Brun Paola, Dickinson Sally C, Zavan Barbara, Cortivo Roberta, Hollander Anthony P, Abatangelo Giovanni
Department of Histology, Microbiology and Medical Biotechnology, Histology Unit, Faculty of Medicine, University of Padova, Padova, Italy.
Arthritis Res Ther. 2008;10(6):R132. doi: 10.1186/ar2549. Epub 2008 Nov 11.
The present study established characteristics of tissue regrowth in patients suffering knee lesions treated with grafts of autologous chondrocytes grown on three-dimensional hyaluronic acid biomaterials.
This multicentred study involved a second-look arthroscopy/biopsy, 5 to 33 months post implant (n = 63). Seven patients allowed a third-look biopsy, three of which were performed 18 months post implant. Characteristics of tissues were histologically and histochemically evaluated. The remaining bone stubs were evaluated for cartilage/bone integration. For data analysis, biopsies were further divided into those obtained from postoperative symptomatic patients (n = 41) or from asymptomatic patients (n = 22).
The percentage of hyaline regenerated tissues was significantly greater in biopsies obtained after, versus within, 18 months of implantation. Differences were also observed between symptomatic and asymptomatic patients: reparative tissues taken from symptomatic patients 18 months after grafting were mainly fibrocartilage or mixed (hyaline-fibrocartilage) tissue, while tissues taken from asymptomatic patients were hyaline cartilage in 83% of biopsies. In a small group of asymptomatic patients (n = 3), second-look and third-look biopsies taken 18 months after surgery confirmed maturation of the newly formed tissue over time. Cartilage maturation occurred from the inner regions of the graft, in contact with subchondral bone, towards the periphery of the implant.
The study indicates that, in asymptomatic patients after chondrocyte implantation, regenerated tissue undergoes a process of maturation that in the majority of cases takes longer than 18 months for completion and leads to hyaline tissue and not fibrous cartilage. Persistence of symptoms might reflect the presence of a nonhyaline cartilage repair tissue.
本研究确定了使用在三维透明质酸生物材料上培养的自体软骨细胞移植治疗膝关节损伤患者的组织再生特征。
这项多中心研究涉及在植入后5至33个月进行的二次关节镜检查/活检（n = 63）。7名患者接受了三次活检，其中3次在植入后18个月进行。对组织特征进行了组织学和组织化学评估。对剩余的骨残端进行软骨/骨整合评估。为了进行数据分析，活检样本进一步分为术后有症状患者（n = 41）或无症状患者（n = 22）的样本。
植入后18个月后获得的活检样本中，透明质酸再生组织的百分比明显高于18个月内获得的样本。有症状和无症状患者之间也观察到差异：移植后18个月从有症状患者身上获取的修复组织主要是纤维软骨或混合（透明质酸-纤维软骨）组织，而从无症状患者身上获取的组织在83%的活检样本中是透明软骨。在一小群无症状患者（n = 3）中，术后18个月进行的二次和三次活检证实了新形成组织随时间的成熟。软骨成熟从移植物与软骨下骨接触的内部区域向植入物周边发展。
该研究表明，在软骨细胞植入后的无症状患者中，再生组织会经历一个成熟过程，在大多数情况下，这个过程需要超过18个月才能完成，并导致透明质酸组织而非纤维软骨的形成。症状的持续可能反映了非透明软骨修复组织的存在。
