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Management of Osteochondritis Dissecans  

Microsoft Academic Search

Osteochondritis dissecans (OCD) is an acquired condition affecting subchondral bone that manifests as a pathologic spectrum\\u000a including softening of the overlying articular cartilage with an intact articular surface, early articular cartilage separation,\\u000a partial detachment of an articular lesion, and osteochondral separation with loose bodies. The etiology of OCD remains speculative;\\u000a however. repetitive microtrauma is a common association. Nonoperative initial management

Mininder S. Kocher; Joseph J. Czarnecki


Osteochondritis dissecans of the knee  

Microsoft Academic Search

Summary  BACKGROUND: Osteochondritis dissecans is a localized condition or injury affecting an articular surface that involves separation of a segment of cartilage and subchondral bone. METHODS: This article discusses the etiology, anatomy, evaluation, classification and treatment of osteochondritis dissecans lesions in the knee joint. RESULTS: Osteochondritis dissecans is primarily found in the knee, ankle and elbow joints. Various theories about its

S. Marlovits; P. Singer; C. Resinger; S. Aldrian; F. Kutscha-Lissberg; V. Vécsei



Osteochondral tissue engineering.  


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



Osteochondritis dissecans of the capitellum.  


Osteochondritis dissecans of the capitellum is a well-recognized cause of elbow pain and disability in the adolescent athlete. This condition typically affects young athletes, such as throwers and gymnasts, involved in high-demand, repetitive overhead, or weightbearing activities. The true cause, natural history, and optimal treatment of osteochondritis dissecans of the capitellum remain unknown. Suspicion of this condition warrants investigation with proper radiographs and magnetic resonance imaging. Prompt recognition of this disorder and institution of nonoperative treatment for early, stable lesions can result in healing with later resumption of sporting activities. Patients with unstable lesions or those failing nonoperative therapy require operative intervention with treatment based on lesion size and extent. Historically, surgical treatment included arthrotomy with loose body removal and curettage of the residual osteochondral defect base. The introduction of elbow arthroscopy in the treatment of osteochondritis dissecans of the capitellum permits a thorough lesion assessment and evaluation of the entire elbow joint with the ability to treat the lesion and coexistent pathology in a minimally invasive fashion. Unfortunately, the prognosis for advanced lesions remains more guarded, but short-term results after newer reconstruction techniques are promising. PMID:20097927

Baker, Champ L; Romeo, Anthony A; Baker, Champ L



The Morbidity Associated With Osteochondral Harvest From Asymptomatic Knees for the Treatment of Osteochondral Lesions of the Talus  

Microsoft Academic Search

Background: Mosaic autogenous osteochondral transplantation has been used to treat large osteochondral defects.Hypothesis: There is potential, previously unrecognized donor-site morbidity associated with osteochondral harvest from asymptomatic knees for the treatment of talar osteochondral defect lesions.Study Design: Case series; Level of evidence, 4.Methods: Fifteen patients underwent mosaic osteochondral transplantation to treat a talar osteochondral defect lesion, with 11 patients available for

Sudheer Reddy; David I. Pedowitz; Selene G. Parekh; Brian J. Sennett; Enyi Okereke



Genetics Home Reference: Familial osteochondritis dissecans  


... and Families Resources for Health Professionals What glossary definitions help with understanding familial osteochondritis dissecans? autosomal ; autosomal dominant ; cartilage ; cell ; compression ; familial ; gene ; injury ; joint ; lesion ; mutation ; OCD ; ...


Osteochondral Autograft Transplantation for Osteochondritis Dissecans of the Elbow in Juvenile Baseball PlayersMinimum 2Year Follow-up  

Microsoft Academic Search

Background: Osteochondral autografts have recently become popular to treat articular cartilage defects, and they are used for unstable osteochondritis dissecans lesions as a means of biological fixation.Purpose: To evaluate the clinical results of osteochondral autograft transfer for osteochondritis dissecans of the elbow.Study Design: Case series; Level of evidence, 4.Methods: Osteochondral autograft transfer was performed on 18 baseball players (mean age,

Yuji Yamamoto; Yasuyuki Ishibashi; Eiichi Tsuda; Hideki Sato; Satoshi Toh



Posterosuperior osteochondritis of the calcaneus.  


Osteochondritis of the posterosuperior area of the talocalcaneal surface is a relatively uncommon injury, and only 1 case has been described in the literature. We present a 37-year-old man who complained of pain in the tarsal canal area during walking and when standing up. The magnetic resonance imaging study showed an osteochondral signal in the posterosuperior medial area of the calcaneus on the talocalcaneal surface. The persistence of pain and lack of improvement with conservative treatment made arthroscopic debridement of the injury necessary. The arthroscopic procedure was performed through 2 medial portals, made under fluoroscopy, marked with needles, and dissected with mosquito clamps, and the affected surface could be fully visualized, showing a chondral lesion. Debridement of the osteonecrotic area was performed, and the Steadman technique was used on the injured bone surface. The patient was pain-free, and limited activity (i.e., standing up and walking without symptoms) was allowed. After 24 months, the patient remains asymptomatic with weight-bearing working activities and when standing. Arthroscopic curettage and scission of the injury have been shown to yield good or excellent outcomes in 75% to 80% of patients with regard to the talar surface. PMID:17868846

Cugat, Ramón; Cuscó, Xavier; García, Montserrat; Samitier, Gonzalo; Seijas, Roberto



Cartilage and bone morphology in osteochondritis dissecans.  


Osteochondritis dissecans (OD) is a syndrome that can be characterized as a non-infectious disturbance of enchondral ossification or as a post-traumatic event. OD occurs in the joint cartilage and physis of long bones, as well as in the talus or metacarpal head especially of young athletes. The medial femoral condyle is the most commonly affected site. The causes of osteochondritis dissecans are poorly understood. Thirty human osteochondral cylinders from patients (aged 16-44 years) with osteochondritis dissecans of the medial femoral condyle (grades IV and V according to Rodegerdts and Gleissner) were harvested intraoperatively from osteochondritic areas as part of a cartilage-bone transplantation. Light microscopy, electron microscopy, and immunohistochemistry using poly- and monoclonal antibodies against collagens and glycosaminoglycans revealed differences between osteochondrotic and normal cartilage. Staining with toluidine blue at pH 1 shows a decrease in acidic glycosaminoglycans in OD. Modified pentachrome staining showed a thinned subchondral growth plate compared to normal osteochondral samples. Borders to the healthy tissue are clearly visible micro- and macroscopically. Scanning electron microscopy revealed structural differences in the subchondral area. Immunohistochemistry found a general decrease in glycosaminoglycan content and a change in composition. Only faint staining for chondroitin and keratan sulfates was observed in osteochondritic cartilage, whereas increased staining was shown for keratan sulfate in bone. PMID:9127853

Koch, S; Kampen, W U; Laprell, H



Osteochondritis (osteochondrosis) dissecans: A review and new MRI classification  

Microsoft Academic Search

.   Osteochondritis (osteochondrosis) dissecans (OCD) is a common condition in children, adolescents, and young adults. Describing\\u000a OCD together with osteochondral fractures and epiphyseal ossification disturbances and considering these three conditions\\u000a as one entity has caused much confusion. Age distribution and localization combined with the radiologic and surgical presentation\\u000a distinguishes these conditions. Osteochondritis dissecans represents an osseous lesion with secondary involvement

K. Bohndorf



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.

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



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.

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



Osteochondral mosaicplasty of the femoral head.  


Young adults with osteochondral lesions of the femoral head are at risk of rapid progression to symptomatic arthritis of the hip joint. Between January 2008 and July 2009, 10 patients were treated for femoral cartilage damage by a osteochondral mosaicplasty of the femoral head through a trochanteric flap with dislocation of the hip. The consecutive series had the following exclusion criteria: acetabular chondropathy, age above 25 years, and femoral head osteonecrosis. Patients were followed up after surgery using the Oxford-12 score, Harris hip score and the Merle d'Aubigné score, and activity assessed by the UCLA and Devane scores. Radiological evaluation by computed tomographic (CT) arthrography was undertaken in all patients at 6 months and plain radiographs. Mean follow-up was 29.2 months (20-39 months). The Postel Merle d'Aubigné score improved from the pre-operative period to the latest follow-up, from 10.5 points (8-13) to 15.5 points (12-17). Global range of motion increased from 175.4° (140-215) to 210.7° (175-240). All radiological investigations at latest follow-up showed that the autograft plugs were well-incorporated at the site of osteochondroplasty in the femoral head with intact cartilage over them and smooth interfaces between articulating bony surfaces. Osteochondral autograft transplantation may be a new alternative option for osteochondral lesions of the femoral head, but this has to be confirmed with longer follow-up and in a larger number of patients. The results of similar surgery in the knee have been mixed, and in the hip the technique is demanding, requiring familiarity with surgical hip dislocation. PMID:21948031

Girard, Julien; Roumazeille, Thibaut; Sakr, Mazen; Migaud, Henri


In vitro generation of osteochondral composites  

Microsoft Academic Search

Osteochondral repair involves the regeneration of articular cartilage and underlying bone, and the development of a well-defined tissue-to-tissue interface. We investigated tissue engineering of three-dimensional cartilage\\/bone composites based on biodegradable polymer scaffolds, chondrogenic and osteogenic cells. Cartilage constructs were created by cultivating primary bovine calf articular chondrocytes on polyglycolic acid meshes; bone-like constructs were created by cultivating expanded bovine calf

D Schaefer; I Martin; P Shastri; R. F Padera; R Langer; L. E Freed; G Vunjak-Novakovic



Treatment principles for osteochondral lesions in foot and ankle.  


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



Comparison of the bony ingrowth into an osteochondral defect and an artificial osteochondral composite device in load-bearing joints  

Microsoft Academic Search

In order to preserve as much subchondral cancellous bone as possible in the repair of damaged joint surfaces, we have attempted to develop an artificial articular cartilage, using polyvinyl alcohol hydrogel, a rubber-like gel. In this study, osteochondral defects were made and an osteochondral composite device was implanted in the weight-bearing portions of medial and lateral femoral condyles of dogs.

Y.-S. Chang; H.-O. Gu; M. Kobayashi; M. Oka



Surgical fixation of massive osteochondritis dissecans lesion using cylindrical osteochondral plugs  

Microsoft Academic Search

The prognosis of osteochondritis dissecans (OCD) depends on the age of manifestation and the size of the lesion. Before epiphyseal closure, OCD usually responds well to the restriction of the patient’s sporting activities. Surgical intervention is not always necessary. However, if the disease manifests after epiphyseal closure, it often needs surgical treatment because the lesion is usually found at an

Tatsuo Kobayashi; Kyosuke Fujikawa; Motoki Oohashi



Immunogenicity of unprocessed and photooxidized bovine and human osteochondral grafts in collagen-sensitive mice  

Microsoft Academic Search

BACKGROUND: Autologous and allogeneic osteochondral grafts have been used to repair damaged or diseased cartilage. There are drawbacks to both of these methods, however. Another possible source for osteochondral grafting is photooxidized xenograft scaffolds. The purpose of this study was to evaluate the adaptive immune response to unprocessed and photooxidized xenogeneic osteochondral grafts in a collagen-sensitive mouse model. METHODS: Unprocessed

Jill S Kawalec-Carroll; Vincent J Hetherington; Douglas S Dockery; Carey Shive; Oleg S Targoni; Paul V Lehmann; Daniel Nadler; Dustin Prins



Surgical Treatment for Osteochondritis Dissecans of the Capitellum  

PubMed Central

Context: Osteochondritis dissecans (OCD) of the capitellum is most often seen in adolescents who participate in sports that involve repetitive loading of the elbow. Unstable defects typically require surgical intervention that involves fragment fixation, debridement, or reconstruction with an osteochondral autograft transfer. Optimum surgical management of unstable defects remains controversial. Type of Study: Clinical review. Evidence Acquisition: Relevant articles published after 1992 were identified using MEDLINE, the EMBASE database, and the Cochrane Library. Results: Both debridement and osteochondral autograft transfer for treatment of capitellar OCD lesions result in good short- and midterm outcomes with a high rate of return to sports. Larger defects involving more than 50% of the articular surface or involving the lateral margin of the capitellum may have worse outcomes after debridement and may be better treated with fragment fixation or osteochondral autograft transfer. Conclusions: High-level evidence is lacking to determine the superiority of debridement or osteochondral autograft transfer for the treatment of capitellar OCD lesions. A prospective longitudinal multicenter study, using validated outcome measures, that enrolls a large number of patients is needed to establish optimal treatment for unstable capitellar OCD lesions.

Smith, Matthew V.; Bedi, Asheesh; Chen, Neal C.



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.

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



Atraumatic Osteochondral Fracture and Osteoarthritis in a Collegiate Volleyball Player: A Case Report  

PubMed Central

Objective: To present the case of a collegiate athlete with an atraumatic osteochondral fracture influenced by the presence of osteoarthritis. Background: Osteochondral fractures are fairly common occurrences in athletes, although it can be difficult to recognize such an injury in the absence of a traumatic event. Osteoarthritis is 1 condition that can increase an athlete's susceptibility to an atraumatic osteochondral fracture. However, because of the atraumatic nature of the injury, the possibility of an osteochondral fracture may be overlooked. Differential Diagnosis: Meniscal damage, osteochondritis dissecans, patellofemoral disorders. Treatment: The osteochondral fragment was surgically removed, and fibrous growth was encouraged by drilling and laser smoothing. Uniqueness: Osteochondral fractures are usually associated with some type of traumatic mechanism, such as a rotational and compressive force. Also, osteoarthritis is not common in young collegiate athletes. However, this 20-year-old volleyball player had no apparent injury and lacked the usual signs and symptoms (eg, locking, giving way, crepitus, loss of range of motion) associated with an osteochondral fracture. The athlete's susceptibility to an osteochondral fracture was increased by the presence of osteoarthritis. Conclusions: The athletic trainer should consider the possibility of an osteochondral fracture in an athlete with persistent effusion and pain in the absence of a traumatic mechanism of injury. ImagesFigure 1.Figure 2.Figure 3.Figure 4.Figure 5.Figure 6.

Baum, Jessica S.; Deivert, Richard G.



Surgical management of osteochondritis dissecans of the capitellum  

Microsoft Academic Search

Ten cases of osteochondritis dissecans of the humeral capitellum which were treated surgically are reviewed. All 10 cases were males and involved the dominant side. The ages at surgery ranged from 13 to 17 years. Follow-up ranged from 1 to 7 years. All of the youths had competed in organized athletics, either baseball or football. By position there were three

Michael C. Tivnon; Sanford H. Anzel; Theodore R. Waugh



Arthroscopic versus conservative treatment of osteochondritis dissecans of the knee  

Microsoft Academic Search

Purpose: Magnetic resonance imaging (MRI) was used to control the short-term outcome of osteochondritis dissecans (OCD) of the femoral condyle depending on conservative or surgical treatment at the beginning of therapy. Type of Study: Case series. Methods: Treatment planning for OCD depended on the stage on MRI when analyzing the appearance of the interface between parent bone and fragment on

Ingke Jürgensen; Georg Bachmann; Iris Schleicher; Holger Haas



Ipsilateral Patellofemoral Arthroplasty and Autogenous Osteochondral Femoral Condylar Transplantation  

Microsoft Academic Search

The aim of this study was to report the results of ipsilateral patellofemoral arthroplasty and autologous osteochondral transplantation for patellofemoral arthritis and focal full-thickness chondral defects of the femoral condyles. The size of the condylar cartilage defects ranged from as small as 10 × 9 mm to as big as 24 × 7 mm. The mean Knee Society function score

Jess H. Lonner; Samir Mehta; Robert E. Booth



Osteochondritis dissecans of the capitellum in fraternal twins: case report.  


The etiology of osteochondritis dissecans (OCD) of the capitellum is unknown but has generally been attributed to repetitive microtrauma or ischemia. We present a case report of fraternal twins with OCD lesions in their nondominant arms without a known history of repetitive injury to the elbow. This report provides evidence to support the idea of genetic predisposition for OCD lesions. PMID:18929205

Kenniston, Julia A; Beredjiklian, Pedro K; Bozentka, David J



Osteochondral microdamage from valgus bending of the human knee  

Microsoft Academic Search

BackgroundValgus bending of the knee is promoted as an anterior cruciate ligament injury mechanism and is associated with a characteristic “footprint” of bone bruising. The hypothesis of this study was that during ligamentous failure caused by valgus bending of the knee, high tibiofemoral contact pressures induce acute osteochondral microdamage.

Eric G. Meyer; Mark R. Villwock; Roger C. Haut



Bilateral osteochondritis dissecans of the lateral trochlea of the femur: a case report  

Microsoft Academic Search

Osteochondritis dissecans of the bilateral trochlea of femur is unusual case for orthopedic surgeon. The patient was a healthy\\u000a 15-year-old male with symptomatic osteochondritis dissecans of the bilateral distal lateral femoral condyle of the trochlea.\\u000a A surgery on the bilateral knee joints was performed simultaneously. The osteochondral free fragment of the right knee was\\u000a resected by a minimum open surgery

Yoshimasa Takahashi; Koji Nawata; Hirokazu Hashiguchi; Kei Kawaguchi; Daisuke Yamasaki; Hidetoshi Tanaka



Operative treatment of osteochondral lesions of the talus.  


? Osteochondral lesions of the talus are common injuries in recreational and professional athletes, with up to 50% of acute ankle sprains and fractures developing some form of chondral injury. Surgical treatment paradigms aim to restore the articular surface with a repair tissue similar to native cartilage and to provide long-term symptomatic relief.? Arthroscopic bone-marrow stimulation techniques, such as microfracture and drilling, perforate the subchondral plate with multiple openings to recruit mesenchymal stem cells from the underlying bone marrow to stimulate the differentiation of fibrocartilaginous repair tissue in the defect site. The ability of fibrocartilage to withstand mechanical loading and protect the subchondral bone over time is a concern.? Autologous osteochondral transplantation techniques replace the defect with a tubular unit of viable hyaline cartilage and bone from a donor site in the ipsilateral knee. In rare cases, a graft can also be harvested from the ipsilateral talus or contralateral knee. The limitations of donor site morbidity and the potential need for an osteotomy about the ankle should be considered. Some anterior or far posterior talar lesions can be accessed without arthrotomy or with a plafondplasty.? Osteochondral allograft transplantation allows an osteochondral lesion with a large surface area to be replaced with a single unit of viable articular cartilage and subchondral bone from a donor that is matched to size, shape, and surface curvature. The best available evidence suggests that this procedure should be limited to large-volume cystic lesions or salvage procedures.? Autologous chondrocyte implantation techniques require a two-stage procedure, the first for chondrocyte harvest and the second for implantation in a periosteum-covered or matrix-induced form after in vivo culture expansion. Theoretically, the transplantation of chondrocyte-like cells into the defect will result in hyaline-like repair tissue. PMID:23780543

Murawski, Christopher D; Kennedy, John G



Human growth hormone and the development of osteochondritis dissecans lesions  

Microsoft Academic Search

No single etiology regarding the cause of osteochondritis dissecans (OCD) lesions is unanimously accepted. This report documents\\u000a a novel case of multiple OCD lesions affecting the left knee and a solitary defect of the right elbow in a patient with acquired\\u000a human growth hormone (hGH) deficiency and supplementation. hGH deficiency and hormone replacement may be related to the development\\u000a of

Waqas M. HussainHaroon; Haroon M. Hussain; Mohammed S. Hussain; Sherwin S. W. Ho


Human growth hormone and the development of osteochondritis dissecans lesions.  


No single etiology regarding the cause of osteochondritis dissecans (OCD) lesions is unanimously accepted. This report documents a novel case of multiple OCD lesions affecting the left knee and a solitary defect of the right elbow in a patient with acquired human growth hormone (hGH) deficiency and supplementation. hGH deficiency and hormone replacement may be related to the development of OCD lesions. PMID:21222104

Hussain, Waqas M; Hussain, Haroon M; Hussain, Mohammed S; Ho, Sherwin S W



Osteochondritis dissecans of the humeral capitellum in identical twins  

PubMed Central

Osteochondritis dissecans (OCD) of the humeral capitellum is a disorder affecting mainly boys between the ages of 12 and 15 years. The exact etiology of OCD is not clear, but it is believed that repetitive trauma is the primary cause. Genetic factors are thought to play a secondary role in the pathogenesis. We present 17-year-old identical twins with similar MRI and arthroscopic findings, suggesting that genetic components are involved in the etiology of OCD of the humeral capitellum.

Pudas, Tomi; Koskinen, Seppo K; Hiltunen, Ari; Mattila, Kimmo T



An example of unhealed osteochondritis dissecans of the medial cuneiform  

Microsoft Academic Search

One hundred and thirty-six well-preserved medieval skeletons were excavated in advance of redevelopment in Norwich. A 13 to 15-year-old displayed a large circular defect on the distal articular surface of the right medial cuneiform. This is considered to be an unhealed example of osteochondritis dissecans (OD). The atypical site, apparently the first published case of OD involving this bone in

T. Anderson



Osteochondral fractures of the dome of the talus.  


Osteochondral fracture of the talar dome is an uncommon lesion occurring after ankle inversion and tearing of the lateral ligaments. This lesion can be overlooked if internal oblique radiographs are not obtained. The value of tomography is discussed. Symptoms may persist for many months if accurate radiographic diagnosis is delayed. Prompt arthrotomy is indicated to prevent post-traumatic arthritis of the ankle joint. PMID:427359

Newberg, A H



[Patellar osteochondral injury as onset of patellar instability].  


Patellar osteochondral fractures with no dislocation are uncommon and usually affect the centromedial facet of the patella. We present the case of a 10 year-old, overweight, female patient. She was seen in the emergency room after suffering an accidental fall, assessed as an osteochondral fracture-dislocation of the right patella with upper-outer displaced free fragments. By patient interview, she referred to no previous episodes of patellar dislocation. To complete the study, we performed an MRI which showed a medial facet patellar fracture, with two osteochondral fragments located in the sub-quadricipital recess, associated with other lesions suggesting patellar subluxation. We considered that the best treatment was surgery, so the following was performed: an open reduction and internal fixation with absorbable bars, lateral patellar release (Ficat technique), patellar coverage by medial portion of quadriceps (Insall technique) and internal moving of the lateral half of the patellar tendon (Goldwaith technique). The injury was checked one year later using arthroscopy. It confirmed a good reconstruction of the articular surface, and right patellar centering. At follow-up, during the physiotherapy period, the patient began to have repeated episodes of instability in the contralateral patella. The CT scan confirmed the patellar lateralisation (TAGT 17). Centering surgery was indicated due to the occurrence of multiple dislocation episodes. The patient currently carries out normal physical activity and she has a complete range of movement. Patellar osteochondral fracture is an injury frequently associated with patellar instability, which may onset in the first episode. The medial location of the lesions and the involvement of the system of medial knee stability is a fundamental finding. This fact reinforces the diagnosis of pre-fracture patellar dislocation. This is not a fracture-dislocation, but a dislocation-fracture. We may, therefore, treat the injury and its cause. PMID:23177946

Cepero-Campà, S; Ullot-Font, R; Pérez-López, L M



Treatment of osteochondral lesions of the talus: a systematic review  

Microsoft Academic Search

The aim of this study was to summarize all eligible studies to compare the effectiveness of treatment strategies for osteochondral\\u000a defects (OCD) of the talus. Electronic databases from January 1966 to December 2006 were systematically screened. The proportion\\u000a of the patient population treated successfully was noted, and percentages were calculated. For each treatment strategy, study\\u000a size weighted success rates were

Maartje ZengerinkPeter; Peter A. A. Struijs; Johannes L. Tol; Cornelis Niek van Dijk



Osteochondral lesions in children with juvenile idiopathic arthritis  

PubMed Central

Background Joint pain and swelling are typical symptoms in children with juvenile idiopathic arthritis (JIA) and these are often related to inflammation of the joint. Juvenile osteochondritis dissecans (JOCD), that is separation of a bone-cartilage segment from the articular surface, can manifest with similar symptoms. Findings We studied thirteen cases of osteochondritis dissecans lesions (OCD) in children with JIA. There were nine girls and four boys with a mean age of 6.5 (2–12) years at the time of diagnosis of JIA. Mean time between diagnosis of JIA and manifestation of OCD was 5.5 (1–11) years. Indications for MRI were the presence of pain or discomfort in the joint, despite otherwise effective treatment, with no evidence from ultrasound examination of any obvious signs of active inflammation. The most common location of osteochondral lesion was the knee, although the ankle joint was affected in one case. Five patients had lesions in both knees. Operative treatment was needed in eight cases (joints). Conclusions Pain, and minor dysfunction of the joint are common complaints of children suffering from JIA. Earlier research has discounted the possibility of children who were not athletes presenting with this condition. However, this study demonstrates that these lesions also seem to be relatively common in patients with JIA. When there is no sign of inflammation, the possibility of OCD must therefore be considered in these children.



A Surgical Treatment for Unstable Osteochondritis Dissecans Lesions of the Humeral Capitellum in Adolescent Baseball Players  

Microsoft Academic Search

Background: Various methods of surgical treatment for unstable osteochondritis dissecans lesions of the humeral capitellum have shown the potential to lead to osteoarthritis and poor functional results in throwing activities.Purpose: The purpose of this study was to evaluate the results of surgical treatment with pull-out wiring and bone grafting (as established by Kondo in 1989) in patients with unstable osteochondritis

Hideaki Takeda; Koji Watarai; Takashi Matsushita; Takao Saito; Yuichiro Terashima



Bilateral Osteochondritis Dissecans of the Femoral Condyles in Both Knees: A Report of Two Sibling Cases  

PubMed Central

Osteochondritis dissecans (OCD) of both femoral condyles is very rare, with no previously reported cases of bilateral OCD of both knees in two siblings. We report on a brother and sister with both femoral condyle OCD with a description of surgical technique and clinical results. Fixation using headless compressive screws, osteochondral autologous transplantation and autologous chondrocyte implantation were all successful.

Mascarenhas, Randy; Yoon, Hang Seob



Femoral osteochondral fracture--a non-contact injury in martial arts? A case report.  

PubMed Central

A report of a case of osteochondral fracture of the lateral femoral condyle in a patient doing a karate kick. The problems related to fixation of osteochondral fragments with protruding screws are highlighted and the suitability of Herbert screw fixation noted. Images Figure 1 Figure 2 Figure 3

Mbubaegbu, C E; Percy, A J



Bilateral osteochondritis dissecans of the femoral condyles in both knees: a report of two sibling cases.  


Osteochondritis dissecans (OCD) of both femoral condyles is very rare, with no previously reported cases of bilateral OCD of both knees in two siblings. We report on a brother and sister with both femoral condyle OCD with a description of surgical technique and clinical results. Fixation using headless compressive screws, osteochondral autologous transplantation and autologous chondrocyte implantation were all successful. PMID:23741705

Jeong, Jae-Hoon; Mascarenhas, Randy; Yoon, Hang Seob



A new surgical technique to facilitate osteochondral autograft transfer in osteochondral defects of the capitellum: a case report.  


A 17-year-old boy who was engaged in amateur weightlifting and body building presented with complaints of right elbow pain and limitation in elbow range of motion. Plain x-rays and magnetic resonance imaging showed an osteochondral defect in the medial third of the capitellum. At surgery, as a new technique, the lateral collateral ligament was detached from the humeral attachment to provide access to the capitellum with a clear and perpendicular exposure. Following removal of loose fragments within the joint, an osteochondral graft harvested from the lateral femoral condyle was implanted to the defect area of the capitellum. Postoperative radiologic controls showed that the defect was entirely filled by the graft with appropriate graft height. On follow-up examination at 12 months, the patient did not have any complaint about his elbow, and had no limitation of movement compared to the left elbow. Magnetic resonance imaging showed that the graft was successfully adapted to the recipient site without any sign of loosening. At final follow-up 40 months after surgery, the surface of the articular cartilage appeared normal. The range of elbow motion was preserved and the patient had no restriction in daily and sports activities. Considering technical difficulties posed by the narrow and complex structure of the elbow joint, this new technique involving detachment of the lateral collateral ligament facilitates perpendicular implantation of the graft. In our opinion, utilization of this new technique will improve functional and radiological results of osteochondral autograft transfer. PMID:20513997

Bilsel, Kerem; Demirhan, Mehmet; Atalar, Ata Can; Akkaya, Semih



Arthroscopically-assisted reduction and fixation of an old osteochondral fracture of the lateral femoral condyle  

PubMed Central

Summary Background Osteochondral fracture (OCF) of the lateral femoral condyle has a low incidence and old OCF is even more rarely seen; it is difficult to differentiate from late osteochondritis dissecans (OCD). Case Report In this report, we present the case of a 20-year-old male patient with an old OCF of the lateral femoral condyle. The possible etiology of OCF is discussed, along with its clinical manifestation, diagnosis, and treatment. He underwent arthroscopically-assisted reduction and fixation with cannulated screws. Four months after the surgery, arthroscopy showed good osteochondral healing, and screws were removed. He had achieved good functional recovery by the follow-up visit. Conclusions Old OCF should be distinguished from OCD in clinical practice, and osteochondral bodies should be preserved as much as possible. Osteochondral reduction and fixation under arthroscopy was minimal and the clinical effect was good.

Li, Runguang; Guo, Gang; Chen, Bin; Zhu, Lijun; Lin, Angru



Meniscoplasty for stable osteochondritis dissecans of the lateral femoral condyle combined with a discoid lateral meniscus: a case report  

PubMed Central

Introduction Osteochondritis dissecans of the lateral femoral condyle is relatively rare, and it is reported to often be combined with a discoid lateral meniscus. Given the potential for healing, conservative management is indicated for stable osteochondritis dissecans in patients who are skeletally immature. However, patients with osteochondritis dissecans of the lateral femoral condyle combined with a discoid lateral meniscus often have persistent symptoms despite conservative management. Case presentation We present the case of a seven-year-old Korean girl who had osteochondritis dissecans of the lateral femoral condyle combined with a discoid lateral meniscus, which healed after meniscoplasty for the symptomatic lateral discoid meniscus without surgical intervention for the osteochondritis dissecans. In addition, healing of the osteochondritis dissecans lesion was confirmed by an MRI scan five months after the operation. Conclusions Meniscoplasty can be recommended for symptomatic stable juvenile osteochondritis dissecans of the lateral femoral condyle combined with a discoid lateral meniscus when conservative treatment fails.



Osteochondral angiogenesis and increased protease inhibitor expression in OA  

PubMed Central

Summary Objective Normal cartilage is resistant to vascular invasion and anti-angiogenic protease inhibitors may contribute to its avascular status. We hypothesized that dysregulated expression of four key anti-angiogenic protease inhibitors may contribute to increased osteochondral vascularity in osteoarthritis (OA). Design Medial tibial plateaux from OA patients (n = 40) were compared with those from non-arthritic controls collected post-mortem (PM, n = 10). Immunohistochemistry was performed for protease inhibitors TIMP-1, TIMP-3, PAI-1 and SLPI and the pro-angiogenic factor vascular endothelial growth factor (VEGF). Immunoreactivity in articular chondrocytes was scored. Chondropathy was measured as a modified Mankin score, and osteochondral vascular density as number of channels crossing each mm of tidemark. Non-parametric analyses were used for all data. Results All protease inhibitors and VEGF were localised to chondrocytes near the articular surface, less often in the middle zone, and rarely to deep chondrocytes. Scores for VEGF, TIMP-1, TIMP-3, SLPI and PAI-1 were all increased in OA compared with PM, and higher scores were associated with greater chondropathy. Chondrocyte expression of VEGF was associated with higher osteochondral vascular density (r = 0.32, P < 0.05), whereas protease inhibitors were not. Conclusions The resistance of normal articular cartilage to vascular invasion may be more due to its matrix environment than ongoing protease inhibitor expression. Upregulation of protease inhibitors by superficial chondrocytes in OA may moderate the angiogenic effects of growth factors such as VEGF. However, failure of deep chondrocytes to express anti-angiogenic protease inhibitors may permit vascular invasion into the articular cartilage.

Franses, R.E.; McWilliams, D.F.; Mapp, P.I.; Walsh, D.A.



MR imaging of osteochondral grafts and autologous chondrocyte implantation  

Microsoft Academic Search

Surgical articular cartilage repair therapies for cartilage defects such as osteochondral autograft transfer, autologous chondrocyte\\u000a implantation (ACI) or matrix associated autologous chondrocyte transplantation (MACT) are becoming more common. MRI has become\\u000a the method of choice for non-invasive follow-up of patients after cartilage repair surgery. It should be performed with cartilage\\u000a sensitive sequences, including fat-suppressed proton density-weighted T2 fast spin-echo (PD\\/T2-FSE)

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



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.

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



Hybrid fixation: evaluation of a novel technique in adult osteochondritis dissecans of the knee  

Microsoft Academic Search

Purpose  Treatment of osteochondritis dissecans of the adult knee requires bone and cartilage integration of the loose fragment. Screw\\u000a fixation provides primary stability but does not guarantee bony consolidation. Additional biological fixation using osteochondral\\u000a grafts—hybrid fixation—could improve fragment integration.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  The study included seven patients [median age 21 years (15–29)] who underwent surgery for Bedouelle IIB or III osteochondritis\\u000a dissecans of the medial

Francois Lintz; Nicolas Pujol; Christophe Pandeirada; Philippe Boisrenoult; Philippe Beaufils



The use of allograft in joint-preserving surgery for ankle osteochondral lesions and osteoarthritis.  


The surgical management of young patients with large osteochondral lesions of the talus or end-stage osteoarthritis of the ankle joint presents a challenge to the orthopedic surgeon because these are well-recognized sources of pain and dysfunction. Procedures designed to address these disorders either have a limited role because of poor success rates or have significant implications, such as with the total ankle arthroplasty. Fresh osteochondral allografts allow defective tissue to be anatomically matched and reconstructed through transplantation. This article presents an overview of fresh osteochondral allografts, as well as potential concerns with their use, and summarizes the current literature. PMID:24008217

Winters, Brian S; Raikin, Steven M



Anterior talar dome as an alternative donor site for osteochondral transplantation for medial talar dome lesions.  


An alternative donor site for osteochondral transplantation for medial osteochondral defects of the talus eliminates the need for a second surgical site and decreases operative time. Additionally, the donor osteochondral grafts topographical shape and contour more closely resembles the medical talar shoulder than grafts harvested from the lateral femoral condyle or the superolateral margin of the intra-articular notch. This approach has been used with good preliminary results and no evidence of donor site complications. Long-term follow-up will be needed to adequately evaluate the validity of this procedure. Further investigation and clinical evaluation is warranted. PMID:11499180

Lee, M S



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.

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



Surgical management of osteochondritis dissecans of the knee using Medicarb Gateshead rods  

Microsoft Academic Search

We report three cases of osteochondritis dissecans (OCD) lesions of the knee which were treated with carbon rod `fixation'. The outcome was successful in each case and the technique is presented as one method of dealing with these lesions.

M. L Harding; D. B Findlay



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


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



Autologous osteochondral transplantation for the treatment of chondral defects of the knee  

Microsoft Academic Search

Full-thickness chondral defects of weight-bearing articular surfaces of the knee are a difficult condition to treat. Our aim is to evaluate the mid- and long-term functional outcome of the treatment of osteochondral defects of the knee with autologous osteochondral transplantation with the OATS technique. Thirty-six patients (37 procedures) were included in this study. Twenty-three patients were male and thirteen were

D. Karataglis; M. A. Green; D. J. A. Learmonth



Growth factor gradients via microsphere delivery in biopolymer scaffolds for osteochondral tissue engineering  

Microsoft Academic Search

Temporally and spatially controlled delivery of growth factors in polymeric scaffolds is crucial for engineering composite tissue structures, such as osteochondral constructs. In the present study, microsphere-mediated growth factor delivery in polymer scaffolds and its impact on osteochondral differentiation of human bone marrow-derived mesenchymal stem cells (hMSCs) was evaluated. Two growth factors, bone morphogenetic protein 2 (rhBMP-2) and insulin-like growth

Xiaoqin Wang; Esther Wenk; Xiaohui Zhang; Lorenz Meinel; Gordana Vunjak-Novakovic; David L. Kaplan



Biochemical, biomechanical and histological properties of osteoarthritic porcine knee cartilage: implications for osteochondral transplantation  

Microsoft Academic Search

Introduction  Cartilage lesions of the knee joint are frequently observed during arthroscopy and when surgical intervention is required,\\u000a osteochondral autograft procedures are an established method of treatment. Frequently lesions are located on the medial femoral\\u000a condyle (MFC), and typical donor locations for osteochondral grafts include the medial and lateral patellar groove. This technique\\u000a provides good results, even when the quality of

Alfred Hennerbichler; Ralf Rosenberger; Rohit Arora; Diana Hennerbichler



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

Microsoft Academic Search

Introduction  Osteochondral grafts have become popular for treating small, isolated and full-thickness cartilage lesions. It is recommended\\u000a that a slightly oversized, rather than an exact-sized, osteochondral plug is transplanted to achieve a tight fit. Consequently,\\u000a impacting forces are required to insert the osteochondral plug into the recipient site. However, it remains controversial\\u000a whether these impacting forces affect the biomechanical condition of

Koji Hattori; Kota Uematsu; Tomohiro Matsumoto; Hajime Ohgushi



Unusual orientation of talar osteochondral fragment: a case report.  


The identification of the correct orientation of an osteochondral fragment can be challenging. Orthopaedists have been able to take advantage of advanced imaging techniques to provide guidance to the appropriate surgical intervention. Many advancements have been made in imaging modalities specific to articular cartilage [Fischbach F, Bruhn H, Unterhauser F, Ricke J, Wieners G, Felix R, et al. Magnetic resonance imaging of hyaline cartilage defects at 1.5T and 3.0T: comparison of medium T2-weighted fast spin echo, T1-weighted two-dimensional and three-dimensional gradient echo pulse sequences. Acta Radiol 2005;46(1):67-73 [Erratum in: Acta Radiol 2005;46(April (2)):218

Wade, Allison M; Bustillo, Jorge



Additive manufacturing for in situ repair of osteochondral defects.  


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



Surgical management of osteochondritis dissecans of the capitellum.  


Ten cases of osteochondritis dissecans of the humeral capitellum which were treated surgically are reviewed. All 10 cases were males and involved the dominant side. The ages at surgery ranged from 13 to 17 years. Follow-up ranged from 1 to 7 years. All of the youths had competed in organized athletics, either baseball or football. By position there were three pitchers, two catchers, two infielders, and one outfielder; in addition there were one quarterback and one linebacker. Only one patient presented with locking of the elbow, whereas the others presented with pain and limitation of extension. The locked elbow was explored immediately and the others were explored after immobilization failed to relieve their symptoms. In seven of the joints a loose fragment of the capitellum was found lying either in the joint or in a defect in the capitellum. The fragment had multiple small holes. In three cases there was no loose fragment. In this situation a corticol window was cut above the capitellum. The capitellum was then drilled and bone was grafted from above. Over all, there were one excellent, six good, one fair, and two poor results. There seemed to be little difference between curretting alone or curetting and drilling. The cases with the cartilage intact and bone grafted from above did worse, with one fair and one poor result of three cases. The two poor results required further surgery, which consisted of partial excision of the capitellum. All cases lacked elbow extension before and after surgery, but nine of 10 gained some motion after surgery. Pre- and postoperative x-rays are shown in this report and a brief review of the literature concerning osteochondritis dissecans is presented. PMID:984288

Tivnon, M C; Anzel, S H; Waugh, T R


Repair of articular cartilage defects with tissue-engineered osteochondral composites in pigs.  


To compare the results of repair of knee cartilage defects with tissue-engineered osteochondral composites and tissue-engineered cartilage in pigs. Autologous chondrocytes and osteoblasts were seeded on scaffolds of polylactic-co-glycolic acid (PLGA) and tricalcium phosphate (TCP) to generate tissue-engineered cartilage and tissue-engineered bone, respectively. The tissue-engineered osteochondral composite was formed by a chondrocyte-PLGA construct sutured to an osteoblast-TCP construct with an absorbable suture. Cartilage defects were surgically created at the weightbearing surface of the bilateral femoral medial condyles of 12 mini-pigs. Thus, 24 defects in 12 pigs were randomly assigned to three treatment groups: tissue-engineered osteochondral composite group, tissue-engineered cartilage group, and blank control group. Six months after surgery, the regenerated cartilage was scored macroscopically and histologically. The compressive properties and glycosaminoglycan (GAG) content of the cartilage were also assessed. The gross grading scale indicated that the mean scores of the tissue-engineered osteochondral composite group were significantly higher than those of the tissue-engineered cartilage group. According to the International Cartilage Repair Society (ICRS) Visual Histological Assessment Scale, the scores of the osteochondral composite group were significantly better than those of the tissue-engineered cartilage group and blank control group. Assessment of compressive properties and GAG content showed better repair results in the osteochondral composite group than those of the tissue-engineered cartilage group. Using tissue-engineered osteochondral composites to repair cartilage defects was better than that of tissue-engineered cartilage. PMID:21208828

Cui, Weiding; Wang, Qing; Chen, Gang; Zhou, Shixiang; Chang, Qing; Zuo, Qiang; Ren, Kewei; Fan, Weimin



Autologous chondrocyte implantation with collagen bioscaffold for the treatment of osteochondral defects in rabbits.  


Osteochondral injury is therapeutically irreversible within current treatment parameters. Autologous chondrocyte implantation (ACI) promises to regenerate hyaline articular cartilage, but conventional ACI is plagued by complications determined by periosteal grafting. Here we propose the utilization of collagen membrane in ACI as an effective bioscaffold for the regeneration of osteochondral lesions. Using a rabbit model of osteochondral injury, we have inoculated autologous chondrocytes onto a type I/III collagen scaffold [so-called matrix-induced ACI (MACI)] and implanted into 3-mm osteochondral knee defects. All untreated defect histology showed inferior fibrocartilage and/or fibrous tissue repair. In our time-course study, ACI with type I/III collagen membrane regenerated cartilage with healthy osteochondral architecture in osteochondral defects at 6 weeks. At 12 weeks, articular cartilage regeneration was maintained, with reduced thickness and proteoglycan compared with the adjacent cartilage. Both 6-week (p < 0.01) and 12-week (p < 0.05) ACI with collagen membrane showed significant improvement as compared with untreated controls. To further examine the efficacy of cartilage regeneration by ACI, we conducted a dose-response study, using chondrocytes at various cell densities between 10(4) and 10(6) cells/cm(2). The results showed that cell density had no effect on outcome histology, but all cell densities were significantly better than untreated controls (p < 0.01) and cell-free collagen membrane treatment (p < 0.05). In short, our data suggest that autologous chondrocyte-seeded type I/III collagen membrane is an effective method for the treatment of focal osteochondral knee injury in rabbits. PMID:16144442

Willers, C; Chen, J; Wood, D; Xu, J; Zheng, M H


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-




Dynamic regulation of bone morphogenetic proteins in engineered osteochondral constructs by biomechanical stimulation.  


Osteochondral tissue-engineered grafts are proposed to hold greater potential to repair/regenerate damaged cartilage through enhanced biochemical and mechanical interactions with underlying subchondral bone as compared to simple engineered cartilage. Additionally, biomechanical stimulation of articular chondrocytes (ACs) or osteoblasts (OBs) was shown to induce greater morphogenesis of the engineered tissues composed of these cells. In this report, to define the advantages of biomechanical stimulation to osteochondral grafts for tissue engineering, we examined whether (1) ACs and OBs in three-dimensional (3D) osteochondral constructs support functional development of each other at the molecular level, and (2) biomechanical stimulation of osteochondral constructs further promotes the regenerative potential of such grafts. Various configurations of cell/scaffold assemblies, including chondral, osseous, and osteochondral constructs, were engineered with mechano-responsive electrospun poly(?-caprolactone) scaffolds. These constructs were subjected to either static or dynamic (10% cyclic compressive strain at 1?Hz for 3?h/day) culture conditions for 2 weeks. The expression of bone morphogenetic proteins (BMPs) was examined to assess the regenerative potential of each treatment on the cells. Biomechanical stimulation augmented a marked upregulation of Bmp2, Bmp6, and Bmp7 as well as downregulation of BMP antagonist, Bmp3, in a time-specific manner in the ACs and OBs of 3D osteochondral constructs. More importantly, the presence of biomechanically stimulated OBs was especially crucial for the induction of Bmp6 in ACs, a BMP required for chondrocytic growth and differentiation. Biomechanical stimulation led to enhanced tissue morphogenesis possibly through this BMP regulation, evident by the improved effective compressive modulus of the osteochondral constructs (710?kPa of dynamic culture vs. 280?kPa of static culture). Similar BMP regulation was observed in the femoral cartilages of the rats subjected to gentle exercise, demonstrating the physiological relevance of in vitro biomechanical stimulation of osteochondral constructs. Overall, our findings show that biomechanical stimulation may be critical for cross signaling between ACs and OBs to support chondrocytic growth in 3D osteochondral tissues. PMID:23198877

Nam, Jin; Perera, Priyangi; Rath, Bjoern; Agarwal, Sudha



Human umbilical cord mesenchymal stromal cells in a sandwich approach for osteochondral tissue engineering  

PubMed Central

Cell sources and tissue integration between cartilage and bone regions are critical to successful osteochondral regeneration. In this study, human umbilical cord mesenchymal stromal cells (hUCMSCs), derived from Wharton’s jelly, were introduced to the field of osteochondral tissue engineering and a new strategy for osteochondral integration was developed by sandwiching a layer of cells between chondrogenic and osteogenic constructs before suturing them together. Specifically, hUCMSCs were cultured in biodegradable poly-l-lactic acid scaffolds for 3 weeks in either chondrogenic or osteogenic medium to differentiate cells toward cartilage or bone lineages, respectively. A highly concentrated cell solution containing undifferentiated hUCMSCs was pasted onto the surface of the bone layer at week 3 and the two layers were then sutured together to form an osteochondral composite for another 3 week culture period. Chondrogenic and osteogenic differentiation was initiated during the first 3 weeks, as evidenced by the expression of type II collagen and runt-related transcription factor 2 genes, respectively, and continued with the increase of extracellular matrix during the last 3 weeks. Histological and immunohistochemical staining, such as for glycosaminoglycans, type I collagen and calcium, revealed better integration and transition of these matrices between two layers in the composite group containing sandwiched cells compared to other control composites. These results suggest that hUCMSCs may be a suitable cell source for osteochondral regeneration, and the strategy of sandwiching cells between two layers may facilitate scaffold and tissue integration.

Wang, Limin; Zhao, Liang; Detamore, Michael S.



Hierarchical Structure of Articular Bone-Cartilage Interface and Its Potential Application for Osteochondral Tissue Engineering  

NASA Astrophysics Data System (ADS)

The artificial biodegradable osteochondral construct is one of mostly promising lifetime substitute in the joint replacement. And the complex hierarchical structure of natural joint is important in developing the osteochondral construct. However, the architecture features of the interface between cartilage and bone, in particular those at the micro-and nano-structural level, remain poorly understood. This paper investigates these structural data of the cartilage-bone interface by micro computerized tomography (?CT) and Scanning Electron Microscope (SEM). The result of ?CT shows that important bone parameters and the density of articular cartilage are all related to the position in the hierarchical structure. The conjunctions of bone and cartilage were defined by SEM. All of the study results would be useful for the design of osteochondral construct further manufactured by nano-tech. A three-dimensional model with gradient porous structure is constructed in the environment of Pro/ENGINEERING software.

Bian, Weiguo; Qin, Lian; Li, Dichen; Wang, Jin; Jin, Zhongmin



Autologous chondrocyte transplantation for osteochondritis dissecans of the talus.  


Eight patients with osteochondritis dissecans of the talus were reviewed. The average followup was 17.6 months (range, 8-26 months). The mean age of the patients was 31.8 years (range, 22-42 years). All patients had a preoperative examination, magnetic resonance imaging, and radiologic classification of the lesion through regular anteroposterior and lateral radiographs. Diagnostic arthroscopy and biopsies of healthy cartilage were done, which then had chondrocyte extraction and culture. After an average of 2.5 weeks, an arthrotomy, malleolar osteotomy, subchondral bone sclerosis debridement, and autologous chondrocyte transplantation were done. The postoperative treatment included nonweightbearing for 6 to 7 weeks, physiotherapy, and continuous passive motion. According to the postoperative evaluation score, all results were excellent to good with an average score of 0.6. No complications occurred. The arthroscopic reexamination of three patients at the sixth postoperative month and the radiologic evaluation of all patients showed the existence of cartilagelike tissue with complete coverage of the chondral defect. This method enables reconstructive intervention for unicompartmental defects of articular cartilage through implantation of new chondrocytes, establishment of a subchondral blood supply, and reconstruction of the articular surface. PMID:11937880

Koulalis, D; Schultz, W; Heyden, M



Cell cultured chondrocyte implantation and scaffold techniques for osteochondral talar lesions.  


Cell cultured techniques have gained interest and popularity in osteochondral defects because, unlike bone marrow stimulation methods, where fibrocartilage fills the defect, they allow for the regeneration of "hyaline-like cartilage" with better stiffness, resilience, and wear characteristics. Osteochondral defects in the ankle are a rare but challenging problem to treat in young active patients. If left alone, they can cause pain and reduced function and risk progressive degenerative changes in the joint. Clinical results of cell cultured and scaffold technology in the ankle, although still limited by small studies and midterm follow-up, are certainly encouraging. PMID:23465953

Johnson, Ben; Lever, Caroline; Roberts, Sally; Richardson, James; McCarthy, Helen; Harrison, Paul; Laing, Patrick; Makwana, Nilesh



Fixation of osteochondral fragments in the human knee using Meniscus Arrows.  


The aim of this study is to compare the hold in bone of Meniscus Arrows and Smart Nails, followed by the report of the results of the clinical application of Meniscus Arrows as fixation devices. First, pull-out tests were performed to analyse the holdfast of both nails in bone. Statistical analysis showed no significant difference; therefore, the thinner Meniscus Arrow was chosen as fixation device in the patient series of two patients with a symptomatic Osteochondritis dissecans fragment and three patients with an osteochondral fracture of a femur condyle. The cartilage margins were glued with Tissuecoll. All fragments consolidated. Second look arthroscopy in three patients showed fixed fragments with stable, congruent cartilage edges. At an average follow-up period of 5 years no pain, effusion, locking, restricted range of motion or signs of osteoarthritis were reported. Based on the results of the pull-out tests and available clinical studies, Meniscus Arrows and Smart Nails are both likely to perform adequately as fixation devices in the treatment of Osteochondritis dissecans and osteochondral fractures in the knee. They both provide the advantage of one stage surgery. However, based on their smaller diameter, the Meniscus Arrows should be preferred for this indication. PMID:20464370

Wouters, Diederick B; Burgerhof, Johannes G M; de Hosson, Jeff T M; Bos, Rudolf R M



Osteochondritis dissecans of the lateral femoral condyle following total resection of the discoid lateral meniscus  

Microsoft Academic Search

Purpose: The purpose of this study was to describe the clinical presentation of 6 athletically active children with symptomatic osteochondritis dissecans (OCD) of the lateral femoral condyle following total resection for a torn discoid lateral meniscus and to discuss its cause. Type of Study: Case series. Methods: Six patients in whom OCD affecting the lateral femoral condyle developed after total

Hiroshi Mizuta; Eiichi Nakamura; Yutaka Otsuka; Satoshi Kudo; Katsumasa Takagi



Osteochondritis Dissecans of the Lateral Femoral Condyle of the Knee Joint  

Microsoft Academic Search

Summary: Differences in the features of osteochondritis dissecans (OCD) affecting the lateral and medial femoral condyles were investigated in 13 patients (14 knees) treated from 1991 to 1994. OCD affected the lateral femoral condyle in 6 knees (lateral group) and the medial condyle in 8 knees (medial group). The lateral group was younger (mean age, 14 v 20 years). The

Tomoki Mitsuoka; Konsei Shino; Masayuki Hamada; Shuji Horibe



Fragment fixation with a bone graft and dynamic staples for osteochondritis dissecans of the humeral capitellum  

Microsoft Academic Search

To attain bony union of the fragment in osteochondritis dissecans of the humeral capitellum, fragment fixation was performed with a bone graft and dynamic staples in 4 patients. The staples were inserted not from the articular surface but from the lateral aspect of the capitellum. All patients achieved bony union without complication, and 3 of them returned to playing competitive

Mikio Harada; Toshihiko Ogino; Masatoshi Takahara; Daisuke Ishigaki; Hideo Kashiwa; Yumiko Kanauchi



In-vivo biomechanical analysis of osteochondritis dissecans of the humeral trochlea: a case report.  


Osteochondritis dissecans (OCD) of the humeral trochlea can occur among adolescent gymnasts or throwing athletes. However, the natural history and treatment strategy remain unclear because of its low incidence. The aim of this report was to determine the biomechanical influence of trochlear OCD on the elbow joint by analyzing three-dimensional in-vivo joint biomechanics in a trochlear OCD case. PMID:23426027

Miyake, Junichi; Kataoka, Toshiyuki; Murase, Tsuyoshi; Yoshikawa, Hideki



Tissue engineering of human cartilage and osteochondral composites using recirculation bioreactors  

Microsoft Academic Search

Chondrocytes isolated from human foetal epiphyseal cartilage were seeded dynamically into polyglycolic acid (PGA) scaffolds and cultured in recirculation column bioreactors to produce tissue-engineered cartilage. Several culture techniques with the potential to provide endogenous growth factors and other conditions beneficial for de novo cartilage synthesis were investigated. Osteochondral composite constructs were generated by seeding separate PGA scaffolds with either foetal

Nastaran Mahmoudifar; Pauline M. Doran



A cell-free nanofiber composite scaffold regenerated osteochondral defects in miniature pigs.  


The aim of the study was to evaluate the effect of a cell-free hyaluronate/type I collagen/fibrin composite scaffold containing polyvinyl alcohol (PVA) nanofibers enriched with liposomes, basic fibroblast growth factor (bFGF) and insulin on the regeneration of osteochondral defects. A novel drug delivery system was developed on the basis of the intake effect of liposomes encapsulated in PVA nanofibers. Time-controlled release of insulin and bFGF improved MSC viability in vitro. Nanofibers functionalized with liposomes also improved the mechanical characteristics of the composite gel scaffold. In addition, time-controlled release of insulin and bFGF stimulated MSC recruitment from bone marrow in vivo. Cell-free composite scaffolds containing PVA nanofibers enriched with liposomes, bFGF, and insulin were implanted into seven osteochondral defects of miniature pigs. Control defects were left untreated. After 12 weeks, the composite scaffold had enhanced osteochondral regeneration towards hyaline cartilage and/or fibrocartilage compared with untreated defects that were filled predominantly with fibrous tissue. The cell-free composite scaffold containing PVA nanofibers, liposomes and growth factors enhanced migration of the cells into the defect, and their differentiation into chondrocytes; the scaffold was able to enhance the regeneration of osteochondral defects in minipigs. PMID:23499757

Filová, Eva; Rampichová, Michala; Litvinec, Andrej; Držík, Milan; Mí?ková, Andrea; Buzgo, Matej; Koš?áková, Eva; Martinová, Lenka; Usvald, Dušan; Prosecká, Eva; Uhlík, Ji?í; Motlík, Jan; Vajner, Lud?k; Amler, Evžen



Biofabrication of osteochondral tissue equivalents by printing topologically defined, cell-laden hydrogel scaffolds.  


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; Alblas, Jacqueline; Dhert, Wouter J A



Computational biomechanics of articular cartilage of human knee joint: Effect of osteochondral defects  

Microsoft Academic Search

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

R. Shirazi; A. Shirazi-Adl



Arthroscopic technique for fragment fixation using absorbable pins for osteochondritis dissecans of the humeral capitellum: a report of 4 cases  

Microsoft Academic Search

This is the first report to describe a method of arthroscopic osteochondral fixation using absorbable pins to treat osteochondritis\\u000a dissecans (OCD) of the capitellum. Four adolescent baseball players with OCD of the capitellum were treated, and good short-term\\u000a results were obtained. During this arthroscopic procedure, the elbow was maintained in the maximum flexed position, and posterolateral\\u000a portals were used to

Jun Takeba; Toshiaki Takahashi; Kazunori Hino; Seiji Watanabe; Hiroshi Imai; Haruyasu Yamamoto



Arthroscopic Surgery for Isolated Capitellar Osteochondritis Dissecans in Adolescent Baseball PlayersMinimum Three-Year Follow-Up  

Microsoft Academic Search

Background: Osteochondritis dissecans of the capitellum of the humerus usually occurs in adolescence and is caused by the valgus forces associated with excessive throwing.Hypothesis: Arthroscopic surgery is an appropriate procedure for this condition.Study Design: Retrospective cohort study.Methods: Arthroscopic surgery was performed on 10 baseball players (average age, 13.8 years) with osteochondritis dissecans whose symptoms had been apparent for an average

J. W. Thomas Byrd; Kay S. Jones



Repair of osteochondral defects with biodegradable hydrogel composites encapsulating marrow mesenchymal stem cells in a rabbit model  

Microsoft Academic Search

This work investigated the delivery of marrow mesenchymal stem cells (MSCs), with or without the growth factor transforming growth factor-?1 (TGF-?1), from biodegradable hydrogel composites on the repair of osteochondral defects in a rabbit model. Three formulations of oligo(poly(ethylene glycol) fumarate) (OPF) hydrogel composites containing gelatin microparticles (GMPs) and MSCs were implanted in osteochondral defects, including (i) OPF\\/GMP hydrogel composites;

Xuan Guo; Simon Young; James D. Kretlow; Jeroen J. van den Beucken; L. Scott Baggett; Yasuhiko Tabata; F. Kurtis Kasper; Antonios G. Mikos; John A. Jansen



Knee locking secondary to osteochondral fracture of the patella: an unusual presentation.  


Acute locking is a sign of internal derangement of the knee and is an orthopaedic surgical emergency. Differential diagnoses of this condition are torn meniscus, intra-articular loose bodies and torn anterior cruciate ligament. We present a 15-year-old schoolboy who developed acute locking of the knee during dancing. Arthroscopy revealed that he had sustained an osteochondral fracture of the patella and the loose fragment from it caused locking of the knee. That this was not pseudo-locking was confirmed by examination of the knee under anaesthesia. Locking of the knee by a loose osteochondral fragment following acute dislocation of the patella, though rare, should be considered as a possible cause of true locking. PMID:18581027

Goh, S K; Koh, J S B; Tan, M H



Histological evaluation of juvenile osteochondritis dissecans of the knee: a case series  

Microsoft Academic Search

Osteochondritis dissecans (OCD) is an acquired, potentially reversible idiopathic disease of subchondral bone resulting in\\u000a delamination and sequestration. Although juvenile-type OCD lesions typically appear stable on superficial examination, conservative\\u000a treatment results in cure in approximate 50% of patients. We hypothesized that juvenile-type OCD lesions exhibit an underlying\\u000a instability despite stability at the articular surface and this underlying instability might underlie

Yasukazu Yonetani; Norimasa Nakamura; Takashi Natsuume; Yoshiki Shiozaki; Yoshinari Tanaka; Shuji Horibe



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: [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)



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



Microscopic localization of active gelatinases in equine osteochondritis dissecans (OCD) cartilage  

Microsoft Academic Search

Objective To investigate the relationship between matrix metalloproteinase (MMP) activity and osteochondritis dissecans (OCD) in the equine joint.Methods Equine articular cartilage was obtained from normal (N=8) and osteochondrotic (OCD) (N=6) femoropatellar joints from horses at necropsy. The activity of gelatinase MMPs was determined in sections of cartilage by in situ gelatin zymography.Results Gelatinase activity was markedly increased in articular cartilage

F. Al-Hizab; P. D. Clegg; C. C. Thompson; S. D. Carter



Variation of Mesenchymal Cells in Polylactic Acid Scaffold in an Osteochondral Repair Model  

PubMed Central

Objective To achieve osteochondral regeneration utilizing transplantation of cartilage-lineage cells and adequate scaffolds, it is essential to characterize the behavior of transplanted cells in the repair process. The objectives of this study were to elucidate the survival of mesenchymal cells (MCs). In a polylactic acid (PLA) scaffold and assess the possibility of MC/PLA constructs for osteochondral repair. Design Bone marrow from mature male rabbits was cultured for 2 weeks, and fibroblast-like MCs, which contain mesenchymal stem cells (MSCs), were obtained. A cell/scaffold construct was prepared with one million MCs and a biodegradable PLA core using a rotator device. One week after culturing, the construct was transplanted into an osteochondral defect in the medial femoral condyle of female rabbits and the healing process examined histologically. To examine the survivability of transplanted MCs, the male-derived sex-determining region Y (SRY) gene was assessed as a marker of MCs in the defect by polymerase chain reaction (PCR). Results In the groups of defects without any treatment, and the transplantation of PLA without cells, the defects were not repaired with hyaline cartilage. The cartilaginous matrix by safranin O staining and type II collagen by immunohistochemical staining were recognized, however the PLA matrix was still present in the defects at 24 weeks after transplantation of the construct. During the time passage, transplanted MCs numbers decreased from 7.8?×?105 at 1 week, to 3.5?×?105 at 4 weeks, and to 3.8?×?104 at 12 weeks. Transplanted MCs were not detectable at 24 weeks. Conclusions MCs contribute to the osteochondral repair expressing the cartilaginous matrix, however the number of MCs were decreasing with time (i.e. 24 weeks). These results could be essential for achieving cartilage regeneration by cell transplantation strategies with growth factors and/or gene therapy.

Oshima, Yasushi; Harwood, Frederick L.; Coutts, Richard D.; Kubo, Toshikazu



Osteochondral repair: evaluation with sweep imaging with fourier transform in an equine model.  


Purpose: To evaluate the status of articular cartilage and bone in an equine model of spontaneous repair by using the sweep imaging with Fourier transform (SWIFT) magnetic resonance (MR) imaging technique. Materials and Methods: Experiments were approved by the Utrecht University Animal Ethics Committee. Six-millimeter-diameter chondral (n = 5) and osteochondral (n = 5, 3-4 mm deep into subchondral bone) defects were created in the intercarpal joints of seven 2-year-old horses and examined with SWIFT at 9.4 T after spontaneous healing for 12 months. Conventional T2 maps and gradient-echo images were obtained for comparison, and histologic assessment of cartilage and micro-computed tomography (CT) of bone were performed for reference. Signal-to-noise ratio (SNR) analysis was performed, and a radiologist evaluated the MR images. Structural bone parameters were derived from SWIFT and micro-CT datasets. Significance of differences was investigated with the Wilcoxon signed rank test and Pearson correlation analysis. Results: SWIFT was able to depict the different outcomes of spontaneous healing of focal chondral versus osteochondral defects. SWIFT produced constant signal intensity throughout cartilage, whereas T2 mapping showed elevated T2 values (P = .06) in repair tissue (mean T2 in superficial region of interest in an osteochondral lesion = 50.0 msec ± 10.2) in comparison to adjacent intact cartilage (mean T2 = 32.7 msec ± 4.2). The relative SNR in the subchondral plate with SWIFT (0.91) was more than four times higher than that with conventional fast spin-echo (0.12) and gradient-echo (0.19) MR imaging. The correlation between bone volume-to-tissue volume fractions determined with SWIFT and micro-CT was significant (r = 0.83, P < .01). Conclusion: SWIFT enabled assessment of spontaneous osteochondral repair in an equine model. © RSNA, 2013. PMID:23674789

Rautiainen, Jari; Lehto, Lauri J; Tiitu, Virpi; Kiekara, Outi; Pulkkinen, Hertta; Brünott, Anne; van Weeren, René; Brommer, Harold; Brama, Pieter A J; Ellermann, Jutta; Kiviranta, Ilkka; Nieminen, Miika T; Nissi, Mikko J



The Clinical Utility and Diagnostic Performance of MRI for Identification and Classification of Knee Osteochondritis Dissecans  

PubMed Central

Background: Magnetic resonance imaging (MRI) is a common clinical tool used to diagnose and monitor the progression and/or healing of osteochondritis dissecans of the knee. The purpose of this study was to systematically review the literature relative to the following questions: (1) Is MRI a valid, sensitive, specific, accurate, and reliable imaging modality to identify knee osteochondritis dissecans compared with arthroscopy? (2) Is MRI a sensitive tool that can be utilized to characterize lesion severity and stability of osteochondritis dissecans fragments in the knee? Methods: A systematic search was performed in December 2010 with use of PubMed MEDLINE (from 1966), CINAHL (from 1982), SPORTDiscus (from 1985), Scopus (from 1996), and EMBASE (from 1974) databases. Results: Seven studies, four Level-II and three Level-III investigations, met the specified inclusion criteria. No randomized controlled studies were identified. Because of inconsistencies between imaging techniques and methodological shortcomings of many of the studies, a meta-analysis was not performed. Conclusions: The limited available evidence, methodological inconsistencies in imaging techniques, and lack of standardized grading criteria used in current studies prevent clear conclusions regarding the diagnostic and specific staging equivalency of MRI with arthroscopy. However, available evidence supports the use of MRI to detect the stability or instability of the lesion. Given the benefits of the use of MRI as a noninvasive tool to diagnose, predict lesion progression, and assess clinical outcomes of treatment, there is a pressing need for high-level, systematic, sound, and thorough studies related to the clinical utility of MRI for assessing osteochondritis dissecans of the knee. Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Quatman, Carmen E.; Quatman-Yates, Catherine C.; Schmitt, Laura C.; Paterno, Mark V.



Long term in-vivo studies of a photo-oxidized bovine osteochondral transplant in sheep  

PubMed Central

Background Articular cartilage has limited capacity to repair. Defects greater than 3 mm heal with formation of inferior fibrous cartilage. Therefore, many attempts have been made to find the ideal graft for larger cartilage lesions. Different grafts, such as untreated or cryopreserved osteochondral transplants, have been used with variable success. Methods Photo-oxidized osteochondral grafts were implanted in both femoral condyles of one ovine knee. Untreated xenogeneic and autogeneic grafts served as controls. Three groups of 8 sheep each were formed and they were sacrificed 6, 12 or 18 months after surgery. Results The macroscopic evaluation of the condyle and graft showed a well-maintained cartilage surface in most grafts at all time points. However, the host cartilage matrix deteriorated considerably in all xenogeneic, most autogeneic and fewer of the photo-oxidized grafts at 12 and 18 months, respectively. The blue colour of the photo-oxidized grafts resulting from the process of photo-oxidation was visible in all grafts at 6 months, had diminished at 12 months and had completely disappeared at 18 months after surgery. Histologically a loss of matrix staining was almost never noticed in untreated xenografts, transiently at 6 months in photo-oxidized grafts and increased at 12 and 18 months. Fusion between graft and host cartilage could be seen in photo-oxidized grafts at 12 and 18 months, but was never seen in autografts and xenografts. Conclusions The photo-oxidation of osteochondral grafts and its use as transplant appears to have a beneficial effect on cartilage and bone remodelling. Osteochondral grafts pre-treated with photo-oxidation may be considered for articular cartilage replacement and therefore may delay artificial joint replacements in human patients.

Akens, Margarete K; von Rechenberg, Brigitte; Bittmann, Pedro; Nadler, Daniel; Zlinszky, Kati; Auer, Jorg A



Osteochondral interface regeneration of the rabbit knee with macroscopic gradients of bioactive signals.  


To date, most interfacial tissue engineering approaches have used 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) microspheres with a continuous gradient transition between cartilage-promoting and bone-promoting growth factors. At 6 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 preseeding 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 prelocalizing 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



Sensitivity and specificity of ultrasound in detecting (osteo)chondral defects: a cadaveric study.  


The long-term prognosis of cartilage lesions evolving into an eroding subchondral bone defect is not known. Longitudinal monitoring using ultrasound could assist in overall understanding. The aim of the work described in this article was to determine the feasibility of using ultrasound to detect small (osteo)chondral defects. On the anterior talar surface of 10 human cadaveric ankles, at most four defects were arthroscopically created: two pure chondral defects 3 and 1.5 mm in diameter and two osteochondral defects 3 and 1.5 mm in diameter. All ankles were examined by two observers, and their ultrasound observations were validated using computed tomography scans and photographs. Overall sensitivity was 96% for observer 1 and 92% for observer 2, and specificity for both observers was 100%. Sixty-eight percent and 79% of defect sizes were within relevant limits of agreement (-0.2 ± 1.0 mm), respectively. Ultrasound imaging has the potential to detect small (osteo)chondral defects located within visible areas. PMID:23711501

Tuijthof, G J M; Kok, A C; Terra, M P; Aaftink, J F A; Streekstra, G J; van Dijk, C N; Kerkhoffs, G M M J



Hemi-Hamate Osteochondral Transplantation in Proximal Interphalangeal Dorsal Fracture Dislocations: a Minimum 4 Year Follow-Up in Eight Patients  

Microsoft Academic Search

Fracture dislocations of the PIP joint are challenging to treat. In hemi-hamate arthroplasty, the palmar lip joint surface is reconstructed using an osteochondral graft from the hamate and the immediate stability permits early movement. In the long term, collapse of non-vascularized osteochondral grafts might lead to degenerative arthritis. We examined the radiographic result after a minimum of 4 years with

G. Afendras; A. Abramo; A. Konjic; M. Geijer; P. Kopylov; M. Tägil



Treatment of Osteochondral Defects in the Rabbit's Knee Joint by Implantation of Allogeneic Mesenchymal Stem Cells in Fibrin Clots.  


The treatment of osteochondral articular defects has been challenging physicians for many years. The better understanding of interactions of articular cartilage and subchondral bone in recent years led to increased attention to restoration of the entire osteochondral unit. In comparison to chondral lesions the regeneration of osteochondral defects is much more complex and a far greater surgical and therapeutic challenge. The damaged tissue does not only include the superficial cartilage layer but also the subchondral bone. For deep, osteochondral damage, as it occurs for example with osteochondrosis dissecans, the full thickness of the defect needs to be replaced to restore the joint surface (1). Eligible therapeutic procedures have to consider these two different tissues with their different intrinsic healing potential (2). In the last decades, several surgical treatment options have emerged and have already been clinically established (3-6). Autologous or allogeneic osteochondral transplants consist of articular cartilage and subchondral bone and allow the replacement of the entire osteochondral unit. The defects are filled with cylindrical osteochondral grafts that aim to provide a congruent hyaline cartilage covered surface (3,7,8). Disadvantages are the limited amount of available grafts, donor site morbidity (for autologous transplants) and the incongruence of the surface; thereby the application of this method is especially limited for large defects. New approaches in the field of tissue engineering opened up promising possibilities for regenerative osteochondral therapy. The implantation of autologous chondrocytes marked the first cell based biological approach for the treatment of full-thickness cartilage lesions and is now worldwide established with good clinical results even 10 to 20 years after implantation (9,10). However, to date, this technique is not suitable for the treatment of all types of lesions such as deep defects involving the subchondral bone (11). The sandwich-technique combines bone grafting with current approaches in Tissue Engineering (5,6). This combination seems to be able to overcome the limitations seen in osteochondral grafts alone. After autologous bone grafting to the subchondral defect area, a membrane seeded with autologous chondrocytes is sutured above and facilitates to match the topology of the graft with the injured site. Of course, the previous bone reconstruction needs additional surgical time and often even an additional surgery. Moreover, to date, long-term data is missing (12). Tissue Engineering without additional bone grafting aims to restore the complex structure and properties of native articular cartilage by chondrogenic and osteogenic potential of the transplanted cells. However, again, it is usually only the cartilage tissue that is more or less regenerated. Additional osteochondral damage needs a specific further treatment. In order to achieve a regeneration of the multilayered structure of osteochondral defects, three-dimensional tissue engineered products seeded with autologous/allogeneic cells might provide a good regeneration capacity (11). Beside autologous chondrocytes, mesenchymal stem cells (MSC) seem to be an attractive alternative for the development of a full-thickness cartilage tissue. In numerous preclinical in vitro and in vivo studies, mesenchymal stem cells have displayed excellent tissue regeneration potential (13,14). The important advantage of mesenchymal stem cells especially for the treatment of osteochondral defects is that they have the capacity to differentiate in osteocytes as well as chondrocytes. Therefore, they potentially allow a multilayered regeneration of the defect. In recent years, several scaffolds with osteochondral regenerative potential have therefore been developed and evaluated with promising preliminary results (1,15-18). Furthermore, fibrin glue as a cell carrier became one of the preferred techniques in experimental cartilage repair and has already successfully been used in several animal studies (19-21) and even first human

Berninger, Markus T; Wexel, Gabriele; Rummeny, Ernst J; Imhoff, Andreas B; Anton, Martina; Henning, Tobias D; Vogt, Stephan



Arthroscopic technique for fragment fixation using absorbable pins for osteochondritis dissecans of the humeral capitellum: a report of 4 cases.  


This is the first report to describe a method of arthroscopic osteochondral fixation using absorbable pins to treat osteochondritis dissecans (OCD) of the capitellum. Four adolescent baseball players with OCD of the capitellum were treated, and good short-term results were obtained. During this arthroscopic procedure, the elbow was maintained in the maximum flexed position, and posterolateral portals were used to visualize the lesion, perform drilling, and insert the pins. This procedure is less invasive and easier to perform than other fixation procedures that require harvesting or production of autologous bone pegs. This is an effective method of fragment fixation with absorbable pins. PMID:19859694

Takeba, Jun; Takahashi, Toshiaki; Hino, Kazunori; Watanabe, Seiji; Imai, Hiroshi; Yamamoto, Haruyasu



Autogenous osteochondral graft transplantation for steroid-induced osteonecrosis of the femoral condyle: A report of three young patients  

PubMed Central

Steroid-induced osteonecrosis of the femoral condyle is a relatively uncommon condition and is often difficult to select appropriate treatment especially in young patients. Three young men (aged 25, 18, and 24) presented with severe pain and dysfunction of the knee diagnosed as steroid-induced osteonecrosis of the femoral condyle by magnetic resonance imaging (MRIs). Full-thickness cartilage defects sized 20 × 10, 15 × 10, and 30 × 20 mm respectively were classified as International Cartilage Repair Society Grade IV lesions and treated with osteochondral autograft transplantation. They were treated successfully with osteochondral autograft transplantation certificated by post-operative MRI and second look arthroscopy.



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.

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



Construction of tissue-engineered osteochondral composites and repair of large joint defects in rabbit.  


In this study, a novel three-dimensional (3D) heterogeneous/bilayered scaffold was constructed to repair large defects in rabbit joints. The scaffold includes two distinct but integrated layers corresponding to the cartilage and bone components. The upper layer consists of gelatin, chondroitin sulphate and sodium hyaluronate (GCH), and the lower layer consists of gelatin and ceramic bovine bone (GCBB). The two form a 3D bilayered scaffold (GCH-GCBB), which mimics the natural osteochondral matrix for use as a scaffold for osteochondral tissue engineering. The purpose of this study was to evaluate the efficacy of this novel scaffold, combined with chondrocytes and bone marrow stem cells (BMSCs) to repair large defects in rabbit joints. Thirty-six large defects in rabbit femoral condyles were created; 12 defects were treated with the same scaffold combined with cells (group A); another 12 defects were treated with cell-free scaffolds (group B); the others were untreated (group C). At 6 and 12?weeks, in group A hyaline-like cartilage formation could be observed by histological examination; the newly formed cartilage, which stained for type II collagen, was detected by RT-PCR at high-level expression. Most of the GCBB was replaced by bone, while little remained in the underlying cartilage. At 36?weeks, GCBB was completely resorbed and a tidemark was observed in some areas. In contrast, groups B and C showed no cartilage formation but a great amount of fibrous tissue, with only a little bone formation. In summary, this study demonstrated that a novel scaffold, comprising a top layer of GCH, having mechanical properties comparable to native cartilage, and a bottom layer composed of GCBB, could be used to repair large osteochondral defects in joints. Copyright © 2012 John Wiley & Sons, Ltd. PMID:22777833

Deng, Tianzheng; Lv, Jing; Pang, Jianliang; Liu, Bing; Ke, Jie



Morphologic and biochemical study of sternal cartilage autografts for resurfacing induced osteochondral defects in horses.  


Using biodegradable pins, sternal cartilage autografts were fixed into osteochondral defects of the distal radial carpal bone in ten 2 to 3-year-old horses. The defects measured 1 cm2 at the surface and were 4 mm deep. Control osteochondral defects of contralateral carpi were not grafted. After confinement for 7 weeks, horses were walked 1 hour daily on a walker for an additional 9 weeks. Horses were euthanatized at 16 weeks. Half of the repair tissue was processed for histologic and histochemical (H&E and safranin-O fast green) examinations. The other half was used for the following biochemical analyses: type-I and type-II collagen contents, total glycosaminoglycan content, and galactosamine-to-glucosamine ratio. On histologic examination, the repair tissue in the grafted defects consisted of hyaline-like cartilage. Repair tissue in the nongrafted defects consisted of fibrocartilaginous tissue, with fibrous tissue in surface layers. On biochemical analysis, repair tissue of grafted defects was composed predominantly of type-II collagen; repair tissue of non-grafted defects was composed of type-I collagen. Total glycosaminoglycan content of repair tissue of grafted defects was similar to that of normal articular cartilage. Total glycosaminoglycan content of nongrafted defects was 62% of that of normal articular cartilage (P less than 0.05). Repair tissue of all defects was characterized by galactosamine-to-glucosamine ratio significantly (P less than 0.05) higher than that of normal articular cartilage. These results at 16 weeks after grafting indicate that sternal cartilage may potentially constitute a suitable substitute for articular cartilage in large osteochondral defects of horses. PMID:1626773

Vachon, A M; McIlwraith, C W; Powers, B E; McFadden, P R; Amiel, D




PubMed Central

Purpose The purpose of this study was to investigate the effect of differing storage medium on osteochondral plug diameter. Methods Four storage conditions were evaluated: air, hypotonic (sterile water), isotonic saline (0.9% NaCl), and hypertonic saline (3.0% NaCl). Four osteochondral plugs were acquired (4.5 mm harvesting system) from each of 10 fresh calf femurs and randomized to one of four storage media (n=40). Micro-CT was used to evaluate the precise diameter of each plug. Following a time zero scan, each plug was placed in a designated storage medium and rescanned at three time points over approximately one hour. A region of interest was identified from approximately 1 to 6 mm proximal to the tidemark. Custom software automatically calculated the diameter of each plug. Results The time zero plug diameter (mean ± CI) for all specimens was 4.66 ± 0.01 mm. There were no significant differences between any of the groups at the baseline scan. There were also no significant differences between the time zero and subsequent scans of the unsubmerged specimens. However, all of the liquid solutions (hypertonic, isotonic, and hypotonic) resulted in a significant increase in diameter from their baseline scans (p < 0.05), indicating a cause may be increased extracellular matrix fluid pressure. Conclusions Placing an osteochondral plug in a liquid solution increased the diameter of the subchondral bone. Size increase from the storage medium appeared to level off within 14 minutes after being placed in solution. Clinical Relevance Increases in diameter of the plug may alter the ease of insertion of the graft, possibly increasing contact pressure on cartilage during plug implantation.

Fening, Stephen D.; Mihnovets, Jonathon; Jones, Morgan H.; Midura, Ronald J.; Miniaci, Anthony



Vascularized osteochondral graft from the medial femoral trochlea: anatomical study and clinical perspectives  

Microsoft Academic Search

Purpose  Few donor sites for vascularized reconstruction of convex joint surfaces have been described. We studied the feasibility of\\u000a a convex vascularized osteochondral graft harvested from the medial femoral condyle and trochlea, on an anatomical and practical\\u000a point of view.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  An injection-corrosion technique was used on 16 fresh cadaver specimens, and completed by a modified Spalteholz clearing.\\u000a The extra- and intraosseous

Sébastien Hugon; Alain Koninckx; Olivier Barbier



Imaging of cartilage and osteochondral injuries: a case-based review.  


Current high-field magnetic resonance imaging (MRI) techniques provide a sensitive and reliable diagnostic tool for the evaluation of cartilage and osteochondral injury. This article summarizes technical factors for optimal MRI evaluation of articular cartilage of the knee. There is emphasis on the important correlation of the MRI signal to the structure of the type II collagen matrix in normal cartilage, with an understanding that alterations in this signal pattern can be an important sign of cartilage injury. Finally, specific patterns of cartilage injury and application of MRI in evaluating cartilage repair are illustrated through a series of selected cases. PMID:23773878

Gallo, Robert A; Mosher, Timothy J



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


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 can easily create small bony particles on retrieval of the probe that may stay behind in the joint. It is emphasized that the joint should be carefully inspected and flushed at the end of each procedure, in order to prevent leaving behind any loose bony particles. PMID:18810392

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



Bioabsorbable Pins for Treatment of Osteochondral Fractures of the Knee after Acute Patella Dislocation in Children and Young Adolescents  

PubMed Central

A retrospective study was performed on the use of bioabsorbable pins in the fixation of osteochondral fractures (OCFs) after traumatic patellar dislocation in children. Eighteen children (13 females, 5 males) aged 11 to 15 years (mean age 13.1 years) with osteochondral fracture (OCF) of the knee joint were treated at the authors' institution. Followup ranged from 22 months to 5 years. Diagnosis was verified by X-ray and magnetic resonance imaging (MRI) of the knee and patella. In seven patients the osteochondral fragment was detached from the patella and in 11 it was detached from the lateral femoral condyle. All patients were subjected to open reduction and fixation of the lesion with bioabsorbable pins. Postoperatively, the knee was immobilized in a cast and all patients were mobilized applying a standardized protocol. Bone consolidation was successful in 17 of the 18 patients. Bioabsorbable pins reliably fix OCF in children and adolescents, demonstrating a high incidence of consolidation of the detached osteochondral fragment in short- and middle-term followup without requiring further operative procedures.

Gkiokas, A.; Morassi, L. G.; Kohl, S.; Zampakides, C.; Megremis, P.; Evangelopoulos, D. S.



Pulsed electromagnetic fields after arthroscopic treatment for osteochondral defects of the talus: double-blind randomized controlled multicenter trial  

Microsoft Academic Search

BACKGROUND: Osteochondral talar defects usually affect athletic patients. The primary surgical treatment consists of arthroscopic debridement and microfracturing. Although this is mostly successful, early sport resumption is difficult to achieve, and it can take up to one year to obtain clinical improvement. Pulsed electromagnetic fields (PEMFs) may be effective for talar defects after arthroscopic treatment by promoting tissue healing, suppressing

Christiaan JA van Bergen; Leendert Blankevoort; Rob J de Haan; Inger N Sierevelt; Duncan E Meuffels; Pieter RN d'Hooghe; Rover Krips; Geert van Damme; C Niek van Dijk



Indirect MR-arthrography in osteochondral autograft and crushed bone graft with a collagen membrane—Correlation with histology  

Microsoft Academic Search

ObjectiveTo analyze the spectrum of findings in indirect MR-arthrography following osteochondral autograft transfer system (OATS) and crushed bone graft using a magnetic resonance imaging (MRI) scoring and grading system in relation to histology as the standard of reference.

F. Streitparth; P. Schöttle; H. Schell; L. Lehmkuhl; T. Madej; G. Wieners; G. N. Duda; R. J. Schröder



Functional and Radiographic Outcomes of Juvenile Osteochondritis Dissecans of the Knee Treated With Extra-Articular Retrograde Drilling  

Microsoft Academic Search

Background: Osteochondritis dissecans (OCD) lesions of the medial femoral condyle in the adolescent population can cause significant impairment and restriction in physical activity. Studies have established the efficacy of transarticular antegrade drilling for juvenile OCD lesions of the knee, although concerns of consequences from drilling through the articular cartilage remain. Alternatively, retrograde extra-articular drilling avoids drilling the cartilage while ensuring

Jay Boughanem; Rehan Riaz; Ronak M. Patel; John F. Sarwark



Localization of vascular endothelial growth factor during the early stages of osteochondral regeneration using a bioabsorbable synthetic polymer scaffold.  


Vascular endothelial growth factor (VEGF) plays a critical role in chondrogenic differentiation in the growth plate of the epiphysis. This function is necessary for chondrocyte survival in cartilage development. We investigated the localization of VEGF in the osteochondral regeneration process using a bioabsorbable polymer scaffold. Osteochondral defects (5 mm in diameter and 5 mm in depth) were made on the femoral condyle of forty-eight skeletally mature female Japanese white rabbits. In total, twenty-four defects were filled with poly(DL-lactide-co-glycolide) scaffolds and the others were left untreated. The regeneration process was investigated macroscopically, histologically, immunohistochemically, and by gene expression analysis. In the early stages of osteochondral regeneration, bone ingrowth was observed in the deep zone of the scaffold with continuous VEGF expression; cartilage regeneration was observed in the superficial zone of the scaffold with decreased VEGF expression. In contrast, when the defect was left untreated, VEGF localization was observed throughout the entire defect area, and cartilage regeneration at the articular surface was delayed. We conclude that decrease in localization of VEGF at the articular surface in the postoperative early stage is closely related to the progression of cartilage regeneration in osteochondral defects. PMID:21809378

Sakata, Ryosuke; Kokubu, Takeshi; Nagura, Issei; Toyokawa, Narikazu; Inui, Atsuyuki; Fujioka, Hiroyuki; Kurosaka, Masahiro



Advancements in Orthopedic Intervention: Retrograde Drilling and Bone Grafting of Osteochondral Lesions of the Knee Using Magnetic Resonance Imaging Guidance  

SciTech Connect

Computer-assisted surgery is currently a novel challenge for surgeons and interventional radiologists. Magnetic resonance imaging (MRI)-guided procedures are still evolving. In this experimental study, we describe and assess an innovative passive-navigation method for MRI-guided treatment of osteochondritis dissecans of the knee. A navigation principle using a passive-navigation device was evaluated in six cadaveric knee joint specimens for potential applicability in retrograde drilling and bone grafting of osteochondral lesions using MRI guidance. Feasibility and accuracy were evaluated in an open MRI scanner (1.0 T Philips Panorama HFO MRI System). Interactive MRI navigation allowed precise drilling and bone grafting of osteochondral lesions of the knee. All lesions were hit with an accuracy of 1.86 mm in the coronal plane and 1.4 mm the sagittal plane. Targeting of all lesions was possible with a single drilling. MRI allowed excellent assessment of correct positioning of the cancellous bone cylinder during bone grafting. The navigation device and anatomic structures could be clearly identified and distinguished throughout the entire drilling procedure. MRI-assisted navigation method using a passive navigation device is feasible for the treatment of osteochondral lesions of the knee under MRI guidance and allows precise and safe drilling without exposure to ionizing radiation. This method may be a viable alternative to other navigation principles, especially for pediatric and adolescent patients. This MRI-navigated method is also potentially applicable in many other MRI-guided interventions.

Seebauer, Christian J., E-mail: christian.seebauer@charite.d [Charite - Universitaetsmedizin Berlin, Center for Musculoskeletal Surgery (Germany); Bail, Hermann J., E-mail: hermann-josef.bail@klinikum-nuernberg.d [Clinic Nuremberg, Department of Trauma and Orthopedic Surgery (Germany); Rump, Jens C., E-mail:; Walter, Thula, E-mail:; Teichgraeber, Ulf K. M., E-mail: ulf.teichgraeber@charite.d [Charite - Universitaetsmedizin Berlin, Department of Radiology (Germany)



Histological and cell biological characterization of dissected cartilage fragments in human osteochondritis dissecans of the femoral condyle  

Microsoft Academic Search

Introduction: Osteochondritis dissecans (OCD) within the weight-bearing femoral condyle carries a high risk of osteoarthritis. The definitive pathogenetic cause is unclear. Therefore biochemical and cellular features of OCD were analyzed and compared to macroscopically normal cartilage of the same joint surface. Materials and methods: Dissected fragments from 14 patients and biopsies of normal cartilage from the intercondylar notch as controls

Matthias Aurich; Jens Anders; Tilo Trommer; Eckehard Liesaus; Mandy Seifert; Jana Schömburg; Bernd Rolauffs; Andreas Wagner; Jürgen Mollenhauer



Evaluation of cartilage, synovium and adipose tissue as cellular sources for osteochondral repair.  


Osteochondral lesions are a major cause of pain and disability in several species including dogs, horses and human beings. The objective of this study was to assess three potential sources of canine cells for their osteochondral regenerative potential. Cartilage, synovium and adipose tissue cells were grown in pellet culture in chondrogenic or osteogenic media. Cartilage-derived pellets displayed the best chondrogenic differentiation as indicated by significantly higher COL2A1 and SOX9 mRNA expression, greater glycosaminoglycan content, and higher retention of Safranin-O stain compared to the synovium and adipose-derived cells. Following application of the osteogenic media, all three cell sources exhibited small areas of positive alizarin red staining. Poor intracellular alkaline phosphatase activity was found in all three cell types when stimulated although osteocalcin and RUNX2 expression were significantly increased. Cells isolated and cultured from canine articular cartilage retained their specific chondrocytic phenotype. Furthermore, canine adipocytes and synovial cells did not undergo chondrogenic differentiation and did not exhibit evidence of multipotency. Although osteogenic differentiation was initiated at a genomic level, phenotypic osteoblastic differentiation was not observed. The findings of this study suggest that cells isolated from canine adipose tissue and synovium are sub-optimal substitutes for chondrocytes when engineering articular cartilage in vitro. PMID:23886701

Innes, J F; Gordon, C; Vaughan-Thomas, A; Rhodes, N P; Clegg, P D



The use of fibrin adhesive in the repair of chondral and osteochondral injuries.  


Fibrin adhesive proved to be useful in the reattachment of chondral and osteochondral fragments. Its use is based on sound biological principles. It offers a number of advantages over internal fixation; it causes no further damage to the cartilage, even small chondral fragments can be reattached and a second operation for the removal of metalwork is unnecessary. Its bonding strength provides only contact stability, so that immobilization in plaster for 3 weeks is always necessary. In the last 5 years we have used fibrin adhesive in 28 patients for the fixation of 39 chondral or osteochondral fragments. Of these, 26 cases were followed up for periods of 6 months to 5 years. Twelve patients were examined arthroscopically; 9 of them showed complete healing of the fragments, and only 3 slight localized degenerative changes. In 15 cases we were able to see radiological healing. All except two showed union of the fragments and restoration of the joint surface. In view of our results fibrin adhesive can be recommended for the operative management of cartilage injuries. PMID:2466002

Kaplonyi, G; Zimmerman, I; Frenyo, A D; Farkas, T; Nemes, G



Osteochondritis Dissecans of the Talar Dome in a Collegiate Swimmer: A Case Report  

PubMed Central

Objective: To present the case of an intercollegiate swimmer with a stage IV lateral talar dome injury and associated bony fragments. Background: Lack of distinct diagnostic symptoms, low index of clinical suspicion, and the difficulty of visualizing the early stages of this injury on standard x-rays cause frequent misdiagnosis of talar dome lesions. Differential Diagnosis: Ganglion cyst, with inflammatory synovitis secondary to rupture of cyst; loose bodies from previous occult fracture; osteochondral fracture. Treatment: Initial treatment with nonsteroidal antiinflammatory drugs and a posterior splint for comfort, followed by arthroscopic excision of loose bodies with abrasion and drilling arthroplasty. Uniqueness: Patient presented to the team physician for care of acute left medial ankle pain after the athletic trainer had attempted to rupture a ganglion cyst on the anterolateral aspect of the patient's ankle. Conclusions: Increased clinical suspicion is necessary to correctly diagnose osteochondral lesions, particularly in the early stages. Aggressive treatment of talar dome lesions has a good success rate and may be an attractive option for competitive athletes. ImagesFigure 2.Figure 3.Figure 4.Figure 5.

Smith, Michelle; Chang, Cindy J.



Improved repair of chondral and osteochondral defects in the ovine trochlea compared with the medial condyle.  


Associations between topographic location and articular cartilage repair in preclinical animal models are unknown. Based on clinical investigations, we hypothesized that lesions in the ovine femoral condyle repair better than in the trochlea. Full-thickness chondral and osteochondral defects were simultaneously established in the weightbearing area of the medial femoral condyle and the lateral trochlear facet in sheep, with chondral defects subjected to subchondral drilling. After 6 months in vivo, cartilage repair and osteoarthritis development was evaluated by macroscopic, histological, immunohistochemical, and biochemical analyses. Macroscopic and histological articular cartilage repair and type-II collagen immunoreactivity were better in the femoral trochlea, regardless of the defect type. Location-independently, osteochondral defects induced more osteoarthritic degeneration of the adjacent cartilage than drilled chondral lesions. DNA and proteoglycan contents of chondral defects were higher in the condyle, reflecting physiological topographical differences. The results indicate that topographic location dictates the structural patterns and biochemical composition of the repair tissue in sheep. These findings suggest that repair of cartilage defects at different anatomical sites of the ovine stifle joint needs to be assessed independently and that the sheep trochlea exhibits cartilage repair patterns reflective of the human medial femoral condyle. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31:1772-1779, 2013. PMID:23813860

Orth, Patrick; Meyer, Heinz-Lothar; Goebel, Lars; Eldracher, Mona; Ong, Mei Fang; Cucchiarini, Magali; Madry, Henning



Fresh Osteochondral Allografts for Posttraumatic Knee Defects: Long-term Followup  

PubMed Central

Fresh osteochondral allograft transplantation has been an effective treatment option with promising long-term clinical outcomes for focal posttraumatic defects in the knee for young, active individuals. We examined histologic features of 35 fresh osteochondral allograft specimens retrieved at the time of subsequent graft revision, osteotomy, or TKA. Graft survival time ranged from 1 to 25 years based on their time to reoperation. Histologic features of early graft failures were lack of chondrocyte viability and loss of matrix cationic staining. Histologic features of late graft failures were fracture through the graft, active and incomplete remodeling of the graft bone by the host bone, and resorption of the graft tissue by synovial inflammatory activity at graft edges. Histologic features associated with long-term allograft survival included viable chondrocytes, functional preservation of matrix, and complete replacement of the graft bone with the host bone. Given chondrocyte viability, long-term allograft survival depends on graft stability by rigid fixation of host bone to graft bone. With the stable osseous graft base, the hyaline cartilage portion of the allograft can survive and function for 25 years or more.

Kim, W.; Las Heras, F.; Backstein, D.; Safir, O.; Pritzker, K. P. H.



Transduction of Anti-Cell Death Protein FNK Suppresses Graft Degeneration After Autologous Cylindrical Osteochondral Transplantation  

PubMed Central

This study shows that artificial super antiapoptotic FNK protein fused with a protein transduction domain (PTD-FNK) maintains the quality of osteochondral transplant by preventing chondrocyte death. Cylindrical osteochondral grafts were obtained from enhanced green fluorescent protein (EGFP)-expressing transgenic rats, in which living chondrocytes express green fluorescence, and submerged into medium containing PTD-FNK, followed by transplantation into cartilage defects of wild-type rats by impact insertion simulating autologous transplantation. The tissues were histologically evaluated by hematoxylin–eosin and Safranin-O staining. At 1 week, chondrocyte alignment was normal in the PTD-FNK treatment group, whereas all grafts without PTD-FNK treatment showed mixed cluster cell distribution. At 4 weeks, all grafts with PTD-FNK treatment showed almost normal matrix, whereas two grafts without PTD-FNK treatment showed fibrocartilage. Notably, all grafts with PTD-FNK retained high intensity of Safranin-O staining, but all grafts without PTD-FNK largely lost Safranin-O staining. PTD-FNK significantly suppressed a decrease in the survival rate and the density of EGFP-positive cells at 1 and 2 weeks, and this tendency continued at 4 weeks. The results of terminal deoxynucleotidyl transferase (TdT)-mediated deoxyuridine triphosphate (dUTP)-nick end-labeling staining showed that PTD-FNK inhibited cell death, indicating that PTD-FNK protects chondrocyte death and suppresses graft degeneration. (J Histochem Cytochem 57:197–206, 2009)

Nakachi, Noriki; Asoh, Sadamitsu; Watanabe, Nobuyoshi; Mori, Takashi; Matsushita, Takashi; Takai, Shinro; Ohta, Shigeo



Alterations of the subchondral bone in osteochondral repair--translational data and clinical evidence.  


Alterations of the subchondral bone are pathological features associated with spontaneous osteochondral repair following an acute injury and with articular cartilage repair procedures. The aim of this review is to discuss their incidence, extent and relevance, focusing on recent knowledge gained from both translational models and clinical studies of articular cartilage repair. Efforts to unravel the complexity of subchondral bone alterations have identified (1) the upward migration of the subchondral bone plate, (2) the formation of intralesional osteophytes, (3) the appearance of subchondral bone cysts, and (4) the impairment of the osseous microarchitecture as potential problems. Their incidence and extent varies among the different small and large animal models of cartilage repair, operative principles, and over time. When placed in the context of recent clinical investigations, these deteriorations of the subchondral bone likely are an additional, previously underestimated, factor that influences the long-term outcome of cartilage repair strategies. Understanding the role of the subchondral bone in both experimental and clinical articular cartilage repair thus holds great promise of being translated into further improved cell- or biomaterial-based techniques to preserve and restore the entire osteochondral unit. PMID:23813020

Orth, P; Cucchiarini, M; Kohn, D; Madry, H




PubMed Central

Objective To develop a method for repeated same-site measurement of mechanical properties suitable for the detection of degenerative changes in a biologically-active explant model after a single blunt impact injury. Background Focal blunt impact injuries to articular surfaces lead to local cartilage degeneration and loss of mechanical properties. We employed a repeated measurement methodology to determine variations in mechanical same-site properties before and after injury in living cartilage with the hypothesis that normalization with initial mechanical properties may provide a clearer evaluation of impact effects and improve our understanding of the biologic responses to impact injury. Materials and Methods Bovine osteochondral explants were cultured for up to 14 days after impact injury. Indentation tests were performed before and after impact injury to assess relative changes in mechanical properties. Results Creep strain increased significantly in impacted explants after 7 days and in both impacted and control explants after 14 days. Further analysis at 14 days revealed decreases in stretch factor ?, creep time constant and local compressive modulus. Conclusion A repeated measures methodology reliably detected changes in mechanical behavior viable osteochondral explants after a single impact injury.

Ramakrishnan, Prem S.; Pedersen, Douglas R.; Stroud, Nicholas J.; McCabe, Daniel J.; Martin, James A.



Bilayered constructs aimed at osteochondral strategies: the influence of medium supplements in the osteogenic and chondrogenic differentiation of amniotic fluid-derived stem cells.  


The development of osteochondral tissue engineered interfaces would be a novel treatment for traumatic injuries and aging associated diseases that affect joints. This study reports the development of a bilayered scaffold, which consists of both bone and cartilage regions. On the other hand, amniotic fluid-derived stem cells (AFSCs) could be differentiated into either osteogenic or chondrogenic cells, respectively. In this study we have developed a bilayered scaffolding system, which includes a starch/polycaprolactone (SPCL) scaffold for osteogenesis and an agarose hydrogel for chondrogenesis. AFSC-seeded scaffolds were cultured for 1 or 2 weeks in an osteochondral-defined culture medium containing both osteogenic and chondrogenic differentiation factors. Additionally, the effect of the presence or absence of insulin-like growth factor-1 (IGF-1) in the culture medium was assessed. Cell viability and phenotypic expression were assessed within the constructs in order to determine the influence of the osteochondral differentiation medium. The results indicated that, after osteogenic differentiation, AFSCs that had been seeded onto SPCL scaffolds did not require osteochondral medium to maintain their phenotype, and they produced a protein-rich, mineralized extracellular matrix (ECM) for up to 2 weeks. However, AFSCs differentiated into chondrocyte-like cells appeared to require osteochondral medium, but not IGF-1, to synthesize ECM proteins and maintain the chondrogenic phenotype. Thus, although IGF-1 was not essential for creating osteochondral constructs with AFSCs in this study, the osteochondral supplements used appear to be important to generate cartilage in long-term tissue engineering approaches for osteochondral interfaces. In addition, constructs generated from agarose-SPCL bilayered scaffolds containing pre-differentiated AFSCs may be useful for potential applications in regeneration strategies for damaged or diseased joints. PMID:22510402

Rodrigues, Márcia T; Lee, Sang Jin; Gomes, Manuela E; Reis, Rui L; Atala, Anthony; Yoo, James J



Early results of one-stage knee extensor realignment and autologous osteochondral grafting  

PubMed Central

We treated 49 patients with recurrent patellar dislocations or persistent patellar subluxations. Chondral defects were graded according to the International Cartilage Repair Society (ICRS). Thirty patients (group I) had chondral defects grade I or II, and 19 patients (group II) had chondral defects grade III or IV. All patients were treated with proximal and distal realignment of the knee extensor mechanism, but group II also had a simultaneous autologous osteochondral grafting of the chondral defect. Patients were followed for 2 years and clinically assessed using the Marshall score comparing the two groups. Apart from a slower recovery in group II, the clinical and functional results were almost the same at the final follow-up.

Walawski, J.; Weglowski, R.; Drelich, M.; Mazurkiewicz, T.



Improved visualization of the 70° arthroscope in the treatment of talar osteochondral defects.  


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



Repair of osteochondral defects in joints--how to achieve success.  


Osteochondral defects in the knee are difficult to repair because intrinsic healing of cartilage is poor and gradual progression to "early-onset" osteoarthritis leads to severe pain and disability. Of all methods tested to achieve regeneration of hyaline cartilage and long-lasting repair, autologous chondrocyte transplantation (ACI-C and MACI) has been the most successful with 80% of good results and graft survival in this unit in a very large series over 10 years. The repair mechanism is unclear but our work shows that the criteria for success are: young patient age, no previous operative procedures on the defect, no obesity, no smoking, defect on femoral condyles or trochlea and no pre-existing degenerative joint changes. Future research is aimed at non-transplantation, single-stage procedures aided by use of new scaffolds and growth factors and the extension of such techniques into arthritic joints. PMID:23351867

Bentley, George; Bhamra, Jagmeet Singh; Gikas, Panagiotis D; Skinner, John A; Carrington, Richard; Briggs, Timothy W



Autologous osteochondral mosaicplasty or TruFit™ plugs for cartilage repair.  


PURPOSE: Autologous osteochondral mosaicplasty and TruFit™ Bone graft substitute plugs are methods used to repair symptomatic articular cartilage defects in the adult knee. There have been no comparative studies of the two techniques. METHODS: This retrospective study assessed functional outcome of patients using the EQ-5D, Knee Injury and Osteoarthritis Outcome Score (KOOS) and Modified Cincinnati scores at follow-up of 1-5 years. RESULTS: There were 66 patients in the study (35 TruFit and 31 Mosaicplasty): 44 males and 22 females with a mean age of 37.3 years (SD 12.6). The mean BMI was 26.8. Thirty-six articular cartilage lesions were due to trauma, twenty-six due to osteochondritis dissecans and three due to non-specific degenerative change or unknown. There was no difference between the two groups age (n.s.), sex (n.s.), BMI (n.s.), defect location (n.s.) or aetiology (n.s.). The median follow-up was 22 months for the TruFit cohort and 30 months for the mosaicplasty group. There was no significant difference in the requirement for re-operation (n.s). Patients undergoing autologous mosaicplasty had a higher rate of returning to sport (p = 0.006), lower EQ-5D pain scores (p = 0.048) and higher KOOS activities of daily living (p = 0.029) scores. Sub-group analysis showed no difference related to the number of cases the surgeon performed. Patients requiring re-operation had lower outcome scores regardless of their initial procedure. CONCLUSION: This study demonstrated significantly better outcomes using two validated outcome scores (KOOS, EQ-5D), and an ability to return to sport in those undergoing autologous mosaicplasty compared to those receiving TruFit plugs. LEVEL OF EVIDENCE: IV. PMID:23589126

Hindle, Paul; Hendry, Jane L; Keating, John F; Biant, Leela C



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.

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



The effect of porosity and mechanical property of a synthetic polymer scaffold on repair of osteochondral defects.  


We have made three types of poly (DL-lactide-co-glycolide) (PLG) scaffolds (porosity: scaffold I 80 +/- 0.9%, II 85 +/- 0.8%, III 92 +/- 0.7%; compression module determined with 10% strain: scaffold I 0.26 MPa, II 0.091 MPa, III 0.0047 MPa). Osteochondral defects made in the femoral condyle of rabbits were treated with these scaffolds and the possibilities of cartilage repair were investigated histologically. At post-operative weeks 6 and 12, histological scores in the groups of scaffolds II and III were significantly higher than the score in the group of scaffold I. Scaffolds II and III, which have higher porosity than scaffold I, allow better migration of bone marrow cells and better replacement of the scaffold with bone and cartilage than scaffold I. This study suggests that higher porosity allowing bone marrow cells to migrate to the scaffold is important in repairing osteochondral defects. PMID:18415099

Ikeda, Risa; Fujioka, Hiroyuki; Nagura, Issei; Kokubu, Takeshi; Toyokawa, Narikazu; Inui, Atsuyuki; Makino, Takeshi; Kaneko, Hiroaki; Doita, Minoru; Kurosaka, Masahiro



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


Osteochondral defects are frequent, painful, debilitating and expensive to treat, often resulting in poor results. The goal of the present study was to synthesize and characterize a novel biocompatible and biodegradable hydrogel comprised of poly(ethylene glycol), gelatin, and genipin, and examine the hydrogel as an injectable biomaterial in combination with a cyanoacrylate-based surgical sealant for cartilage repair. An osteochondral knee defect was generated in 24 rats, then the hydrogel, with or without a surgical sealant, was injected into the defect and followed for 14 days. The results demonstrated that the hydrogel is biocompatible and biodegradable, and that the cyanoacrylate-based surgical sealant is a relatively safe option for maintaining the hydrogel in the defect. This is the first study describing a cyanoacrylate-based surgical sealant in combination with a polymer hydrogel for cartilage repair. PMID:19633829

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



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

Microsoft Academic Search

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 13½ years. The scintigrams were repeated at 6-week intervals until

Bernard R. Cahill; Ben C. Berg



Association Between Mechanical Axis of the Leg and Osteochondritis Dissecans of the KneeRadiographic Study on 103 Knees  

Microsoft Academic Search

Background: The cause of osteochondritis dissecans (OCD) is unknown, but mechanical factors seem to play a role.Purpose: To identify a relationship between localization of OCD and mechanical axis of the leg.Study Design: Case series; Level of evidence, 4.Methods: Using bilateral full-leg standing radiographs, we analyzed the position of the mechanical axis of the leg in a group of 93 adolescent

Matthias Jacobi; Peter Wahl; Samy Bouaicha; Roland P. Jakob; Emanuel Gautier



In vivo effects of isolated implantation of salmon-derived crosslinked atelocollagen sponge into an osteochondral defect  

Microsoft Academic Search

We have developed crosslinked salmon-derived atelocollagen (SC) sponge, which has a denaturation temperature of 47°C. Sixty-four\\u000a knees of 32 mature rabbits were randomly divided into 4 groups after creating an osteochondral defect in the femoral trochlea.\\u000a Defects in Groups I, II, and III were filled with the crosslinked SC sponge, the crosslinked porcine collagen (PC) sponge,\\u000a and the non-crosslinked PC

Eiji Kondo; Nobuto Kitamura; Kazunobu Arakaki; Yasuhito Tanaka; Masanobu Munekata; Nobuhiro Nagai; Kazunori Yasuda



The effects of early or late treatment of osteochondral defects on joint homoeostasis: an experimental study in rabbits  

Microsoft Academic Search

A 3.5 × 4 mm tubular osteochondral defect was created on the right medial femoral condyles of 51 adult rabbits. In the control\\u000a group (CG), defects were left untreated. In the early-(ETG) and late-(LTG) treatment groups, defects were treated by an osteoperiosteal\\u000a graft 1 and 12 weeks, respectively, after the index procedure. Synovial fluid (SF) samples were collected regularly and proteoglycan\\u000a fragments (PF), total

Mehmet Hakan Ozsoy; Semih Aydogdu; Dilek Taskiran; Murat Sezak; Mutlu Hayran; Fikri Oztop; Arzu Ozsoy



Bone marrow mesenchymal stem cells in a hyaluronan scaffold for treatment of an osteochondral defect in a rabbit model  

Microsoft Academic Search

The purpose of this study was to evaluate the efficiency of using mesenchymal stem cells (MSC) in a hyaluronan scaffold for\\u000a repair of an osteochondral defect in rabbit knee. Bone marrow was harvested from the posterior iliac crest in 11 New Zealand\\u000a White rabbits. MSC were isolated and cultured in autologous serum for 28 days and transferred to a hyaluronan scaffold

S. Løken; R. B. Jakobsen; A. Årøen; S. Heir; A. Shahdadfar; J. E. Brinchmann; L. Engebretsen; F. P. Reinholt



The dimpling phenomenon: articular cartilage injury overlying an occult osteochondral lesion at the time of anterior cruciate ligament reconstruction.  


The authors report the arthroscopic finding of articular cartilage "dimpling" when a probe is placed onto the discrete chondral area involved over the geographic bone bruise incurred during traumatic anterior cruciate ligament disruption. As we develop an understanding of the pathology and sequelae of this osteochondral injury, this finding may be useful to document injury extent and possibly guide treatment including weight-bearing status and rehabilitation. PMID:8864012

Coen, M J; Caborn, D N; Johnson, D L



Evaluation of a hybrid scaffold\\/cell construct in repair of high-load-bearing osteochondral defects in rabbits  

Microsoft Academic Search

The objective of this study was to evaluate the feasibility and potential of a hybrid scaffold system in large- and high-load-bearing osteochondral defects repair. The implants were made of medical-grade PCL (mPCL) for the bone compartment whereas fibrin glue was used for the cartilage part. Both matrices were seeded with allogenic bone marrow-derived mesenchymal cells (BMSC) and implanted in the

Xin Xin Shao; Dietmar W. Hutmacher; Saey Tuan Ho; James C. H. Goh; Eng Hin Lee



Ultrasound properties of articular cartilage immediately after osteochondral grafting surgery: in cases of traumatic cartilage lesions and osteonecrosis  

Microsoft Academic Search

Although osteochondral grafting surgery is believed to replace damaged cartilage with healthy-looking normal cartilage, no\\u000a study focuses on ultrasound quantification of those cartilage immediately after the surgery. It is unknown whether the ultrasound\\u000a properties of damaged cartilage from trauma or osteonecrosis are same with each other. We have examined ultrasound properties\\u000a of damaged cartilage, adjacent intact cartilage and plug cartilage

Hiroshi Kuroki; Yasuaki Nakagawa; Koji Mori; Masahiko Kobayashi; Shinichiro Nakamura; Kohei Nishitani; Takaaki Shirai; Takashi Nakamura



Distribution of Bone Mineral Density at Osteochondral Donor Sites in the Patellofemoral Joint Among Baseball Players and Controls  

Microsoft Academic Search

Background: To theoretically minimize complications of osteochondral graft harvest from the knee, grafts should be obtained from the site of lowest stress distribution across the joint.Hypothesis: Long-term stress distribution over the patellofemoral (PF) joint surface is not equal in athletes.Study Design: Cross-sectional study; Level of evidence, 3.Methods: Measurement of subchondral bone density can determine long-term resultant stress acting on an

Kinya Nishida; Norimasa Iwasaki; Kazuhiro Fujisaki; Tadanao Funakoshi; Tamotsu Kamishima; Shigeru Tadano; Akio Minami



Giant cell tumour of bone: reconstruction of the index metacarpophalangeal joint with an osteochondral graft from the lateral femoral condyle.  


We describe the successful reconstruction of the index finger metacarpophalangeal joint with an osteochondral autograft from the lateral femoral condyle following failed curettage and cementation of a giant cell tumour of the proximal phalanx base. At the 2-year follow-up, a good functional outcome was noted with 0-80° range of motion of the metacarpophalangeal joint and no clinical or radiographic evidence of tumour recurrence. PMID:22999591

Spiro, Alexander S; Pogoda, Pia; Amling, Michael; Meenen, Norbert M; Zustin, Jozef; Rueger, Johannes M; Priemel, Matthias H



Cartilage constructs engineered from chondrocytes overexpressing IGF-I improve the repair of osteochondral defects in a rabbit model.  


Tissue engineering combined with gene therapy is a promising approach for promoting articular cartilage repair. Here, we tested the hypothesis that engineered cartilage with chondrocytes overexpressing a human insulin-like growth factor I (IGF-I) gene can enhance the repair of osteochondral defects, in a manner dependent on the duration of cultivation. Genetically modified chondrocytes were cultured on biodegradable polyglycolic acid scaffolds in dynamic flow rotating bioreactors for either 10 or 28 d. The resulting cartilaginous constructs were implanted into osteochondral defects in rabbit knee joints. After 28 weeks of in vivo implantation, immunoreactivity to ß-gal was detectable in the repair tissue of defects that received lacZ constructs. Engineered cartilaginous constructs based on IGF-I-overexpressing chondrocytes markedly improved osteochondral repair compared with control (lacZ) constructs. Moreover, IGF-I constructs cultivated for 28 d in vitro significantly promoted osteochondral repair vis-à-vis similar constructs cultivated for 10 d, leading to significantly decreased osteoarthritic changes in the cartilage adjacent to the defects. Hence, the combination of spatially defined overexpression of human IGF-I within a tissue-engineered construct and prolonged bioreactor cultivation resulted in most enhanced articular cartilage repair and reduction of osteoarthritic changes in the cartilage adjacent to the defect. Such genetically enhanced tissue engineering provides a versatile tool to evaluate potential therapeutic genes in vivo and to improve our comprehension of the development of the repair tissue within articular cartilage defects. Insights gained with additional exploration using this model may lead to more effective treatment options for acute cartilage defects. PMID:23588785

Madry, H; Kaul, G; Zurakowski, D; Vunjak-Novakovic, G; Cucchiarini, M



Cartilage repair: A review of Stanmore experience in the treatment of osteochondral defects in the knee with various surgical techniques  

PubMed Central

Articular cartilage damage in the young adult knee, if left untreated, it may proceed to degenerative osteoarthritis and is a serious cause of disability and loss of function. Surgical cartilage repair of an osteochondral defect can give the patient significant relief from symptoms and preserve the functional life of the joint. Several techniques including bone marrow stimulation, cartilage tissue based therapy, cartilage cell seeded therapies and osteotomies have been described in the literature with varying results. Established techniques rely mainly on the formation of fibro-cartilage, which has been shown to degenerate over time due to shear forces. The implantation of autologous cultured chondrocytes into an osteochondral defect, may replace damaged cartilage with hyaline or hyaline-like cartilage. This clinical review assesses current surgical techniques and makes recommendations on the most appropriate method of cartilage repair when managing symptomatic osteochondral defects of the knee. We also discuss the experience with the technique of autologous chondrocyte implantation at our institution over the past 11 years.

Vijayan, S; Bentley, G; Briggs, TWR; Skinner, JA; Carrington, RWJ; Pollock, R; Flanagan, AM



Osteochondritis Dissecans  


... may refer you to a doctor who specializes in sports medicine or orthopedic surgery. What you can do ... RM, et al. Pediatric sports elbow injuries. Clinics in Sports Medicine. 2010;29:677. Knee problems. National Institute ...


In vivo efficacy of fresh versus frozen osteochondral allografts in the goat at 6 months is associated with PRG4 secretion.  


The long-term efficacy of osteochondral allografts is due to the presence of viable chondrocytes within graft cartilage. Chondrocytes in osteochondral allografts, especially those at the articular surface that normally produce the lubricant proteoglycan-4 (PRG4), are susceptible to storage-associated death. The hypothesis of this study was that the loss of chondrocytes within osteochondral grafts leads to decreased PRG4 secretion, after graft storage and subsequent implant. The objectives were to determine the effect of osteochondral allograft treatment (FROZEN vs. FRESH) on secretion of functional PRG4 after (i) storage, and (ii) 6 months in vivo in adult goats. FROZEN allograft storage reduced PRG4 secretion from cartilage by ?85% compared to FRESH allograft storage. After 6 months in vivo, the PRG4-secreting function of osteochondral allografts was diminished with prior FROZEN storage by ?81% versus FRESH allografts and by ?84% versus non-operated control cartilage. Concomitantly, cellularity at the articular surface in FROZEN allografts was ?96% lower than FRESH allografts and non-operated cartilage. Thus, the PRG4-secreting function of allografts appears to be maintained in vivo based on its state after storage. PRG4 secretion may be not only a useful marker of allograft performance, but also a biological process protecting the articular surface of grafts following cartilage repair. PMID:23362152

Pallante-Kichura, Andrea L; Chen, Albert C; Temple-Wong, Michele M; Bugbee, William D; Sah, Robert L



Microporous calcium phosphate ceramics as tissue engineering scaffolds for the repair of osteochondral defects: Histological results.  


Treatment of defects in joint cartilage aims to re-establish normal joint function. In vitro experiments have shown that the application of synthetic scaffolds is a promising alternative to existing therapeutic options. A sheep study was conducted to test the suitability of microporous pure ?-tricalcium phosphate (TCP) ceramics as tissue engineering scaffolds for the repair of osteochondral defects. Cylindrical plugs of microporous ?-TCP (diameter: 7mm; length: 25mm; porosity: 43.5±2.4%; pore diameter: ~5?m) with interconnecting pores were used. Scaffolds were seeded with autologous chondrocytes in vitro and cultured for 4weeks. A drill hole (diameter 7mm) was placed in both medial femoral condyles of sheep. For the left knee the defect was filled with a TCP plug and for the right knee the defect was left empty. After 6, 12, 26 and 52weeks, seven animals from each group were killed and studied. The samples were examined employing histological, histomorphometric and immunohistological methods as well as various imaging techniques (X-ray, microcomputer tomography and scanning electron microscopy). After explantation the cartilage defects were first assessed macroscopically. There were no signs of infection or inflammation. Histological grading scales were used for assessment of bony integration and cartilage repair. An increasing degradation (81% after 52weeks) of the ceramic with concomitant bone formation was observed. The original structure of cancellous bone was almost completely restored. After 26 and 52weeks, collagen II-positive hyaline cartilage was detected in several samples. New subchondral bone had formed. The formation of cartilage began at the outer edge and proceeded to the middle. According to the O'Driscoll score, values corresponding to healthy cartilage were not reached after 1year. Integration of the newly formed cartilage tissue into the surrounding native cartilage was found. The formation of biomechanical stable cartilage began at the edge and progressed towards the centre of the defect. After 1year this process was still not completed. Microporous ?-TCP scaffolds seeded with chondrocytes are suitable for the treatment of osteochondral defects. PMID:23528497

Bernstein, A; Niemeyer, P; Salzmann, G; Südkamp, N P; Hube, R; Klehm, J; Menzel, M; von Eisenhart-Rothe, R; Bohner, M; Görz, L; Mayr, H O




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.

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



Osteochondritis dissecans of the capitellum: a review of the literature and a distal ulnar portal.  


Osteochondritis dissecans (OCD) of the humeral capitellum most commonly affects young athletes engaged in sports that repetitively stress the elbow. It is characterized by localized injury of subchondral bone of the humeral capitellum. To determine the best treatment option for OCD in young athletes, it is important to differentiate between stable and unstable OCD lesions. Stable lesions can be treated with rest, whereas unstable lesions, as well stable lesions that do not respond to conservative therapy, may require a surgical approach. Magnetic resonance imaging is the diagnostic study of choice to evaluate capitellar OCD lesions and loose bodies and to accurately determine the stability and viability of the OCD fragment. A variety of surgical approaches have been reported, from internal fixation of large fragments to autologous chondrocyte grafts. Arthroscopic surgery is becoming the standard treatment of capitellar OCD. This minimally invasive approach shows good results, a low risk of operative morbidity, and early recuperation postoperatively. The distal ulnar portal we describe here allows for ergonomic exposure to the posterolateral capitellum, providing easier access for drilling, burring, and local debridement of lesions amenable to arthroscopy. PMID:21035989

van den Ende, Kimberly I M; McIntosh, Amy L; Adams, Julie E; Steinmann, Scott P



Osteochondral flap avulsion fracture in a child with forearm compartment syndrome.  


Traumatic elbow dislocations account for approximately 3% to 6% of childhood upper extremity injuries, and 41% of these dislocations are concomitant injuries around the elbow. Most of these injuries are associated with a fall on an outstretched hand. Compartment syndrome is one recognized complication after elbow dislocation and distal humeral and radial neck fracture. Compartment syndrome in the forearm is a devastating complication in children with forearm, elbow, and supracondylar fractures. Compartment syndrome occurs as the result of hypoxic damage caused by interruption of the circulation to the muscles. Any evidence of compartment syndrome requires compartment pressure measurements and possibly fasciotomy. Fasciotomy is recommended in the presence of clinical signs of compartment syndrome, such as undue pain (out of proportion to severity of injury), pallor, paresthesia, absent or deficient pulse, and paralysis of the limb. Osteochondral flap avulsion fracture is a rare clinical presentation in pediatric elbow injuries. To our knowledge only 8 cases have been reported in the literature. Our case is different from others in terms of delayed presentation, and is associated with olecranon fracture and forearm compartment syndrome. This case reemphasizes the anatomy of the semilunar notch of the proximal ulna and the importance of careful clinical and radiological examination in the treatment of childhood elbow injuries. PMID:19292414

Kowtharapu, Durga Nagaraju; Thabet, Ahmed M; Holmes, Larry; Kruse, Richard



Effects of management practices as risk factors for juvenile osteochondral conditions in 259 French yearlings.  


Several studies have demonstrated a statistical association between management practices and juvenile osteochondral conditions (JOCC) in foals from birth to 6months of age, but this association has not been investigated in yearlings. The purpose of the current study was to determine the adjusted effects of management practices on the onset and evolution of JOCC in French yearlings. The study sample consisted of 259 yearlings born on 20 stud farms in Normandy. The breeding conditions of these horses were monitored from 6 to 17months. They were radiographed at 6 and 17months to determine their radiographic score (RS) and its evolution. Potential risk factors were investigated using univariate and multivariate analyses. The prevalence of JOCC was 48% at 6months and 42% at 17months. Between 6 and 17months, the RS changed (for better or worse) in 52% of yearlings. The main risk factors leading to deterioration in the RS were traumatic. 'Mixed housing' during winter, pastures with rough ground and a bad RS at 6months were significantly associated with deterioration in RS between 6 and 17months. In the multivariate analysis, the breed was not significantly associated with any evolution in the yearlings' RS. This study provides some indications on protective measures to prevent the worsening of JOCC lesions between 6 and 17months, a crucial period since it precedes the sale of yearlings and the beginning of training. PMID:23642463

Praud, Anne; Dufour, Barbara; Robert, Céline; Valette, Jean-Paul; Denoix, Jean-Marie; Crevier-Denoix, Nathalie



Material Properties of Fresh Cold-stored Allografts for Osteochondral Defects at 1 Year  

PubMed Central

Little is known about the long-term properties of fresh cold-stored osteochondral allograft tissue. We hypothesized fresh cold-stored tissue would yield superior material properties in an in vivo ovine model compared to those using freeze-thawed acellular grafts. In addition, we speculated that a long storage time would yield less successful grafts. We created 10-mm defects in medial femoral condyles of 20 sheep. Defects were reconstructed with allograft plugs stored at 4°C for 1, 14, and 42 days; control specimens were freeze-thawed or defect-only. At 52 weeks, animals were euthanized and retrieved grafts were analyzed for cell viability, gross morphology, histologic grade, and biomechanical and biochemical analysis. Explanted cold-stored tissue had superior histologic scores over freeze-thawed and defect-only grafts. Specimens stored for 1 and 42 days had higher equilibrium moduli and proteoglycan content than freeze-thawed specimens. We observed no difference among any of the cold-stored specimens for chondrocyte viability, histology, equilibrium aggregate modulus, proteoglycan content, or hypotonic swelling. Reconstructing cartilage defects with cold-stored allograft resulted in superior histologic and biomechanical properties compared with acellular freeze-thawed specimens; however, storage time did not appear to be a critical factor in the success of the transplanted allograft.

Ranawat, Anil S.; Vidal, Armando F.; Chen, Chris T.; Zelken, Jonathan A.; Turner, A. Simon



Radiographic findings of juvenile osteochondral conditions detected in 392 foals using a field radiographic protocol.  


Radiographic examination in young horses is commonly used to detect juvenile osteochondral conditions (JOCC). The aim of this study is to present the radiographic findings (RF) detected at the age of 6months in the joints of 392 foals from three breeds: French Trotter Standardbreds (FT), Selle-Français Warmbloods (SF) and Thoroughbreds (TB). Radiographic examination included lateromedial views of the fore and hind digits, tarsi and stifles, and dorsopalmar projections of both carpi. In all areas RF indicative of JOCC were classified according to a four-grade severity scoring system. Distribution and severity of the RF varied according to breed with the SF most affected. The most frequently affected site was the hind fetlock (28.3% of foals). The second most affected site was the fore fetlock in TB and SF, while the carpus and proximal tarsus were the second and third affected sites in FT. The radiographic protocol and grading system used can serve as a basis for field research and further studies on the evolution of RF, risk factors for JOCC or the correlation between RF and the subsequent athletic career of horses. PMID:23643868

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



Acute hyperextension/valgus trauma to the elbow in top-level adult male water polo goalkeepers: a cause of osteochondritis disecans of the capitellum?  


We report on 2 cases of hyperextension/valgus elbow injuries in two adult male national team water polo goalkeepers. Both were healthy and had never sustained any major injuries of the elbow. Mechanism and type of injury in both of them was identical. Different medical treatment protocols of these injuries possibly have led to different outcomes, with one of them developing osteochondritis dissecans (OCD). Inadequate medical treatment of acute impact elbow injuries could lead to osteochondritis disecans of the elbow in top-level adult male water polo goalkeepers. PMID:24060018

Rod, Eduard; Ivkovic, Alan; Boric, Igor; Jankovic, Sasa; Radic, Andrej; Hudetz, Damir



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


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



Equine developmental orthopaedic diseases - a genome-wide association study of first phalanx plantar osteochondral fragments in Standardbred trotters.  


Palmar/plantar osteochondral fragments (POF) in fetlock joints commonly affect and influence the athletic performance of horses. In this study, we used the Equine SNP50 BeadChip(®) to perform a genome-wide association study of metatarsophalangeal POF in 176 Norwegian Standardbred trotter yearlings. Putative quantitative trait loci (QTL) for medial and/or lateral POF, and medial POF only were identified on ECA1, 2, 7, 9 and 31, whereas for lateral POF, only on ECA7, 11, 27 and X. The moderate number of QTL evidences a complex inheritance and suggests various genes controlling POF development in medial and lateral locations. PMID:23742657

Lykkjen, S; Dolvik, N I; McCue, M E; Rendahl, A K; Mickelson, J R; Røed, K H



Construction of osteochondral-like tissue graft combining ?-tricalcium phosphate block and scaffold-free centrifuged chondrocyte cell sheet  

Microsoft Academic Search

Background  The combination of a ?-tricalcium phosphate (?TCP) block with a scaffold-free chondrocyte sheet formed by the centrifugation\\u000a of chondrocytes in a well was investigated with the aim of constructing an osteochondral-like structure.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Human and porcine articular cartilage chondrocytes were respectively centrifuged in a 96-well plate or cell culture insert\\u000a (0.32 cm2) that was set in a 24-well plate, cultivated in the

Kouhei Niyama; Naoto Ide; Kaori Onoue; Takahiro Okabe; Shigeyuki Wakitani; Mutsumi Takagi


Heritability estimates of tarsocrural osteochondrosis and palmar/plantar first phalanx osteochondral fragments in Standardbred trotters.  


REASONS FOR PERFORMING STUDY: The pathogenesis of osteochondrosis (OC) and palmar/plantar first phalanx osteochondral fragments (POFs) is multifactorial, but specific knowledge of heritability is limited. OBJECTIVES: To improve the precision of heritability estimates and to estimate the genetic correlation between tarsocrural OC and POFs in Standardbred trotters. Further aims were to examine whether the prevalence of OC/POFs was different in the American and French lineages that have contributed to the Norwegian population, and if the prevalence was affected by heterozygosity. STUDY DESIGN: Retrospective cohort study. METHODS: Categorical data on tarsocrural OC and POFs from 2 radiographic studies performed in 1989 and 2007/2008 (n = 1217) were analysed with sire threshold models that included 230 sires. RESULTS: Heritability of OC at the distal intermediate ridge of the tibia and/or the lateral trochlear ridge of the talus was estimated at 0.29 ± 0.15. For OC at the distal intermediate ridge of the tibia only, the estimate was 0.40 ± 0.17. Heritability of POFs in all 4 limbs was estimated at 0.23 ± 0.13; for metatarsophalangeal POFs this was 0.26 ± 0.13 and for medial metatarsophalangeal POFs 0.32 ± 0.14. Estimates of genetic correlation between OC and POFs ranged from 0.68 ± 0.27 to 0.73 ± 0.28 but were not significantly different from a zero-genetic correlation. Effects of lineages or heterozygosity were not observed. CONCLUSIONS AND POTENTIAL RELEVANCE: This study confirmed a moderate to high heritability of tarsocrural OC and POF, providing further evidence of the heritable nature of these diseases. Examination of specific lesions yielded the highest heritability; therefore, breeding programmes and future genome-analysis studies should focus on predilection sites rather than the entire disease complex. PMID:23448227

Lykkjen, S; Olsen, H F; Dolvik, N I; Grøndahl, A M; Røed, K H; Klemetsdal, G



Bone marrow concentrated cell transplantation: rationale for its use in the treatment of human osteochondral lesions.  


Bone marrow is one of the best characterized stem cell microenvironments that contains Mesenchymal Stem Cells (MSCs), a rare population of non-hematopoietic stromal cells. MSCs have been indicated as a new option for regenerative medicine because of their ability to differentiate into various lineages such as bone, cartilage and adipose tissue. However, isolation procedures are crucial for the functional activity of the transplanted cells. The use of concentrated bone marrow cells (BMCs) enables a cell population surrounded by its microenvironment (niche) to be implanted while avoiding all the complications related to the in vitro culture. The cells of the niche are able to regulate stem cell behavior through direct physical contact and secreting paracrine factors. The aim of this study was to characterize BMCs in vitro to evaluate their ability to differentiate toward mature cells and try to understand whether there are differences in the chondrogenic and osteogenic potential of cells from patients of different ages. Mononuclear Cells (MNCs) isolated by Ficoll were used as control. Both cell populations were grown in monolayers and differentiated with specific factors and analyzed by histological and molecular biology assays to evaluate the expression of some specific extracellular matrix molecules. The present investigations revealed the ability of BMCs to act as isolated cells. They are able to form colonies and differentiate toward chondrogenic and osteogenic lineages, the latter pathway appearing to be influenced by donor age. The results obtained by this study support the use of BMCs in clinical practice for the repair of osteochondral damage, which might be particularly useful for the one-step procedure allowing cells to be directly implanted in operating room. PMID:23489696

Cavallo, C; Desando, G; Cattini, L; Cavallo, M; Buda, R; Giannini, S; Facchini, A; Grigolo, B


Influence of juvenile osteochondral conditions on racing performance in Thoroughbreds born in Normandy.  


The relationship between osteoarticular status and future athletic capacity is commonly accepted in equine practice, but there is little to support this belief in Thoroughbreds. The objective of this study was to assess the prevalence of juvenile osteochondral conditions (JOCC) in Thoroughbred yearlings and to investigate the significance of these with regard to subsequent racing performance. The radiographic files from 328 Thoroughbred yearlings born in Normandy were assessed in a consistent manner and entered into a database together with racing records. Logistic regression models were used to quantify the association between each radiographic parameter and racing performance (raced/not raced, placed/not placed, performer/not performer) at 2, 3, 4 and 5years of age. The front fetlock (30.2% of horses), the dorsal aspect of the hind fetlock (18%), the carpus (15.9%) and the distal part of the hock (15.5%) were the most commonly affected joints. Most horses (87.5%) raced either in turf flat races or in hurdle races. Starting a race at 2years old was more frequent for yearlings without radiographic findings (RF) on the carpus or with less than one RF of moderate severity. The proportions of horses placed at 3years old decreased with increasing number or severity of RF. In racing horses, there was no association between the presence of RF and earnings. The radiographic score, calculated as the sum of all the severity indices found on the radiographic file of the horse appeared well correlated with performance. Using this synthetic index might help veterinarians to evaluate radiographs of Thoroughbred yearlings for potential buyers. PMID:23639369

Robert, Céline; Valette, Jean-Paul; Jacquet, Sandrine; Denoix, Jean-Marie



In vivo MRI of fresh stored osteochondral allograft transplantation with delayed gadolinium-enhanced MRI of cartilage: protocol considerations and recommendations.  


The protocol for delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) was adapted for the evaluation of transplanted osteochondral allograft cartilage. Eight patients with focal grade 4 cartilage defects of the femoral condyle were treated with single cylindrical osteochondral allografts. At 1 and 2 years, dGEMRIC image sequences were acquired and regions of interest (ROIs) were drawn in repair and native control cartilage. Mean T1 values of region of interest were used to calculate established dGEMRIC metrics. The correlation was measured between the ?R1 and R1 -Post metrics for repair and native cartilage. T1 times were measured in deep and superficial zones of cartilage. A strong correlation was identified between full-thickness, deep, and superficial ?R1 and R1 -Post values for native cartilage and repair cartilage for all years (range: 0.893-1.0). The mean T1 times and ?R1 rate between deep and superficial regions of articular cartilage were statistically different for all regions of the distal femora analyzed at 1 year and 2 years after osteochondral allograft transplantation (P<0.05). The dGEMRIC pre-Gadolinium scan is unnecessary when evaluating transplanted osteochondral allograft cartilage. The observation of stratified T1 and ?R1 values indicates a need to re-evaluate the methodology behind the placement of region of interest in dGEMRIC. PMID:22829500

Durkan, Michael G; Szumowski, Jerzy; Brown, Dawson S; Foss, Erik W; Crawford, Dennis C



An anterior ankle arthroscopic technique for retrograde osteochondral autograft transplantation of posteromedial and central talar dome cartilage defects.  


PURPOSE: The purpose of this study was to present an arthroscopic technique for the treatment for posteromedial and central cartilage defects of the talus using anterior arthroscopic portals and without performing a medial malleolar osteotomy. METHODS: Nine fresh cadavers were dissected. Autografts were implanted under arthroscopy using a retrograde osteochondral transplantation system, and their position was estimated using specific angular calibrators and later confirmed by software analysis of two photographs of the disarticulated ankle joint. RESULTS: In eight cases, the congruence between the surrounding articular cartilage and the cartilage of the graft was high, with differences measuring <1 mm. There were no iatrogenic cartilage lesions of the tibial plafond and no fractures of the talus. All the autografts remained stable during full range of motion cycles of the ankle joint. One failure was reported. CONCLUSION: This cadaveric study showed that the retrograde osteochondral autograft transplantation technique in the talus is feasible. It can be used to restore the posteromedial and central talar articular surfaces using conventional ankle arthroscopic instrumentation and anterior arthroscopic portals without resorting to a medial malleolar osteotomy. Further clinical and biomechanical studies are required to prove the efficacy of this technique and its reproducibility in routine clinical practice. PMID:23579227

Wajsfisz, Anthony; Makridis, Konstantinos G; Naji, Omar; Hirsh, Caroline; Boisrenoult, Philippe; Beaufils, Philippe



The effect of osteochondral regeneration using polymer constructs and continuous passive motion therapy in the lower weight-bearing zone of femoral trocheal groove in rabbits.  


Remedying patellofemoral osteochondral defects using clinical therapy remains challenging. Construct-based and cell-based regenerative medicine with in vitro physical stimuli has been progressively implemented. However, the effect of physical stimuli in situ in knee joints with degradable constructs is still not well-documented. Therefore, we studied whether it was practical to achieve articular cartilage repair using a poly(lactic-co-glycolic acid) (PLGA) construct in addition to early short-term continuous passive motion (CPM) for treatment of full-thickness osteochondral defects in the lower-weigh bearing (LWB) zone of the femoral trocheal groove. Twenty-six rabbits were randomly allocated into either intermittent active motion (IAM) or CPM treatment groups with or without PLGA constructs, termed PLGA construct-implanted (PCI) and empty defect knee models, respectively. Gross observation, histology, inflammatory cells, which were identified using H&E staining, total collagen and alignment, studied qualitatively using Masson's trichrome staining, glycosaminoglycan (GAG), identified using Alcian blue staining, and newly formed bone, observed using micro-CT, were evaluated at 4 and 12 weeks after surgery. Repair of osteochondral defects in the PCI-CPM group was more promising than all other groups. The better osteochondral defect repair in the PCI-CPM group corresponded to smooth cartilage surfaces, no inflammatory reaction, hyaline cartilaginous tissues composition, sound collagen alignment with positive collagen type II expression, higher GAG content, mature bone regeneration with osteocyte, clear tidemark formation, and better degradation of PLGA. In summary, the use of a simple PLGA construct coupled with passive motion promotes positive healing and may be a promising clinical intervention for osteochondral regeneration in LWB defects. PMID:22987137

Chang, Nai-Jen; Lin, Chih-Chan; Li, Chien-Feng; Su, Kai; Yeh, Ming-Long



Polyvinyl Alcohol Hydrogel Irradiated and Acetalized for Osteochondral Defect Repair: Mechanical, Chemical, and Histological Evaluation after Implantation in Rat Knees  

PubMed Central

Polyvinyl Alcohol (PVA) hydrogel plugs were implanted in artificial osteochondral defects on the trochlear groove of rat knees. After 0, 3, 6, 12, and 24 weeks of followup, samples containing the implants were mechanically evaluated by creep indentation test, chemically, and histologically by optical microscopy. The mechanical test pointed towards an increase of the implant creep modulus and the chemical analysis exhibited an increasing concentration of calcium and phosphorus within the implants over time. Optical microscopy showed no foreign body reaction and revealed formation, differentiation, and maintenance of new tissue at the defect/implant interface. The absence of implant wear indicated that the natural articular lubrication process was not disturbed by the implant. The performance of the irradiated and acetalized PVA was considered satisfactory for the proposed application.

Batista, N. A.; Rodrigues, A. A.; Bavaresco, V. P.; Mariolani, J. R. L.; Belangero, W. D.



Late-diagnosed large osteochondral fracture of the lateral femoral condyle in an adolescent: a case report.  


In this case report, we describe a large osteochondral fracture of the anterolateral femoral condyle in an adolescent athlete while dancing. At 3 months after the misdiagnosed injury, the condylar defect was covered by a layer of disorganized fibrous tissue rich in blood vessels. To achieve good repair, an accurate curettage of the fractured surfaces, a precise reduction, and a stable internal fixation of the fragments were performed. Two poly-L-lactic acid bioabsorbable screws were used to obtain appropriate compression. At the 2-year follow-up, the patient was asymptomatic and had resumed her previous dancing activity. An MRI scan showed no interruptions of the cartilage layer at the boundary with the healthy tissue, but cartilage thinning and extensive subchondral remodeling were detected. PMID:23511583

Enea, Davide; Busilacchi, Alberto; Cecconi, Stefano; Gigante, Antonio



The meniscus Arrow or metal screw for treatment of osteochondritis dissecans? In vitro comparison of their effectiveness.  


Three draw bench tests in axial direction were conducted of the pull out forces in predrilled human condylar bone of one single meniscus Arrow, one single metal screw, and three Meniscus Arrows in one bone block, the Arrows being inserted using the standard hand instruments. Bone blocks with three meniscus Arrows were tested additionally in tangential direction, imitating shear forces. All observed values were within the range of 1 standard error (SE) or higher and exceeded the values in meniscal tissue as reported in the literature. These are much higher than the shear force during a single movement in the human knee. Most metallic devices used for fixation of the fragments in the treatment of osteochondritis dissecans must be removed in a second operation. Left in place, as with the Herbert screws, they can disturb future imaging and damage the opposite cartilage of the tibia plateau. Staples left in place can break. Finally, some metals evoke allergic reactions and, at least in animals, are potent carcinogens. Although fusion of osteochondritis dissecans fragments in their original locations fixed with noncompressive biodegradable pins has been reported, these tests show the hold of compressive meniscus Arrows in bone to contribute to a better result than noncompressive pins. Other biodegradable devices are also available for this application. However, one advantage is that using meniscus Arrows, already available in the hospital for mending ruptured menisci, saves the costs of investing in other sets of instruments and devices. Another advantage is the smaller diameter of the meniscus Arrows than that of other biodegradable devices, resulting in less damage to the fragments. PMID:14586489

Wouters, Diederick B; Bos, Rudolf R M; Mouton, Leonora J; van Horn, Jim R



Functional evaluation of patients treated with osteochondral allograft transplantation for post-traumatic ankle arthritis: One year follow-up.  


Severe post-traumatic ankle arthritis poses a reconstructive challenge in active patients. Whereas traditional surgical treatments, i.e. arthrodesis and arthroplasty, provide good pain relief, arthrodesis is associated to functional and psychological limitations, and arthroplasty is prone to failure in the active patient. More recently the use of bipolar fresh osteochondral allografts transplantation has been proposed as a promising alternative to the traditional treatments. Preliminary short- and long-term clinical outcomes for this procedure have been reported, but no functional evaluations have been performed to date. The clinical and functional outcomes of a series of 10 patients who underwent allograft transplantation at a mean follow-up of 14 months are reported. Clinical evaluation was performed with the AOFAS score, functional assessment by state-of-the-art gait analysis. The clinical score significantly improved from a median of 54 (range 12-65) pre-op to 76.5 (range 61-86) post-op (p=0.002). No significant changes were observed for the spatial-temporal parameters, but motion at the hip and knee joints during early stance, and the range of motion of the ankle joint in the frontal plane (control: 13.8°±2.9°; pre-op: 10.4°±3.1°, post-op: 12.9°±4.2°; p=0.02) showed significant improvements. EMG signals revealed a good recovery in activation of the biceps femoris. This study showed that osteochondral allograft transplantation improves gait patterns. Although re-evaluation at longer follow-ups is required, this technique may represent the right choice for patients who want to delay the need for more invasive joint reconstruction procedures. PMID:23711988

Berti, L; Vannini, F; Lullini, G; Caravaggi, P; Leardini, A; Giannini, S



Pulsed electromagnetic fields after arthroscopic treatment for osteochondral defects of the talus: double-blind randomized controlled multicenter trial  

PubMed Central

Background Osteochondral talar defects usually affect athletic patients. The primary surgical treatment consists of arthroscopic debridement and microfracturing. Although this is mostly successful, early sport resumption is difficult to achieve, and it can take up to one year to obtain clinical improvement. Pulsed electromagnetic fields (PEMFs) may be effective for talar defects after arthroscopic treatment by promoting tissue healing, suppressing inflammation, and relieving pain. We hypothesize that PEMF-treatment compared to sham-treatment after arthroscopy will lead to earlier resumption of sports, and aim at 25% increase in patients that resume sports. Methods/Design A prospective, double-blind, randomized, placebo-controlled trial (RCT) will be conducted in five centers throughout the Netherlands and Belgium. 68 patients will be randomized to either active PEMF-treatment or sham-treatment for 60 days, four hours daily. They will be followed-up for one year. The combined primary outcome measures are (a) the percentage of patients that resume and maintain sports, and (b) the time to resumption of sports, defined by the Ankle Activity Score. Secondary outcome measures include resumption of work, subjective and objective scoring systems (American Orthopaedic Foot and Ankle Society – Ankle-Hindfoot Scale, Foot Ankle Outcome Score, Numeric Rating Scales of pain and satisfaction, EuroQol-5D), and computed tomography. Time to resumption of sports will be analyzed using Kaplan-Meier curves and log-rank tests. Discussion This trial will provide level-1 evidence on the effectiveness of PEMFs in the management of osteochondral ankle lesions after arthroscopy. Trial registration Netherlands Trial Register (NTR1636)

van Bergen, Christiaan JA; Blankevoort, Leendert; de Haan, Rob J; Sierevelt, Inger N; Meuffels, Duncan E; d'Hooghe, Pieter RN; Krips, Rover; van Damme, Geert; van Dijk, C Niek



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


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



Microporous calcium phosphate ceramics as tissue engineering scaffolds for the repair of osteochondral defects: biomechanical results.  


This work investigated the suitability of microporous ?-tricalcium phosphate (TCP) scaffolds pre-seeded with autologous chondrocytes for treatment of osteochondral defects in a large animal model. Microporous ?-TCP cylinders (Ø 7 mm; length 25 mm) were seeded with autologous chondrocytes and cultured for 4 weeks in vitro. Only the upper end of the cylinder was seeded with chondrocytes. Chondrocytes formed a multilayer on the top. The implants were then implanted in defects (diameter 7 mm) created in the left medial femoral condyle of ovine knees. The implants were covered with synovial membrane from the superior recess of the same joint. For the right knees, an empty defect with the same dimensions served as control. Twenty-eight sheep were split into 6-, 12-, 26- and 52 week groups of seven animals. Indentation tests with a spherical (Ø 3mm) indenter were used to determine the biomechanical properties of regenerated tissue. A software-based limit switch was implemented to ensure a maximal penetration depth of 200 ?m and maximal load of 1.5 N. The achieved load, the absorbed energy and the contact stiffness were measured. Newly formed cartilage was assessed with the International Cartilage Repair Society Visual Assessment Scale (ICRS score) and histomorphometric analysis. Results were analysed statistically using the t-test, Mann-Whitney U-test and Wilcoxon test. Statistical significance was set at p<0.05. After 6 weeks of implantation, the transplanted area tolerated an indentation load of 0.05±0.20 N. This value increased to 0.10±0.06 N after 12 weeks, to 0.27±0.18 N after 26 weeks, and 0.27±0.11 N after 52 weeks. The increase in the tolerated load was highly significant (p<0.0001), but the final value was not significantly different from that of intact cartilage (0.30±0.12 N). Similarly, the increase in contact stiffness from 0.87±0.29 N mm-(1) after 6 weeks to 3.14±0.86 N mm(-1) after 52 weeks was highly significant (p<0.0001). The absorbed energy increased significantly (p=0.02) from 0.74×10(-6)±0.38×10(-6) Nm after 6 weeks to 2.83×10(-6)±1.35×10(-6) Nm after 52 weeks. At 52 weeks, the International Cartilage Repair Society (ICRS) scores for the central area of the transplanted area and untreated defects were comparable. In contrast, the score for the area from the edge to the centre of the transplanted area was significantly higher (p=0.001) than the score for the unfilled defects. A biomechanically stable cartilage was built outside the centre of defect. After 52 weeks, all but one empty control defect were covered by bone and a very thin layer of cartilage (ICRS 7 points). The empty hole could still be demonstrated beneath the bone. The histomorphometric evaluation revealed that 81.0±10.6% of TCP was resorbed after 52 weeks. The increase in TCP resorption and replacement by spongy bone during the observation period was highly significant (p<0.0001). In this sheep trial, the mechanical properties of microporous TCP scaffolds seeded with transplanted autologous chondrocytes were similar to those of natural cartilage after 52 weeks of implantation. However, the central area of the implants had a lower ICRS score than healthy cartilage. Microporous TCP was almost fully resorbed at 52 weeks and replaced by bone. PMID:22885682

Mayr, H O; Klehm, J; Schwan, S; Hube, R; Südkamp, N P; Niemeyer, P; Salzmann, G; von Eisenhardt-Rothe, R; Heilmann, A; Bohner, M; Bernstein, A



Vascularized sural nerve graft and extracorporeally irradiated osteochondral autograft for oncological reconstruction of wrist sarcoma: case report and review of literature.  


For tumors that are located beside the main peripheral nerve, combined wide resection of both the tumor and peripheral nerve is mandatory. We here present an interesting case with synovial sarcoma of the wrist. An 8 cm of ulnar nerve defect was reconstructed by vascularized, folded sural nerve graft with the peroneal flap, whereas an 8 cm of distal ulna was reconstructed using extracorporeally irradiated osteochondral autograft. Our case showed excellent nerve regeneration. Extracorporeal irradiated osteochondral graft was a good option for reconstruction of the distal ulna. This procedure should be indicated for the reconstruction of non-weight-bearing joints. These kinds of reconstruction have been addressed in only a few cases of oncological reconstruction. PMID:24051468

Muramatsu, Keiichi; Moriya, Atsushi; Miyoshi, Tomoyuki; Tominaga, Yasuhiro; Seto, Shinichiro; Taguchi, Toshihiko



Accuracy Analysis of a Novel Electromagnetic Navigation Procedure Versus a Standard Fluoroscopic Method for Retrograde Drilling of Osteochondritis Dissecans Lesions of the Knee  

Microsoft Academic Search

Background: Retrograde drilling for osteochondritis dissecans (OCD) remains a challenging operation.Purpose: A novel radiation-free electromagnetic navigation system (ENS)–based method was developed and its feasibility and accuracy for retrograde drilling procedures evaluated and compared with the standard freehand fluoroscopic method in an experimental setting.Study Design: Controlled laboratory study.Methods: A controlled laboratory study with 16 standard freehand fluoroscopically and 16 electromagnetically guided

Michael Hoffmann; Jan Philipp Petersen; Malte Schröder; Maximillian Hartel; Michael Kammal; Johannes Maria Rueger; Andreas Hermann Ruecker



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



One-step surgical procedure for the treatment of osteochondral defects with adipose-derived stem cells in a caprine knee defect: a pilot study.  


Regenerative therapies offer attractive alternatives for the treatment of osteochondral defects. Adipose-derived stromal vascular fraction (SVF) cells allow the development of one-step surgical procedures by their abundant availability and high frequency. In this pilot study we evaluated the in vivo safety, feasibility, and efficacy of this concept using scaffolds seeded with freshly isolated (SVF) or cultured adipose stem cells (ASCs), and compared these to their acellular counterparts. Osteochondral defects were created in medial condyles and trochlear grooves in knees of eight goats. Defects were filled with acellular collagen I/III scaffolds or scaffolds seeded with SVF cells or cultured ASCs. Osteochondral regeneration was evaluated after 1 and 4 months by macroscopy, immunohistochemistry, biomechanical analysis, microCT analysis, and biochemistry. After 1 month, no adverse effects were noted. Microscopic, but not macroscopic evaluation showed considerable yet not significant differences, with cell-loaded constructs showing more extensive regeneration. After 4 months, acellular constructs displayed increased regeneration, however, to a lesser degree than cell-treated constructs. The latter exhibited more extensive collagen type II, hyaline-like cartilage, and higher elastic moduli, and their glycosaminoglycan content in the cartilaginous layer better approached native tissue values. Moreover, their defect regions contained higher levels of regenerated, mature subchondral bone with more intense collagen type I staining. SVF cells tended to perform best on all parameters. In summary, this pilot study demonstrated the preclinical safety and feasibility of a one-step surgical procedure for osteochondral defect regeneration. Similar regeneration was found between freshly isolated SVF cells and cultured ASCs. Larger studies with longer follow-up are required to substantiate these findings. PMID:23914338

Jurgens, Wouter J F M; Kroeze, Robert Jan; Zandieh-Doulabi, Behrouz; van Dijk, Annemieke; Renders, Greetje A P; Smit, Theo H; van Milligen, Florine J; Ritt, Marco J P F; Helder, Marco N



Establishing proof of concept: Platelet-rich plasma and bone marrow aspirate concentrate may improve cartilage repair following surgical treatment for osteochondral lesions of the talus  

PubMed Central

Osteochondral lesions of the talus are common injuries in the athletic patient. They present a challenging clinical problem as cartilage has a poor potential for healing. Current surgical treatments consist of reparative (microfracture) or replacement (autologous osteochondral graft) strategies and demonstrate good clinical outcomes at the short and medium term follow-up. Radiological findings and second-look arthroscopy however, indicate possible poor cartilage repair with evidence of fibrous infill and fissuring of the regenerative tissue following microfracture. Longer-term follow-up echoes these findings as it demonstrates a decline in clinical outcome. The nature of the cartilage repair that occurs for an osteochondral graft to become integrated with the native surround tissue is also of concern. Studies have shown evidence of poor cartilage integration, with chondrocyte death at the periphery of the graft, possibly causing cyst formation due to synovial fluid ingress. Biological adjuncts, in the form of platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC), have been investigated with regard to their potential in improving cartilage repair in both in vitro and in vitro settings. The in vitro literature indicates that these biological adjuncts may increase chondrocyte proliferation as well as synthetic capability, while limiting the catabolic effects of an inflammatory joint environment. These findings have been extrapolated to in vitro animal models, with results showing that both PRP and BMAC improve cartilage repair. The basic science literature therefore establishes the proof of concept that biological adjuncts may improve cartilage repair when used in conjunction with reparative and replacement treatment strategies for osteochondral lesions of the talus.

Smyth, Niall A; Murawski, Christopher D; Haleem, Amgad M; Hannon, Charles P; Savage-Elliott, Ian; Kennedy, John G



A Missense Mutation in the Aggrecan C-type Lectin Domain Disrupts Extracellular Matrix Interactions and Causes Dominant Familial Osteochondritis Dissecans  

PubMed Central

Osteochondritis dissecans is a disorder in which fragments of articular cartilage and subchondral bone dislodge from the joint surface. We analyzed a five-generation family in which affected members had autosomal-dominant familial osteochondritis dissecans. A genome-wide linkage analysis identified aggrecan (ACAN) as a prime candidate gene for the disorder. Sequence analysis of ACAN revealed heterozygosity for a missense mutation (c.6907G > A) in affected individuals, resulting in a p.V2303M amino acid substitution in the aggrecan G3 domain C-type lectin, which mediates interactions with other proteins in the cartilage extracellular matrix. Binding studies with recombinant mutated and wild-type G3 proteins showed loss of fibulin-1, fibulin-2, and tenascin-R interactions for the V2303M protein. Mass spectrometric analyses of aggrecan purified from patient cartilage verified that V2303M aggrecan is produced and present in the tissue. Our results provide a molecular mechanism for the etiology of familial osteochondritis dissecans and show the importance of the aggrecan C-type lectin interactions for cartilage function in vivo.

Stattin, Eva-Lena; Wiklund, Fredrik; Lindblom, Karin; Onnerfjord, Patrik; Jonsson, Bjorn-Anders; Tegner, Yelverton; Sasaki, Takako; Struglics, Andre; Lohmander, Stefan; Dahl, Niklas; Heinegard, Dick; Aspberg, Anders



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



Three-Dimensional Matrix-Induced Autologous Chondrocytes Implantation for Osteochondral Lesions of the Talus: Midterm Results  

PubMed Central

Introduction. We evaluate the midterm results of thirty patients who underwent autologous chondrocytes implantation for talus osteochondral lesions treatment. Materials and Methods. From 2002 to 2009, 30 ankles with a mean lesion size of 2,36?cm2 were treated. We evaluated patients using American Orthopaedic Foot and Ankle Surgery and Coughlin score, Van Dijk scale, recovering time, and Musculoskeletal Outcomes Data Evaluation and Management System. Results. The mean AOFAS score varied from 36.9 to 83.9 at follow-up. Average of Van Dijk scale was 141.1. Coughlin score was excellent/good in 24 patients. MOCART score varied from 6.3 to 3.8. Discussion. This matrix is easy to handle conformable to the lesion and apply by arthroscopy. No correlation between MRI imaging and clinical results is found. Conclusions. Our results, compared with those reported in literature with other surgical procedures, show no superiority evidence for our technique compared to the others regarding the size of the lesions.

Magnan, B.; Samaila, E.; Bondi, M.; Vecchini, E.; Micheloni, G. M.; Bartolozzi, P.



Cell-laden and cell-free biopolymer hydrogel for the treatment of osteochondral defects in a sheep model.  


The objective of the current study was to determine the suitability of cell-laden and cell-free alginate-gelatin biopolymer hydrogel for osteochondral restoration in a sheep model (n = 12). Four femoral defects per animal were filled with hydrogel (cHG) plus autologous chondrocytes (cHG + C) or periosteal cells (cHG + P) or gel only (cHG) or were left untreated (E). In situ solidification enabled instantaneous implant fixation. Sixteen weeks postoperatively, defect sites were processed for light microscopy and immunofluorescence. A modified Mankin and a semi-quantitative immunoreactivity score were used to evaluate histology and immunofluorescence, respectively. Defects after cHG + C were restored with smooth, hyaline-like neo-cartilage and trabecular subchondral bone. cHG + P and cHG treatments revealed slightly inferior regenerate morphology. Undifferentiated tissue was found in E. The histological score showed significant (p < 0.05) differences between all treatment groups. In conclusion, cHG induces satisfactory defect regeneration. Complete filling of the cavity in one step and subsequent rapid in situ solidification was feasible and facilitated graft fixation. Cell implantation might be beneficial, because cells seem to play a key role in histological outcome. Still, their contribution to the repair process remains unresolved because host cell influx takes place. The combination of alginate and gelatin, however, creates an environment capable of serving implanted and host cells for osteo-chondrogenic tissue regeneration. PMID:18783325

Schagemann, Jan C; Erggelet, Christoph; Chung, Hsi-Wei; Lahm, Andreas; Kurz, Haymo; Mrosek, Eike H



[Preliminary studies on repairing osteochondral defects in the rabbit knee joint by using porous PA66/n-HA combination mesenchymal stem cells].  


We have investigated the effects of repairing knee osteochondral defects in rabbit by using porous polyamide 66/nano-Hydroxyapatite (PA66/n-HA) combination bone marrow mesenchymal stem cells (MSCs). Eighteen 6-month-old New Zealand rabbits were used to produce the models of 4 mm x 4 mm osteochondral defect in the middle trochlea groove of femur. These models were randomly divided into 3 groups: PA66/n-HA + MSCs Group (Group A), PA66/n-HA group (Group B) and Operation control-group (Group C) in which operation for osteochondral defects was performed but neither material nor cells were implanted. The materials in Group A were seeded with MSCs (5 x 10(5)) in vitro before being implanted in to defects. The materials in groups A and B were 0.5 - 0.8 mm lower than normal cartilage. The animals were killed 1 and 4 months after operation. We assessed the effects by means of macroscopic observation, HE staining, toluidine blue staining, immunohistochemistry assay for type I and type II collagen. Group A displayed a little effect at the 1 month, but at the 4th month, Group A showed better results,compared to Groups B and C. At this time point, the repair tissue of Group A was regular; it presented more metachromatic substance visualized by toluidine blue staining, and it expressed type II collagen(+ +) and type I collagen(+). These results demonstrate that the repair tissue in Group A is nearly hyaline cartilage. So we presume that porous PA66/n-HA provides biomechanical support, and at the same time, MSCs enhance the repair effects. PMID:19166207

Wu, Jiaqi; Yang, Tianfu; Liu, Yang; Guo, Tao; Mu, Yuanhua; Li, Yubao



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.

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



An arthroscopic approach for the treatment of osteochondral focal defects with cell-free and cell-loaded PLGA scaffolds in sheep.  


Osteochondral injuries are common in humans and are relatively difficult to manage with current treatment options. The combination of novel biomaterials and expanded progenitor or stem cells provides a source of therapeutic and immunologically compatible medicines that can be used in regenerative medicine. However, such new medicinal products need to be tested in translational animal models using the intended route of administration in humans and the intended delivery device. In this study, we evaluated the feasibility of an arthroscopic approach for the implantation of biocompatible copolymeric poly-D,L-lactide-co-glycolide (PLGA) scaffolds in an ovine preclinical model of knee osteochondral defects. Moreover this procedure was further tested using ex vivo expanded autologous chondrocytes derived from cartilaginous tissue, which were loaded in PLGA scaffolds and their potential to generate hyaline cartilage was evaluated. All scaffolds were successfully implanted arthroscopically and the clinical evolution of the animals was followed by non invasive MRI techniques, similar to the standard in human clinical practice. No clinical complications occurred after the transplantation procedures in any of the animals. Interestingly, the macroscopic evaluation demonstrated significant improvement after treatment with scaffolds loaded with cells compared to untreated controls. PMID:23673652

Fonseca, C; Caminal, M; Peris, D; Barrachina, J; Fàbregas, P J; Garcia, F; Cairó, J J; Gòdia, F; Pla, A; Vives, J



Trapezoidal osteochondral autologous plug single-block graft for treating chondral lesions of the knee: clinical and functional medium-term results in an observational study  

PubMed Central

OBJECTIVE: To evaluate the clinical and functional results of autologous trapezoidal plug single-block grafts fixed with absorbable chondral darts in patients with osteochondral knee lesions of varying sizes. METHODS: Twenty-five patients underwent surgery from February 2000 to June 2008. Seventy-two percent of the patients were male, and the mean age was 29 years. RESULTS: The right side (56%) and the medial condyle (92%) were most affected. The lesions had an average area of 5.28 cm2, and the mean follow-up was 59 months. All of the variables other than instability showed significant improvements (p<0.05), as shown by the increase in the mean Lysholm score from 55 points preoperatively to 92 points (p<0.001) postoperatively. There was no loosening or collapse of the osteochondral graft. All of the patients had patellofemoral crepitation and pain for an average of six months. CONCLUSION: Autologous trapezoidal plug single-block grafts are a therapeutic option for defects of varying sizes and provide good clinical results and low morbidity at the donor site in the medium term.

Kawano, Cezar Teruyuki; dos Santos, Marcio Moura Rocha; de Oliveira, Marcus Guilherme; Ourivio, Tadeu Colens



The Normandy field study on juvenile osteochondral conditions: conclusions regarding the influence of genetics, environmental conditions and management, and the effect on performance.  


Juvenile osteochondral conditions (JOCC) have a major impact on the equine industry and include many musculoskeletal disorders of the young horse, of which osteochondrosis (OC) is the most prominent. The Breeding, Osteochondral Status and Athletic Career (BOSAC) project is the first large, comprehensive, longitudinal field study on the subject conducted in three breeds of performance horses (Thoroughbreds, Standardbred Trotters and Warmbloods) that were monitored in their natural environment where they were reared under common field conditions. The BOSAC study used a radiographic protocol designed for field use coupled to an internally validated severity scoring system, providing weighted radiographic findings as the primary outcome measure. The natural courses of various JOCC appear to differ, according to the joint and condition involved. Genetically, there were also large differences with moderate heritabilities in the tarsocrural and metacarpophalangeal/metatarsophalangeal joints and virtually no heritability for femoropatellar OC. There was a strong influence of exercise history (as an environmental condition) on the manifestation and natural course of JOCC. In the younger age class (<6months) lack of exercise or irregular exercise had a negative effect, as had exposure to excessive exercise. In the yearling category, (exercise-associated) intrinsic trauma seemed to be the most important negative factor. In terms of later function, the association of a poor radiographic score with poorer performance in racing Trotters could be demonstrated. PMID:23639367

van Weeren, P René; Denoix, Jean-Marie



Controlled release strategies for bone, cartilage, and osteochondral engineering--Part II: challenges on the evolution from single to multiple bioactive factor delivery.  


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; Gomes, Manuela E; Mano, João F; Reis, Rui L



Repair of osteochondral defects with rehydrated freeze-dried oligo[poly(ethylene glycol) fumarate] hydrogels seeded with bone marrow mesenchymal stem cells in a porcine model.  


Current surgical techniques for osteochondral injuries in young active patients are inadequate clinically. Novel strategies in tissue engineering are continuously explored in this area. Despite numerous animal studies that have shown encouraging results, very few large-scale clinical trials have been done to address this area of interest. To facilitate the eventual translation from rabbit to human subjects, we have performed a study using bone marrow-derived mesenchymal stem cell (BMSC)-oligo[poly(ethylene glycol) fumarate] (OPF) hydrogel scaffold in a porcine model. Our objective was to analyze the morphology of BMSCs seeded into rehydrated freeze-dried OPF hydrogel and in vivo gross morphological and histological outcome of defects implanted with the BMSCs-OPF scaffold in a porcine model. The analyses were based on magnified histologic sections for different types of cartilage repair tissues, the outcome of the subchondral bone, scaffold, and statistical assessment of neotissue-filling percentage, cartilage phenotype, and Wakitani scores. The morphology of the BMSCs seeded into the rehydrated freeze-dried OPF scaffold was observed 24?h after cell seeding, through the phase-contrast microscope. The three-dimensional and cross-sectional structure of the fabrication was analyzed through confocal microscopy and histological methods, respectively. The BMSCs remained viable and were condensed into many pellet-like cell masses with a diameter ranging from 28.5 to 298.4 (113.5±47.9) ?m in the OPF scaffold. In vivo osteochondral defect repair was tested in 12 defects created in six 8-month-old Prestige World Genetics micropigs. The implantation of scaffold alone was used for control. Gross morphological, histological, and statistical analyses were performed at 4 months postoperatively. The scaffold-MSC treatment led to 99% defect filling, with 84% hyaline-like cartilage at 4 months, which was significantly (p<0.0001) more than the 54% neotissue filling and 39% hyaline-like cartilage obtained in the scaffold-only group. The implantation of BMSCs in freeze-dried OPF hydrogel scaffold, which created a conducive environment for cell infiltration and clustering, could fully repair chondral defects with hyaline-like cartilage. This protocol provides a clinically feasible procedure for osteochondral defect treatment. PMID:23517496

Lim, Chin Tat; Ren, Xiafei; Afizah, Mohd Hassan; Tarigan-Panjaitan, Sari; Yang, Zheng; Wu, Yingnan; Chian, Kerm Sin; Mikos, Antonios G; Hui, James Hoi Po



Preparation of an osteochondral composite with mesenchymal stem cells as the single-cell source in a double-chamber bioreactor.  


A double-chamber bioreactor has been developed to generate a tissue-engineered osteochondral composite (TEOC). However, a TEOC generally requires two types of cells (i.e. chondrogenic and osteogenic cells). Therefore, the capacity of mesenchymal stem cells (MSCs) as a single-cell source to work within a double-chamber bioreactor and biphasic scaffolds for generating TEOC was investigated. Compared with static culture, the double-chamber bioreactor not only can promote faster cellular proliferation, indicated by the PicoGreen dsDNA assay, SEM and confocal imaging, but also can trigger efficient chondrogenic and osteogenic differentiation of MSCs in biphasic scaffolds simultaneously, evidenced by gene expression. Thus MSCs are promising as the ideal single-cell source and the double-chamber bioreactor is an advanced culture system to generate TEOC. PMID:23794047

Liu, Xing-Guo; Jiang, Hong-Kui



Controlled release strategies for bone, cartilage, and osteochondral engineering--Part I: recapitulation of native tissue healing and variables for the design of delivery systems.  


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; Gomes, Manuela E; Mano, João F; Reis, Rui L



Spatial Regulation of Human Mesenchymal Stem Cell Differentiation in Engineered Osteochondral Constructs: Effects of Pre-Differentiation, Soluble Factors and Medium Perfusion  

PubMed Central

Objective The objective of the study was to investigate the combined effects of three sets of regulatory factors: cell pre-differentiation, soluble factors and medium perfusion on spatial control of human mesenchymal stem cell (hMSC) differentiation into cells forming the cartilaginous and bone regions in engineered osteochondral constructs. Design Bone-marrow derived hMSCs were expanded in their undifferentiated state (UD) or pre-differentiated (PD) in monolayer culture, seeded into biphasic constructs by interfacing agarose gels and bone scaffolds and cultured for 5 weeks either statically (S) or in a bioreactor (BR) with perfusion of medium through the bone region. Each culture system was operated with medium containing either chondrogenic supplements (C) or a cocktail (Ck) of chondrogenic and osteogenic supplements. Results The formation of engineered cartilage in the gel region was most enhanced by using undifferentiated cells and chondrogenic medium, whereas the cartilaginous properties were negatively affected by using pre-differentiated cells or the combination of perfusion and cocktail medium. The formation of engineered bone in the porous scaffold region was most enhanced by using pre-differentiated cells, perfusion and cocktail medium. Perfusion also enhanced the integration of bone and cartilage regions. Conclusions Pre-differentiation of hMSCs before seeding on scaffold was beneficial for bone but not for cartilage formation. The combination of medium perfusion and cocktail medium inhibited chondrogenesis of hMSCs. Perfusion improved the cell and matrix distribution in the bone region and augmented theintegration at the bone-cartilage interface. Osteochondral grafts can be engineered by differentially regulating the culture conditions in the two regions of the scaffold seeded with hMSCs (hydrogel for cartilage, perfused porous scaffold for bone).

Grayson, Warren L; Bhumiratana, Sarindr; Chao, P. H. Grace; Hung, Clark T.; Vunjak-Novakovic, Gordana



Osteochondritis dissecans of the elbow: excellent mid-term follow-up results in teenage athletes treated by arthroscopic debridement and microfracture  

PubMed Central

Aim To extend the microfracture procedure, which has been proven successful on osteochondritis dissecans (OCD) lesions in the knee and ankle, to OCD lesions in the elbow. Methods Nine young patients were treated by arthroscopic debridement and microfracture by a single surgeon. The average age at operation was 15.0 years (median 15; range 12-19). The average length of the follow-up was 5.3 years (median 5; range 2-9). The follow-up included physical examination and patient interview with elbow function scoring. Success of treatment was determined according to pre-operative and follow-up Mayo Elbow Performance Index scores and the patients’ return to sports. Results Eight patients scored excellent results on the follow-up and 1 scored a good result. Four out of 9 patients were able to increase their training intensity, 2 returned to the same level of activity, 2 changed sports (due to reasons unrelated to the health of their elbow), and 1 left professional sports and started training only recreationally. No patients stopped participating in sports altogether. Conclusions We advocate arthroscopic microfracturing, followed by a strict rehabilitation regime, as a highly effective treatment for OCD of the humeral capitellum.

Bojanic, Ivan; Smoljanovic, Tomislav; Dokuzovic, Stjepan



Matrix generation within a macroporous non-degradable implant for osteochondral defects is not enhanced with partial enzymatic digestion of the surrounding tissue: evaluation in an in vivo rabbit model.  


Articular cartilage defects are a significant source of pain, have limited ability to heal, and can lead to the development of osteoarthritis. However, a surgical solution is not available. To tackle this clinical problem, non-degradable implants capable of carrying mechanical load immediately after implantation and for the duration of implantation, while integrating with the host tissue, may be viable option. But integration between articular cartilage and non-degradable implants is not well studied. Our objective was to assess the in vivo performance of a novel macroporous, nondegradable, polyvinyl alcohol construct. We hypothesized that matrix generation within the implant would be enhanced with partial digestion of the edges of articular cartilage. Our hypothesis was tested by randomizing an osteochondral defect created in the trochlea of 14 New Zealand white rabbits to treatment with: (i) collagenase or (ii) saline, prior to insertion of the implant. At 1 and 3-month post-operatively, the gross morphology and histologic appearance of the implants and the surrounding tissue were assessed. At 3 months, the mechanical properties of the implant were also quantified. Overall, the hydrogel implants performed favorably; at all time-points and in all groups the implants remained well fixed, did not cause inflammation or synovitis, and did not cause extensive damage to the opposing articular cartilage. Regardless of treatment with saline or collagenase, at 1 month post-operatively implants from both groups had a contiguous interface with adjacent cartilage and were populated with chondrocyte-like cells. At 3 months fibrous encapsulation of all implants was evident, there was no difference between area of aggrecan staining in the collagenase versus saline groups, and implant modulus was similar in both groups; leading us to reject our hypothesis. In summary, a porous PVA osteochondral implant remained well fixed in a short term in vivo osteochondral defect model; however, matrix generation within the implant was not enhanced with partial digestion of adjacent articular cartilage. PMID:23846837

Krych, Aaron J; Wanivenhaus, Florian; Ng, Kenneth W; Doty, Stephen; Warren, Russell F; Maher, Suzanne A



Bone cysts after osteochondral allograft repair of cartilage defects in goats suggest abnormal interaction between subchondral bone and overlying synovial joint tissues.  


The efficacy of osteochondral allografts (OCAs) 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 12months in vivo. The objectives of this study were to further analyze OCAs and contralateral non-operated (Non-Op) CONTROLS from the medial femoral condyle to (1) determine the effect of OCA storage on local subchondral bone (ScB) and trabecular bone (TB) 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 OCAs was altered compared to Non-Op, with OCA samples displaying bone cysts, ScB channels, and ScB roughening. ScB BV/TV in FROZEN OCAs was lower than Non-Op and other OCAs. TB BV/TV in FRESH, 4°C/14d, and 4°C/28d OCAs did not vary compared to Non-Op, but BS/TV was lower. (2) OCAs 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 OCAs 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



Anatomically shaped osteochondral constructs for articular cartilage repair  

Microsoft Academic Search

Few successful treatment modalities exist for surface-wide, full-thickness lesions of articular cartilage. Functional tissue engineering offers a great potential for the clinical management of such lesions. Our long-term hypothesis is that anatomically shaped tissue constructs of entire articular layers can be engineered in vitro on a bony substrate, for subsequent implantation. To determine the feasibility, this study investigated the development

Clark T. Hung; Eric G. Lima; Robert L. Mauck; Erica Taki; Michelle A. LeRoux; Helen H. Lu; Robert G. Stark; X. Edward Guo; Gerard A. Ateshian


Functional tissue engineering of chondral and osteochondral constructs  

Microsoft Academic Search

Due to the prevalence of osteoarthritis (OA) and damage to articular cartilage, coupled with the poor intrinsic healing capacity of this avascular connective tissue, there is a great demand for an articular cartilage substitute. As the bearing material of diarthrodial joints, articular cartilage has remarkable functional properties that have been difficult to reproduce in tissue- engineered constructs. We have previously

Eric G. Lima; Robert L. Mauck; Shelley H. Han; Kenneth W. Ng; Gerard A. Ateshian; Clark T. Hung



Wire-loop fixation of volar displaced osteochondral fractures of the distal radius.  


We describe the technique of wire-loop fixation to treat 4 young men with a unique variant of Melone's type 4 articular fracture of the volar lunate facet, characterized by a displaced rotated articular fragment supported by a limited amount of subchondral bone. This is an unusual injury that threatens the integrity of both the radiocarpal and distal radioulnar joints. It is the result of a compressive force to the wrist and may require trispiral computed tomography for delineation. Open reduction and internal fixation is recommended to maintain stability and articular congruity. The displaced volar-articular fragment, however, may be relatively small; therefore, direct manipulation could lead to soft tissue stripping and osteonecrosis. We have found the technique of wire-loop fixation to be a simple, reproducible, and effective alternative method of internal fixation for these difficult fractures. Malunion, nonunion, loss of fixation, tendon rupture, infection, arthrosis, or pain caused by hardware has not occurred. Use of this technique is not recommended in patients with osteoporotic bone. PMID:10357531

Chin, K R; Jupiter, J B



Mechano-regulation of stem cell differentiation and tissue regeneration in osteochondral defects  

Microsoft Academic Search

Cartilage defects that penetrate the subchondral bone can undergo spontaneous repair through the formation of a fibrous or cartilaginous tissue mediated primarily by mesenchymal stem cells from the bone marrow. This tissue is biomechanically inferior to normal articular cartilage, and is often observed to degrade over time. Whether or not biomechanical factors control the type and quality of the repair

D. J. Kelly; P. J. Prendergast



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



Detection of intra-articular osteochondral bodies in the knee using computed arthrotomography  

SciTech Connect

A new technique using air arthrography followed by computed tomography enables identification of free osteocartilaginous fragments in the knee joint. Clinical examples with useful diagnostic information are presented, and potential pitfalls in the interpretation of this information are discussed.

Sartoris, D.J.; Kursunoglu, S.; Pineda, C.; Kerr, R.; Pate, D.; Resnick, D.



632. Retrovirally Transduced Muscle-Derived Stem Cells Facilitate Repair of Osteochondral Defects  

Microsoft Academic Search

Due to their limited intrinsic ability for self-repair, articular cartilage defects caused by inflammation or articular fractures do not fully heal. Skeletal muscle represents a potential source of cells for use in cartilage tissue engineering applications. Subpopulation of muscle-derived stem cells isolated from mouse skeletal muscle (MDSCs), possess the ability of multipotent differentiation and have been found capable to enhance

Ryosuke Kuroda; Arvydas Usas; Hairong Peng; Masamitsu Sakamoto; Johnny Huard



Marrow stromal cells embedded in alginate for repair of osteochondral defects  

Microsoft Academic Search

Summary: Articular cartilage defects of sufficient size ultimately degenerate with time, leading to arthritic changes. Numerous strategies have been used to address full-thickness cartilage defects, yet none thus far has been successful in restoring the articular surface to its preinjury state. We compared the effects of agarose, alginate, and type I collagen gels on the expression of cartilage-specific markers from

David R. Diduch; Louis C. M. Jordan; Cay M. Mierisch; Gary Balian



Are bone bruises a possible cause of osteochondritis dissecans of the capitellum? a case report and review of the literature  

Microsoft Academic Search

A 17-year old soccer-player sustained a fracture and dislocation of the ulnar epicondyle combined with a bone bruises at the radial head and the capitellum. An open reduction and internal fixation was performed using two K-wires. Initial recovery was uneventful. After the operation he was discharged home and reviewed on a regular basis. When bony union had occurred the two

Krappel FA; Bauer E; Harland U



Expression of human bone morphogenic protein 7 in primary rabbit periosteal cells: potential utility in gene therapy for osteochondral repair  

Microsoft Academic Search

A commonly encountered problem in orthopedics is bone and cartilage tissue injury which heals incompletely or without full structural integrity. This necessitates development of improved methods for treatment of injuries which are not amenable to treatment using current therapies. An already large and growing number of growth factors which play significant roles in bone remodeling and repair have been identified

JM Mason; DA Grande; M Barcia; R Grant; RG Pergolizzi; AS Breitbart



Arthroscopically assisted reduction and internal fixation of a femoral anterior cruciate ligament osteochondral avulsion fracture in a 14-year-old girl via transphyseal inside-out technique.  


Femoral avulsion fracture of the anterior cruciate ligament (ACL) in children and adolescents is rare, and its arthroscopic treatment is even more so. A femoral avulsion fracture of the ACL of a 14-year-old girl was arthroscopically reduced and fixed by a Kirschner wire (K-wire) via an inside-out technique. A 1.4-mm K-wire was drilled inside-out into the osseous defect of the lateral femoral condyle under arthroscopic visualization. The avulsed fragment was reduced and then drilled retrograde by the wire. After bending the intra-articular visible end of the K-wire by a knot pusher, the fragment was gently fixed by pulling the wire from outside. At 24 months, both knee stability and range of motion were the same in the operated and the healthy opposite leg. Magnetic resonance imaging evaluation and conventional radiographs showed an intact ACL without detectable disturbance in the growth plate. Only seven cases of a proximal avulsion of the ACL in children and adolescents have been published. Six were treated by open reduction and internal fixation, one by arthroscopic reduction without fixation. PMID:24002803

Langenhan, Ronny; Baumann, Matthias; Hohendorff, Bernd; Probst, Axel; Trobisch, Per



Subchondral pre-solidified chitosan/blood implants elicit reproducible early osteochondral wound-repair responses including neutrophil and stromal cell chemotaxis, bone resorption and repair, enhanced repair tissue integration and delayed matrix deposition  

PubMed Central

Background 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 degrade in situ in a molecular mass-dependent manner, and attract more stromal cells to the site in aged rabbits compared to the blood clot in untreated controls. Methods Three microdrill hole defects, 1.4 mm diameter and 2 mm deep, were created in both knee trochlea of 30 month-old New Zealand White rabbits. Each of 3 isotonic chitosan solutions (150, 40, 10 kDa, 80% degree of deaceylation, with fluorescent chitosan tracer) was mixed with autologous rabbit whole blood, clotted with Tissue Factor to form cylindrical implants, and press-fit in drill holes in the left knee while contralateral holes received Tissue Factor or no treatment. At day 1 or day 21 post-operative, defects were analyzed by micro-computed tomography, histomorphometry and stereology for bone and soft tissue repair. Results All 3 implants filled the top of defects at day 1 and were partly degraded in situ at 21 days post-operative. All implants attracted neutrophils, osteoclasts and abundant bone marrow-derived stromal cells, stimulated bone resorption followed by new woven bone repair (bone remodeling) and promoted repair tissue-bone integration. 150 kDa chitosan implant was less degraded, and elicited more apoptotic neutrophils and bone resorption than 10 kDa chitosan implant. Drilled controls elicited a poorly integrated fibrous or fibrocartilaginous tissue. Conclusions Pre-solidified implants elicit stromal cells and vigorous bone plate remodeling through a phase involving neutrophil chemotaxis. Pre-solidified chitosan implants are tunable by molecular mass, and could be beneficial for augmented marrow stimulation therapy if the recruited stromal cells can progress to bone and cartilage repair.



Autoarthroplasty of knee cartilage defects by osteoperiosteal grafts  

Microsoft Academic Search

Five fresh osteochondral fractures of the knee, which could not be fixed because of extensive fragmentation, were treated by excision of the fragments and reconstruction of the joint surface defect by an autogenous osteoperiosteal graft. The procedure was also used for joint surface reconstruction in sclerotic osteochondritis of the femoral condyle (nine knees) and grave patellofemoral chondromalacia (three knees). Plaster

O. M. Kuokkanen; H. O. M. Kuokkanen



The influence of fibrin based hydrogels on the chondrogenic differentiation of human bone marrow stromal cells  

Microsoft Academic Search

Mesenchymal Stem Cells (MSC) are frequently incorporated into osteochondral implants and cell seeding is often facilitated with hydrogels which exert a profound influence on the chondrogenic differentiation of MSC. An attempt was made to elucidate this effect by comparing the chondrogenic differentiation of Bone Marrow Stromal Cells (BMSC) in fibrin and fibrin alginate composites. A biphasic osteochondral model which simulated

Saey T. B. Ho; Simon M. Cool; James H. Hui; Dietmar W. Hutmacher



Gold bead implants.  


Gold bead implantation is an experimental area of study in the acupuncture field dealing with chronic diseases. Special acupuncture techniques are required to implant the gold beads successfully in the proper location. Gold beads are used to treat degenerative joint disease, osteochondritis, osteochondritis dessicans, ventral spondylosis, and seizures. PMID:1581658

Durkes, T E



William D. Bugbee CV  

Center for Biologics Evaluation and Research (CBER)

Text Version... Methods for Fresh Human Osteochondral Allografts Used for Cartilage Repair Procedures. ... TNF-A on MMP-2 and –9 Activities in ACL/MCL Under ... More results from


Articular Cartilage Repair in the Knee Joint with Autologous Chondrocytes and Periosteal Graft  

Microsoft Academic Search

Objective Repair of articular cartilage defects of knee to restore a pain-free joint function. Indications Full-thickness chondral or osteochondral posttraumatic lesions and osteochondritis dissecans defects that have not been successfully repaired with methods such as debridement, drilling, and microfracturing. Contraindications Osteoarthritis. Rheumatoid arthritis. Surgical Technique During arthroscopy, the cartilage lesion is evaluated, and cartilage slices weighing 200-300 mg are harvested

Mats Brittberg



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


Articular Cartilage Repair Strategies in the Ankle Joint  

Microsoft Academic Search

Osteochondral lesions of the talus represent a significant source of disability to those affected. An understanding of the\\u000a common mechanisms of injury and a high index of suspicion leads to early diagnosis and treatment. Most osteochondral lesions\\u000a are a sequel of trauma; the exact etiology of others is unclear and may be multifactorial and related to microtrauma, genetic\\u000a predisposition, or

Monika Volesky; Timothy Charlton; Jonathan T. Deland


Ex vivo cartilage defect model for the evaluation of cartilage regeneration using mesenchymal stem cells.  


An ex vivo cartilage defect model for the evaluation of cartilage regeneration using mesenchymal stem cells (MSCs) was developed. Porcine chondrocytes and human MSCs were transplanted into cartilage defects created on the porcine osteochondral and chondral discs and cultivated for 3 weeks. Although the regeneration of cartilage-like tissues was observed after the transplantation of chondrocytes to defects on both of the osteochondral and chondral discs, the transplanted MSCs formed cartilage-like tissues only in the defect on the chondral disc, in which an in vivo cartilage-like structure was partly observed, and a degraded tissue was observed in the defect on the osteochondral disc. The effects of medium additives such as serum, transforming growth factor-?3 (TGF-?3), and fibroblast growth factor-2, and the transfection of TGF-?3 gene to MSCs could be clearly estimated using the cartilage defect model. In conclusion, a chondral disc with defects is useful for evaluating cartilage regeneration using MSCs. PMID:21126909

Iwai, Ryosuke; Fujiwara, Masashi; Wakitani, Shigeyuki; Takagi, Mutsumi



Epidemiology and imaging of the subchondral bone in articular cartilage repair.  


Articular cartilage and the subchondral bone act as a functional unit. Following trauma, osteochondritis dissecans, osteonecrosis or osteoarthritis, this intimate connection may become disrupted. Osteochondral defects-the type of defects that extend into the subchondral bone-account for about 5% of all articular cartilage lesions. They are very often caused by trauma, in about one-third of the cases by osteoarthritis and rarely by osteochondritis dissecans. Osteochondral defects are predominantly located on the medial femoral condyle and also on the patella. Frequently, they are associated with lesions of the menisci or the anterior cruciate ligament. Because of the close relationship between the articular cartilage and the subchondral bone, imaging of cartilage defects or cartilage repair should also focus on the subchondral bone. Magnetic resonance imaging is currently considered to be the key modality for the evaluation of cartilage and underlying subchondral bone. However, the choice of imaging technique also depends on the nature of the disease that caused the subchondral bone lesion. For example, radiography is still the golden standard for imaging features of osteoarthritis. Bone scintigraphy is one of the most valuable techniques for early diagnosis of spontaneous osteonecrosis about the knee. A CT scan is a useful technique to rule out a possible depression of the subchondral bone plate, whereas a CT arthrography is highly accurate to evaluate the stability of the osteochondral fragment in osteochondritis dissecans. Particularly for the problem of subchondral bone lesions, image evaluation methods need to be refined for adequate and reproducible analysis. This article highlights recent studies on the epidemiology and imaging of the subchondral bone, with an emphasis on magnetic resonance imaging. PMID:20148327

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



Arthroscopic-Assisted Lateral Ligamentous Reconstruction in Combined Ankle and Subtalar Instability  

Microsoft Academic Search

We describe an arthroscopic technique by which to reconstruct both the calcaneofibular ligament and anterior talofibular ligament anatomically. The ankle joint is examined through the anteromedial portal and a lateral portal close to the talar insertion of the anterior talofibular ligament. The subtalar joint is examined through the anterolateral portal and the middle portal. Associated intra-articular pathology (e.g., osteochondral defect)

Tun Hing Lui



Molecular characterization of spontaneous and growth-factor-augmented chondrogenesis in periosteum–bone tissue transferred into a joint  

Microsoft Academic Search

Multilineage potential of progenitor cells from periosteum is well established, but conditions for differentiation within their native niche are unclear. We evaluated at cellular and molecular levels whether chondrogenesis of periosteal progenitor cells is promoted spontaneously or by growth-factor mixture (GFM) application when transferring periosteum–bone cylinders into cartilage defects. Osteochondral defects in the patellar groove of minipigs were filled with

Martin Jung; Tobias Gotterbarm; Annette Gruettgen; Simona Berardi Vilei; Steffen Breusch; Wiltrud Richter



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



Conditions of the talus in the runner  

Microsoft Academic Search

The anatomy and biomechanics of the talus in its rela tionship with ankle and subtalar joints expose it to increased stresses and forces in the runner. Many injuries to the talus, such as stress fractures, antero lateral compression syndromes, osteochondral Stage I and II lesions, and posterior compartment fractures can be treated with consecutive methods initially. Surgical treatment is indicated

Mark J. Hontas; Ray J. Haddad; Lee C. Schlesinger



An arthroscopic device to assess articular cartilage defects and treatment with a hydrogel.  


The hydraulic resistance R across osteochondral tissue, especially articular cartilage, decreases with degeneration and erosion. Clinically useful measures to quantify and diagnose the extent of cartilage degeneration and efficacy of repair strategies, especially with regard to pressure maintenance, are still developing. The hypothesis of this study was that hydraulic resistance provides a quantitative measure of osteochondral tissue that could be used to evaluate the state of cartilage damage and repair. The aims were to (1) develop a device to measure R in an arthroscopic setting, (2) determine whether the device could detect differences in R for cartilage, an osteochondral defect, and cartilage treated using a hydrogel ex vivo, and (3) determine how quickly such differences could be discerned. The apparent hydraulic resistance of defect samples was ~35% less than intact cartilage controls, while the resistance of hydrogel-filled groups was not statistically different than controls, suggesting some restoration of fluid pressurization in the defect region by the hydrogel. Differences in hydraulic resistance between control and defect groups were apparent after 4 s. The results indicate that the measurement of R is feasible for rapid and quantitative functional assessment of the extent of osteochondral defects and repair. The arthroscopic compatibility of the device demonstrates the potential for this measurement to be made in a clinical setting. PMID:21107696

McCarty, William J; Luan, Anna; Sundaramurthy, Priya; Urbanczyk, Caryn; Patel, Atal; Hahr, Jacob; Sotoudeh, Mohammad; Ratcliffe, Anthony; Sah, Robert L



Ex vivo cartilage defect model for the evaluation of cartilage regeneration using mesenchymal stem cells  

Microsoft Academic Search

An ex vivo cartilage defect model for the evaluation of cartilage regeneration using mesenchymal stem cells (MSCs) was developed. Porcine chondrocytes and human MSCs were transplanted into cartilage defects created on the porcine osteochondral and chondral discs and cultivated for 3weeks. Although the regeneration of cartilage-like tissues was observed after the transplantation of chondrocytes to defects on both of the

Ryosuke Iwai; Masashi Fujiwara; Shigeyuki Wakitani; Mutsumi Takagi



Localisation and activity of cathepsins K and B in equine osteoclasts  

Microsoft Academic Search

Cathepsin K and cathepsin B were immunolocalised in equine osteoclasts (OC s) present in ex vivo cartilage\\/subchondral bone samples. Samples were obtained post mortem from the lateral trochlear ridge (LTR) of six horses and ponies aged between 303 days gestation to 8 months. Strong expression of cathepsin K was detected in OC s, particularly those located at the osteochondral junction,

A. W. Gray; M. E. Davies; L. B. Jeffcott



Regenerating Articular Tissue by Converging Technologies  

Microsoft Academic Search

Scaffolds for osteochondral tissue engineering should provide mechanical stability, while offering specific signals for chondral and bone regeneration with a completely interconnected porous network for cell migration, attachment, and proliferation. Composites of polymers and ceramics are often considered to satisfy these requirements. As such methods largely rely on interfacial bonding between the ceramic and polymer phase, they may often compromise

Lorenzo Moroni; Doreen Hamann; Luca Paoluzzi; Jeroen Pieper; Joost R. de Wijn; Clemens A. van Blitterswijk; Stuart Humphries



Adolescent acute patellardislocation  

Microsoft Academic Search

Acute patellar dislocation is a traumatic and memorable event. The normal patellofemoral joint is controlled by a delicate balance of static and dynamic forces and structural congruity for effective function. Imbalance of the forces or congruity results in dislocation. Current work on osteochondral and chondral lesions that are radiographically silent and found at arthroscopy add new information about the frequency

Jeffrey M. Conrad; Carl L. Stanitski



Segmental bone repair by tissue-engineered periosteal cell transplants with bioresorbable fleece and fibrin scaffolds in rabbits  

Microsoft Academic Search

The biological bone healing depends on the presence of osteochondral progenitors and their ability for proliferation. Isolated periosteal cells were seeded into biodegradable PGLA polymer fleece or fibrin beads and cultivated for 14 days after prior monolayer culture. On 12 New Zealand white rabbits 8mm metadiaphyseal ulna defects were created bilaterally and subsequently filled with cell–fibrin beads, with polymers seeded

Carsten Perka; Olaf Schultz; Ron-Sascha Spitzer; Klaus Lindenhayn; Gerd-R Burmester; Michael Sittinger



Treatment of articular defects with meniscal allografts in a rabbit knee model  

Microsoft Academic Search

Deep-frozen allogeneic meniscal grafts for the treatment of articular cartilage defects were performed experimentally. Osteochondral defects 3 mm in diameter were created bilaterally on the medial femoral condyles of 50 Japanese white rabbits. A meniscus was then grafted into the defect in the left knee, and the right knee was left untreated. At various periods from 2 to 24 weeks

Yoshio Sumen; Mitsuo Ochi; Yoshikazu Ikuta



Ferritin concentrations in synovial fluid are higher in osteoarthritis patients with HFE gene mutations (C282Y or H63D)  

Microsoft Academic Search

Objectives: In view of the clinical similarities between polyarticular osteoarthritis (POA) with metacarpophalangeal (MCP) joint involvement and the arthropathy that occurs in hereditary haemochromatosis (HH), it was hypothesized that osteochondral damage in both disorders may be due to localized iron overload. Accordingly, it was predicted that the concentration of ferritin in synovial fluid (SF) would be higher in OA patients

Graeme J Carroll; G Sharma; A Upadhyay; J A Jazayeri



Arthroscopic findings in the overhand throwing athlete: Evidence for posterior internal impingement of the rotator cuff  

Microsoft Academic Search

The purpose of this article is to describe the outcome of an arthroscopic examination and the pathology in symptomatic shoulders of 41 professional overhand throwing athletes. With the arm in the position of the relocation test, 100% of the subjects had either contact between the rotator cuff undersurface and the posterosuperior glenoid rim or osteochondral lesions. Other key findings included

Kevin J. Paley; Frank W. Jobe; Marilyn M. Pink; Ronald S. Kvitne; Neal S. ElAttrache



Variation of cell and matrix morphologies in articular cartilage among locations in the adult human knee  

Microsoft Academic Search

Summary Objective: Understanding of articular cartilage physiology, remodelling mechanisms, and evaluation of tissue engineering repair methods requires reference information regarding normal structural organization. Our goals were to examine the variation of cartilage cell and matrix morphology in different topographical areas of the adult human knee joint. Methods: Osteochondral explants were acquired from seven distinct anatomical locations of the knee joints

Thomas M. Quinn; Ernst B. Hunziker; Hans-Jörg Häuselmann



MR imaging in congenital lower limb deformities  

Microsoft Academic Search

Treatment for children with congenital deformities of the lower extremities may vary, depending on the state of the unossified skeletal structures and surrounding soft tissues. The purpose of our study was to demonstrate the spectrum of the osteochondral and extrasosseous abnormalities as depicted with MR imaging. We retrospectively reviewed MR examinations of 13 limbs of ten children (aged 1 month-9

T. Laor; D. Jaramillo; F. A. Hoffer; J. R. Kasser



An overview of MR arthrography with emphasis on the current technique and applicational hints and tips  

Microsoft Academic Search

Magnetic resonance (MR) arthrography has been investigated in every major peripheral joint of the body, and has been proven to be effective in determining the integrity of intraarticular ligamentous and fibrocartilaginous structures and in the detection or assessment of osteochondral lesions and loose bodies in selected cases. Several methods could be used to create arthrogram effect during MR imaging, however,

Gülden ?ahin; Mehmet Demirta?



Tissue engineering of biphasic cartilage constructs using various biodegradable scaffolds: an in vitro study  

Microsoft Academic Search

Biological restoration of osteochondral defects requires suitable subchondral support material that also allows the induction of hyaline cartilage tissue. Biphasic implants consisting of pre-fabricated neocartilage and an underlying biodegradable osteoconductive base may meet these requirements. Here we explore various candidate biodegradable support materials onto which neo-cartilage was produced in vitro. Porcine chondrocytes were seeded in a closed and static bioreactor

Xuanhui Wang; Shawn P. Grogan; Franz Rieser; Verena Winkelmann; Véronique Maquet; Martine La Berge; Pierre Mainil-Varlet



Management of patellar instability in children  

Microsoft Academic Search

Patellar instability in children can be categorized into acute dislocations and recurrent patellofemoral instability. A careful history, examination, and the judicious use of diagnostic imaging are required to exclude other conditions of the knee. Patellar dislocations are treated primarily with brief immobilization followed by physical therapy. Surgery is usually necessary only in cases of associated osteochondral fracture. Most loose fragments

Raymund Woo; Michael T. Busch



Simulation of tissue differentiation in a scaffold as a function of porosity, Young's modulus and dissolution rate: Application of mechanobiological models in tissue engineering  

Microsoft Academic Search

Numerous experimental studies have attempted to determine the optimal properties for a scaffold for use in bone tissue engineering but, as yet, no computational or theoretical approach has been developed that suggests how best to combine the various design parameters, e.g. scaffold porosity, Young's modulus, and dissolution rate. Previous research has shown that bone regeneration during fracture healing and osteochondral

Damien P. Byrne; Damien Lacroix; Josep A. Planell; Daniel J. Kelly; Patrick J. Prendergast



In vitro model of full-thickness cartilage defect healing.  


Integration of the host-graft interface is implicated as one of the significant reasons for lack of complete healing in osteochondral grafting procedures for the treatment of cartilage lesions. We developed an in vitro model of cartilage healing in an osteochondral setting to study the effect of developmental age and collagenase treatment. Circular full-thickness vertical surgical incisions were made in the cartilaginous portion of cylindrical bovine osteochondral specimens. Two age groups were selected: Young (1-2 months old) and Older (6-8 months old). Cartilage integration across the surgical incisions was assessed by histologic analysis and by mechanical push-out testing at 2 and 4 weeks in culture. Histologic integration as well as peak push-out shear stress was significantly higher in older calf cartilage than in the young calf. Collagenase pretreatment in the older calf samples increased push-out strength at 4 weeks. Histologic integration correlated well with the mechanical push-out strength. Developmental age and time after injury affected the response to collagenase pretreatment. This osteochondral cartilage integration model can be useful to study factors that modulate healing of surgical replacement procedures in vitro, which may aid the development of newer approaches to promote the healing of cartilage defects. PMID:17549725

Tam, Hok Kei; Srivastava, Ajay; Colwell, Clifford W; D'Lima, Darryl D



Effects of Wnt Signaling on Proliferation and Differentiation of Human Mesenchymal Stem Cells  

Microsoft Academic Search

Mesenchymal stem cells are pluripotent cells from bone marrow, which can be differentiated into the osteogenic, chondrogenic, and adipogenic lineages in vitro and are a source of cells in bone and cartilage tissue engineering. An improvement in current tissue-engineering protocols requires more detailed insight into the molecular cues that regulate the distinct steps of osteochondral differentiation. Because Wnt signaling has

Boer de Jan; Hong Jun Wang; Blitterswijk van Clemens



Surgical restoration/repair of articular cartilage injuries in athletes.  


Articular cartilage injuries of the knee are an increasingly common source of pain and dysfunction, particularly in the athletic population. In the athlete, untreated articular cartilage defects can represent a career threatening injury and create a significant obstacle in returning to full athletic participation. The markedly limited healing potential of articular cartilage often leads to continued deterioration and progressive functional limitations. Numerous studies have shown that full thickness articular cartilage lesions are frequently encountered at the time of arthroscopy, particularly associated with athletic injury. A variety of surgical treatment options exist, including debridement, microfracture, osteochondral autograft, osteochondral allograft, and autologous chondrocyte implantation. Each technique has advantages and limitations for restoring articular cartilage function, and emerging technology continues to improve the results of treatment. Our article provides an evidence-based review on the etiology and prevalence of articular cartilage injuries in athletes, along with the principles and techniques available for restoring articular cartilage function following injury. PMID:23703520

Kane, Patrick; Frederick, Robert; Tucker, Bradford; Dodson, Christopher C; Anderson, John A; Ciccotti, Michael G; Freedman, Kevin B



Interaction of cartilage and ceramic matrix.  


As subchondral bone is often affected during cartilage injuries, the aim of research is to generate osteochondral implants in vitro using tissue engineering techniques. These constructs consist of a cartilage layer grown on top of a bone phase. In clinical applications, phosphate ceramics have gained acceptance as bone substitute materials because of their great affinity to natural bone. Furthermore, the interaction between cartilage and the underlying bone equivalent is essential for the development and success of osteochondral implants. Here, the influence of a carrier containing hydroxyapatite on the quality of cartilage constructs generated in vitro is investigated. Attempts are made to explain the effects described, by considering chemical and physical properties of the biomaterial. PMID:22160177

Wiegandt, K; Goepfert, C; Pörtner, R; Janssen, R



Success Rates and Immunologic Responses of Autogenic, Allogenic, and Xenogenic Treatments to Repair Articular Cartilage Defects  

PubMed Central

This review examines current approaches available for articular cartilage repair, not only in terms of their regeneration potential, but also as a function of immunologic response. Autogenic repair techniques, including osteochondral plug transplantation, chondrocyte implantation, and microfracture, are the most widely accepted clinical treatment options due to the lack of immunogenic reactions, but only moderate graft success rates have been reported. Although suspended allogenic chondrocytes are shown to evoke an immune response upon implantation, allogenic osteochondral plugs and tissue-engineered grafts using allogenic chondrocytes exhibit a tolerable immunogenic response. Additionally, these repair techniques produce neotissue with success rates approaching those of currently available autogenic repair techniques, while simultaneously obviating their major hindrance of donor tissue scarcity. To date, limited research has been performed with xenogenic tissue, although several studies demonstrate the potential for its long-term success. This article focuses on the various treatment options for cartilage repair and their associated success rates and immunologic responses.

Revell, Christopher M.



Imaging pediatric sports injuries: lower extremity.  


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



[Differential diagnosis of secondary chondrosarcoma of the bones].  


A procedure based on multifactorial evaluation of the most important clinical and X-ray signs was suggested to differentiate between secondary bone chondrosarcoma and such benign lesions as chondroma and osteochondrous exostosis. The analysis included 100 patients with secondary bone chondrosarcoma and 36 of those with benign lesions. The study used complex parameters derived from two, three or four simple ones. The method described assured a 95% credibility of differential diagnosis. PMID:2305571

Petrovichev, N N; Karata, D I; Glazkova, T G; Spiridonova, T A; Khmelev, O N; Zatsepin, S T; Lipkin, S I



Effects of Dexamethasone on the Functional Properties of Cartilage Explants During Long-Term Culture  

PubMed Central

Background Intact articular cartilage tissue is used clinically in the form of osteochondral allografts and experimentally as explants in modeling the physiologic behavior of chondrocytes in their native extracellular matrix. Long-term maintenance of allograft tissue is challenging. Hypothesis By carefully modulating the preservation environment, it may be possible to preserve osteochondral allograft tissue over the long term while maintaining its original mechanical and biochemical properties. Study Design Controlled laboratory study. Methods In this study, juvenile bovine, mature bovine, and canine cartilage explants were cultured in chemically defined media with or without supplementation of dexamethasone for up to 4 weeks. Results The mechanical properties and biochemical content of juvenile bovine explants cultured in the presence of dexamethasone were significantly enhanced after 2 weeks in culture and remained stable with sustained cell viability thereafter. In contrast, the mechanical properties and biochemical content of juvenile bovine explants cultured in the absence of the dexamethasone significantly decreased after 2 weeks of culture. The mechanical and biochemical content of mature bovine and canine explants were not significantly affected by the presence of dexamethasone and maintained initial (day 0) mechanical and biochemical properties throughout the entire culture period with or without supplementation of dexamethasone. Conclusion These results suggest that juvenile and mature cartilage explants respond differently to dexamethasone. The functional properties of juvenile cartilage explants can be maintained in vitro through the addition of dexamethasone to culture media. Functional properties of mature cartilage can be preserved for at least 4 weeks in culture regardless of the presence of dexamethasone. Clinical Relevance Biochemical and biomechanical properties of osteochondral allograft tissue may be enhanced by the addition of dexamethasone to culture media. These findings may translate to longer shelf life of preserved osteochondral allograft transplantation tissue and increased clinical availability of grafts.

Bian, Liming; Stoker, Aaron M.; Marberry, Kevin M.; Ateshian, Gerard A.; Cook, James L.; Hung, Clark T.



The Influence of Screw Positions of Bone Fixation Screws on a TMJ Implant  

Microsoft Academic Search

\\u000a There are several diseases that can affect the human temporomandibular joint (TMJ), among which we highlight cancer, trauma\\u000a or fracture, congenital malformation and osteochondritis.\\u000a \\u000a \\u000a TMJ reconstruction was developed to improve mandibular function, reduce disability. Total replacement of the TMJ involves\\u000a the removal of the “non functional” joint and placing an artificial one. Materials and geometry play an important key role

A. Ramos; M. Mesnard; C. Relvas; A. Completo; P. Talaia; J. A. Simões


Arthroplasty of the lunate using bone marrow mesenchymal stromal cells  

Microsoft Academic Search

Mesenchymal stromal cells have the potential to differentiate into a variety of mesenchymal tissues such as bone, cartilage\\u000a and ligaments. The potential for the regeneration of bone with cartilage coverage has still not been achieved. We evaluated\\u000a the ability of bone marrow mesenchymal stromal cells to regenerate osteochondral defects in the cavity of the lunate in an\\u000a animal model. Autologous

Arne Berner; Carola Pfaller; Thomas Dienstknecht; Johannes Zellner; Michael Müller; Lukas Prantl; Richard Kujat; Carsten Englert; Bernd Fuechtmeier; Michael Nerlich; Peter Angele



Periosteum stimulates subchondral bone densification in autologous chondrocyte transplantation in a sheep model  

Microsoft Academic Search

In this sheep study, we have tested the hypothesis that an osteogenic response is triggered in the subchondral bone by periosteum implanted in full thickness cartilage defects and can be prevented by replacing the periosteum by a cell-free collagen type I\\/III membrane. Two 7-mm diameter osteochondral defects were made in the trochlea groove and in the medial femoral condyle of

Martin Russlies; Peter Behrens; Eva-Maria Ehlers; Christin Bröhl; Christina Vindigni; Myron Spector; Bodo Kurz



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




Assessing infection risk in implanted tissue-engineered devices  

Microsoft Academic Search

Peri-operative contamination is the major cause of biomaterial-associated infections, highly complicating surgical patient outcomes. While this risk in traditional implanted biomaterials is well-recognised, newer cell-seeded, biologically conducive tissue-engineered (TE) constructs now targeted for human use have not been assessed for this possibility. We investigated infection incidence of implanted, degradable polyester TE scaffold biomaterials in rabbit knee osteochondral defects. Sterile, polyester

Roel Kuijer; Edwin J. P. Jansen; Pieter J. Emans; Sjoerd K. Bulstra; Jens Riesle; Jeroen Pieper; David W. Grainger; Henk J. Busscher



[Pit falls in the emergency walk-in clinic: lower limb (2)].  


The lower limb is the seat of many traumatic lesions especially the foot and ankle. To misdiagnose these injuries leads to pain, instability, early arthritis and poor results. Clinical examination is very important and also standard X rays. New imaging techniques such as MRI will help to delineate some difficult to see lesions such as Lisfranc's fracture-dislocations, osteochondral lesions or occult hip fractures. PMID:22097450

Abrassart, Sophie; Hoffmeyer, Pierre



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



Acute hemarthrosis of the knee: indications for diagnostic arthroscopy.  


The objective of this study was to define the role of early diagnostic knee arthroscopy for patients with an acute knee injury and hemarthrosis. Forty-five patients with an acute knee injury followed by a posttraumatic hemarthrosis during a 1-year period were prospectively reviewed. All patients were evaluated preoperatively followed by examination under anesthesia and arthroscopy of the knee. The majority of patients, 32 (71%), had an anterior cruciate ligament tear. Meniscal tears occurred in 21 patients (47%). Meniscal tears requiring surgery occurred in only 10 of 25 meniscal tears (40%). Seven patients (16%) had medial collateral ligament and/or posteromedial capsular sprain. Eight patients (18%) had an osteochondral fracture or patellar dislocation associated with an osteochondral fracture. The majority of knees with a torn meniscus or osteochondral fracture had an anterior cruciate ligament tear. Clinically, 18 of 21 knees (86%) with an acute complete anterior cruciate ligament tear were diagnosed preoperatively with the Lachman test. The Lachman test conducted with patients under anesthesia was positive for 19 of 21 knees (90%) with an acute complete anterior cruciate ligament tear. The preoperative examination correctly identified six of seven knees (86%) with a medial collateral ligament sprain. The preoperative Lachman test was positive in only two of five knees (40%) with a partial anterior cruciate ligament tear. The Lachman test with patients under anesthesia was positive for four of five knees (80%) with an acute partial anterior cruciate ligament tear. Preoperative examination yielded the correct diagnosis in only 9 of 21 knees (43%) with a meniscal tear and 1 of 6 knees (17%) with an osteochondral fracture.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2206185

Bomberg, B C; McGinty, J B



Bone and Joint Infections in Children  

Microsoft Academic Search

\\u000a Bones and joints are important sites of bacterial infection in infancy and childhood, with clinical presentations that are\\u000a variable and sometimes non-specific. Major clinical entities seen in children include classical hematogenous long-bone osteomyelitis,\\u000a septic arthritis (both acute and chronic), discitis, and osteochondritis complicating puncture wounds to the foot. Early diagnosis\\u000a and therapy of musculoskeletal infections are critical to the prevention

Sophie Hambleton; Anthony R. Berendt


The knee: Surface-coil MR imaging at 1. 5 T  

Microsoft Academic Search

Seven normal knees (in five volunteers) and seven injured knees (in seven patients) were examined by high-resolution magnetic resonance (MR) imaging at 1.5 T with a surface coil. Seven medial meniscal tears, three anterior cruciate ligament tears, one posterior cruciate ligament avulsion, an old osteochondral fracture, femoral condylar chondro-malacia, and one case of semimembranous tendon reinsertion were identified. MR images

J. Beltran; A. M. Noto; J. C. Mosure; K. L. Weiss; W. Zuelzer; A. J. Christoforidis



Intra-articular Plica Causing Ankle Impingement in a Young Handball Player: A Case Report.  


Ankle sprains are common injuries that respond well to rehabilitation. In the case of persisting symptoms, the differential diagnosis should include osteochondral defects, tendon injury, mechanical instability, and ankle impingement. In the present case report, we describe a 16-year-old male handball player who presented with persisting pain and locking in the right ankle 3 years after having sustained multiple minor inversion trauma. The clinical examination and conventional radiography showed no abnormalities. On magnetic resonance imaging, a flake fracture at the anteromedial talar dome and/or loose body was assumed. Arthroscopic examination revealed an intra-articular plica originating from an osteochondral fossa at the anteromedial tibial plafond. The plica was debrided. Retrospectively, the arthroscopic findings matched the radiographs and magnetic resonance images. The postoperative protocol consisted of early mobilization. At 6 weeks of follow-up, the patient had no pain and had returned to his sports activities. The present case report illustrates, to the best of our knowledge, the first case of ankle impingement due to a, most likely congenital, intra-articular plica arising from an osteochondral fossa at the anteromedial tibial plafond. This rare clinical condition can be diagnosed with magnetic resonance imaging. Arthroscopic debridement will effectively relieve the symptoms. PMID:24160722

Somorjai, Nicolaas; Jong, Bob; Draijer, W F


Trends in biological joint resurfacing  

PubMed Central

The treatment of osteochondral lesions and osteoarthritis remains an ongoing clinical challenge in orthopaedics. This review examines the current research in the fields of cartilage regeneration, osteochondral defect treatment, and biological joint resurfacing, and reports on the results of clinical and pre-clinical studies. We also report on novel treatment strategies and discuss their potential promise or pitfalls. Current focus involves the use of a scaffold providing mechanical support with the addition of chondrocytes or mesenchymal stem cells (MSCs), or the use of cell homing to differentiate the organism’s own endogenous cell sources into cartilage. This method is usually performed with scaffolds that have been coated with a chemotactic agent or with structures that support the sustained release of growth factors or other chondroinductive agents. We also discuss unique methods and designs for cell homing and scaffold production, and improvements in biological joint resurfacing. There have been a number of exciting new studies and techniques developed that aim to repair or restore osteochondral lesions and to treat larger defects or the entire articular surface. The concept of a biological total joint replacement appears to have much potential. Cite this article: Bone Joint Res 2013;2:193–9.

Myers, K. R.; Sgaglione, N. A.; Grande, D. A.



Autoarthroplasty of knee cartilage defects by osteoperiosteal grafts.  


Five fresh osteochondral fractures of the knee, which could not be fixed because of extensive fragmentation, were treated by excision of the fragments and reconstruction of the joint surface defect by an autogenous osteoperiosteal graft. The procedure was also used for joint surface reconstruction in sclerotic osteochondritis of the femoral condyle (nine knees) and grave patellofemoral chondromalacia (three knees). Plaster cast immobilization for 3 weeks was used in the two early cases. In all other cases, we employed a passive motion apparatus for 2 days postoperatively, followed by active mobilization in a knee brace with extension-flexion 30 to 90 degrees (femoral condyle reconstruction) or 0 to 45 degrees (patellar reconstruction). Gradual free movements were started 3 weeks postoperatively. The results after 1.5 to 6.5 years were satisfactory in all but one case. One arthroscopic removal of the loose graft was performed, as were two arthroscopic graft margin shavings. Three other reoperations were unrelated to the osteoperiosteal reconstruction. It appears that periosteal reconstruction should be considered in local osteochondral lesions, where excision of the injured cartilage is mandatory. The results were best in fresh trauma cases and younger people. PMID:7577214

Korkala, O L; Kuokkanen, H O



[Partial autologous reconstruction of the thumb carpometacarpal joint for posttraumatic arthrosis].  


We report about a successful reconstruction of the first carpometacarpal joint (CMC-joint) of the right hand in a 23 years old man with a posttraumatic defect using the OATS-technique (Osteochondral Autologous Transfer System). 2 autologous osteochondral cylinders with matching surfaces were harvested from the knee joint and implanted in osteoarthritic areas of the CMC-1 joint surface in press fit technique. After primary healing clinical and radiological controls were assessed 6 and 12 weeks postoperatively. At clinical follow-up 1 year after the function of the CMC-1 joint was completely free, function nearly fully restored. The osteochondral grafts revealed a sound healing in an additional MRI-investigation. 3 years after the operation, the DASH-score of the patient was measured with 4.2 points. With view to the encouraging results of the OATS technique in other joints it should be taken into consideration in cases of osteoarthritic CMC-1 joint respecting indicatory limitations. PMID:23519714

Kollig, E; Hentsch, S; Johann, M; Franke, A



Surgical treatment of thumb carpometacarpal joint arthritis: a single institution experience from 1995-2005.  


There are numerous techniques for the surgical management of thumb carpometacarpal (CMC) joint arthritis. The four senior authors of this study employ three such techniques: trapeziectomy with hematoma distraction arthroplasty, hemitrapeziectomy with osteochondral allograft, and ligament reconstruction tendon interposition (LRTI). This study examines the three commonly utilized procedures at a single institution. This study examines the 10-year experience from 1995-2005 with a minimum 3-month follow-up. Disabilities of the arm, shoulder, and hand (DASH) scores, pre-and postoperative pinch strength, and operative time were examined. After approval from the institutional review board of our institution was obtained, all patients treated surgically by three of the senior authors were contacted via mail and phone. Each patient was asked to complete and return a DASH questionnaire. Of the 115 patients treated during that period, 60 participated in this study. Each patient's final postoperative pinch measurement was obtained from occupational therapy and clinic records. This pinch strength was compared to the preoperative pinch and contralateral pinch strength. Lastly, the total operative time for each procedure was obtained from the operative record. The only significant finding in this study was a shorter mean operative time with the trapeziectomy group (76.90 min) and osteochondral allograft group (90.45 min) when compared to the LRTI group (139.00 min; p = 0.001 and p = 0.001, respectively). We found no significant difference between groups in terms of DASH score and pinch strength. There was no difference between the techniques in terms of postoperative pinch strength and patient satisfaction measured by DASH scores. The operative times for trapeziectomy and hematoma interposition as well as the osteochondral allograft were significantly shorter than that of the LRTI. This presents further evidence that potentially, "less is more" in the treatment of thumb CMC arthritis. We used a retrospective study design to evaluate potential differences between the three surgical techniques described above, therapeutic, levels III-IV. PMID:18780018

Park, Min J; Lichtman, Greg; Christian, Jennifer B; Weintraub, Jennifer; Chang, James; Hentz, Vincent R; Ladd, Amy L; Yao, Jeffrey



Surgical Treatment of Thumb Carpometacarpal Joint Arthritis: A Single Institution Experience from 1995-2005  

PubMed Central

There are numerous techniques for the surgical management of thumb carpometacarpal (CMC) joint arthritis. The four senior authors of this study employ three such techniques: trapeziectomy with hematoma distraction arthroplasty, hemitrapeziectomy with osteochondral allograft, and ligament reconstruction tendon interposition (LRTI). This study examines the three commonly utilized procedures at a single institution. This study examines the 10-year experience from 1995–2005 with a minimum 3-month follow-up. Disabilities of the arm, shoulder, and hand (DASH) scores, pre-and postoperative pinch strength, and operative time were examined. After approval from the institutional review board of our institution was obtained, all patients treated surgically by three of the senior authors were contacted via mail and phone. Each patient was asked to complete and return a DASH questionnaire. Of the 115 patients treated during that period, 60 participated in this study. Each patient’s final postoperative pinch measurement was obtained from occupational therapy and clinic records. This pinch strength was compared to the preoperative pinch and contralateral pinch strength. Lastly, the total operative time for each procedure was obtained from the operative record. The only significant finding in this study was a shorter mean operative time with the trapeziectomy group (76.90 min) and osteochondral allograft group (90.45 min) when compared to the LRTI group (139.00 min; p?=?0.001 and p?=?0.001, respectively). We found no significant difference between groups in terms of DASH score and pinch strength. There was no difference between the techniques in terms of postoperative pinch strength and patient satisfaction measured by DASH scores. The operative times for trapeziectomy and hematoma interposition as well as the osteochondral allograft were significantly shorter than that of the LRTI. This presents further evidence that potentially, “less is more” in the treatment of thumb CMC arthritis. We used a retrospective study design to evaluate potential differences between the three surgical techniques described above, therapeutic, levels III–IV.

Lichtman, Greg; Christian, Jennifer B.; Weintraub, Jennifer; Chang, James; Hentz, Vincent R.; Ladd, Amy L.; Yao, Jeffrey



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.

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



Future treatment of osteoarthritis.  


Osteoarthritis represents an advanced stage of disease progression caused in part by injury, loss of cartilage structure and function, and an imbalance in inflammatory and noninflammatory pathways. The burden of this disease will increase in direct proportion to the increase in the older adult population. Research on current and experimental treatment protocols are reviewed, including the effect of hyaluronic acid in both in vitro and in vivo studies, autologous chondrocyte and osteochondral plug implantation, and gene therapy. Disease-modifying osteoarthritis drugs and in vivo studies of glucosamine and chondroitin sulfate are reviewed. PMID:15747611

Baker, Champ L; Ferguson, Cristin M



MR imaging of the elbow in the injured athlete.  


This article summarizes key MR imaging findings in common athletic elbow injuries including little leaguer's elbow, Panner disease, osteochondritis dissecans, olecranon stress fracture, occult fracture, degenerative osteophyte formation, flexor-pronator strain, ulnar collateral ligament tear, lateral ulnar collateral ligament and radial collateral ligament tear, lateral epicondylitis, medial epicondylitis, biceps tear, bicipitoradial bursitis, triceps tear, olecranon bursitis, ulnar neuropathy, posterior interosseous nerve syndrome, and radial tunnel syndrome. The article also summarizes important technical considerations in elbow MR imaging that enhance image quality and contribute to the radiologist's success. PMID:23472586

Wenzke, Daniel R



Absorbable pin: a new method of fixation for digital arthrodesis.  


A new method of fixation of digital arthrodesis is being used at Atlanta Hospital. A total of 58 digits have been arthrodesed at the proximal interphalangeal joint using absorbable pin fixation. The technique of absorbable pin insertion, as well as the advantages and disadvantages, are discussed in this article. Infection, foreign body reaction, vascular compromise, or excessive swelling and edema were not evident in any of the 58 digits reviewed. The internal absorbable pin fixation is considered a viable alternative to previous forms of fixation for digital arthrodesis. The absorbable pin previously has been used for osteochondral fractures of the knee. PMID:2338471

Patton, G W; Shaffer, M W; Kostakos, D P


The chondrogenic potential of carbon fiber and carbon fiber periosteum implants: an ultrastructural study in the rabbit.  


The articular tissue generated on carbon fiber rods in rabbit knee joints after 75 days of intermittent active motion was compared with tissue generated on carbon fiber rods whose articular surfaces were covered with a free reversed periosteal graft. Both methods were effective in generating articular tissue; however, tissue with ultrastructural characteristics similar to those of hyaline cartilage was noted more frequently on the composite implants. If such composite implants were clinically effective then they might be useful in treating symptomatic osteochondral defects. PMID:11550710

Curtin, W; Reville, W; Heapes, M; Lyons, J; Muckle, D



Medial patellofemoral ligament injury patterns and associated pathology in lateral patella dislocation: an MRI study  

PubMed Central

Background Lateral Patella dislocations are common injuries seen in the active and young adult populations. Our study focus was to evaluate medial patellofemoral ligament (MPFL) injury patterns and associated knee pathology using Magnetic Resonance Imaging studies. Methods MRI studies taken at one imaging site between January, 2007 to January, 2008 with the final diagnosis of patella dislocation were screened for this study. Of the 324 cases that were found, 195 patients with lateral patellar dislocation traumatic enough to cause bone bruises on the lateral femoral trochlea and the medial facet of the patella were selected for this study. The MRI images were reviewed by three independent observers for location and type of MPFL injury, osteochondral defects, loose bodies, MCL and meniscus tears. The data was analyzed as a single cohort and by gender. Results This study consisted of 127 males and 68 females; mean age of 23 yrs. Tear of the MPFL at the patellar attachment occurred in 93/195 knees (47%), at the femoral attachment in 50/195 knees (26%), and at both the femoral and patella attachment sites in 26/195 knees (13%). Attenuation of the MPFL without rupture occurred in 26/195 knees (13%). Associated findings included loose bodies in 23/195 (13%), meniscus tears 41/195 (21%), patella avulsion/fracture in 14/195 (7%), medial collateral ligament sprains/tears in 37/195 (19%) and osteochondral lesions in 96/195 knees (49%). Statistical analysis showed females had significantly more associated meniscus tears than the males (27% vs. 17%, p = 0.04). Although not statistically significant, osteochondral lesions were seen more in male patients with acute patella dislocation (52% vs. 42%, p = 0.08). Conclusion Patients who present with lateral patella dislocation with the classic bone bruise pattern seen on MRI will likely rupture the MPFL at the patellar side. Females are more likely to have an associated meniscal tear than males; however, more males have underlying osteochondral lesions. Given the high percentage of associated pathology, we recommend a MRI of the knee in all patients who present with acute patella dislocation.

Guerrero, Patrick; Li, Xinning; Patel, Ketan; Brown, Michael; Busconi, Brian



Anterolateral ankle impingement: findings and diagnostic accuracy with ultrasound imaging  

Microsoft Academic Search

Objective  The objective was to evaluate the findings and diagnostic accuracy of ultrasound in antero-lateral ankle impingement (ALI)\\u000a with clinical and arthroscopic correlation.\\u000a \\u000a \\u000a \\u000a Design and patients  Seventeen elite footballers with chronic ankle pain were referred for ultrasound with a clinical diagnosis of ALI (n?=?8) or a control condition (n?=?9; lateral mechanical instability, osteochondral defect, intra-articular bodies and osteoarthritis). Ultrasound examination\\u000a included the

C. L. McCarthy; D. J. Wilson; T. P. Coltman



Musculoskeletal injuries in adolescents.  


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



Overuse injuries in youth sports.  


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



Comparative frequency of osseous macroscopic pathology and first report of gout in captive and wild-caught ratites.  


This systematic survey of museum ratite (Pterocnemia, Rhea, Casuarius, Struthio, Dromias and Apteryx) skeletal collections was performed to reevaluate previous perspectives and assess effect of captivity on macroscopically detectable pathology. Trauma-related pathology (e.g. focal periosteal reaction, malformed vertebrae) was significantly more common in captive birds (chi2 = 13.414, P < 0.0001) with variable timing of the different injuries. Pathology unrelated to trauma was equally represented in captive and wild-caught ratites. The latter included osteophytes of osteoarthritis, osteochondritis dissecans, infectious arthritis, gout (reported for the first time in a ratite) and neoplasia. PMID:17523962

Rothschild, B M; Rühli, F R



Repair of articular cartilage defect with layered chondrocyte sheets and cultured synovial cells.  


In this study, we investigate the effects of treatment with layered chondrocyte sheets and synovial cell transplantation. An osteochondral defect was created of 48 Japanese white rabbits. In order to determine the effects of treatment, the following 6 groups were produced: (A) synovial cells (1.8 × 10(6) cells), (B)layered chondrocyte sheets (1.7 × 10(6) cells), (C) synovial cells (3.0 × 10(5) cells) + layered chondrocyte sheets, (D)synovial cells (6.0 × 10(5) cells) + layered chondrocyte sheets, (E)synovial cells (1.2 × 10(6) cells) + layered chondrocyte sheets, (F) osteochondral defect. Layered chondrocyte sheets and synovial cells were transplanted, sacrificed four and 12 weeks postoperatively. An incapacitance tester (Linton) was used to find trends in the weight distribution ratio of the damaged limbs after surgery. Sections were stained with Safranin-O. Repair sites were evaluated using ICRS grading system. In groups (A) to (E), the damaged limb weight distribution ratio had improved. The repair tissue stained positively with Safranin-O. Four and 12 weeks after surgery, groups (A) to (E) exhibited significantly higher scores than group (F), and groups (D) and (E) exhibited significantly higher scores than groups (A) and (B). This suggests the efficacy of combining layered chondrocyte sheets with synovial cells. PMID:22551484

Ito, Satoshi; Sato, Masato; Yamato, Masayuki; Mitani, Genya; Kutsuna, Toshiharu; Nagai, Toshihiro; Ukai, Taku; Kobayashi, Miyuki; Kokubo, Mami; Okano, Teruo; Mochida, Joji



Attachment, Proliferation, and Chondroinduction of Mesenchymal Stem Cells on Porous Chitosan-Calcium Phosphate Scaffolds  

PubMed Central

Symptomatic osteochondral lesions occur frequently, but relatively few treatment options are currently available. The purpose of this study was to conduct a preliminary investigation into a new tissue engineering approach to osteochondral regeneration. The concept is a biphasic construct consisting of a porous, osteoconductive chitosan-calcium phosphate scaffold supporting a layer of neocartilage formed by marrow-derived mesenchymal stem cells. Two experiments were conducted to assess the feasibility of this approach. The first experiment characterized the attachment efficiency and proliferation of primary human marrow-derived mesenchymal stem cells seeded relatively sparely onto the scaffold’s surface. The second experiment compared two different methods of creating a biphasic construct using a much higher density of primary porcine marrow stromal cells. About 40% of the sparsely seeded human cells attached and proliferated rapidly. Constructs formed by one of the two experimental techniques exhibited a layer of cartilaginous tissue which only partially covered the scaffold’s surface due to inadequate adhesion between the cells and the scaffold. This study demonstrates some potential for the approach to yield an implantable biphasic construct, but further development is required to improve cell-scaffold adhesion.

Elder, Steven; Gottipati, Anuhya; Zelenka, Hilary; Bumgardner, Joel



Histological confirmation and biological significance of cartilage canals demonstrated using high field MRI in swine at predilection sites of osteochondrosis.  


Cartilage canal vessels in epiphyseal cartilage have a pivotal role in the pathogenesis of osteochondrosis/osteochondritis dissecans. The present study aimed to validate high field magnetic resonance imaging (MRI) methods to visualize these vessels in young pigs. Osteochondral samples from the distal femur and distal humerus (predilection sites of osteochondrosis) of piglets were imaged post-mortem: (1) using susceptibility-weighted imaging (SWI) in an MRI scanner, followed by histological evaluation; and (2) after barium perfusion using µCT, followed by clearing techniques. In addition, both stifle joints of a 25-day-old piglet were imaged in vivo using SWI and gadolinium enhanced T1-weighted MRI, after which distal femoral samples were harvested and evaluated using µCT and histology. Histological sections were compared to corresponding MRI slices, and three-dimensional visualizations of vessels identified using MRI were compared to those obtained using µCT and to the cleared specimens. Vessels contained in cartilage canals were identified using MRI, both ex vivo and in vivo; their locations matched those observed in the histological sections, µCT images, and cleared specimens of barium-perfused tissues. The ability to visualize cartilage canal blood vessels by MRI, without using a contrast agent, will allow future longitudinal studies to evaluate their role in developmental orthopedic disease. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31:2006-2012, 2013. PMID:23939946

Tóth, Ferenc; Nissi, Mikko J; Zhang, Jinjin; Benson, Michael; Schmitter, Sebastian; Ellermann, Jutta M; Carlson, Cathy S



In vitro differentiation and biocompatibility of mesenchymal stem cells on a novel platelet releasate-containing injectable composite.  


Underlying changes in subchondral and cancellous bone precede joint degeneration in spinal discs, knees, hips, and other joints. We hypothesize that an early bone remodeling intervention therapy may alleviate or postpone the later manifestation of joint failure. Utilization of a novel biomaterial for injection deliverability to the underlying subchondral and cancellous bone during the onset of osseous changes, before severe cartilaginous damage, is proposed. In this preliminary study, we introduced novel platelet releasate-containing alginate/calcium phosphate composites for this intervention therapy and evaluated them in vitro through mesenchymal stem cell biocompatibility and induction of osteochondral differentiation. DNA quantification and gene expression profiles suggested mesenchymal stem cells were directed along an osteochondral differentiation pathway, more specifically, to the immature nonhypertrophic chondrocyte phenotype. These conclusions were based on reduced mitogenic activity, a rapid upregulation followed by suppression of Runx2 transcription factor mRNA, sustained upregulation of Sox9 transcription factor mRNA and the absence of late marker expressions for both mature articular chondrocytes and osteoblasts over the course of 14 days. Initial findings in regard to the use of these materials for bone remodeling were positive and support the execution of future studies evaluating the inflammatory and angiogenic aspects of the materials. In this study, we have considered one of the many aspects of the endochondral ossification process; neovascularization and resorption of bone with an irregular physiology need to be evaluated. PMID:22042623

McCanless, Jonathan D; Jennings, Lisa K; Cole, Judith A; Bumgardner, Joel D; Haggard, Warren O



Autologous chondrocyte implantation at the knee using a bilayer collagen membrane with bone graft. A preliminary report.  


Autologous chondrocyte implantation (ACI) is a technique used for the treatment of symptomatic osteochondral defects of the knee. A variation of the original periosteum membrane technique is the matrix-induced autologous chondrocyte implantation (MACI) technique. The MACI membrane consists of a porcine type-I/III collagen bilayer seeded with chondrocytes. Osteochondral defects deeper than 8 to 10 mm usually require bone grafting either before or at the time of transplantation of cartilage. We have used a variation of Peterson's ACI-periosteum sandwich technique using two MACI membranes with bone graft which avoids periosteal harvesting. The procedure is suture-free and requires less operating time and surgical exposure. We performed this MACI-sandwich technique on eight patients, five of whom were assessed at six months and one year post-operatively using the modified Cincinnati knee, the Stanmore functional rating and the visual analogue pain scores. All patients improved within six months with further improvement at one year. The clinical outcome was good or excellent in four after six months and one year. No significant graft-associated complications were observed. Our early results of the MACI-sandwich technique are encouraging although larger medium-term studies are required before there is widespread adoption of the technique. PMID:15773640

Bartlett, W; Gooding, C R; Carrington, R W J; Skinner, J A; Briggs, T W R; Bentley, G



Cartilage repair by local delivery of TGF-?1 or BMP-2 from a novel, segmented polyurethane/polylactic-co-glycolic bilayered scaffold.  


This study aimed to analyze the in vitro and in vivo release kinetics and evaluate the grades of repair induced by either the release of 50 ng of transforming growth factor-?1 (TGF-?1) or 2.5 or 5 µg of bone morphogenetic protein-2 (BMP-2) from a bilayer scaffold of segmented polyurethane/polylactic-co-glycolic (SPU/PLGA) in osteochondral defects, in a rabbit model. The scaffold consisted of a porous, bone-directed PLGA layer, overlaid with a cartilage-directed layer of growth factor (GF) loaded PLGA microspheres, dispersed in a matrix of SPU. The PLGA porous layer was fabricated by gas foaming. Microspheres were prepared by a double emulsion method. SPU was synthesized following the two-step method. GF release kinetics were assessed using iodinated ((125) I) GFs. The in vivo release profiles of both GFs fitted to zero order kinetics, demonstrating a consistently good control of their release rates by SPU. Cartilage-like tissue, characterized by histological analysis, scoring, and immunolabeling of chondrogenic differentiation markers, was only observed after 12 weeks, maintaining integrity up to at least 24 weeks, independently of the GF and the dose of BMP-2. The biocompatibility and the resulting good quality, hyaline repair cartilage convert this system into a promising candidate for future applications in osteochondral lesions. PMID:23630022

Reyes, R; Delgado, A; Solis, R; Sánchez, E; Hernández, A; San Román, J; Evora, C



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


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



Treatment of Focal Articular Cartilage Defects in the Knee  

PubMed Central

We asked whether autologous chondrocyte implantation or osteochondral autograft transfer yields better clinical outcomes compared with one another or with traditional abrasive techniques for treatment of isolated articular cartilage defects and whether lesion size influences this clinical outcome. We performed a literature search and identified five randomized, controlled trials and one prospective comparative trial evaluating these treatment techniques in 421 patients. The operative procedures included autologous chondrocyte implantation, osteochondral autograft transfer, matrix-induced autologous chondrocyte implantation, and microfracture. Minimum followup was 1 year (mean, 1.7 years; range, 1–3 years). All studies documented greater than 95% followup for clinical outcome measures. No technique consistently had superior results compared with the others. Outcomes for microfracture tended to be worse in larger lesions. All studies reported improvement in clinical outcome measures in all treatment groups when compared with preoperative assessment; however, no control (nonoperative) groups were used in any of the studies. A large prospective trial investigating these techniques with the addition of a control group would be the best way to definitively address the clinical questions. Level of Evidence: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Magnussen, Robert A.; Dunn, Warren R.; Carey, James L.



Cartilage repair by local delivery of transforming growth factor-?1 or bone morphogenetic protein-2 from a novel, segmented polyurethane/polylactic-co-glycolic bilayered scaffold.  


This study aimed to analyze the in vitro and in vivo release kinetics and evaluate the grades of repair induced by either the release of 50 ng of transforming growth factor-?1 or 2.5 or 5 ?g of bone morphogenetic protein-2 (BMP-2) from a bilayer scaffold of segmented polyurethane/polylactic-co-glycolic (SPU/PLGA) in osteochondral defects, in a rabbit model. The scaffold consisted of a porous, bone-directed PLGA layer, overlaid with a cartilage-directed layer of growth factor (GF)-loaded PLGA microspheres, dispersed in a matrix of SPU. The PLGA porous layer was fabricated by gas foaming. Microspheres were prepared by a double emulsion method. SPU was synthesized by following the two-step method. GF release kinetics were assessed using iodinated ((125) I) GFs. The in vivo release profiles of both GFs fitted to zero-order kinetics, demonstrating a consistently good control of their release rates by SPU. Cartilage-like tissue, characterized by histological analysis, scoring, and immunolabeling of chondrogenic differentiation markers, was observed only after 12 weeks, maintaining integrity up to at least 24 weeks, independently of the GF and the dose of BMP-2. The biocompatibility and the resulting good quality, hyaline repair cartilage convert this system into a promising candidate for future applications in osteochondral lesions. © 2013 Wiley Periodicals, Inc. J Biomed Mater Res Part A, 2013. PMID:23766296

Reyes, Ricardo; Delgado, Araceli; Solis, Raul; Sanchez, Esther; Hernandez, Antonio; Roman, Julio San; Evora, Carmen



Multiple osteochondroses of bilateral knee joints.  


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



Chondrocyte recovery in cryopreserved porcine articular cartilage after bone carrier alteration.  


In order to investigate the consequences on the distribution of cell recovery through a cross-section of articular cartilage, the pathway for ice nucleation and diffusion of water and solutes in porcine osteochondral tissue was altered by drilling a 2mm diameter hole through the subchondral bone to the base of the cartilage. Samples equilibrated with 1M dimethyl sulfoxide were cooled at 1 C/min to -30 degrees C then stored in liquid nitrogen. A significant increase in chondrocyte recovery was documented when compared to samples cryopreserved without holes (48.3 percent vs 28.6 percent, P=0.003). The most significant change due to bone base modification was an increase in recovery in the middle section of the cartilage. These results provide insight into mechanisms of cryoinjury in tissue systems. PMID:12391487

Jomha, N M; Anoop, P C; McGann, L E


[Menisci transplantation and autologous chondrocytes].  


We report 66 patients with chondral and osteochondral knee lesions and 3 with ankle lesions in whom, after clinical and radiological examination, arthroscopy was performed to harvest 0.3 or 0.4 g of hyaline cartilage from the knee or ankle to be sent for culture. After culture, autologous chondrocytes were implanted using open surgery. Our statistics show 85-90% of excellent and good results in patients under 50 years of age, including 30 elite athletes who were able to return to sport. The best results in the knee were obtained in the femoral condyle, and in the talus for ankle lesions. In one patient, an ACI in the lateral condyle and a meniscal graft were performed in the same surgery, thus restoring the normal physiology and biomechanics of the joint. PMID:11382151

Guillén García, P



Glenohumeral Joint Preservation: A Review of Management Options for Young, Active Patients with Osteoarthritis  

PubMed Central

The management of osteoarthritis of the shoulder in young, active patients is a challenge, and the optimal treatment has yet to be completely established. Many of these patients wish to maintain a high level of activity, and arthroplasty may not be a practical treatment option. It is these patients who may be excellent candidates for joint-preservation procedures in an effort to avoid or delay joint replacement. Several palliative and restorative techniques are currently optional. Joint debridement has shown good results and a combination of arthroscopic debridement with a capsular release, humeral osteoplasty, and transcapsular axillary nerve decompression seems promising when humeral osteophytes are present. Currently, microfracture seems the most studied reparative treatment modality available. Other techniques, such as autologous chondrocyte implantation and osteochondral transfers, have reportedly shown potential but are currently mainly still investigational procedures. This paper gives an overview of the currently available joint preserving surgical techniques for glenohumeral osteoarthritis.

van der Meijden, Olivier A.; Gaskill, Trevor R.; Millett, Peter J.



Exposure of the medial talar dome: bi-plane chevron medial malleolus osteotomy.  


Open surgical exposure of the medial aspect of the talus is primarily indicated for osteochondral lesions of the talus and talar body fractures. Secondary to the difficulty of access, a variety of techniques have been described. The surgical techniques described in the literature include transmalleolar access windows, medial and anterior tibial osteotomies, and resection osteotomies (plafondoplasty). The purpose of this article is to describe the surgical technique for the bi-planar chevron osteotomy of the medial malleolus. This osteotomy can provide full exposure to the entire medial aspect of the talus. The orientation of the osteotomy allows for perpendicular placement of instrumentation on the medial half of the talus and is particularly useful for cartilage transplant procedures. The technique is reproducible and has a low complication rate when performed correctly. PMID:23392119

Granata, Jaymes D; DeCarbo, William T; Hyer, Christopher F; Granata, Angela M; Berlet, Gregory C



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.



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.



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.

Schoffl, Volker; Kupper, Thomas



Recent Advances in Cartilage Tissue Engineering: From the Choice of Cell Sources to the Use of Bioreactors  

NASA Astrophysics Data System (ADS)

Grafting engineered cartilage tissues represents a promising approach for the repair of joint injuries. Recent animal experiments have demonstrated that tissues engineered by culturing chondrocytes on 3D scaffolds in bioreactors provide functional templates for orderly repair of large osteochondral lesions. To date, however, a reproducible generation of uniform cartilage tissues of predefined size starting from adult human cells has not been achieved. In this paper we review some of the recent advances and challenges ahead in the identification of appropriate (i) cell sources, (ii) bioactive factors, (iii) 3D scaffolds and (iv) bioreactors for human cartilage tissue engineering. We also present an example of how integrated efforts in these different areas can help addressing fundamental questions and advancing the field of cartilage tissue engineering towards clinical use. The presented experiment demonstrates that human nasal chondrocytes are responsive to dynamic loading and thus could be further investigated as a cell source for implantation in a joint environment.

Martin, Ivan; Démarteau, Olivier; Braccini, Alessandra


Evaluation and management of posterior ankle pain in dancers.  


Posterior ankle pain is a common complaint in dancers. There are multiple structures in the posterior ankle that have the potential to be the source of pain. The objective of this article is to review several of the most common causes of posterior ankle pain: peroneal tendon subluxation, posterior impingement syndrome secondary to a painful os trigonum, posterior talus osteochondritis dissecans, flexor hallucis longus tendinopathy, and posterior tibial tendinopathy. For dancers, we offer typical clinical presentations of these disorders to increase awareness and provide guidance regarding when to seek professional medical attention. For medical personnel who are responsible for optimizing dancers' health and training, we include a discussion of pertinent physical exam findings, diagnostic imaging options, non-operative and operative management, as well as surgical suggestions and postoperative rehabilitation guidelines. PMID:23759482

Luk, Pamela; Thordarson, David; Charlton, Timothy



Autogenous osteoperiosteal grafts in the reconstruction of full-thickness joint surface defects.  


Free, autogenous periosteal grafts from the medial metaphysis of the proximal tibia have been used to reconstruct full thickness cartilage defects of the articular surfaces of the knee joint. If there was a bone defect, it was initially filled with cancellous bone graft. The method is illustrated by six patients, three with acute traumatic patellar defects and three with local sclerotic osteochondritis of the medial femoral condyle. The latter had loose fragments unsuitable for fixation and single excision would have left a large and deep defect. The grafts have given satisfactory results, 14 to 59 months after the procedures. Clinical grading of the defects has been monitored by radiographs with arthroscopy of two knees and CT scan of one knee. PMID:1743838

Korkala, O; Kuokkanen, H



Elbow arthroscopic surgery update for sports medicine conditions.  


Elbow arthroscopic surgery can now effectively treat a variety of conditions that affect athletes. Advances in instrumentation, increased surgeon familiarity, and expanded indications have led to significant growth in elbow arthroscopic surgery in the past few decades. While positioning, portal placement, and specific instruments may vary among surgeons, anatomic considerations guide surgical approaches to minimize neurovascular compromise. Arthroscopic procedures vary in difficulty, and surgeons should follow stepwise advancement with experience. Removal of loose bodies, debridement of synovial plicae, and debridement of the extensor carpi radialis brevis for lateral epicondylitis are considered simple procedures for novice elbow arthroscopic surgeons. More advanced procedures include management of osteochondritis dissecans, valgus extension overload in the throwing athlete, and capsular release. With proper technique, a variety of athletic elbow conditions can be treated arthroscopically with predictable results and minimal morbidity. PMID:23572098

Byram, Ian R; Kim, H Mike; Levine, William N; Ahmad, Christopher S



Elbow injuries in throwing athletes: a current concepts review.  


Repetitive overhead throwing imparts high valgus and extension loads to the athlete's elbow, often leading to either acute or chronic injury or progressive structural change. Tensile force is applied to the medial stabilizing structures with compression on the lateral compartment and shear stress posteriorly. Common injuries encountered in the throwing elbow include ulnar collateral ligament tears, ulnar neuritis, flexor-pronator muscle strain or tendinitis, medial epicondyle apophysitis or avulsion, valgus extension overload syndrome with olecranon osteophytes, olecranon stress fractures, osteochondritis dissecans of the capitellum, and loose bodies. Knowledge of the anatomy and function of the elbow complex, along with an understanding of throwing biomechanics, is imperative to properly diagnose and treat the throwing athlete. Recent advantages in arthroscopic surgical techniques and ligament reconstruction in the elbow have improved the prognosis for return to competition for the highly motivated athlete. However, continued overhead throwing often results in subsequent injury and symptom recurrence in the competitive athlete. PMID:12860556

Cain, E Lyle; Dugas, Jeffrey R; Wolf, Robert S; Andrews, James R


Traumatic hip dislocation in childhood.  


Traumatic dislocation of the hip in childhood is uncommon and can be a consequence of minor trauma. The authors report a series of 35 dislocations in skeletally immature patients. Most were isolated posterior dislocations without acetabular lesions. In 75% of cases, reduction of the dislocation was easy. Nine children required surgery to remove interposed joint capsule and/or osteochondral fragments to achieve anatomic reduction. Outcomes were generally good, except in one patient in whom a displaced fracture of the femoral physis was followed by total head avascular necrosis. One case of partial necrosis had a satisfactory outcome. Epiphyseal necrosis, though uncommon, appeared to be inconsistent to prevent and hard to predict. Bone scan seems to be more effective than MRI for the detection of necrosis. PMID:15718889

Vialle, Raphaël; Odent, Thierry; Pannier, Stéphanie; Pauthier, François; Laumonier, Frédéric; Glorion, Christophe


Systematic evaluation of acute knee injuries.  


The high percentage of significant injury associated with a hemarthrosis correlates with the findings of Noyes, DeHaven, and others. The development of significant knee swelling immediately after injury should be an alarming sign. Our study revealed a significant probability of anterior cruciate ligament tear or meniscal tear in the acute hemarthrosis. Arthroscopy in acute hemarthrosis certainly should be considered and, in many cases, performed. Although not within the scope of this article, acute arthroscopic repair of a torn meniscus, evaluation of the degree of tear of the anterior cruciate ligament, and arthroscopic repair of osteochondral fractures are all benefited by acute arthroscopic examination. Decisions in diagnosis are helped by the knee aspiration. PMID:3986928

Jensen, J E; Conn, R R; Hazelrigg, G; Hewett, J E



Transient lateral patellar dislocation: review of imaging findings, patellofemoral anatomy, and treatment options.  


Transient patellar dislocation is a common sports-related injury in young adults. Although patients often present to the emergency department with acute knee pain and hemarthrosis, spontaneous reduction frequently occurs, and half of cases are unsuspected clinically. Characteristic magnetic resonance imaging (MRI) findings often lead to the diagnosis. The purpose of this review is to illustrate the MRI findings of lateral patellar dislocation and concomitant injuries, such as kissing contusions of the medial patella and lateral femoral condyle; osteochondral and avulsion fractures; and injuries of the medial patellofemoral ligament/retinacular complex. This article will also briefly review patellofemoral anatomy and passive, active, and static stabilizers. Predisposing factors for patellar instability, including trochlear dysplasia, patella alta, and lateralization of the patella or tibial tuberosity and their relevant measurements will also be highlighted. Treatment options, including surgery, such as medial patellofemoral ligament reconstruction, tibial tuberosity transfer, and trochleoplasty, and their postoperative imaging appearances will also be discussed. PMID:22941569

Earhart, Christina; Patel, Dakshesh B; White, Eric A; Gottsegen, Christopher J; Forrester, Deborah M; Matcuk, George R



Osteocartilaginous lesions of the talus in soccer players  

Microsoft Academic Search

Objective  The objective of this study is to describe the results of arthroscopic debridement for talar lesions in a population of soccer\\u000a players.\\u000a \\u000a \\u000a \\u000a Patients  Patients were sixteen soccer players with osteochondral talar lesions, treated surgically between 1999 and 2004.\\u000a \\u000a \\u000a \\u000a Interventions  All patients were diagnosed clinically. Complementary imaging studies included X-ray, scintigraphy, and magnetic resonance\\u000a imaging. All patients underwent arthroscopic debridement.\\u000a \\u000a \\u000a \\u000a Main outcome measurements  At

Roberto Seijas; P. Álvarez; O. Ares; G. Steinbacher; X. Cuscó; R. Cugat



Pyoderma gangrenosum with wrist joint destruction: case report.  


Pyoderma gangrenosum (PG) is a rare, noninfectious, neurotrophic dermatosis. We observed a case of PG mimicking cutaneous and osteoarticular infections that presented with a prolonged ulcer on the forearm, severe wrist pain, anemia, substantial local and systemic inflammation as evaluated by serum laboratory data, and carpal osteolysis. Although PG rarely damages joints, the ulcer extended to the joint and destroyed the osteochondral tissues. Advanced ulcerative colitis, which is a most common comorbidity of PG, proved to be an underlying disease. Antibiotic and surgical treatment did not heal the ulcer, which was successfully treated with corticosteroids. This intractable ulcer is often misdiagnosed. Hence when a patient presents with an enlarged, painful, unusual skin lesion, PG should always be considered. PMID:23267758

Choe, Hyonmin; Sakano, Hiroaki; Takigami, Hidetake; Inaba, Yutaka; Matsuo, Kosuke; Saito, Tomoyuki



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.

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



Quantitative analysis of cyanogen bromide-cleaved peptides for the assessment of type I: type II collagen ratios in equine articular repair tissue.  


Cyanogen bromide was used to solubilise and specifically fragment purified equine Type I and II collagen and equine articular surface repair tissue. The resultant peptides were separated by sodium dodecyl sulphate-polyacrylamide gel electrophoresis and quantified by densitometric scanning. Measurement of the relative amounts of the peptides alpha 2(I) CB3, 5 and alpha 1(II)CB10 provided an accurate method of establishing the ratio of Type I to Type II collagen in mixtures of purified equine collagens. The method was sensitive to 6% Type II collagen when the band areas were corrected for peptide molecular weight and the number of chains in the parent tropocollagen molecule which contain that particular peptide. Use of this technique showed that repair tissue in full thickness osteochondral defects in the dorso-distal margins of the intermediate carpal bones of ponies did not contain detectable amounts of Type II collagen 11 weeks after defect induction. PMID:8143659

Barr, A R; Duance, V C; Wotton, S F; Waterman, A E; Holt, P E



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.



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


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. PMID:21135464

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



Applications of computer navigation in sports medicine knee surgery: an evidence-based review.  


Computer-assisted surgery (CAS) has been investigated in a number of sports medicine procedures in the knee. Current barriers to its widespread introduction include increased costs, duration, and invasiveness of surgery. Randomized trials on the use of CAS in anterior cruciate ligament reconstruction have failed to demonstrate a clinical benefit. Data on CAS use in high tibial osteotomy are more promising; however, long-term studies are lacking. CAS has a number of research applications in knee ligament surgery, and studies continue to explore its use in the treatment of osteochondral lesions. This article reviews the applications of CAS in sports medicine knee surgery and summarizes current literature on clinical outcomes. PMID:23483407

Young, Simon W; Safran, Marc R; Clatworthy, Mark



Reduction of Sample Size Requirements by Bilateral Versus Unilateral Research Designs in Animal Models for Cartilage Tissue Engineering  

PubMed Central

Advanced tissue engineering approaches for articular cartilage repair in the knee joint rely on translational animal models. In these investigations, cartilage defects may be established either in one joint (unilateral design) or in both joints of the same animal (bilateral design). We hypothesized that a lower intraindividual variability following the bilateral strategy would reduce the number of required joints. Standardized osteochondral defects were created in the trochlear groove of 18 rabbits. In 12 animals, defects were produced unilaterally (unilateral design; n=12 defects), while defects were created bilaterally in 6 animals (bilateral design; n=12 defects). After 3 weeks, osteochondral repair was evaluated histologically applying an established grading system. Based on intra- and interindividual variabilities, required sample sizes for the detection of discrete differences in the histological score were determined for both study designs (?=0.05, ?=0.20). Coefficients of variation (%CV) of the total histological score values were 1.9-fold increased following the unilateral design when compared with the bilateral approach (26 versus 14%CV). The resulting numbers of joints needed to treat were always higher for the unilateral design, resulting in an up to 3.9-fold increase in the required number of experimental animals. This effect was most pronounced for the detection of small-effect sizes and estimating large standard deviations. The data underline the possible benefit of bilateral study designs for the decrease of sample size requirements for certain investigations in articular cartilage research. These findings might also be transferred to other scoring systems, defect types, or translational animal models in the field of cartilage tissue engineering.

Orth, Patrick; Zurakowski, David; Alini, Mauro; Cucchiarini, Magali



Three-dimensional polycaprolactone scaffold-conjugated bone morphogenetic protein-2 promotes cartilage regeneration from primary chondrocytes in vitro and in vivo without accelerated endochondral ossification.  


As articular cartilage is avascular, and mature chondrocytes do not proliferate, cartilage lesions have a limited capacity for regeneration after severe damage. The treatment of such damage has been challenging due to the limited availability of autologous healthy cartilage and lengthy and expensive cell isolation and expansion procedures. Hence, the use of bone morphogenetic protein-2 (BMP-2), a potent regulator of chondrogenic expression, has received considerable attention in cartilage and osteochondral tissue engineering. However, the exact role of BMP-2 in cartilage repair has been postulated to promote both cartilage formation and subsequent cartilage degradation through hypertrophy and endochondral ossification. Furthermore, it is likely that the manner in which BMP-2 is presented to chondrocytes will influence the physiologic pathway (repair vs. degeneration). This study investigates the relative influence of BMP-2 on cartilage matrix and potential subsequent bone matrix production using primary chondrocytes seeded on designed 3D polycaprolactone (PCL) scaffolds with chemically conjugated BMP-2. The results show that chemically conjugated BMP-2 PCL scaffolds can promote significantly greater cartilage regeneration from seeded chondrocytes both in vitro and in vivo compared with untreated scaffolds. Furthermore, our results demonstrate that the conjugated BMP-2 does not particularly accelerate endochondral ossification even in a readily permissible and highly vascular in vivo environment compared with untreated PCL scaffolds. This study not only reveals the potential use of the BMP-2 conjugation delivery method for enhanced cartilage tissue formation but also gives new insights for the effects of conjugated BMP-2 on cartilage regeneration and osteochondral ossification. PMID:22615065

Jeong, Claire G; Zhang, Huina; Hollister, Scott J



Clinical use of bone marrow, bone marrow concentrate, and expanded bone marrow mesenchymal stem cells in cartilage disease.  


Mesenchymal stem cells (MSCs) from bone marrow (BM) are widely used for bone and less for cartilage tissue regeneration due to their self-renewal and differentiating properties into osteogenic or chondrogenic lineages. This review considers the last decade of clinical trials involving a two-step procedure, by expanding in vitro MSCs from BM, or the so called "one-step" procedure, using BM in toto or BM concentrate, for the regeneration of cartilage and osteochondral tissue defects. The following conclusions were drawn: (1) Cartilage defects that can be repaired by the two-step technique are about twice the size as those where the one-step method is used; (2) the two-step procedure is especially used for the treatment of osteoarthritic lesions, whereas the one-step procedure is used for osteochondral defects; (3) the number of transplanted cells ranges between 3.8×10(6) and 11.2×10(6) cells/mL, and the period of cell culture expansion of implanted MSCs varies widely with regard to the two-step procedure; (4) hyaluronic or collagenic scaffolds are used in all the clinical studies analyzed for both techniques; (5) the follow-up of the two-step procedure is longer than that of the one-step method, despite having a lower number of patients; and, finally, (6) the mean age of the patients (about 39 years old) is similar in both procedures. Clinical results underline the safety and good and encouraging outcomes for the use of MSCs in clinics. Although more standardized procedures are required, the length of follow-up and the number of patients observed should be augmented, and the design of trials should be implemented to achieve evidence-based results. PMID:23030230

Veronesi, Francesca; Giavaresi, Gianluca; Tschon, Matilde; Borsari, Veronica; Nicoli Aldini, Nicolò; Fini, Milena



Recombinant adeno-associated virus vectors efficiently and persistently transduce chondrocytes in normal and osteoarthritic human articular cartilage.  


Successful gene transfer into articular cartilage is a prerequisite for gene therapy of articular joint disorders. In the present study we tested the hypothesis that recombinant adeno-associated virus (rAAV) vectors are capable of effecting gene transfer in isolated articular chondrocytes in vitro, articular cartilage tissue in vitro, and sites of articular damage in vivo. Using an rAAV vector carrying the Escherichia coli beta-galactosidase gene (lacZ) under the control of the cytomegalovirus (CMV) immediate-early promoter/enhancer (rAAV-lacZ), transduction efficiency exceeded 70% for isolated normal human adult articular chondrocytes, and osteoarthritic human articular chondrocytes. These were comparable to the transduction efficiency obtained with neonatal bovine articular chondrocytes. Transduction of explant cultures of articular cartilage resulted in reporter gene expression within the tissue of all three cartilage types to a depth exceeding 450 microm, which remained present until 150 days. When rAAV-lacZ vectors were applied to femoral chondral defects and osteochondral defects in vivo in a rat knee model, reporter gene expression was achieved for at least 10 days after transduction. These data suggest that AAV-based vectors can efficiently transduce and stably express foreign genes in articular chondrocytes, including chondrocytes of normal and osteoarthritic human articular cartilage. The data further suggest that the same rAAV vectors are capable of transducing chondrocytes in situ within their native matrix to a depth sufficient to be of potential clinical significance. Finally, the data demonstrate that these rAAV vectors are capable of effectively delivering recombinant genes to chondral and osteochondral defects in vivo. PMID:12659680

Madry, Henning; Cucchiarini, Magali; Terwilliger, Ernest F; Trippel, Stephen B



Treatment of knee chondropathy with platelet rich plasma. Preliminary results at 6 months of follow-up with only one injection.  


Application of new biological treatments in orthopaedics is controversial nowadays. Surgeons and practitioners know how difficult can be to choose a solution for chondral injuries. Joint damages are from little contusions, osteochondral fractures, avascular necrosis, osteochondritis and degenerative processes like osteoarthritis and rheumatisms. All mentioned have a common problem: the lack of regenerating hyaline cartilage by themselves. Recently, PRP have been used to treat early moderate chondropathies. Here we show the preliminary results of 30 patients affected by chondropathy of the knee after 6 months treated with a single intrarticular injection of PRP. Thirty patients, 18-65 years old, with a diagnosis of I to III Outerbridge chondropathy in the knee, pain for more than 3 months following conservative treatment and no bone axial defect, were treated with one intraarticular injection of PRP (GPS mini set, BIOMET), after written consent and Ethic and Legal Committee approval. VAS and KOOS scores were evaluated before PRP injection and at 1, 3 and 6 months after the treatment. ANOVA with repeated measures using the SPSS showed significantly better results in term of KOOS and VAS scores at 1, 3 and 6 months respect to the pre-injection value (p less than 0,05) We think that PRP treatment is a promising alternative for the treatment of knee chondropathy; however its efficacy has to be demonstrated with more clinical works, with longer follow up and with greater number of patients, even with controlled and randomized trials. In our study only one injection of PRP has been able to allow a clinical improvement, suggesting the possibility to avoid multiple injections protocols, and consequently reducing the health expenses. Until the efficacy of PRP will not be definitely demonstrated, surgeon should be very prudent in indications. PMID:23648201

Torrero, J I; Aroles, F; Ferrer, D


Gene expression profile of the cartilage tissue spontaneously regenerated in vivo by using a novel double-network gel: Comparisons with the normal articular cartilage  

PubMed Central

Background We have recently found a phenomenon that spontaneous regeneration of a hyaline cartilage-like tissue can be induced in a large osteochondral defect by implanting a double-network (DN) hydrogel plug, which was composed of poly-(2-Acrylamido-2-methylpropanesulfonic acid) and poly-(N, N'-Dimetyl acrylamide), at the bottom of the defect. The purpose of this study was to clarify gene expression profile of the regenerated tissue in comparison with that of the normal articular cartilage. Methods We created a cylindrical osteochondral defect in the rabbit femoral grooves. Then, we implanted the DN gel plug at the bottom of the defect. At 2 and 4 weeks after surgery, the regenerated tissue was analyzed using DNA microarray and immunohistochemical examinations. Results The gene expression profiles of the regenerated tissues were macroscopically similar to the normal cartilage, but showed some minor differences. The expression degree of COL2A1, COL1A2, COL10A1, DCN, FMOD, SPARC, FLOD2, CHAD, CTGF, and COMP genes was greater in the regenerated tissue than in the normal cartilage. The top 30 genes that expressed 5 times or more in the regenerated tissue as compared with the normal cartilage included type-2 collagen, type-10 collagen, FN, vimentin, COMP, EF1alpha, TFCP2, and GAPDH genes. Conclusions The tissue regenerated by using the DN gel was genetically similar but not completely identical to articular cartilage. The genetic data shown in this study are useful for future studies to identify specific genes involved in spontaneous cartilage regeneration.



Upper extremity interaction with a deploying side airbag: a characterization of elbow joint loading.  


Computer simulations, dummy experiments with a new enhanced upper extremity and small female cadaver experiments were used to analyze the small female upper extremity response under side airbag loading. After establishing a worst case initial position, three tests were performed with the fifth percentile female hybrid III anthropometric test dummy and six experiments with small female cadaver subjects. A new fifth percentile female enhanced upper extremity was developed for the dummy experiments that included a two-axis wrist load cell in addition to the existing six-axis load cells in both the forearm and humerus. Forearm pronation was also included in the new dummy upper extremity to increase the biofidelity of the interaction with the handgrip. Instrumentation for both the cadaver and dummy tests included accelerometers and MHD angular rate sensors on the forearm, humerus, upper and lower spine. In order to quantify the applied loads to the cadaver hand and wrist from the door mounted handgrip, the handgrip was mounted to the door through a five-axis load cell and instrumented with accelerometers for inertial compensation. All six of the cadaver tests resulted in upper extremity injuries including comminuted mid-shaft humerus fractures, osteochondral fractures of the elbow joint surfaces, a transverse fracture of the distal radius and an osteochondral fracture of the lunate carpal bone. The results from the 6 cadaver tests presented in this study were combined with the results from 12 previous cadaver tests. A multivariate logistic regression analysis was performed to investigate the correlation between observed injuries and measured occupant response. Using inertially compensated force measurements from the dummy mid-shaft forearm load cell, the linear combination of elbow axial force and shear force was significantly (P=0.05) correlated to the observed elbow injuries. PMID:12643959

Duma, Stefan M; Boggess, Brian M; Crandall, Jeff R; Hurwitz, Shepard R; Seki, Kazuhiro; Aoki, Takashi



Iron Administration before Stem Cell Harvest Enables MR Imaging Tracking after Transplantation.  


Purpose: To determine whether intravenous ferumoxytol can be used to effectively label mesenchymal stem cells (MSCs) in vivo and can be used for tracking of stem cell transplants. Materials and Methods: This study was approved by the institutional animal care and use committee. Sprague-Dawley rats (6-8 weeks old) were injected with ferumoxytol 48 hours prior to extraction of MSCs from bone marrow. Ferumoxytol uptake by these MSCs was evaluated with fluorescence, confocal, and electron microscopy and compared with results of traditional ex vivo-labeling procedures. The in vivo-labeled cells were subsequently transplanted in osteochondral defects of 14 knees of seven athymic rats and were evaluated with magnetic resonance (MR) imaging up to 4 weeks after transplantation. T2 relaxation times of in vivo-labeled MSC transplants and unlabeled control transplants were compared by using t tests. MR data were correlated with histopathologic results. Results: In vivo-labeled MSCs demonstrated significantly higher ferumoxytol uptake compared with ex vivo-labeled cells. With electron microscopy, iron oxide nanoparticles were localized in secondary lysosomes. In vivo-labeled cells demonstrated significant T2 shortening effects in vitro and in vivo when they were compared with unlabeled control cells (T2 in vivo, 15.4 vs 24.4 msec; P < .05) and could be tracked in osteochondral defects for 4 weeks. Histologic examination confirmed the presence of iron in labeled transplants and defect remodeling. Conclusion: Intravenous ferumoxytol can be used to effectively label MSCs in vivo and can be used for tracking of stem cell transplants with MR imaging. This method eliminates risks of contamination and biologic alteration of MSCs associated with ex vivo-labeling procedures. © RSNA, 2013 Supplemental material: PMID:23850832

Khurana, Aman; Chapelin, Fanny; Beck, Graham; Lenkov, Olga D; Donig, Jessica; Nejadnik, Hossein; Messing, Solomon; Derugin, Nikita; Chan, Ray Chun-Fai; Gaur, Amitabh; Sennino, Barbara; McDonald, Donald M; Kempen, Paul J; Tikhomirov, Grigory A; Rao, Jianghong; Daldrup-Link, Heike E



Cartilage repair using mesenchymal stem cell (MSC) sheet and MSCs-loaded bilayer PLGA scaffold in a rabbit model.  


PURPOSE: The integration of regenerated cartilage with surrounding native cartilage is a major challenge for the success of cartilage tissue-engineering strategies. The purpose of this study is to investigate whether incorporation of the power of mesenchymal stem cell (MSC) sheet to MSCs-loaded bilayer poly-(lactic-co-glycolic acid) (PLGA) scaffolds can improve the integration and repair of cartilage defects in a rabbit model. METHODS: Rabbit bone marrow-derived MSCs were cultured and formed cell sheet. Full-thickness cylindrical osteochondral defects (4 mm in diameter, 3 mm in depth) were created in the patellar groove of 18 New Zealand white rabbits and the osteochondral defects were treated with PLGA scaffold (n = 6), PLGA/MSCs (n = 6) or MSC sheet-encapsulated PLGA/MSCs (n = 6). After 6 and 12 weeks, the integration and tissue response were evaluated histologically. RESULTS: The MSC sheet-encapsulated PLGA/MCSs group showed significantly more amounts of hyaline cartilage and higher histological scores than PLGA/MSCs group and PLGA group (P < 0.05). In addition, the MSC sheet-encapsulated PLGA/MCSs group showed the best integration between the repaired cartilage and surrounding normal cartilage and subchondral bone compared to other two groups. CONCLUSIONS: The novel method of incorporation of MSC sheet to PLGA/MCSs could enhance the ability of cartilage regeneration and integration between repair cartilage and the surrounding cartilage. Transplantation of autologous MSC sheet combined with traditional strategies or cartilage debris might provide therapeutic opportunities for improving cartilage regeneration and integration in humans. PMID:23108680

Qi, Yiying; Du, Yi; Li, Weixu; Dai, Xuesong; Zhao, Tengfei; Yan, Weiqi



MRI findings in 232 horses with lameness localized to the metacarpo(tarso)phalangeal region and without a radiographic diagnosis.  


Two hundred and thirty-two horses with lameness localized to the metacarpo(tarso)phalangeal (MCP/MTP) region without a radiographic diagnosis were evaluated. All horses had high-field magnetic resonance (MR) imaging of the MCP/MTP region performed for the lame limb and the contralateral limb for comparison. There were 46 horses that had bilateral abnormalities in the forelimbs; 27 of these horses were not lame in the contralateral limb at the time of examination. Bilateral hind limb abnormalities were observed in 37 horses; 22 horses were not lame in the contralateral limb. Soft tissue abnormalities alone were observed in 218 limbs (162 horses). Subchondral bone and articular cartilage abnormalities alone were observed in 43 limbs (34 horses). A combination of soft tissue, subchondral bone, and cartilage abnormalities were observed in 64 limbs (36 horses). The distribution of primary abnormalities was as follows; oblique distal sesamoidean ligament desmitis (73 limbs in 56 horses), straight distal sesamoidean ligament desmitis (44 limbs in 38 horses), chronic subchondral bone injuries (15 limbs in 12 horses), suspensory ligament branch desmitis (14 limbs in 12 horses), collateral ligament desmitis (12 limbs in 12 horses), tendonitis of the superficial and deep digital flexor tendons (10 limbs in 10 horses), osteochondral defects greater than 1 cm (nine limbs in six horses), osteochondral defects less than 1 cm (eight limbs in seven horses), bone marrow lesions (six limbs in five horses), intersesamoidean ligament desmitis (five limbs in four horses). MR imaging is useful in diagnosing bone and soft tissue injuries when radiographs and ultrasound fail to yield a diagnosis. PMID:23020207

King, Jennifer N; Zubrod, Chad J; Schneider, Robert K; Sampson, Sarah N; Roberts, Greg



Tissue engineering for articular cartilage repair--the state of the art.  


Articular cartilage exhibits little capacity for intrinsic repair, and thus even minor injuries or lesions may lead to progressive damage and osteoarthritic joint degeneration, resulting in significant pain and disability. While there have been numerous attempts to develop tissue-engineered grafts or patches to repair focal chondral and osteochondral defects, there remain significant challenges in the clinical application of cell-based therapies for cartilage repair. This paper reviews the current state of cartilage tissue engineering with respect to different cell sources and their potential genetic modification, biomaterial scaffolds and growth factors, as well as preclinical testing in various animal models. This is not intended as a systematic review, rather an opinion of where the field is moving in light of current literature. While significant advances have been made in recent years, the complexity of this problem suggests that a multidisciplinary approach - combining a clinical perspective with expertise in cell biology, biomechanics, biomaterials science and high-throughput analysis will likely be necessary to address the challenge of developing functional cartilage replacements. With this approach we are more likely to realise the clinical goal of treating both focal defects and even large-scale osteoarthritic degenerative changes in the joint. PMID:23636950

Johnstone, Brian; Alini, Mauro; Cucchiarini, Magali; Dodge, George R; Eglin, David; Guilak, Farshid; Madry, Henning; Mata, Alvaro; Mauck, Robert L; Semino, Carlos E; Stoddart, Martin J



Ligament Injury, Reconstruction and Osteoarthritis.  


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



Basic science and treatment options for articular cartilage injuries.  


Articular cartilage injuries can produce significant musculoskeletal morbidity for both young and active aging patient populations. The complex and highly specialized composition of normal hyaline cartilage makes treatment of focal chondral injuries a formidable challenge for the basic scientist, surgeon, and physical therapist. The current array of surgical treatment options offers palliative, reparative, and restorative treatment strategies. Palliative options include simple arthroscopic debridement. Reparative strategies utilize marrow stimulation techniques to induce formation of fibrocartilage within the chondral defect. Restorative tactics attempt to replace damaged cartilage with hyaline or hyaline-like tissue using osteochondral or chondrocyte transplantation. Furthermore, while treatment success is obviously dependent on good surgical selection and technique, the importance of sound, compliant postoperative rehabilitation cannot be understated. The purpose of this article is to review the basic science of articular cartilage, current treatment options available, and outline the clinical decision making involved when using these procedures by presenting the algorithm used at our institution for treating focal cartilage lesions. PMID:17063834

Lewis, Paul B; McCarty, L Pearce; Kang, Richard W; Cole, Brian J



Femoral tunnel defect filled with a synthetic dowel graft for a single-staged revision anterior cruciate ligament reconstruction.  


Bone defects are a common obstacle to successful revision anterior cruciate ligament (ACL) reconstruction. We describe the use of a synthetic bone graft plug to fill a cylindric defect after femoral interference screw removal. During revision ACL reconstruction performed through a 2-incision technique, we placed an outside-in guidewire for a new femoral tunnel that converged with the femoral screw from the primary ACL reconstruction. The screw was removed, and the resultant defect appeared very similar to the cylindric bone defect left after an osteochondral graft harvest. The confluence of the defect and the planned femoral tunnel would have allowed a "windshield wiper" effect of the graft at the lateral wall of the notch. We filled the screw defect with a synthetic bone graft plug to limit the aperture size of the femoral tunnel and to buttress the tendinous portion of the revision ACL graft, while maintaining proper anatomic graft position. In this article, we present a readily available all-arthroscopic option for repairing cylindric bone defects without the risk of an allograft or the morbidity of an autograft for a single-stage revision ACL reconstruction. PMID:17637422

Barrett, Gene R; Brown, Taylor D



Differences in structural and pain phenotypes in the sodium monoiodoacetate and meniscal transection models of osteoarthritis  

PubMed Central

Summary Objectives To characterize differences in joint pathology and pain behavior between two rat models of osteoarthritis (OA) in order to inform selection of animal models for interventional studies. Method Knee OA was induced in Sprague Dawley rats by either meniscal transection (MNX) or intra-articular injection of monosodium iodoacetate (MIA). Controls were subjected to sham surgery or saline-injection. In a separate experiment, a single intra-articular injection of triamcinolone acetonide was administered 14 days after MNX or MIA arthritis induction. Pain behavior and joint pathology were quantified. Results Both models displayed synovial inflammation, chondropathy and osteophytosis. Chondropathy scores increased with time similarly in the two models. Inflammation and osteophyte scores were greater in MNX model compared to the MIA model. At day 49, the MNX model exhibited a greater number of channels crossing the osteochondral junction compared to all other groups. The MNX model exhibited greater weight bearing asymmetry compared to the MIA model, whereas the MIA model displayed more consistent hindpaw allodynia. Triamcinolone attenuated weight bearing asymmetry and distal allodynia to control levels in the MNX model, but distal allodynia was unaltered in the MIA model. Conclusions The comparison of the two models of OA in rats, using identical assessment tools has demonstrated that although both models display features of OA, there are differences between the models which may represent different aspects of human OA. Thus, model selection should be based on the pathological aspects of OA under investigation.

Mapp, P.I.; Sagar, D.R.; Ashraf, S.; Burston, J.J.; Suri, S.; Chapman, V.; Walsh, D.A.



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

NASA Astrophysics Data System (ADS)

To repair complexly shaped tissue defects, an injectable cell carrier is desirable to achieve an accurate fit and to minimize surgical intervention. However, the injectable carriers available at present have limitations, and are not used clinically for cartilage regeneration. Here, we report nanofibrous hollow microspheres self-assembled from star-shaped biodegradable polymers as an injectable cell carrier. The nanofibrous hollow microspheres, integrating the extracellular-matrix-mimicking architecture with a highly porous injectable form, were shown to efficiently accommodate cells and enhance cartilage regeneration, compared with control microspheres. The nanofibrous hollow microspheres also supported a significantly larger amount of, and higher-quality, cartilage regeneration than 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 than the chondrocytes-alone group that simulates the clinically available autologous chondrocyte implantation procedure. These results indicate that the nanofibrous hollow microspheres are an excellent injectable cell carrier for cartilage regeneration.

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



Occult posterolateral rotatory dislocation of the elbow with olecranon fracture in a child: a case report  

PubMed Central

Introduction Acute posterolateral rotator elbow dislocation in a child is rare and can be easily misdiagnosed due to immaturity of the epiphysis. This is the first case of occult posterolateral rotator elbow dislocation in combination with an olecranon fracture. We report our experience with this case, which was not diagnosed correctly by plain radiographs. Case presentation An 11-year-old Asian boy suffered severe pain and swelling of his right elbow after his outstretched arm hit a car dashboard in a motor vehicle accident. Plain radiographs showed only a minimally displaced olecranon fracture and a tiny lateral epicondylar avulsion fracture. However, stress radiographs under general anesthesia revealed severe posterolateral rotatory instability. During surgery, we found that the cartilaginous lateral epicondylar apophysis was much larger than the epicondylar fragment on the radiographs. After the lateral epicondylar osteochondral fragment and lateral collateral ligament complex were fixed, the instability disappeared. Conclusion Our experience with this case shows that it is important to check for instability with pediatric elbow fractures, because a tiny avulsion fracture was able to cause severe posterolateral rotatory instability in a child.



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.

Rutsch, Frank; Nitschke, Yvonne; Terkeltaub, Robert



Development of large engineered cartilage constructs from a small population of cells.  


Confronted with articular cartilage's limited capacity for self-repair, joint resurfacing techniques offer an attractive treatment for damaged or diseased tissue. Although tissue engineered cartilage constructs can be created, a substantial number of cells are required to generate sufficient quantities of tissue for the repair of large defects. As routine cell expansion methods tend to elicit negative effects on chondrocyte function, we have developed an approach to generate phenotypically stable, large-sized engineered constructs (?3 cm(2) ) directly from a small amount of donor tissue or cells (as little as 20,000 cells to generate a 3 cm(2) tissue construct). Using rabbit donor tissue, the bioreactor-cultivated constructs were hyaline-like in appearance and possessed a biochemical composition similar to native articular cartilage. Longer bioreactor cultivation times resulted in increased matrix deposition and improved mechanical properties determined over a 4 week period. Additionally, as the anatomy of the joint will need to be taken in account to effectively resurface large affected areas, we have also explored the possibility of generating constructs matched to the shape and surface geometry of a defect site through the use of rapid-prototyped defect tissue culture molds. Similar hyaline-like tissue constructs were developed that also possessed a high degree of shape correlation to the original defect mold. Future studies will be aimed at determining the effectiveness of this approach to the repair of cartilage defects in an animal model and the creation of large-sized osteochondral constructs. PMID:23197468

Brenner, Jillian M; Kunz, Manuela; Tse, Man Yat; Winterborn, Andrew; Bardana, Davide D; Pang, Stephen C; Waldman, Stephen D



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.



Alignment, segmentation and 3-D reconstruction of serial sections based on automated algorithm  

NASA Astrophysics Data System (ADS)

A well-defined three-dimensional (3-D) reconstruction of bone-cartilage transitional structures is crucial for the osteochondral restoration. This paper presents an accurate, computationally efficient and fully-automated algorithm for the alignment and segmentation of two-dimensional (2-D) serial to construct the 3-D model of bone-cartilage transitional structures. Entire system includes the following five components: (1) image harvest, (2) image registration, (3) image segmentation, (4) 3-D reconstruction and visualization, and (5) evaluation. A computer program was developed in the environment of Matlab for the automatic alignment and segmentation of serial sections. Automatic alignment algorithm based on the position's cross-correlation of the anatomical characteristic feature points of two sequential sections. A method combining an automatic segmentation and an image threshold processing was applied to capture the regions and structures of interest. SEM micrograph and 3-D model reconstructed directly in digital microscope were used to evaluate the reliability and accuracy of this strategy. The morphology of 3-D model constructed by serial sections is consistent with the results of SEM micrograph and 3-D model of digital microscope.

Bian, Weiguo; Tang, Shaojie; Xu, Qiong; Lian, Qin; Wang, Jin; Li, Dichen



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



Review of the literature: elbow incongruity in the dog.  


Elbow incongruity is the term to describe bad alignment of the joint surfaces of the elbow. Two features illustrate incongruity of the elbow: an abnormal shape of the ulnar trochlear notch and a step between the radius and ulna, caused by either a short radius or a short ulna. It has been suggested that both an elliptical notch, and a step, can cause increased local pressure within the joint, resulting in loose fragments at different locations: ununited anconeal process (UAP), fragmented coronoid process (FCP), osteochondritis dissecans of the humeral condyle (OCD). These lesions are grouped under the term 'elbow dysplasia' and are the most frequent causes of front leg lameness in the dog. Although several radiographic features to diagnose incongruity have been described, the 'scoring' of incongruity is subjective because there is currently no objective method to measure the degree of incongruity. Because superimposition is avoided, CT is suggested as a standard technique to measure incongruity. Arthroscopy on the other hand, allows the direct visualisation of the intra-articular structures and their abnormalities. Information on both techniques are still relatively new. Several surgical techniques have been proposed to restore joint congruity; the one most frequently used is an ulnar osteotomy. But because of possible complications, other techniques are being developed. Reports evaluating the results of the different techniques are not yet available. PMID:16594537

Samoy, Y; Van Ryssen, B; Gielen, I; Walschot, N; van Bree, H



Arterial Calcification Is Driven by RAGE in Enpp1-/- Mice  

PubMed Central

Background/Aims Ectopic osteochondral differentiation, driven by ENPP1-catalyzed generation of the chondrogenesis and calcification inhibitor inorganic pyrophosphate (PPi), promotes generalized arterial calcification of infancy. The multiligand receptor for advanced glycation end-products (RAGE), which promotes atherosclerosis and diabetic cardiovascular and renal complications, also mediates chondrocyte differentiation in response to RAGE ligand calgranulins such as S100A11. Here, we tested RAGE involvement in ENPP1 deficiency-associated arterial calcification. Methods Because ectopic artery calcification in Enpp1–/– mice is Pi-dependent and mediated by PPi deficiency, in vitro studies on effects of S100A11 and RAGE on mouse aortic explants were conducted using exogenous Pi, as well as alkaline phosphatase to hydrolyze ambient PPi. Results S100A11 induced cartilage-specific collagen IX/XI expression and calcification dependent on RAGE in mouse aortic explants that was inhibited by the endogenous RAGE signaling inhibitor soluble RAGE (sRAGE). Enpp1–/– aortic explants demonstrated decreased Pi-stimulated release of sRAGE, and increased calcification and type IX/XI collagen expression that were suppressed by exogenous sRAGE and by Rage knockout. Last, Rage knockout suppressed spontaneous aortic calcification in situ in Enpp1–/– mice. Conclusion Cultured Enpp1–/– aortic explants have decreased Pi-stimulated release of sRAGE, and RAGE promotes ectopic chondrogenic differentiation and arterial calcification in Enpp1–/– mice.

Cecil, Denise L.; Terkeltaub, Robert A.



Talar injuries--the orthopaedic challenge.  


Injuries of the talus represents an important part of the foot and ankle trauma. Since talar bone connect the lower limb and foot, the sequelas of its trauma could have significant influence on the function of the whole lower limb and gait. The specific vascularization of the talus results in delayed union and even in the avascular necrosis. The diagnosis of the fractures of the talus can be made on the x-rays, but sometimes real picture of the fracture pattern can be seen only in the CT scans. Ocult fractures such as osteochondral fractures and avascular necrosis can be exactly detected on MRI in aim not to be overlookded as the ankle sprain diagnosis. The precise reduction and stable internal fixation is mandatory in the treatment to enable the anatomical position of the talonavicular, talocrural and subtalar joint and to make possible early motion and rehabilitation, without weight bearing. On the other hand, crushed fractures, open fractures and the Hawkins III-IV fractures with the dislocations of the talar body sometimes needs salvage procedures like Blair or tibio-talar or tibio-calcaneal fusion. PMID:22924299

Lesi?, Aleksandar R; Zagorac, Slavisa G; Bumbasirevi?, Marko Z



Assessment of chemical species of lead accumulated in tidemarks of human articular cartilage by X-ray absorption near-edge structure analysis  

PubMed Central

A highly specific accumulation of the toxic element lead was recently measured in the transition zone between non-calcified and calcified normal human articular cartilage. This transition zone, the so-called ‘tidemark’, is considered to be an active calcification front of great clinical importance. However, little is known about the mechanisms of accumulation and the chemical form of Pb in calcified cartilage and bone. Using spatially resolved X-ray absorption near-edge structure analysis (µ-XANES) at the Pb L 3-edge, the chemical state of Pb in the osteochondral region was investigated. The feasibility of the µ-XANES set-up at the SUL-X beamline (ANKA synchrotron light source) was tested and confirmed by comparing XANES spectra of bulk Pb-reference compounds recorded at both the XAS and the SUL-X beamline at ANKA. The µ-XANES set-up was then used to investigate the tidemark region of human bone (two patella samples and one femoral head sample). The spectra recorded at the tidemark and at the trabecular bone were found to be highly correlated with the spectra of synthetic Pb-doped carbonated hydroxyapatite, suggesting that in both of these very different tissues Pb is incorporated into the hydroxyapatite structure.

Meirer, Florian; Pemmer, Bernhard; Pepponi, Giancarlo; Zoeger, Norbert; Wobrauschek, Peter; Sprio, Simone; Tampieri, Anna; Goettlicher, Joerg; Steininger, Ralph; Mangold, Stefan; Roschger, Paul; Berzlanovich, Andrea; Hofstaetter, Jochen G.; Streli, Christina



[Research on repair strategies for articular cartilage defects].  


Articular cartilage damage is very common in clinical practices. Due to the low self-healing abilities of articular cartilage, the repair strategies for articular cartilage such as arthroscopic lavage and debridement,osteaochondral or chondrocytes transplantation, tissue engineering and hydrogel based artificial cartilage materials are the primary technologies of repairing articular cartilage defect. In this paper,the main repair strategies for the articular cartilage damage and the advantages or disadvantages of each repair technology are summarized. The arthroscopic lavage and debridement is successful in treating the early stage of osteoarthritis. Osteochondral and chondrocytes transplantation are beneficial to treat small full thickness defects. The technology of tissue engineering becomes a new method to heal articular cartilage damage, but the major problem is the absence of bonding strength between the implants and natural defect surfaces. Hydrogel based artificial cartilage possesses similar bio-mechanical and bio-tribological performances to that of natural articular cartilage. However, both bioactivity and interfacial bonding strength between the implant and natural cartilage could be further improved. How to simultaneously optimize the mechanical and bioactive as well as biotribological properties of hydrogel based materials is a focus problem concerned. PMID:23678772

Pan, Yu-Song; Ding, Guo-Xin; Wang, Jing



Low friction hydrogel for articular cartilage repair: evaluation of mechanical and tribological properties in comparison with natural cartilage tissue.  


The mechanical and tribological properties of a novel biomaterial, a boundary lubricant functionalized hydrogel, were investigated and compared to natural cartilage tissue. This low friction hydrogel material was developed for use as a synthetic replacement for focal defects in articular cartilage. The hydrogel was made by functionalizing the biocompatible polymer polyvinyl alcohol with a carboxylic acid derivative boundary lubricant molecule. Two different gel processing techniques were used to create the hydrogels. The first method consisted of initially functionalizing the boundary lubricant to the polyvinyl alcohol and then creating hydrogels by physically crosslinking the reacted polymer. The second method consisted of creating non-functionalized polyvinyl alcohol hydrogels and then performing the functionalization reaction on the fully formed gel. Osteochondral bovine samples were collected and replicate experiments were conducted to compare the mechanical and tribological performance of the boundary lubricant functionalized hydrogels to non-functionalized hydrogels and native cartilage. Friction experiments displayed a maximum decrease in friction coefficient of 70% for the functionalized hydrogels compared to neat polyvinyl alcohol. Indentation investigated the elastic modulus of the hydrogels, demonstrating that stability of the hydrogel was affected by processing method. Hydrogel performance was within the lower ranges of natural cartilage tested under the exact same conditions, showing the potential of the boundary lubricant functionalized hydrogels to perform as a biomimetic synthetic articular cartilage replacement. PMID:23910356

Blum, Michelle M; Ovaert, Timothy C



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.

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



Arthroscopic surgery of the knee: its role in the support of U.S. troops during Operation Desert Shield on USNS mercy.  


The role of arthroscopy in the preconflict deployment of a large number of military troops is not well defined. Between September 1990 and January 1991, while deployed to the Persian Gulf for Operation Desert Shield 73 patients underwent on-board elective arthroscopy on the USNS Mercy. There were 71 men and two women with an average age of 27 years (range 19-47). Indications for arthroscopy included clinical diagnosis of meniscus tear, acute hemarthrosis, chronic effusion, and intra-articular loose body. Findings at the time of arthroscopy included 34 patients (47%) with meniscus tears; 17 (23%) with anterior cruciate ligament tears; five (7%) with isolated grade II-IV chondromalacia involving the patella, trochlea, femoral condyles, or tibial plateaus; six (8%) with synovitis; four (5%) with osteochondritis dissecans of the medial femoral condyle; two (3%) with a medial retinacular tear secondary to patella dislocation; and 10 (14%) with normal arthroscopic examinations. Forty-nine patients (66%) were returned to duty at an average of 6 days postoperatively, obviating the need to evacuate these patients from the Middle East theatre. PMID:1418209

Buckley, S L; Alexander, A; Jones, M; Culp, R W; Smallman, T



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.

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



[Locked posterior dislocation of the hip: a case report].  


Impaction fractures of the femoral head occurring after anterior or posterior hip dislocations are well described. However, locked posterior hip dislocation resulting in sinking of the posterior acetabular rim into the femoral head has hitherto been undescribed. A 26-year-old male patient presented with complaints of severe pain in the left thigh and marked limitation in the movements of the left hip two weeks after an in-car crash. He could only walk with crutches. Shortly after the accident, he was examined at another center with physical examination and plain radiographies and was given bed rest and medications for pain relief. Computed tomography demonstrated the locked posterior hip by the impact of the posterior acetabular rim against the femoral head. At surgery, the posterior acetabular rim was embedded in the anteromedial surface of the femoral head resulting in an osteochondral impaction fracture with a penetration depth of 12 mm. Due to wide destruction to the cartilage surface, an uncemented bipolar hemiarthroplasty was performed. After 28 months of follow-up, he had no complaints and hip movements were painless with full range of motion. PMID:17483654

Esenkaya, Irfan; Elmali, Nurzat



Morphometric changes in the epiphyseal plate of the growing and young adult male rat after long-term salmon calcitonin administration.  


The function of the epiphyseal plate is related to the differentiation and maturation of the chondrocytes, especially of the hypertrophic zone. Salmon calcitonin exerts a positive effect on chondrocytes of different types of cartilage, e.g., articular cartilage, osteochondral callus formation, and the epiphyseal plate. In the present study, the effect of long-term daily salmon calcitonin treatment upon epiphyseal plate function was examined in 80 male Wistar rats aged 12 weeks at the beginning of the experiment. A daily dose of 6 IU of salmon calcitonin enhanced the number of the chondrocytes of the hypertrophic zone of the upper tibial epiphyseal plate, increased the mean thickness of the epiphyseal plate, and accelerated the longitudinal growth of long bones. It was found that the peripheral growth of the epiphyseal plate was delayed after calcitonin treatment in comparison with the placebo-treated animals. The most effective period for calcitonin treatment on epiphyseal plate function seems to be the late accelerated period of growth, i.e., puberty. In conclusion, long-term salmon calcitonin treatment has a beneficial effect on longitudinal skeletal growth and this effect remains throughout the adult life of the animal. Salmon calcitonin does not enlarge the surface of the epiphyseal plate. PMID:15895285

Khaldi, L; Karachalios, Th; Galanos, A; Lyritis, G P



Regenerating articular tissue by converging technologies.  


Scaffolds for osteochondral tissue engineering should provide mechanical stability, while offering specific signals for chondral and bone regeneration with a completely interconnected porous network for cell migration, attachment, and proliferation. Composites of polymers and ceramics are often considered to satisfy these requirements. As such methods largely rely on interfacial bonding between the ceramic and polymer phase, they may often compromise the use of the interface as an instrument to direct cell fate. Alternatively, here, we have designed hybrid 3D scaffolds using a novel concept based on biomaterial assembly, thereby omitting the drawbacks of interfacial bonding. Rapid prototyped ceramic particles were integrated into the pores of polymeric 3D fiber-deposited (3DF) matrices and infused with demineralized bone matrix (DBM) to obtain constructs that display the mechanical robustness of ceramics and the flexibility of polymers, mimicking bone tissue properties. Ostechondral scaffolds were then fabricated by directly depositing a 3DF structure optimized for cartilage regeneration adjacent to the bone scaffold. Stem cell seeded scaffolds regenerated both cartilage and bone in vivo. PMID:18716660

Moroni, Lorenzo; Hamann, Doreen; Paoluzzi, Luca; Pieper, Jeroen; de Wijn, Joost R; van Blitterswijk, Clemens A



Technology insight: adult mesenchymal stem cells for osteoarthritis therapy.  


Despite the high prevalence and morbidity of osteoarthritis (OA), an effective treatment for this disease is currently lacking. Restoration of the diseased articular cartilage in patients with OA is, therefore, a challenge of considerable appeal to researchers and clinicians. Techniques that cause multipotent adult mesenchymal stem cells (MSCs) to differentiate into cells of the chondrogenic lineage have led to a variety of experimental strategies to investigate whether MSCs instead of chondrocytes can be used for the regeneration and maintenance of articular cartilage. MSC-based strategies should provide practical advantages for the patient with OA. These strategies include use of MSCs as progenitor cells to engineer cartilage implants that can be used to repair chondral and osteochondral lesions, or as trophic producers of bioactive factors to initiate endogenous regenerative activities in the OA joint. Targeted gene therapy might further enhance these activities of MSCs. Delivery of MSCs might be attained by direct intra-articular injection or by graft of engineered constructs derived from cell-seeded scaffolds; this latter approach could provide a three-dimensional construct with mechanical properties that are congruous with the weight-bearing function of the joint. Promising experimental and clinical data are beginning to emerge in support of the use of MSCs for regenerative applications. PMID:18477997

Nöth, Ulrich; Steinert, Andre F; Tuan, Rocky S



Increasing the Osmolarity of Joint Irrigation Solutions May Avoid Injury to Cartilage: A Pilot Study  

PubMed Central

Saline (0.9%, 285 mOsm) and Hartmann’s solution (255 mOsm) are two commonly used joint irrigation solutions that alter the extracellular osmolarity of in situ chondrocytes during articular surgery. We asked whether varying the osmolarity of these solutions influences in situ chondrocyte death in mechanically injured articular cartilage. We initially exposed osteochondral tissue harvested from the metacarpophalangeal joints of 3-year-old cows to solutions of 0.9% saline and Hartmann’s solution of different osmolarity (100–600 mOsm) for 2 minutes to allow in situ chondrocytes to respond to the altered osmotic environment. The full thickness of articular cartilage then was “injured” with a fresh scalpel. Using confocal laser scanning microscopy, in situ chondrocyte death at the injured cartilage edge was quantified spatially as a function of osmolarity at 2.5 hours. Increasing the osmolarity of 0.9% saline and Hartmann’s solution to 600 mOsm decreased in situ chondrocyte death in the superficial zone of injured cartilage. Compared with 0.9% saline, Hartmann’s solution was associated with greater chondrocyte death in the superficial zone of injured cartilage, but not when the osmolarity of both solutions was increased to 600 mOsm. These experiments may have implications for the design of irrigation solutions used during arthroscopic and open articular surgery.

Huntley, James S.; Simpson, A. Hamish R. W.; Hall, Andrew C.



Passaged Adult Chondrocytes Can Form Engineered Cartilage with Functional Mechanical Properties: A Canine Model  

PubMed Central

It was hypothesized that previously optimized serum-free culture conditions for juvenile bovine chondrocytes could be adapted to generate engineered cartilage with physiologic mechanical properties in a preclinical, adult canine model. Primary or passaged (using growth factors) adult chondrocytes from three adult dogs were encapsulated in agarose, and cultured in serum-free media with transforming growth factor-?3. After 28 days in culture, engineered cartilage formed by primary chondrocytes exhibited only small increases in glycosaminoglycan content. However, all passaged chondrocytes on day 28 elaborated a cartilage matrix with compressive properties and glycosaminoglycan content in the range of native adult canine cartilage values. A preliminary biocompatibility study utilizing chondral and osteochondral constructs showed no gross or histological signs of rejection, with all implanted constructs showing excellent integration with surrounding cartilage and subchondral bone. This study demonstrates that adult canine chondrocytes can form a mechanically functional, biocompatible engineered cartilage tissue under optimized culture conditions. The encouraging findings of this work highlight the potential for tissue engineering strategies using adult chondrocytes in the clinical treatment of cartilage defects.

Ng, Kenneth W.; Lima, Eric G.; Bian, Liming; O'Conor, Christopher J.; Jayabalan, Prakash S.; Stoker, Aaron M.; Kuroki, Keiichi; Cook, Cristi R.; Ateshian, Gerard A.; Cook, James L.



Basic science and surgical treatment options for articular cartilage injuries of the knee.  


The complex structure of articular cartilage allows for diverse knee function throughout range of motion and weight bearing. However, disruption to the structural integrity of the articular surface can cause significant morbidity. Due to an inherently poor regenerative capacity, articular cartilage defects present a treatment challenge for physicians and therapists. For many patients, a trial of nonsurgical treatment options is paramount prior to surgical intervention. In instances of failed conservative treatment, patients can undergo an array of palliative, restorative, or reparative surgical procedures to treat these lesions. Palliative methods include debridement and lavage, while restorative techniques include marrow stimulation. For larger lesions involving subchondral bone, reparative procedures such as osteochondral grafting or autologous chondrocyte implantation are considered. Clinical success not only depends on the surgical techniques but also requires strict adherence to rehabilitation guidelines. The purpose of this article is to review the basic science of articular cartilage and to provide an overview of the procedures currently performed at our institution for patients presenting with symptomatic cartilage lesions. PMID:22383075

Tetteh, Elizabeth S; Bajaj, Sarvottam; Ghodadra, Neil S



Repair of full-thickness cartilage defects in rabbit knees with free periosteal graft preincubated with transforming growth factor.  


This study compared different concentrations of transforming growth factor-beta 1 (TGF-beta1) used for short-term preincubation in vitro of large periosteal explants to determine the effect of chondrogenesis and the fate of repair cartilage over time. Eighty-two rabbits were divided into four groups: group A, non-grafted; group B, non-incubated grafted; group C, 100 ng/mL recombinant human (rh) TGF-beta1 preincubated grafted; and group D, 20 ng/mL rhTGF-beta1 preincubated grafted. Rabbits from each group were sacrificed at intervals between 2 and 24 weeks. Histologic slides were stained with safranin O and were scored based on a subjective scoring system. Group A healed with non-cartilaginous material. Group B healed with hyaline cartilage-like material with progressive thinning of this regenerated layer; at 24 weeks, this layer was fibrous tissue. Group C enhanced repair with hyaline cartilage-like material but accelerated early degeneration and osteophyte formation; the cartilage became fibrous tissue at 24 weeks. Group D did not enhance cartilaginous repair. At 24 weeks, all groups had the same result. The 100 ng/mL rhTGF-beta1 preincubation in vitro with periosteum enhanced early osteochondral repair but did not show prolonged durability. Clinical application of this growth factor necessitates further study. PMID:12722910

Hsieh, Po-Ching; Thanapipatsiri, Surin; Anderson, Peggy C; Wang, Gwo-Jaw; Balian, Gary



Mechanical and Biochemical Characterization of Cartilage Explants in Serum-Free Culture  

PubMed Central

Allografts of articular cartilage are both used clinically for tissue-transplantation procedures and experimentally as model systems to study the physiological behavior of chondrocytes in their native extracellular matrix. Long-term maintenance of allograft tissue is challenging. Chemical mediators in poorly defined culture media can stimulate cells to quickly degrade their surrounding extracellular matrix. This is particularly true of juvenile cartilage which is generally more responsive to chemical stimuli than mature tissue. By carefully modulating the culture media however it may be possible to preserve allograft tissue over the long-term while maintaining its original mechanical and biochemical properties. In this study juvenile bovine cartilage explants (both chondral and osteochondral) were cultured in both chemically defined medium and serum-supplemented medium for up to 6 weeks. The mechanical properties and biochemical content of explants cultured in chemically-defined medium were enhanced after 2 weeks in culture and thereafter remained stable with no loss of cell viability. In contrast, the mechanical properties of explants in serum-supplemented medium were degraded by (~70%) along with a concurrent loss of biochemical content (30~40% GAG). These results suggest that long-term maintenance of allografts can be extended significantly by the use of a chemically-defined medium.

Bian, L.; Lima, E.G.; Angione, S.L..; Ng, K.W.; Williams, D.Y.; Xu, D.; Stoker, A.M.; Cook, J.L.; Ateshian, G.A.; Hung, C.T.



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.

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



The effects of focal articular defects on intra-tissue strains in the surrounding and opposing cartilage.  


Focal damage to articular cartilage is commonly found in symptomatic knees and may contribute to patient discomfort and progressive cartilage degeneration. The objective of this study was to quantify changes in cartilage intra-tissue strain and sliding occurring near a focal defect. Pairs of human osteochondral blocks were compressed by 20% of the total cartilage thicknesses, and tissue deformation was recorded by video microscopy. Then, a single, full-thickness defect was created in one block from each pair, blocks were allowed to re-swell, and the pairs were retested. Stained nuclei, acting as fiducial markers, were tracked by digital image correlation and used to calculate cartilage strains and surface displacement. With intact samples, axial strain decreased with depth, as is typical of cartilage, and relatively little sliding occurred between surfaces. With defect samples, axial compression of cartilage at the defect rim rose by approximately 30%, shear in the opposing tissue increased 10-fold to approximately 0.15, and local sliding was elevated to > 50 microm. In vivo, tissue near a defect likely experiences increased overall compression, magnifying these observed in vitro effects. Excessive strains may contribute to cell death, matrix damage, or accelerated wear, and repair efficacy may depend on the ability to alleviate adverse mechanical conditions. PMID:18836224

Gratz, Kenneth R; Wong, Benjamin L; Bae, Won C; Sah, Robert L



Cationic contrast agents improve quantification of glycosaminoglycan (GAG) content by contrast enhanced CT imaging of cartilage.  


Minimally invasive and non-destructive methods to quantify glycosaminoglycans (GAGs) in articular cartilage extracellular matrix are of significant interest for the biochemical analysis of cartilage and diagnosis and tracking of osteoarthritis in vivo. Here, we report the use of cationic iodinated contrast agents in comparison to conventional anionic contrast agents for the quantitative monitoring of GAG concentrations with peripheral quantitative computed tomography. Using an ex vivo bovine osteochondral plug model, the cationic contrast agents were evaluated for their ability to distribute into articular cartilage and generate a positive relationship with GAG content. The cationic agents resulted in much higher equilibrium X-ray attenuations in cartilage extracellular matrix (ECM) than anionic agents. Experiments with samples subjected to enzymatic GAG degradation demonstrated that the cationic agents were up to five times more sensitive (p?=?0.0001) to changes in GAG content and had a 24% higher correlation (p?=?0.002) compared to the anionic agent (R(2) ?=?0.86, p?

Bansal, Prashant N; Joshi, Neel S; Entezari, Vahid; Malone, Bethany C; Stewart, Rachel C; Snyder, Brian D; Grinstaff, Mark W



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


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



Arthroscopy of the knee in children.  


Diagnostic arthroscopy was performed in 174 consecutive patients under the age of 18 years. Eight arthroscopies were bilateral. The clinical diagnosis was confirmed in only three of 17 knees in children under aged 14 years and in 44 per cent of the knees in older children. The most commonly disproved diagnoses were torn meniscus and chondromalacia patella. Arthroscopy seldom changed the diagnosis in cases of osteochondritis dissecans. In 38 per cent of the knees, arthroscopy revealed no surgical treatable abnormality, and unnecessary arthrotomy was avoided. Arthroscopy in acute hemarthrosis revealed that ligamentous tears are rather common in children; in nine of 25 knees a partial or complete tear of the anterior cruciate ligament was demonstrated at arthroscopy. The clinical diagnosis was confirmed in eight knees in cases of hemarthrosis. There was no significant difference between the hemarthrosis group and the remaining group as regards a disproved clinical diagnosis. We conclude that arthrotomy should always be preceded by diagnostic arthroscopy in children and adolescents if the clinical diagnosis leaves any doubt. PMID:3630661

Eiskjaer, S; Larsen, S T



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.



Dual tunnel medial patellofemoral ligament reconstruction for patients with patellar dislocation using a semitendinosus tendon autograft.  


The purpose of this study was to describe a safer and more anatomical technique of MPFL reconstruction and to report the short-term results. The subjects included 20 patients with patellar dislocation with a mean age of 23. The operation was performed using a double-looped autogenous semitendinosus tendon graft. Two small bone tunnels were made at the medial edge of the patella, mimicking the wide patellar insertion of the MPFL and a bone tunnel was made at the femoral insertion site. The free ends of the graft attached to the patella and the loop end was fixed to the femoral side. Five patients were available for follow-up interviews by telephone and the remaining 15 were directly examined by physical examination and radiographic evaluation at 2 years or longer postoperatively. The average follow-up period was 30 months. Re-dislocation or patellar fracture was not seen in any patients. The average Kujala's score was 96 with a range from 84 to 100. Six patients were classified as excellent and 14 as good, according to the Crosby and Insall grading system. Radiographically, narrowing of the patellofemoral joint space was observed in 2 cases with previous osteochondral fracture out of those who were directly examined. The dual tunnel MPFL reconstruction produces favorable results in subjective and functional assessment of outcome without complications. PMID:20684880

Toritsuka, Yukiyoshi; Amano, Hiroshi; Mae, Tatsuo; Uchida, Ryohei; Hamada, Masayuki; Ohzono, Kenji; Shino, Konsei



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.

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



Association of growth, feeding practices and exercise conditions with the severity of the osteoarticular status of limbs in French foals.  


The aim of this study was to identify the risk factors for the severity of Juvenile OsteoChondral Conditions (JOCC) in limbs of French foals. Twenty-one farms in Normandy, France, were sampled and enrolled in a cohort study including 378 foals from three breeds, followed from the 8th month of pregnancy of the mares until the foals were approximately 6months old. Data on growth, feeding practices and exercise conditions were regularly collected. The carpus, the front and hind digits, the hock and the stifle of the foals were radiographed at the end of follow-up. JOCC severity in each foal was described using a global appraisal of its osteoarticular status (OAS) depending on the number and the severity of radiographic findings. Of the 378 foals, 53% had a good OAS, 34% had an intermediate OAS and 13% had a poor OAS. The breed (Selle Français and French Trotter Standardbred vs. Thoroughbred), a high girth perimeter at early age and an irregular exercise were significantly associated with a poor OAS. This study contributes to the understanding of the development of JOCC. An increased growth and reduced or irregular physical activity during the first weeks of life would be responsible for more severe lesions. Growth and exercise conditions should be carefully monitored to reduce the prevalence of severe JOCC in foals. PMID:23664071

Lepeule, Johanna; Bareille, Nathalie; Robert, Céline; Valette, Jean-Paul; Jacquet, Sandrine; Blanchard, Géraldine; Denoix, Jean-Marie; Seegers, Henri



Management of Focal Chondral Lesion in the Knee Joint  

PubMed Central

Articular cartilage does not contain vascular, nervous and lymphatic tissue and chondrocytes hardly participate in the healing or repair process of chondral tissue because of being surrounded by plenty of extracellular matrix. Therefore, the injury to articular cartilage frequently requires an operative treatment. The goal of surgical repair of articular cartilage is to regenerate nearly normal chondral tissue and prevent degenerative arthritis caused by the articular cartilage defect. Microfracture is a kind of cartilage repair procedure that makes a fibrin clot containing mesenchymal stem cells in the chondral lesion. Microfracture is a simple procedure but it has a disadvantage that the repaired tissue is fibrocartilage. Autologous chondrocyte implantation has an advantage that it implants fully differentiated chondrocytes to the lesion, which theoretically produces hyaline cartilage. Its disadvantages are that it is a two stage and a costly procedure. Osteochondral autograft transplantation is a one stage procedure and repairs the lesion with hyaline cartilage. But its limitation is the lack of donor site availability. Surgeons who understand the theoretical background, indications, surgical methods, rehabilitation, complications, and clinical course of cartilage repair procedures can achieve the goal of preventing degenerative arthritis.

Kim, Chang-Wan; Jung, Dae-Won



Chronic ankle instability.  


Chronic instability of the ankle and anterolateral impingement syndrome are abnormalities that present as a result of inversion and forced plantar-flexion traumas of the foot, despite strict conservative management in the ER and in rehabilitation. A conservative approach is always the first choice of treatment, including anti-inflammatory medications, rehabilitation and proprioception, infiltration with steroids in impingement cases, and use of orthotics, whose true effectiveness is the subject of multiple studies and much debate. Good to excellent results can be obtained surgically with a minimally invasive approach, such as the arthroscopic technique presented herein. Such an approach is useful in managing a combination of conditions such as anterolateral impingement, synovitis, and osteochondral lesions of the talus. The method is easily reproducible, its learning curve is rapid, and it has the advantage of not preventing the use other arthroscopic methods, or open anatomic or nonanatomic methods (tendon transfers), in the case of failure. No nerve lesion was recorded, probably owing to the use of the security zone, and neither was there any arthrofibrosis, possibly related to the use of nonsteroidal anti-inflammatory medications in the immediate postsurgical period coupled with aggressive rehabilitation from the fourth week. The success of the technique is due to multidisciplinary team work leading to the ultimate achievement of patient satisfaction. This technique is not indicated for patients with a high sports demand or for sport professionals, until further biomechanical studies on its use and success are completed. PMID:22938637

Gerstner Garces, Juan Bernardo



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


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. Original submitted 28 February 2012; Revised submitted 8 November 2012. 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



Glenohumeral relationships: Subchondral mineralization patterns, thickness of cartilage, and radii of curvature.  


Subchondral mineralization represents the loading history of a joint and can be measured in vivo using computed tomography osteoabsorptiometry. Different mineralization patterns in the glenohumeral joint have been explained by the principle of physiologic incongruence. We sought to support this explanation by measurement of mineralization, radii, and cartilage thickness in 18 fresh shoulder specimens. We found three mineralization patterns: bicentric, monocentric anterior, and monocentric central. Mean radii of the glenoids were 27.4?mm for bicentric glenoids, 27.3?mm for monocentric anterior, and 24.8?mm for monocentric central glenoids. Cartilage thickness measurement revealed the highest values in anterior parts; the thinnest cartilage was found centrally. Our findings support the principle of a physiologic incongruence in the glenohumeral joint. Bicentric mineralization patterns exist in joints consisting of more flat glenoids compared to the corresponding humeral head. Monocentric distribution with a central maximum was found in specimens with glenoids being more curved, indicating higher degrees of congruence, which might represent an early stage of degenerative disease. The obtained information might also be important for implant fixation in resurfacing procedures or to achieve the best possible fit of an osteochondral allograft in the repair of cartilage defects. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31:1704-1707, 2013. PMID:23817988

Zumstein, Valentin; Kraljevi?, Marko; Müller-Gerbl, Magdalena



Complement in acute and chronic arthritides: assessment of C3c, C9, and protectin (CD59) in synovial membrane.  

PubMed Central

OBJECTIVES: To investigate the role of complement cascade induced damage and protection against it in acute arthritides compared to rheumatoid arthritis and other chronic joint derangements. METHODS: C3c, C9, and protectin (CD59) were examined by avidin-biotin-peroxidase complex staining. RESULTS: Marked deposits of C3c and C9 were found in synovial vasculature and intercellular matrix of the lining in rheumatoid arthritis and in acute arthritides (including bacterial, reactive, and osteoarthritis flare up). Furthermore, protectin was not visible in synovial lining cells and was relatively weakly expressed in stromal and endothelial cells in rheumatoid arthritis; also in acute arthritides protectin expression was weak. In contrast, C3c and C9 deposits were not found in chronic conditions associated with degenerative diseases (osteoarthritis and osteochondritis dissecans) or mechanical causes (patellar luxation and a ruptured meniscus), in which also the protectin expression was prominent in synovial lining, endothelial and some stromal cells. CONCLUSIONS: Activation of the complement in rheumatoid arthritis and in acute arthritides seems to be associated with a decreased protection of synovial cells against cellular effects and lysis mediated by membrane attack complex. Images

Konttinen, Y T; Ceponis, A; Meri, S; Vuorikoski, A; Kortekangas, P; Sorsa, T; Sukura, A; Santavirta, S



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:



[Acute knee block. Assessment with magnetic resonance, correlated with arthroscopy].  


Posttraumatic acute articular blocks of the knee may be caused by "mechanical" factors, such as the interposition of some osteochondral, meniscal or ligamentous fragments between condyles and tibial plateau or by non-mechanical ("functional") factors, such as the pain associated with capsular-ligamentous structure injuries or with intraosseous bruises involving the synovia. From January, 1994, to January, 1996, we examined 751 patients for posttraumatic knee injuries. The patients were submitted to MRI with a dedicated unit and we selected 86 of them who had an acute articular block as the major symptom. The block had a mechanical cause in 36 patients of the selected group (41.8%), as confirmed at arthroscopy, while the other 50 patients (58.2%) had a functional block. Fifteen of the latter patients had only intraosseous bruising, with no ligament or meniscus damage, while the other 35 had isolated or variously associated menisco-ligamentous injuries, as confirmed at arthroscopy. All the patients also had some intraosseous bruises which were clearly depicted at MRI. This study demonstrates that MRI is an extremely valuable tool in assessing the cause of articular blocks, allowing a prompt appropriate choice to be made between therapeutic arthroscopy and weight-free limb immobilization. PMID:9380865

Perin, B; Nardacchione, R; Bonaga, S; Angelini, F; Girotto, A; Giovagnoni, A; Valeri, G


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.

Yang, Peter J.



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.

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



Comparison of ultrasound and optical coherence tomography techniques for evaluation of integrity of spontaneously repaired horse cartilage.  


The aim of this study was to compare sensitivity of ultrasound and optical coherence tomography (OCT) techniques for the evaluation of the integrity of spontaneously repaired horse cartilage. Articular surfaces of horse intercarpal joints, featuring both intact tissue and spontaneously healed chondral or osteochondral defects, were imaged ex vivo with arthroscopic ultrasound and laboratory OCT devices. Quantitative ultrasound (integrated reflection coefficient (IRC), apparent integrated backscattering coefficient (AIB) and ultrasound roughness index (URI)) and optical parameters (optical reflection coefficient (ORC), optical roughness index (ORI) and optical backscattering (OBS)) were determined and compared with histological integrity and mechanical properties of the tissue. Spontaneously healed tissue could be quantitatively discerned from the intact tissue with ultrasound and OCT techniques. Furthermore, several significant correlations (p?

Virén, T; Huang, Y P; Saarakkala, S; Pulkkinen, H; Tiitu, V; Linjama, A; Kiviranta, I; Lammi, M J; Brünott, A; Brommer, H; Van Weeren, R; Brama, P A J; Zheng, Y P; Jurvelin, J S; Töyräs, J



Arthroscopic ultrasound technique for simultaneous quantitative assessment of articular cartilage and subchondral bone: an in vitro and in vivo feasibility study.  


Traditional arthroscopic examination is subjective and poorly reproducible. Recently, we introduced an arthroscopic ultrasound method for quantitative diagnostics of cartilage lesions. Here we describe our investigation of the feasibility of ultrasound arthroscopy for simultaneous measurements of articular cartilage and subchondral bone. Human osteochondral samples (n = 13) were imaged using a clinical 9-MHz ultrasound system. Ultrasound reflection coefficients (R, IRC), the ultrasound roughness index (URI) and the apparent integrated backscattering coefficient (AIB) were determined for both tissues. Mechanical testing, histologic analyses and micro-scale computed tomography imaging were the reference methods. Ultrasound arthroscopies were conducted on two patients. The ultrasound reflection coefficient correlated with the Mankin score and Young's modulus of cartilage (|r| > 0.56, p < 0.05). Ultrasound parameters (R, IRC, AIB) for subchondral bone correlated with the bone surface/volume ratio (|r| > 0.70, p < 0.05) and trabecular thickness (|r| > 0.59, p < 0.05). Furthermore, R and subchondral bone mineral density were significantly correlated (|r| > 0.65, p < 0.05). Arthroscopic ultrasound examination provided diagnostically valuable information on cartilage and subchondral bone in vivo. PMID:23743098

Liukkonen, J; Hirvasniemi, J; Joukainen, A; Penttilä, P; Virén, T; Saarakkala, S; Kröger, H; Jurvelin, J S; Töyräs, J



Regional cartilage properties of three quadruped tibiofemoral joints used in musculoskeletal research studies.  


Quadruped joints are commonly used in musculoskeletal studies as a surrogate for human joints despite inherent differences in tissue properties. Although concerns exist regarding model validity, relatively few studies comparing the mechanical properties of quadruped tissue exist. This study aimed to characterise the regional intrinsic mechanical properties and thickness of tibiofemoral cartilage from three quadrupeds used in modern musculoskeletal research. Osteochondral plugs were removed from the major weight-bearing regions of porcine (6 months), bovine (18-24 months) and ovine (approximately 5 years) tibiofemoral joints. The equilibrium elastic modulus and permeability of the cartilage were derived by combining the creep indention deformation results and calculated tissue thickness within an in-silica model. Results showed significant interspecies and regional variation in cartilage thickness. Cartilage was thickest on porcine femoral condyles whereas ovine cartilage was consistently thinner across all sites. Furthermore, porcine tissue had a significantly lower equilibrium elastic modulus and significantly higher permeability than ovine cartilage. The results highlight the importance of considering the interspecies and regional variation in quadruped tissue properties when selecting animal joints for musculoskeletal investigations. PMID:23057238

McLure, Stewart W D; Fisher, John; Conaghan, Philip G; Williams, Sophie



Intraarticular gene transfer of thrombospondin-1 suppresses the disease progression of experimental osteoarthritis.  


In osteoarthritis, angiogenesis, which occurs in the osteochondral junction and synovium, may accelerate inflammation and contribute to the severity of the disease. We used anterior cruciate ligament-transection (ACLT) to investigate the therapeutic effect of an angiogenesis inhibitor, thrombospondin-1 (TSP-1), in a rat model of osteoarthritis. Osteoarthritis was induced in Wistar rats in the knee of one hind leg. After ACLT, AdTSP-1 (adenoviral vector encoding mouse TSP-1) was intraarticularly injected into the knee joints. Transgene expression, angiogenesis, and inflammatory responses in the knee joints were examined. They were also assessed morphologically, radiographically, and histologically for manifestations of disease. The levels of TSP-1 peaked on day 3 and were substantially maintained for at least 9 days after AdTSP-1 infection. Adenovirus-mediated gene expression was detected in the synovial membrane and chondrocytes. TSP-1 gene transfer induced transforming growth factor-? (TGF-?) production, but it reduced microvessel density, macrophage infiltration, and interleukin-1? (IL-1?) levels. Gross morphological and histopathological examinations revealed that rats treated with AdTSP-1 had less severe osteoarthritis than controls. In vivo adenovirus-mediated TSP-1 gene transfer significantly reduced microvessel density, inflammation, and suppressed the progression of osteoarthritis. This study provides potential applications of TSP-1 gene delivery for treating osteoarthritis. PMID:20309955

Hsieh, Jeng-Long; Shen, Po-Chuan; Shiau, Ai-Li; Jou, I-Ming; Lee, Che-Hsin; Wang, Chrong-Reen; Teo, Min-Li; Wu, Chao-Liang



Design and validation of a compressive tissue stimulator with high-throughput capacity and real-time modulus measurement capability.  


Mechanical stimulation has been shown to impact the properties of engineered hyaline cartilage constructs and is relevant for engineering of cartilage and osteochondral tissues. Most mechanical stimulators developed to date emphasize precision over adaptability to standard tissue culture equipment and protocols. The realization of mechanical characteristics in engineered constructs approaching native cartilage requires the optimization of complex variables (type of stimulus, regimen, and bimolecular signals). We have proposed and validated a stimulator design that focuses on high construct capacity, compatibility with tissue culture plastic ware, and regimen adaptability to maximize throughput. This design utilizes thin force sensors in lieu of a load cell and a linear encoder to verify position. The implementation of an individual force sensor for each sample enables the measurement of Young's modulus while stimulating the sample. Removable and interchangeable Teflon plungers mounted using neodymium magnets contact each sample. Variations in plunger height and design can vary the strain and force type on individual samples. This allows for the evaluation of a myriad of culture conditions and regimens simultaneously. The system was validated using contact accuracy, and Young's modulus measurements range as key parameters. Contact accuracy for the system was excellent within 1.16% error of the construct height in comparison to measurements made with a micrometer. Biomaterials ranging from bioceramics (cancellous bone, 123?MPa) to soft gels (1% agarose, 20?KPa) can be measured without any modification to the device. The accuracy of measurements in conjunction with the wide range of moduli tested demonstrate the unique characteristics of the device and the feasibility of using this device in mapping real-time changes to Young's modulus of tissue constructs (cartilage, bone) through the developmental phases in ex vivo culture conditions. PMID:21988089

Salvetti, David J; Pino, Christopher J; Manuel, Steven G; Dallmeyer, Ian; Rangarajan, Sanjeet V; Meyer, Tobias; Kotov, Misha; Shastri, V Prasad



The restoration of full-thickness cartilage defects with BMSCs and TGF-beta 1 loaded PLGA/fibrin gel constructs.  


Poly(lactide-co-glycolide) (PLGA) sponge was filled with fibrin gel, bone marrow mesenchymal stem cells (BMSCs) and transforming growth factor-?1 (TGF-?1) to obtain a construct for cartilage restoration in vivo. The PLGA sponge lost its weight steadily in vitro, but degraded much faster in the construct of PLGA/fibrin gel/BMSCs implanted in the full-thickness cartilage defects. The in vivo degradation of the fibrin gel inside the construct was prolonged to 12 wk too. The CM-DiI labeled allogenic BMSCs were detectable after transplantation (implantation) into the defects for 12 wk by small animal in vivo fluorescence imaging and confocal laser scanning microscopy. In vivo repair experiments were firstly performed by implantation of the PLGA/fibrin gel/BMSCs and PLGA/BMSCs constructs into full-thickness cartilage defects (3 mm in diameter and 4 mm in depth) of New Zealand white rabbits for 12 wk. The defects implanted with the PLGA/fibrin gel/BMSCs constructs were filled with cartilage-like tissue containing collagen type II and glycosaminoglycans (GAGs), while those by the PLGA/BMSCs constructs were filled with fibrous-like tissues. To repair the defects of larger size (4 mm in diameter), addition of growth factors was mandatory as exemplified here by further loading of TGF-?1. Implantation of the PLGA/fibrin gel/BMSCs/TGF-?1 constructs into the full-thickness cartilage defects for 12 wk resulted in full restoration of the osteochondral tissue. The neo-cartilage integrated well with its surrounding cartilage and subchondral bone. Immunohistochemical and GAGs staining confirmed the similar distribution of collagen type II and GAGs in the regenerated cartilage as that of hyaline cartilage. The quantitative reverse transcription-polymerase chain reaction (qRT-PCR) revealed that the cartilage special genes were significantly up-regulated compared with those of the TGF-?1 absent constructs. PMID:20822812

Wang, Wei; Li, Bo; Yang, Junzhou; Xin, Long; Li, Yanglin; Yin, Hongpin; Qi, Yiying; Jiang, Yangzi; Ouyang, Hongwei; Gao, Changyou



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.

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



Transphyseal reconstruction of the anterior cruciate ligament in prepubescent athletes.  


ACL reconstruction in adolescents undergoing or being beyond the final growth spurt can be performed as in adults without major concern of growth disturbance. Whereas for the young athlete with wide-open physis a lot of controversy still exists about the technical aspect of the procedure to minimise the risk of growth disturbance. Between 10/1997 and 10/2002 31 children graded Tanner stage 1 or 2 (median age 11 years) with an intraligamental rupture of the anterior cruciate ligament were enrolled. Seventeen patients with coexisting intraarticular damage (meniscus, osteochondral flake) underwent transphsyeal reconstruction of the ACL with the use of an autogenous semitendinosus tendon graft, whereas 14 patients without coexisting pathologies received a nonoperative regime. Growth disturbance, functional and radiographic outcome could be evaluated in 28 patients at a median of 70 months after initial treatment. No patient had clinical or radiological evidence for varus/valgus malalignment or leg length discrepancy. The mean of subsequent body growth within the study population was 20.3 cm. Patients operated on revealed significant (P < 0.05) better clinical (KT-1000 side-to-side difference, pivot shift) and functional results according to the IKDC (median, 95 vs. 87), Lysholm (median, 93 vs. 84) and the Tegner score. More than half of the conservatively treated patients (58%) had subsequent surgery due to persistent instability. Transphyseal reconstruction of intraligamental ACL ruptures with an autologous ST graft yielded superior clinical results if compared to a nonoperative treatment in immature prepubescent patients being Tanner stage 1 and 2. PMID:20130837

Streich, Nikolaus A; Barié, Alexander; Gotterbarm, Tobias; Keil, Maximilian; Schmitt, Holger



Short-term changes in cell and matrix damage following mechanical injury of articular cartilage explants and modelling of microphysical mediators.  


The short-term responses of articular cartilage to mechanical injury have important implications for prevention and treatment of degenerative disease. Cell and matrix responses were monitored for 11 days following injurious compression of cartilage in osteochondral explants. Injury was applied as a single ramp compression to 14 MPa peak stress at one of three strain rates: 7 x 10(-1), 7 x 10(-3) or 7 x 10(-5) s(-1). Responses were quantified in terms of the appearance of macroscopic matrix cracks, changes in cell viability, and changes in cartilage wet weights. Loading at the highest strain rate resulted in acute cell death near the superficial zone in association with cracks, followed over the 11 days after compression by a gradual increase in cell death and loss of demarcation between matrix zones containing viable versus nonviable cells. In contrast, loading at the lowest strain rate resulted in more severe, nearly full-depth cell death acutely, but with no apparent worsening over the 11 days following compression. Between days 4 and 11, all mechanically injured explants significantly increased in wet weight, suggesting loss of matrix mechanical integrity independent of compression strain rate. Results demonstrate that short-term responses of cartilage depend upon the biomechanical characteristics of injurious loading, and suggest multiple independent pathways of mechanically-induced cell death and matrix degradation. Modifications to an existing fiber-reinforced poroelastic finite element model were introduced and the model was used for data interpretation and identification of microphysical events involved in cell and matrix injury. The model performed reasonably well at the slower strain rates and exhibited some capacity for anticipating the formation of superficial cracks during injurious loading. However, several improvements appear to be necessary before such a model could reliably be used to draw upon in vitro experimental results for prediction of injurious loading situations in vivo. PMID:15299282

Morel, V; Quinn, T M



Chondrogenesis and Mineralization During In Vitro Culture of Human Mesenchymal Stem Cells on Three-Dimensional Woven Scaffolds  

PubMed Central

Human mesenchymal stem cells (hMSCs) and three-dimensional (3D) woven poly(?-caprolactone) (PCL) scaffolds are promising tools for skeletal tissue engineering. We hypothesized that in vitro culture duration and medium additives can individually and interactively influence the structure, composition, mechanical, and molecular properties of engineered tissues based on hMSCs and 3D poly(?-caprolactone). Bone marrow hMSCs were suspended in collagen gel, seeded on scaffolds, and cultured for 1, 21, or 45 days under chondrogenic and/or osteogenic conditions. Structure, composition, biomechanics, and gene expression were analyzed. In chondrogenic medium, cartilaginous tissue formed by day 21, and hypertrophic mineralization was observed in the newly formed extracellular matrix at the interface with underlying scaffold by day 45. Glycosaminoglycan, hydroxyproline, and calcium contents, and alkaline phosphatase activity depended on culture duration and medium additives, with significant interactive effects (all p?osteochondral defect repair.

Abrahamsson, Christoffer K.; Yang, Fan; Park, Hyoungshin; Brunger, Jonathan M.; Valonen, Piia K.; Langer, Robert; Welter, Jean F.; Caplan, Arnold I.; Guilak, Farshid



Poly(2-acrylamido-2-methylpropanesulfonic acid) gel induces articular cartilage regeneration in vivo: comparisons of the induction ability between single- and double-network gels.  


The purpose of this study was to determine the in vivo cartilage induction effect of the poly(2-acrylamido-2-methylpropanesulfonic acid) (PAMPS) single-network (SN) gel and poly(N,N'-dimethyl acrylamide) (PDMAAm) SN gel in comparison with that of the PAMPS/PDMAAm double-network (DN) gel. An osteochondral defect created in rabbit trochlea was treated with PAMPS/PDMAAm DN, PAMPS SN, or PDMAAm SN gel implantation or left untreated. The gel was implanted into the defect so that a 2-mm depth remained. The defects were examined by histologic and immunohistochemical evaluations, surface assessment using confocal laser scanning microscopy, and real-time polymerase chain reaction analysis at 4 weeks. Samples were quantitatively evaluated with a scoring system reported by Wayne et al. The PAMPS/PDMAAm DN gel-implanted defect was filled with the hyaline-like cartilage tissue. The PAMPS SN gel-implanted defect was filled inhomogenously with hyaline/fibrocartilage tissue. The histology score of the defect treated with PAMPS/PDMAAm DN gel was significantly higher than those treated with PAMPS and PDMAAm SN gels, and the untreated defect (p = 0.0408, p < 0.0001, and p < 0.0001, respectively) and the scores of the defect treated with PAMPS SN gel were significantly higher than those treated with PDMAAm SN gel and the untreated defect (p = 0.0026 and p = 0.0026, respectively). These results suggested that the PAMPS SN gel has an ability that can induce hyaline cartilage regeneration in vivo, but that the PDMAAm SN gel does not. The current study indicates that the chondrogenic potential of a negatively charged PAMPS gel component plays an important role in the cartilage regeneration ability of the PAMPS/PDMAAm DN gel in vivo. PMID:22492713

Ogawa, Munehiro; Kitamura, Nobuto; Kurokawa, Takayuki; Arakaki, Kazunobu; Tanaka, Yasuhito; Gong, Jian Ping; Yasuda, Kazunori



Magnetic resonance imaging of the knee.  


Magnetic resonance imaging (MRI) is an accepted non-invasive modality for evaluation of soft tissue pathology without exposure to ionizing radiation. Current applications demonstrate excellent visualization of the anatomy and pathology of various organs. Preliminary studies in the knee reveal fine resolution of anatomy and pathology involving the meniscus. The purpose of this study is to determine a prospective correlation between MRI scans and actual meniscal pathology as documented at the time of arthroscopy. MRI scans were obtained in 155 patients, on 156 knees (one patient with bilateral scans), with 86 patients (87 knees) eventually undergoing diagnostic and operative videoarthroscopy performed by the same surgeon (DWJ). All images were obtained on the same high-resolution 1.5 Tesla GE Signa Magnetic Resonance Scanner with the same radiologist performing all readings (PEB). The knees were studied in the coronal and sagittal plane using a spin echo sequence and 5 mm slice thicknesses. The menisci were described as having Grade 1, 2, or 3 changes, with Grade 3 reserved for complete tears. Using arthroscopy as the diagnostic standard, the accuracy of MRI in diagnosing medial and lateral meniscal tears was 93.1% and 96.6%, respectively with a Grade 3 MRI reading. For tears of the ACL, the accuracy was 96.6% as confirmed at arthroscopy. Five tears of the PCL were also documented by MRI and correlated with clinical evaluation. Other abnormalities seen were articular cartilage and osteochondral defects, bone tumors, tibial plateau fractures, Baker's cysts, and meniscal cysts. The MRI scan is a highly accurate, noninvasive modality for documentation of meniscal pathology as well as cruciate ligament tears in the knee. PMID:3344877

Jackson, D W; Jennings, L D; Maywood, R M; Berger, P E


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.

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



Multiple recombinant adeno-associated viral vector serotypes display persistent in vivo gene expression in vector-transduced rat stifle joints.  


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

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



Effects of optical beam angle on quantitative optical coherence tomography (OCT) in normal and surface degenerated bovine articular cartilage  

NASA Astrophysics Data System (ADS)

Quantitative measurement of articular cartilage using optical coherence tomography (OCT) is a potential approach for diagnosing the early degeneration of cartilage and assessing the quality of its repair. However, a non-perpendicular angle of the incident optical beam with respect to the tissue surface may cause uncertainty to the quantitative analysis, and therefore, significantly affect the reliability of measurement. This non-perpendicularity was systematically investigated in the current study using bovine articular cartilage with and without mechanical degradation. Ten fresh osteochondral disks were quantitatively measured before and after artificially induced surface degradation by mechanical grinding. The following quantitative OCT parameters were determined with a precise control of the surface inclination up to an angle of 10° using a step of 2°: optical reflection coefficient (ORC), variation of surface reflection (VSR) along the surface profile, optical roughness index (ORI) and optical backscattering (OBS). It was found that non-perpendicularity caused systematic changes to all of the parameters. ORC was the most sensitive and OBS the most insensitive to the inclination angle. At the optimal perpendicular angle, all parameters could detect significant changes after surface degradation (p < 0.01), except OBS (p > 0.05). Nonsignificant change of OBS after surface degradation was expected since OBS reflected properties of the internal cartilage tissue and was not affected by the superficial mechanical degradation. As a conclusion, quantitative OCT parameters are diagnostically potential for characterizing the cartilage degeneration. However, efforts through a better controlled operation or corrections based on computational compensation mechanism should be made to minimize the effects of non-perpendicularity of the incident optical beam when clinical use of quantitative OCT is considered for assessing the articular cartilage.

Huang, Yan-Ping; Saarakkala, Simo; Toyras, Juha; Wang, Li-Ke; Jurvelin, Jukka S.; Zheng, Yong-Ping



Articular cartilage repair using allogeneic perichondrocyte-seeded biodegradable porous polylactic acid (PLA): a tissue-engineering study.  


Efforts to expand treatment options for articular cartilage repair have increasingly focused on the implantation of cell-polymer constructs. The purpose of this study is to determine the suitability of porous D,D-L,L-polylactic acid as a carrier for delivering repair cells obtained from rib perichondrium into full-thickness articular cartilage defects. In vitro characterization of perichondrocyte-polylactic acid composite grafts was combined with in vivo assessment of the early articular cartilage repair in a clinically relevant model. Using a fluorescent double-stain protocol to visualize live and dead cells in situ, primary cells cultured from perichondrium were found to be capable of attaching to and surviving within a porous D,D-L,L-polylactic acid matrix. These perichondrocyte-polylactic acid composite grafts were then implanted within osteochondral defects drilled into the left medial femoral condyles of 16 adult New Zealand white rabbits. Experimental animals were sacrificed 6 weeks after implantation and the repair tissue was evaluated grossly, histologically, and biochemically. Grossly, 96% (15/16) of the experimental animals demonstrated repairs consisting of a smooth, firm neocartilage which appeared similar in color and texture to the surrounding articular surface. Matrix staining for cartilaginous protein was seen surrounding chondrocyte-like cells in the cartilage regions of the repair. Cellular alignment was found to be related to scaffold architecture. These results suggest that scaffolds composed of porous D,D-L,L-polylactic acid support the growth of cartilaginous repair tissue and are compatible with both in vitro and in vivo survival of chondrogenic cells. PMID:8567713

Chu, C R; Coutts, R D; Yoshioka, M; Harwood, F L; Monosov, A Z; Amiel, D



Strategies for articular cartilage lesion repair and functional restoration.  


Injury of articular cartilage due to trauma or pathological conditions is the major cause of disability worldwide, especially in North America. The increasing number of patients suffering from joint-related conditions leads to a concomitant increase in the economic burden. In this review article, we focus on strategies to repair and replace knee joint cartilage, since knee-associated disabilities are more prevalent than any other joint. Because of inadequacies associated with widely used approaches, the orthopedic community has an increasing tendency to develop biological strategies, which include transplantation of autologous (i.e., mosaicplasty) or allogeneic osteochondral grafts, autologous chondrocytes (autologous chondrocyte transplantation), or tissue-engineered cartilage substitutes. Tissue-engineered cartilage constructs represent a highly promising treatment option for knee injury as they mimic the biomechanical environment of the native cartilage and have superior integration capabilities. Currently, a wide range of tissue-engineering-based strategies are established and investigated clinically as an alternative to the routinely used techniques (i.e., knee replacement and autologous chondrocyte transplantation). Tissue-engineering-based strategies include implantation of autologous chondrocytes in combination with collagen I, collagen I/III (matrix-induced autologous chondrocyte implantation), HYAFF 11 (Hyalograft C), and fibrin glue (Tissucol) or implantation of minced cartilage in combination with copolymers of polyglycolic acid along with polycaprolactone (cartilage autograft implantation system), and fibrin glue (DeNovo NT graft). Tissue-engineered cartilage replacements show better clinical outcomes in the short term, and with advances that have been made in orthopedics they can be introduced arthroscopically in a minimally invasive fashion. Thus, the future is bright for this innovative approach to restore function. PMID:20025455

Ahmed, Tamer A E; Hincke, Maxwell T



Fabrication of poly(lactide-co-glycolide) scaffold filled with fibrin gel, mesenchymal stem cells, and poly(ethylene oxide)-b-poly(L-lysine)/TGF-?1 plasmid DNA complexes for cartilage restoration in vivo.  


A poly (lactide-co-glycolide) (PLGA) scaffold filled with fibrin gel, mesenchymal stem cells (MSCs) and poly(ethylene oxide)-b-poly (L-lysine) (PEO-b-PLL)/pDNA-TGF-?1 complexes was fabricated and applied in vivo for synchronized regeneration of cartilage and subchondral bone. The PEO-b-PLL/pDNA-TGF-?1 complexes could transfect MSCs in vitro to produce TGF-?1 in situ and up regulate the expression of chondrogenesis-related genes in the construct. The expression of heterogeneous TGF-?1 in vivo declined along with the prolongation of implantation time, and lasted for 3 and 6 weeks in the mRNA and protein levels, respectively. The constructs (Experimental group) of PLGA/fibrin gel/MSCs/(PEO-b-PLL/pDNA-TGF-?1 complexes) were implanted into the osteochondral defects of rabbits to restore the functional cartilages, with gene-absent constructs as the Control. After 12 weeks, the Experimental group regenerated the neo-cartilage and subchondral bone with abundant deposition of glycosaminoglycans (GAGs) and type II collagen. The regenerated tissues had good integration with the host tissues too. By contrast, the defects were only partially repaired by the Control constructs. qRT-PCR results demonstrated that expression of the chondrogenesis-marker genes in the Experimental group was significantly higher than that of the Control group, and was very close to that of the normal cartilage tissue. © 2013 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 101A: 3097-3108, 2013. PMID:23529956

Li, Bo; Yang, Junzhou; Ma, Lie; Li, Feifei; Tu, Zhengyuan; Gao, Changyou



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


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



Histopomorphic Evaluation of Radiofrequency Mediated D?bridement 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.

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



Blocking VEGF with sFlt1 improves the chondrogenic potential of mouse skeletal muscle-derived stem cells  

PubMed Central

Objective To investigate the effect of VEGF stimulation and the effect of blocking VEGF with its antagonist, sFlt1, on chondrogenesis using skeletal muscle-derived stem cells (MDSCs). Methods The direct effect of VEGF on the in vitro chondrogenic ability of mouse MDSCs was tested using a pellet culture system followed by quantitative real time PCR and histological analyses. Next, the effect of VEGF on chondrogenesis within the synovial joint was tested using genetically engineered MDSCs implanted into the rat osteochondral defect. In this model, MDSCs, transduced with a retroviral vector to express BMP4, were co-implanted with MDSCs transduced to express either VEGF or sFlt1 (a VEGF antagonist) to provide a gain- and loss-of VEGF function experimental design. Histological scoring was used to compare cartilage formation among the treatment groups. Results Hyaline-like cartilage matrix production was observed in both VEGF-treated and VEGF-blocked (sFlt1-treated) pellet cultures, but real-time PCR revealed that sFlt1 treatment improved the expression of chondrogenic genes in MDSCs that were stimulated to undergo chondrogenic differentiation with BMP4 and TGF-?3. In vivo testing of articular cartilage repair showed that VEGF-transduced MDSCs caused an arthritic change in the knee joint, and sFlt1 improved the MDSC-mediated repair of articular cartilage, compared to BMP4 alone. Conclusion sFlt1 gene therapy improved BMP4- and TGF-?3-induced chondrogenic gene expression of MDSCs in vitro, and improved the persistence of repaired articular cartilage by preventing vascularization and bone invasion into the repaired articular cartilage.

Kubo, Seiji; Cooper, Gregory M.; Matsumoto, Tomoyuki; Phillippi, Julie A.; Corsi, Karin A.; Usas, Arvydas; Li, Guangheng; Fu, Freddie H.; Huard, Johnny



Persistence, localization, and external control of transgene expression after single injection of adeno-associated virus into injured joints.  


A single intra-articular injection of adeno-associated virus (AAV) results in stable and controllable transgene expression in normal rat knees. Because undamaged joints are unlikely to require treatment, the study of AAV delivery in joint injury models is crucial to potential therapeutic applications. This study tests the hypotheses that persistent and controllable AAV-transgene expression are (1) highly localized to the cartilage when AAV is injected postinjury and (2) localized to the intra-articular soft tissues when AAV is injected preinjury. Two AAV injection time points, postinjury and preinjury, were investigated in osteochondral defect and anterior cruciate ligament transection models of joint injury. Rats injected with AAV tetracycline response element (TRE)-luciferase received oral doxycycline for 7 days. Luciferase expression was evaluated longitudinally for 6 months. Transgene expression was persistent and controllable with oral doxycycline for 6 months in all groups. However, the location of transgene expression was different: postinjury AAV-injected knees had luciferase expression highly localized to the cartilage, while preinjury AAV-injected knees had more widespread signal from intra-articular soft tissues. The differential transgene localization between preinjury and postinjury injection can be used to optimize treatment strategies. Highly localized postinjury injection appears advantageous for treatments targeting repair cells. The more generalized and controllable reservoir of transgene expression following AAV injection before anterior cruciate ligament transection (ACLT) suggests an intriguing concept for prophylactic delivery of joint protective factors to individuals at high risk for early osteoarthritis (OA). Successful external control of intra-articular transgene expression provides an added margin of safety for these potential clinical applications. PMID:23496155

Lee, Hannah H; O'Malley, Michael J; Friel, Nicole A; Payne, Karin A; Qiao, Chunping; Xiao, Xiao; Chu, Constance R



Assessment of articular cartilage and subchondral bone: subtle and progressive changes in experimental osteoarthritis using 50 MHz echography in vitro.  


The main objectives of this work were to demonstrate the potential of 50 MHz echography for assessing initial and progressive morphological and structural changes of articular cartilage and bone developed in an experimental model of osteoarthritis (OA). Degenerative lesions were induced in rat knees by the unilateral intra-articular injection of a 3 mg dose of mono-iodo-acetic acid. To assess the lesion progression, the animals (n = 30) were sacrificed at different time intervals up to 8 weeks after the injection. Three-dimensional echographic data were acquired in vitro on patellar cartilage and bone at various stages of the remodeling process using a scanning ultrasound microscope. Changes involving the OA cartilage characteristics are discussed relative to those of the contralateral control joint which received a placebo. Images of control cartilage showed a smooth hyperechoic articular surface and an echoic matrix. The cartilage thickness was 266 +/- 44 microns (mean +/- SD) in the central region of the tissue. The precision of ultrasonic thickness measurements was better than 1.3%. First changes in cartilage internal structure and subchondral bone appeared on ultrasound images 3 days after the injection and were even more evident by day 7. They resulted in a slight thinning of the cartilage, a 30% increase of its internal structure echogenicity, and the appearance of echoic zones in subchondral bone. Histologic findings confirmed chondrocyte depletion and degeneration, decrease of matrix proteoglycans, and fibrovascular connective tissue proliferation at the subchondral plate. Progressive and severe lesions at both bone and cartilage surface and internal structure were assessed and correlated to histologic features. These results show that high resolution echography is sensitive to subtle and progressive osteochondral remodeling. This technique has the potential to be used for intra-articular quantitative imaging and assessment of early changes in bone and cartilage structure associated with natural human disease. PMID:9286753

Saïed, A; Chérin, E; Gaucher, H; Laugier, P; Gillet, P; Floquet, J; Netter, P; Berger, G



Analysis of the load on the knee joint and vertebral column with changes in squatting depth and weight load.  


It has been suggested that deep squats could cause an increased injury risk of the lumbar spine and the knee joints. Avoiding deep flexion has been recommended to minimize the magnitude of knee-joint forces. Unfortunately this suggestion has not taken the influence of the wrapping effect, functional adaptations and soft tissue contact between the back of thigh and calf into account. The aim of this literature review is to assess whether squats with less knee flexion (half/quarter squats) are safer on the musculoskeletal system than deep squats. A search of relevant scientific publications was conducted between March 2011 and January 2013 using PubMed. Over 164 articles were included in the review. There are no realistic estimations of knee-joint forces for knee-flexion angles beyond 50° in the deep squat. Based on biomechanical calculations and measurements of cadaver knee joints, the highest retropatellar compressive forces and stresses can be seen at 90°. With increasing flexion, the wrapping effect contributes to an enhanced load distribution and enhanced force transfer with lower retropatellar compressive forces. Additionally, with further flexion of the knee joint a cranial displacement of facet contact areas with continuous enlargement of the retropatellar articulating surface occurs. Both lead to lower retropatellar compressive stresses. Menisci and cartilage, ligaments and bones are susceptible to anabolic metabolic processes and functional structural adaptations in response to increased activity and mechanical influences. Concerns about degenerative changes of the tendofemoral complex and the apparent higher risk for chondromalacia, osteoarthritis, and osteochondritis in deep squats are unfounded. With the same load configuration as in the deep squat, half and quarter squat training with comparatively supra-maximal loads will favour degenerative changes in the knee joints and spinal joints in the long term. Provided that technique is learned accurately under expert supervision and with progressive training loads, the deep squat presents an effective training exercise for protection against injuries and strengthening of the lower extremity. Contrary to commonly voiced concern, deep squats do not contribute increased risk of injury to passive tissues. PMID:23821469

Hartmann, Hagen; Wirth, Klaus; Klusemann, Markus



Intra-articular Lesions in Chronic Lateral Ankle Instability: Comparison of Arthroscopy with Magnetic Resonance Imaging Findings  

PubMed Central

Background Chronic lateral ankle instability often accompanies intra-articular lesions, and arthroscopy is often useful in diagnosis and treatment of intra-articular lesions. Methods Preoperative magnetic resonance imaging (MRI) examinations and arthroscopic findings were reviewed retrospectively and compared in 65 patients who underwent surgery for chronic lateral ankle instability from January 2006 to January 2010. MR images obtained were assessed by two radiologists, and the inter- and intra-observer reliability was calculated. American Orthopedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) scores were evaluated. Results Abnormalities of the anterior talofibular ligament (ATFL) were found in all 65 (100%) cases. In arthroscopy examinations, 33 (51%) cases had talar cartilage lesions, and 3 (5%) cases had 'tram-track' cartilage lesion. Additionally, 39 (60%) cases of synovitis, 9 (14%) cases of anterior impingement syndrome caused by osteophyte, 14 (22%) cases of impingement syndrome caused by fibrotic band and tissue were found. Sensitivity of MRI examination for each abnormality was: ATFL, 60%; osteochondral lesion of talus (OLT), 46%; syndesmosis injury, 21%; synovitis, 21%; anterior impingement syndrome caused by osteophyte, 22%. Paired intra-observer reliability was measured by a kappa statistic of 0.787 (95% confidence interval [CI], 0.641 to 0.864) for ATFL injury, 0.818 (95% CI, 0.743 to 0.908) for OLT, 0.713 (95% CI, 0.605 to 0.821) for synovitis, and 0.739 (95% CI, 0.642 to 0.817) for impingement. Paired inter-observer reliability was measured by a kappa statistic of 0.381 (95% CI, 0.241 to 0.463) for ATFL injury, 0.613 (95% CI, 0.541 to 0.721) for OLT, 0.324 (95% CI, 0.217 to 0.441) for synovitis, and 0.394 (95% CI, 0.249 to 0.471) for impingement. Mean AOFAS score increased from 64.5 to 87.92 (p < 0.001) when there was no intra-articular lesion, from 61.07 to 89.04 (p < 0.001) in patients who had one intra-articular lesion, and from 61.12 to 87.6 (p < 0.001) in patients who had more than two intra-articular lesions. Conclusions Although intra-articular lesion in patients with chronic lateral ankle instability is usually diagnosed with MRI, its sensitivity and inter-observer reliability are low. Therefore, arthroscopic examination is strongly recommended because it improved patients' residual symptoms and significantly increased patient satisfaction.

Kim, Hyoung Soo; Chung, Soo Tai; Yoo, Jeong Hyun; Park, Jai Hyung; Kim, Joo Hak; Hyung, Jae Won



Transplantation of free tibial periosteal grafts for the repair of articular cartilage defect: An experimental study  

PubMed Central

Background: Articular chondrocytes have got a long lifespan but rarely divides after maturity. Thus, an articular cartilage has a limited capacity for repair. Periosteal grafts have chondrogenic potential and have been used to repair defects in the articular cartilage. The purpose of the present study is to investigate the differentiation of free periosteal grafts in the patellofemoral joint where the cambium layer faces the subchondral bone and to investigate the applicability of periosteal grafts in the reconstruction of articular surfaces. Materials and Methods: The study was carried out over a period of 1 year on 25 adult, male Indian rabbits after obtaining permission from the institutional animal ethical committee. A full-thickness osteochondral defect was created by shaving off the whole articular cartilage of the patella of the left knee. The defect thus created was grafted with free periosteal graft. The patella of the right knee was taken as a control where no grafting was done after shaving off the articular cartilage. The first animal was used to study the normal histology of the patellar articular cartilage and periosteum obtained from the medial surface of tibial condyle. Rest 24 animals were subjected to patellectomy, 4 each at serial intervals of 2, 4, 8, 16, 32 and 48 weeks and the patellar articular surfaces were examined macroscopically and histologically. Results: The grafts got adherent to the underlying patellar articular surface at the end of 4 weeks. Microscopically, graft incorporation could be appreciated at 4 weeks. Mesenchymal cells of the cambium layer were seen differentiating into chondrocytes by the end of 4 weeks in four grafts (100%) and they were arranged in a haphazard manner. Till the end of 8 weeks, the cellular arrangement was mostly wooly. At 16 weeks, one graft (25%) had wooly arrangement of chondrocytes and three grafts (75%) had columnar formation of cells. Same percentage was maintained at 32 weeks. Four grafts (100%) at 48 weeks showed columnar orientation. The control side showed no changes over the shaved off articular surface in all the rabbits. One rabbit at 4 weeks had a dislocation of the patella on the control side. None of the rabbits developed any infection or wound dehiscence. Conclusion: Autologous periosteal graft transplantation can be a promising substitute for articular cartilaginous defects.

Singh, Ravijot; Chauhan, Vijendra; Chauhan, Neena; Sharma, Sansar



Ankle impingement: a review of multimodality imaging approach.  


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



Arthroscopic-assisted lateral ligamentous reconstruction in combined ankle and subtalar instability.  


We describe an arthroscopic technique by which to reconstruct both the calcaneofibular ligament and anterior talofibular ligament anatomically. The ankle joint is examined through the anteromedial portal and a lateral portal close to the talar insertion of the anterior talofibular ligament. The subtalar joint is examined through the anterolateral portal and the middle portal. Associated intra-articular pathology (e.g., osteochondral defect) is evaluated and addressed. The calcaneofibular ligament is an extracapsular structure that can be examined arthroscopically through the anterolateral portal in the extra-articular plane. The peroneal tendon sheath is stripped with a small periosteal elevator through the middle subtalar portal, and the calcaneal insertion of the calcaneofibular ligament is identified. The plantaris tendon is identified and freed through multiple small wounds at the medial calf, and the tendon is cut proximally and retrieved to its calcaneal insertion. A calcaneal bone tunnel (tunnel 1) is created between the plantaris tendon and the calcaneofibular ligament insertions by use of a 3.5-mm drill bit. The tendon graft is then looped onto a suture, and the suture is passed through the tunnel to the calcaneofibular ligament insertion and retrieved to the middle subtalar portal. Through the anterolateral subtalar portal, the fibular insertion of the calcaneofibular ligament is identified. Another bone tunnel is created from this point to the posterior edge of the fibula (tunnel 2) with a 3.5-mm drill through the middle subtalar portal. The fibular insertion of the anterior talofibular ligament is identified on ankle arthroscopy. Tunnel 3 is created from this point to the exit point of tunnel 2 through the lateral ankle portal. The tendon graft is retrieved to the lateral ankle joints through the second and third tunnels and is pierced through the lateral ankle capsule and course from intracapsular to extracapsular. The tendon graft loop is anchored to the insertion point of the anterior talofibular ligament by a 4.0-mm cancellous screw with a spiked washer. The tendon graft is tensioned by pulling the free end of the tendon graft while tightening the screw. The free end of the tendon graft and the stay stitch are sutured to surrounding soft tissue or anchored with another 4.0-mm cancellous screw and spiked washer. The procedure is then completed, and a short leg cast is applied. The patient is advised to perform non-weight-bearing walking for 6 weeks. PMID:17478288

Lui, Tun Hing



Surface modified PLGA/carbon nanofiber composite enhances articular chondrocyte functions  

NASA Astrophysics Data System (ADS)

Since articular cartilage has a limited self regeneration capability, alternative methods are needed for repairing cartilage defects. The purpose of the present in vitro study was to explore the effects of material surface properties and external stimulation on chondrocyte (cartilage-synthesizing cell) functions. Based on this information, a goal of this research was to propose a scaffold composite material for enhancing articular chondrocyte function. To improve functions of chondrocytes, material (namely, poly(lactic-co-glycolic acid); PLGA) surfaces were modified via chemical (NaOH) etching techniques. Chondrocytes were cultured on surface-modified 2-D PLGA films and 3-D PLGA tissue engineering scaffolds, which were created by a salt-leaching method. Carbon nanofibers were imprinted on PLGA matrices in an aligned pattern for controlled electrically-active surface features. Electrical stimulation was applied to expedite and enhance chondrocyte functions. Results demonstrated that both NaOH-treated 2-D and 3-D substrates enhanced chondrocyte functions (cell numbers as well as extracellular matrix production) compared to non-treated PLGA substrates. Furthermore, chondrocytes preferred to attach along the carbon nanofiber patterns imprinted on PLGA. Electrical stimulation also enhanced chondrocyte functions on carbon nanofiber/PLGA composites. Underlying material properties that may have enhanced chondrocyte functions include a more hydrophilic surface, surface energy differences due to the presence of carbon nanofibers, increased surface area, altered porosity, and a greater degree of nanometer roughness. Moreover, these altered surface properties positively influenced select protein adsorption that controlled subsequent chondrocyte adhesion. Collectively, this study provided a scaffold model for osteochondral defects that can be synthesized using the above techniques and a layer by layer approach to accommodate the property differences in each layer of natural cartilage. Specifically, these results suggest that the superficial zone, middle zone, and deep zone of cartilage should be composed of carbon nanofibers aligned parallel to the surface in PLGA, randomly oriented carbon nanofibers in PLGA, and carbon nanofibers aligned perpendicular to the surface in PLGA, respectively. Clearly, such scaffolds may ultimately enhance the efficacy of scaffolds used for articular cartilage repair.

Park, Grace Eunseung


Development of a salmon-derived crosslinked atelocollagen sponge disc containing osteogenic protein-1 for articular cartilage regeneration: in vivo evaluations with rabbits  

PubMed Central

Background We have developed crosslinked salmon-derived atelocollagen sponge, which has a denaturation temperature of 47 degrees Celsius. The purpose of this study is to evaluate the fundamental in vivo efficacy of the osteogenic protein (OP) -1 containing salmon-derived collagen sponge disc (SCS) on cartilage regeneration, using a rabbit model. Methods A total of 24 rabbits were used in this study. In each animal, a full-thickness osteochondral defect was created in each femoral trochlea. Then, each 12 rabbits were randomly divided into the two groups. In Group I, an OP1-SCS disc was implanted into the defect in the right knee. In Group II, a SCS disc without OP-1 was implanted into the defect in the right knee. A control group of 12 rabbits was assembled from randomly-selected left knees from among the first two groups. In Group-III, we applied no treatment for a defect in the left knee to obtain the untreated control. All rabbits were sacrificed at 12 weeks after surgery. In each group, 10 animals were used for histological and immunohistological evaluations, and the remaining 2 were used for real-time polymerase chain reaction (PCR) analyses. Results In Group I, a regenerated cartilage tissue rich in proteoglycan and type-2 collagen was found at 12 weeks, although the width was thicker than that of Group II. In Group II, the defect was filled with thick inhomogeneous tissues, including cartilage, fibrous, and bone tissues at 12 weeks. Concerning the gross observation and histological scores at 12 weeks, the ANOVA showed significant differences (p?



Low-pressure foaming: a novel method for the fabrication of porous scaffolds for tissue engineering.  


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



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.