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Cytotherapy Aug 2021Articular cartilage has limited regenerative ability when damaged through trauma or disease. Failure to treat focal chondral lesions results in changes that inevitably... (Review)
Review
Use of human induced pluripotent stem cells for cartilage regeneration in vitro and within chondral defect models of knee joint cartilage in vivo: a Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic literature review.
BACKGROUND AIMS
Articular cartilage has limited regenerative ability when damaged through trauma or disease. Failure to treat focal chondral lesions results in changes that inevitably progress to osteoarthritis. Osteoarthritis is a major contributor to disability globally, which results in significant medical costs and lost wages every year. Human induced pluripotent stem cells (hiPSCs) have long been considered a potential autologous therapeutic option for the treatment of focal chondral lesions. Although there are significant advantages to hiPSCs over other stem cell options, such as mesenchymal and embryonic stem cells, there are concerns regarding their ability to form bona fide cartilage and their tumorgenicity in vivo.
METHODS
The authors carried out a systematic literature review on the use of hiPSCs to produce differentiated progeny capable of producing high-quality cartilage in vitro and regenerate cartilage in osteochondral defects in vivo in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eight studies were included in the review that used hiPSCs or their derived progeny in xenogeneic transplants in animal models to regenerate cartilage in osteochondral defects of the knee joint. The in vitro-differentiated, hiPSC-derived and in vivo defect repair ability of the hiPSC-derived progeny transplants were assessed.
RESULTS
Most studies reported the generation of high-quality cartilage-producing progeny that were able to successfully repair cartilage defects in vivo. No tumorigenicity was observed.
CONCLUSIONS
The authors conclude that hiPSCs offer a valuable source of cartilage-producing progeny that show promise as an effective cell-based therapy in treating focal chondral lesions.
Topics: Animals; Cartilage, Articular; Cell Differentiation; Humans; Induced Pluripotent Stem Cells; Knee Joint; Osteoarthritis
PubMed: 34059422
DOI: 10.1016/j.jcyt.2021.03.008 -
Cartilage Dec 2021A systematic review and meta-analysis of Autologous Matrix-Induced Chondrogenesis (AMIC®) outcomes for grade III/IV chondral and osteochondral lesions of the knee... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
A systematic review and meta-analysis of Autologous Matrix-Induced Chondrogenesis (AMIC®) outcomes for grade III/IV chondral and osteochondral lesions of the knee treated with Chondro-Gide®.
DESIGN
Studies with a minimum follow-up of 1 year providing clinical results of AMIC repair in the knee were included based on PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Methodological quality was assessed by the modified Coleman Methodology Score (mCMS). The meta-analysis was comparing pain VAS (Visual Analog Scale), Lysholm score, and IKDC score (International Knee Documentation Committee) between baseline and follow-up after 1 or 2 years and after >3 years.
RESULTS
Twelve studies (375 patients) were included. The mCMS demonstrated a suboptimal study design (ranking between 52 and 80). The mean age was 36.2 years (14-70 years). The mean defect size was 4.24 cm (0.8-22 cm). The results from the random effects model indicated a clinically significant ( < 0.05) improvement of pain VAS from baseline to follow-up at year 1 to 2 of -4.02(confidence interval -4.37; -3.67), still significant after 3 years. Lysholm score at year 1 or 2 improved significantly and remained highly significant after 3 years. IKDC score showed highly significant improvement of 32.61 between 1 and 2 years versus baseline values maintained after 3 years.
CONCLUSIONS
The AMIC procedure significantly improved the clinical status and functional scoring versus preoperative values. Evidence was obtained in a non-selected patient population, corresponding to real-life treatment of knee chondral and osteochondral defects. The evidence is sufficient to recommend AMIC in this indication.
Topics: Adolescent; Adult; Aged; Arthroplasty, Subchondral; Cartilage, Articular; Chondrogenesis; Collagen; Female; Fractures, Stress; Guided Tissue Regeneration; Humans; Intra-Articular Fractures; Knee Injuries; Male; Middle Aged; Patellofemoral Joint; Patient Satisfaction; Transplantation, Autologous; Treatment Outcome
PubMed: 31508990
DOI: 10.1177/1947603519870846 -
Acta Ortopedica Brasileira 2021This study aimed to identify the most used scales in the assessment of the clinical outcomes for the treatment of osteochondral lesions of the talus. (Review)
Review
OBJECTIVE
This study aimed to identify the most used scales in the assessment of the clinical outcomes for the treatment of osteochondral lesions of the talus.
METHODS
We performed a systematic review of the PubMed/MEDLINE databases from September 1999 to September 2019, based on the guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The research strategy was: osteochondral [All Fields], AND ("talus" [MeSH Terms] OR "talus" [All Fields]) AND lesion [All Fields]. Of the 364 articles found in the literature, 166 (45%) were included in the study and 198 (55%) excluded. In total, 23 clinical assessment tools were used in the studies.
RESULTS
We found 49.4% of the studies to use the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS Ankle-Hindfoot Scale) and 29.5% the Visual Analogue Scale (VAS).
CONCLUSION
The use of AOFAS increased in relation to VAS in the last 6 years ( = 0.046), and these two scales, either alone or combined, were the most used for studying osteochondral lesions of the talus
PubMed: 34290565
DOI: 10.1590/1413-785220212903238274 -
Arthroscopy, Sports Medicine, and... Aug 2021The purpose of the present study is to systematically review the available literature for management of bipolar lesions within the tibiofemoral joint and determine... (Review)
Review
PURPOSE
The purpose of the present study is to systematically review the available literature for management of bipolar lesions within the tibiofemoral joint and determine whether tibiofemoral cartilage restoration is an effective treatment modality.
METHODS
PubMed and MEDLINE databases were queried between 2000 and 2020 using the following keywords: "osteochondral" and "knee" and "microfracture," "autologous chondrocyte implantation (ACI)," or "transplantation." Articles were reviewed for the presence of a bipolar or "kissing" tibiofemoral lesion and reported lesion size, concomitant procedures, failure rates, and time to failure.
RESULTS
After screening 1,295 articles, there were 4 articles available for analysis and a total of 152 knees involving the management of bipolar tibiofemoral lesions. Age ranged from 14 to 60 years, and mean follow-up was between 12 and 240 months. There was 1 retrospective cohort study (36 knees) and 3 case series (mean, 38.7 ± 17.5 knees). There were 58 knees treated with bipolar osteochondral allograft (OCA) transplantation, 58 knees treated with bipolar ACI, 20 knees treated with femoral OCA and tibial debridement, and 16 knees treated with femoral OCA and tibial microfracture. There were 37 failures (24.3%): 16 patients (10.5%) were converted to unicompartmental or total knee arthroplasty, 4 restorative procedures (2.6%) were revised, and 8 patients (1.6%) had unsatisfactory outcomes only. The remaining 15 failures (9.9%) had an unspecified combination of objective failure. The mean rate of failure ranged between 0% and 44.1% ( = 83.2%). The mean time to failure ranged between 2.7 and 4.1 years ( = 79.1%).
CONCLUSIONS
Cartilage restoration, through both ACI and OCA, had failure rates between 0% and 44% in patients with bipolar lesions of the tibiofemoral compartment. Although a higher level of evidence is required to prove efficacy, the current study demonstrates midterm survivorship rates between 55% and 100%, which may delay the need for secondary arthroplasty.
LEVEL OF EVIDENCE
Level IV, systematic review of Level IV studies.
PubMed: 34430903
DOI: 10.1016/j.asmr.2021.03.020 -
Arthroscopy : the Journal of... Sep 2019This review explores the current literature regarding both the clinical indications and utility of minimally invasive in-office needle arthroscopy (IONA) relative to...
PURPOSE
This review explores the current literature regarding both the clinical indications and utility of minimally invasive in-office needle arthroscopy (IONA) relative to conventional imaging modalities.
METHODS
In compliance with R-AMSTAR (Revised Assessment of Multiple Systematic Reviews) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, 3 databases (MEDLINE, Embase, and PubMed) were searched in July 2018, in addition to the conference abstract databases of 5 prominent meetings between 2013 and 2018, for studies using IONA for diagnostic purposes. Study quality was assessed with the Methodological Index for Non-Randomized Studies (MINORS) criteria.
RESULTS
Among 932 conference abstracts and 369 studies identified, 11 publications involving 404 patients (395 knees and 9 shoulders) were included, with 9 clinical studies and 2 cost analyses. The median Methodological Index for Non-Randomized Studies (MINORS) score was 9 for noncomparative and 23 for comparative studies. Among the 9 clinical studies, IONA had a superior sensitivity, specificity, positive predictive value, and negative predictive value to magnetic resonance imaging (MRI) in the evaluation of knee osteoarthritis, anterior cruciate ligament insufficiency, and meniscal tears. IONA was comparable or inferior to MRI in the same parameters for the diagnosis of osteochondral defects and rotator cuff tears. In the 2 cost analyses, IONA had lower costs when used in place of MRI for treatment algorithms involving medial meniscal tears and rotator cuff tears but not lateral meniscal tears.
CONCLUSIONS
IONA holds potential for cost savings and improved diagnostic accuracy relative to MRI, primarily for intra-articular meniscal, ligamentous, and chondral defects of the knee. However, its current indications for use in other joints are limited to rotator cuff tears in the shoulder, making its diagnostic value in other joints much more limited. The current quality and breadth of evidence are significantly lacking, with numerous practical shortcomings. To improve acceptance of IONA, priority should be placed on establishing defined protocols, indications, contraindications, and patient perspectives for the procedure.
LEVEL OF EVIDENCE
Level IV, systematic review of Level II, III, and IV studies.
Topics: Algorithms; Ambulatory Surgical Procedures; Arthroscopy; Data Collection; Humans; Joint Diseases; Magnetic Resonance Imaging; Needles
PubMed: 31416656
DOI: 10.1016/j.arthro.2019.03.045 -
The Journal of Foot and Ankle Surgery :... 2021Osteochondral lesions of the talus (OLT) are common injuries requiring surgery. Arthroscopic microfracture treatment is effective and acceptable. Although the concept of... (Meta-Analysis)
Meta-Analysis Review
Osteochondral lesions of the talus (OLT) are common injuries requiring surgery. Arthroscopic microfracture treatment is effective and acceptable. Although the concept of postoperative rehabilitation is continuously being updated, the choice between early weightbearing (EWB) versus delayed weightbearing (DWB) following microfracture is still not settled. A meta-analysis and systematic review was performed to compare the rehabilitation effect of 2 different weightbearing protocols following microfracture. Five databases were searched for relevant studies, and full-text articles comparing EWB and DWB were reviewed. Review Manager 5.3 software was used to summarize the results of the included studies. Two reviewers independently filtered the studies, assessed quality, extracted data, and estimated the risk of bias. The pain score and functional assessment of the ankle were selected as the endpoints. The mean difference was calculated as the summary statistic for continuous data. Then, visual analog scale and American Orthopedic Foot and Ankle Society scale scores were collected and pooled. Five randomized controlled trials including 283 patients were identified for this study, revealing that there was no significant difference in pain scores between EWB and DWB following microfracture 3 months, 6 months, 12 months, and 24 months postoperatively. Function assessment showed similar results. Comprehensive analysis of current evidence still suggests that EWB and DWB after microfracture of OLT produce comparable clinical outcomes in terms of pain and functional activity. Therefore, EWB is recommended to shorten the length of time before returning to work or sports after microfracture of OLT.
Topics: Arthroscopy; Cartilage, Articular; Fractures, Stress; Humans; Randomized Controlled Trials as Topic; Talus; Treatment Outcome; Weight-Bearing
PubMed: 34215515
DOI: 10.1053/j.jfas.2021.04.022 -
Foot and Ankle Surgery : Official... Jul 2023Treating osteochondral lesions of the first metatarsal head can help reducing pain and preventing end-stage arthritic cartilage degeneration and hallux rigidus. Several... (Review)
Review
BACKGROUND
Treating osteochondral lesions of the first metatarsal head can help reducing pain and preventing end-stage arthritic cartilage degeneration and hallux rigidus. Several surgical techniques have been described, but no clear indications are reported. This systematic review aims to offer an overview of the current surgical treatments for focal osteochondral lesions of the first metatarsal head.
METHODS
The selected articles were examined to extract data about population, surgical technique, and clinical outcomes.
RESULTS
Eleven articles were included. Mean age at surgery was 38,2 years. Osteochondral autograft was the most used technique. After surgery, an improvement was achieved in AOFAS, VAS, and hallux dorsiflexion but not in plantarflexion.
CONCLUSION
There is limited evidence and knowledge regarding the surgical management of the first metatarsal head osteochondral lesions. Various surgical techniques have been proposed, drawn from other districts. Good clinical results have been reported. Further high-level comparative studies are necessary to design an evidence-based treatment algorithm.
Topics: Humans; Metatarsal Bones; Hallux Rigidus; Hallux; Metatarsophalangeal Joint; Treatment Outcome; Follow-Up Studies
PubMed: 37301674
DOI: 10.1016/j.fas.2023.05.007 -
Foot (Edinburgh, Scotland) Dec 2021Arthroscopic debridement (AD) for the osteochondral lesions of the talar dome (OLT) was widely documented in the nineties with satisfactory results. However, in modern... (Review)
Review
BACKGROUND
Arthroscopic debridement (AD) for the osteochondral lesions of the talar dome (OLT) was widely documented in the nineties with satisfactory results. However, in modern treatment algorithms, its role is not described. The present systematic review aims to evaluate the current evidence on the clinical outcomes of AD in the management of OLT.
METHODS
Two independent reviewers searched PubMed, EMBASE, Scopus, and Virtual Health Library databases evaluating the clinical outcomes of AD of OLT with a minimum 6-month follow-up. The following terms "talus", "chondral", "cartilage", "injury", "lesion", "delamination", "damage", "excision", "curettage", "debridement", "chondrectomy", "chondroplasty", were used alone and in combination with Boolean operators AND and OR. Studies in which surgical technique was not described, an additional procedure was performed after debridement, and/or outcomes were not reported separately when more than one technique was implemented were excluded. The modified Coleman methodology score (mCMS) was used to evaluate the methodological quality of the included studies. A narrative analysis was conducted. Publication bias was assessed using the ROBIS tool.
RESULTS
AD showed satisfactory short and medium-term outcomes for the primary treatment of OLT irrespectively of size and depth. However, the heterogeneity of the included studies and the level of available evidence hinders its recommendation.
CONCLUSIONS
There is a paucity of evidence evaluating AD alone for OLT treatment in the last two decades. Bone-marrow stimulation techniques remain the first-line surgical strategy for OLT treatment without proven superiority. Adopting AD for OLT treatment instead of MF could represent a paradigm breakthrough in clinical practice given its many potential advantages while preserving the subchondral plate.
Topics: Arthroscopy; Cartilage, Articular; Debridement; Humans; Intra-Articular Fractures; Talus; Treatment Outcome
PubMed: 34536818
DOI: 10.1016/j.foot.2021.101852 -
Knee Surgery, Sports Traumatology,... Dec 2021The purpose of this systematic review was to determine the return to sport rates following surgical management of ostechondritis dissecans of the elbow. (Meta-Analysis)
Meta-Analysis
PURPOSE
The purpose of this systematic review was to determine the return to sport rates following surgical management of ostechondritis dissecans of the elbow.
METHODS
The databases EMBASE, PubMed, and MEDLINE were searched for relevant literature from database inception until August 2020 and studies were screened by two reviewers independently and in duplicate for studies reporting rates of return to sport following surgical management of posterior shoulder instability. A meta-analysis of proportions was used to combine the rates of return to sport using a random effects model. A risk of bias assessment was performed for all included studies using the MINORS score.
RESULTS
Overall, 31 studies met inclusion criteria and comprised of 548 patients (553 elbows) with a median age of 14 (range 10-18.5) and a median follow-up of 39 months (range 5-156). Of the 31 studies included, 14 studies (267 patients) had patients who underwent open stabilization, 11 studies (152 patients) had patients who underwent arthroscopic stabilization, and 6 studies (129 patients) had patients who underwent arthroscopic-assisted stabilization. The pooled rate of return to any level of sport was 97.6% (95% CI 94.8-99.5%, I = 32%). In addition, the pooled rate of return to the preinjury level was 79.1% (95% CI 70-87.1%, I = 78%). Moreover, the pooled rate of return to sport rate at the competitive level was 86.9% (95% CI 77.3-94.5%, I = 64.3%), and the return to sport for overhead athletes was 89.4% (95% CI 82.5-95.1%, I = 59%). The overall return to sport after an arthroscopic procedure was 96.4% (95% CI 91.3-99.6%, I = 1%) and for an open procedure was 97.8% (95% CI 93.7-99.9%, I = 46%). All functional outcome scores showed improvement postoperatively and the most common complication was revision surgery for loose body removal (19 patients).
CONCLUSION
Surgical management of osteochondritis dissecans of the elbow resulted in a high rate of return to sport, including in competitive and overhead athletes. Similar rates of return to sport were noted across both open and arthroscopic procedures.
LEVEL OF EVIDENCE
Level IV.
Topics: Adolescent; Arthroscopy; Child; Elbow; Humans; Infant; Joint Instability; Osteochondritis Dissecans; Return to Sport; Shoulder Joint
PubMed: 33620512
DOI: 10.1007/s00167-021-06489-9 -
The American Journal of Sports Medicine Nov 2022Commercially available products used in knee cartilage reconstructive and restorative surgical practices fall under unique US Food and Drug Administration (FDA)...
BACKGROUND
Commercially available products used in knee cartilage reconstructive and restorative surgical practices fall under unique US Food and Drug Administration (FDA) regulatory pathways that determine the level of evidence required to market each product.
PURPOSE
To evaluate the levels of evidence in the literature supporting commercially available cartilage repair procedures stratified by FDA regulatory pathway (section 351 vs section 361 of "Human Cells, Tissues, and Cellular and Tissue-Based Products" [HCT/P] in the Code of Federal Regulation) with the hypothesis that products requiring approval under a stringent regulatory pathway (351 HCT/P) have higher levels of evidence in the literature supporting use and that products with a less stringent regulatory pathway (361 HCT/P) have a higher number of products available for use in the United States.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
A search of the PubMed database was performed to identify all peer-reviewed articles pertaining to either allograft or autologous cartilage repair technologies. Predefined inclusion and exclusion criteria were used to find clinical, preclinical, and laboratory studies while excluding duplicates, systematic reviews, and products not available in the United States. Articles were categorized by regulatory pathway (351 and 361 HCT/P), and variables including publication year, type of publication, level of evidence, and number of publications were analyzed.
RESULTS
After application of predefined criteria, 470 of 1924 articles were included in this study. The 351 HCT/P group was composed entirely of autologous chondrocyte implantation (ACI) technology; 94% of the 361 HCT/P group was composed of osteochondral allografts (OCA). The articles regarding 351 HCT/P were more likely to be clinical in nature than the articles on 361 HCT/P (80% vs 48%, respectively; = .0001) and entailed significantly more level 1 studies (25 vs 0, respectively; < .0001). Twice as many articles in the 351 HCT/P group were published in the compared with the 361 HCT/P group (71 vs 38, respectively; = .18).
CONCLUSION
Both ACI and OCA have robust evidence supporting their use, whereas the remaining regulated products have little or no supporting evidence. Technologies regulated by 351 HCT/P were more likely to be level 1 clinical studies and published in the highest impact journal. The 361 HCT/P pathway regulated many more products, with fewer articles supporting their use.
Topics: Humans; United States; United States Food and Drug Administration; Cartilage; Knee Joint; Cartilage Diseases; Transplantation, Autologous; Intra-Articular Fractures; Cartilage, Articular; Chondrocytes
PubMed: 34524032
DOI: 10.1177/03635465211037233