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Objective: To investigate the effectiveness of micro-fracture therapy combined with intra-articular injection of platelet-rich plasma (PRP) in the treatment of small sized osteochondral lesion of the talus (OLT). Methods: Between September 2014 and October 2017, 43 patients with small sized OLT met the inclusive criteria were admitted and randomly divided into micro-fracture group (21 cases) and combined group (22 cases). Patients in the micro-fracture group were treated with micro-fracture therapy, and patients in the combined group were treated with micro-fracture therapy combined with intra-articular injection of PRP. There was no significant difference in gender, age, disease duration, side of OLT, injured position, lesion area, Mintz classification, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score and visual analogue scale (VAS) score between the two groups ( P>0.05). After treatment, MRI, VAS score, and AOFAS ankle-hind foot score were used to evaluate the recovery of OLT and the ankle function. Results: All incisions healed by first intention, and no complications such as venous thrombosis and ankle joint infection occurred. All patients were followed up 12-18 months after operation, with an average of 15.6 months. The VAS scores and the AOFAS ankle-hind foot scores were significantly improved at 6 and 12 months after operation in the two groups ( P<0.05), and the scores at 12 months were significantly improved when compared with postoperative scores at 6 months ( P<0.05). Compared with the micro-fracture group, the VAS score and the AOFAS ankle-hind foot score were significantly improved in the combined group at 6 and 12 months after operation ( P<0.05). MRI showed that OLT was well filled in both groups at 12 months after operation. Conclusion: Compared with micro- fracture therapy, micro-fracture therapy combined with intra-articular injection of PRP can effectively reduce pain, improve ankle function, and has a good effectiveness in the treatment of small sized OLT.
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Objective: To explore the changes of bone and risk of micro-fracture in femoral head after removal of cannulated screws following femoral neck fracture healing under the impact force of daily stress. Methods: A total of 42 specimens of normal hip joint were collected from 21 adult fresh cadaveric pelvic specimens. Wiberg central-edge (CE) angle, bone mineral density, diameter of femoral head, neck-shaft angle, and anteversion angle of femoral neck were measured. Then, the 3 cannulated screws were implanted according to the AO recommended method and removed to simulate the complete anatomical union of femoral neck fracture. The morphology of screw canal in the femoral head was observed by CT. Finally, the specimens were immobilized vertically within the impact device in an upside-down manner, and the femoral heads were impacted vertically. Every specimen was impacted at 200, 600, and 1 980 N for 20 times with the impacting device. After impact, every specimen was scanned by CT to observe the morphology changes of screw canal in the femoral head. Micro-fractures in the femoral head could be confirmed when there was change in the morphology of screw canal, and statistical software was used to analyze the risk factors associated with micro-fractures. Results: After impact at 200 and 600 N, CT showed that the morphology of screw canal of all specimens did not change significantly compared with the original. After impact at 1 980 N, there were protrusion and narrowing in the screw canal of the 22 femoral head specimens (11 pelvic specimens), showing obvious changes compared with the original screw canal, indicating that there were micro-fractures in the femoral head. The incidence of micro-fracture was 52.38% (11/21). logistic regression results showed that there was correlation between micro-fracture and bone mineral density ( P= 0.039), but no correlation was found with CE angle, diameter of femoral head, neck-shaft angle, and anteversion angle ( P>0.05). Conclusion: The micro-fractures in the femoral head may occur when the femoral head is impacted by daily activities after removal of cannulated screws for femoral neck fractures, and such micro-fractures are associated with decreased bone density of the femoral head.
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Objective To analyze the curative effect of fossa intercondyloidea of micro-fracture and comminution of subcutaneous fat pad on meniscal tear healing under arthroscopy. Methods During the clinical operation, the samples of the micro-fracture and fat pad comminution were attracted to the outside of the joint. The source and properties of cells were identified based on preclinical medicine experiment in vitro. In clinical research, 75 cases of the simple meniscus injury were selected from January 2014 to January 2016 and divided into three groups refer to treatment: Group A, B and C. Different treatments were used in the three groups. Group A - micro-fracture group; Group B - fat pad group; Group C - blank group. All patients' conditions were assessed with Lysholm, VAS score and adverse event (Swelling, anterior knee pain). Results In the preclinical medicine experiment, cells released by micro fracture were fibroblast-like cells which tend to grow more rapidly in vortex shape. Cells released by comminution of fat pad contained a small amount of impurities and necrotic cells and are mostly similar to fibroblast in long spindle shape. Besides, the Human MSC Analysis Kit was used to authenticate two cells which were considered to be as BMSCs and IPFPSCs. In clinical research, all patients received an average of 10 (8 ～ 11) months follow-up visit. No severe complication, such as blood-vessel and nerve injury, infection occurred after operations in the patients followed. Before receiving the treatment, difference in Lysholm, VAS score and general condition of joint of Group A and B, C showed no statistical difference (P > 0.05). Compared with those before operation and after operation in both of four groups, the Lysholm and VAS score were improved (P < 0.05). Besides, there had significantly difference between group A and C, B and C after post treatment in Lysholm and VAS score (P < 0.05), however, group A and B did not. Compared group A and C, the early prevalence of adverse event of group B was higher, but last follow-up show no difference between three groups. Conclusion Combined with basic experimental and clinical studies, our research suggest that micro-fracture and comminution of fat pad have good effect on the repair of meniscus injuries. Nevertheless, it should be concerned that early prevalence of increased swelling amd anterior knee pain of comminution of fat pad.
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El tratamiento de las lesiones osteocondrales de gran tamaño y profundidad resultan un desafío debido a que las técnicas habituales (microfractura o transplante osteocondral autólogo), son insuficientes para cubrir el defecto; eso es particularmente importante en pacientes jóvenes, pues se debe intentar técnicas que generen la menor comorbilidad posible. Presentamos un caso de un paciente de 18 años con una lesión osteocondral de 6 cm2 por 14 mm de profundidad, tratado mediante autoinjerto óseo, concentrado de médula ósea y matriz colágena, con resultados satisfactorios tanto en lo funcional como en lo imagenológico. Esa técnica presenta la ventaja de realizarse en un tiempo y con una fuente de células troncales mesenquimáticas (Médula ósea), validada en la literatura y altamente reproducible.
The treatment of large osteochondral defects represent a challenge, because the common techniques used (micro fracture or osteochondral autologous transplantation) are insufficient to cover the defect; this is particularly important in young patients where we expect the least comorbidity. We report a case of an 18-year-old patient with an ostechondral injury of 6 cm2 and 14 mm deep, treated with bone autograft, bone marrow concentrate and a matrix of collagen with satisfactory functional and images results. This technique has the advantage to be performed in one single time and with a source of mesenchymal stem cells (bone marrow) validated in the literature.
Subject(s)
Humans , Male , Adolescent , Bone Transplantation , Mesenchymal Stem Cell Transplantation/methods , Osteochondritis/surgery , Collagen/therapeutic use , Transplantation, Autologous , Treatment OutcomeABSTRACT
Articular cartilage injuries caused by traumatic, mechanical and/or by progressive degeneration result in pain, swelling, subsequent loss of joint function and finally osteoarthritis. Due to the peculiar structure of the tissue (no blood supply), chondrocytes, the unique cellular phenotype in cartilage, receive their nutrition through diffusion from the synovial fluid and this limits their intrinsic capacity for healing. The first cellular avenue explored for cartilage repair involved the in situ transplantation of isolated chondrocytes. Latterly, an improved alternative for the above reparative strategy involved the infusion of mesenchymal stem cells (MSC), which in addition to a self-renewal capacity exhibit a differentiation potential to chondrocytes, as well as a capability to produce a vast array of growth factors, cytokines and extracellular matrix compounds involved in cartilage development. In addition to the above and foremost reparative options up till now in use, other therapeutic options have been developed, comprising the design of biomaterial substrates (scaffolds) capable of sustaining MSC attachment, proliferation and differentiation. The implantation of these engineered platforms, closely to the site of cartilage damage, may well facilitate the initiation of an \'in situ' cartilage reparation process. In this mini-review, we examined the timely and conceptual development of several cell-based methods, designed to repair/regenerate a damaged cartilage. In addition to the above described cartilage reparative options, other therapeutic alternatives still in progress are portrayed.
Subject(s)
Cartilage , Cartilage, Articular , Cell- and Tissue-Based Therapy , Chondrocytes , Cytokines , Diffusion , Extracellular Matrix , Intercellular Signaling Peptides and Proteins , Joints , Mesenchymal Stem Cells , Osteoarthritis , Phenotype , Regeneration , Synovial Fluid , Tissue EngineeringABSTRACT
Objective To develop a knee joint impact device to produce animal model of subchondral bone micro-fracture in rabbits. Methods A knee joint impact device was designed. 12 New Zealand rabbits were divided into group A (n=6) and Group B (n=6). In the group A, 6 patellar-femoral joints of the 6 rabbits were impacted (1.74 kg from height of 30 cm). In the group B, 6 femoral condyles of the 6 rabbits were impacted (1.14 kg from height of 28 cm). All the rabbits were evaluated with X-ray and MRI post injury. The femora of all the rabbits were observed with HE staining. Results No fracture line was found in all the animals with X-rays. The MRI of the 6 knee joints in the group A showed low signal intensities on T1 weighted, T2 weighted and fat suppression images. Histopathology demonstrated integrated cartilage and sunchondral bone plate, micro-fractures of cancellous and bleeding in marrow. The MRI of the 5 knee joints in the group B showed low signal intensities on T1 weighted images and high signal intensities on T2 weighted and fat suppression images. Histopathology demonstrated integrated cartilage and sunchondral bone plate, micro-fractures of cancellous and bleeding in marrow. No disorder was found with MRI and histology in the contral sides. Conclusion The impact device of the knee joint can produce controllable and reproducible sub-chondral bone micro-fracture in rabbits.
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@#Objective To develop a knee joint impact device to produce animal model of subchondral bone micro-fracture in rabbits.Methods A knee joint impact device was designed. 12 New Zealand rabbits were divided into group A (n=6) and Group B (n=6). In the group A, 6 patellar-femoral joints of the 6 rabbits were impacted (1.74 kg from height of 30 cm). In the group B, 6 femoral condyles of the 6 rabbits were impacted (1.14 kg from height of 28 cm). All the rabbits were evaluated with X-ray and MRI post injury. The femora of all the rabbits were observed with HE staining. Results No fracture line was found in all the animals with X-rays. The MRI of the 6 knee joints in the group A showed low signal intensities on T1 weighted, T2 weighted and fat suppression images. Histopathology demonstrated integrated cartilage and sunchondral bone plate, micro-fractures of cancellous and bleeding in marrow. The MRI of the 5 knee joints in the group B showed low signal intensities on T1 weighted images and high signal intensities on T2 weighted and fat suppression images. Histopathology demonstrated integrated cartilage and sunchondral bone plate, micro-fractures of cancellous and bleeding in marrow. No disorder was found with MRI and histology in the contral sides. Conclusion The impact device of the knee joint can produce controllable and reproducible subchondral bone micro-fracture in rabbits.
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Introducción: las lesiones completas del cartílago articular hialino de la rodilla son lesiones muy difíciles de reparar debido a las características anatómicas de este tejido, de ahí la importancia de buscar soluciones prácticas y con un alto porcentaje de efectividad. Descripción: la técnica de microfractura constituye un procedimiento de primera línea en el tratamiento de lesiones completas del cartílago en todo su espesor; en este trabajo se exponen los detalles técnicos de ese procedimiento, así como sus indicaciones, selección de los enfermos y se muestran los resultados de los autores en un período de seguimiento de 2 años. Conclusiones: la microfractura constituye un procedimiento seguro, rápido, asociado a un alto porcentaje de efectividad en aproximadamente 80 por ciento de los enfermos con un bajo índice de complicaciones
Introduction: the complex lesions of hyaline articular cartilage of knee are lesions very difficult to repair due to the anatomic features of this tissue, thus the significance of seeking practical solutions and with a high level of effectiveness. Description: the microfracture technique is a first line procedure in the treatment of whole lesions of cartilage in all its thickness; in present paper are expressed the technical details of such procedure, as well as its indications, selection of patients and the results obtained by authors during a 2-years follow-up. Conclusions: the microfracture is a safe, fast procedure associated with a high percentage of effectiveness in almost an 80 percent of patients and with a low rate of complications