Review: Interventions for Cartilage Disease: Current State‐of‐the‐Art and Emerging Technologies

Ambra, Luiz Felipe; Mosier, Brian; Gomoll, Andreas H.

doi:10.1002/art.40094

Cited by 23 publications

(15 citation statements)

References 79 publications

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“…2 Since the introduction of autologous cartilage implantation, 3 an increasing number of surgical techniques and available scaffolds have been developed. 4 Consequently, standardized and reproducible assessment of patient outcome-and of the cartilage repair tissue morphology-became increasingly important for treatment monitoring of individual patients and for comparison between a growing number of different surgical techniques and scaffolds. 1,[5][6][7] Clinical scores, such as the Lysholm Knee Score, 8 the IKDC (International Knee Documentation Committee) score, 9 or the KOOS (Knee Injury and Osteoarthritis Outcome Score) score, 10 reflect the individual disease burden and overall joint health.…”

Section: Introductionmentioning

confidence: 99%

The MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) 2.0 Knee Score and Atlas

et al. 2019

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Objective Since the first introduction of the MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score, significant progress has been made with regard to surgical treatment options for cartilage defects, as well as magnetic resonance imaging (MRI) of such defects. Thus, the aim of this study was to introduce the MOCART 2.0 knee score — an incremental update on the original MOCART score — that incorporates this progression. Materials and Methods The volume of cartilage defect filling is now assessed in 25% increments, with hypertrophic filling of up to 150% receiving the same scoring as complete repair. Integration now assesses only the integration to neighboring native cartilage, and the severity of surface irregularities is assessed in reference to cartilage repair length rather than depth. The signal intensity of the repair tissue differentiates normal signal, minor abnormal, or severely abnormal signal alterations. The assessment of the variables “subchondral lamina,” “adhesions,” and “synovitis” was removed and the points were reallocated to the new variable “bony defect or bony overgrowth.” The variable “subchondral bone” was renamed to “subchondral changes” and assesses minor and severe edema-like marrow signal, as well as subchondral cysts or osteonecrosis-like signal. Overall, a MOCART 2.0 knee score ranging from 0 to 100 points may be reached. Four independent readers (two expert readers and two radiology residents with limited experience) assessed the 3 T MRI examinations of 24 patients, who had undergone cartilage repair of a femoral cartilage defect using the new MOCART 2.0 knee score. One of the expert readers and both inexperienced readers performed two readings, separated by a four-week interval. For the inexperienced readers, the first reading was based on the evaluation sheet only. For the second reading, a newly introduced atlas was used as an additional reference. Intrarater and interrater reliability was assessed using intraclass correlation coefficients (ICCs) and weighted kappa statistics. ICCs were interpreted according to Koo and Li; weighted kappa statistics were interpreted according to the criteria of Landis and Koch. Results The overall intrarater (ICC = 0.88, P < 0.001) as well as the interrater (ICC = 0.84, P < 0.001) reliability of the expert readers was almost perfect. Based on the evaluation sheet of the MOCART 2.0 knee score, the overall interrater reliability of the inexperienced readers was poor (ICC = 0.34, P < 0.019) and improved to moderate (ICC = 0.59, P = 0.001) with the use of the atlas. Conclusions The MOCART 2.0 knee score was updated to account for changes in the past decade and demonstrates almost perfect interrater and intrarater reliability in expert readers. In inexperienced readers, use of the atlas may improve interrater reliability and, thus, increase the comparability of results across studies.

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Section: Introductionmentioning

confidence: 99%

The MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) 2.0 Knee Score and Atlas

et al. 2019

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“…While OAT has the advantage of transferring hyaline cartilage in a one-stage procedure with good bony integration and no risk of immunologic complications, donor site morbidity remains a concern in OAT procedures. This limits the indication for OAT to only small cartilage lesions up to 2–3 cm 2 in size [ 75 ]. In a biomechanical study, Garretson et al [ 76 ] found that the medial trochlea and distal lateral trochlea had the lowest contact loads and hence could provide desirable cylinder grafts for the PFJ.…”

Section: Introductionmentioning

confidence: 99%

Patellofemoral Cartilage Repair

Mestriner

Ackermann

Gomoll

2018

Curr Rev Musculoskelet Med

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Purpose of ReviewThis review provides an overview of well-established and newly developed cartilage repair techniques for cartilage defects in the patellofemoral joint (PFJ). An algorithm will be presented for approaching cartilage defects considering the distinct anatomy of both the patellar and trochlear articular surfaces.Recent FindingsRecent studies on cartilage repair in the PFJ have demonstrated improved outcomes in an attempt to delay or obviate the need for arthroplasty, and improve symptoms in young patients. While autologous chondrocyte implantation shows good and excellent outcomes for chondral lesions, osteochondral defects are adequately addressed with osteochondral allograft transplantation. In case of patellar malalignment, concomitant tibial tubercle osteotomy can significantly improve outcomes. Particulated cartilage and bone marrow aspirate concentrate are potential new alternative treatments for cartilage repair, currently in early clinical studies.SummaryDue to the frequency of concomitant anatomic abnormalities in the PFJ, a thorough clinical examination combined with careful indication for each procedure in each individual patient combined with meticulous surgical technique is central to achieve satisfying outcomes. Additional comparative studies of cartilage repair procedures, as well as investigation of newer techniques, are needed.

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“…The management of cartilage lesions still represents a challenge for surgeons, due to the limited regenerative ability of cartilage, given its avascularity and hypocellularity. Additionally, cartilage defects can lead to the pathogenesis of osteoarthritis, resulting in pain and disability with a high economic and social impact in many developed countries [ 1 ]. Depending on the type of cartilage defect, different methodologies for cartilage repair and regeneration can be applied today, such as arthroscopic debridement [ 2 ], bone marrow stimulations [ 3 ], osteochondral autografts, or allograft [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Rationale and pre-clinical evidences for the use of autologous cartilage micrografts in cartilage repair

Viganò

Tessaro

Trovato³

et al. 2018

J Orthop Surg Res

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BackgroundThe management of cartilage lesions is an open issue in clinical practice, and regenerative medicine represents a promising approach, including the use of autologous micrografts whose efficacy was already tested in different clinical settings. The aim of this study was to characterize in vitro the effect of autologous cartilage micrografts on chondrocyte viability and differentiation and perform an evaluation of their application in racehorses affected by joint diseases.Materials and methodsMatched human chondrocytes and micrografts were obtained from articular cartilage using Rigenera® procedure. Chondrocytes were cultured in the presence or absence of micrografts and chondrogenic medium to assess cell viability and cell differentiation. For the pre-clinical evaluation, three racehorses affected by joint diseases were treated with a suspension of autologous micrografts and PRP in arthroscopy interventions. Clinical and radiographic follow-ups were performed up to 4 months after the procedure.ResultsAutologous micrografts support the formation of chondrogenic micromasses thanks to their content of matrix and growth factors, such as transforming growth factor β (TGFβ) and insulin-like growth factor 1 (IGF-1). On the other hand, no significant differences were observed on the gene expression of type II collagen, aggrecan, and SOX9. Preliminary data in the treatment of racehorses are suggestive of a potential in vivo use of micrografts to treat cartilage lesions.ConclusionThe results reported in this study showed the role of articular micrografts in the promoting chondrocyte differentiation suggesting their potential use in the clinical practice to treat articular lesions.Electronic supplementary materialThe online version of this article (10.1186/s13018-018-0983-y) contains supplementary material, which is available to authorized users.

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Review: Interventions for Cartilage Disease: Current State‐of‐the‐Art and Emerging Technologies

Cited by 23 publications

References 79 publications

The MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) 2.0 Knee Score and Atlas

The MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) 2.0 Knee Score and Atlas

Patellofemoral Cartilage Repair

Rationale and pre-clinical evidences for the use of autologous cartilage micrografts in cartilage repair

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