Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom.
Faculty of Biological Sciences, Institute of Medical and Biological Engineering, University of Leeds, Leeds, United Kingdom.
PLoS One. 2021 Apr 26;16(4):e0250077. doi: 10.1371/journal.pone.0250077. eCollection 2021.
A range of surgical techniques and osteochondral interventions have been developed for early stage chondral/osteochondral repair interventions in the knee however, methods for functional, pre-clinical assessment of these therapies are limited. In this study, a method for simulating physiological loading and motion in the porcine patellofemoral joint was developed using a 6-axis simulator. As an example of how the method can be used, the influence of surgical positioning of osteochondral allografts in the patella on cartilage wear, deformation and damage and graft stability was investigated in this porcine patellofemoral joint model. The functional performance of allografts implanted either optimally (flush with the cartilage surface) or 1 mm proud of the cartilage surface was compared to a positive control (stainless steel pin implanted 1 mm proud of the cartilage surface), a negative control (no intervention) and a defect model. Allografts implanted flush with the surrounding cartilage could restore the articulating surface of the patella resulting in low wear, damage and deformation of the opposing cartilage surface, similar to that of the negative control group. Implanting the graft proud of the patella surface resulted in cartilage lesions on the femoral trochlea (ICRS grade 2) and a cartilage volume difference of 2.0 ± 3.9 mm3; the positive controls resulted in more severe lesions, a higher volume difference (14.2 ± 7.4 mm3) which in some cases exposed subchondral bone (ICRS grade 4). Defects in the patella caused deformation of the opposing cartilage surface. All grafts implanted in the patella subsided over the duration of the study. This study demonstrated a method that can be used to evaluate osteochondral repair strategies in the patellofemoral joint applying physiological loading and motions.
已经开发出一系列用于膝关节早期软骨/骨软骨修复干预的手术技术和软骨下骨干预措施，但是，这些治疗方法的功能、临床前评估方法有限。在这项研究中，使用 6 轴模拟器开发了一种模拟猪髌股关节生理加载和运动的方法。作为该方法如何使用的一个例子，研究了同种异体软骨移植物在髌骨中的手术定位对软骨磨损、变形和损伤以及移植物稳定性的影响。将同种异体移植物植入最佳位置（与软骨表面平齐）或 1 毫米高于软骨表面的位置，与阳性对照（植入软骨表面 1 毫米处的不锈钢销）、阴性对照（无干预）和缺陷模型进行了比较。与周围软骨平齐植入的同种异体移植物可以恢复髌骨的关节表面，从而导致对侧软骨表面的磨损、损伤和变形减少，类似于阴性对照组。将移植物植入髌骨表面以上会导致股骨滑车的软骨病变（ICRS 分级 2）和软骨体积差异为 2.0±3.9mm3；阳性对照导致更严重的病变、更大的体积差异（14.2±7.4mm3），在某些情况下暴露了软骨下骨（ICRS 分级 4）。髌骨缺损导致对侧软骨表面变形。所有植入髌骨的移植物在研究期间都有下沉。本研究展示了一种可用于评估髌股关节中骨软骨修复策略的方法，该方法可施加生理负荷和运动。
