Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
Global Station for Soft Matter, Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo, Japan.
Am J Sports Med. 2019 Feb;47(2):468-478. doi: 10.1177/0363546518817527. Epub 2019 Jan 9.
One of the most important limitations of osteochondral autograft transplantation (OAT) is the adverse effect on donor sites in the knee. To decrease the number and/or size of osteochondral defects, we devised a method with biomaterial implantation after OAT.
OAT augmented by ultrapurified alginate (UPAL) gel enhances cartilage repair capacity.
Controlled laboratory study.
Seventy-five osteochondral defects in rabbits were divided into 3 groups: osteochondral defects with OAT alone, defects with OAT augmented by UPAL gel (combined group), and defects without intervention as controls. Macroscopic and histological evaluations of the reparative tissues were performed at 4 and 12 weeks postoperatively. Histological evaluation of graft cartilage degradation was also performed. To evaluate the effects of UPAL gel on graft healing, repaired bone volumes and osseointegration of the graft were evaluated. Collagen orientation and the mechanical properties of the reparative tissue and graft cartilage were also evaluated qualitatively.
The macroscopic and histological evaluations of the combined group were significantly superior to the other groups at 12 weeks postoperatively. Regarding degenerative change of the graft, the histological scores of the combined group were significantly higher than those of the OAT-alone group. The values of repaired subchondral bone volumes and osseointegration of the graft were almost identical in both groups. Collagen orientation and the mechanical properties of the reparative tissue and graft cartilage were significantly better in the combined group than in the other groups.
Administration of UPAL gel in OAT enhanced cartilage repair and protected graft cartilage without inhibiting subchondral bone repair and graft survival.
OAT augmented by UPAL gel decreases the number and/or size of osteochondral grafts, minimizing the risk of donor site morbidity. This combination technique has the potential to improve clinical outcomes and expand the surgical indications for OAT.
骨软骨自体移植（OAT）最重要的局限性之一是对膝关节供体部位的不利影响。为了减少骨软骨缺损的数量和/或大小，我们设计了一种在 OAT 后进行生物材料植入的方法。
OAT 与超纯藻酸盐（UPAL）凝胶联合使用可增强软骨修复能力。
对照实验室研究。
将 75 个兔骨软骨缺损分为 3 组：单纯 OAT 组、OAT 联合 UPAL 凝胶组（联合组）和无干预对照组。术后 4 周和 12 周进行修复组织的宏观和组织学评估。还对移植物软骨降解的组织学评估进行了评估。为了评估 UPAL 凝胶对移植物愈合的影响，评估了修复骨体积和移植物的骨整合。还定性评估了修复组织和移植物软骨的胶原取向和机械性能。
术后 12 周，联合组的宏观和组织学评估明显优于其他组。关于移植物的退行性变化，联合组的组织学评分明显高于单纯 OAT 组。两组修复的软骨下骨体积和移植物的骨整合值几乎相同。联合组修复组织和移植物软骨的胶原取向和机械性能明显优于其他组。
在 OAT 中加入 UPAL 凝胶可增强软骨修复并保护移植物软骨，而不会抑制软骨下骨修复和移植物存活。
OAT 联合 UPAL 凝胶可减少骨软骨移植物的数量和/或大小，最大限度地降低供体部位发病率的风险。这种联合技术有可能改善临床结果并扩大 OAT 的手术适应证。
