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Soft Tissue Surgery of the Knee
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Stephen Key, Jonathan Miles, Richard Carrington
Autologous chondrocyte implantation is performed as a two-stage procedure. The first stage is arthroscopic and includes a diagnostic arthroscopy and debridement of any chondral flaps around the area of chondral damage. This should be done to provide a rim of stable or healthy cartilage all around the lesion and is essential for attachment of the graft. At the end of the first-stage arthroscopy, small segments of healthy cartilage are harvested from the outer border of the anterosuperior femur, usually on the medial side of the trochlea. This is performed with a small gouge to loosen the segment and rongeurs to retrieve it. A venous blood sample is taken to screen for infectious diseases.
Regenerative Orthopedics Enabled by Cross-Cutting Technologies
Published in Kohlstadt Ingrid, Cintron Kenneth, Metabolic Therapies in Orthopedics, Second Edition, 2018
There is a need for optional treatments in moderate and severe OA, as there are currently no disease‑modifying treatments for OA. This treatment gap paves the way for cellular therapy. Autologous chondrocyte implantation was the first cellular treatment to regenerate cartilage. One such therapy involved arthroscopic injection of MSCs by the way of a single-stage arthroscopic cartilage repair procedures, which was evaluated in 30 patients. The surgical procedure involved debridement of the lesion, microfracture, and application of concentrated bone marrow aspirate concentric cells with hyaluronic acid and fibrin gel under CO2 insufflation. Clinical outcome showed significant benefit, but the effect of only the cells on the healing process should be evaluated [43]. The efficacy of cellular therapy can be augmented by combining it with minor surgery, multiple injections, arthroscopic injection, and biomimetic composites [31].
Tissue engineering and regeneration
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Fully differentiated specialised cells (somatic cells) obtained from normal tissues have been used for tissue engineering and regenerative therapy with some degree of success. For example, skin has been engineered using cultured epithelial cells grown in vitro and used to treat patients with burn injuries. Chondrocytes have been isolated, expanded in vitro, and implanted into areas of deficient cartilage in a procedure called autologous chondrocyte implantation. Bladder wall has also been engineered using a combination of smooth muscle cells and uroepithelial cells expanded in vitro and grown on a scaffold before reimplantation. Such tissues can be grown using cells obtained from the intended recipient by tissue biopsy (autologous cells) or using cells obtained from deceased unrelated donors (allogeneic cells). The major advantage of the former source is that after implantation they are not rejected by the recipient’s immune system and hence there is no requirement for immunosuppression (see Chapter 82 for a description of immunosuppressive agents and their side effects).
Cost-effectiveness of a new ACI technique for the treatment of articular cartilage defects of the knee compared to regularly used ACI technique and microfracture
Published in Journal of Medical Economics, 2023
Martyn Snow, Vipul Mandalia, Roel Custers, Pieter J. Emans, Elizaveta Kon, Philipp Niemeyer, René Verdonk, Christoph Gaissmaier, André Roeder, Sina Weinand, York Zöllner, Tino Schubert
We adopted utility values which were used in the economic evaluation of autologous chondrocyte implantation (ACI) compared to microfracture by Mistry et al.15. Mistry et al. used utility values for ACI and microfracture from a RCT comparing ACI to microfracture in which HRQoL was derived by using the SF-36 health survey30. Utility values for knee replacements in Mistry et al. were based on two other studies in which HRQoL was elicited using the EQ-5D questionnaire31,32. For successful 1st and 2nd repair, utility values were dependent on the years notional patients remain in “success” (given in Table 2). Time-dependent tunnel state variables were used to count the number of years notional patients stayed in a successful health state. Utility values for Markov health states independent of time are given in Table 3.
Particulated juvenile articular cartilage allograft transplantation for osteochondral lesions of the knee and ankle
Published in Expert Review of Medical Devices, 2020
Colleen M. Wixted, Travis J. Dekker, Samuel B. Adams
Consideration of initial conservative management should be based upon the severity of symptoms, the size and displacement of the lesion, the presence of adjacent joint arthritis, and skeletal maturity[5]. Deep ankle pain, limited range of motion, and swelling can negatively impact activities of daily living or sports participation. Immobilization and weight-bearing limitations can alleviate joint pain and may allow return to full function[6]. When conservative management fails to achieve these goals or when the lesion is not originally thought to be amenable to non-operative management, surgical treatment is indicated. The challenge surgeons face when treating an OLT is not a consequence of limited surgical techniques but a result of the small and finite regenerative capacity of hyaline cartilage. In vitro, surrounding chondrocytes have demonstrated adequate proliferation and migration to the lesion in order to facilitate a successful healing process, but this has not been replicated in vivo due to the constraints that the rigidity of the extracellular matrix places on chondrocyte migration [7–9]. The chondrocytes have restricted access to the vasculature and have a tendency to undergo apoptosis. Current surgical treatment options focus on methods that deliver autologous or allogenic cells to the site of the lesion and include debridement, marrow stimulation techniques, osteochondral autograft transfer, fresh osteochondral allograft transplantation, autologous chondrocyte implantation (ACI), and matrix–induced autologous chondrocyte implantation (MACI).
Proteomic analysis of synovial fluid: current and potential uses to improve clinical outcomes
Published in Expert Review of Proteomics, 2019
Mandy Jayne Peffers, Aibek Smagul, James Ross Anderson
In addition to identifying markers of OA disease, proteomic methodologies have also been applied to SF to investigate novel therapeutics and response to therapies. Davidson et al. have previously identified that sulforaphane, an isothiocyanate which is derived from glucosinolate found in broccoli, is chondroprotective within both in vitro and in vivo OA models [123]. These findings subsequently led to a proof-of-principle trial in which 40 patients undergoing total knee replacement surgery were placed onto a low or high glucosinolate diet for a two week period prior to surgery [35]. Elevations in isothiocyanate levels were identified within the high glucosinolate group which were not present within the low glucosinolate group with SF proteomic analysis identifying discriminant profiles, including 125 differentially expressed proteins. Therefore proteomic methodologies can be applied to assess the effect of novel therapeutic agents as well as the pathways they are involved with. Additionally, SF proteomic analysis has been utilised as a prognostic indicator of procedure outcome. Autologous chondrocyte implantation is a clinical technique applied following traumatic cartilage injuries, consisting of two surgeries to prevent OA onset [36]. However, the procedure currently has a failure rate of 20% with prognostic markers required to predict surgery success and thus allow appropriate management/alternative therapies. Using Isobaric tagging for relative and absolute quantitation (iTRAQ) proteomic analysis and label free quantification of SF, Hulme et al. identified numerous biomarker candidates which can separate responders and non-responders, including complement C1s subcomponent and MMP-3 [64].