Department of Orthopaedic Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
Global Institution for Collaborative Research and Education (GI-CoRE), Frontier Research Center for Advanced Material and Life Science, Hokkaido University, Sapporo, Japan.
Am J Sports Med. 2018 Jul;46(8):1970-1979. doi: 10.1177/0363546518770436. Epub 2018 May 15.
The optimal treatment for a medium- or large-sized cartilage lesion is still controversial. Since an ultrapurified alginate (UPAL) gel enhances cartilage repair in animal models, this material is expected to improve the efficacy of the current treatment strategies for cartilage lesions.
The bone marrow stimulation technique (BMST) augmented by UPAL gel can induce hyaline-like cartilage repair.
Controlled laboratory study.
Two cylindrical osteochondral defects were created in the patellar groove of 27 beagle dogs. A total of 108 defects were divided into 3 groups: defects without intervention (control group), defects with the BMST (microfracture group), and defects with the BMST augmented by implantation of UPAL gel (combined group). At 27 weeks postoperatively, macroscopic and histological evaluations, micro-computed tomography assessment, and mechanical testing were performed for each reparative tissue.
The defects in the combined group were almost fully covered with translucent reparative tissues, which consisted of hyaline-like cartilage with well-organized collagen structures. The macroscopic score was significantly better in the combined group than in the control group ( P < .05). The histological scores in the combined group were significantly better than those in the control group ( P < .01) and microfracture group ( P < .05). Although the repaired subchondral bone volumes were not influenced by UPAL gel augmentation, the mechanical properties of the combined group were significantly better than those of the microfracture group ( P < .05).
The BMST augmented by UPAL gel elicited hyaline-like cartilage repair that had characteristics of rich glycosaminoglycan and matrix immunostained by type II collagen antibody in a canine osteochondral defect model. The present results suggest that the current technique has the potential to be one of the autologous matrix-induced chondrogenesis techniques of the future and to expand the operative indications for the BMST without loss of its technical simplicity.
The data support the clinical reality of 1-step minimally invasive cartilage-reparative medicine with UPAL gel without harvesting donor cells.
对于中等或大型软骨损伤，最佳的治疗方法仍存在争议。由于超纯海藻酸钠（UPAL）凝胶可增强动物模型中的软骨修复，因此该材料有望改善当前软骨损伤治疗策略的疗效。
UPAL 凝胶增强的骨髓刺激技术（BMST）可诱导类透明软骨修复。
对照性实验室研究。
在 27 只比格犬的髌骨关节槽中创建了 2 个圆柱形的骨软骨缺损。共 108 个缺损分为 3 组：无干预组（对照组）、BMST 组（微骨折组）和 UPAL 凝胶植入增强 BMST 组（联合组）。术后 27 周，对每个修复组织进行大体和组织学评估、微计算机断层扫描评估和力学测试。
联合组的缺损几乎完全被半透明的修复组织覆盖，这些修复组织由具有组织有序胶原结构的类透明软骨组成。联合组的大体评分明显优于对照组（P <.05）。联合组的组织学评分明显优于对照组（P <.01）和微骨折组（P <.05）。虽然 UPAL 凝胶增强对修复的软骨下骨体积没有影响，但联合组的力学性能明显优于微骨折组（P <.05）。
在犬骨软骨缺损模型中，BMST 增强 UPAL 凝胶诱导产生了富含糖胺聚糖和 II 型胶原抗体免疫染色的类透明软骨修复。本研究结果表明，该技术有可能成为未来自体基质诱导软骨生成技术之一，并扩大 BMST 的手术适应证，而不会失去其技术简单性。
数据支持了在不采集供体细胞的情况下，使用 UPAL 凝胶进行 1 步微创软骨修复医学的临床现实。
