Department of Sports Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.
Laboratory Animal Center, Department of Medical Research, Chi Mei Medical Center, Tainan City, Taiwan.
Am J Sports Med. 2018 Jul;46(9):2232-2241. doi: 10.1177/0363546518780955. Epub 2018 Jun 21.
Treating articular cartilage lesions is clinically challenging. However, whether the addition of autologous platelet-rich plasma (PRP) to bioimplants along with early rehabilitation exercise provides therapeutic effects and regenerates the osteochondral defect remains uninvestigated.
The addition of PRP to a polylactic-co-glycolic acid (PLGA) scaffold along with continuous passive motion (CPM) in osteochondral defects may offer beneficial in situ microenvironment changes to facilitate hyaline cartilage and subchondral bone tissue repair.
Controlled laboratory study.
In 26 rabbits, 52 critical osteochondral defects were created in bilateral femoral trochlear grooves. The rabbits were allocated to 1 of the following 3 groups: PRP gel (PG group), PRP + PLGA scaffold (PP group), and PRP + PLGA scaffold + CPM (PPC group). At 4 and 12 weeks after surgery, the specimens were assessed by a macroscopic examination, a histological evaluation with immunohistochemical staining, and micro-computed tomography.
The PPC group exhibited the most favorable therapeutic outcomes in terms of hyaline cartilage regeneration. At week 4, the PPC group exhibited significantly higher levels of glycosaminoglycan (GAG) and collagen (COL) II and modest increases in COL I, matrix metalloproteinase-3 (MMP-3), and inflammatory cells with tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6). At week 12, the PPC group had significantly higher tissue repair scores, corresponding to a sound articular cartilage surface and chondrocyte and collagen arrangement. This group demonstrated restored hyaline cartilage and mineralized bone volume per tissue volume, which had an integrating structure in the repair site. However, the PG and PP groups exhibited mainly fibrous tissue and fibrocartilage, corresponding to higher expressions of COL I, TNF-α, IL-6, and MMP-3.
PRP with a PLGA graft along with early CPM exercise is promising for the repair of osteochondral defects in rabbit knee joints.
This study demonstrates the efficacy of a triad therapy involving the addition of PRP to bioimplants along with early CPM intervention for hyaline cartilage and subchondral regeneration. However, PRP alone (with or without PLGA implants) is limited to osteochondral defect repair without significant regeneration.
治疗关节软骨损伤具有临床挑战性。然而，在生物植入物中添加自体富血小板血浆（PRP）并结合早期康复运动是否具有治疗效果并再生骨软骨缺损仍未得到研究。
在骨软骨缺损中，将 PRP 添加到聚乳酸-共-乙醇酸（PLGA）支架中并结合持续被动运动（CPM）可能会提供有益的原位微环境变化，以促进透明软骨和软骨下骨组织的修复。
对照实验室研究。
在 26 只兔子中，双侧股骨滑车沟共创建 52 个临界骨软骨缺损。将兔子分为以下 3 组之一：PRP 凝胶（PG 组）、PRP+PLGA 支架（PP 组）和 PRP+PLGA 支架+CPM（PPC 组）。手术后 4 周和 12 周，通过大体检查、免疫组织化学染色的组织学评估和微计算机断层扫描进行评估。
在透明软骨再生方面，PPC 组的治疗效果最理想。在第 4 周时，PPC 组的糖胺聚糖（GAG）和胶原（COL）II 水平明显升高，COL I、基质金属蛋白酶-3（MMP-3）和炎症细胞（肿瘤坏死因子-α[TNF-α]和白细胞介素-6[IL-6]）适度增加。在第 12 周时，PPC 组的组织修复评分显著更高，对应于关节软骨表面和软骨细胞以及胶原排列良好。该组表现出修复部位具有整合结构的透明软骨和矿化骨体积恢复。然而，PG 和 PP 组主要表现为纤维组织和纤维软骨，对应于更高的 COL I、TNF-α、IL-6 和 MMP-3 表达。
PRP 与 PLGA 移植物联合早期 CPM 运动有望修复兔膝关节的骨软骨缺损。
本研究证明了在生物植入物中添加 PRP 并结合早期 CPM 干预对透明软骨和软骨下再生的三联疗法的疗效。然而，PRP 单独（有或没有 PLGA 植入物）仅限于骨软骨缺损修复，没有明显的再生。
