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Eur Cell Mater. 2021 Jan 7;41:40-51. doi: 10.22203/eCM.v041a04.
The repair of focal cartilage defects remains one of the foremost issues in the field of orthopaedics. Chondral defects may arise from a variety of joint pathologies and left untreated, will likely progress to osteoarthritis. Current repair techniques, such as microfracture, result in short-term clinical improvements but have poor long-term outcomes. Emerging scaffold-based repair strategies have reported superior outcomes compared to microfracture and motivate the development of new biomaterials for this purpose. In this study, unique composite implants consisting of a base porous reinforcing component (woven poly(ε-caprolactone)) infiltrated with 1 of 2 hydrogels (self-assembling peptide or thermo-gelling hyaluronan) or bone marrow aspirate were evaluated. The objective was to evaluate cartilage repair with composite scaffold treatment compared to the current standard of care (microfracture) in a translationally relevant large animal model, the Yucatan minipig. While many cartilage-repair studies have shown some success in vivo, most are short term and not clinically relevant. Informed by promising 6-week findings, a 12-month study was carried out and those results are presented here. To aid in comparisons across platforms, several structural and functionally relevant outcome measures were performed. Despite positive early findings, the long-term results indicated less than optimal structural and mechanical results with respect to cartilage repair, with all treatment groups performing worse than the standard of care. This study is important in that it brings much needed attention to the importance of performing translationally relevant long-term studies in an appropriate animal model when developing new clinical cartilage repair approaches.
关节软骨缺损的修复仍然是矫形外科领域的首要问题之一。软骨缺损可能由多种关节病变引起，如果不治疗，很可能发展为骨关节炎。目前的修复技术，如微骨折，虽然能在短期内改善临床效果，但长期效果不佳。新兴的支架修复策略与微骨折相比，报告了更好的结果，这促使了为此目的开发新的生物材料。在这项研究中，评估了由基底多孔增强组件（编织聚（ε-己内酯））和 1 种水凝胶（自组装肽或热凝胶透明质酸）或骨髓抽吸物组成的独特复合植入物。目的是评估与当前的标准治疗（微骨折）相比，复合支架治疗在转化相关的大型动物模型（尤卡坦小型猪）中的软骨修复效果。虽然许多软骨修复研究在体内已经取得了一些成功，但大多数都是短期的，不具有临床相关性。在有希望的 6 周研究结果的指导下，进行了为期 12 个月的研究，现将结果报告如下。为了便于在不同平台上进行比较，进行了几种结构和功能相关的结果测量。尽管早期结果积极，但长期结果表明，与软骨修复相比，结构和机械结果并不理想，所有治疗组的表现均不如标准治疗。这项研究很重要，因为它强调了在开发新的临床软骨修复方法时，在适当的动物模型中进行转化相关的长期研究的重要性。
