60 research outputs found
Platelet rich plasma: a valid augmentation for cartilage scaffolds? A systematic review.
No full textIt has been shown that modern regenerative scaffold-based procedures for the treatment of articular cartilage defects offer good clinical results, although the properties of native healthy cartilage have not yet been matched by any substitute. Several implants have been tested and clinically used over the years to promote articular surface restoration, some of them producing a hyaline-like reparative tissue. There has been an increase in the number of new biological strategies, alone and in combination with scaffolds, to enhance the clinical outcome in patients with chondral disease. Among these innovative methods, one of the most widely used is Platelet-rich Plasma (PRP), based on the rationale of using the growth factors contained in platelet alpha granules to promote tissue regeneration. The aim of the present manuscript is to review systematically the current evidence in pre-clinical and clinical studies for the use of PRP augmented scaffolds to treat chondral or osteochondral disorders
Non-surgical and surgical approaches for osteoarthritis
No full textLarge cartilage lessions in patients over 60 years old are mainly associated with a degenerative environment and can be included in the definition of osteoarthritis (OA). OA is the most common cause of chronic disability in older adults: it leads to articular cartilage degeneration and ends in joint destruction. While in advanced OA unicompartimental or total arthroplasty remain the main choice for the orthopaedic surgeon, for the treatment of early stages with limited cartilage damage, numerous more conservative approaches have been proposed, such as pharmaceuticals or surgical techniques less invasive than a prosthesis
Autologous osteochondral transplantation for the treatment of knee lesions: results and limitations at two years' follow-up.
No full textFocal chondral and osteochondral knee lesions are a common condition, particularly hard to treat, and often involve young active patients with high expectations in terms of symptomatic relief and return to sports. Autologous osteochondral transplantation allows the defect area to be restored with hyaline cartilage. The aim of this study is to analyse whether it represents a safe and effective treatment option for small-medium-sized knee chondral and osteochondral lesions in a young and active population.Thirty-one patients (18 men, 13 women; mean age 32 ± ten; mean BMI 24 ± 3) affected by focal knee chondral and osteochondral lesions were enrolled and treated with autologous osteochondral transplantation. They were prospectively followed-up for 24 months with the IKDC-subjective, IKDC-objective, and Tegner scores. Adverse events and failures were also reported, as well as the Bandi score to detect symptoms from the donor area.A significant increase was reported in all the clinical scores adopted. In particular, the IKDC-subjective score increased from a basal value of 40.3 ± 16.2 to 62.6 ± 18.0 at the 12 months' evaluation, with a further significant increase up to 71.6 ± 20.5 at the final 24 months' follow-up (p < 0.0005). A positive trend was also found by analysing the IKDC-objective score. The Tegner score revealed a significant improvement from a basal value of 2.2 ± 1.8 to 3.7 ± 1.5 at the final evaluation (p = 0.003), although it was not possible to regain the same pre-injury sports activity level of 5.0 ± 2.2. Two failures were reported. The Bandi score revealed patients complaining of mild and moderate symptoms, not correlated to the lesion size. The presence of symptoms ascribable to the donor area was significantly correlated with a lower clinical outcome.Autologous osteochondral transplantation proved to be, at short-term evaluation, a suitable option to treat small-medium sized chondral and osteochondral lesions. However, clinical improvement is slow and a significant percentage of patients develop symptoms attributable to the donor area, thus reducing the overall benefit of this procedure
Maioregen: Our Experience.
No full textDifferent techniques have been proposed across the years to treat
osteochondral diseases: minimally invasive bone marrow stimulation
techniques aimed at favoring the healing process in the injured area
through the migration of stem cells from the subchondral bone; on the
other side, some more aggressive techniques are based on autologous or
allogenic tissue transplant. Unfortunately, both the high specialization
and the low healing potential of the cartilage tissue still make the
treatment of cartilage defects a challenge for the orthopedic surgeon.
Bioengineered scaffolds or polymeric matrices implanted in the injured
area showed promising results. The range of scaffolds in use for chondral
or osteochondral repair is very wide; they differ not only with respect to
the type of the materials used for their realization but also for the presence
or absence of one or more cell lines – either chondrogenic or osteogenic.
When approaching big chondral lesions, the subchondral bone is often
involved and it also needs to be treated in order to have a correct
restoration of the most superficial layers of the joint. In our opinion the
smartest treatment choice could be a cell-free osteochondral scaffold, an
off-the-shelf product, thus immediately available, avoiding the double
surgical time. Following this rationale, after preclinical in vitro and
animal studies and under the approval of the local ethics committee,
we introduced the use of a newly developed nanostructured biomimetic
scaffold in a clinical pilot study to treat chondral and osteochondral
lesions of the knee. Its safety and manageability, as much as the surgical
procedure reproducibility and the clinical outcome, have been evaluated
up to 36 months’ follow-up in order to test its intrinsic potential without
any cells culture aid
New scaffold–based one step procedure
No full textThe use of scaffolds in combination with autologous chondrocytes is well established in clinical practice in Europe (even if not yet available in the US). The rationale for using a scaffold is to have a temporary three dimensional structure of biodegradable polymers for the growth of living cells. An ideal scaffold should mimic biology and the architectural and structural properties of the native tissue, thus facilitating cell infiltration, attachment, proliferation and differentiation. Other important properties include biocompatibility and biodegradability through safe biochemical pathways at suitable time intervals to support the first phases of tissue formation and gradual replacement by regenerating tissue. There is increasing interest in utilising various biomaterials in clinical practice, not only to deliver expanded autologous chondrocytes for tissue regeneration, but also as a new treatment approach, which involves the implant of various biomaterials for "in situ" cartilage repair exploiting bone marrow stem cell differentiation induced by the scaffold properties. In fact, some scaffolds may have a potential themselves to promote chondral or osteochondral regeneration by exploiting the self-regenerative potential of the body. An ideal graft would be an off-the-shelf product from both a surgical and commercial standpoint. The possibility to produce a cell-free implant that is "smart" enought to provide the joint with the appropriate stimuli to induce orderly and durable tissue regeneration is realy attractive, and new, different biomaterials have recently been proposed to induce "in situ" cartilage regeneration after direct transplantation onto the defect site both in research and in clinical practice
Total Knee Arthroplasty (TKA): When Do the Risks of TKA Overcome the Benefits? Double Risk of Failure in Patients up to 65 Years Old
No full textObjective: The aim of this study was to document the survival rate in the middle-aged patient group up to 65 years old and to compare it with other age groups of patients undergoing total knee arthroplasty (TKA) for knee osteoarthritis (OA). Design: The Register of Orthopaedic Prosthetic Implants (RIPO) regional registry was used to analyze the results of patients <80 years old affected by primary OA and treated with TKA from 2000 to 2019. The database was investigated according to the age group: younger than 50 years, 50-65 years, or 66-79 years, with the aim to estimate revision surgeries and implant survivorship. Results: A total of 45,488 TKAs for primary OA were included in the analysis (M: 11,388; F: 27,846). The percentage of patients <65 years old increased from 13.5% to 24.8% between 2000 and 2019 (P < 0.0001). The survival analysis showed an overall influence of age on the implant revision rate (P < 0.0001), with an estimated survival rate of 78.7%, 89.4%, and 94.8% at 15 years in the 3 groups, respectively. Compared with the older-aged group, the relative risk of failure was 3.1 (95% confidence interval [CI] = 2.2-4.3; P < 0.001) higher in patients <50 years old and 1.8 (95% CI = 1.6-2.0; P < 0.001) higher in patients 50-65 years old. Conclusions: TKA use in the middle-aged patient population up to 65 years old increased significantly over time. These patients present a double risk of failure with respect to older patients. This is particularly important considering the increasing life expectancy and the emergence of new joint preserving strategies, which could postpone the need for TKA to an older age
Acellular matrix-based cartilage regeneration techniques for osteochondral repair
No full textThe aim of the present review is to illustrate the clinical state of the art of cell-free scaffolds application as regeneration techniques for the treatment of osteochondral lesions
Tibial plateau lesions. Surface reconstruction with a biomimetic osteochondral scaffold: Results at 2 years of follow-up.
No full textAbstract
INTRODUCTION:
Tibial plateau articular pathology caused by post-traumatic or degenerative lesions is a challenge for the orthopaedic surgeon and can lead to early osteoarthritis. The aim of the present study was to evaluate the results of treatment of these complex defects with implantation of an osteochondral scaffold, which is designed to target the cartilage surface and to reconstruct joint anatomy by addressing the entire osteochondral unit.
MATERIALS AND METHODS:
Eleven patients (5 female and 6 male) with a mean age of 37.3±11.0 years and osteochondral lesions of the tibial plateau (mean 5.1±2.7cm(2); range 3.0-12.5cm(2)) were treated with the implantation of an osteochondral biomimetic collagen-hydroxyapatite scaffold (Maioregen(®), Fin-Ceramica, Faenza, Italy). Comorbidities were addressed taking care to restore the correct limb alignment. Patients were evaluated pre-operatively and prospectively followed-up for 2 years using the International Knee Documentation Committee (IKDC) subjective and objective scores; activity level was documented using the Tegner score.
RESULTS:
Three patients experienced minor adverse events. No patients required further surgery for treatment failure during the study follow-up period, and 8 patients (72.7%) reported a marked improvement. The IKDC subjective score improved from 42.5±10.2 before treatment to 69.8±19.0 at 12 months (p<0.05), with stable results at 24 months. The IKDC objective score increased from 27.3% normal and nearly normal knees before treatment to 85.7% normal and nearly normal knees at 24 months of follow-up. The Tegner score increased from 2.3±2.1 before treatment to 4.8±2.4 at 12 months (p<0.05), and was stable at the final follow-up.
CONCLUSION:
The present study on the implantation of an osteochondral scaffold for the treatment of tibial plateau lesions showed a promising clinical outcome at short-term follow-up, which indicates that this procedure can be considered as a possible treatment option, even in these complex defects, when comorbidities are concomitantly addressed
Treatment of osteochondral defects of the knee: results at 2 years using a cell-free biomimetic scaffold
No full textObjectives: To successfully treat osteochondral defects is a real challenge for the orthopaedic surgeon, since only the formation of fibrocartilage and poor subchondral regeneration have yet been proved with the techniques currently available. Preclinical tests demonstrated that this new biomaterial (obtained by enucleating equine collagen type 1 fibrils with hydroxyapatite nanoparticles in 3 different layers with 3 different gradient ratios at physiological conditions) induced an ‘‘in situ’’ cartilage regeneration into the defect site, exploiting the self-regenerative potential due to the stem cells incoming from the bone marrow. The first pilot clinical study confirmed safety and manageability of the procedure, showing good and stable results over time on 30 patients.
Methods: 99 patients (75 M, 24 F, mean age 32.9 yy) were treated for a total of 113 chondral/osteochondral lesions of the knee (36 medial femoral condyles, 25 lateral femoral condyles, 23 patellae, 23 femoral throcleas and 6 tibial plateaux). Mean size of the lesions was 3.4 ± 2.6 cm2. All patients and their clinical outcome were analyzed prospectively at 6, 12 and 24 months using the Cartilage standard Evaluation Form as proposed by ICRS. An high resolution MRI was performed and the MOCART scoring scale was used to analyze the repaired tissue.
Results: A statistically significant improvement and function recovery comparing the pre-operative were recorded up to 24 months. IKDC subj score increased from 45.6 ± 16.2 to 69.9 ± 18.9 and 74 ± 18.6 at the 1 year and final evaluation respectively (p\0.05). Tegner score increased from 2.6 ± 2.0 to 4.2 ± 1.6 at 2 years’ follow-up (p\0.05). A tendency to a better clinical outcome was detected for OCD lesions. MRI evaluation confirmed the good results, showing a good filling in most of the lesions treated. Three patients failed, being re-operated for the same reason.
Conclusions: The use of this biomimetic cell-free scaffold for osteochondral lesions of the knee allows to obtain function recovery and a good clinical outcome at short-time follow-up. Better results are recorded in case of OCDs. These promising results have to be proven at longer follow-up
Biomaterials for Osteochondral reconstruction
No full textThe modern regenerative procedures demonstrated to offer the replacement of the articular surface with a hyaline-like tissue, but the properties of healthy cartilage tissue are still unmatched by any available substitute. Moreover, the treatment of osteochondral lesions is even more biologically challenging since two different tissues are involved (bone and articular cartilage) with a distinctly different intrinsic healing capacity. For the repair of the entire osteochondral unit, several authors have highlighted the need for biphasic scaffolds, to reproduce the different biological and functional requirements for guiding the growht of the two tissues, and different specific scaffolds have been developed for the treatment of large chondral or osteochondral articular defects.
At the time being, among these only two scaffols used for osteochondral regeneration are commercialized for clinical application. One is a bilayer porous PLGA-calcium-sulphate biopolymer. The second osteochondral scaffold is a nanostructured biomimetic HA-collagen scaffold with a porous 3-D tri-layer composite structure, mimicking the whole osteochonfral anatomy. Other osteochondral scaffolds are still under preclinical investigation. In this chapter we focus on reviewing the available evidence on the clinical outcome of these osteochondral scaffolds, as well as on reporting the new biomaterials developed and tested in preclinical studies that show to be promising for osteochondral regeneration
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