Giannini S, Buda R, Grigolo B, Vannini F, De Franceschi L, Facchini A
Orthopaedic Department, Rizzoli Orthopaedic Institute, Bologna, Italy.
Osteoarthritis Cartilage. 2005 Jul;13(7):601-7. doi: 10.1016/j.joca.2005.02.010.
Autologous chondrocyte implantation (ACI) has been successfully used for the treatment of osteochondral lesions of the talus. One of the main problems of this surgical strategy is related to the harvesting of the cartilage slice from a healthy knee. The aim of this study was to examine the capacity of chondrocytes harvested from a detached osteochondral fragment to proliferate and to serve as a source of viable cells for ACI in the repair of ankle cartilage defects.
Detached osteochondral fragments harvested from the ankle joint of 20 patients with osteochondral lesions of the talus served as the source of human articular cartilage specimens. All of the osteochondral lesions were chronic and of traumatic origin. In all cases, the fragments were utilized to evaluate the viability and proliferation of the cells, the histological appearance of the cartilage tissue and the expression of specific cartilage markers by real-time polymerase chain reaction (PCR). In the 16 patients scheduled for ACI, the expanded chondrocytes were used for chondrocyte implantation. In the other 4 patients, with lesion size <1.5cm(2), microfractures were created during the initial arthroscopic step. As a control group, 7 patients with comparable osteochondral lesions underwent the same surgery, but received chondrocytes harvested from the ipsilateral knee.
According to the American Orthopaedic Foot and Ankle Scoring (AOFAS) system, patients in the experimental group had a preoperative score of 54.2+/-16 points and a postoperative one of 89+/-9.6 points after a minimum follow-up time of 12 months (P<0.0005). The control group of patients had a preoperative score of 54.6+/-11.7 points and a postoperative one of 90.2+/-9.7 points at a minimum follow-up time of 12 months (P<0.0005). The clinical results of the two groups did not differ significantly from each other. Chondrocytes isolated from the detached fragments were highly viable, phenotypically stable, proliferated in culture and redifferentiated when grown within the three-dimensional scaffold used for ACI. The morphological and molecular characteristics of the cartilage samples obtained from the detached osteochondral fragments were similar to those of healthy hyaline articular cartilage.
The good results achieved with this strategy indicate that cells derived from the lesioned area may be useful in the treatment of osteochondral defects of the talus.
自体软骨细胞移植（ACI）已成功用于距骨骨软骨损伤的治疗。这种手术策略的主要问题之一与从健康膝关节获取软骨切片有关。本研究的目的是检查从分离的骨软骨碎片中获取的软骨细胞的增殖能力，并作为ACI修复踝关节软骨缺损时活细胞的来源。
从20例距骨骨软骨损伤患者的踝关节获取的分离骨软骨碎片作为人关节软骨标本的来源。所有骨软骨损伤均为慢性且由创伤引起。在所有病例中，利用碎片评估细胞的活力和增殖、软骨组织的组织学外观以及通过实时聚合酶链反应（PCR）检测特定软骨标志物的表达。在计划进行ACI的16例患者中，扩增的软骨细胞用于软骨细胞移植。在其他4例病变大小<1.5cm²的患者中，在初次关节镜检查时进行微骨折术。作为对照组，7例具有类似骨软骨损伤的患者接受相同手术，但接受从同侧膝关节获取的软骨细胞。
根据美国矫形足踝评分（AOFAS）系统，实验组患者在至少随访12个月后，术前评分为54.2±16分，术后为89±9.6分（P<0.0005）。对照组患者在至少随访12个月时，术前评分为54.6±11.7分，术后为90.2±9.7分（P<0.0005）。两组的临床结果无显著差异。从分离碎片中分离出的软骨细胞具有高活力、表型稳定，在培养中增殖并在用于ACI的三维支架内生长时重新分化。从分离的骨软骨碎片获得的软骨样本的形态和分子特征与健康透明关节软骨相似。
该策略取得的良好结果表明，来自病变区域的细胞可能对距骨骨软骨缺损的治疗有用。
