Hoffman James K, Geraghty Sandra, Protzman Nicole M
Department of Orthopedics, Coordinated Health, 2775 Schoenersville Road, Bethlehem, PA 18017, USA.
Product Development Department, Osiris Therapeutics, 7015 Einstein Drive, Columbia, MD 21046, USA.
Case Rep Orthop. 2015;2015:617365. doi: 10.1155/2015/617365. Epub 2015 Jan 1.
Marrow stimulation is frequently employed to treat focal chondral defects of the knee. However, marrow stimulation typically results in fibrocartilage repair tissue rather than healthy hyaline cartilage, which, over time, predisposes the repair to failure. Recently, a cryopreserved viable chondral allograft was developed to augment marrow stimulation. The chondral allograft is comprised of native viable chondrocytes, chondrogenic growth factors, and extracellular matrix proteins within the superficial, transitional, and radial zones of hyaline cartilage. Therefore, host mesenchymal stem cells that infiltrate the graft from the underlying bone marrow following marrow stimulation are provided with the optimal microenvironment to undergo chondrogenesis. The present report describes treatment of a trochlear defect with marrow stimulation augmented with this novel chondral allograft, along with nine month postoperative histological results. At nine months, the patient demonstrated complete resolution of pain and improvement in function, and the repair tissue consisted of 85% hyaline cartilage. For comparison, a biopsy obtained from a patient 8.2 months after treatment with marrow stimulation alone contained only 5% hyaline cartilage. These outcomes suggest that augmenting marrow stimulation with the viable chondral allograft can eliminate pain and improve outcomes, compared with marrow stimulation alone.
骨髓刺激术常用于治疗膝关节局灶性软骨缺损。然而，骨髓刺激术通常会产生纤维软骨修复组织，而非健康的透明软骨，随着时间推移，这种修复组织容易导致修复失败。最近，一种冷冻保存的活性软骨同种异体移植物被开发出来，用于增强骨髓刺激效果。该软骨同种异体移植物由透明软骨表层、过渡层和放射状区域内的天然活性软骨细胞、软骨生成生长因子以及细胞外基质蛋白组成。因此，骨髓刺激后从下方骨髓渗入移植物的宿主间充质干细胞会获得进行软骨生成的最佳微环境。本报告描述了使用这种新型软骨同种异体移植物增强骨髓刺激术治疗滑车缺损的情况，以及术后九个月的组织学结果。九个月时，患者疼痛完全缓解，功能改善，修复组织中透明软骨占85%。作为对比，一名仅接受骨髓刺激术治疗8.2个月后的患者的活检样本中，透明软骨仅占5%。这些结果表明，与单纯骨髓刺激术相比，使用活性软骨同种异体移植物增强骨髓刺激术可消除疼痛并改善治疗效果。
