Division of Orthopedics, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.
Karl Chiari Lab for Orthopaedic Biology, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.
Am J Sports Med. 2020 May;48(6):1338-1346. doi: 10.1177/0363546520906411. Epub 2020 Mar 9.
Biological regeneration in an early stage of osteoarthritis (OA) is an important clinical challenge. An early-stage compartmentalized OA model was used to evaluate different biological regeneration techniques.
Biological regeneration in an early stage of compartmentalized OA is possible.
Controlled laboratory study.
A 7-mm cartilage defect was surgically created in 24 sheep. After 3 months, by which time early OA had set in, the sheep were randomized into 4 different treatment groups and operated for the second time. One group (CONTROL) served as a long-term follow-up group for the further development of OA. The other 3 groups (regeneration groups) each underwent a different regeneration procedure after abrasion of the subchondral bone (defect size: 20 × 10 mm with a depth of 2.5 mm): spongialization alone (SPONGIO), spongialization followed by implantation of an unseeded hyaluronan matrix (MATRIX), or spongialization followed by implantation of a hyaluronan matrix seeded with autologous chondrocytes (MACT). Then, 12 months after the second operative procedure, the animals were euthanized and the defects subjected to macroscopic and histological grading. Historical 4-month data were compared with the 12-month results.
After 12 months of follow-up, advanced cartilage degeneration was observed in the CONTROL group. On the other hand, all regeneration groups improved significantly compared with the 4-month results using the Mankin score. Cartilage quality in the MACT group was significantly better than in the MATRIX group, as determined by the Mankin and the O'Driscoll scores.
There are no existing clinical options for preventing early OA from progressing to a severe disease. This study provides important information on how a surgical intervention can forestall the development of OA.
OA of the knee is very common. Total joint replacement is not an acceptable option for active patients. Biological regeneration in OA is successful for focal cartilage defects; however, a long-term follow-up for biological regeneration in OA is missing. It is essential to have long-term results for a regenerative procedure involving cartilage, which is a tissue with a very slow turnover.
骨关节炎（OA）早期的生物学再生是一个重要的临床挑战。本研究采用早期局限性 OA 模型来评估不同的生物学再生技术。
局限性 OA 早期的生物学再生是可能的。
对照实验室研究。
在 24 只绵羊中手术造成 7mm 大小的软骨缺损。3 个月后，即早期 OA 发生时，绵羊被随机分为 4 个不同的治疗组并进行第二次手术。一组（对照组）作为长期随访组，以观察 OA 的进一步发展。其他 3 组（再生组）在软骨下骨打磨后分别进行不同的再生程序：单纯骨海绵化（SPONGIO）、骨海绵化后植入未种细胞的透明质酸基质（MATRIX）或骨海绵化后植入自体软骨细胞种细胞的透明质酸基质（MACT）。第二次手术后 12 个月，处死动物并对缺陷进行宏观和组织学分级。比较 4 个月和 12 个月的历史数据。
12 个月的随访后，对照组观察到严重的软骨退变。另一方面，所有再生组的 Mankin 评分均较 4 个月时显著改善。MACT 组的软骨质量明显优于 MATRIX 组，Mankin 和 O'Driscoll 评分均显示如此。
目前尚无阻止早期 OA 进展为严重疾病的临床选择。本研究为手术干预如何阻止 OA 发展提供了重要信息。
膝骨关节炎非常常见。对于活跃的患者，全关节置换不是一个可接受的选择。OA 的生物学再生对局限性软骨缺损是成功的；然而，OA 生物学再生的长期随访结果尚缺乏。对于涉及软骨的再生程序，软骨是一种新陈代谢非常缓慢的组织，获得其长期结果至关重要。
