in vitro postmortem chondrocyte viability analysis in the conditions that imitate a dead body. Osteochondral cylinders were procured from femoral condyles and talar trochleas of three male donors and stored in the cell culture media at 4 ± 2°C and 23 ± 2°C. The samples were analyzed by a cell viability analyzer and a confocal laser scanning microscope (CLSM) initially 24-36 h after death and then in 4-week intervals. The results reconfirmed the significant influence of time (p = 0.0002), but not of the temperature (p = 0.237). The largest reproducibility was presented for the knee joint and the CLSM. PMID:22621167

Alibegovi?, Armin; Balažic, Jože; Petrovi?, Danijel; Velikonja, Nevenka Kregar; Blagus, Rok; Suput, Dušan; Drobni?, Matej

2012-11-01

268

Viability of human articular chondrocytes harvested postmortem: changes with time and temperature of in vitro culture conditions.  

PubMed

Different studies of long-term chondrocytes viability have shown a gradual reduction as a function of time and ambient temperature. The aim of our in vitro study was to establish chondrocyte postmortem viability curves for 4°C, 11°C, 23°C, 35°C during 63 days after the donors' death. Osteochondral cylinders were procured from the knees of 16 male donors (20-47 years), stored in preservation media that was not changed, and analyzed in 3-day intervals using a confocal laser scanning microscope. A significant influence of time on viability was found from Day 9 (p = 0.0029) and onwards (p < 0.0001). The lowest overall chondrocyte viability was at 35°C, followed by 4°C (p < 0.0001). The conditions used in this in vitro analysis suggest that similar viabilities may occur while in situ in the decedent. Further studies of chondrocyte viability from individuals with known postmortem intervals may show premise to help evaluate time since death in the late postmortem interval. PMID:24502347

Alibegovi?, Armin; Balažic, Jože; Petrovi?, Danijel; Hribar, Gorazd; Blagus, Rok; Drobni?, Matej

2014-03-01

269

New perspectives for articular cartilage repair treatment through tissue engineering: A contemporary review  

PubMed Central

In this paper review we describe benefits and disadvantages of the established methods of cartilage regeneration that seem to have a better long-term effectiveness. We illustrated the anatomical aspect of the knee joint cartilage, the current state of cartilage tissue engineering, through mesenchymal stem cells and biomaterials, and in conclusion we provide a short overview on the rehabilitation after articular cartilage repair procedures. Adult articular cartilage has low capacity to repair itself, and thus even minor injuries may lead to progressive damage and osteoarthritic joint degeneration, resulting in significant pain and disability. Numerous efforts have been made to develop tissue-engineered grafts or patches to repair focal chondral and osteochondral defects, and to date several researchers aim to implement clinical application of cell-based therapies for cartilage repair. A literature review was conducted on PubMed, Scopus and Google Scholar using appropriate keywords, examining the current literature on the well-known tissue engineering methods for the treatment of knee osteoarthritis. PMID:24829869

Musumeci, Giuseppe; Castrogiovanni, Paola; Leonardi, Rosalia; Trovato, Francesca Maria; Szychlinska, Marta Anna; Di Giunta, Angelo; Loreto, Carla; Castorina, Sergio

2014-01-01

270

Continuous gradient scaffolds for rapid screening of cell-material interactions and interfacial tissue regeneration  

PubMed Central

In tissue engineering, the physical and chemical properties of the scaffold mediates cell behavior including regeneration. Thus, a strategy that permits rapid screening of cell-scaffold interactions is critical. Herein, we have prepared eight “hybrid” hydrogel scaffolds in the form of continuous gradients such that a single scaffold contains spatially varied properties. These scaffolds are based on combining an inorganic macromer [methacrylated star polydimethylsiloxane, PDMSstar-MA] and organic macromer [poly(ethylene glycol)diacrylate, PEG-DA] as well both aqueous and organic fabrication solvents. Having previously demonstrated its bioactivity and osteoinductivity, PDMSstar-MA is a particularly powerful component to incorporate into instructive gradient scaffolds based on PEG-DA. The following parameters were varied to produce the different gradients or gradual transitions in: (1) the wt% ratio of PDMSstar-MA to PEG-DA macromers, (2) the total wt% macromer concentration, (3) the number average molecular weight (Mn) of PEG-DA and (4) the Mn of PDMSstar-MA. Upon dividing each scaffold into four “zones” perpendicular to the gradient, we were able to demonstrate the spatial variation in morphology, bioactivity, swelling and modulus. Among these gradient scaffolds are those in which swelling and modulus are conveniently decoupled. In addition to rapid screening of cell-material interactions, these scaffolds are well-suited for regeneration of interfacial tissues (e.g. osteochondral tissues) that transition from one tissue type to another. PMID:23707502

Bailey, Brennan M.; Nail, Lindsay N.; Grunlan, Melissa A.

2013-01-01

271

Ligament Injury, Reconstruction and Osteoarthritis  

PubMed Central

Purpose of Review The recent literature on the factors that initiate and accelerate the progression of osteoarthritis following ligament injuries and their treatment is reviewed. Recent Findings The ligament-injured joint is at high risk for osteoarthritis. Current conservative (e.g. rehabilitation) and surgical (e.g. reconstruction) treatment options appear not to reduce osteoarthritis following ligament injury. The extent of osteoarthritis does not appear dependent on which joint is affected, or the presence of damage to other tissues within the joint. Mechanical instability is the likely initiator of osteoarthritis in the ligament-injured patient. Summary The mechanism osteoarthritis begins with the injury rendering the joint unstable. The instability increases the sliding between the joint surfaces and reduces the efficiency of the muscles, factors that alter joint contact mechanics. The load distribution in the cartilage and underlying bone is disrupted, causing wear and increasing shear, which eventually leads to the osteochondral degeneration. The catalyst to the mechanical process is the inflammation response induced by the injury and sustained during healing. In contrast, the inflammation could be responsible for onset, while the mechanical factors accelerate progression. The mechanisms leading to osteoarthritis following ligament injury have not been fully established. A better understanding of these mechanisms should lead to alternative surgical, drug, and tissue-engineering treatment options, which could eliminate osteoarthritis in these patients. Progress is being made on all fronts. Considering that osteoarthritis is likely to occur despite current treatment options, the best solution may be prevention. PMID:17710194

Fleming, Braden C.; Hulstyn, Michael J.; Oksendahl, Heidi L.; Fadale, Paul D.

2007-01-01

272

Direct Human Cartilage Repair Using Three-Dimensional Bioprinting Technology  

PubMed Central

Current cartilage tissue engineering strategies cannot as yet fabricate new tissue that is indistinguishable from native cartilage with respect to zonal organization, extracellular matrix composition, and mechanical properties. Integration of implants with surrounding native tissues is crucial for long-term stability and enhanced functionality. In this study, we developed a bioprinting system with simultaneous photopolymerization capable for three-dimensional (3D) cartilage tissue engineering. Poly(ethylene glycol) dimethacrylate (PEGDMA) with human chondrocytes were printed to repair defects in osteochondral plugs (3D biopaper) in layer-by-layer assembly. Compressive modulus of printed PEGDMA was 395.73±80.40?kPa, which was close to the range of the properties of native human articular cartilage. Printed human chondrocytes maintained the initially deposited positions due to simultaneous photopolymerization of surrounded biomaterial scaffold, which is ideal in precise cell distribution for anatomic cartilage engineering. Viability of printed human chondrocytes increased 26% in simultaneous polymerization than polymerized after printing. Printed cartilage implant attached firmly with surrounding tissue and greater proteoglycan deposition was observed at the interface of implant and native cartilage in Safranin-O staining. This is consistent with the enhanced interface failure strength during the culture assessed by push-out testing. Printed cartilage in 3D biopaper had elevated glycosaminoglycan (GAG) content comparing to that without biopaper when normalized to DNA. These observations were consistent with gene expression results. This study indicates the importance of direct cartilage repair and promising anatomic cartilage engineering using 3D bioprinting technology. PMID:22394017

Cui, Xiaofeng; Breitenkamp, Kurt; Finn, M.G.; Lotz, Martin

2012-01-01

273

Cartilage viability and catabolism in the intact porcine knee following transarticular impact loading with and without articular fracture.  

PubMed

Posttraumatic arthritis commonly develops following articular fracture. The objective of this study was to develop a closed joint model of transarticular impact with and without creation of an articular fracture that maintains the physiologic environment during loading. Fresh intact porcine knees were preloaded and impacted at 294 J via a drop track. Osteochondral cores were obtained from the medial and lateral aspects of the femoral condyles and tibial plateau. Chondrocyte viability was assessed at days 0, 3, and 5 postimpact in sham, impacted nonfractured, and impacted fractured joints. Total matrix metalloproteinase (MMP) activity, aggrecanase (ADAMTS-4) activity, and sulfated glycosaminoglycan (S-GAG) release were measured in culture media from days 3 and 5 posttrauma. No differences were observed in chondrocyte viability of impacted nonfractured joints (95.9 ± 6.9%) when compared to sham joints (93.8 ± 7.7%). In impacted fractured joints, viability of the fractured edge was 40.5 ± 27.6% and significantly lower than all other sites, including cartilage adjacent to the fractured edge (p < 0.001). MMP and aggrecanase activity and S-GAG release were significantly increased in specimens from the fractured edge. This study showed that joint impact resulting in articular fracture significantly decreased chondrocyte viability, increased production of MMPs and aggrecanases, and enhanced S-GAG release, whereas the same level of impact without fracture did not cause such changes. PMID:21337389

Backus, Jonathon D; Furman, Bridgette D; Swimmer, Troy; Kent, Collin L; McNulty, Amy L; Defrate, Louis E; Guilak, Farshid; Olson, Steven A

2011-04-01

274

Cartilage Viability and Catabolism in the Intact Porcine Knee Following Transarticular Impact Loading with and without Articular Fracture  

PubMed Central

Posttraumatic arthritis commonly develops following articular fracture. The objective of this study was to develop a closed joint model of transarticular impact with and without creation of an articular fracture that maintains the physiologic environment during loading. Fresh intact porcine knees were preloaded and impacted at 294 J via a drop track. Osteochondral cores were obtained from the medial and lateral aspects of the femoral condyles and tibial plateau. Chondrocyte viability was assessed at days 0, 3 and 5 post-impact in sham, impacted nonfractured, and impacted fractured joints. Total matrix metalloproteinase (MMP) activity, aggrecanase (ADAMTS-4) activity, and sulfated glycosaminoglycan (S-GAG) release was measured in culture media from days 3 and 5 post-trauma. No differences were observed in chondrocyte viability of impacted nonfractured joints (95.9±6.9%) when compared to sham joints (93.8±7.7%). In impacted fractured joints, viability of the fractured edge was 40.5±27.6% and significantly lower than all other sites, including cartilage adjacent to the fractured edge (p<0.001). MMP and aggrecanase activity and S-GAG release were significantly increased in specimens from the fractured edge. This study showed that joint impact resulting in articular fracture significantly decreased chondrocyte viability, increased production of MMPs and aggrecanases, and enhanced S-GAG release, whereas the same level of impact without fracture did not cause such changes. PMID:21337389

Backus, Jonathon D.; Furman, Bridgette D.; Swimmer, Troy; Kent, Collin L.; McNulty, Amy L.; DeFrate, Louis E.; Guilak, Farshid; Olson, Steven A.

2011-01-01

275

Stem cell regulatory function mediated by expression of a novel mouse Oct4 pseudogene  

SciTech Connect

Multiple pseudogenes have been proposed for embryonic stem (ES) cell-specific genes, and their abundance suggests that some of these potential pseudogenes may be functional. ES cell-specific expression of Oct4 regulates stem cell pluripotency and self-renewing state. Although Oct4 expression has been reported in adult tissues during gene reprogramming, the detected Oct4 signal might be contributed by Oct4 pseudogenes. Among the multiple Oct4 transcripts characterized here is a {approx}1 kb clone derived from P19 embryonal carcinoma stem cells, which shares a {approx}87% sequence homology with the parent Oct4 gene, and has the potential of encoding an 80-amino acid product (designated as Oct4P1). Adenoviral expression of Oct4P1 in mesenchymal stem cells promotes their proliferation and inhibits their osteochondral differentiation. These dual effects of Oct4P1 are reminiscent of the stem cell regulatory function of the parent Oct4, and suggest that Oct4P1 may be a functional pseudogene or a novel Oct4-related gene with a unique function in stem cells.

Lin, Huey [Department of Biochemistry, SUNY at Buffalo, 3435 Main Street, Buffalo, NY 14214 (United States); Shabbir, Arsalan [Department of Biochemistry, SUNY at Buffalo, 3435 Main Street, Buffalo, NY 14214 (United States); Molnar, Merced [Department of Biochemistry, SUNY at Buffalo, 3435 Main Street, Buffalo, NY 14214 (United States); Lee, Techung [Department of Biochemistry, SUNY at Buffalo, 3435 Main Street, Buffalo, NY 14214 (United States)]. E-mail: chunglee@buffalo.edu

2007-03-30

276

Genetics in Arterial Calcification  

PubMed Central

Artery calcification reflects an admixture of factors such as ectopic osteochondral differentiation with primary host pathological conditions. We review how genetic factors, as identified by human genome-wide association studies, and incomplete correlations with various mouse studies, including knockout and strain analyses, fit into “pieces of the puzzle” in intimal calcification in human atherosclerosis, and artery tunica media calcification in aging, diabetes mellitus, and chronic kidney disease. We also describe in sharp contrast how ENPP1, CD73, and ABCC6 serve as “cogs in a wheel” of arterial calcification. Specifically, each is a minor component in the function of a much larger network of factors that exert balanced effects to promote and suppress arterial calcification. For the network to normally suppress spontaneous arterial calcification, the “cogs” ENPP1, CD73, and ABCC6 must be present and in working order. Monogenic ENPP1, CD73, and ABCC6 deficiencies each drive a molecular pathophysiology of closely related but phenotypically different diseases (generalized arterial calcification of infancy (GACI), pseudoxan-thoma elasticum (PXE) and arterial calcification caused by CD73 deficiency (ACDC)), in which premature onset arterial calcification is a prominent but not the sole feature. PMID:21852556

Rutsch, Frank; Nitschke, Yvonne; Terkeltaub, Robert

2011-01-01

277

Early Intra-Articular Complement Activation in Ankle Fractures  

PubMed Central

Cytokine regulation possibly influences long term outcome following ankle fractures, but little is known about synovial fracture biochemistry. Eight patients with an ankle dislocation fracture were included in a prospective case series and matched with patients suffering from grade 2 osteochondritis dissecans (OCD) of the ankle. All fractures needed external fixation during which joint effusions were collected. Fluid analysis was done by ELISA measuring aggrecan, bFGF, IL-1?, IGF-1, and the complement components C3a, C5a, and C5b-9. The time periods between occurrence of fracture and collection of effusion were only significantly associated with synovial aggrecan and C5b-9 levels (P < 0.001). Furthermore, synovial expressions of both proteins correlated with each other (P < 0.001). Although IL-1? expression was relatively low, intra-articular levels correlated with C5a (P < 0.01) and serological C-reactive protein concentrations 2 days after surgery (P < 0.05). Joint effusions were initially dominated by neutrophils, but the portion of monocytes constantly increased reaching 50% at day 6 after fracture (P < 0.02). Whereas aggrecan and IL-1? concentrations were not different in fracture and OCD patients, bFGF, IGF-1, and all complement components were significantly higher concentrated in ankle joints with fractures (P < 0.01). Complement activation and inflammatory cell infiltration characterize the joint biology following acute ankle fractures. PMID:24967368

Salzmann, Gian M.; Niemeyer, Philipp; Guo, Renfeng

2014-01-01

278

In vitro observation of cartilage-degeneration progression by Fourier-domain OCT  

NASA Astrophysics Data System (ADS)

Optical Coherence Tomography (OCT) as emerging clinical diagnostic imaging technology for dermatology and other semitransparent tissues has shown high potential in monitoring and evaluating the inner structure of articular cartilages. Since novel therapies for the limitation of cartilage degeneration in early stages of osteoarthritis are available, the early minimal invasive diagnosis of cartilage degradation is clinically essential for further treatment options. With the advancing performance and thus diagnostic opportunities of 3D-OCT devices, we carried out a systematic study by monitoring arthrotic alterations of porcine osteochondral explants that are mechanically induced under traumatic impaction. As for in-vitro tomographic imaging we utilized two OCT devices, a Thorlabs FD-OCT device with 92KHz A-scan rate and 1310nm as central wavelength and a self-developed FD-OCT device at 840nm central wavelength. This allows the comparison in image contrast and optical penetration of cartilage tissue between these two spectral bandwidths. Further we analyzed human biopsies of articular cartilages with various degrees of osteoarthritis. The 2D and 3D OCT tomograms are characterized qualitatively regarding the inner tissue structure and quantitatively regarding the tissue absorption parameters. Therefore, we are developing image processing algorithms for the automated monitoring of cartilage tissue. A scoring system for 3D-monitoring allows the characterization of the probe volume regarding the morphological structure and tissue compactness by processing the C - scan data.

Marx, Ulrich; Schmitt, Robert; Nebelung, Sven; Tingart, Markus; Lüring, Christian; Rath, Björn

2012-03-01

279

Ossification defects detected in CT scans represent early osteochondrosis in the distal femur of piglets.  

PubMed

The purpose of the current study was to validate the use of CT for selection against osteochondrosis in pigs by calculating positive predictive value and comparing it to the positive predictive value of macroscopic evaluation, using histological examination as the reference standard. Eighteen male, hereditarily osteochondrosis-predisposed piglets underwent terminal examination at biweekly intervals from the ages of 82-180 days old, including CT scanning, macroscopic, and histological evaluation of the left distal femur. Areas of ischemic chondronecrosis (osteochondrosis) were confirmed in histological sections from 44/56 macroscopically suspected lesions, resulting in a positive predictive value of 79% (95% CI: 67-84%). Suspected lesions, that is; focal, radiolucent defects in the ossification front in CT scans corresponded to areas of ischemic chondronecrosis in 36/36 histologically examined lesions, resulting in a positive predictive value of 100% (95% CI: 90-100%). CT was superior to macroscopic evaluation for diagnosis of early stages of osteochondrosis in the distal femur of piglets. The current histologically validated observations can potentially be extrapolated to diagnostic monitoring of juvenile osteochondritis dissecans in children, or to animal models of human juvenile articular cartilage injury and repair. PMID:24740876

Olstad, Kristin; Kongsro, Jørgen; Grindflek, Eli; Dolvik, Nils Ivar

2014-08-01

280

Chondrogenesis of infrapatellar fat pad derived adipose stem cells in 3D printed chitosan scaffold.  

PubMed

Infrapatellar fat pad adipose stem cells (IPFP-ASCs) have been shown to harbor chondrogenic potential. When combined with 3D polymeric structures, the stem cells provide a source of stem cells to engineer 3D tissues for cartilage repair. In this study, we have shown human IPFP-ASCs seeded onto 3D printed chitosan scaffolds can undergo chondrogenesis using TGF?3 and BMP6. By week 4, a pearlescent, cartilage-like matrix had formed that penetrated the top layers of the chitosan scaffold forming a 'cap' on the scaffold. Chondrocytic morphology showed typical cells encased in extracellular matrix which stained positively with toluidine blue. Immunohistochemistry demonstrated positive staining for collagen type II and cartilage proteoglycans, as well as collagen type I. Real time PCR analysis showed up-regulation of collagen type II, aggrecan and SOX9 genes when IPFP-ASCs were stimulated by TGF?3 and BMP6. Thus, IPFP-ASCs can successfully undergo chondrogenesis using TGF?3 and BMP6 and the cartilage-like tissue that forms on the surface of 3D-printed chitosan scaffold may prove useful as an osteochondral graft. PMID:24918443

Ye, Ken; Felimban, Raed; Traianedes, Kathy; Moulton, Simon E; Wallace, Gordon G; Chung, Johnson; Quigley, Anita; Choong, Peter F M; Myers, Damian E

2014-01-01

281

An amphiphilic degradable polymer/hydroxyapatite composite with enhanced handling characteristics promotes osteogenic gene expression in bone marrow stromal cells  

PubMed Central

Electrospun polymer/hydroxyapatite (HA) composites combining biodegradability with osteoconductivity are attractive for skeletal tissue engineering applications. However, most biodegradable polymers such as PLA are hydrophobic and do not blend with adequate interfacial adhesion with HA, compromising the structural homogeneity, mechanical integrity, and biological performance of the composite. To overcome this challenge, we incorporated a hydrophilic polyethylene glycol (PEG) block to poly(D,L-lactic acid) to improve the adhesion of the degradable polymer with HA. The amphiphilic triblock copolymer PLA-PEG-PLA (PELA) improved the stability of HA-PELA suspension at 25 wt% HA content, which was readily electrospun into HA-PELA composite scaffolds with uniform fiber dimensions. HA-PELA was highly extensible (failure strain >200% vs. <40% for HA-PLA), superhydrophilic (~0° water contact angle vs. >100° for HA-PLA), and exhibited an 8-fold storage modulus increase (unlike deterioration for HA-PLA) upon hydration, owing to the favorable interaction between HA and PEG. HA-PELA also better promoted osteochondral lineage commitment of bone marrow stromal cells in unstimulated culture and supported far more potent osteogenesis upon induction than HA-PLA. We demonstrate that the chemical incorporation of PEG is an effective strategy to improve the performance of degradable polymer/HA composites for bone tissue engineering applications. PMID:23791675

Kutikov, Artem B.; Song, Jie

2013-01-01

282

Acute septicemia caused by Streptococcus gallolyticus subsp. pasteurianus in turkey poults.  

PubMed

Streptococcus gallolyticus, previously known as Streptococcus bovis biotypes I and II/2, is a well-known cause of sepsis and meningitis in humans and birds. The present case report describes an outbreak of fatal septicemia associated with S. gallolyticus subsp. pasteurianus (S. bovis biotype II/2) in 11 turkey flocks in Pennsylvania between 2010 and 2013. Affected poults were 2-3 wk of age. Major clinical observation was sudden increase in mortality among turkey poults without any premonitory clinical signs. Postmortem examination findings revealed acute septicemia with lesions such as fibrinous pericarditis, meningitis, splenic multifocal fibrinoid necrosis, hepatitis, osteochondritis, myositis, and airsacculitis. Gram-positive cocci were isolated from several organs by routine bacterial culture. Biotyping identified bacteria as streptococci, whereas 16S ribosomal RNA gene sequencing identified them as S. gallolyticus subsp. pasteurianus. Antibiotic susceptibility profiles revealed that all the strains isolated were sensitive to penicillin and erythromycin with different sensitivity profiles for other antibacterial agents tested. The present study reports the first confirmed case of acute septicemia in turkey poults caused by S. gallolyticus subsp. pasteurianus. PMID:25055641

Saumya, Dona; Wijetunge, S; Dunn, Patricia; Wallner-Pendleton, Eva; Lintner, Valerie; Matthews, Tammy; Pierre, Traci; Kariyawasam, Subhashinie

2014-06-01

283

Early intra-articular complement activation in ankle fractures.  

PubMed

Cytokine regulation possibly influences long term outcome following ankle fractures, but little is known about synovial fracture biochemistry. Eight patients with an ankle dislocation fracture were included in a prospective case series and matched with patients suffering from grade 2 osteochondritis dissecans (OCD) of the ankle. All fractures needed external fixation during which joint effusions were collected. Fluid analysis was done by ELISA measuring aggrecan, bFGF, IL-1 ?, IGF-1, and the complement components C3a, C5a, and C5b-9. The time periods between occurrence of fracture and collection of effusion were only significantly associated with synovial aggrecan and C5b-9 levels (P < 0.001). Furthermore, synovial expressions of both proteins correlated with each other (P < 0.001). Although IL-1 ? expression was relatively low, intra-articular levels correlated with C5a (P < 0.01) and serological C-reactive protein concentrations 2 days after surgery (P < 0.05). Joint effusions were initially dominated by neutrophils, but the portion of monocytes constantly increased reaching 50% at day 6 after fracture (P < 0.02). Whereas aggrecan and IL-1? concentrations were not different in fracture and OCD patients, bFGF, IGF-1, and all complement components were significantly higher concentrated in ankle joints with fractures (P < 0.01). Complement activation and inflammatory cell infiltration characterize the joint biology following acute ankle fractures. PMID:24967368

Schmal, Hagen; Salzmann, Gian M; Niemeyer, Philipp; Langenmair, Elia; Guo, Renfeng; Schneider, Conny; Habel, Maria; Riedemann, Niels

2014-01-01

284

Ankle arthroscopy in children  

PubMed Central

INTRODUCTION Arthroscopy of the ankle has gained acceptance as a procedure for diagnosing and treating chronic and post-traumatic ankle problems. The senior author's perception is that magnetic resonance imaging (MRI) under-diagnoses anterior soft tissue impingement lesions in children. The purpose of this study was retrospectively to analyse the outcome of ankle arthroscopy in the paediatric age group. PATIENTS AND METHODS Between March 2005 and September 2007, 23 children underwent ankle arthroscopy for post-traumatic pathology. The indications for arthroscopy were failure of non-operative treatment for at least 12 weeks or a grade 3 or 4 osteochondral defect (OCD) on imaging. RESULTS At arthroscopy, OCDs were visualised in 12 cases and impingement lesions were seen in 17 ankles. MRI was performed in 8 of these 12 cases and only 1 suggested the possibility of an impingement lesion. Of the 17 cases of impingement seen on arthroscopy, 12 reported mechanical symptoms preoperatively and 4 were unstable on examination under anaesthetic. Eighteen of the twenty-three patients had complete relief of symptoms at 3 months. Eighteen children who were evaluated at one-year follow up had a mean American Orthopaedic Foot and Ankle Society score of 87. 5 (range: 49-100). CONCLUSIONS Ankle arthroscopy has a successful outcome in paediatric patients and the results are comparable with those reported in adult series. MRI was found to be insensitive for the diagnosis of soft tissue impingement of the ankle. PMID:21477438

Val Vasukutty, Nijil; Akrawi, Hawar; Theruvil, Bipin; Uglow, Mike

2011-01-01

285

Bony island within the articular cartilage of the knee in a child: a rare condition for early osteoarthritis.  

PubMed

Articular cartilage is a specific type of connective tissue composed of hydrated proteoglycans within a matrix of collagen fibrils. In the elderly population, it shows degenerative changes that may results in osteoarthritis. The more severe form of osteoarthritis occasionally demonstrates bone formation within the cartilage, which is designated as a bony protuberance, however, such lesions are rare in children. This report presents the case of a 10-year-old boy with a bony protuberance within the articular cartilage of the knee. The patient initially complained of knee pain and he subsequently developed flexion contracture. Radiological and arthroscopic examinations revealed a bony protuberance in the articular cartilage and degenerative changes of the cartilage above it. He was successfully treated by the removal of the bony protuberance and osteochondral grafting. The bony protuberance may have caused cartilage degradation since the thickness of the cartilage above it was thinner than that around the lesion. The bony protuberance within the articular cartilage formed in the younger population may be a possible cause of osteoarthritis. This case is a noteworthy with regard to the pathogenesis of osteoarthritis. PMID:21808717

Hatta, Taku; Sugita, Takehiko; Aizawa, Toshimi; Ohnuma, Masahiro; Takahashi, Atsushi; Itoi, Eiji

2011-03-17

286

Bony island within the articular cartilage of the knee in a child: a rare condition for early osteoarthritis.  

PubMed

Articular cartilage is a specific type of connective tissue composed of hydrated proteoglycans within a matrix of collagen fibrils. In the elderly population, it shows degenerative changes that may results in osteoarthritis. The more severe form of osteoarthritis occasionally demonstrates bone formation within the cartilage, which is designated as a bony protuberance, however, such lesions are rare in children. This report presents the case of a 10-year-old boy with a bony protuberance within the articular cartilage of the knee. The patient initially complained of knee pain and he subsequently developed flexion contracture. Radiological and arthroscopic examinations revealed a bony protuberance in the articular cartilage and degenerative changes of the cartilage above it. He was successfully treated by the removal of the bony protuberance and osteochondral grafting. The bony protuberance may have caused cartilage degradation since the thickness of the cartilage above it was thinner than that around the lesion. The bony protuberance within the articular cartilage formed in the younger population may be a possible cause of osteoarthritis. This case is a noteworthy with regard to the pathogenesis of osteoarthritis. PMID:21808719

Hatta, Taku; Sugita, Takehiko; Aizawa, Toshimi; Ohnuma, Masahiro; Takahashi, Atsushi; Itoi, Eiji

2011-03-17

287

Development and evaluation of a device for simultaneous uniaxial compression and optical imaging of cartilage samples in vitro.  

PubMed

In this paper, we present a system that allows imaging of cartilage tissue via optical coherence tomography (OCT) during controlled uniaxial unconfined compression of cylindrical osteochondral cores in vitro. We describe the system design and conduct a static and dynamic performance analysis. While reference measurements yield a full scale maximum deviation of 0.14% in displacement, force can be measured with a full scale standard deviation of 1.4%. The dynamic performance evaluation indicates a high accuracy in force controlled mode up to 25 Hz, but it also reveals a strong effect of variance of sample mechanical properties on the tracking performance under displacement control. In order to counterbalance these disturbances, an adaptive feed forward approach was applied which finally resulted in an improved displacement tracking accuracy up to 3 Hz. A built-in imaging probe allows on-line monitoring of the sample via OCT while being loaded in the cultivation chamber. We show that cartilage topology and defects in the tissue can be observed and demonstrate the visualization of the compression process during static mechanical loading. PMID:25362424

Steinert, Marian; Kratz, Marita; Jaedicke, Volker; Hofmann, Martin R; Jones, David B

2014-10-01

288

Cell-based approaches to joint surface repair: a research perspective  

PubMed Central

Summary Repair of lesions of the articular cartilage lining the joints remains a major clinical challenge. Surgical interventions include osteochondral autograft transfer and microfracture. They can provide some relief of symptoms to patients, but generally fail to durably repair the cartilage. Autologous chondrocyte implantation has thus far shown the most promise for the durable repair of cartilage, with long-term follow-up studies indicating improved structural and functional outcomes. However, disadvantages of this technique include the need for additional surgery, availability of sufficient chondrocytes for implantation, and maintenance of their phenotype during culture-expansion. Mesenchymal stem cells offer an attractive alternative cell-source for cartilage repair, due to their ease of isolation and amenability to ex vivo expansion while retaining stem cell properties. Preclinical and clinical studies have demonstrated the potential of mesenchymal stem cells to promote articular cartilage repair, but have also highlighted several key challenges. Most notably, the quality and durability of the repair tissue, its resistance to endochondral ossification, and its effective integration with the surrounding host tissue. In addition, challenges exist related to the heterogeneity of mesenchymal stem cell preparations and their quality-control, as well as optimising the delivery method. Finally, as our knowledge of the cellular and molecular mechanisms underlying articular cartilage repair increases, promising studies are emerging employing bioactive scaffolds or therapeutics that elicit an effective tissue repair response through activation and mobilisation of endogenous stem and progenitor cells. PMID:23598176

Roelofs, A.J.; Rocke, J.P.J.; De Bari, C.

2013-01-01

289

Gout in a 15-year-old boy with juvenile idiopathic arthritis: a case study  

PubMed Central

Joint pain is a common complaint in pediatrics and is most often attributed to overuse or injury. In the face of persistent, severe, or recurrent symptoms, the differential typically expands to include bony or structural causes versus rheumatologic conditions. Rarely, a child has two distinct causes for joint pain. In this case, an obese 15-year-old male was diagnosed with gout, a disease common in adults but virtually ignored in the field of pediatrics. The presence of juvenile idiopathic arthritis (JIA) complicated and delayed the consideration of this second diagnosis. Indeed, the absence of gout from this patient’s differential diagnosis resulted in a greater than two-year delay in receiving treatment. The patients’ BMI was 47.4, and he was also mis-diagnosed with osteochondritis dissecans and underwent medical treatment for JIA, assorted imaging studies, and multiple surgical procedures before the key history of increased pain with red meat ingestion, noticed by the patient, and a subsequent elevated uric acid confirmed his ultimate diagnosis. With the increased prevalence of obesity in the adolescent population, the diagnosis of gout should be an important consideration in the differential diagnosis for an arthritic joint in an overweight patient, regardless of age. PMID:24393408

2014-01-01

290

The glenohumeral joint - a mismatching system? A morphological analysis of the cartilaginous and osseous curvature of the humeral head and the glenoid cavity  

PubMed Central

Background Radial mismatch, glenohumeral conformity ratios and differences between cartilaginous and osseous radii highly depend on the measured plane. The comparison of cartilaginous radii between humeral head and glenoid in different planes provides new information to understand the degree of conformity during abduction of the upper limb. Methods To investigate the radii, CT-images in soft-tissue kernel of 9 specimen were analysed using an image visualization software. Statistical analysis of the obtained data was performed using the t-test. Results Measurements of the radii in the glenoid revealed a significantly larger radius for bone than cartilage, whereas for the humeral head the opposite was the case. Highest ratios for cartilage in the transverse plane were found in the inferior and central areas of the joint surface, whereas the smallest ratios were found in the superior area. The radial mismatch varied between 0.1 mm and 13.6 mm, depending on the measured plane. Conclusions The results suggest that in abduction, the cartilaginous guidance of the humeral head decreases. This might permit the humeral head an anterior-posterior shifting as well as superior-inferior translation. Surgical reconstruction of the normal glenohumeral relationships necessitates precise information about the glenohumeral morphology to ensure proper sizing and correct placement of prosthetic components and osteochondral allografts. PMID:24886613

2014-01-01

291

The Different Roles of Aggrecan Interaction Domains  

PubMed Central

The aggregating proteoglycans of the lectican family are important components of extracellular matrices. Aggrecan is the most well studied of these and is central to cartilage biomechanical properties and skeletal development. Key to its biological function is the fixed charge of the many glycosaminoglycan chains, that provide the basis for the viscoelastic properties necessary for load distribution over the articular surface. This review is focused on the globular domains of aggrecan and their role in anchoring the proteoglycans to other extracellular matrix components. The N-terminal G1 domain is vital in that it binds the proteoglycan to hyaluronan in ternary complex with link protein, retaining the proteoglycan in the tissue. The importance of the C-terminal G3 domain interactions has recently been emphasized by two different human hereditary disorders: autosomal recessive aggrecan-type spondyloepimetaphyseal dysplasia and autosomal dominant familial osteochondritis dissecans. In these two conditions, different missense mutations in the aggrecan C-type lectin repeat have been described. The resulting amino acid replacements affect the ligand interactions of the G3 domain, albeit with widely different phenotypic outcomes. PMID:23019016

2012-01-01

292

Current concepts: tissue engineering and regenerative medicine applications in the ankle joint  

PubMed Central

Tissue engineering and regenerative medicine (TERM) has caused a revolution in present and future trends of medicine and surgery. In different tissues, advanced TERM approaches bring new therapeutic possibilities in general population as well as in young patients and high-level athletes, improving restoration of biological functions and rehabilitation. The mainstream components required to obtain a functional regeneration of tissues may include biodegradable scaffolds, drugs or growth factors and different cell types (either autologous or heterologous) that can be cultured in bioreactor systems (in vitro) prior to implantation into the patient. Particularly in the ankle, which is subject to many different injuries (e.g. acute, chronic, traumatic and degenerative), there is still no definitive and feasible answer to ‘conventional’ methods. This review aims to provide current concepts of TERM applications to ankle injuries under preclinical and/or clinical research applied to skin, tendon, bone and cartilage problems. A particular attention has been given to biomaterial design and scaffold processing with potential use in osteochondral ankle lesions. PMID:24352667

Correia, S. I.; Pereira, H.; Silva-Correia, J.; Van Dijk, C. N.; Espregueira-Mendes, J.; Oliveira, J. M.; Reis, R. L.

2014-01-01

293

Surgical Treatment Options for the Young and Active Middle-Aged Patient with Glenohumeral Arthritis  

PubMed Central

The diagnosis and treatment of symptomatic chondral lesions in young and active middle-aged patients continues to be a challenging issue. Surgeons must differentiate between incidental chondral lesions from symptomatic pathology that is responsible for the patient's pain. A thorough history, physical examination, and imaging work up is necessary and often results in a diagnosis of exclusion that is verified on arthroscopy. Treatment of symptomatic glenohumeral chondral lesions depends on several factors including the patient's age, occupation, comorbidities, activity level, degree of injury and concomitant shoulder pathology. Furthermore, the size, depth, and location of symptomatic cartilaginous injury should be carefully considered. Patients with lower functional demands may experience success with nonoperative measures such as injection or anti-inflammatory pharmacotherapy. When conservative management fails, surgical options are broadly classified into palliative, reparative, restorative, and reconstructive techniques. Patients with lower functional demands and smaller lesions are best suited for simpler, lower morbidity palliative procedures such as debridement (chondroplasty) and cartilage reparative techniques (microfracture). Those with higher functional demands and large glenohumeral defects will usually benefit more from restorative techniques including autograft or allograft osteochondral transfers and autologous chondrocyte implantation (ACI). Reconstructive surgical options are best suited for patients with bipolar lesions. PMID:22536515

Bhatia, Sanjeev; Hsu, Andrew; Lin, Emery C.; Chalmers, Peter; Ellman, Michael; Cole, Brian J.; Verma, Nikhil N.

2012-01-01

294

Recent advances in the research of an endemic osteochondropathy in China: Kashin-Beck disease.  

PubMed

Kashin-Beck disease (KBD) is an endemic chronic osteochondral disease, which has a high prevalence and morbidity in the Eastern Siberia of Russia, and in the broad diagonal, northern-east to southern-west belt in China and North Korea. In 1990's, it was estimated that in China 1-3 million people had some degree of symptoms of the disease, although even higher estimates have been presented. In China, the extensive prevalence peaked in the late 1950's, but since then, in contrast to the global trend of the osteoarthritis (OA), the number of cases has been dramatically falling. Up to 2013, there are 0.64 millions patients with the KBD and 1.16 millions at risk in 377 counties of 13 provinces or autonomous regions. This is obviously thanks to the preventive efforts carried out, which include providing millions of people with dietary supplements and clean water, as well as relocation of whole villages in China. However, relatively little is known about the molecular mechanisms behind the cartilage damage, the genetic and the environmental risk factors, and the rationale of the preventive effects. During the last decade, new data on a cellular and molecular level has begun to accumulate, which hopefully will uncover the grounds of the disease. PMID:25106677

Guo, X; Ma, W-J; Zhang, F; Ren, F-L; Qu, C-J; Lammi, M J

2014-11-01

295

Popliteomeniscal Fascicle Tear: Diagnosis and Operative Technique  

PubMed Central

The occurrence and the consistency of the popliteomeniscal fascicle between the popliteus tendon and the lateral meniscus have been the subject of debate. It is difficult to diagnose and treat popliteomeniscal fascicle tears. Furthermore, popliteomeniscal fascicle tears are difficult to identify with arthroscopy. This article describes the diagnostic factors for popliteomeniscal fascicle tears and the safe, effective operative techniques that can be used for their treatment. We suggest that popliteomeniscal fascicle tears are diagnosed when the following 3 conditions are confirmed: (1) existence of mechanical symptoms such as pain, locking, and giving way in the lateral compartment of the knee; (2) identification of hypermobility of the lateral meniscus through arthroscopic probing; and (3) occurrence of an osteochondral lesion in the posterior area of the lateral femoral condyle. In the case of popliteomeniscal fascicle tears, the tear area can be repaired with a suture hook and polydioxanone with an all-inside technique. If the joint space is narrowing because of soft-tissue tightness, it can be repaired with a zone-specific cannula through an inside-out technique. PMID:23766962

Shin, Hong-Kwan; Lee, Hee-Sung; Lee, Young-Kuk; Bae, Ki-Cheor; Cho, Chul-Hyun; Lee, Kyung-Jae

2012-01-01

296

Engineering Orthopedic Tissue Interfaces  

PubMed Central

While a wide variety of approaches to engineering orthopedic tissues have been proposed, less attention has been paid to the interfaces, the specialized areas that connect two tissues of different biochemical and mechanical properties. The interface tissue plays an important role in transitioning mechanical load between disparate tissues. Thus, the relatively new field of interfacial tissue engineering presents new challenges—to not only consider the regeneration of individual orthopedic tissues, but also to design the biochemical and cellular composition of the linking tissue. Approaches to interfacial tissue engineering may be distinguished based on if the goal is to recreate the interface itself, or generate an entire integrated tissue unit (such as an osteochondral plug). As background for future efforts in engineering orthopedic interfaces, a brief review of the biology and mechanics of each interface (cartilage–bone, ligament–bone, meniscus–bone, and muscle–tendon) is presented, followed by an overview of the state-of-the-art in engineering each tissue, including advances and challenges specific to regenerating the interfaces. PMID:19231983

Yang, Peter J.

2009-01-01

297

Histomorphochemical comparison of microfracture as a first-line and a salvage procedure: is microfracture still a viable option for knee cartilage repair in a salvage situation?  

PubMed

Microfracture is considered as the first-line procedure for knee cartilage repair, but the results of microfracture seem less predictable and rather controversial in a salvage situation. Thus, the purpose of the study was to histomorphochemically compare microfracture as a salvage procedure with microfracture as a first-line procedure in a rabbit model. We hypothesized that microfracture in a salvage situation would result in histomorphochemically inferior cartilage repair compared to microfracture as a first-line procedure, and the inferiority would be attributed to less migration of reparable marrow cells to the defect due to destruction of microarchitecture of the subchondral bone. Thirty-six New Zealand white rabbits were divided into three groups: (i) untreated full-thickness chondral defect, (ii) single microfracture treatment (first microfracture group), and (iii) repeated microfracture in 8 weeks after the first procedure (second microfracture group). In each group, rabbits were sacrificed at the end of 8 weeks, and osteochondral specimens at the repair sites were obtained for histomorphochemical analysis. Results showed that microfracture as a salvage procedure resulted in overall inferior cartilage repair histomorphochemically compared with microfracture as a first-line procedure, which correlated with deteriorative changes in the quality of underlying subchondral bone rather than intrinsic incapability to recruit the reparative cells in the defect area. In conclusion, although a comparable number of reparable cells and a mechanically weakened subchondral bone are anticipated, more study is necessary to clearly determine when a microfracture should be performed in a situation. PMID:24676881

Truong, Minh-Dung; Chung, Jun Young; Kim, Young Jick; Jin, Long Hao; Kim, Byoung Ju; Choi, Byung Hyune; Min, Byoung-Hyun

2014-06-01

298

Magnetic Resonance Imaging of Ferumoxide-Labeled Mesenchymal Stem Cells in Cartilage Defects: In Vitro and In Vivo Investigations  

PubMed Central

The purpose of this study was to (1) compare three different techniques for ferumoxide labeling of mesenchymal stem cells (MSCs), (2) evaluate if ferumoxide labeling allows in vivo tracking of matrix-associated stem cell implants (MASIs) in an animal model, and (3) compare the magnetic resonance imaging (MRI) characteristics of ferumoxide-labeled viable and apoptotic MSCs. MSCs labeled with ferumoxide by simple incubation, protamine transfection, or Lipofectin transfection were evaluated with MRI and histopathology. Ferumoxide-labeled and unlabeled viable and apoptotic MSCs in osteochondral defects of rat knee joints were evaluated over 12 weeks with MRI. Signal to noise ratios (SNRs) of viable and apoptotic labeled MASIs were tested for significant differences using t-tests. A simple incubation labeling protocol demonstrated the best compromise between significant magnetic resonance signal effects and preserved cell viability and potential for immediate clinical translation. Labeled viable and apoptotic MASIs did not show significant differences in SNR. Labeled viable but not apoptotic MSCs demonstrated an increasing area of T2 signal loss over time, which correlated to stem cell proliferation at the transplantation site. Histopathology confirmed successful engraftment of viable MSCs. The engraftment of iron oxide–labeled MASIs by simple incubation can be monitored over several weeks with MRI. Viable and apoptotic MASIs can be distinguished via imaging signs of cell proliferation at the transplantation site. PMID:22554484

Henning, Tobias D.; Gawande, Rakhee; Khurana, Aman; Tavri, Sidhartha; Mandrussow, Lydia; Golovko, Daniel; Horvai, Andrew; Sennino, Barbara; McDonald, Donald; Meier, Reinhard; Wendland, Michael; Derugin, Nikita; Link, Thomas M.; Daldrup-Link, Heike E.

2013-01-01

299

Bioinspired nanofibers support chondrogenesis for articular cartilage repair  

PubMed Central

Articular cartilage repair remains a significant and growing clinical challenge with the aging population. The native extracellular matrix (ECM) of articular cartilage is a 3D structure composed of proteinaceous fibers and a hydrogel ground substance that together provide the physical and biological cues to instruct cell behavior. Here we present fibrous scaffolds composed of poly(vinyl alcohol) and the biological cue chondroitin sulfate with fiber dimensions on the nanoscale for application to articular cartilage repair. The unique, low-density nature of the described nanofiber scaffolds allows for immediate cell infiltration for optimal tissue repair. The capacity for the scaffolds to facilitate cartilage-like tissue formation was evaluated in vitro. Compared with pellet cultures, the nanofiber scaffolds enhance chondrogenic differentiation of mesenchymal stems cells as indicated by increased ECM production and cartilage specific gene expression while also permitting cell proliferation. When implanted into rat osteochondral defects, acellular nanofiber scaffolds supported enhanced chondrogenesis marked by proteoglycan production minimally apparent in defects left empty. Furthermore, inclusion of chondroitin sulfate into the fibers enhanced cartilage-specific type II collagen synthesis in vitro and in vivo. By mimicking physical and biological cues of native ECM, the nanofiber scaffolds enhanced cartilaginous tissue formation, suggesting their potential utility for articular cartilage repair. PMID:22665791

Coburn, Jeannine M.; Gibson, Matthew; Monagle, Sean; Patterson, Zachary; Elisseeff, Jennifer H.

2012-01-01

300

Inorganic-organic hydrogel scaffolds for tissue engineering  

NASA Astrophysics Data System (ADS)

Analogous to the extracellular matrix (ECM) of natural tissues, properties of a tissue engineering scaffold direct cell behavior and thus regenerated tissue properties. These include both physical properties (e.g. morphology and modulus) and chemical properties (e.g. hydrophobicity, hydration and bioactivity). Notably, recent studies suggest that scaffold properties (e.g. modulus) may be as potent as growth factors in terms of directing stem cell fate. Thus, 3D scaffolds possessing specific properties modified for optimal cell regeneration have the potential to regenerate native-like tissues. Photopolymerizable poly(ethylene glycol) diacrylate (PEG-DA)-based hydrogels are frequently used as scaffolds for tissue engineering. They are ideal for controlled studies of cell-material interactions due to their poor protein adsorption in the absence of adhesive ligands thereby making them "biological blank slates". However, their range of physical and chemical properties is limited. Thus, hydrogel scaffolds which maintain the benefits of PEG-DA but possess a broader set of tunable properties would allow the establishment of predictive relationships between scaffold properties, cell behavior and regenerated tissue properties. Towards this goal, this work describes a series of unique hybrid inorganic-organic hydrogel scaffolds prepared using different solvents and also in the form of continuous gradients. Properties relevant to tissue regeneration were investigated including: swelling, morphology, modulus, degradation rates, bioactivity, cytocompatibility, and protein adhesion. These scaffolds were based on the incorporation of hydrophobic, bioactive and osteoinductive methacrylated star polydimethylsiloxane (PDMSstar-MA) ["inorganic component"] into hydrophilic PEG-DA ["organic component"]. The following parameters were varied: molecular weight (Mn) of PEG-DA (Mn = 3k & 6k g/mol) and PDMSstar-MA (Mn = 1.8k, 7k, 14k), ratio of PDMSstar-MA to PEG-DA (0:100 to 20:80), total macromer concentration (5 to 20 wt%) and utilizing either water or dichloromethane (DCM) fabrication solvent. The use of DCM produced solvent induced phase separation (SIPS) resulting in scaffolds with macroporous morphologies, enhanced modulus and a more homogenous distribution of the PDMSstar-MA component throughout. These hybrid hydrogel scaffolds were prepared in the form of continuous gradients such that a single scaffold contains spatially varied chemical and physical properties. Thus, cell-material interaction studies may be conducted more rapidly at different "zones" defined along the gradient. These gradients are also expected to benefit the regeneration of the osteochondral interface, an interfacial tissue that gradually transitions in tissue type. The final aspect of this work was focused on enhancing the osteogenic potential of PDMS via functionalization with amine and phosphonate. Both amine and phosphonate moieties have demonstrated bioactivity. Thus, it was expected that these properties will be enhanced for amine and phosphonate functionalized PDMS. The subsequent incorporation of these PDMS-based macromers into the previously described PEG-DA scaffold system is expected to be valuable for osteochondral tissue regeneration.

Bailey, Brennan Margaret

301

Biomechanical evaluation of suture-holding properties of native and tissue-engineered articular cartilage.  

PubMed

The purpose of this study was to determine suture-holding properties of tissue-engineered neocartilage relative to native articular cartilage. To this end, suture pull-out strength was quantified for native articular cartilage and for neocartilages possessing various mechanical properties. Suture-holding properties were examined in vitro and in vivo. Neocartilage from bovine chondrocytes was engineered using two sets of exogenous stimuli, resulting in neotissue of different biochemical compositions. Compressive and tensile properties and glycosaminoglycan, collagen, and pyridinoline cross-link contents were assayed (study 1). Suture pull-out strength was compared between neocartilage constructs, and bovine and leporine native cartilage. Uniaxial pull-out test until failure was performed after passing 6-0 Vicryl through each tissue (study 2). Subsequently, neocartilage was implanted into a rabbit model to examine short-term suture-holding ability in vivo (study 3). Neocartilage glycosaminoglycan and collagen content per wet weight reached [Formula: see text] and [Formula: see text], respectively. Tensile properties for neocartilage constructs reached [Formula: see text] MPa for Young's modulus and [Formula: see text] MPa for ultimate tensile strength. Neocartilage reached [Formula: see text]33 % of suture pull-out strength of native articular cartilage. Neocartilage cross-link content reached 50 % of native values, and suture pull-out strength correlated positively with cross-link content [Formula: see text]. Neocartilage sutured into rabbit osteochondral defects was successfully maintained for 3 weeks. This study shows that pyridinoline cross-links in neocartilage may be vital in controlling suture pull-out strength. Neocartilage produced in vitro with one-third of native tissue pull-out strength appears sufficient for construct suturing and retention in vivo. PMID:24848644

DuRaine, G D; Arzi, B; Lee, J K; Lee, C A; Responte, D J; Hu, J C; Athanasiou, K A

2015-01-01

302

COMPARISON OF CARTILAGE HISTOPATHOLOGY ASSESSMENT SYSTEMS ON HUMAN KNEE JOINTS AT ALL STAGES OF OSTEOARTHRITIS DEVELOPMENT  

PubMed Central

Objective To compare the MANKIN and OARSI cartilage histopathology assessment systems using human articular cartilage from a large number of donors across the adult age spectrum representing all levels of cartilage degradation. Design Human knees (n=125 from 65 donors; age range 23–92) were obtained from tissue banks. All cartilage surfaces were macroscopically graded. Osteochondral slabs representing the entire central regions of both femoral condyles, tibial plateaus, and the patella were processed for histology and Safranin O – Fast Green staining. Slides representing normal, aged, and OA tissue were scanned and electronic images were scored online by five observers. Statistical analysis was performed for inter- and intra-observer variability, reproducibility and reliability. Results The inter-observer variability among five observers for the MANKIN system showed a similar good intra-class coefficient (ICC >0.81) as for the OARSI system (ICC >0.78). Repeat scoring by three of the five readers showed very good agreement (ICC >0.94). Both systems showed a high reproducibility among four of the five readers as indicated by the Spearman’s rho value. For the MANKIN system, the surface represented by lesion depth was the parameter where all readers showed an excellent agreement. Other parameters such as cellularity, Safranin O staining intensity and tidemark had greater inter-reader disagreement. Conclusion Both scoring systems were reliable but appeared too complex and time consuming for assessment of lesion severity, the major parameter determined in standardized scoring systems. To rapidly and reproducibly assess severity of cartilage degradation, we propose to develop a simplified system for lesion volume. PMID:22353747

Pauli, C.; Whiteside, R.; Heras, F. Las; Nesic, D.; Koziol1, J.; Grogan, S.P.; Matyas, J.; Pritzker, K.P.H.; D’Lima, D.D.; Lotz, M.K.

2012-01-01

303

Identification of Cold-Temperature-Regulated Genes in Flavobacterium psychrophilum ?  

PubMed Central

Flavobacterium psychrophilum is the etiological agent of bacterial coldwater disease (BCWD) and rainbow trout fry syndrome (RTFS). It causes disease primarily in fresh water-reared salmonids, but other fish species can also be affected. A diverse array of clinical conditions is associated with BCWD, including tail rot (peduncle disease), necrotic myositis, and cephalic osteochondritis. Degradation of connective and muscular tissues by extracellular proteases is common to all of these presentations. There are no effective vaccines to prevent BCWD or RTFS, and antibiotics are often used to prevent and control disease. To identify virulence factors that might permit development of an efficacious vaccine, cDNA suppression subtractive hybridization (SSH) was used to identify cold-regulated genes in a virulent strain of F. psychrophilum. Genes predicted to encode a two-component system sensor histidine kinase (LytS), an ATP-dependent RNA helicase, a multidrug ABC transporter permease/ATPase, an outer membrane protein/protective antigen OMA87, an M43 cytophagalysin zinc-dependent metalloprotease, a hypothetical protein, and four housekeeping genes were upregulated at 8°C versus the level of expression at 20°C. Because no F. psychrophilum gene was known to be suitable as an internal standard in reverse transcription-quantitative real-time PCR (RT-qPCR) experiments, the expression stability of nine commonly used reference genes was evaluated at 8°C and 20°C. Expression of the 16S rRNA was equivalent at both temperatures, and this gene was used in RT-qPCR experiments to verify the SSH findings. With the exception of the ATCC 49513 strain, similar patterns of gene expression were obtained with 11 other representative strains of F. psychrophilum. PMID:21216906

Hesami, Shohreh; Metcalf, Devon S.; Lumsden, John S.; MacInnes, Janet I.

2011-01-01

304

Effects of excimer laser on healing of articular cartilage in rabbits.  

PubMed

This study examined healing of 1.0 mm diameter defects in rabbit knee articular cartilage for as long as 14 weeks after creation of the defects by either laser or drilling. The purpose of the research was to determine the effects of laser debridement of cartilage on the intrinsic biomechanical properties of the repair tissue. We therefore imitated chondral shaving and subchondral abrasion of cartilage by creating partial-thickness and full-thickness cartilage defects of standardized size with both excimer laser and drilling. Light and scanning electron microscopic examinations of the repair tissue showed that healing of osteochondral defects created by laser may be delayed compared with defects created by drilling, for at least 6 weeks postoperatively. Even though there initially was a considerable delay in healing in the laser group, neither laser nor drilling had any appreciable effects on the mechanical properties of the repair tissue, as demonstrated by biomechanical testing at 14 weeks. Specifically, the repair cartilage in the defects in the laser group had the following material properties (mean +/- SD): aggregate modulus, 0.40 +/- 0.24 MPa; Poisson's ratio, 0.37 +/- 0.08; permeability, 3.72 +/- 4.28 x 10(-15) m4/N.s; and thickness, 0.20 +/- 0.06 mm. The corresponding values for the defects in the drilling group were 0.39 +/- 0.23 MPa, 0.34 +/- 0.09, 3.82 +/- 3.44 x 10(-15) m4/N.s, and 0.22 +/- 0.09 mm. The repair tissue from both types of defects was pooled, and the values were compared with those for contralateral (control) tissue.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7674065

Athanasiou, K A; Fischer, R; Niederauer, G G; Puhl, W

1995-07-01

305

Inducible cell labeling and lineage tracking during fracture repair.  

PubMed

Mouse models incorporating inducible Cre-ER(T) (2) /LoxP recombination coupled with sensitive fluorescent reporter lines are being increasingly used to track cell lineages in vivo. In this study we use two inducible reporter strains, Ai9iCol2a1 (Ai9 × Col2a1-creER(T) (2) ) to track contribution of chondrogenic progenitors during bone regeneration in a closed fracture model and Ai9i UBC (Ai9 × UBC-creER(T) (2) ) to examine methods for inducing localized recombination. By comparing with Ai9 littermate controls as well as inducible reporter mice not dosed with tamoxifen, we revealed significant leakiness of the CreER(T2) system, particularly in the bone marrow of both lines. These studies highlight the challenges associated with highly sensitive reporters that may be activated without induction in tissues where the CreER(T2) fusion is expressed. Examination of the growth plate in the Ai9iCol2a1 strain showed cells of the osteochondral lineage (cell co-staining with chondrocyte and osteoblast markers) labeled with the tdTom reporter. However, no such labeling was noted in healing fractures of Ai9iCol2a1 mice. Attempts to label a single limb using intramuscular injection of 4-hydroxytamoxifen in the Ai9i UBC strain resulted in complete labeling of the entire animal, comparable to intraperitoneal injection. While a challenge to interpret, these data are nonetheless informative regarding the limitations of these inducible reporter models, and justify caution and expansive controls in future studies using such models. PMID:25389084

Seime, Till; Kolind, Mille; Mikulec, Kathy; Summers, Matthew A; Cantrill, Laurence; Little, David G; Schindeler, Aaron

2015-01-01

306

Viability of human chondrocytes in an ex vivo model in relation to temperature and cartilage depth.  

PubMed

Chondrocytes in human articular cartilage remain viable post-mortem. It has however not been established yet how the storage temperature affects their survival, which is essential information when post-mortem cartilage is used for toxicologic studies. Our aim was to construct a simple model of explanted knee cartilage and to test the influences of time and temperature on the viability of chondrocytes in the ex vivo conditions. Osteochondral cylinders were procured from the cadaveric femoral condyles. The cylinders were embedded in water-tight rubber tubes, which formed separate chondral and osteal compartments. Tubes were filled with normal saline, without additives, to keep chondrocytes under close-to-normal conditions. The samples were divided into two groups stored at 4 degrees C and 35 degrees C, respectively. Three samples of each of these two groups were analysed at the time of removal, and then three and nine days later. Images of Live-Dead staining were scanned by a confocal laser microscope. Count of viable chondrocytes in four regions, from surface to bone, was obtained using image analysis software. The regression model revealed that the number of viable chondrocytes decreased every day by 19% and that an increase in temperature by 1 degree C decreased their viability by 5.8%. The temperature effect fell by 0.2 percentage points for every 100 microm from the surface to the bone. Herein we demonstrate that chondrocytes remain viable in the ex vivo model of human knee cartilage long enough to be able to serve as a model for toxicologic studies. Their viability is, however, significantly influenced by time and temperature. PMID:16180545

Drobnic, M; Mars, T; Alibegovi?, A; Bole, V; Balazic, J; Grubic, Z; Brecelj, J

2005-01-01

307

Histopomorphic Evaluation of Radiofrequency Mediated Débridement Chondroplasty  

PubMed Central

The use of radiofrequency devices has become widespread for surgical ablation procedures. When ablation devices have been deployed in treatment settings requiring tissue preservation like débridement chondroplasty, adoption has been limited due to the collateral damage caused by these devices in healthy tissue surrounding the treatment site. Ex vivo radiofrequency mediated débridement chondroplasty was performed on osteochondral specimens demonstrating surface fibrillation obtained from patients undergoing knee total joint replacement. Three radiofrequency systems designed to perform débridement chondroplasty were tested each demonstrating different energy delivery methods: monopolar ablation, bipolar ablation, and non-ablation energy. Treatment outcomes were compared with control specimens as to clinical endpoint and histopomorphic characteristics. Fibrillated cartilage was removed in all specimens; however, the residual tissue remaining at the treatment site displayed significantly different characteristics attributable to radiofrequency energy delivery method. Systems that delivered ablation-based energies caused tissue necrosis and collateral damage at the treatment site including corruption of cartilage Superficial and Transitional Zones; whereas, the non-ablation system created a smooth articular surface with Superficial Zone maintenance and without chondrocyte death or tissue necrosis. The mechanism of radiofrequency energy deposition upon tissues is particularly important in treatment settings requiring tissue preservation. Ablation-based device systems can cause a worsened state of articular cartilage from that of pre-treatment. Non-ablation energy can be successful in modifying/preconditioning tissue during débridement chondroplasty without causing collateral damage. Utilizing a non-ablation radiofrequency system provides the ability to perform successful débridement chondroplasty without causing additional articular cartilage tissue damage and may allow for other cartilage intervention success. PMID:20721322

Ganguly, Kumkum; McRury, Ian D; Goodwin, Peter M; Morgan, Roy E; Augé II, Wayne K

2010-01-01

308

Does Lateral Knee Geometry Influence Bone Bruise Patterns after Anterior Cruciate Ligament Injury? A Report of two Cases  

PubMed Central

Bone bruise patterns are commonly seen after acute anterior cruciate ligament injuries; they represent a subchondral impaction injury that occurs in the lateral knee joint between the mid-lateral femoral condyle and the posterior lateral tibial plateau. These contusion patterns are present in the majority of noncontact ACL injuries. These injury patterns vary significantly in severity and this aspect is poorly understood. Edema patterns have gained increased interest in the literature of late; they may indicate the severity of the initial injury. They also may be correlated with the development of subsequent osteochondral defects and osteoarthritis. Given the location of this subchondral injury, it is plausible to assume that the geometry of the lateral femorotibial joint may play a role in ACL injury mechanism and severity of injury. We are reporting two cases of clinically identical ACL injuries. A patient with a flat lateral tibial plateau was noted to have a much larger bone edema pattern than a second patient with the highly convex lateral tibial plateau. This may shed light on the pathomechanics of ACL injury and suggests that an individual with a relatively flat tibial plateau has a stable lateral knee joint. Therefore, we hypothesize that much greater force is required to dislocate a flat and stable lateral femorotibial joint in a pivot shift pattern to produce an ACL injury. The greater force required results in a large bone edema pattern. Conversely, the individual with a relatively short and convex tibial plateau has an inherently unstable lateral joint and relatively smaller amounts of force would be needed to produce the identical injury to the ACL. As less force is required, smaller bone edema patterns result. PMID:24027487

Westermann, Robert W; Wolf, Brian R; Wahl, Christopher J

2013-01-01

309

Molecular changes after shockwave therapy in osteoarthritic knee in rats  

NASA Astrophysics Data System (ADS)

This study investigated the molecular changes of DKK-1, MMP13, Wnt-5a and \\upbeta-catenin after extracorporeal shockwave therapy (ESWT) in anterior cruciate ligament transected (ACLT) osteoarthritic (OA) knee in rats. 27 male Spraque-Dawley rats were divided into three groups. Group I was the control one and received sham knee arthrotomy but no ACLT or ESWT. Group II underwent ACLT, but no ESWT. Group III underwent ACLT and received ESWT. The animals were killed at 12 weeks, and the harvested knee specimens were subjected to histopathological examination and immunohistochemical analysis. Radiographs of the knees were obtained at 0 and 12 weeks. At 12 weeks, radiographs of group II showed more arthritic changes with formation of osteochondral fragments, whereas very subtle arthritis was noted in groups I and III. In histopathological examination, group II showed a significant increase of Mankin score and a decrease of subchondral bone as compared to groups I and III. Group III showed a significant decrease of Mankin score and an increase of subchondral bone, with the data comparable to group I. In immunohistochemical analysis, group II showed significant increases of DKK-1 and MMP13 and decreases of Wnt-5a and \\upbeta-catenin in articular cartilage and subchondral bone as compared to groups I and III. Group III showed significant decreases of DKK-1 and MMP13 and increases of Wnt-5a and \\upbeta-catenin, with the data comparable to group I. In conclusion, the application of ESWT causes molecular changes that are consistent with the improvement in subchondral bone remodeling and chondroprotective effect in ACLT OA knees in rats.

Wang, C.-J.; Sun, Y.-C.; Wu, C.-T.; Weng, L.-H.; Wang, F.-S.

2013-10-01

310

Of mice, men and elephants: the relation between articular cartilage thickness and body mass.  

PubMed

Mammalian articular cartilage serves diverse functions, including shock absorption, force transmission and enabling low-friction joint motion. These challenging requirements are met by the tissue's thickness combined with its highly specific extracellular matrix, consisting of a glycosaminoglycan-interspersed collagen fiber network that provides a unique combination of resilience and high compressive and shear resistance. It is unknown how this critical tissue deals with the challenges posed by increases in body mass. For this study, osteochondral cores were harvested post-mortem from the central sites of both medial and lateral femoral condyles of 58 different mammalian species ranging from 25 g (mouse) to 4000 kg (African elephant). Joint size and cartilage thickness were measured and biochemical composition (glycosaminoclycan, collagen and DNA content) and collagen cross-links densities were analyzed. Here, we show that cartilage thickness at the femoral condyle in the mammalian species investigated varies between 90 µm and 3000 µm and bears a negative allometric relationship to body mass, unlike the isometric scaling of the skeleton. Cellular density (as determined by DNA content) decreases with increasing body mass, but gross biochemical composition is remarkably constant. This however need not affect life-long performance of the tissue in heavier mammals, due to relatively constant static compressive stresses, the zonal organization of the tissue and additional compensation by joint congruence, posture and activity pattern of larger mammals. These findings provide insight in the scaling of articular cartilage thickness with body weight, as well as in cartilage biochemical composition and cellularity across mammalian species. They underscore the need for the use of appropriate in vivo models in translational research aiming at human applications. PMID:23437402

Malda, Jos; de Grauw, Janny C; Benders, Kim E M; Kik, Marja J L; van de Lest, Chris H A; Creemers, Laura B; Dhert, Wouter J A; van Weeren, P René

2013-01-01

311

Quantification of stiffness change in degenerated articular cartilage using optical coherence tomography-based air-jet indentation.  

PubMed

Articular cartilage is a thin complex tissue that covers the bony ends of joints. Changes in the composition and structure of articular cartilage will cause degeneration, which may further lead to osteoarthritis. Decreased stiffness is one of the earliest symptoms of cartilage degeneration and also represents the imperfect quality of repaired cartilage. An optical coherence tomography (OCT)-based air-jet indentation system was recently developed in our group to measure the mechanical properties of soft tissues. In this study, this system was applied to quantify the change of mechanical properties of articular cartilage after degeneration induced by enzymatic digestions. Forty osteochondral disks (n = 20 × 2) were prepared from bovine patellae and treated with collagenase and trypsin digestions, respectively. The apparent stiffness of the cartilage was measured by the OCT-based air-jet indentation system before and after the degeneration. The results were also compared with those from a rigid contact mechanical indentation and an ultrasound water-jet indentation. Through the air-jet indentation, it was found that the articular cartilage stiffness dropped significantly by 84% (p < 0.001) and 63% (p < 0.001) on average after collagenase and trypsin digestions, respectively. The stiffness measured by the air-jet indentation system was highly correlated (R > 0.8, p < 0.001) with that from the other two indentation methods. This study demonstrated that the OCT-based air-jet indentation can be a useful tool to quantitatively assess the mechanical properties of articular cartilage, and this encourages us to further develop a miniaturized probe suitable for arthroscopic applications. PMID:21591927

Huang, Yan-Ping; Wang, Shu-Zhe; Saarakkala, Simo; Zheng, Yong-Ping

2011-10-01

312

A new Enpp1 allele, Enpp1(ttw-Ham), identified in an ICR closed colony.  

PubMed

We recently have reported on a novel ankylosis gene that is closely linked to the Enpp1 (ectonucleotide pyrophosphatase/phosphodiesterase 1) gene on chromosome 10. Here, we have discovered novel mutant mice in a Jcl:ICR closed colony with ankylosis in the toes of the forelimbs at about 3 weeks of age. The mutant mice exhibited rigidity in almost all joints, including the vertebral column, which increased with age. These mice also showed hypogrowth with age after 16 weeks due to a loss of visceral fat, which may have been caused by poor nutrition. Histological examination and soft X-ray imaging demonstrated the ectopic ossification of various joints in the mutant mice. In particular, increased calcium deposits were observed in the joints of the toes, the carpal bones and the vertebral column. We sequenced all exons and exon/intron boundaries of Enpp1 in the normal and mutant mice, and identified a G-to-T substitution (c.259+1G>T) in the 5' splice donor site of intron 2 in the Enpp1 gene of the mutant mice. This substitution led to the skipping of exon 2 (73 bp), which generated a stop codon at position 354 bp (amino acid 62) of the cDNA (p.V63Xfs). Nucleotide pyrophosphohydrolase (NPPH) activity of ENPP1 in the mutant mice was also decreased, suggesting that Enpp1 gene function is disrupted in this novel mutant. The mutant mice reported in this study will be a valuable animal model for future studies of human osteochondral diseases and malnutrition. PMID:24770645

Takabayashi, Shuji; Seto, Shintaro; Katoh, Hideki

2014-01-01

313

The cartilage-bone interface.  

PubMed

In the knee joint, the purpose of the cartilage-bone interface is to maintain structural integrity of the osteochondral unit during walking, kneeling, pivoting, and jumping--during which tensile, compressive, and shear forces are transmitted from the viscoelastic articular cartilage layer to the much stiffer mineralized end of the long bone. Mature articular cartilage is integrated with subchondral bone through a approximately 20 to approximately 250 microm thick layer of calcified cartilage. Inside the calcified cartilage layer, perpendicular chondrocyte-derived collagen type II fibers become structurally cemented to collagen type I osteoid deposited by osteoblasts. The mature mineralization front is delineated by a thin approximately 5 microm undulating tidemark structure that forms at the base of articular cartilage. Growth plate cartilage is anchored to epiphyseal bone, sometimes via a thin layer of calcified cartilage and tidemark, while the hypertrophic edge does not form a tidemark and undergoes continual vascular invasion and endochondral ossification (EO) until skeletal maturity upon which the growth plates are fully resorbed and replaced by bone. In this review, the formation of the cartilage-bone interface during skeletal development and cartilage repair, and its structure and composition are presented. Animal models and human anatomical studies show that the tidemark is a dynamic structure that forms within a purely collagen type II-positive and collagen type I-negative hyaline cartilage matrix. Cartilage repair strategies that elicit fibrocartilage, a mixture of collagen type I and type II, are predicted to show little tidemark/calcified cartilage regeneration and to develop a less stable repair tissue-bone interface. The tidemark can be regenerated through a bone marrow-driven growth process of EO near the articular surface. PMID:22928426

Hoemann, Caroline D; Lafantaisie-Favreau, Charles-Hubert; Lascau-Coman, Viorica; Chen, Gaoping; Guzmán-Morales, Jessica

2012-05-01

314

Anaesthesia in medetomidine premedicated New Zealand White rabbits: a comparison between intravenous sufentanil-midazolam and isoflurane anaesthesia for orthopaedic surgery.  

PubMed

Eighteen female New Zealand White rabbits (3.9?±?0.4?kg) were anaesthetized with sufentanil-midazolam by intravenous infusion (SUF-MID, n?=?9) or isoflurane (ISO, n?=?9) for bilateral creation of an osteochondral defect in the medial femur condyle. Subcutaneous premedication with 0.1?mg/kg medetomidine and anaesthesia induction by intravenous infusion of 1.1?µg/kg sufentanil and 0.2?mg/kg midazolam were identical in both groups. During surgery (60?min), the effects on respiratory and circulatory variables serum lactate, total protein and blood glucose were examined. Intermittent positive pressure ventilation (IPPV) was initiated if apnoea lasted>30?s or if end-tidal CO2 ?8?kPa. The righting reflex was lost in 3?min. IPPV was necessary during most of the anaesthesia for most of the rabbits. Maintenance doses during surgery were 2.0?µg/kg/h sufentanil and 0.4?mg/kg/h midazolam, and 1.4% isoflurane, respectively. Mean arterial blood pressure (MAP) was higher in group SUF-MID than group ISO during surgery (63?±?12 vs 50?±?8?mmHg). In group ISO the heart rate was higher during surgery than before anaesthesia (197?±?26 vs 158?±?40 bpm) as was blood glucose (9?±?2 vs 12?±?3?mmol/L). Serum lactate levels remained unchanged whereas total protein decreased in both groups. Time to recover from anaesthesia did not differ between groups (20?min). Intravenous sufentanil-midazolam infusion provided surgical anaesthesia with a higher MAP than isoflurane anaesthesia. The protocol can be useful in situations in which gas anaesthesia cannot be used or in animals with limited cardiovascular reserves. However, IPPV is necessary. PMID:24464922

Hedenqvist, Patricia; Edner, Anna; Jensen-Waern, Marianne

2014-04-01

315

Bioactive glass in tissue engineering  

PubMed Central

This review focuses on recent advances in the development and use of bioactive glass for tissue engineering applications. Despite its inherent brittleness, bioactive glass has several appealing characteristics as a scaffold material for bone tissue engineering. New bioactive glasses based on borate and borosilicate compositions have shown the ability to enhance new bone formation when compared to silicate bioactive glass. Borate-based bioactive glasses also have controllable degradation rates, so the degradation of the bioactive glass implant can be more closely matched to the rate of new bone formation. Bioactive glasses can be doped with trace quantities of elements such as Cu, Zn and Sr, which are known to be beneficial for healthy bone growth. In addition to the new bioactive glasses, recent advances in biomaterials processing have resulted in the creation of scaffold architectures with a range of mechanical properties suitable for the substitution of loaded as well as non-loaded bone. While bioactive glass has been extensively investigated for bone repair, there has been relatively little research on the application of bioactive glass to the repair of soft tissues. However, recent work has shown the ability of bioactive glass to promote angiogenesis, which is critical to numerous applications in tissue regeneration, such as neovascularization for bone regeneration and the healing of soft tissue wounds. Bioactive glass has also been shown to enhance neocartilage formation during in vitro culture of chondrocyte-seeded hydrogels, and to serve as a subchondral substrate for tissue-engineered osteochondral constructs. Methods used to manipulate the structure and performance of bioactive glass in these tissue engineering applications are analyzed. PMID:21421084

Rahaman, Mohamed N.; Day, Delbert E.; Bal, B. Sonny; Fu, Qiang; Jung, Steven B.; Bonewald, Lynda F.; Tomsia, Antoni P.

2011-01-01

316

Prevalent cartilage damage and cartilage loss over time are associated with incident bone marrow lesions in the tibiofemoral compartments: the MOST Study  

PubMed Central

Objective To assess the association of prevalent cartilage damage and cartilage loss over time with incident bone marrow lesions (BMLs) in the same subregion of the tibiofemoral compartments as detected on magnetic resonance imaging (MRI). Methods The Multicenter Osteoarthritis Study is an observational study of individuals with or at risk for knee osteoarthritis (OA). Subjects whose baseline and 30-month follow-up MRIs were read for findings of OA were included. MRI was performed with a 1.0T extremity system. Tibiofemoral compartments were divided into 10 subregions. Cartilage morphology was scored from 0 to 6 and BMLs were scored from 0 to 3. Prevalent cartilage damage and cartilage loss over time were considered predictors of incident BMLs. Associations were assessed using logistic regression, with adjustments for potential confounders. Results Medially, incident BMLs were associated with baseline cartilage damage (adjusted odds ratio (OR) 3.9 [95% CI 3.0, 5.1]), incident cartilage loss (7.3 [95% CI 5.0, 10.7]) and progression of cartilage loss (7.6 [95% CI 5.1, 11.3]) Laterally, incident BMLs were associated with baseline cartilage damage (4.1 [95% CI 2.6, 6.3]), incident cartilage loss (6.0 [95% CI 3.1, 11.8]), and progression of cartilage loss (11.9 [95% CI 6.2, 23.0]). Conclusion Prevalent cartilage damage and cartilage loss over time are strongly associated with incident BMLs in the same subregion, supporting the significance of the close interrelation of the osteochondral unit in the progression of knee OA. PMID:23178289

Crema, Michel D.; Felson, David T.; Roemer, Frank W.; Wang, Ke; Marra, Monica D.; Nevitt, Michael C.; Lynch, John A.; Torner, James; Lewis, Cora E.; Guermazi, Ali

2012-01-01

317

Computed tomography and magnetic resonance imaging in the study of joint development in the equine pelvic limb.  

PubMed

Osteochondrosis dissecans (OCD) is a focal failure of endochondral ossification of the epiphysis characterized by the presence of cartilage flaps and osteochondral fragments. The objective of this study was to image epiphyseal development in the equine pelvic limb to determine whether there was a variation in site maturation that could be a predisposing factor for OCD. Pelvic limbs (fetuses and foals) were studied post-mortem. The epiphyses of the distal femur, tibia and talus were scanned with computed tomography (CT) and 1.5T magnetic resonance imaging (MRI) to investigate the degree and pattern of ossification, the regularity of the ossification front and cartilage percentage (articular epiphyseal cartilage thickness as a percentage of total epiphyseal diameter) at predetermined sites. The secondary ossification centers (SOCs) were first identified in the femoral epiphyses at 7months, and both tibia and talus at 8months of gestation (MOG). At ?8 MOG the cartilage percentage was higher at the majority of OCD-susceptible sites when compared to control sites. At 8-9 MOG the lateral trochlear ridge of the femur, medial malleolus of the tibia (MM), cranial part of the distal intermediate ridge of the tibia (DIRT(Cr)), all OCD susceptible sites, had the greatest cartilage percentage compared to all other sites assessed. Post-partum, the cartilage percentage of the MM and DIRT(Cr), common sites of OCD, remained high. CT and MRI images illustrate equine epiphyseal development and provide additional evidence that greater cartilage thickness at specific joint sites could play a role in the development of OCD. PMID:23688440

Fontaine, Pascal; Blond, Laurent; Alexander, Kate; Beauchamp, Guy; Richard, Hélène; Laverty, Sheila

2013-07-01

318

Multiple Recombinant Adeno-Associated Viral Vector Serotypes Display Persistent In Vivo Gene Expression in Vector-Transduced Rat Stifle Joints  

PubMed Central

Abstract Our aim was to investigate serotype-specific cell and tissue-transduction tropisms, transgene expression levels and longevity, and immunogenicity of candidate rAAV serotypes in rat osteochondral cells, tissues, and stifle joints. In vitro, we used six rAAV serotypes and two promoters to transduce synoviocytes and chondrocytes. Serotypes rAAV2/5 and 2/2 yielded the highest transduction efficiency 4 days after transduction. No differences were detected between cytomegalovirus and chicken ?-actin promoters. In vivo, intra-articular injection was used to introduce four rAAV serotypes into 4-month-old rats in the left stifle joint. Eleven months later, serotype 2/5 vector, diluted with saline or surfactant, was injected into the right stifle joint of the same rats. Rats were analyzed up to 12 months after initial injection. Bioluminescence was detected at 7 days and all serotypes tested displayed bioluminescence above controls after 1 year in the left stifle. Gene expression was detected in the right stifle joints of all rats with the exception of rats previously injected with serotype 2/5. We observed no difference irrespective of whether the luciferin was injected subcutaneously or intraperitoneally. However, surfactant-diluted vectors led to increased gene expression compared with saline-diluted vectors. Cell- and tissue-specific transduction was observed in rat stifles injected with an nLacZ-containing rAAV. Transduction was greatest in stromal tissues and mesenchymal cell types. Exposure to a specific serotype did not inhibit subsequent transduction with a different serotype at a second vector injection. Including surfactant as a vector diluent increased gene expression within the stifle joint and should be considered for in vivo gene therapy applications. PMID:23659250

Gurda, Brittney L.; Engiles, Julie B.; Hankenson, Kurt D.; Wilson, James M.; Richardson, Dean W.

2013-01-01

319

Identification of cold-temperature-regulated genes in Flavobacterium psychrophilum.  

PubMed

Flavobacterium psychrophilum is the etiological agent of bacterial coldwater disease (BCWD) and rainbow trout fry syndrome (RTFS). It causes disease primarily in fresh water-reared salmonids, but other fish species can also be affected. A diverse array of clinical conditions is associated with BCWD, including tail rot (peduncle disease), necrotic myositis, and cephalic osteochondritis. Degradation of connective and muscular tissues by extracellular proteases is common to all of these presentations. There are no effective vaccines to prevent BCWD or RTFS, and antibiotics are often used to prevent and control disease. To identify virulence factors that might permit development of an efficacious vaccine, cDNA suppression subtractive hybridization (SSH) was used to identify cold-regulated genes in a virulent strain of F. psychrophilum. Genes predicted to encode a two-component system sensor histidine kinase (LytS), an ATP-dependent RNA helicase, a multidrug ABC transporter permease/ATPase, an outer membrane protein/protective antigen OMA87, an M43 cytophagalysin zinc-dependent metalloprotease, a hypothetical protein, and four housekeeping genes were upregulated at 8°C versus the level of expression at 20°C. Because no F. psychrophilum gene was known to be suitable as an internal standard in reverse transcription-quantitative real-time PCR (RT-qPCR) experiments, the expression stability of nine commonly used reference genes was evaluated at 8°C and 20°C. Expression of the 16S rRNA was equivalent at both temperatures, and this gene was used in RT-qPCR experiments to verify the SSH findings. With the exception of the ATCC 49513 strain, similar patterns of gene expression were obtained with 11 other representative strains of F. psychrophilum. PMID:21216906

Hesami, Shohreh; Metcalf, Devon S; Lumsden, John S; Macinnes, Janet I

2011-03-01

320

Investigation of Localized Delivery of Diclofenac Sodium from Poly(D,L-Lactic Acid-co-Glycolic Acid)/Poly(Ethylene Glycol) Scaffolds Using an In Vitro Osteoblast Inflammation Model  

PubMed Central

Nonunion fractures and large bone defects are significant targets for osteochondral tissue engineering strategies. A major hurdle in the use of these therapies is the foreign body response of the host. Herein, we report the development of a bone tissue engineering scaffold with the ability to release anti-inflammatory drugs, in the hope of evading this response. Porous, sintered scaffolds composed of poly(D,L-lactic acid-co-glycolic acid) (PLGA) and poly(ethylene glycol) (PEG) were prepared with and without the anti-inflammatory drug diclofenac sodium. Analysis of drug release over time demonstrated a profile suitable for the treatment of acute inflammation with ?80% of drug released over the first 4 days and a subsequent release of around 0.2% per day. Effect of drug release was monitored using an in vitro osteoblast inflammation model, comprised of mouse primary calvarial osteoblasts stimulated with proinflammatory cytokines interleukin-1? (IL-1?), tumor necrosis factor-? (TNF-?), and interferon-? (IFN-?). Levels of inflammation were monitored by cell viability and cellular production of nitric oxide (NO) and prostaglandin E2 (PGE2). The osteoblast inflammation model revealed that proinflammatory cytokine addition to the medium reduced cell viability to 33%, but the release of diclofenac sodium from scaffolds inhibited this effect with a final cell viability of ?70%. However, releasing diclofenac sodium at high concentrations had a toxic effect on the cells. Proinflammatory cytokine addition led to increased NO and PGE2 production; diclofenac-sodium-releasing scaffolds inhibited NO release by ?64% and PGE2 production by ?52%, when the scaffold was loaded with the optimal concentration of drug. These observations demonstrate the potential use of PLGA/PEG scaffolds for localized delivery of anti-inflammatory drugs in bone tissue engineering applications. PMID:25104438

Sidney, Laura E.; Heathman, Thomas R.J.; Britchford, Emily R.; Abed, Arif; Rahman, Cheryl V.

2015-01-01

321

Loss of Tbx1 induces bone phenotypes similar to cleidocranial dysplasia.  

PubMed

T-box transcription factor, TBX1, is the major candidate gene for 22q11.2 deletion syndrome (DiGeorge/ Velo-cardio-facial syndrome) characterized by facial defects, thymus hypoplasia, cardiovascular anomalies and cleft palates. Here, we report that the loss of Tbx1 in mouse (Tbx1(-/-)) results in skeletal abnormalities similar to those of cleidocranial dysplasia (CCD) in humans, which is an autosomal-dominant skeletal disease caused by mutations in RUNX2. Tbx1(-/-) mice display short stature, absence of hyoid bone, failed closure of fontanelle, bifid xiphoid process and hypoplasia of clavicle and zygomatic arch. A cell-type-specific deletion of Tbx1 in osteochondro-progenitor (Tbx1(OPKO)) or mesodermal (Tbx1(MKO)) lineage partially recapitulates the Tbx1(-/-) bone phenotypes. Although Tbx1 expression has not been previously reported in neural crest, inactivation of Tbx1 in the neural crest lineage (Tbx1(NCKO)) leads to an absence of the body of hyoid bone and postnatal lethality, indicating an unanticipated role of Tbx1 in neural crest development. Indeed, Tbx1 is expressed in the neural crest-derived hyoid bone primordium, in addition to mesoderm-derived osteochondral progenitors. Ablation of Tbx1 affected Runx2 expression in calvarial bones and overexpression of Tbx1 induced Runx2 expression in vitro. Taken together, our current studies reveal that Tbx1 is required for mesoderm- and neural crest-derived osteoblast differentiation and normal skeletal development. TBX1 mutation could lead to CCD-like bone phenotypes in human. PMID:25209980

Funato, Noriko; Nakamura, Masataka; Richardson, James A; Srivastava, Deepak; Yanagisawa, Hiromi

2015-01-15

322

Of Mice, Men and Elephants: The Relation between Articular Cartilage Thickness and Body Mass  

PubMed Central

Mammalian articular cartilage serves diverse functions, including shock absorption, force transmission and enabling low-friction joint motion. These challenging requirements are met by the tissue’s thickness combined with its highly specific extracellular matrix, consisting of a glycosaminoglycan-interspersed collagen fiber network that provides a unique combination of resilience and high compressive and shear resistance. It is unknown how this critical tissue deals with the challenges posed by increases in body mass. For this study, osteochondral cores were harvested post-mortem from the central sites of both medial and lateral femoral condyles of 58 different mammalian species ranging from 25 g (mouse) to 4000 kg (African elephant). Joint size and cartilage thickness were measured and biochemical composition (glycosaminoclycan, collagen and DNA content) and collagen cross-links densities were analyzed. Here, we show that cartilage thickness at the femoral condyle in the mammalian species investigated varies between 90 µm and 3000 µm and bears a negative allometric relationship to body mass, unlike the isometric scaling of the skeleton. Cellular density (as determined by DNA content) decreases with increasing body mass, but gross biochemical composition is remarkably constant. This however need not affect life-long performance of the tissue in heavier mammals, due to relatively constant static compressive stresses, the zonal organization of the tissue and additional compensation by joint congruence, posture and activity pattern of larger mammals. These findings provide insight in the scaling of articular cartilage thickness with body weight, as well as in cartilage biochemical composition and cellularity across mammalian species. They underscore the need for the use of appropriate in vivo models in translational research aiming at human applications. PMID:23437402

Malda, Jos; de Grauw, Janny C.; Benders, Kim E. M.; Kik, Marja J. L.; van de Lest, Chris H. A.; Creemers, Laura B.; Dhert, Wouter J. A.; van Weeren, P. René

2013-01-01

323

Investigation of Localized Delivery of Diclofenac Sodium from Poly(D,L-Lactic Acid-co-Glycolic Acid)/Poly(Ethylene Glycol) Scaffolds Using an In Vitro Osteoblast Inflammation Model.  

PubMed

Nonunion fractures and large bone defects are significant targets for osteochondral tissue engineering strategies. A major hurdle in the use of these therapies is the foreign body response of the host. Herein, we report the development of a bone tissue engineering scaffold with the ability to release anti-inflammatory drugs, in the hope of evading this response. Porous, sintered scaffolds composed of poly(D,L-lactic acid-co-glycolic acid) (PLGA) and poly(ethylene glycol) (PEG) were prepared with and without the anti-inflammatory drug diclofenac sodium. Analysis of drug release over time demonstrated a profile suitable for the treatment of acute inflammation with ?80% of drug released over the first 4 days and a subsequent release of around 0.2% per day. Effect of drug release was monitored using an in vitro osteoblast inflammation model, comprised of mouse primary calvarial osteoblasts stimulated with proinflammatory cytokines interleukin-1? (IL-1?), tumor necrosis factor-? (TNF-?), and interferon-? (IFN-?). Levels of inflammation were monitored by cell viability and cellular production of nitric oxide (NO) and prostaglandin E2 (PGE2). The osteoblast inflammation model revealed that proinflammatory cytokine addition to the medium reduced cell viability to 33%, but the release of diclofenac sodium from scaffolds inhibited this effect with a final cell viability of ?70%. However, releasing diclofenac sodium at high concentrations had a toxic effect on the cells. Proinflammatory cytokine addition led to increased NO and PGE2 production; diclofenac-sodium-releasing scaffolds inhibited NO release by ?64% and PGE2 production by ?52%, when the scaffold was loaded with the optimal concentration of drug. These observations demonstrate the potential use of PLGA/PEG scaffolds for localized delivery of anti-inflammatory drugs in bone tissue engineering applications. PMID:25104438

Sidney, Laura E; Heathman, Thomas R J; Britchford, Emily R; Abed, Arif; Rahman, Cheryl V; Buttery, Lee D K

2015-01-01

324

Lateral Ligament Repair and Reconstruction Restore Neither Contact Mechanics of the Ankle Joint nor Motion Patterns of the Hindfoot  

PubMed Central

Background: Ankle sprains may damage both the lateral ligaments of the hindfoot and the osteochondral tissue of the ankle joint. When nonoperative treatment fails, operative approaches are indicated to restore both native motion patterns at the hindfoot and ankle joint contact mechanics. The goal of the present study was to determine the effect of lateral ligament injury, repair, and reconstruction on ankle joint contact mechanics and hindfoot motion patterns. Methods: Eight cadaveric specimens were tested with use of robotic technology to apply combined compressive (200-N) and inversion (4.5-Nm) loads to the hindfoot at 0° and 20° of plantar flexion. Contact mechanics at the ankle joint were simultaneously measured. A repeated-measures experiment was designed with use of the intact condition as control, with the other conditions including sectioned anterior talofibular and calcaneofibular ligaments, the Broström and Broström-Gould repairs, and graft reconstruction. Results: Ligament sectioning decreased contact area and caused a medial and anterior shift in the center of pressure with inversion loads relative to those with the intact condition. There were no significant differences in inversion or coupled axial rotation with inversion between the Broström repair and the intact condition; however, medial translation of the center of pressure remained elevated after the Broström repair relative to the intact condition. The Gould modification of the Broström procedure provided additional support to the hindfoot relative to the Broström repair, reducing inversion and axial rotation with inversion beyond that of intact ligaments. There were no significant differences in center-of-pressure excursion patterns between the Broström-Gould repair and the intact ligament condition, but this repair increased contact area beyond that with the ligaments intact. Graft reconstruction more closely restored inversion motion than did the Broström-Gould repair at 20° of plantar flexion but limited coupled axial rotation. Graft reconstruction also increased contact areas beyond the lateral ligament-deficient conditions but altered center-of-pressure excursion patterns relative to the intact condition. Conclusions: No lateral ankle ligament reconstruction completely restored native contact mechanics of the ankle joint and hindfoot motion patterns. Clinical Relevance: Our results provide a rationale for conducting long-term, prospective, comparative, in vivo studies to assess the impact of altered mechanics following lateral ligament injury, and its nonoperative and operative treatment, on the development of ankle osteoarthritis. PMID:20962188

Prisk, Victor R.; Imhauser, Carl W.; O'Loughlin, Padhraig F.; Kennedy, John G.

2010-01-01

325

Ankle impingement: a review of multimodality imaging approach.  

PubMed

Ankle impingement is defined as entrapment of an anatomic structure that leads to pain and decreased range of motion of the ankle and can be classified as either soft tissue or osseous (Bassett et al. in J Bone Joint Surg Am 72:55-59, 1990). The impingement syndromes of the ankle are a group of painful disorders that limit full range of movement. Symptoms are due to compression of soft-tissues or osseous structures during particular movements (Ogilvie-Harris et al. in Arthroscopy 13:564-574, 1997). Osseous impingement can result from spur formation along the anterior margin of the distal tibia and talus or as a result of a prominent posterolateral talar process, the os trigonum. Soft-tissue impingement usually results from scarring and fibrosis associated with synovial, capsular, or ligamentous injury. Soft-tissue impingement most often occurs in the anterolateral gutter, the medial ankle, or in the region of the syndesmosis (Van den Bekerom and Raven in Knee Surg Sports Traumatol Arthrosc 15:465-471, 2007). The main impingement syndromes are anterolateral, anterior, anteromedial, posterior, and posteromedial impingement. These conditions arise from initial ankle injuries, which, in the subacute or chronic situation, lead to development of abnormal osseous and soft-tissue thickening within the ankle joint. The relative contributions of the osseous and soft-tissue abnormalities are variable, but whatever component is dominant there is physical impingement and painful limitation of ankle movement. Conventional radiography is usually the first imaging technique performer and allows assessment of any potential bone abnormality, particularly in anterior and posterior impingement. Computed tomography (CT) and isotope bone scanning have been largely superseded by magnetic resonance (MR) imaging. MR imaging can demonstrate osseous and soft-tissue edema in anterior or posterior impingement. MR imaging is the most useful imaging modality in evaluating suspected soft-tissue impingement or in excluding other ankle pathology such as an osteochondral lesion of the talus. MR imaging can reveal evidence of previous ligamentous injury and also can demonstrate thickened synovium, fibrosis, or adjacent reactive soft-tissue edema. Studies of conventional MR imaging have produced conflicting sensitivities and specificities in assessment of anterolateral impingement. CT and MR arthrographic techniques allow the most accurate assessment of the capsular recesses, albeit with important limitations in diagnosis of clinical impingement syndromes. In the majority of cases, ankle impingement is treated with conservative measures, with surgical debridement via arthroscopy or an open procedure reserved for patients who have refractory symptoms. In this article, we describe the clinical and potential imaging features, for the four main impingement syndromes of the ankle: anterolateral, anterior, anteromedial, posterior, and posteromedial impingement. PMID:23949938

Russo, A; Zappia, M; Reginelli, A; Carfora, M; D'Agosto, G F; La Porta, M; Genovese, E A; Fonio, P

2013-08-01

326

Functionally graded scaffolds for the engineering of interface tissues using hybrid twin screw extrusion/electrospinning technology  

NASA Astrophysics Data System (ADS)

Tissue engineering is the application of the principles of engineering and life sciences for the development of biological alternatives for improvement or regeneration of native tissues. Native tissues are complex structures with functions and properties changing spatially and temporally, and engineering of such structures requires functionally graded scaffolds with composition and properties changing systematically along various directions. Utilization of a new hybrid technology integrating the controlled feeding, compounding, dispersion, deaeration, and pressurization capabilities of extrusion process with electrospinning allows incorporation of liquids and solid particles/nanoparticles into polymeric fibers/nanofibers for fabrication of functionally graded non-woven meshes to be used as scaffolds in engineering of tissues. The capabilities of the hybrid technology were demonstrated with a series of scaffold fabrication and cell culturing studies along with characterization of biomechanical properties. In the first study, the hybrid technology was employed to generate concentration gradations of beta-tricalcium phosphate (beta-TCP) nanoparticles in a polycaprolactone (PCL) binder, between two surfaces of nanofibrous scaffolds. These scaffolds were seeded with pre-osteoblastic cell line (MC3T3-E1) to attempt to engineer cartilage-bone interface, and after four weeks, the tissue constructs revealed formation of continuous gradations in extracellular matrix akin to cartilage-bone interface in terms of distributions of mineral concentrations and biomechanical properties. In a second demonstration of the hybrid technology, graded differentiation of stem cells was attempted by using insulin, a known stimulator of chondrogenic differentiation, and beta-glycerol phosphate (beta-GP), for mineralization. Concentrations of insulin and beta-GP in PCL were controlled to monotonically increase and decrease, respectively, along the length of scaffolds, which were then seeded with adipose derived stromal cells (h-ADSCs). Analysis of resulting tissue constructs revealed chondrocytic differentiation of h-ADSCs, with both the chondrocytic cell concentration and mineralization varying as a function of distributions of concentrations of insulin and beta-GP, respectively. The investigation also covered characterization of biomechanical properties of native bovine osteochondral tissue samples, which were then compared with biomechanical properties of tissue constructs at different stages of development. The hybrid technology developed in this thesis should provide another enabling platform for the fabrication of functionally graded scaffolds that aim to mimic the elegant gradations found in myriad native tissues.

Erisken, Cevat

327

Effects of glucosamine and risedronate alone or in combination in an experimental rabbit model of osteoarthritis  

PubMed Central

Background The osteoarthritis (OA) treatment in humans and in animals is a major orthopaedic challenge because there is not an ideal drug for preserving the joint structure and function. The aim of this study was to assess the effects of the treatment with oral glucosamine and risedronate alone or in combination on articular cartilage, synovial membrane and subchondral bone in an experimental rabbit model of OA. Osteoarthritis was surgically induced on one knee of 32 New Zealand White rabbits using the contralateral as healthy controls. Three weeks later treatments were started and lasted 8 weeks. Animal were divided in four groups of oral treatment: the first group received only saline, the second 21.5 mg/kg/day of glucosamine sulfate, the third 0.07 mg/kg/day of risedronate; and the fourth group both drugs simultaneously at the same dosages. Following sacrifice femurs were removed and osteochondral cylinders and synovial membrane were obtained for its histological and micro-CT evaluation. Results Sample analysis revealed that the model induced osteoarthritic changes in operated knees. OA placebo group showed a significant increase in cartilage thickness respect to the control and inflammatory changes in synovial membrane; whereas subchondral bone structure and volumetric bone mineral density remained unchanged. All the treated animals showed an improvement of the cartilage swelling independent of the drug used. Treatment with glucosamine alone seemed to have no effect in the progression of cartilage pathology while risedronate treatment had better results in superficial fibrillation and in resolving the inflammatory changes of the tissues, as well as modifying the orientation of trabecular lattice. The combination of both compounds seemed to have additive effects showing better results than those treated with only one drug. Conclusions The results of this animal study suggested that glucosamine sulfate and risedronate treatment alone or in combination may be able to stop cartilage swelling. The risedronate treatment could partially stop the fibrillation and the inflammation of synovial membrane as well as modify the orientation of trabeculae in healthy and in osteoarthritic knees. PMID:24766775

2014-01-01

328

A method to screen and evaluate tissue adhesives for joint repair applications  

PubMed Central

Background Tissue adhesives are useful means for various medical procedures. Since varying requirements cause that a single adhesive cannot meet all needs, bond strength testing remains one of the key applications used to screen for new products and study the influence of experimental variables. This study was conducted to develop an easy to use method to screen and evaluate tissue adhesives for tissue engineering applications. Method Tissue grips were designed to facilitate the reproducible production of substrate tissue and adhesive strength measurements in universal testing machines. Porcine femoral condyles were used to generate osteochondral test tissue cylinders (substrates) of different shapes. Viability of substrates was tested using PI/FDA staining. Self-bonding properties were determined to examine reusability of substrates (n?=?3). Serial measurements (n?=?5) in different operation modes (OM) were performed to analyze the bonding strength of tissue adhesives in bone (OM-1) and cartilage tissue either in isolation (OM-2) or under specific requirements in joint repair such as filling cartilage defects with clinical applied fibrin/PLGA-cell-transplants (OM-3) or tissues (OM-4). The efficiency of the method was determined on the basis of adhesive properties of fibrin glue for different assembly times (30 s, 60 s). Seven randomly generated collagen formulations were analyzed to examine the potential of method to identify new tissue adhesives. Results Viability analysis of test tissue cylinders revealed vital cells (>80%) in cartilage components even 48 h post preparation. Reuse (n?=?10) of test substrate did not significantly change adhesive characteristics. Adhesive strength of fibrin varied in different test settings (OM-1: 7.1 kPa, OM-2: 2.6 kPa, OM-3: 32.7 kPa, OM-4: 30.1 kPa) and was increasing with assembly time on average (2.4-fold). The screening of the different collagen formulations revealed a substance with significant higher adhesive strength on cartilage (14.8 kPa) and bone tissue (11.8 kPa) compared to fibrin and also considerable adhesive properties when filling defects with cartilage tissue (23.2 kPa). Conclusion The method confirmed adhesive properties of fibrin and demonstrated the dependence of adhesive properties and applied settings. Furthermore the method was suitable to screen for potential adhesives and to identify a promising candidate for cartilage and bone applications. The method can offer simple, replicable and efficient evaluation of adhesive properties in ex vivo specimens and may be a useful supplement to existing methods in clinical relevant settings. PMID:22984926

2012-01-01

329

Microscale Material Properties of Bone and the Mineralized Tissues of the Intervertebral Disc-Vertebral Body Interface  

NASA Astrophysics Data System (ADS)

The objective of this dissertation is to understand the influences of material structure on the properties, function and failure of biological connective tissues. Biological interfaces are becoming an increasingly studied system within mechanics and tissue engineering as a model for attaching dissimilar materials. The elastic modulus of bone (? 20 GPa) and cartilage (? 0.1-1 MPa) differ over orders of magnitude, which should intuitively create high stress concentrations and failure at the interface. Yet, these natural interface systems rarely fail in vivo, and the mechanism by which loads are transferred between tissues has not yet been established. Tissue quality is one major contributor to the mechanical behavior of bone and cartilage, and is defined by properties such as collagen orientation, mineral volume fraction, porosity and tissue geometry. These properties have yet to be established at the bone-cartilage interface in the spine, and the lack of quantitative data on material microstructure and behavior limits treatments and tissue engineering construct design. In this dissertation, second harmonic generation imaging, quantitative backscattered scanning electron imaging and nanoindentation are combined to characterize micrometer scale tissue quality and modulus in both bone and calcified cartilage. These techniques are utilized to: 1) determine the hierarchical micrometer to millimeter scale properties of lamellar bone, 2) quantify changes throughout development and aging at the human intervertebral disc-vertebral body junction, and 3) explore compressive fractures at this interface. This work is the first to provide quantitative data on the mineral volume fraction, collagen orientation and modulus from the same, undecalcified sections of tissue to corroborate tissue structure and mineralization and describe quantitative parameters of the interface. The principal findings from this work indicate that the underlying matrix, or collagen, organization in mineralized biological tissues and at the bone-cartilage interface plays an important mechanical role. Nanoindentation measurements in osteonal bone are affected by location within the lamellar structure, even though mineral volume fraction within a single osteon is relatively consistent compared to the differences observed between bone and calcified cartilage. While increasing mineral volume fraction contributes to increases in modulus in the calcified cartilage layer of the vertebral body-intervertebral disc interface, significant scatter remains. The collagenous matrix structure and type of collagen appear to have a significant influence on modulus as well. Collagen fibers of the disc mineralize adjacent to the bone of the vertebral body, and the persistence of this attachment zone from adolescence through senescence indicates that it likely serves a mechanical function. Fiber insertions into thick calcified cartilage regions likely create mechanically robust anchor points at the osteochondral interface.

Paietta, Rachel C.

330

[Biomechanical correlations of lesions associated with traumatic diseases of the anterior cruciate ligament. Analysis with magnetic resonance].  

PubMed

To investigate the correlations between traumatic injuries of the anterior cruciate ligament and other ligamentous, meniscal and bone traumatic injuries, a series of 193 patients with anterior cruciate ligament injuries studied with MRI between January 1992 and December 1994, was retrospectively reviewed. MR results were compared with arthroscopic and/or surgical findings in most (181) patients; in the remaining 12 patients, clinical follow-up was performed. We used two 0.5 superconductive MR units, with dedicated coils and T1-weighted spin-echo and T2*-weighted gradient-echo sequences on the axial, sagittal and coronal planes. Anterior cruciate ligament injuries were associated with other ligamentous, meniscal and bone injuries in 78% of patients. The patients were classified in 5 groups depending on biomechanics and the association of injuries: -group I: isolated injury of the anterior cruciate ligament (41 patients), most frequently caused by forced extension stress associated with "kissing contusions" of the anterior portion of the lateral femoral condyle and of the lateral tibial plateau; this type of injury is less frequently caused by forced flexion stress associated with avulsion fracture of the tibial eminence; -group II: associated injury of the anterior cruciate ligament and medial compartment (62 patients), caused by forced flexion-external rotation stress (abduction, valgism and external rotation). The classic association of this mechanism was the injury of the anterior cruciate ligament, medial collateral ligament and medial meniscus (O'Donoghue triad) (9 patients). Valgus stress and the pivot-shift phenomenon can impact the tibial and femoral articular surfaces, with consequent osteochondral contusion; -group III: associated injury of the anterior cruciate ligament and lateral compartment (26 patients), caused by forced flexion-internal rotation stress (adduction, varism and internal rotation). This mechanism can cause, as a typical bone lesion, Segond fractures; -group IV: associated injury of the anterior cruciate ligament, lateral and medial compartments observed in 52 patients with different associations of varus-valgus and rotatory stress; -group V: in 5 patients, anterior cruciate ligament injury was associated with traumatic injury of the posterior cruciate ligament; in this case, posterior displacement of the tibia and knee hyperextension were the most common mechanisms of injury. In conclusion, our results demonstrate that anterior cruciate ligament injuries due to traumatic sprains of the knee are rarely isolated (21%). Thus, it is important to know the biomechanics of knee trauma to read MR images in order to detect possibly associated injuries. The final goal is to assess the actual extent of the traumatic damage for best subsequent clinical-therapeutic management. PMID:8830351

De Maria, M; Barbiera, F; Lo Casto, A; Iovane, A; Rossello, M; Sparacia, G; Lagalla, R

1996-06-01

331

A History of Lumbar Disc Herniation From Hippocrates to the 1990s.  

PubMed

In ancient times, a supernatural understanding of the syndrome of lumbar radiculopathy often involved demonic forces vexing the individual with often crippling pain. The ancient Greeks and Egyptians began to take a more naturalistic view and, critically, suspected a relationship between lumbar spinal pathology and leg symptoms. Relatively little then changed for those with sciatica until the classic works by Cotugno and Kocher arrived in the late 18th century. Early lumbar canal explorations were performed in the late 1800s and early 1900s by MacEwen, Horsley, Krause, Taylor, Dandy, and Cushing, among others. In these cases, when compressive pathologies were found and removed, the lesions typically were (mis-)identified as enchondromas or osteochondritis dissecans. To better understand the history, learn more about the first treatments of lumbar disc herniation, and evaluate the impact of the early influences on modern spine practice, searches of PubMed and Embase were performed using the search terms discectomy, medical history, lumbar spine surgery, herniated disc, herniated nucleus pulposus, sciatica, and lumbar radiculopathy. Additional sources were identified from the reference lists of the reviewed papers. Many older and ancient sources including De Ischiade Nervosa are available in English translations and were used. When full texts were not available, English abstracts were used. The first true, intentional discectomy surgery was performed by Mixter and Barr in 1932. Early on, a transdural approach was favored. In 1938, Love described the intralaminar, extradural approach. His technique, although modified with improved lighting, magnification, and retractors, remains a staple approach to disc herniations today. Other modalities such as chymopapain have been investigated. Some remain a part of the therapeutic armamentarium, whereas others have disappeared. By the 1970s, CT scanning after myelography markedly improved the clinical evaluation of patients with lumbar disc herniation. In this era, use of discectomy surgery increased rapidly. Even patients with very early symptoms were offered surgery. Later work, especially by Weber and Hakelius, showed that many patients with lumbar disc herniation would improve without surgical intervention. In the ensuing decades, the debate over operative indications and timing continued, reaching another pivotal moment with the 2006 publication of the initial results of Spine Patient Outcomes Research Trial. PMID:24752913

Truumees, Eeric

2014-04-22

332

Subcapital Correction Osteotomy for Malunited Slipped Capital Femoral Epiphysis  

PubMed Central

Background Slipped capital femoral epiphysis (SCFE), causing posterior and inferior displacement and retroversion of the femoral head, is a well-recognized etiology for femoroacetabular impingement (FAI) and can lead to premature arthritis in the young adult. The treatment of malunited SCFE remains controversial. Surgical dislocation and subcapital correction osteotomy (SCO) has been described as a powerful method to correct the proximal femoral deformity. Methods Between January 2003 and January 2010, 11 patients (12 hips) with closed femoral physes and symptomatic FAI from malunited SCFE were treated with surgical dislocation and SCO. We performed a retrospective review of patient histories, physical exams, operative findings, and pre and postoperative anteroposterior (AP) and groin lateral (GLat) radiographs. Mean follow-up was 61 months. Results There were 4 female and 7 male patients with an average age of 15 years at the time of SCO. On the AP radiograph the mean inferior femoral head displacement (AP epiphyseal-neck angle) was significantly improved (-26° to -6°, p<0.001). On the groin lateral radiograph the mean posterior femoral head displacement (Lateral epiphyseal-neck angle) was significantly improved (-45° to -3°, p<0.001). The mean alpha angle was also significantly improved on both views (AP: 85° to 56°, P<0.001; GLat: 85° to 46°, p<0.001). Operative findings included one femoral osteochondral defect, 8 Outerbridge grade 3-4 acetabular cartilage lesions, and 10 labral lesions. Significant improvement of the mean Harris hip score (HHS) was seen at latest follow-up (54 to 77, p=0.016). Complications occurred in 4 of the 12 cases with AVN in two patients, a worse postoperative HHS in one patient, and failure of fixation treated successfully with revision open reduction internal fixation in one patient. Conclusions Subcapital correction osteotomy as an adjunct to surgical dislocation and osteochondroplasty can be used to correct the deformity of the proximal femur associated with malunited SCFE. Normalization of proximal femoral anatomy may postpone progression to severe osteoarthritis and thus delay the need for arthroplasty in this young patient population. However, surgeons and patients should be aware that the risks of this procedure in this population are significant. PMID:23653020

Anderson, Lucas A.; Gililland, Jeremy; Pelt, Christoper; Peters, Christopher L.

2013-01-01

333

Low-pressure foaming: a novel method for the fabrication of porous scaffolds for tissue engineering.  

PubMed

Scaffolds for tissue engineering applications must incorporate porosity for optimal cell seeding, tissue ingrowth, and vascularization, but common fabrication methods for achieving porosity are incompatible with a variety of polymers, limiting widespread use. In this study, porous scaffolds consisting of poly(1,8-octanediol-co-citrate) (POC) containing hydroxyapatite nanocrystals (HA) were fabricated using low-pressure foaming (LPF). LPF is a novel method of fabricating an interconnected, porous scaffold with relative ease. LPF takes advantage of air bubbles that act as pore nucleation sites during a polymer mixing step. Vacuum is applied to expand the nucleation sites into interconnected pores that are stabilized through cross-linking. POC was combined with 20%, 40%, and 60% by weight HA, and the effect of increasing HA particle content on porosity, mechanical properties, and alkaline phosphatase (ALP) activity of human mesenchymal stem cells (hMSC) was evaluated. The effect of the prepolymer viscosity on porosity and the mechanical properties of POC with 40% by weight HA (POC-40HA) were also assessed. POC-40HA scaffolds were also implanted in an osteochondral defect of a rabbit model, and the explants were assessed at 6 weeks using histology. With increasing HA content, the pore size of POC-HA scaffolds can be varied (85 to 1,003 ?m) and controlled to mimic the pore size of native trabecular bone. The compression modulus increased with greater HA content under dry conditions and were retained to a greater extent than with porous scaffolds fabricated using salt-leaching under wet conditions. Furthermore, all POC-HA scaffolds prepared using LPF supported hMSC attachment, and an increase in ALP activity correlated with an increase in HA content. An increase in the prepolymer viscosity resulted in increased compression modulus, greater distance between pores, and less porosity. After 6 weeks in vivo, cell and tissue infiltration was present throughout the scaffold. This study describes a novel method of creating porous osteoconductive POC scaffolds without the need for porogen leaching and provides the groundwork for applying LPF to other elastomers and composites. PMID:21933018

Chung, Eun Ji; Sugimoto, Matthew; Koh, Jason L; Ameer, Guillermo A

2012-02-01

334

Experimental validation of arthroscopic cartilage stiffness measurement using enzymatically degraded cartilage samples  

NASA Astrophysics Data System (ADS)

In order to evaluate the ability of the arthroscopic indentation instrument, originally developed for the measurement of cartilage stiffness during arthroscopy, to detect cartilage degeneration, we compared changes in the stiffness with the structural and constitutional alterations induced by enzymes on the tissue in vitro. The culturing of osteochondral plugs on Petri dishes was initiated in Minimum Essential Medium with Earle's salts and the baseline stiffness was measured. Then, the experimental specimens were digested using trypsin for 24 h, chondroitinase ABC or purified collagenase (type VII) for 24 h or 48 h ( n = 8-15 per group). The control specimens were incubated in the medium. After the enzyme digestion, the end-point stiffness was measured and the specimens for the microscopic analyses were processed. The proteoglycan (PG) distribution was analysed using quantitative microspectrophotometry and the quantitative evaluation of the collagen network was made using a computer-based polarized light microscopy analysis. Decrease of cartilage stiffness was found after 24 h trypsin (36%) and 48 h chondroitinase ABC (24%) digestion corresponding to a decrease of up to 80% and up to 30% in the PG content respectively. Decrease of the superficial zone collagen content or arrangement (78%, ) after 48 h collagenase digestion also induced a decrease (30%, ) in cartilage stiffness. We conclude that our instrument is capable of detecting early structural and compositional changes related to cartilage degeneration.

Lyyra, T.; Arokoski, J. P. A.; Oksala, N.; Vihko, A.; Hyttinen, M.; Jurvelin, J. S.; Kiviranta, I.

1999-02-01

335

Hallux limitus and hallux rigidus. Clinical examination, radiographic findings, and natural history.  

PubMed

Numerous clinical features of hallux limitus/rigidus have been previously reported as isolated entities based on individual case review or myopic observations. Few attempts have been made to synthesize a comprehensive natural history which correlates the inter-relationship of these findings. Frequently unrecognized or overlooked subtle clinical findings, such as shoe-wear patterns, hyperkeratoses locations, and gait disturbances, precede significant radiographic changes or painful degenerative arthritis by months to years. Recognition of these subtle clinical features will aid in establishing an early and accurate diagnosis, and provide the physician with an opportunity to institute treatment prior to the need for surgical reconstruction. Several conclusions can be made regarding the natural history of hallux rigidus. 1. Predisposing factors (pes planovalgus, uncompensated varus) lead to spastic contracture of the hallux (hallux equinus). 2. A shift in the axis of movement occurs within the first metatarsophalangeal joint, from centrally within the metatarsal head to plantarly at the level of the sesamoidophalangeal ligament. 3. Dorsal articular impingement of the proximal phalangeal base on the metatarsal head leads to either a chronic erosion of the dorsal metatarsal head (chondritis dissecans), or fracture through the subchondral bone plate (osteochondritis dissecans). 4. Progressive degenerative arthritis within the first metatarsophalangeal joint appears as joint space narrowing, dorsal osteophyte proliferation, subchondral cyst formation and sclerosis, and articular flattening. 5. Synovial effusion produces periarticular pain, resulting in chronic splinting of the hallux. 6. Auto-fusion of the metatarsophalangeal joint represents the end-stage progression of hallux rigidus. In addition to degeneration of the metatarsophalangeal joint, sesamoid degeneration further compounds joint immobility. 1. Sesamoid immobility from chronic spasm leads to traction proliferation of the sesamoid bones (hypertrophy). 2. Disuse osteopenia of the sesamoids is an indication of sesamoid-metatarsal degeneration, and parallels degenerative changes of the first metatarsophalangeal joint. 3. Proximal sesamoid retraction reflects the degree of hallux equinus. Metatarsus primus elevatus is a co-existant feature of hallux limitus and hallux rigidus. 1. Primary metatarsus primus elevatus is encountered in patients with a more proximal level of uncompensated varus, with hallux equinus occurring secondarily in an attempt to provide medial column support. 2. Secondary metatarsus primus elevatus results from the retrograde effects of hallux equinus on the first metatarsal, and occurs in patients with pes planovalgus. 3. Flexor stabilization syndrome of the hallux occurs in patients with pes planovalgus, and is analogous to a flexor stabilization hammertoe of the lesser digits. 4. Differentiation between primary and secondary metatarsus primus elevatus is made by evaluation of weight-bearing radiographs, comparing the standard lateral radiograph to a lateral radiograph using a forefoot block test, in which the digits are suspended off of the weight-bearing surface. PMID:8829034

Camasta, C A

1996-07-01