Validation of compositional MRI from a histological standpoint: Advantages of three-dimensional T1ρ mapping for quantitative evaluation of articular cartilage.

PURPOSE: We aimed to investigate the relationship between quantitative evaluation by compositional MRI, including T1ρ, and histological and macroscopic assessments, to verify the validity of compositional MRI, and examine the relationship between compositional MRI evaluation reconstructed in three dimensions (3D) and histological and visual assessments. METHOD: Twenty-seven patients with knee osteoarthritis underwent T1ρ and T2 magnetic resonance imaging (MRI). Histological and gross tissue evaluations were performed on the excised bone sections of total knee arthroplasty. Semi-quantitative histological evaluation of tissue changes were assessed by measuring the optical density of digitally captured safranin O-stained and Collagen type II antibody-stained paraffin sections. Macroscopic cartilage severity was determined on a 5-grade scale (G0-G5). T1ρ and T2 values (3D and 2D), and their correlation with each of these parameters were investigated. RESULTS: 3D T1 ρ is negatively correlated with histological evaluations and positively correlated with visual assessments. Only 3D T1ρ values correlated with histological quantitative evaluation (Safranin-O staining; r = -0.53, P = 0.014, Collagen type II antibody staining; r = -0.60, P = 0.019). 2D T1ρ and 3D, 2D T2 values did not correlate with histological evaluation results. Macroscopic cartilage severity grade correlated with all T1ρ and T2 values (3D T1ρ; r = 0.61, P < 0.001, 2D T1ρ; r = 0.52, P < 0.001, 3D T2; r = 0.33, P = 0.045, 2D T2; r = 0.41, P = 0.01). CONCLUSIONS: 3D T1ρ mapping reflects the changes in the molecular structure of the cartilage matrix that occur in arthropathic changes and may be an effective tool for detecting cartilage degeneration.

Risk factors for mortality after hip fracture surgery in Japan using the National Database of Health Insurance Claims and Specific Health Checkups of Japan.

We investigated the risk factors for mortality of hip fracture in the elderly using the National Database of Health Insurance Claims in Japan, and survival was significantly related to sex, age, fracture type, surgical procedure, delayed operative date, comorbidities, blood transfusions, and pulmonary embolism. PURPOSE: Hip fracture is the most common fracture in the elderly and is known to have a high mortality rate. In Japan, to the best of our knowledge, no studies have reported on mortality risk factors for hip fracture using nationwide registry databases. This study aimed to determine the number of occurrences of hip fracture and factors that increase mortality using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. METHODS: This study included extracted data from patients who were hospitalized and underwent surgical treatment for hip fracture between 2013 and 2021, using a nationwide health insurance claims database in Japan. Patient characteristics, such as sex, age, fracture type, surgical procedure, delayed operative date, comorbidities, blood transfusions, and pulmonary embolism, were tabulated to obtain 1-year and in-hospital mortality rates. RESULTS: Both 1-year and in-patient survival were significantly lower in men, older patients, patients who underwent surgery after 3 days of admission, and patients with trochanteric and subtrochanteric fractures, internal fixation, more preoperative comorbidities, blood transfusions, and pulmonary embolism. CONCLUSIONS: Survival was significantly related to sex, age, fracture type, surgical procedure, delayed operative date, comorbidities, blood transfusions, and pulmonary embolism. As the number of male patients with hip fracture will increase with the aging of society, medical staff must provide sufficient information before surgery to avoid postoperative mortality.

A pilot study with 3D T1ρ-mapping for quantitative evaluation of cartilage after open-wedge high tibial osteotomy.

PURPOSE: To evaluate the recently developed three-dimensional (3D) T1ρ-mapping technique for the quantitative evaluation of cartilage changes after open-wedge high tibial osteotomy (OWHTO). METHOD: Eleven patients with medial knee osteoarthritis and spontaneous osteonecrosis of the medial femoral condyle underwent T1ρ magnetic resonance imaging. The full-thickness cartilage of the medial femoral condyle (MFC), lateral femoral condyle, medial tibial condyle, and lateral tibial condyle, and the trochlea and patella were set as regions of interest; mean T1ρ values were calculated using two-dimensional (2D) and 3D analyses. The state of cartilage injury was evaluated using the International Cartilage Repair Society grading system (ICRS grade). T1ρ values before OWHTO and after hardware removal were compared using the Wilcoxon signed-rank test. The correlation between T1ρ values and the ICRS grade was explored using the Spearman rank correlation coefficient. RESULTS: Cartilage repair at the MFC was observed in a high proportion of patients (82%), but 2D analysis did not reveal a significant difference after surgery at any site. In contrast, 3D analysis revealed a significant decrease in T1ρ values after surgery at the MFC (before surgery: 44.1 ms; after surgery: 38.9 ms; p = 0.016), but no significant difference at any other site. In the MFC, there was a positive correlation between 3D T1ρ values and arthroscopic findings before and after surgery (rs = 0.62, p < 0.01), which was absent from the 2D T1ρ values. CONCLUSIONS: 3D T1ρ-mapping may be an effective tool for detecting changes in cartilage quality after OWHTO.

RT-qPCR analyses on the osteogenic differentiation from human iPS cells: an investigation of reference genes.

Reverse transcription quantitative PCR (RT-qPCR) is used to quantify gene expression and require standardization with reference genes. We sought to identify the reference genes best suited for experiments that induce osteogenic differentiation from human induced pluripotent stem cells. They were cultured in an undifferentiated maintenance medium and after confluence, further cultured in an osteogenic differentiation medium for 28 days. RT-qPCR was performed on undifferentiation markers, osteoblast and osteocyte differentiation markers, and reference gene candidates. The expression stability of each reference gene candidate was ranked using four algorithms. General rankings identified TATA box binding protein in the first place, followed by transferrin receptor, ribosomal protein large P0, and finally, beta-2-microglobulin, which was revealed as the least stable. Interestingly, universally used GAPDH and ACTB were found to be unsuitable. Our findings strongly suggest a need to evaluate the expression stability of reference gene candidates for each experiment.

Pathoanatomy of the Jones Fracture in Male University Soccer Players.

BACKGROUND: Jones fractures are relatively common in soccer players and require an extended recovery period because this type of fracture has a high incidence of delayed union, nonunion, and refracture. There has been some previous research on risk factors for Jones fracture, but no study has yet investigated the effect of the length of the fifth metatarsal bone and the positional relationship of the articular surface of the fifth metatarsal bones and the tarsal bones. Clarification of the characteristics of the foot structure that predispose soccer players to Jones fracture may aid in the prevention of this injury. PURPOSE: To investigate the association between Jones fracture and foot structure as assessed with a mapping system on weightbearing dorsoplantar and lateral foot radiographs. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: We used a mapping system to evaluate the radiographs of 60 feet from 30 university soccer players with Jones fractures and a control group of 60 feet from 60 male university soccer players without Jones fracture. The groups were compared regarding the length of the fifth metatarsal and the positions of the metatarsal and tarsal bones. RESULTS: Analysis of weightbearing dorsoplantar foot radiographs showed that the fifth metatarsal was significantly longer and that its proximal tip was positioned more proximally in the Jones fracture group as compared with the control group. Analysis of weightbearing lateral foot radiographs showed that the reference points for the medial arch were significantly higher in the Jones fracture group than in the control group. CONCLUSION: This study indicated that the proximally longer fifth metatarsal may cause greater stress at the base of the fifth metatarsal bone because the lever arm becomes long. In addition, high medial longitudinal arch may contribute to increased load on the lateral side of the foot. Thus, these anatomic features may be useful to identify soccer players at high risk of Jones fracture at medical checkup.

Silicate-substituted strontium apatite nano coating improves osteogenesis around artificial ligament.

BACKGROUND: Treatment of anterior cruciate ligament injuries commonly involves the use of polyethylene terephthalate (PET) artificial ligaments for reconstruction. However, the currently available methods require long fixation periods, thereby necessitating the development of alternative methods to accelerate the healing process between tendons and bones. Thus, we developed and evaluated a novel technique that utilizes silicate-substituted strontium (SrSiP). METHODS: PET films, nano-coated with SrSiP, were prepared. Bone marrow mesenchymal cells (BMSCs) from femurs of male rats were cultured and seeded at a density of 1.0 × 104/cm2 onto the SrSiP-coated and non-coated PET film, and subsequently placed in an osteogenic medium. The osteocalcin concentration secreted into the medium was compared in each case. Next, PET artificial ligament, nano-coated with SrSiP, were prepared. BMSCs were seeded at a density of 4.5 × 105/cm2 onto the SrSiP-coated, and non-coated artificial ligament, and then placed in osteogenic medium. The osteocalcin and calcium concentrations in the culture medium were measured on the 8th, 10th, 12th, and 14th day of culture. Furthermore, mRNA expression of osteocalcin, alkaline phosphatase (ALP), bone morphogenetic protein-2 (BMP2), and runt-related transcription factor 2 (Runx2) was evaluated by qPCR. We transplanted the SrSiP-coated and non-coated artificial ligament to the tibiae of mature New Zealand white rabbits. Two months later, we sacrificed them and histologically evaluated them. RESULTS: The secretory osteocalcin concentration in the medium on the film was significantly higher for the SrSiP group than for the non-coated group. Secretory osteocalcin concentration in the medium on the artificial ligament was also significantly higher in the SrSiP group than in the non-coated group on the 14th day. Calcium concentration on the artificial ligament was significantly lower in the SrSiP group than in the non-coated group on the 8th, 10th, 12th, and 14th day. In qPCR as well, OC, ALP, BMP2, and Runx2 mRNA expression were significantly higher in the SrSiP group than in the non-coated group. Newly formed bone was histologically found around the artificial ligament in the SrSiP group. CONCLUSIONS: Our findings demonstrate that artificial ligaments using SrSiP display high osteogenic potential and thus may be efficiently used in future clinical applications.

The muscle pre-activity timing of the hamstrings and quadriceps during 180° and 360° rotational jump landings in healthy female subjects.

BACKGROUND/OBJECTIVE: The muscle activity before the initial contact between during jump landings is referred to as the pre-activity. The muscle pre-activity that occur during jump landing are considered to be an important predictor of non-contact anterior cruciate ligament (ACL) injury risk. ACL injury prevention programs have been widely conducted; these programs are generally focused on increasing the muscle pre-activity and include rotational jump landing. The purpose of this study was to investigate the timing of the muscle pre-activity of the hamstrings and quadriceps during 180° and 360° rotational jump landing. METHODS: The participants were 10 healthy females. Electromyography was conducted on the knee joint muscles of the left leg (the non-dominant leg) during clockwise 180° and 360° rotational jump landings. RESULTS: The muscle pre-activities during 180° rotational jump landing was VM: 35.68 ±â€¯11.22 msec, RF: 38.05 ±â€¯14.77 msec, VL: 47.10 ±â€¯19.96 msec, BF: 115.63 ±â€¯30.48 msec and SM: 136.45 ±â€¯47.52 msec. And the muscle pre-activities during 360° rotational jump landing was VM: 45.25 ±â€¯17.41 msec, RF: 42.38 ±â€¯13.35 msec, VL: 48.75 ±â€¯19.20 msec, BF: 132.20 ±â€¯46.74 msec and SM: 140.70 ±â€¯40.64 msec. For both the 180° rotational jump landing and the 360° jump landing, the pre-activities of the hamstrings occurred significantly earlier than those of the quadriceps (p < 0.01). CONCLUSION: The results of the present study indicate that it may be beneficial for ACL injury prevention programs to include rotational jump landing tasks.

Modifying oxygen tension affects bone marrow stromal cell osteogenesis for regenerative medicine.

AIM: To establish a hypoxic environment for promoting osteogenesis in rat marrow stromal cells (MSCs) using osteogenic matrix cell sheets (OMCSs). METHODS: Rat MSCs were cultured in osteogenic media under one of four varying oxygen conditions: Normoxia (21% O2) for 14 d (NN), normoxia for 7 d followed by hypoxia (5% O2) for 7 d (NH), hypoxia for 7 d followed by normoxia for 7 d (HN), or hypoxia for 14 d (HH). Osteogenesis was evaluated by observing changes in cell morphology and calcium deposition, and by measuring osteocalcin secretion (ELISA) and calcium content. In vivo syngeneic transplantation using OMCSs and ß-tricalcium phosphate discs, preconditioned under NN or HN conditions, was also evaluated by histology, calcium content measurements, and real-time quantitative PCR. RESULTS: In the NN and HN groups, differentiated, cuboidal-shaped cells were readily observed, along with calcium deposits. In the HN group, the levels of secreted osteocalcin increased rapidly from day 10 as compared with the other groups, and plateaued at day 12 (P < 0.05). At day 14, the HN group showed the highest amount of calcium deposition. In vivo, the HN group showed histologically prominent new bone formation, increased calcium deposition, and higher collagen type I messenger RNA expression as compared with the NN group. CONCLUSION: The results of this study indicate that modifying oxygen tension is an effective method to enhance the osteogenic ability of MSCs used for OMCSs.

Human knee joint sound during the Lachman test: Comparison between healthy and anterior cruciate ligament-deficient knees.

BACKGROUND: The Lachman test is clinically considered to be a reliable physical examination for anterior cruciate ligament (ACL) deficiency. However, the test involves subjective judgement of differences in tibial translation and endpoint quality. An auscultation system has been developed to allow assessment of the Lachman test. The knee joint sound during the Lachman test was analyzed using fast Fourier transformation. The purpose of the present study was to quantitatively evaluate knee joint sounds in healthy and ACL-deficient human knees. METHODS: Sixty healthy volunteers and 24 patients with ACL injury were examined. The Lachman test with joint auscultation was evaluated using a microphone. Knee joint sound during the Lachman test (Lachman sound) was analyzed by fast Fourier transformation. As quantitative indices of the Lachman sound, the peak sound (Lachman peak sound) as the maximum relative amplitude (acoustic pressure) and its frequency were used. RESULTS: In healthy volunteers, the mean Lachman peak sound of intact knees was 100.6 Hz in frequency and -45 dB in acoustic pressure. Moreover, a sex difference was found in the frequency of the Lachman peak sound. In patients with ACL injury, the frequency of the Lachman peak sound of the ACL-deficient knees was widely dispersed. In the ACL-deficient knees, the mean Lachman peak sound was 306.8 Hz in frequency and -63.1 dB in acoustic pressure. If the reference range was set at the frequency of the healthy volunteer Lachman peak sound, the sensitivity, specificity, positive predictive value, and negative predictive value were 83.3%, 95.6%, 95.2%, and 85.2%, respectively. CONCLUSION: Knee joint auscultation during the Lachman test was capable of judging ACL deficiency on the basis of objective data. In particular, the frequency of the Lachman peak sound was able to assess ACL condition.

Can joint sound assess soft and hard endpoints of the Lachman test?: A preliminary study.

The Lachman test is considered to be a reliable physical examination for anterior cruciate ligament (ACL) injury. Patients with a damaged ACL demonstrate a soft endpoint feeling. However, examiners judge the soft and hard endpoints subjectively. The purpose of our study was to confirm objective performance of the Lachman test using joint auscultation. Human and porcine knee joints were examined. Knee joint sound during the Lachman test (Lachman sound) was analyzed by fast Fourier transformation. As quantitative indices of Lachman sound, the peak sound as the maximum relative amplitude (acoustic pressure) and its frequency were used. The mean Lachman peak sound for healthy volunteer knees was 86.9 ± 12.9 Hz in frequency and -40 ± 2.5 dB in acoustic pressure. The mean Lachman peak sound for intact porcine knees was 84.1 ± 9.4 Hz and -40.5 ± 1.7 dB. Porcine knees with ACL deficiency had a soft endpoint feeling during the Lachman test. The Lachman peak sounds of porcine knees with ACL deficiency were dispersed into four distinct groups, with center frequencies of around 40, 160, 450, and 1600. The Lachman peak sound was capable of assessing soft and hard endpoints of the Lachman test objectively.

Nontraumatic tibial polyethylene insert cone fracture in mobile-bearing posterior-stabilized total knee arthroplasty.

A 72-year-old male patient underwent mobile-bearing posterior-stabilized total knee arthroplasty for osteoarthritis. He experienced a nontraumatic polyethylene tibial insert cone fracture 27 months after surgery. Scanning electron microscopy of the fracture surface of the tibial insert cone suggested progress of ductile breaking from the posterior toward the anterior of the cone due to repeated longitudinal bending stress, leading to fatigue breaking at the anterior side of the cone, followed by the tibial insert cone fracture at the anterior side of the cone, resulting in fracture at the base of the cone. This analysis shows the risk of tibial insert cone fracture due to longitudinal stress in mobile-bearing posterior-stabilized total knee arthroplasty in which an insert is designed to highly conform to the femoral component.

Osteogenic matrix cell sheet transplantation enhances early tendon graft to bone tunnel healing in rabbits.

The objective of this study was to determine whether osteogenic matrix cell sheets (OMCS) could induce bone formation around grafted tendons, thereby enhancing early stage tendon to bone tunnel healing in skeletally mature male Japanese white rabbits. First, the osteogenic potential of rabbit OMCS was evaluated. Then, the OMCS were transplanted into the interface between the grafted tendon and the bone tunnel created at the tibia. Histological assessments and biomechanical tensile testing were performed after 3 weeks. The rabbit OMCS showed high alkaline phosphatase (ALP) activity, positive staining of ALP, and osteogenic potential when transplanted subcutaneously with beta tricalcium phosphate disks. Newly formed bony walls and positive collagen type I staining were seen around the grafted tendon with OMCS transplantation, whereas such bony walls were thinner or less frequent without OMCS transplantation. Micro-computed tomography images showed significantly higher bone volume in the OMCS transplantation group. The pullout strength was significantly higher with OMCS (0.74 ± 0.23 N/mm(2)) than without OMCS (0.58 ± 0.15 N/mm(2)). These results show that OMCS enhance early tendon to bone tunnel healing. This method can be applied to cases requiring early tendon to bone tunnel healing after ligament reconstruction surgery.

A novel medial collateral ligament reconstruction procedure using semitendinosus tendon autograft in patients with multiligamentous knee injuries: clinical outcomes.

BACKGROUND: Several new procedures for medial collateral ligament (MCL) reconstruction using a hamstring tendon graft have been reported in the 2000s. However, the midterm and long-term clinical outcomes of these procedures have not been reported. HYPOTHESIS: Postoperative medial stability of the knee that underwent our MCL reconstruction may not be significantly different from that of the noninjured knee. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 37 patients who sustained multiligamentous knee injuries underwent combined MCL and cruciate ligament reconstruction at our institution between 1994 and 2007. Thirty of the 37 patients were clinically evaluated at least 2 years after surgery. Sixteen had combined MCL and anterior cruciate ligament (ACL) reconstruction, 5 had combined MCL and posterior cruciate ligament (PCL) reconstruction, and 9 had combined MCL, ACL, and PCL reconstruction. The International Knee Documentation Committee (IKDC) evaluation form and Lysholm score were used to evaluate postoperative knee function. Anteroposterior knee laxity was examined with a KT-2000 arthrometer. To assess objective medial instability, we performed a stress radiograph examination under valgus stress with the knee at 20° of flexion. RESULTS: At the final follow-up, 1 patient showed a loss of knee extension of more than 3°. Five patients revealed a loss of knee flexion of 6° to 15° and 2 patients of 16° to 25°. Lysholm scores averaged 94.8 points. In the IKDC evaluation, 9 patients were graded as A, 17 were graded as B, 3 were graded as C, and 1 was graded as D. In the stress radiograph examination, the mean medial joint opening was 8.5 ± 1.6 mm in the reconstructed knee and 8.0 ± 1.2 mm in the healthy opposite knee. There was no significant difference in the medial joint opening between reconstructed and intact knees. CONCLUSION: Medial collateral ligament reconstruction for chronic combined knee instabilities can be safely performed using hamstring tendon autografts, and the clinical outcome with a minimum 2-year follow-up was favorable with satisfactory stability.

Early fixation of cobalt-chromium based alloy surgical implants to bone using a tissue-engineering approach.

To establish the methods of demonstrating early fixation of metal implants to bone, one side of a Cobalt-Chromium (CoCr) based alloy implant surface was seeded with rabbit marrow mesenchymal cells and the other side was left unseeded. The mesenchymal cells were further cultured in the presence of ascorbic acid, ß-glycerophosphate and dexamethasone, resulting in the appearance of osteoblasts and bone matrix on the implant surface. Thus, we succeeded in generating tissue-engineered bone on one side of the CoCr implant. The CoCr implants were then implanted in rabbit bone defects. Three weeks after the implantation, evaluations of mechanical test, undecalcified histological section and electron microscope analysis were performed. Histological and electron microscope images of the tissue engineered surface exhibited abundant new bone formation. However, newly formed bone tissue was difficult to detect on the side without cell seeding. In the mechanical test, the mean values of pull-out forces were 77.15 N and 44.94 N for the tissue-engineered and non-cell-seeded surfaces, respectively. These findings indicate early bone fixation of the tissue-engineered CoCr surface just three weeks after implantation.

Poly(2-acrylamido-2-methylpropanesulfonic acid) gel induces articular cartilage regeneration in vivo: comparisons of the induction ability between single- and double-network gels.

The purpose of this study was to determine the in vivo cartilage induction effect of the poly(2-acrylamido-2-methylpropanesulfonic acid) (PAMPS) single-network (SN) gel and poly(N,N'-dimethyl acrylamide) (PDMAAm) SN gel in comparison with that of the PAMPS/PDMAAm double-network (DN) gel. An osteochondral defect created in rabbit trochlea was treated with PAMPS/PDMAAm DN, PAMPS SN, or PDMAAm SN gel implantation or left untreated. The gel was implanted into the defect so that a 2-mm depth remained. The defects were examined by histologic and immunohistochemical evaluations, surface assessment using confocal laser scanning microscopy, and real-time polymerase chain reaction analysis at 4 weeks. Samples were quantitatively evaluated with a scoring system reported by Wayne et al. The PAMPS/PDMAAm DN gel-implanted defect was filled with the hyaline-like cartilage tissue. The PAMPS SN gel-implanted defect was filled inhomogenously with hyaline/fibrocartilage tissue. The histology score of the defect treated with PAMPS/PDMAAm DN gel was significantly higher than those treated with PAMPS and PDMAAm SN gels, and the untreated defect (p = 0.0408, p < 0.0001, and p < 0.0001, respectively) and the scores of the defect treated with PAMPS SN gel were significantly higher than those treated with PDMAAm SN gel and the untreated defect (p = 0.0026 and p = 0.0026, respectively). These results suggested that the PAMPS SN gel has an ability that can induce hyaline cartilage regeneration in vivo, but that the PDMAAm SN gel does not. The current study indicates that the chondrogenic potential of a negatively charged PAMPS gel component plays an important role in the cartilage regeneration ability of the PAMPS/PDMAAm DN gel in vivo.

Induction of spontaneous hyaline cartilage regeneration using a double-network gel: efficacy of a novel therapeutic strategy for an articular cartilage defect.

BACKGROUND: A double-network (DN) gel, which was composed of poly-(2-acrylamido-2-methylpropanesulfonic acid) and poly-(N,N'-dimetyl acrylamide) (PAMPS/PDMAAm), has the potential to induce chondrogenesis both in vitro and in vivo. PURPOSE: To establish the efficacy of a therapeutic strategy for an articular cartilage defect using a DN gel. STUDY DESIGN: Controlled laboratory study. METHODS: A 4.3-mm-diameter osteochondral defect was created in rabbit trochlea. A DN gel plug was implanted into the defect of the right knee so that a defect 2 mm in depth remained after surgery. An untreated defect of the left knee provided control data. The osteochondral defects created were examined by histological and immunohistochemical evaluations, surface assessment using confocal laser scanning microscopy, and real-time polymerase chain reaction (PCR) analysis at 4 and 12 weeks. Samples were quantitatively evaluated with 2 scoring systems reported by Wayne et al and O'Driscoll et al. RESULTS: The DN gel-implanted defect was filled with a sufficient volume of the hyaline cartilage tissue rich in proteoglycan and type 2 collagen. Quantitative evaluation using the grading scales revealed a significantly higher score in the DN gel-implanted defects compared with the untreated control at each period (P < .0001). The mean relative values of type 2 collagen mRNAs in the regenerated tissue were obviously higher in the DN gel-implanted defect than in the untreated control at each period. The mean surface roughness of the untreated control was significantly higher than the normal cartilage at 12 weeks (P = .0106), while there was no statistical difference between the DN gel-implanted and normal knees. CONCLUSION: This study using the mature rabbit femoral trochlea osteochondral defect model demonstrated that DN gel implantation is an effective treatment to induce cartilage regeneration in vivo without any cultured cells or mammalian-derived scaffolds. CLINICAL RELEVANCE: This study has prompted us to develop a potential innovative strategy to repair cartilage lesions in the field of joint surgery.