Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.
Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China.
Am J Sports Med. 2019 Aug;47(10):2308-2315. doi: 10.1177/0363546519856346. Epub 2019 Jun 27.
The repair of porcine articular cartilage defects by using particulated juvenile allograft cartilage (PJAC) has demonstrated good short-term clinical efficacy, but the repair process and mechanism have not been fully elucidated.
To study the efficacy of PJAC in repairing full-thickness cartilage defects and to provide an experimental basis for its clinical application.
Controlled laboratory study.
Thirty Guizhou minipigs were randomly divided into an experimental group and control group. An 8-mm cylindrical full-thickness cartilage defect was created in the femoral trochlea of either knee in all minipigs. The experimental group received the PJAC transplantation (PJAC group; n = 15) and the control group received autologous cartilage chips (ACC group; n = 15). Five minipigs were euthanized at 1, 3, and 6 months in each group to obtain samples, which were evaluated by general view of the knee joint and histomorphometry of the chondral defect area (hematoxylin and eosin, safranin O). International Cartilage Repair Society (ICRS) II semiquantitative evaluation and collagen type II staining immunohistochemistry were also performed.
All 30 Guizhou minipigs were followed; there was no infection or incision healing disorder after the operation. At 1 month postoperatively, more hyaline cartilage was found in the ACC group (29.4%) compared with the PJAC group (20.1%) ( < .05); there was no statistical difference between the 2 groups at 3 and 6 months after operation. The fibrocartilage content in the ACC group was significantly more than that in the PJAC group at 1 and 3 months postoperatively (27.4% vs 18.2% and 49.9% vs 41.1%, respectively; < .05); significant differences disappeared at 6 months postoperatively. The PJAC group produced more fibrous tissue than the ACC group at 1 and 3 months postoperatively (60.1% vs 40.6% and 38.8% vs 24.4%, respectively; < .05) but showed no statistical difference at 6 months postoperatively. Regarding the ICRS II scores, those of the ACC group were significantly better than the scores of the PJAC group in some subclasses at 3 and 6 months postoperatively. The positive rates of immunohistochemical staining in the ACC group were higher at 1 and 3 months postoperatively than those in the PJAC group (54.2% vs 37.8% and 46.4% vs 34.4%, respectively; < .05). The difference was not statistically significant between the 2 groups at 6 months postoperatively.
Both PJAC and ACC can produce a good repair effect on cartilage defects. At 1 and 3 months postoperatively, ACC resulted in better outcomes than PJAC, but there was no statistical difference in the repair effect between the 2 techniques at 6 months postoperatively.
Based on this animal experiment, further clinical studies are needed to investigate PJAC as a possible alternative first-line treatment for cartilage defects.
使用颗粒状幼年同种异体软骨（PJAC）修复猪关节软骨缺损已显示出良好的短期临床疗效，但修复过程和机制尚未完全阐明。
研究 PJAC 修复全层软骨缺损的效果，为其临床应用提供实验依据。
对照实验研究。
30 只贵州小型猪随机分为实验组和对照组。所有小型猪的膝关节股骨滑车均造成 8mm 圆柱形全层软骨缺损。实验组接受 PJAC 移植（PJAC 组；n=15），对照组接受自体软骨片（ACC 组；n=15）。每组各有 5 只小型猪在术后 1、3、6 个月处死，取标本，采用膝关节大体观察和软骨缺损区组织形态学（苏木精和伊红、番红 O）评估。还进行了国际软骨修复学会（ICRS）II 半定量评估和 II 型胶原免疫组织化学染色。
30 只贵州小型猪均被随访；术后无感染或切口愈合不良。术后 1 个月，ACC 组（29.4%）的透明软骨较 PJAC 组（20.1%）多（<0.05）；术后 3、6 个月 2 组间无统计学差异。术后 1、3 个月，ACC 组的纤维软骨含量明显多于 PJAC 组（分别为 27.4%比 18.2%和 49.9%比 41.1%；<0.05）；术后 6 个月差异消失。术后 1、3 个月，PJAC 组产生的纤维组织多于 ACC 组（分别为 60.1%比 40.6%和 38.8%比 24.4%；<0.05），但术后 6 个月无统计学差异。关于 ICRS II 评分，术后 3、6 个月，ACC 组在一些亚类中的评分明显优于 PJAC 组。术后 1、3 个月，ACC 组免疫组织化学染色的阳性率高于 PJAC 组（分别为 54.2%比 37.8%和 46.4%比 34.4%；<0.05）。术后 6 个月，2 组间差异无统计学意义。
PJAC 和 ACC 均可对软骨缺损产生良好的修复效果。术后 1、3 个月，ACC 组的效果优于 PJAC 组，但术后 6 个月 2 种技术的修复效果无统计学差异。
基于这项动物实验，需要进一步的临床研究来探讨 PJAC 是否可以作为软骨缺损的一种潜在一线治疗方法。
