Department of Anatomy-Surgical Training, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam.
Department of Orthopedic Surgery, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea.
Am J Sports Med. 2023 May;51(6):1560-1570. doi: 10.1177/03635465231162316. Epub 2023 Apr 4.
Osteochondral defects of the talus can be effectively treated using microfracture, which is technically safe, accessible, and affordable. However, fibrous tissue and fibrocartilage comprise the majority of tissue repairs resulting from these procedures. These tissue types lack the mechanical characteristics of native hyaline cartilage and might significantly contribute to the decline in long-term outcomes. Recombinant human-bone morphogenetic protein-2 (rhBMP-2) has been shown to promote matrix synthesis and increase cartilage formation, thus enhancing chondrogenesis in vitro.
This study aimed to evaluate the treatment ability of combining rhBMP-2 with microfracture in rabbit talus osteochondral defect.
Controlled laboratory study.
A full-thickness chondral defect (3 × 3 × 2 mm) was constructed in the center talar dome of 24 New Zealand White male rabbits, which were then divided into 4 groups of 6. Each group received the appropriate treatment: group 1 (control; no treatment of defect), group 2 (microfracture treatment), group 3 (rhBMP-2/hydroxyapatite treatment), and group 4 (microfracture combined with rhBMP-2/hydroxyapatite treatment). Animals were sacrificed at 2, 4, and 6 weeks postoperatively. The International Cartilage Regeneration & Joint Preservation Society macroscopic score, which considers the degree of defect repair, the integration to the border zone, and the macroscopic appearance, was used to assess the repaired tissue's macroscopic appearance. Subchondral bone regeneration in defects was analyzed using micro-computed tomography, and the histological findings were graded using a modified version of the Wakitani scoring system for osteochondral repair.
At 2, 4, and 6 weeks, micro-computed tomography analysis revealed that groups 3 and 4 exhibited subchondral bone healing that was more significantly improved compared with groups 1. No sample showed excessive bone growth from the subchondral bone area. According to macroscopic and histological results, group 4 showed higher-quality cartilage and more accelerated cartilage regeneration than the other groups over time.
These findings show that osteochondral defect repair in a rabbit talus model could be effectively accelerated and improved by combining rhBMP-2 with microfracture.
Using rhBMP-2 in combination with microfracture may enhance the repair of talar osteochondral lesions.
微骨折技术是一种技术安全、易于操作且价格合理的治疗距骨骨软骨缺损的方法，能有效治疗骨软骨缺损。然而，这些手术的组织修复主要由纤维组织和纤维软骨组成。这些组织类型缺乏透明软骨的机械特性，可能会显著影响长期结果。重组人骨形态发生蛋白-2（rhBMP-2）已被证明可促进基质合成和增加软骨形成，从而增强体外软骨形成。
本研究旨在评估 rhBMP-2 联合微骨折治疗兔距骨骨软骨缺损的能力。
对照实验室研究。
在 24 只新西兰雄性白兔的距骨穹顶中心构建全层软骨缺损（3×3×2mm），然后将其分为 4 组，每组 6 只。每组接受相应的治疗：第 1 组（对照组；不治疗缺损）、第 2 组（微骨折治疗）、第 3 组（rhBMP-2/羟基磷灰石治疗）和第 4 组（微骨折联合 rhBMP-2/羟基磷灰石治疗）。术后 2、4 和 6 周处死动物。采用国际软骨再生与关节保存协会（ICRS）宏观评分标准评估修复组织的宏观外观，该评分标准考虑了缺损修复程度、与边界区的整合以及宏观外观。使用改良的 Wakitani 骨软骨修复评分系统对缺损处的软骨下骨再生进行分析。
在 2、4 和 6 周时，微计算机断层扫描分析显示，第 3 组和第 4 组的软骨下骨愈合明显优于第 1 组。没有样本显示软骨下骨区域有过多的骨生长。根据宏观和组织学结果，随着时间的推移，第 4 组的软骨质量更高，软骨再生速度更快。
这些发现表明，rhBMP-2 联合微骨折可有效加速和改善兔距骨模型的骨软骨缺损修复。
rhBMP-2 联合微骨折可增强距骨骨软骨病变的修复。
