Articular Debridement Versus Washout for Degeneration of the Medial Femoral Condyle

Hubbard, Michael J.

doi:10.1302/0301-620x.78b2.0780217

Cited by 202 publications

(117 citation statements)

References 12 publications

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“…Arthroscopic debridement and lavage provides symptomatic relief but does not change the natural course of the disease and has similar outcomes to placebo surgery [10,11]. Marrow stimulation, usually in the form of microfracture, relies on local recruitment of marrow based stem cells and growth factors to the site of articular repair [12].…”

Section: Introductionmentioning

confidence: 99%

Bioengineering of Articular Cartilage: Past, Present and Future

Felimban

Moulton

et al. 2013

Regen. Med.

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The treatment of cartilage defects poses a clinical challenge owing to the lack of intrinsic regenerative capacity of cartilage. The use of tissue engineering techniques to bioengineer articular cartilage is promising and may hold the key to the successful regeneration of cartilage tissue. Natural and synthetic biomaterials have been used to recreate the microarchitecture of articular cartilage through multilayered biomimetic scaffolds. Acellular scaffolds preserve the microarchitecture of articular cartilage through a process of decellularization of biological tissue. Although promising, this technique often results in poor biomechanical strength of the graft. However, biomechanical strength could be improved if biomaterials could be incorporated back into the decellularized tissue to overcome this limitation.

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Section: Introductionmentioning

confidence: 99%

Bioengineering of Articular Cartilage: Past, Present and Future

Felimban

Moulton

et al. 2013

Regen. Med.

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“…1 Various surgical procedures have been employed to promote cartilage repair or regeneration in both animal and clinical studies. [2][3][4][5][6][7][8][9] One approach entails the use of mechanical penetration of the subchondral bone at the site of the lesion by abrasion, drilling or microfracture.…”

Section: Introductionmentioning

confidence: 99%

Gene delivery to cartilage defects using coagulated bone marrow aspirate

et al. 2004

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The long-term goal of the present study is to develop a clinically applicable approach to enhance natural repair mechanisms within cartilage lesions by targeting bone marrow-derived cells for genetic modification. To determine if bone marrow-derived cells infiltrating osteochondral defects could be transduced in situ, we implanted collagen-glycosaminoglycan (CG) matrices preloaded with adenoviral vectors containing various marker genes into lesions surgically generated in rabbit femoral condyles. Analysis of the recovered implants showed transgenic expression up to 21 days; however, a considerable portion was found in the synovial lining, indicating leakage of the vector and/or transduced cells from the matrix. As an alternative medium for gene delivery, we investigated the feasibility of using coagulated bone marrow aspirates. Mixture of an adenoviral suspension with the fluid phase of freshly aspirated bone marrow resulted in uniform dispersion of the vector throughout, and levels of transgenic expression in direct proportion to the density of nucleated cells in the ensuing clot. Furthermore, cultures of mesenchymal progenitor cells, previously transduced ex vivo with recombinant adenovirus, were readily incorporated into the coagulate when mixed with fresh aspirate. These vector-seeded and cell-seeded bone marrow clots were found to maintain their structural integrity following extensive culture and maintained transgenic expression in this manner for several weeks. When used in place of the CG matrix as a gene delivery vehicle in vivo, genetically modified bone marrow clots were able to generate similarly high levels of transgenic expression in osteochondral defects with better containment of the vector within the defect. Our results suggest that coagulates formed from aspirated bone marrow may be useful as a means of gene delivery to cartilage and perhaps other musculoskeletal tissues. Cells within the fluid can be readily modified with an adenoviral vector, and the matrix formed from the clot is completely natural, native to the host and is the fundamental platform on which healing and repair of mesenchymal tissues is based.

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“…Common cartilage repair techniques comprise debridement, bone marrow stimulating techniques, osteochondral grafting, and autologous chondrocyte implantation. [1][2][3][4] Autologous chondrocyte implantation (ACI) has been shown to be clinically effective when implanting culture-expanded chondrocytes alone [5][6][7][8] or in combination with resorbable scaffolds made of collagen, hyaluronan, or polymers. [9][10][11] However, in clinical routine, bone marrow stimulating techniques like drilling, abrasion, or microfracture are frequently used, 1,12,13 are cost effective, and are firstline treatment options for focal cartilage defects.…”

mentioning

confidence: 99%

Formation of cartilage repair tissue in articular cartilage defects pretreated with microfracture and covered with cell‐free polymer‐based implants

Erggelet

Endres

Neumann

et al. 2009

Journal Orthopaedic Research

161

118

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The aim of our study was to evaluate the mid-term outcome of a cell-free polymer-based cartilage repair approach in a sheep cartilage defect model in comparison to microfracture treatment. Cell-free, freeze-dried implants (chondrotissue 1 ) made of a poly-glycolic acid (PGA) scaffold and hyaluronan were immersed in autologous serum and used for covering microfractured full-thickness articular cartilage defects of the sheep (n ¼ 4). Defects treated with microfracture only served as controls (n ¼ 4). Six months after implantation, cartilage implants and controls were analyzed by immunohistochemical staining of type II collagen, histological staining of proteoglycans, and histological scoring. Histological analysis showed the formation of a cartilaginous repair tissue rich in proteoglycans. Histological scoring documented significant improvement of repair tissue formation when the defects were covered with the cell-free implant, compared to controls treated with microfracture. Immunohistochemistry showed that the cell-free implant induced cartilaginous repair tissue and type II collagen. Controls treated with microfracture showed marginal formation of a mixed-type repair tissue consisting of cartilaginous tissue and fibro-cartilage. Covering of microfractured defects with the cell-free polymer-based cartilage implant is suggested to be a promising treatment option for cartilage defects and improves the regeneration of articular cartilage. ß

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Articular Debridement Versus Washout for Degeneration of the Medial Femoral Condyle

Cited by 202 publications

References 12 publications

Bioengineering of Articular Cartilage: Past, Present and Future

Bioengineering of Articular Cartilage: Past, Present and Future

Gene delivery to cartilage defects using coagulated bone marrow aspirate

Formation of cartilage repair tissue in articular cartilage defects pretreated with microfracture and covered with cell‐free polymer‐based implants

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