Castagnini Francesco, Pellegrini Camilla, Perazzo Luca, Vannini Francesca, Buda Roberto
I Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy.
Orthopaedics and Traumatology, I Clinic, Rizzoli Orthopaedic Institute, University of Bologna, Bologna, Italy.
J Exp Orthop. 2016 Dec;3(1):3. doi: 10.1186/s40634-016-0038-4. Epub 2016 Jan 15.
Ankle osteoarthritis (AOA) is a severe pathology, mostly affecting a post-traumatic young population. Arthroscopic debridement, arthrodiastasis, osteotomy are the current joint sparing procedures, but, in the available studies, controversial results were achieved, with better outcomes in case of limited degeneration. Only osteotomy in case of malalignment is universally accepted as a joint sparing procedure in case of partial AOA. Recently, the biological mechanism of osteoarthritis has been intensively studied: it is a whole joint pathology, affecting cartilage, bone and synovial membrane. In particular, the first stage is characterized by a reversible catabolic activity with a state of chondropenia. Thus, biological procedures for early AOA were proposed in order to delay or to avoid end stage procedures. Mesenchymal stem cells (MSCs) may be a good solution to prevent or reverse degeneration, due to their immunomodulatory features (able to control the catabolic joint environment) and their regenerative osteochondral capabilities (able to treat the chondral defects). In fact, MSCs may regulate the cytokine cascade and the metalloproteinases release, restoring the osteochondral tissue as well. After interesting reports of mesenchymal stem cells seeded on scaffold and applied to cartilage defects in non-degenerated joints, bone marrow derived cells transplantation appears to be a promising technique in order to control the degenerative pathway and restore the osteochondral defects.
踝关节骨关节炎（AOA）是一种严重的病理状况，主要影响创伤后的年轻人群。关节镜清创术、关节扩张术、截骨术是目前保留关节的手术方法，但在现有研究中，结果存在争议，在退变有限的情况下效果较好。在部分AOA病例中，只有在存在对线不良时进行截骨术被普遍认为是一种保留关节的手术方法。最近，骨关节炎的生物学机制得到了深入研究：它是一种全关节病理状况，影响软骨、骨骼和滑膜。特别是，第一阶段的特征是具有软骨减少状态的可逆分解代谢活动。因此，为了延迟或避免终末期手术，人们提出了针对早期AOA的生物学手术方法。间充质干细胞（MSCs）可能是预防或逆转退变的良好解决方案，这是由于它们的免疫调节特性（能够控制分解代谢的关节环境）和它们的再生骨软骨能力（能够治疗软骨缺损）。事实上，MSCs可以调节细胞因子级联反应和金属蛋白酶的释放，也能恢复骨软骨组织。在关于将间充质干细胞接种在支架上并应用于未退变关节的软骨缺损的有趣报道之后，骨髓来源细胞移植似乎是一种有前途的技术，以便控制退变途径并修复骨软骨缺损。
