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CC BY-NC-ND 4.0 · Joints 2017; 05(01): 027-033
DOI: 10.1055/s-0037-1601412
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Second Generation Needling Techniques for the Treatment of Chondral Defects in Animal Model

Pietro Zedde
1   Orthopedic and Traumatology Unit, Nuoro Hospital, Nuoro, Italy
,
Sebastiano Cudoni
1   Orthopedic and Traumatology Unit, Nuoro Hospital, Nuoro, Italy
,
Lucia Manunta
2   Department of Veterinary Surgery, University of Sassari, Sassari, Italy
,
Eraldo Sanna Passino
2   Department of Veterinary Surgery, University of Sassari, Sassari, Italy
,
Gerolamo Masala
2   Department of Veterinary Surgery, University of Sassari, Sassari, Italy
,
Antonio Brunetti
3   Polcoming Department, University of Sassari, Sassari, Italy
,
Francesco Mattia Uboldi
4   Orthopedic Traumatology Unit, Department of Biomedical Science, Sassari University Hospital, Sassari, Italy
,
Andrea Fabio Manunta
4   Orthopedic Traumatology Unit, Department of Biomedical Science, Sassari University Hospital, Sassari, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
05 June 2017 (online)

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Abstract

Purpose To compare the macroscopic, histological, and immunohistochemical characteristics of the repair tissue of chondral defects treated with microfracture and nanofracture in an ovine model.

Methods Full-thickness chondral lesions were created in the medial femoral condyle of both knees in four adult sheep and were treated with microfracture on one side and with nanofracture on the contralateral side. Chondral repair was assessed after 12 months by macroscopic, histological, and immunohistochemical analyses.

Results Histological cartilage repair significantly improved in the samples treated with nanofracture for cellular morphological characteristics and cartilage architecture. The immunohistochemical analysis showed a significantly higher immunoreactivity to type II collagen in the defects treated with nanofracture.

Conclusion Nanofracture provided better repair tissue than microfracture, with a more satisfactory cartilage architecture renovation and tissue having greater type II collagen content.

Clinical Relevance Mesenchymal stem cell stimulation is the most frequently used primary cartilage repair procedure. Nanofracture represents a novel technique to stimulate bone marrow that results into a successful repair of chondral defects.

Keywords

microfracture - nanofracture - articular cartilage repair - mesenchymal stem cells - sheep
 

  • References

  • 1 Smillie IS. Treatment of osteochondritis dissecans. J Bone Joint Surg Br 1957; 39-B (02) 248-260
    CrossrefPubMedGoogle Scholar
  • 2 Mazor M, Lespessailles E, Coursier R, Daniellou R, Best TM, Toumi H. Mesenchymal stem-cell potential in cartilage repair: an update. J Cell Mol Med 2014; 18 (12) 2340-2350
    CrossrefPubMedGoogle Scholar
  • 3 Steadman JR, Rodkey WG, Rodrigo JJ. Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop Relat Res 2001; ;(391 Suppl): S362-S369
    PubMedGoogle Scholar
  • 4 McCormick F, Harris JD, Abrams GD. , et al. Trends in the surgical treatment of articular cartilage lesions in the United States: an analysis of a large private-payer database over a period of 8 years. Arthroscopy 2014; 30 (02) 222-226
    CrossrefPubMedGoogle Scholar
  • 5 Montgomery SR, Foster BD, Ngo SS. , et al. Trends in the surgical treatment of articular cartilage defects of the knee in the United States. Knee Surg Sports Traumatol Arthrosc 2014; 22 (09) 2070-2075
    CrossrefPubMedGoogle Scholar
  • 6 Khan WS, Johnson DS, Hardingham TE. The potential of stem cells in the treatment of knee cartilage defects. Knee 2010; 17 (06) 369-374
    CrossrefPubMedGoogle Scholar
  • 7 Mithoefer K, Williams III RJ, Warren RF. , et al. The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospective cohort study. J Bone Joint Surg Am 2005; 87 (09) 1911-1920
    CrossrefPubMedGoogle Scholar
  • 8 Mithoefer K, Williams III RJ, Warren RF. , et al. Chondral resurfacing of articular cartilage defects in the knee with the microfracture technique. Surgical technique. J Bone Joint Surg Am 2006; 88 (Suppl 1 Pt 2): 294-304
    CrossrefPubMedGoogle Scholar
  • 9 Benthien JP, Behrens P. Reviewing subchondral cartilage surgery: considerations for standardised and outcome predictable cartilage remodelling: a technical note. Int Orthop 2013; 37 (11) 2139-2145
    CrossrefPubMedGoogle Scholar
  • 10 Min BH, Choi WH, Lee YS. , et al. Effect of different bone marrow stimulation techniques (BSTs) on MSCs mobilization. J Orthop Res 2013; 31 (11) 1814-1819
    CrossrefPubMedGoogle Scholar
  • 11 Shapiro F, Koide S, Glimcher MJ. Cell origin and differentiation in the repair of full-thickness defects of articular cartilage. J Bone Joint Surg Am 1993; 75 (04) 532-553
    CrossrefPubMedGoogle Scholar
  • 12 Kreuz PC, Steinwachs MR, Erggelet C. , et al. Results after microfracture of full-thickness chondral defects in different compartments in the knee. Osteoarthritis Cartilage 2006; 14 (11) 1119-1125
    CrossrefPubMedGoogle Scholar
  • 13 Mithoefer K, Williams III RJ, Warren RF, Wickiewicz TL, Marx RG. High-impact athletics after knee articular cartilage repair: a prospective evaluation of the microfracture technique. Am J Sports Med 2006; 34 (09) 1413-1418
    CrossrefPubMedGoogle Scholar
  • 14 Saris DB, Vanlauwe J, Victor J. , et al. Characterized chondrocyte implantation results in better structural repair when treating symptomatic cartilage defects of the knee in a randomized controlled trial versus microfracture. Am J Sports Med 2008; 36 (02) 235-246
    CrossrefPubMedGoogle Scholar
  • 15 Saris DB, Vanlauwe J, Victor J. , et al; TIG/ACT/01/2000&EXT Study Group. Treatment of symptomatic cartilage defects of the knee: characterized chondrocyte implantation results in better clinical outcome at 36 months in a randomized trial compared to microfracture. Am J Sports Med 2009; 37 (Suppl. 01) 10S-19S
    CrossrefPubMedGoogle Scholar
  • 16 Hoemann CD, Gosselin Y, Chen H. , et al. Characterization of initial microfracture defects in human condyles. J Knee Surg 2013; 26 (05) 347-355
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Chen H, Sun J, Hoemann CD. , et al. Drilling and microfracture lead to different bone structure and necrosis during bone-marrow stimulation for cartilage repair. J Orthop Res 2009; 27 (11) 1432-1438
    CrossrefPubMedGoogle Scholar
  • 18 Orth P, Goebel L, Wolfram U. , et al. Effect of subchondral drilling on the microarchitecture of subchondral bone: analysis in a large animal model at 6 months. Am J Sports Med 2012; 40 (04) 828-836
    CrossrefPubMedGoogle Scholar
  • 19 Orth P, Cucchiarini M, Kaul G. , et al. Temporal and spatial migration pattern of the subchondral bone plate in a rabbit osteochondral defect model. Osteoarthritis Cartilage 2012; 20 (10) 1161-1169
    CrossrefPubMedGoogle Scholar
  • 20 Caplan AI, Dennis JE. Mesenchymal stem cells as trophic mediators. J Cell Biochem 2006; 98 (05) 1076-1084
    CrossrefPubMedGoogle Scholar
  • 21 Lodi D, Iannitti T, Palmieri B. Stem cells in clinical practice: applications and warnings. J Exp Clin Cancer Res 2011; 30: 9 . Doi: 10.1186/1756-9966-30-9
    CrossrefPubMedGoogle Scholar
  • 22 Caplan AI. Review: mesenchymal stem cells: cell-based reconstructive therapy in orthopedics. Tissue Eng 2005; 11 (7-8): 1198-1211
    CrossrefPubMedGoogle Scholar
  • 23 Chen FH, Tuan RS. Mesenchymal stem cells in arthritic diseases. Arthritis Res Ther 2008; 10 (05) 223 . Doi: 10.1186/ar2514
    CrossrefPubMedGoogle Scholar
  • 24 Steadman JR, Rodkey WG, Singleton SB. , et al. Microfracture technique for full-thickness chondral defects. Technique and clinical results. Oper Tech Orthop 1997; 7: 300-304
    CrossrefPubMedGoogle Scholar
  • 25 Steadman JR, Miller BS, Karas SG, Schlegel TF, Briggs KK, Hawkins RJ. The microfracture technique in the treatment of full-thickness chondral lesions of the knee in National Football League players. J Knee Surg 2003; 16 (02) 83-86
    PubMedGoogle Scholar
  • 26 Steadman JR, Briggs KK, Rodrigo JJ, Kocher MS, Gill TJ, Rodkey WG. Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy 2003; 19 (05) 477-484
    CrossrefPubMedGoogle Scholar
  • 27 Kon E, Gobbi A, Filardo G, Delcogliano M, Zaffagnini S, Marcacci M. Arthroscopic second-generation autologous chondrocyte implantation compared with microfracture for chondral lesions of the knee: prospective nonrandomized study at 5 years. Am J Sports Med 2009; 37 (01) 33-41
    CrossrefPubMedGoogle Scholar
  • 28 Kon E, Filardo G, Berruto M. , et al. Articular cartilage treatment in high-level male soccer players: a prospective comparative study of arthroscopic second-generation autologous chondrocyte implantation versus microfracture. Am J Sports Med 2011; 39 (12) 2549-2557
    CrossrefPubMedGoogle Scholar
  • 29 Mithoefer K, McAdams T, Williams RJ, Kreuz PC, Mandelbaum BR. Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: an evidence-based systematic analysis. Am J Sports Med 2009; 37 (10) 2053-2063
    CrossrefPubMedGoogle Scholar
  • 30 Namdari S, Baldwin K, Anakwenze O, Park MJ, Huffman GR, Sennett BJ. Results and performance after microfracture in National Basketball Association athletes. Am J Sports Med 2009; 37 (05) 943-948
    CrossrefPubMedGoogle Scholar
  • 31 Chen H, Chevrier A, Hoemann CD, Sun J, Ouyang W, Buschmann MD. Characterization of subchondral bone repair for marrow-stimulated chondral defects and its relationship to articular cartilage resurfacing. Am J Sports Med 2011; 39 (08) 1731-1740
    CrossrefPubMedGoogle Scholar
  • 32 Orth P, Duffner J, Zurakowski D, Cucchiarini M, Madry H. Small-diameter awls improve articular cartilage repair after Microfracture treatment in a translation animal model. Am J Sports Med 2016; 44 (01) 209-219
    CrossrefPubMedGoogle Scholar
  • 33 Eldracher M, Orth P, Cucchiarini M, Pape D, Madry H. Small subchondral drill holes improve marrow stimulation of articular cartilage defects. Am J Sports Med 2014; 42 (11) 2741-2750
    CrossrefPubMedGoogle Scholar
  • 34 Chen H, Hoemann CD, Sun J. , et al. Depth of subchondral perforation influences the outcome of bone marrow stimulation cartilage repair. J Orthop Res 2011; 29 (08) 1178-1184
    CrossrefPubMedGoogle Scholar