Autologous Dual-Tissue Transplantation for Osteochondral Repair

Abstract

BackgroundNumerous treatment methods for osteochondral repair have been implemented, including auto- and allogeneic osteochondral transplantations, combined bone and chondrocyte transplantations, and synthetic implants, but no gold standard treatment has been established. We present preliminary data on a combined autologous bone and cartilage chips: autologous dual-tissue transplantation (ADTT); an easily applicable, low-cost treatment option for osteochondral repair. The aim of this study was to investigate the early biological and clinical outcome of ADTT.MaterialsEight patients (age 32 ± 7.5 years) suffering from osteochondritis dissecans (OCD) in the knee were enrolled. The OCD lesion was debrided and the osteochondral defect was filled with autologous bone, to a level at the base of the adjacent cartilage. Cartilage biopsies from the intercondylar notch were chipped and embedded within fibrin glue in the defect. Evaluation was performed using magnetic resonance imaging, computed tomography, and clinical scores, preoperative and 1 year postoperative.ResultsCartilage tissue repair evaluated using MOCART score improved from 22.5 to 52.5 (P < 0.01). Computed tomography imaging demonstrated very good subchondral bone healing with all 8 patients having a bone filling of >80%. We found improvements 1 year postoperative in the International Knee Documentation Committee score (from 35.9 to 68.1, P < 0.01), Tegner score (from 2.6 to 4.7, P < 0.05), and Knee injury and Osteoarthritis Outcome Score pain, symptoms, sport/recreation and quality of life (P < 0.05).ConclusionTreatment of OCD with ADTT resulted in very good subchondral bone restoration and good cartilage repair. Significant improvements in patient reported outcome was found at 1 year postoperative. This study suggests ADTT as a promising, low-cost, treatment option for osteochondral injuries.

Second-Generation Autologous Minced Cartilage Repair Technique

“…1 At present many different surgical techniques to repair defective cartilage are on offer for the managing physician. The goal of cartilage repair surgery must be (1) to generate tissue that will finally be as close to the surrounding native tissue as possible (i.e., hyaline cartilage), (2) to reverse clinical symptoms with return to previous activity, and (3) to provide with long-term durability. Tissue quality and clinical symptoms are most likely closely connected.…”

“…Care is taken not to harm the cartilage and foremost the chondrocytes within because these are very susceptible to mechanical force. 7 Fragments are primarily fixed within the defect using a second fibrin glue application that mixes with the fragments and generates a stable fragment and/or fibrin clot as also described by Christensen et al 3 After this step of the procedure, the defect is already filled up to the level of the surrounding cartilage or slightly beneath so the membrane can be placed with ease. Finally and before drying out of the fibrin, the Chondro-Gide membrane is placed on top of the fibrin glue-coated chips (rough side facing the chips) and directly sutured to the surrounding healthy cartilage.…”

“…1 Because ACI is not always available to the surgeon due to several reasons, we here present a technique to apply autologous chondrocytes during a one-step procedure (particulate cartilage fragments) not only for the treatment of largediameter cartilage defects but also for fresh purely chondral flakes that cannot be refixed. This technique had already been described in the early 1980s, 2 it was further developed by different authors, and 2-year data were recently presented by Christensen et al 3…”

An MRI Evaluation of Patients Who Underwent Treatment with a Cell-Mediated Gene Therapy for Degenerative Knee Arthritis: A Phase IIa Clinical Trial

“…20 Furthermore, the process of stem cell procurement, gene transfection, and development of these treatment injections often come with considerably costs, which have yet to be justified for widespread clinical use. 21 However, in Tan et al's evaluation of the cost of tissue engineering, it was found that these methods may actually be associated with lower costs than using material from donors. 22 Despite these limitations, previous evaluations have demonstrated clinical improvements in this cohort of patients.…”

Constructing Gene‐Enhanced Tissue Engineering for Regeneration and Repair of Osteochondral Defects

“…3D tissue engineering composite biomaterials constructed in vitro can be used to repair, maintain, or improve the damaged tissue by transplanting them into the lesion site . Autologous transplantation is called the “golden standard” of clinical repair treatment, but its small repair area, high secondary incidence of donor area, and insufficient donor sources have been restricting the large‐scale clinical application of autologous transplantation . Tissue engineering not only provides a new therapeutic option to relieve the patient's pain, but more importantly, it overcomes the above difficulties and may be a viable alternative to regenerative therapy close to the gold standard .…”