CARTILAGE最新文献

BackgroundRetrograde drilling is an established surgical technique to treat osteochondral lesions of the talus (OLT). It involves non-trans-articular drilling to induce subchondral bone revascularization and bone formation without damaging the overlying articular cartilage. The present study aimed to elucidate the heterogeneity of clinical studies on retrograde drilling for OLT.DesignA systematic search of the MEDLINE, Web of Science, EMBASE, and Cochrane Library databases for studies published between January 1996 and August 27, 2022, was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines by two independent reviewers. The included studies were evaluated for their level of evidence (LoE) and quality of evidence (QoE) using the Modified Coleman Methodology Score. Variables reporting surgical and clinical outcomes and complications were evaluated.ResultsEleven studies with 207 ankles were included (mean follow-up period = 31.1 months). The mean LoE was 3.8 (LoE 3: two studies, LoE 4: nine studies), and the mean QoE was 50.8 (fair: three studies, poor: eight studies). Ten studies used the American Orthopedic Foot and Ankle Society (AOFAS) score, which improved from 57.9 preoperatively to 86.1 postoperatively. The period and protocol of conservative treatment, lesion character, surgical technique, and postoperative protocol were inconsistent or underreported.ConclusionsThis systematic review revealed that low LoE and poor QoE, coupled with heterogeneity among the included studies, impede definitive conclusions regarding the effectiveness of this technique. Consequently, well-designed clinical trials are essential to develop standardized clinical guidelines for using retrograde drilling in OLT.

ObjectiveThe purpose of this study was to evaluate outcomes following autologous osteochondral transplantation (AOT) for the treatment of osteochondral lesions of the talus (OLT) at a minimum of 10-year follow-up.DesignRetrospective chart review identified patients who underwent AOT for the treatment of OLT. Pre-operative magnetic resonance imaging (MRI) scans were obtained in all patients. Clinical outcomes assessed included: pre- and post-operative foot and ankle outcome score (FAOS), visual analog scale (VAS), patient satisfaction, complications, failures and secondary surgical procedures.ResultsThirty-nine patients with a mean lesion size was 122.3 ± 64.1 mm² and mean follow-up time of 138.9 ± 16.9 months were included. The mean FAOS scores improved from a preoperative score of 51.9 ± 16.0 to 75.3 ± 21.9 (P < 0.001). Increasing lesion size was variable associated with inferior FAOS scores (R² = 0.2228). There was statistically significant higher mean T2 relaxation values at the superficial layer at the site of the AOT graft (42.9 ± 5.2 ms) compared to the superficial layer of the adjacent native cartilage (35.8 ± 3.8 ms) (P < 0.001). Seventeen complications (43.6%) were observed, the most common of which was anterior ankle impingement (25.6%). There were 2 failures (5.1%), both of which had a history of prior bone marrow stimulation via microfracture and post-operative cysts identified on MRI.ConclusionThis retrospective review found that AOT for the treatment of large OLTs produced a 94.9% survival rate at a minimum of 10-year follow-up. Increasing lesion size was associated with inferior clinical outcomes. The findings of this study indicates that AOT is a viable long-term surgical strategy for the treatment of large OLTs.

ObjectiveThe purpose of this study was to determine the M1/M2 macrophage ratio in concentrated bone marrow aspirate (cBMA) in patients undergoing surgical intervention augmented with cBMA for osteochondral lesions of the talus (OLTs).DesignSamples of peripheral blood (PB), bone marrow aspirate (BMA), and cBMA were collected during the procedure. The samples were analyzed by automated cell counting and multicolor fluorescence-activated cell sorting with specific antibodies recognizing monocytes (CD14+ CD16+) and the M1 (CD86+) and M2 (CD163+CD206+) populations within that monocyte population. Cytokine concentrations within the samples were evaluated with enzyme-linked immunosorbent assay (ELISA). The composition of cBMA was compared between 2 commercially available BMA concentration systems.ResultsThirty-eight patients with a mean age of 43.2 ± 10.1 years old undergoing a surgical procedure for the treatment of OLTs involving the use of cBMA were included. cBMA had a mean fold increase of 4.7 for all white blood cells, 6.1 for monocytes, 7.9 for lymphocytes, 2.4 for neutrophils, and 9.6 for platelets when compared to BMA. The mean M1/M2 ratio for PB, BMA, and cBMA was 15.2 ± 12.0, 20.8 ± 13.3, and 22.1 ± 16.0, respectively. There was a statistically significant higher concentration of interleukin-1 receptor antagonist (IL-1Ra) in the cBMA sample (8243.3 ± 14,837.4 pg/mL) compared to both BMA (3143.0 ± 2218.5 pg/mL) and PB (1847.5 ± 1520.4 pg/mL) samples. The IL-1Ra/IL-1β ratio for PB, BMA, and cBMA was 790.6 ± 581.9, 764.7 ± 675.2, and 235.7 ± 192.1, respectively. There was no difference in the cBMA M1/M2 ratio (19.0 ± 11.1 vs 24.0 ± 18.3) between the Magellan (Isto Biologics, Hopkinton, Massachusetts) and Angel systems (Arthrex Inc, Naples, Florida).ConclusionThis prospective study found that the M1/M2 ratio in cBMA was 22.1 ± 16.0, with significant patient to patient variation observed. Overall, there was no statistically significant difference in the M1/M2 ratio across PB, BMA, and cBMA samples. This is the first study to characterize the macrophage subpopulation within cBMA, which may have significant clinical implications in future studies.

ObjectiveTo investigate water and lipid composition changes in knee subchondral bone marrow and cartilage in chronic kidney disease (CKD) patients compared with age- and sex-matched healthy controls using magnetic resonance spectroscopy (MRS) and T2 mapping.DesignThis IRB-approved case-control study included 20 CKD patients (12 men, 8 women) and 20 age- and sex-matched healthy controls (10 men, 10 women). MRS and T2 measurements were performed on regions of interest in the knee subchondral bone and cartilage. Water content, lipid composition, fat content, and the unsaturation index (UI) were quantified using LCModel. Differences between groups were assessed using independent samples T-tests.ResultsThe CKD group showed a significantly higher lipid UI compared with controls (P = 0.035). In subgroup analysis, women with CKD had significantly higher water content (4.7 ppm), lower fat content, and higher lipid UI than female controls (P = 0.023, 0.048, and 0.018, respectively). No significant differences were observed between men with CKD and male controls (all P > 0.4). Among CKD patients, men had significantly lower lipid composition (5.3 ppm) and lipid UI compared with women (P = 0.026 and 0.012, respectively). T2 values were significantly elevated in CKD patients (P = 0.016 for men; P = 0.031 for women).ConclusionsQuantitative MRS and T2 mapping are feasible tools for assessing CKD-related changes in the knee joint. Increased unsaturated lipid content and water in subchondral bone may contribute to early degenerative changes.

ObjectiveLesions of adult articular cartilage occur due to trauma or disease, such as osteoarthritis. If they do not penetrate the subchondral bone, they are called partial-thickness defects (PTDs), which are believed not to heal. However, some reports indicate that minor PTDs can be repaired. We hypothesize that a critical-size PTD exists below which spontaneous healing occurs.Design/MethodsIn an adult pig model, we created PTDs of minimal width (a scalpel cut) and systematically increased their width up to 0.5 mm. Defect analyses were conducted at 1 and 3 months post-surgery using light microscopy and histomorphometry.ResultsNone of the defects healed by repair cartilage; therefore, all PTDs are of a critical size. Surprisingly, a critical defect-size range was identified where significant mesenchymal tissue (MT) formation occurs, specifically in defects measuring 50-100 μm in width. The presence of this MT was limited to a 1-month time window. Furthermore, physiological joint loading during the postsurgical phase was associated with substantial structural tissue deformation, often leading to an overlapping of the side walls of the smallest defects. This results in a pseudo-covering of the defect void, which may thus be invisible when observed from above.ConclusionsThe main novel finding of this study is that there is no critical width below which PTDs undergo repair.

PurposeThis review aims to elucidate the mechanisms underlying chondrocyte senescence in osteoarthritis (OA) from 4 core perspectives: extracellular inflammation, mechanical overload and stress, intracellular metabolic and signaling dysregulation, and genetics-related alterations. It further summarizes emerging therapeutic strategies targeting chondrocyte senescence to address the unmet clinical need for disease-modifying OA interventions.FindingsAccumulating evidence indicates that chondrocyte senescence drives OA progression through multiple interconnected mechanisms. These include amplification of inflammation and extracellular matrix degradation via the senescence-associated secretory phenotype (SASP), disruption of anabolic-catabolic homeostasis, dysregulation of mechanotransduction pathways under excessive mechanical load, and reshaping of intracellular metabolism and redox balance. Additional contributing mechanisms involve epigenetic dysregulation, non-coding RNA-mediated gene modulation, and impaired autophagy. Therapeutic approaches under preclinical or clinical investigation encompass senolytic and senomorphic agents, chondroprotective biological materials, genetic or RNA-based interventions, as well as strategies targeting SASP modulation and extracellular microenvironment repair.ConclusionsChondrocyte senescence serves as a central convergent mechanism in OA pathogenesis and a promising target for disease-modifying therapies. Advances in mechanistic understanding and senescence-targeted interventions offer new avenues for translational innovation, though critical challenges related to specificity, safety, and long-term efficacy require further resolution.

ObjectiveLower limb malalignment accelerates the progression of knee osteoarthritis (KOA). Knee realignment osteotomy is a well-established treatment for unicompartmental KOA with malalignment. Traditional planning in KOA patients corrects deformities with an osteotomy at the metaphysis but overlooks Paley's approach, which targets the center of rotation angulation (CORA). Osteotomy at the metaphysis may induce secondary translational deformities, which remain unstudied in KOA patients. This study aims to identify the CORA in KOA patients with tibial malalignment.MethodsThirty tibiae (10 varus, 10 neutral, 10 valgus) from the IMI-APPROACH cohort were analyzed using computed tomography (CT) scans. The CORA, defined as the intersection of the proximal and distal mechanical axes, was identified. Translational deformity was calculated by multiplying the CORA-to-osteotomy distance by the tangent of the correction angle.ResultsAmong the varus tibiae, 9 out of 10 CORAs were located in the diaphysis, while 8 out of 10 valgus tibiae had their CORA in the diaphysis. When osteotomies were performed in the proximal metaphysis instead of the CORA location, secondary translational deformities of up to 3 cm were induced.ConclusionIn KOA patients with tibial malalignment, the CORA is predominantly located in the diaphysis rather than in the proximal metaphysis, where osteotomies are typically performed. This discrepancy leads to iatrogenic translational deformities. Future research should investigate the clinical impact of these deformities to optimize osteotomy planning and potentially improve long-term surgical outcomes.

PurposeTo compare the clinical and biological outcomes of minced autologous cartilage transplantation versus hyaluronic acid-based scaffold with bone marrow aspirate concentrate (HA-BMAC) in the treatment of full-thickness cartilage lesions of the knee.MethodsA total of 41 patients treated with minced autologous cartilage transplantation were retrospectively analyzed. Using propensity score matching, a control group of 41 patients was selected from a large cohort treated with HA-BMAC-based cartilage repair. Minced cartilage was harvested from unloaded cartilage and fibrin-glued into the defect. Bone marrow aspirate concentrate (BMAC) was obtained from the iliac crest, centrifuge concentrated, and seeded onto a hyaluronic acid scaffold. Clinical outcomes were assessed using the Knee Injury Outcome Score (KOOS) score. Magnetic resonance imaging (MRI) evaluations were performed preoperatively with AMADEUS score and at 1-year follow-up using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART)-2 score.ResultsThe groups were comparable in terms of age, sex, lesion size, and location. Significant improvements were observed in all KOOS subscales in both cartilage repair groups, with no statistical difference between them at 1-year follow-up. MOCART-2 scores showed a trend toward superior biological healing in the minced cartilage group (mean score: 77) compared to the BMAC group (mean score: 73). Excellent healing (MOCART >80) was observed in 51% of minced cartilage cases versus 38% of BMAC cases.ConclusionBoth minced cartilage transplantation and HA-BMAC treatments resulted in comparable subjective clinical outcomes. However, minced cartilage transplantation demonstrated a tendency for enhanced biological healing based on MRI compared to HA-BMAC. This suggests potential advantages of minced cartilage transplantation over HA-BMAC cartilage repair.

ObjectiveThis study investigated the effect of synovial cell fractionation on tenascin-C (TNC) expression in chondrocytes by coculturing human chondrocytes with synovial cells derived from osteoarthritis (OA) patients.DesignHuman cartilage and synovium were isolated from patients undergoing total knee arthroplasty. Synovial cells were classified into CD68 positive- and negative groups using western blotting. Cocultures were performed for 7 days using Cell Culture Inserts. The expression of TNC, syndecan-4 (SDC4), and anabolic and catabolic factors was measured by real-time polymerase chain reaction. TNC levels in the medium were compared using enzyme-linked immunosorbent assay. Flow cytometry examined M1 and M2 macrophage proportions in synovial cells immediately after isolation, after 7 days of monoculture, and after coculture.ResultsIn the CD68 positive group, TNC and matrix metalloproteinase (MMP)-3 were significantly upregulated in cocultured chondrocytes, and SDC4 was significantly upregulated in cocultured synovial cells. TNC concentration in the medium was significantly higher in CD68 positive cocultures. M1 proportions were significantly higher in synovial cells immediately after isolation and in cocultured synovial cells than in those cultured alone.ConclusionsSynovial cell fractionation differentially affects TNC and SDC4 expression. Macrophage-like synovial cells (MLS) increase TNC expression in chondrocytes and may contribute to OA pathology.