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Particulated Autologous Chondral-Platelet-Rich Plasma Matrix Implantation (PACI) for Treatment of Full-Thickness Cartilage Osteochondral Defects.

ABSTRACT: Articular hyaline cartilage injuries can occur as a result of either traumatic of progressive degeneration. When the articular cartilage in a joint is damaged, it can cause joint pain and dysfunction, predisposing patients for the development of early-onset osteoarthritis. There are many restoration procedures available to treat these injuries, such as bone marrow-stimulation techniques, osteoarticular auto/allograft transplants, and autologous chondrocyte implantation. Each of these techniques has its own limitations, which led researchers to explore new regenerative and repair techniques to produce normal hyaline cartilage. The purpose of this Technical Note is to describe in detail the particulated autologous chondral-platelet-rich plasma matrix implantation (PACI) technique that could be used as a single-stage cartilage restoration procedure for treatment of full-thickness cartilage and osteochondral defects.

SUBMITTER: Cugat R

PROVIDER: S-EPMC7917299 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Implantation of rAAV5-IGF-I transduced autologous chondrocytes improves cartilage repair in full-thickness defects in the equine model.

Project description:Cartilage injury often precipitates osteoarthritis which has driven research to bolster repair in cartilage impact damage. Autologous chondrocytes transduced with rAAV5-IGF-I were evaluated in chondral defects in a well-established large animal model. Cartilage was harvested from the talus of 24 horses; chondrocytes were isolated and stored frozen. Twenty million cells were cultured and transduced with 10(5) AAV vg/cell prior to implantation. Chondrocytes from eight horses were transduced with rAAV5-IGF-I, chondrocytes from eight horses with rAAV5-GFP, and chondrocytes from eight horses were not transduced. A 15 mm full-thickness chondral defect was created arthroscopically in the lateral trochlear ridge of the femur in both femoropatellar joints. Treated defects were filled with naive or gene-enhanced chondrocytes, in fibrin vehicle. Control defects in the opposite limb received fibrin alone. rAAV5-IGF-I transduced chondrocytes resulted in significantly better healing at 8 week arthroscopy and 8 month necropsy examination when compared to controls. At 8 months, defects implanted with cells expressing IGF-I had better histological scores compared to control defects and defects repaired with naive chondrocytes. This included increased chondrocyte predominance and collagen type II, both features of hyaline-like repair tissue. The equine model closely approximates human cartilage healing, indicating AAV-mediated genetic modification of chondrocytes may be clinically beneficial to humans.

| S-EPMC4445609 | biostudies-literature

Autologous Costal Chondral/Osteochondral Transplantation and Costa-Derived Chondrocyte Implantation for Articular Cartilage Repair: Basic Science and Clinical Applications.

Project description:There has been increasing application of autologous costal chondral/osteochondral transplantation (ACCT/ACOT) and costa-derived chondrocyte implantation (ACCI) for articular cartilage repair over the past three decades. This review presents the major evidence on the properties of costal cartilage and bone and their qualifications as grafts for articular cartilage repair, the major clinical applications, and the risks and strategies for costal chondral/osteochondral graft(s) harvest. First, costal cartilage has many specific properties that help restore the articular surface. Costa, which can provide abundant cartilage and cylindrical corticocancellous bone, preserves permanent chondrocyte and is the largest source of hyaline cartilage. Second, in the past three decades, autologous costal cartilage-derived grafts, including cartilage, osteochondral graft(s), and chondrocyte, have expanded their indications in trauma and orthopaedic therapy from small to large joints, from the upper to lower limbs, and from non-weight-bearing to weight-bearing joints. Third, the rate of donor-site complications of ACCT or ACOT is low, acceptable, and controllable, and some skills and accumulated experience can help reduce the risks of ACCT and ACOT. Costal cartilage-derived autografting is a promising technique and could be an ideal option for articular chondral lesions with or without subchondral cysts. More high-quality clinical studies are urgently needed to help us further understand the clinical value of such technologies.

| S-EPMC10925498 | biostudies-literature

Clinical Outcomes after Revision of Autologous Chondrocyte Implantation to Osteochondral Allograft Transplantation for Large Chondral Defects: A Comparative Matched-Group Analysis.

Project description:ObjectiveOsteochondral allograft transplantation (OCA) is a well-established procedure for patients with symptomatic cartilage defects in the knee. Revision to OCA after prior failed cartilage repair has shown similar clinical outcomes as primary OCA; however, most of the failed procedures were arthroscopic procedures for smaller defects. There is no literature investigating the clinical outcomes after OCA for prior failed autologous chondrocyte implantation (ACI) for the treatment of large chondral defects of the knee. The purpose of this study was therefore to determine clinical outcomes of patients undergoing revision to OCA after prior failed ACI as compared with a matched cohort of patients undergoing OCA as a primary cartilage repair procedure (primary OCA).DesignIn this review of prospectively collected data, we analyzed data from 26 patients with at least 2 years follow-up. Thirteen patients who underwent revision to OCA after prior failed ACI by a single surgeon were compared with a matched group of patients who underwent primary OCA. The patients were matched per age, gender, body mass index, and defect size. Patient-reported outcomes, reoperations, and survival rates were compared between groups.ResultsThere were no significant differences in patient-reported clinical outcome scores between the groups at final follow-up. Moreover, there was no significant difference in reoperation rates and survival rates between the groups.ConclusionThe present study demonstrates that revision to OCA is a viable treatment option with favorable functional outcomes and similar reoperation and survival rate as primary OCA even for revision of large chondral defects previously treated with ACI.

| S-EPMC7970380 | biostudies-literature

Osteochondral Autograft Transfer for Capitellar Chondral and Osteochondral Defects.

Project description:Chondral and osteochondral lesions of the humeral capitellum, most notably osteochondritis dissecans, most commonly present in adolescent baseball players and gymnasts. A variety of surgical techniques can be used to address these lesions. Osteochondral autograft transfer has recently shown superior rates of return to sport. We describe osteochondral autograft transfer from the contralateral knee to treat a large full-thickness chondral lesion of the humeral capitellum. Osteochondral allograft backfill of the donor site is shown as well. This surgical procedure is technically demanding but very reproducible and maximizes return to play in patients while minimizing donor-site morbidity.

| S-EPMC7695613 | biostudies-literature

High-Density Autologous Chondrocyte Implantation as Treatment for Ankle Osteochondral Defects.

Project description:PurposeTwo-year follow-up to assess efficacy and safety of high-density autologous chondrocyte implantation (HD-ACI) in patients with cartilage lesions in the ankle.DesignTwenty-four consecutive patients with International Cartilage repair Society (ICRS) grade 3-4 cartilage lesions of the ankle were included. Five million chondrocytes per cm2 of lesion were implanted using a type I/III collagen membrane as a carrier and treatment effectiveness was assessed by evaluating pain with the visual analogue scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score at baseline, 12-month, and 24-month follow-up, together with dorsal and plantar flexion. Magnetic resonance observation for cartilage repair tissue (MOCART) score was used to evaluate cartilage healing. Histological study was possible in 5 cases.ResultsPatients' median age was 31 years (range 18-55 years). Median VAS score was 8 (range 5-10) at baseline, 1.5 (range 0-8) at 12-month follow-up, and 2 (rang e0-5) at 24-month follow-up (P < 0.001). Median AOFAS score was 39.5 (range 29-48) at baseline, 90 (range 38-100) at 12-month follow-up, and 90 (range 40-100) at 24-month follow-up (P < 0.001). Complete dorsal flexion significantly increased at 12 months (16/24, 66.7%) and 24 months (17/24, 70.8%) with regard to baseline (13/24, 54.2%) (P = 0.002). MOCART at 12- and 24-month follow-ups were 73.71 ± 15.99 and 72.33 ± 16.21. Histological study confirmed that neosynthetized tissue was cartilage with hyaline extracellular matrix and numerous viable chondrocytes.ConclusionHD-ACI is a safe and effective technique to treat osteochondral lesions in the talus, providing good clinical and histological results at short- and mid-term follow-ups.

| S-EPMC8236657 | biostudies-literature

Microfractures, autologous matrix-induced chondrogenesis, osteochondral autograft transplantation and autologous chondrocyte implantation for knee chondral defects: a systematic review and network meta-analysis of randomized controlled trials.

Project description:PurposeDespite the publication of several randomized controlled trials (RCTs), it is not clear which technique for the treatment of focal chondral and osteochondral defects of the knee grants the best clinical outcome. The aim of this network meta-analysis (NMA) was to compare the efficacy and safety of microfractures (MF), autologous chondrocyte implantation (ACI), autologous matrix-induced chondrogenesis (AMIC), osteochondral autograft transplantation (OCT) at short (< 1 year), intermediate (1-5 years) and long-term (> 5 years).MethodsWe carried out an NMA with Bayesian random-effect model, according to PRISMA guidelines. The search was performed in MEDLINE, EMBASE, Web of Science, CENTRAL, CINAHL, SPORTDiscus, clinicaltrials.gov, WHO ICTRP, from inception to November 2022. The eligibilities were randomized controlled trials on patients with knee chondral and osteochondral defects, undergoing microfractures, OCT, AMIC, ACI, without restrictions for prior or concomitant surgery on ligaments, menisci or limb alignment, prior surgery for fixation or ablation of osteochondritis dissecans fragments, and prior cartilage procedures as microfractures, drilling, abrasion, or debridement.ResultsNineteen RCTs were included. No difference among treatments was shown in the pooled comparison of patient reported outcome measures (PROMs) at any timepoint. Safety data were not available for all trials due to the heterogeneity of reporting, but chondrospheres seemed to have lower failure and reoperation rates.ConclusionThis NMA showed no difference for PROMs with any technique. The lower failure and reoperation rates with chondrospheres must be interpreted with caution since adverse event data was heterogenous among trials. The standardization of the efficacy and safety outcome measures for future trials on knee cartilage repair and regeneration is necessary.

| S-EPMC11370723 | biostudies-literature

Carbon Dioxide Insufflation of the Knee in the Treatment of Full-Thickness Chondral Defects With Micronized Human Articular Cartilage.

Project description:BioCartilage (BC) is dehydrated, minced human hyaline articular cartilage that was developed as an adjunct to microfracture surgery to help stimulate the bone marrow and stem cells to form hyaline-like tissue in full-thickness chondral defects. The minced pieces of BC require a dry environment for application and can easily be disrupted by residual moisture of saline solution in the surrounding tissues. We present a technique of carbon dioxide insufflation during knee arthroscopy as a means of maintaining a dry environment for preparation of the bony bed during BC augmentation of microfracture surgery. This technique is safe and provides more than adequate visualization, as well as a dry environment, to make the arthroscopic application of BC significantly more efficient.

| S-EPMC6205084 | biostudies-other

The Use of Bone Marrow Concentrate in the Treatment of Full-Thickness Chondral Defects.

Project description:This article is a critical analysis of a study, "Minimally Manipulated Bone Marrow Concentrate Compared with Microfracture Treatment of Full-Thickness Chondral Defects: A One-Year Study in an Equine Model," by Chu et al. (J Bone Joint Surg Am. 100(2):138-146, 2018). The investigation compared two interventions in the management of full-thickness chondral defects in an equine model: autologous bone marrow concentrate without concomitant microfracture treatment versus microfracture treatment alone. This review analyzes the methodology and results of their investigation and examines how their findings may influence the continued development of therapeutic options for full-thickness cartilage injuries. The study utilized in vitro analysis, arthroscopic assessment, magnetic resonance imaging (MRI) evaluation, and histological analysis to compare the treatments and their influence on the quality of cartilage repair. Although Chu et al. reported similar results between groups, their findings offer insight into the role of arthroscopy, MRI, and histology in the evaluation of repair quality. We compare their findings to those of similar investigations, highlighting the limited therapeutic options and variable clinical outcomes related to the treatment of full-thickness articular cartilage defects.

| S-EPMC6384207 | biostudies-literature

Combined Particulated Juvenile Cartilage Allograft Transplantation and Medial Patellofemoral Ligament Reconstruction for Symptomatic Chondral Defects in the Setting of Recurrent Patellar Instability.

Project description:Successful management of patellar osteochondral lesions has proved difficult, with unreliable outcomes reported using traditional cartilage repair and restoration procedures. Unique considerations for this type of defect include the multiplanar contours of the articular surface of the patella, high compressive and shear forces with knee range of motion that may disrupt graft healing, and the potential need for concomitant surgery to address patellar malalignment and instability. We describe our preferred method for treatment of a symptomatic chondral defect in the setting of recurrent patellar instability using particulated juvenile articular cartilage allograft transplantation and medial patellofemoral ligament reconstruction with semitendinosus allograft. Distinct advantages of this cartilage restoration technique include single-stage restoration of relevant cartilage pathology and the ability to easily contour the graft to the size and shape of the chondral defect.

| S-EPMC5310190 | biostudies-literature

All-Arthroscopic Implantation of Minced Juvenile Chondral Allograft for an Isolated, Full-Thickness Chondral Lesion in the Trochlea of an Adult Knee.

Project description:Current use of juvenile chondral allograft (DeNovo; Zimmer, Warsaw, IN) within the knee is an emerging treatment option for full-thickness, isolated chondral lesions. Its implantation traditionally involves a formal arthrotomy for exposure. Arthroscopic implantation minimizes the morbidity associated with this treatment option yet retains the promising functional results already established in the literature. We present a technique for all-arthroscopic implantation of juvenile chondral allograft (DeNovo) for a symptomatic, isolated chondral lesion within the trochlea of an adult knee.

| S-EPMC4948013 | biostudies-literature

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