Chona Deepak V, Kha Stephanie T, Minetos Paul D, LaPrade Christopher M, Chu Constance R, Abrams Geoffrey D, Safran Marc R, Sherman Seth L
Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA.
Orthop J Sports Med. 2021 Nov 4;9(11):23259671211049756. doi: 10.1177/23259671211049756. eCollection 2021 Nov.
Various surgical treatment options exist for repairing, replacing, or regenerating tissue to fill osteochondral defects. Biologic augmentation has been increasingly studied as an adjunct in the surgical treatment of osteochondral defects of the knee in animal and human models.
PURPOSE/HYPOTHESIS: The purpose of the study was to systematically review use of platelet-rich plasma (PRP) and bone marrow concentrate (BMC) augmentation in the surgical treatment of osteochondral knee defects and to describe the outcomes. It was hypothesized that both PRP and BMC augmentation will result in improved outcomes in osteochondral knee surgery in both animal and human models.
Systematic review.
PubMed, MEDLINE, and Embase were searched for studies relating to PRP or BMC and treatment of osteochondral defects of the knee, from database inception to February 1, 2020. Included were articles that (1) studied PRP or BMC augmentation; (2) used osteochondral autograft, allograft, or biologic scaffold; and (3) treated osteochondral defects in the knee. Data on use of PRP or BMC, outcomes assessed, and results were recorded for each publication.
Of the 541 articles identified initially, 17 were included in the final review. Five articles studied osteochondral grafts in animals, 5 studied biologic scaffolds in animals, and 7 studied scaffolds or allografts in humans; the combined sample size was 202 patients. Of 4 histologic scaffold studies, 3 PRP-augmented scaffold studies identified histologic improvements in regenerated cartilage in animal models, while 1 BMC study demonstrated similar improvement in histologic scores of BMC-augmented scaffolds compared with controls. Three studies associated greater collagen type 2 and glycosaminoglycan content with PRP treatment. Comparative studies found that both augments increase osteogenic proteins, including bone morphogenetic protein-2 and osteoprotegerin. Two of 3 studies on BMC-augmented osteochondral allografts reported no difference in radiographic features postoperatively. Long-term improvement in clinical and radiographic outcomes of PRP-augmented scaffolds was demonstrated in 1 human study.
Animal studies suggest that biologics possess potential as adjuncts to surgical treatment of osteochondral knee defects; however, clinical data remain limited.
存在多种用于修复、置换或再生组织以填补骨软骨缺损的手术治疗选择。生物增强作为膝关节骨软骨缺损手术治疗的辅助手段，在动物和人体模型中得到了越来越多的研究。
目的/假设：本研究的目的是系统评价富血小板血浆（PRP）和骨髓浓缩物（BMC）增强在膝关节骨软骨缺损手术治疗中的应用并描述结果。假设PRP和BMC增强在动物和人体模型的膝关节骨软骨手术中均能带来更好的结果。
系统评价。
检索PubMed、MEDLINE和Embase数据库，查找从建库至2020年2月1日与PRP或BMC及膝关节骨软骨缺损治疗相关的研究。纳入的文章需满足：（1）研究PRP或BMC增强；（2）使用骨软骨自体移植、异体移植或生物支架；（3）治疗膝关节骨软骨缺损。记录各出版物中PRP或BMC的使用情况、评估的结果及结果。
最初识别出541篇文章，最终纳入17篇进行综述。5篇文章研究动物的骨软骨移植，5篇研究动物的生物支架，7篇研究人体的支架或异体移植；样本总量为202例患者。在4项组织学支架研究中，3项PRP增强支架研究在动物模型中发现再生软骨的组织学改善，而1项BMC研究表明，与对照组相比，BMC增强支架的组织学评分有类似改善。3项研究将PRP治疗与更高的Ⅱ型胶原蛋白和糖胺聚糖含量相关联。比较研究发现，两种增强剂均能增加成骨蛋白，包括骨形态发生蛋白-2和骨保护素。3项关于BMC增强骨软骨异体移植的研究中有2项报告术后影像学特征无差异。1项人体研究证明PRP增强支架的临床和影像学结果有长期改善。
动物研究表明，生物制剂作为膝关节骨软骨缺损手术治疗的辅助手段具有潜力；然而，临床数据仍然有限。
