Effect of open wedge high tibial osteotomy on the lateral compartment in sheep. Part I: analysis of the lateral meniscus

Madry, Henning; Ziegler, R.; Orth, Patrick; Goebel, Lars; Ong, Mei Fang; Kohn, Dieter; Cucchiarini, Magali; Pape, Dietrich

doi:10.1007/s00167-012-2176-2

Cited by 31 publications

(38 citation statements)

References 55 publications

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“…Osteochondral defects provoked significantly more severe osteoarthritic degeneration of the adjacent cartilage than chondral lesions after 6 months in vivo. This time point was chosen based on the extensive experience with ovine cartilage repair after 6 months by several research groups 15,17,19,20,26,[44][45][46] and the suitability of this observation period to assess the development of osteoarthritis. 5 In accordance, Hepp et al 24 confirmed degenerative perilesional changes already 3 months after creation of cylindrical 7 mm osteochondral defects in ovine femoral condyles.…”

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Improved repair of chondral and osteochondral defects in the ovine trochlea compared with the medial condyle

Orth

Meyer

Goebel

et al. 2013

Journal Orthopaedic Research

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Associations between topographic location and articular cartilage repair in preclinical animal models are unknown. Based on clinical investigations, we hypothesized that lesions in the ovine femoral condyle repair better than in the trochlea. Full-thickness chondral and osteochondral defects were simultaneously established in the weightbearing area of the medial femoral condyle and the lateral trochlear facet in sheep, with chondral defects subjected to subchondral drilling. After 6 months in vivo, cartilage repair and osteoarthritis development was evaluated by macroscopic, histological, immunohistochemical, and biochemical analyses. Macroscopic and histological articular cartilage repair and type-II collagen immunoreactivity were better in the femoral trochlea, regardless of the defect type. Location-independently, osteochondral defects induced more osteoarthritic degeneration of the adjacent cartilage than drilled chondral lesions. DNA and proteoglycan contents of chondral defects were higher in the condyle, reflecting physiological topographical differences. The results indicate that topographic location dictates the structural patterns and biochemical composition of the repair tissue in sheep. These findings suggest that repair of cartilage defects at different anatomical sites of the ovine stifle joint needs to be assessed independently and that the sheep trochlea exhibits cartilage repair patterns reflective of the human medial femoral condyle. ß

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confidence: 99%

Improved repair of chondral and osteochondral defects in the ovine trochlea compared with the medial condyle

Orth

Meyer

Goebel

et al. 2013

Journal Orthopaedic Research

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“…Many of these degenerative changes might initiate an inflammatory status and secretion of catabolic factors that lead to development of late-stage osteoarthritis [ 10 ]. In the context of early osteoarthritis, significant correlations between early osteoarthritic changes in the submeniscal tibial plateau cartilage and meniscal degeneration have recently been detected [ 29 ]. Additionally, there appears to be a correlation between meniscal extrusion and cartilage damage in the peripheral region of the tibial plateau, underlining the fact that the submeniscal region is vulnerable to early osteoarthritis [ 30 ], and thus leads to structural and mechanical alterations of the meniscus leading to further implications within the joint [ 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Autologous mesenchymal stem cells or meniscal cells: what is the best cell source for regenerative meniscus treatment in an early osteoarthritis situation?

et al. 2017

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BackgroundTreatment of meniscus tears within the avascular region represents a significant challenge, particularly in a situation of early osteoarthritis. Cell-based tissue engineering approaches have shown promising results. However, studies have not found a consensus on the appropriate autologous cell source in a clinical situation, specifically in a challenging degenerative environment. The present study sought to evaluate the appropriate cell source for autologous meniscal repair in a demanding setting of early osteoarthritis.MethodsA rabbit model was used to test autologous meniscal repair. Bone marrow and medial menisci were harvested 4 weeks prior to surgery. Bone marrow-derived mesenchymal stem cells (MSCs) and meniscal cells were isolated, expanded, and seeded onto collagen-hyaluronan scaffolds before implantation. A punch defect model was performed on the lateral meniscus and then a cell-seeded scaffold was press-fit into the defect. Following 6 or 12 weeks, gross joint morphology and OARSI grade were assessed, and menisci were harvested for macroscopic, histological, and immunohistochemical evaluation using a validated meniscus scoring system. In conjunction, human meniscal cells isolated from non-repairable bucket handle tears and human MSCs were expanded and, using the pellet culture model, assessed for their meniscus-like potential in a translational setting through collagen type I and II immunostaining, collagen type II enzyme-linked immunosorbent assay (ELISA), and gene expression analysis.ResultsAfter resections of the medial menisci, all knees showed early osteoarthritic changes (average OARSI grade 3.1). However, successful repair of meniscus punch defects was performed using either meniscal cells or MSCs. Gross joint assessment demonstrated donor site morbidity for meniscal cell treatment. Furthermore, human MSCs had significantly increased collagen type II gene expression and production compared to meniscal cells (p < 0.05).ConclusionsThe regenerative potential of the meniscus by an autologous cell-based tissue engineering approach was shown even in a challenging setting of early osteoarthritis. Autologous MSCs and meniscal cells were found to have improved meniscal healing in an animal model, thus demonstrating their feasibility in a clinical setting. However, donor site morbidity, reduced availability, and reduced chondrogenic differentiation of human meniscal cells from debris of meniscal tears favors autologous MSCs for clinical use for cell-based meniscus regeneration.

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“…Although the clinical result of our case was satisfactory so far, concerns remain about the survival of this procedure. An animal study in sheep has shown that standard correction with a valgus angle of 4.5° has no major detrimental effect on lateral compartment compared to 9° valgus which caused reduced cell numbers and low proliferative activities in the middle third of the vascular zone of lateral meniscus [ 13 ]. From this point of view, we tried to correct the preoperative varus alignment to only slight valgus (2.7°) angle.…”

Section: Discussionmentioning

confidence: 99%

A Switch of an Idea: Simultaneous High Tibial Osteotomy and Lateral Meniscal Allograft Transplantation

Choi

2018

Cureus

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High tibial osteotomy (HTO) has been regarded as an effective treatment modality for isolated medial compartment knee osteoarthritis (OA) with varus deformity. However, management for relatively young active patients with both varus-aligned medial compartment knee OA and symptomatic irreparable lateral meniscus tear can be challenging. In this situation, correction of varus alignment by HTO and restoring the function of the lateral meniscus by meniscal allograft transplantation (MAT) can be a possible solution. We present the clinical result and technical considerations for a case of varus-aligned medial compartment OA combined with lateral meniscus tear treated by simultaneously performed medial open wedge HTO and lateral MAT.

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Effect of open wedge high tibial osteotomy on the lateral compartment in sheep. Part I: analysis of the lateral meniscus

Abstract: Open wedge HTO does not lead to significant macroscopic and microscopic structural changes in the lateral meniscus after 6 months in vivo. Overcorrection significantly decreases the proliferative activity of the cells in the red-red zone of the middle third in the sheep model.

Cited by 31 publications

References 55 publications

Improved repair of chondral and osteochondral defects in the ovine trochlea compared with the medial condyle

Improved repair of chondral and osteochondral defects in the ovine trochlea compared with the medial condyle

Autologous mesenchymal stem cells or meniscal cells: what is the best cell source for regenerative meniscus treatment in an early osteoarthritis situation?

A Switch of an Idea: Simultaneous High Tibial Osteotomy and Lateral Meniscal Allograft Transplantation

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