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Cureus May 2024This study aims to compare the mid-term functional outcomes of microfracture and mosaicplasty techniques in talus osteochondral lesions.
PURPOSE
This study aims to compare the mid-term functional outcomes of microfracture and mosaicplasty techniques in talus osteochondral lesions.
MATERIALS AND METHODS
This study consists of 47 patients with talus osteochondral lesions who underwent arthroscopic surgery. These patients were divided into two groups: microfracture (28 patients) and mosaicplasty (19 patients). The American Orthopedic Foot and Ankle Society (AOFAS) scoring system was used to evaluate ankle function, and the Visual Analog Scale (VAS) score was used for pain assessment.
RESULTS
The mean follow-up period was 26 months (range 10-36 months). It was determined that the mean preoperative AOFAS score of individuals in the mosaicplasty group was 38.84±2.83, and the postoperative AOFAS score was 78.79±3.91. A statistically significant difference was found between the two measurements of AOFAS scores (preoperative and postoperative) in the mosaicplasty group (*t=33.756; p<0.001). The effect size for this difference observed in the mosaicplasty group was determined to be r=0.992 (large). Similarly, a statistically significant difference was found between the two measurements of AOFAS scores (preoperative and postoperative) in the microfracture group (*t=28.152; p<0.001). The effect size for this difference observed in the microfracture group was determined to be r=0.983 (large).
CONCLUSION
We believe that both treatment methods have similar positive effects on pain and ankle function. However, larger controlled studies with longer follow-up periods are needed to reach a definitive conclusion.
PubMed: 38807971
DOI: 10.7759/cureus.61217 -
Scientific Reports May 2024Physiochemical tissue inducers and mechanical stimulation are both efficient variables in cartilage tissue fabrication and regeneration. In the presence of biomolecules,...
Physiochemical tissue inducers and mechanical stimulation are both efficient variables in cartilage tissue fabrication and regeneration. In the presence of biomolecules, decellularized extracellular matrix (ECM) may trigger and enhance stem cell proliferation and differentiation. Here, we investigated the controlled release of transforming growth factor beta (TGF-β1) as an active mediator of mesenchymal stromal cells (MSCs) in a biocompatible scaffold and mechanical stimulation for cartilage tissue engineering. ECM-derived hydrogel with TGF-β1-loaded alginate-based microspheres (MSs) was created to promote human MSC chondrogenic development. Ex vivo explants and a complicated multiaxial loading bioreactor replicated the physiological conditions. Hydrogels with/without MSs and TGF-β1 were highly cytocompatible. MSCs in ECM-derived hydrogel containing TGF-β1/MSs showed comparable chondrogenic gene expression levels as those hydrogels with TGF-β1 added in culture media or those without TGF-β1. However, constructs with TGF-β1 directly added within the hydrogel had inferior properties under unloaded conditions. The ECM-derived hydrogel group including TGF-β1/MSs under loading circumstances formed better cartilage matrix in an ex vivo osteochondral defect than control settings. This study demonstrates that controlled local delivery of TGF-β1 using MSs and mechanical loading is essential for neocartilage formation by MSCs and that further optimization is needed to prevent MSC differentiation towards hypertrophy.
Topics: Alginates; Microspheres; Tissue Engineering; Humans; Bioreactors; Hydrogels; Mesenchymal Stem Cells; Chondrogenesis; Animals; Cartilage; Tissue Scaffolds; Decellularized Extracellular Matrix; Transforming Growth Factor beta1; Cell Differentiation; Cells, Cultured; Transforming Growth Factor beta; Extracellular Matrix
PubMed: 38796487
DOI: 10.1038/s41598-024-62474-5 -
Journal of ISAKOS : Joint Disorders &... May 2024Patellofemoral instability is usually initially treated non-operatively. Surgery is considered in patients with recurrent patellar dislocation, and after a first-time... (Review)
Review
Patellofemoral instability is usually initially treated non-operatively. Surgery is considered in patients with recurrent patellar dislocation, and after a first-time patellar dislocation in the presence of either an associated osteochondral fracture or high risk of recurrence. Stratifying the risk of recurrence includes evaluating risk factors such as age, trochlear dysplasia, contralateral dislocation and patellar height. Surgery with soft tissue procedures include restoring the medial patellar restraints and balancing the lateral side of the joint. Reconstruction of the medial patellofemoral ligament is the most frequent way of addressing the medial soft tissues in patients with patellofemoral instability. Meanwhile, lateral tightness can be achieved by lateral retinaculum lengthening or release. Approaching patellofemoral instability in a patient-specific approach, combined with a shared decision-making process with the patient/family, will guide surgeons to the deliver optimal care for the patellar instability patient.
PubMed: 38795864
DOI: 10.1016/j.jisako.2024.05.013 -
Biomedicines May 2024This pilot study examined the long-term structural changes in the osteochondral unit of 20 patients with knee osteoarthritis (KOA) who underwent high tibial osteotomy...
Long-Term Structural Changes in the Osteochondral Unit in Patients with Osteoarthritis Undergoing Corrective Osteotomy with Platelet-Rich Plasma or Stromal Vascular Fraction Post-Treatment.
This pilot study examined the long-term structural changes in the osteochondral unit of 20 patients with knee osteoarthritis (KOA) who underwent high tibial osteotomy (HTO) and received post-treatment with either platelet-rich plasma (PRP) or stromal vascular fraction (SVF). Ten patients were injected with autologous PRP (PRP subgroup), while another ten patients received autologous SVF (SVF subgroup) six weeks after surgery and were monitored for 18 months. Histological samples of bone and cartilage (2 mm in diameter and 2 cm long) were taken from tibial and femoral sites during surgery and 18-month post-HTO, and morphometric analyses were conducted using Mega-Morf12 software. Both post-treatment resulted in an increase in articular cartilage height at both sites ( < 0.001 in the tibia and femur), indicating positive outcomes. Significant improvements in subchondral and trabecular bone architecture were also observed, with SVF injection showing higher reparative capacity in terms of bone volume ( < 0.001 for the tibia and = 0.004 for the femur), subchondral bone height ( < 0.001 for the tibia and = 0.014 for the femur), trabecular bone volume ( < 0.001 for the femur), and intertrabecular space ( = 0.009 for the tibia and = 0.007 for the femur). This pilot study, for the first time, demonstrates that HTO surgery combined with PRP and SVF post-treatments can lead to significant enhancements in knee articular cartilage and bone architecture in KOA patients, with SVF showing higher regenerative potential. These findings may contribute to improving treatment strategies for better clinical outcomes in HTO therapy for patients with KOA.
PubMed: 38791006
DOI: 10.3390/biomedicines12051044 -
Bioengineering (Basel, Switzerland) May 2024This study explores an approach to design and prepare a multilayer scaffold mimicking interstratified natural tissue. This multilayer construct, composed of chitosan...
This study explores an approach to design and prepare a multilayer scaffold mimicking interstratified natural tissue. This multilayer construct, composed of chitosan matrices with graded nanohydroxyapatite concentrations, was achieved through an in situ biomineralization process applied to individual layers. Three distinct precursor concentrations were considered, resulting in 10, 20, and 30 wt% nanohydroxyapatite content in each layer. The resulting chitosan/nanohydroxyapatite (Cs/n-HAp) scaffolds, created via freeze-drying, exhibited nanohydroxyapatite nucleation, homogeneous distribution, improved mechanical properties, and good cytocompatibility. The cytocompatibility analysis revealed that the Cs/n-HAp layers presented cell proliferation similar to the control in pure Cs for the samples with 10% n-HAp, indicating good cytocompatibility at this concentration, while no induction of apoptotic death pathways was demonstrated up to a 20 wt% n-Hap concentration. Successful multilayer assembly of Cs and Cs/n-HAp layers highlighted that the proposed approach represents a promising strategy for mimicking multifaceted tissues, such as osteochondral ones.
PubMed: 38790339
DOI: 10.3390/bioengineering11050471 -
Bioengineering (Basel, Switzerland) Apr 2024To address the limitations of alginate and gelatin as separate hydrogels, partially oxidized alginate, alginate dialdehyde (ADA), is usually combined with gelatin to...
To address the limitations of alginate and gelatin as separate hydrogels, partially oxidized alginate, alginate dialdehyde (ADA), is usually combined with gelatin to prepare ADA-GEL hydrogels. These hydrogels offer tunable properties, controllable degradation, and suitable stiffness for 3D bioprinting and tissue engineering applications. Several processing variables affect the final properties of the hydrogel, including degree of oxidation, gelatin content and type of crosslinking agent. In addition, in 3D-printed structures, pore size and the possible addition of a filler to make a hydrogel composite also affect the final physical and biological properties. This study utilized datasets from 13 research papers, encompassing 33 unique combinations of ADA concentration, gelatin concentration, CaCl and microbial transglutaminase (mTG) concentrations (as crosslinkers), pore size, bioactive glass (BG) filler content, and one identified target property of the hydrogels, stiffness, utilizing the Extreme Boost (XGB) machine learning algorithm to create a predictive model for understanding the combined influence of these parameters on hydrogel stiffness. The stiffness of ADA-GEL hydrogels is notably affected by the ADA to GEL ratio, and higher gelatin content for different ADA gel concentrations weakens the scaffold, likely due to the presence of unbound gelatin. Pore size and the inclusion of a BG particulate filler also have a significant impact on stiffness; smaller pore sizes and higher BG content lead to increased stiffness. The optimization of ADA-GEL composition and the inclusion of BG fillers are key determinants to tailor the stiffness of these 3D printed hydrogels, as found by the analysis of the available data.
PubMed: 38790283
DOI: 10.3390/bioengineering11050415 -
Medical Engineering & Physics Jun 2024Mass transport properties within three-dimensional (3D) scaffold are essential for tissue regeneration, such as various fluid environmental cues influence mesenchymal...
Mass transport properties within three-dimensional (3D) scaffold are essential for tissue regeneration, such as various fluid environmental cues influence mesenchymal stem cells differentiation. Recently, 3D printing has been emerging as a new technology for scaffold fabrication by controlling the scaffold pore geometry to affect cell growth environment. In this study, the flow field within scaffolds in a perfusion system was investigated with uniform structures, single gradient structures and complex gradient structures using computational fluid dynamics (CFD) method. The CFD results from those uniform structures indicate the fluid velocity and fluid shear stress within the scaffold structure increased as the filament diameter increasing, pore width decreasing, pore shape decreased from 90° to 15°, and layer configuration changing from lattice to stagger structure. By assembling those uniform structure as single gradient structures, it is noted that the fluid dynamic characterisation within the scaffold remains the same as the corresponding uniform structures. A complex gradient structure was designed to mimic natural osteochondral tissue by assembly the uniform structures of filament diameter, pore width, pore shape and layer configuration. The results show that the fluid velocity and fluid shear stress within the complex gradient structure distribute gradually increasing and their maximum magnitude were from 1.15 to 3.20 mm/s, and from 12 to 39 mPa, respectively. CFD technique allows the prediction of velocity and fluid shear stress within the designed 3D gradient scaffolds, which would be beneficial for the tissue scaffold development for interfacial tissue engineering in the future.
Topics: Hydrodynamics; Printing, Three-Dimensional; Tissue Engineering; Tissue Scaffolds; Porosity; Stress, Mechanical; Computer Simulation
PubMed: 38789213
DOI: 10.1016/j.medengphy.2024.104173 -
Medicine May 2024Osteochondral lesions on the lateral process of the talus involving the subtalar joint are rare; the optimal surgical treatment remains to be clarified as there are few...
RATIONALE
Osteochondral lesions on the lateral process of the talus involving the subtalar joint are rare; the optimal surgical treatment remains to be clarified as there are few reports. Additionally, bilateral cases are extremely rare. Therefore, the clinical outcomes of the surgical treatment for bilateral osteochondral lesions on the lateral process of the talus involving the subtalar joint have not been fully elucidated.
PATIENT CONCERNS
A 16-year-old boy who played soccer presented to our hospital with bilateral hindfoot pain. The symptoms persisted even after 3 months of conservative treatment. The patient and family requested surgical treatment to relieve the symptoms.
DIAGNOSES
The patient was diagnosed with bilateral osteochondral lesions on the lateral process of the talus, involving the subtalar joint based on computed tomography and magnetic resonance imaging findings.
INTERVENTIONS
Arthroscopic debridement and microfracture were performed bilaterally.
OUTCOMES
Postoperative computed tomography and magnetic resonance imaging of both feet revealed remodeling of the subchondral bone. The patient returned to play at the pre-injury level with no pain.
LESSONS
This report describes a case of bilateral osteochondral lesions on the lateral process of the talus, involving the subtalar joint. Arthroscopic debridement and microfracture were effective in relieving symptoms and the subchondral bone remodeling. To the best of our knowledge, this is the first report of arthroscopic treatment of osteochondral lesions of the lateral process of the talus involving the subtalar joint.
Topics: Humans; Male; Adolescent; Debridement; Talus; Subtalar Joint; Arthroscopy; Magnetic Resonance Imaging; Soccer; Tomography, X-Ray Computed; Arthroplasty, Subchondral
PubMed: 38787984
DOI: 10.1097/MD.0000000000038302 -
Journal of Orthopaedic Case Reports May 2024Transplantation with fresh cadaveric osteochondral allograft (FOCA) is frequently used in defects of the femoral condyle and tibial plateau to preserve the knee joint....
INTRODUCTION
Transplantation with fresh cadaveric osteochondral allograft (FOCA) is frequently used in defects of the femoral condyle and tibial plateau to preserve the knee joint. However, the use of FOCA in bipolar lesions remains controversial in cases with bipolar defects and a history of infection.
CASE REPORT
We present a 21-year-old male patient with a massive post-traumatic osteochondral defect of the lateral compartment of the knee and a history of infection, treated by a two-stage approach. In stage 1, infection was eradicated, and joint function recovered with aggressive debridement, polymethyl methacrylate beads, bone cement spacers, and Judet's quadricepsplasty. In stage 2, transplantation was performed with a bipolar FOCA. All treatments were planned using 3D-printed models.
CONCLUSION
The two-stage approach and 3D planning can increase the chances of transplant success by preparing the future allograft bed and obtaining an optimal match between the cadaveric allograft and the patient's defect in cases with potential contraindications, such as a bipolar lesion in the femoral condyle and tibial plateau and a history of infection. A combined approach may lead to a more beneficial outcome for the patient to preserve joint function and improve quality of life.
PubMed: 38784883
DOI: 10.13107/jocr.2024.v14.i05.4452 -
Journal of Orthopaedic Translation May 2024Osteochondral regeneration has long been recognized as a complex and challenging project in the field of tissue engineering. In particular, reconstructing the...
BACKGROUND
Osteochondral regeneration has long been recognized as a complex and challenging project in the field of tissue engineering. In particular, reconstructing the osteochondral interface is crucial for determining the effectiveness of the repair. Although several artificial layered or gradient scaffolds have been developed recently to simulate the natural interface, the functions of this unique structure have still not been fully replicated. In this paper, we utilized laser micro-patterning technology (LMPT) to modify the natural osteochondral "plugs" for use as grafts and aimed to directly apply the functional interface unit to repair osteochondral defects in a goat model.
METHODS
For in vitro evaluations, the optimal combination of LMPT parameters was confirmed through mechanical testing, finite element analysis, and comparing decellularization efficiency. The structural and biological properties of the laser micro-patterned osteochondral implants (LMP-OI) were verified by measuring the permeability of the interface and assessing the recellularization processes. In the goat model for osteochondral regeneration, a conical frustum-shaped defect was specifically created in the weight-bearing area of femoral condyles using a customized trephine with a variable diameter. This unreported defect shape enabled the implant to properly self-fix as expected.
RESULTS
The micro-patterning with the suitable pore density and morphology increased the permeability of the LMP-OIs, accelerated decellularization, maintained mechanical stability, and provided two relative independent microenvironments for subsequent recellularization. The LMP-OIs with goat's autologous bone marrow stromal cells in the cartilage layer have securely integrated into the osteochondral defects. At 6 and 12 months after implantation, both imaging and histological assessments showed a significant improvement in the healing of the cartilage and subchondral bone.
CONCLUSION
With the natural interface unit and zonal recellularization, the LMP-OI is an ideal scaffold to repair osteochondral defects especially in large animals.
THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE
These findings suggest that such a modified xenogeneic osteochondral implant could potentially be explored in clinical translation for treatment of osteochondral injuries. Furthermore, trimming a conical frustum shape to the defect region, especially for large-sized defects, may be an effective way to achieve self-fixing for the implant.
PubMed: 38774916
DOI: 10.1016/j.jot.2024.04.005