Autologous Fibrin-Base Scaffold for Chondrocytes and Bone Marrow Mesenchymal Stem Cells Implantation: The Development and Comparison to Conventional Fibrin Glue.

Objective: The authors developed the autologous fibrin-base scaffold for chondrocytes and bone marrow mesenchymal stem cells (BM-MSCs) implantation and evaluated cells viability in autologous fibrin-base scaffold comparing to commercial fibrin glue. Material and Method: The chondrocytes and BM-MSCs were seeded into autologous fibrin-base scaffold and commercial fibrin glue. The cell viability and proliferation were evaluated at 1 and 7 days. The histology were evaluated with hematoxylineosin (H&E) staining and cartilaginous matrices formation with Alcian blue, Saffanin-0, Toluidine blue, and Collagen type II staining at 6 weeks. The fixation of the scaffolds was observed. Results: The chondrocytes and BM-MSCs could not survive in commercial fibrin glue. The chondrocytes and BM-MSCs in autologous fibrin-base scaffold could proliferate and synthesize the cartilaginous matrices on Alcian blue, Saffanin-0, Toluidine blue, and Collagen type II staining at 6 weeks. The fixation strength is excellent. Conclusion: The developed autologous fibrin-base scaffold can be used as the scaffold for chondrocytes and BM-MSCs implantation with potential to implant chondrocytes and BM-MSCs arthroscopically.

Autologous bone marrow mesenchymal stem cells implantation for cartilage defects: two cases report.

OBJECTIVE: The authors reported the results of autologous bone marrow mesenchymal stem cells (BM-MSCs) implantation in two patients with large traumatic cartilage defects of the knee. MATERIAL AND METHOD: Two patients with grade 3-4 according to the International Cartilage Repair Society Classification System were performed autologous bone marrow mesenchymal stem cells (BM-MSCs) implantation on December 2007 and January 2008. The bone marrow aspiration was performed in the outpatient visit under local anesthesia and sent to the laboratory for BM-MSCs isolation and expansion. The BM-MSCs were re-implanted into the defects with the three-dimensional collagen scaffold. The patients were clinical evaluated preoperatively and postoperatively with Knee and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee Score (IKDC Score) and arthroscopic examination. The duration of follow-up was 30-31 months. RESULTS: There was no postoperative complication. The clinical evaluation with Knee and Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee Score (IKDC Score) showed significant improvement. The arthroscopic assessment showed the good defect fill, stiffness and incorporation to the adjacent cartilage. CONCLUSION: The autologous bone marrow mesenchymal stem cells implantation showed the potential for the treatment of large cartilage defects. The one-stage procedure is the advantage over the conventional autologous chondrocytes implantation. The long-term follow-up with long last hyaline-like cartilage is required.

Autologous chondrocytes implantation with three-dimensional collagen scaffold.

OBJECTIVE: The authors report a patient with large traumatic knee cartilage defects treated with autologous chondrocytes implantation (ACI) in three-dimensional collagen scaffold. MATERIAL AND METHOD: A patient with grade 3-4 according to ICRS (International Cartilage Repair Society) Classification System was performed ACI with three-dimensional collagen scaffold. The two-stage procedure was performed First, the cartilage was arthroscopic harvested. The chondrocytes were isolated in the laboratory. Second, the chondrocytes were re-implanted into the defects using three-dimensional collagen scaffold. The patients were clinically evaluated pre-operatively and post operatively and magnetic resonance imaging. The duration of follow-up was 12 months. RESULTS: There was no post operative complication. The clinical evaluations were excellent. The MRI showed the hyaline-like cartilage tissue formation at the defects. CONCLUSION: The autologous chondrocytes implantation with three-dimensional collagen scaffold showed the excellent outcome. Long-term follow-up is required.

Autologous chondrocytes implantation for traumatic cartilage defects of the knee.

OBJECTIVE: To evaluate the results of autologous chondrocytes implantation in the patients with large traumatic cartilage defects of the knee. MATERIAL AND METHOD: Five patients (six knees) with grade 3-4 according to International Cartilage Repair Society Classification System were performed ACI between May 2006 and April 2007. The two-stage procedure was performed. First, the cartilage was arthroscopic harvested. The chondrocytes were isolated in the laboratory. Second, the chondrocytes were re-implanted into the defects. The patients were clinically evaluated preoperatively and postoperatively with Knee and Osteoarthritis Outcome Score (KOOS), magnetic resonance imaging, and arthroscopic assessment. The mean duration of follow-up was 19.8 +/- 4.6 months. RESULTS: There was no postoperative complication. The clinical evaluation with Knee and Osteoarthritis Outcome Score (KOOS) showed significant improvement. The MRI showed the filling of regenerative cartilage tissue formation at the defects. The arthroscopic assessment showed the good defect fill, stiffness, and incorporation to the adjacent cartilage. CONCLUSION: The autologous chondrocytes implantation showed the potential for the treatment of large cartilage defects. The excellent results allowed patients to return to normal activity level.

Arthroscopic outside-in meniscal repair through a needle hole.

This article describes an alternative method for outside-in repair of a longitudinal meniscal tear through a needle hole, which will produce an almost negligible cutaneous scar. The procedure is performed under arthroscopic set-up using an 18-gauge needle preloaded with appropriate suture material. Insert the needle twice through the same cutaneous entry hole to form a mattress loop across the torn meniscal segments. The first insertion penetrates both segments and forms a loop. The second insertion then engages the outer segment and forms another loop. Draw the free end of this second loop into the joint and feed it into the first loop. Pull the first loop out from the joint together with the trapped portion near the free end, until the whole suture becomes a vertical mattress. Finally, tie a slipknot and several half hitches to close the meniscal gap under the stitch. In a large bucket-handle tear, stitches should be started at the middle and then alternating anteriorly and posteriorly 3 to 4 mm apart. To ensure that no significant extracapsular structures are trapped in each stitch, a 13-gauge needle can be used as a cannula sheath. This technique is economical and technically safe and simple for reparable meniscal lesions, including the posterior horn.