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Next Generation Cartilage Repair and the Pre-arthroplasty Patient. Pre-arthroplasty artificial Implants Part B: Metallic 下一代软骨修复和关节置换术前患者。关节置换术前人工植入物B部分:金属
IF 0.3 4区 医学 Q4 SPORT SCIENCES Pub Date : 2022-12-01 DOI: 10.1016/j.otsm.2022.150965
Tim Spalding , Iswadi Damasena

Mini-metal implants are indicated for the treatment of symptomatic focal chondral or osteochondral defects in patients considered too old for biological reconstruction or too young with limited cartilage defects for knee arthroplasty. Precise surgical techniques are required to ensure optimal positioning with recession below the articular cartilage surface. Partial resurfacing for femoral or trochlea surfaces using the HemiCAP and UniCAP implants or the Episealer system has shown good short-term outcomes for middle-aged patients. In some series, however, quantification of tibial articular surface wear was not reported making interpretation of the clinical benefit difficult. When successful, clinical function is high and results appear durable. Favorable outcomes are seen with well-defined indications of: isolated defect, healthy opposing articular cartilage, and >50% volume meniscus. Indications also include patients with failed previous cartilage repair and those facing revision articular cartilage repair. Extended indications may include multiple lesions and the requirement for concomitant osteotomy or ligament reconstruction.

微型金属植入物适用于治疗症状性局灶性软骨或骨软骨缺损的患者,这些患者年龄太大,无法进行生物重建,或者年龄太小,软骨缺损有限,无法进行膝关节置换术。精确的手术技术需要确保最佳定位与关节软骨表面以下的衰退。使用HemiCAP和UniCAP植入物或Episealer系统对中年患者进行股骨或滑车表面局部表面置换显示出良好的短期效果。然而,在一些系列中,胫骨关节面磨损的量化没有报道,这使得临床益处的解释变得困难。成功时,临床功能高,效果持久。良好的结果可以看到明确的适应症:孤立的缺陷,健康的对侧关节软骨和50%体积的半月板。适应症还包括先前软骨修复失败的患者和面临关节软骨修复翻修的患者。扩大适应症可能包括多发病变和需要同时截骨或韧带重建。
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引用次数: 0
A Biphasic Aragonite off the Shelf Implant for Articular Cartilage Restoration in Early OA 双相现成霰石种植体修复早期OA关节软骨
IF 0.3 4区 医学 Q4 SPORT SCIENCES Pub Date : 2022-12-01 DOI: 10.1016/j.otsm.2022.150960
Enrico Maria Bertolino , Berardo Di Matteo , Daniele Altomare , Elizaveta Kon

Osteoarthritis (OA) refers to a group of mechanically induced joint disorders characterized by an epigenetic nature. It has been defined as a disease of the entire joint. Articular chondrocytes and subchondral osteocytes are constantly subject to stress, strain and load and, if homeostatic and reparative processes are unable to compensate for the destructive processes, the joint environment will suffer and present with structural damage and clinical symptoms. The lack of drugs able to cure patients from OA has resulted in the use of intra-articular infiltrations and surgical procedures among which the implantation of biomimetic scaffolds. Biomimetic scaffolds are innovative materials created with the aim of encouraging bone and cartilage regeneration. The latest generation of scaffolds has been developed with the aim of increasing the healing abilities of the human body's own cells and signaling factors to achieve a superior tissue quality and better clinical outcomes. The present paper presents the in vivo performance of biphasic aragonite scaffolds on knees affected by early OA. The implantation of bioscaffolds has been been evaluated with MRIs, KOOS scores at follow up and histologically. The Agili-C scaffold's analysis has revealed it to be a viable option in the use of patients with mild to moderate OA.

骨关节炎(OA)是指一组机械诱导的以表观遗传为特征的关节疾病。它被定义为整个关节的疾病。关节软骨细胞和软骨下骨细胞不断受到应力、应变和负荷的影响,如果体内平衡和修复过程无法补偿这些破坏过程,关节环境就会受到损害,并出现结构损伤和临床症状。由于缺乏能够治愈OA患者的药物,导致使用关节内浸润和外科手术,其中植入仿生支架。仿生支架是一种创新材料,旨在促进骨骼和软骨再生。最新一代支架的发展目标是提高人体自身细胞和信号因子的愈合能力,以达到更高的组织质量和更好的临床效果。本文报道双相文石支架在早期OA患者膝关节上的体内性能。生物支架的植入已通过mri,随访时的kos评分和组织学进行评估。Agili-C支架的分析表明,它是轻度至中度OA患者的可行选择。
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引用次数: 1
Use of Allogeneic Mesenchymal Signaling Cells (MSCs) to Augment Cartilage Repair 利用同种异体间充质信号细胞(MSCs)增强软骨修复
IF 0.3 4区 医学 Q4 SPORT SCIENCES Pub Date : 2022-12-01 DOI: 10.1016/j.otsm.2022.150962
Tim F.F. Saris , Tommy S. de Windt , Roel J.H. Custers , Daniël B.F. Saris

Preserving articular cartilage extends the life span and functional capabilities of a joint, and prevents early joint arthroplasty. Mesenchymal signaling cells (MSCs) induce chondrocytes and stimulate the innate capacity to regenerate and restore damaged cartilage. Preserving the pericellular matrix of chondrocytes boosts the ability of MSC to stimulate chondrocytes. The ability to augment joint homeostasis and induce cartilage regeneration with the use of allogenic MSCs unlocks the possibility of a single stage cell based surgical therapy for medium to large cartilage defects. The results of cell therapy with recycled autologous chondrons mixed with allogeneic (bone-marrow or adipose derived) mesenchymal signaling cells (IMPACT/RECLAIM) after 7 years have supported the safety and clinical efficacy of this treatment. Patients have shown clinically relevant and statistically significant improvement in multiple validated patient reported outcome measures for knee pain and quality of life. Once fully industrialized the single stage approach, compared to conventional 2 stage procedures, should also provide a more economical and logistically friendly treatment option. Low failure rates and similar results compared to the current golden standard reinforce the longevity of this proof of concept. The phase III randomized controlled trial comparing results of the treatment after a non-surgical approach will conclude in 2024. As for now, research supports this unique first in man one stage cartilage repair to be safe, feasible, and have good clinical outcomes when combining recycled cartilage with allogeneic MSCs.

保留关节软骨可以延长关节的寿命和功能,并防止早期关节置换术。间充质信号细胞(MSCs)诱导软骨细胞形成并刺激软骨再生和修复的先天能力。保留软骨细胞的细胞周基质可增强间充质干细胞刺激软骨细胞的能力。利用同种异体间充质干细胞增强关节内稳态和诱导软骨再生的能力,为大中型软骨缺损的单阶段细胞手术治疗提供了可能。使用再生的自体软骨混合同种异体(骨髓或脂肪来源)间充质信号细胞(IMPACT/RECLAIM)进行细胞治疗7年后的结果支持了这种治疗的安全性和临床有效性。在多个经过验证的患者报告的膝关节疼痛和生活质量的结果测量中,患者显示出临床相关和统计上显着的改善。一旦完全工业化,与传统的两阶段手术相比,单阶段方法也应该提供更经济和物流友好的治疗选择。与目前的黄金标准相比,低故障率和类似的结果加强了这种概念证明的寿命。比较非手术治疗后治疗结果的III期随机对照试验将于2024年结束。就目前而言,研究支持这种独特的首次人体一期软骨修复是安全可行的,并且在将再生软骨与异体间充质干细胞结合时具有良好的临床效果。
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引用次数: 0
Augmented Marrow Stimulation: Drilling Techniques and Scaffold Options 增强骨髓刺激:钻孔技术和支架选择。
IF 0.3 4区 医学 Q4 SPORT SCIENCES Pub Date : 2022-12-01 DOI: 10.1016/j.otsm.2022.150958
Joshua T. Kaiser, Mario Hevesi, Kyle R. Wagner, Zachary D. Meeker, Brian J. Cole

Marrow stimulation is a commonly used surgical adjunct in the treatment of knee cartilage injuries. While initial studies on traditional microfracture demonstrated favorable short-term results, survivorship and clinical outcomes at medium- and long-term follow-up were subsequently shown to be inferior as compared to cell- and graft-based treatment options. As a result, numerous technical modifications and biologic augmentation approaches have been developed with the goal of improving the efficacy and the durability of marrow stimulation procedures. This chapter presents an overview of the basic and clinical science of marrow stimulation, its evolution over the past 25 years, and preliminary outcomes of treatment augmentation with biologic, scaffold, and cartilage-based approaches.

骨髓刺激是治疗膝关节软骨损伤的常用手术辅助手段。虽然传统微骨折的初步研究显示了良好的短期效果,但与基于细胞和移植物的治疗方案相比,中期和长期随访的生存率和临床结果随后显示较差。因此,为了提高骨髓刺激程序的疗效和持久性,已经开发了许多技术改进和生物增强方法。本章概述了骨髓刺激的基础和临床科学,它在过去25年的发展,以及生物、支架和软骨为基础的治疗方法的初步结果。
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引用次数: 0
Editorial Board (pick up from previous issue) 编辑委员会(选自上一期)
IF 0.3 4区 医学 Q4 SPORT SCIENCES Pub Date : 2022-12-01 DOI: 10.1053/S1060-1872(22)00083-1
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引用次数: 0
Autologous Stem Cells for the Treatment of Chondral Injury and Disease 自体干细胞治疗软骨损伤和疾病
IF 0.3 4区 医学 Q4 SPORT SCIENCES Pub Date : 2022-12-01 DOI: 10.1016/j.otsm.2022.150963
Eric A. Branch , Travis J. Dekker , Adam W. Anz

While the enthusiasm of stem cells from benchtop and animal study has captured the attention of orthopedic clinicians treating and patients with knee pain, the development of an evidence base has been slow. Appropriate regulatory steps, the development of common language, and emerging mechanisms around stem cells are important. Early clinical trials around varying cell sources are encouraging and foster continued excitement. More comparative trials are needed to clarify the true role of these emerging technologies.

虽然来自实验台上和动物研究的干细胞的热情已经引起了治疗膝关节疼痛的骨科临床医生和患者的注意,但证据基础的发展却很缓慢。适当的调控步骤、共同语言的发展以及围绕干细胞的新兴机制是重要的。围绕不同细胞来源的早期临床试验令人鼓舞,并促进了持续的兴奋。需要更多的比较试验来阐明这些新兴技术的真正作用。
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引用次数: 0
Orthobiologics: Optimizing the Joint for Restoration or Delaying Arthroplasty 骨科:优化关节修复或延迟关节置换术
IF 0.3 4区 医学 Q4 SPORT SCIENCES Pub Date : 2022-12-01 DOI: 10.1016/j.otsm.2022.150957
Bert Mandelbaum , Eric Chen

New medical interventions have helped people live longer and healthier lives, which has been accompanied by the expectation of patients remaining active even into their eighth decade and beyond. Unfortunately, advances in the orthopaedic literature for joint preservation have lagged behind. Research into techniques for joint preservation with the goal of delaying arthroplasty have risen to the forefront due to the tremendous physical and economic burden associated with osteoarthritis. One component has been the field of orthobiologics, the class of therapies that utilize biological products to enhance the body's natural healing process. Several potential candidates have emerged and entered the public consciousness, which portends increasing interest into these therapeutics. Among these possibilities include hyaluronic acid, platelet-rich plasma, bone marrow aspirate concentrate, and mesenchymal stem cells (MSC's). Despite concerns regarding the efficacy and cost-benefit ratio, both the basic science and the clinical data have supported their use to varying degrees. Further research remains to provide concrete guidelines for clinicians to provide optimal care for their patients.

新的医疗干预措施帮助人们活得更久、更健康,与之相伴的是,人们期望病人在八十岁甚至八十岁以后还能保持活跃。不幸的是,关节保护的骨科文献进展滞后。由于与骨关节炎相关的巨大的身体和经济负担,以延迟关节置换术为目标的关节保存技术的研究已经上升到最前沿。其中一个组成部分是骨科领域,这是一类利用生物制品来增强人体自然愈合过程的疗法。一些潜在的候选药物已经出现并进入了公众的意识,这预示着人们对这些治疗方法的兴趣越来越大。这些可能包括透明质酸、富血小板血浆、骨髓浓缩液和间充质干细胞(MSC)。尽管存在疗效和成本效益比方面的担忧,但基础科学和临床数据都在不同程度上支持它们的使用。进一步的研究仍需为临床医生提供具体的指导方针,为患者提供最佳的护理。
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引用次数: 0
Table of Contents (pick up from previous issue w/updates) 目录(选自上一期的内容和更新)
IF 0.3 4区 医学 Q4 SPORT SCIENCES Pub Date : 2022-12-01 DOI: 10.1053/S1060-1872(22)00082-X
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引用次数: 0
Autologous Chondrocyte Implantation (ACI) for Cartilage Defects of the Knee Using Novocart 3D and Novocart Inject 自体软骨细胞植入术治疗膝关节软骨缺损的研究
IF 0.3 4区 医学 Q4 SPORT SCIENCES Pub Date : 2022-12-01 DOI: 10.1016/j.otsm.2022.150959
Philipp Niemeyer MD, PhD , Peter Angele MD, PhD

Ever since autologous chondrocyte implantation (ACI) has been introduced, there have been important advancements and progress leading to a more reliable and more standardized application of this technology. While first-generation ACI followed the principle of a cell-suspension being injected under an autologous periosteum patch, second and third generation ACI are characterized by the use of biomaterials, either using a cell-suspension (second generation) or a combination of cells and the biomaterial (third generation). Due to easier handling and improved clinical outcome, third generation ACI has become the gold standard for the use of ACI at this time. The present chapter focuses on the Novocart third generation ACI products. While Novocart 3D uses a collagen membrane and therefore an implantable biomaterial, Novocart Inject is a hydrogel-based ACI product that can be injected into cartilage defects. Both products are currently underway for central European market authorization by the European Medicinal Agency (EMA), additionally, an FDA-approval trial is underway for Novocart 3D. Product characteristics, indications, surgical techniques, and clinical outcomes are summarized in the present chapter.

自引入自体软骨细胞植入(ACI)以来,已经取得了重要的进展和进展,导致该技术的应用更加可靠和标准化。第一代ACI的原理是在自体骨膜贴片下注射细胞悬液,而第二代和第三代ACI的特点是使用生物材料,要么使用细胞悬液(第二代),要么使用细胞和生物材料的组合(第三代)。由于更容易操作和改善临床效果,第三代ACI已成为此时使用ACI的金标准。本章主要介绍Novocart第三代ACI产品。虽然Novocart 3D使用胶原膜,因此是一种可植入的生物材料,但Novocart Inject是一种基于水凝胶的ACI产品,可以注射到软骨缺陷中。这两种产品目前正在欧洲药品管理局(EMA)的中欧市场授权中,此外,fda批准的Novocart 3D正在进行试验。本章总结了产品特点、适应症、手术技术和临床结果。
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引用次数: 1
Use of 3D-Printed Patient Specific Guides in Osteotomies around the Knee 3D打印患者专用导向器在膝关节周围截骨术中的应用
IF 0.3 4区 医学 Q4 SPORT SCIENCES Pub Date : 2022-09-01 DOI: 10.1016/j.otsm.2022.150936
Suhas P. Dasari MD , Luc M. Fortier MD, Bhargavi Maheshwer MD, Mario Hevesi MD, PhD, Safa Gursoy MD, PhD, Jorge Chahla MD, PhD

High tibial osteotomies are challenging procedures that have traditionally implemented two-dimensional planning (2D) for a complex three-dimensional surgery (3D). In an effort to improve the accuracy and precision of the technique, there has been a growing interest in the use of patient specific instrumentation (PSI). The implementation of PSI in osteotomies has demonstrated consistent and reliable results in the correction of the hip-knee-ankle angle, proximal tibial angle, and the posterior tibial slope. Initial clinical studies describing the implementation of this technology have reported superior accuracy in both the coronal and sagittal planes as compared to free-hand techniques. Additionally, these studies reported a fast surgeon learning curve, short operative times, and minimal fluoroscopy exposure. The senior author's preferred closing wedge HTO technique utilizes a patient specific cutting guide with osteotomy fixation provided by an extra-cortical titanium alloy locking plate. This technique is designed to provide reliable and accurate HTOs while minimizing the risk of major complications such as hinge fractures on the contralateral cortex.

高位胫骨截骨术是一项具有挑战性的手术,传统上采用二维计划(2D)来进行复杂的三维手术(3D)。为了提高该技术的准确性和精密度,人们对使用患者专用仪器(PSI)越来越感兴趣。PSI在截骨术中的应用在矫正髋关节-膝关节-踝关节角、胫骨近端角和胫骨后斜度方面显示出一致和可靠的结果。初步临床研究表明,与徒手技术相比,该技术在冠状面和矢状面均具有更高的准确性。此外,这些研究报告了快速的外科医生学习曲线,较短的手术时间和最小的透视暴露。资深作者推荐的闭合楔形HTO技术采用患者特异性切割指南,由皮质外钛合金锁定钢板提供截骨固定。该技术旨在提供可靠和准确的hto,同时最大限度地减少对侧皮质铰链骨折等主要并发症的风险。
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引用次数: 1
期刊
Operative Techniques in Sports Medicine
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