Osteocondritis dissecans lesions of the knee restored by bone marrow aspirate concentrate. Clinical and imaging results in 18 patients.
Bone marrow-derived cell transplantation (BMDCT)
Cartilage
Knee
Osteochondritis dissecans (OCD)
Journal
European journal of orthopaedic surgery & traumatology : orthopedie traumatologie
ISSN: 1432-1068
Titre abrégé: Eur J Orthop Surg Traumatol
Pays: France
ID NLM: 9518037
Informations de publication
Date de publication:
May 2023
May 2023
Historique:
received:
17
09
2021
accepted:
24
01
2022
medline:
26
4
2023
pubmed:
9
2
2022
entrez:
8
2
2022
Statut:
ppublish
Résumé
Osteochondritis dissecans (OCD) is a common cartilage disorder that specifically affects the knees of skeletally immature and young adult patients. There have been a few treatments that have been proposed: fixation of the fragment, drilling, microfractures. The aim of this study was to analyze retrospectively clinical and imaging results obtained by treating it with one-step bone marrow-derived cells Transplantation (BMDCT) technique. From 2007 to 2014, 18 patients (mean-age 19.1 ± 5.0 years) affected by OCD were treated with one-step BMDC transplantation. In our observational study, clinical evaluation was performed at a scheduled follow-up through IKDC, Tegner, KOOS and EQ-VAS. X-rays and MRI were conducted preoperatively and at 12 months. At final follow-up, MRI MOCART Score was evaluated. IKDC and KOOS clinical scores showed a progressive increase. Tegner Score at final follow-up (5.3 ± 2.7) was significantly lower compared to the pre-injury level (6.5 ± 2.1); however, these results showed a statistically significant improvement that remained over time. EQ-VAS showed a significant improvement in every follow-up measure. MRI Mocart Score showed a complete or almost complete filling of the lesion in 13 patients. "One-step" technique allows articular surface restoration with viable physiologic osteochondral tissue with a high clinical efficacy and imaging results. The number of cases is still limited, and further studies with larger sample sizes and greater follow-up evaluations are required to confirm our results. Nevertheless, we believe that BMDCT may represent a suitable option to treat OCD lesion in young adults.
Sections du résumé
BACKGROUND
BACKGROUND
Osteochondritis dissecans (OCD) is a common cartilage disorder that specifically affects the knees of skeletally immature and young adult patients. There have been a few treatments that have been proposed: fixation of the fragment, drilling, microfractures. The aim of this study was to analyze retrospectively clinical and imaging results obtained by treating it with one-step bone marrow-derived cells Transplantation (BMDCT) technique.
METHODS
METHODS
From 2007 to 2014, 18 patients (mean-age 19.1 ± 5.0 years) affected by OCD were treated with one-step BMDC transplantation. In our observational study, clinical evaluation was performed at a scheduled follow-up through IKDC, Tegner, KOOS and EQ-VAS. X-rays and MRI were conducted preoperatively and at 12 months. At final follow-up, MRI MOCART Score was evaluated.
RESULTS
RESULTS
IKDC and KOOS clinical scores showed a progressive increase. Tegner Score at final follow-up (5.3 ± 2.7) was significantly lower compared to the pre-injury level (6.5 ± 2.1); however, these results showed a statistically significant improvement that remained over time. EQ-VAS showed a significant improvement in every follow-up measure. MRI Mocart Score showed a complete or almost complete filling of the lesion in 13 patients.
CONCLUSIONS
CONCLUSIONS
"One-step" technique allows articular surface restoration with viable physiologic osteochondral tissue with a high clinical efficacy and imaging results. The number of cases is still limited, and further studies with larger sample sizes and greater follow-up evaluations are required to confirm our results. Nevertheless, we believe that BMDCT may represent a suitable option to treat OCD lesion in young adults.
Identifiants
pubmed: 35133501
doi: 10.1007/s00590-022-03214-1
pii: 10.1007/s00590-022-03214-1
pmc: PMC10126062
doi:
Types de publication
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
857-867Commentaires et corrections
Type : ErratumIn
Informations de copyright
© 2022. The Author(s).
Références
König F (1888) Ueber freie Körper in den Gelenken. Dtsch Z Chir 27:90–109
doi: 10.1007/BF02792135
Konig F (2013) The classic: on loose bodies in the joint 1887. Clin Orthop Relat Res 471(4):1107–1115. https://doi.org/10.1007/s11999-013-2824y .
doi: 10.1007/s11999-013-2824y
pubmed: 23404416
pmcid: 3586001
Tarabella V, Filardo G, Di Matteo B, Andriolo L, Tomba P, Viganò A et al (2016) From loose body to osteochondritis dissecans: a historical account of disease d definition. Joints 4(3):165–170. https://doi.org/10.11138/jts/2016.4.3.165 .
doi: 10.11138/jts/2016.4.3.165
Shea KG, Jacobs JC Jr, Carey JL, Anderson AF, Oxford JT (2013) Osteochondritis dissecans knee histology studies have variable findings and theories of aetiology. Clin Orthop Relat Res 471(4):1127–1136
doi: 10.1007/s11999-012-2619-6
pubmed: 23054514
Kocher MS, Tucker R, Ganley TJ, Flynn JM (2006) Management of osteochondritis dissecans of the knee: current concepts review. Am J Sports Med 34(7):1181–1191. https://doi.org/10.1177/0363546506290127
doi: 10.1177/0363546506290127
pubmed: 16794036
Chambers HG, Shea KG, Carey JL (2011) AAOS Clinical practice guideline: diagnosis and treatment of osteochondritis dissecans. J Am Acad Orthop Surg 19:307–309
doi: 10.5435/00124635-201105000-00008
pubmed: 21536630
Linden B (1976) The incidence of osteochondritis dissecans in the condyles of the femur. Acta Orthop Scand 47(6):664–667
doi: 10.3109/17453677608988756
pubmed: 1015263
Cooper T, Boyles A, Samora WP, Klingele KE (2015) Prevalence of Bilateral JOCD of the Knee and Associated Risk Factors. J Pediatr Orthop 35(5):507–10. https://doi.org/10.1097/bpo.0000000000000323 .
Cahill BR (1995) Osteochondritis dissecans of the knee: treatment of juvenile and adult forms. J Am Acad Orthop Surg 3:237–247
doi: 10.5435/00124635-199507000-00006
pubmed: 10795030
DeSmet AA, Ilahi OA, Graf BK (1996) Reassessment of the MR criteria for stability of osteochondritis dissecans in the knee and ankle. Skelet Radiol 25(2):159–163
doi: 10.1007/s002560050054
Glancy GL (1999) Juvenile osteochondritis dissecans. Am J Knee Surg 12:120–124
pubmed: 10323505
Cahill BR, Phillips MR, Navarro R (1989) The results of conservative management of juvenile osteochondritis dissecans using joint scintigraphy: a prospective study. Am J Sports Med 17:601–606
doi: 10.1177/036354658901700502
pubmed: 2610273
Wright RW, McLean M, Matava MJ, Shivelt RA (2004) Osteochondritis dissecans of the knee: long-term results of excision of the fragment. Clin Orthop Relat Res 424:239–243
doi: 10.1097/01.blo.0000128216.10732.d8
Yonetani Y, Tanaka Y, Shiozaki Y, Kanamoto T, Kusano M, Tsujii A, Horibe S (2012) Transarticular drilling for stable juvenile osteochondritis dissecans of the medial femoral condyle. Knee Surg Sports Traumatol Arthrosc 20(8):1528-32. https://doi.org/10.1007/s00167-011-1736-1 .
Kocher MS, Micheli LJ, Yaniv M, Zurakowski D, Ames A, Adrignolo AA (2001) Functional and radiographic outcome of juvenile osteochondritis dissecans of the knee treated with transarticular arthroscopic drilling. Am J Sports Med 29(5):562–566
doi: 10.1177/03635465010290050701
pubmed: 11573913
Camp CL, Krych AJ, Stuart MJ (2013) Arthroscopic preparation and internal fixation of an unstable osteochondritis dissecans lesion of the knee. Arthrosc Technol 2(4):e461–e465
doi: 10.1016/j.eats.2013.07.005
Steadman JR, Briggs KK, Rodrigo JJ, Gill TJ et al (2003) Outcomes of patients treated arthroscopically by microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy 19(5):477–484
doi: 10.1053/jars.2003.50112
pubmed: 12724676
Gudas R, Simonaityte R, Cekanauskas E, Tamosiunas R (2009) A prospective, randomized clinical study of osteochondral autologous transplantation versus microfracture for the treatment of osteochondritis dissecans in the knee joint in children. J Pediatr Orthop 29(7):741–748
doi: 10.1097/BPO.0b013e3181b8f6c7
pubmed: 20104156
Peterson L, Minas T, Brittberg M, Lindahl A (2003) Treatment of osteochondritis dissecans of the knee with autologous chondrocyte transplantation: results at two to ten years. J Bone Joint Surg Am 85-A(Suppl 2):17–24.
doi: 10.2106/00004623-200300002-00003
Filardo G, Kon E, Di Martino A et al (2013) Treatment of knee osteochondritis dissecans with a cell-free biomimetic osteochondral scaffold: clinical and imaging evaluation at 2-year follow-up. Am J Sports Med 41:1786–1793
doi: 10.1177/0363546513490658
pubmed: 23761684
Giannini S, Buda R, Vannini F, Cavallo M, Grigolo B (2009) One-step bone marrow-derived cell transplantation in talar osteochondral lesions. Clin Orthop Relat Res 467(12):3307–3320
doi: 10.1007/s11999-009-0885-8
pubmed: 19449082
pmcid: 2772930
Daniele N, Scerpa MC, Rossi C, Lanti A, Adorno G, Isacchi G, Zinno F (2014) The processing of stem cell concentrates from the bone marrow in ABO-incompatible transplants: how and when. Blood Transfus 12:150–158. https://doi.org/10.2450/2013.0127-13
Song F, Tang J, Geng R, Hu H, Zhu C, Cui W, Fan W (2014) Comparison of the efficacy of bone marrow mononuclear cells and bone mesenchymal stem cells in the treatment of osteoarthritis in a sheep model. Int J Clin Exp Pathol 7(4):1415–1426 (PMID: 24817937)
pubmed: 24817937
pmcid: 4014221
Buda R, Vannini F, Cavallo M, Baldassarri M, Luciani D, Mazzotti A, Pungetti C, Olivieri A, Giannini S (2013) One-step arthroscopic technique for the treatment of osteochondral lesions of the knee with bone-marrow-derived cells: three years results. Musculoskelet Surg 97(2):145–151. https://doi.org/10.1007/s12306-013-0242-7
doi: 10.1007/s12306-013-0242-7
pubmed: 23420394
Salter RB (1994) The physiological basis of continuous passive motion for articular cartilage healing and regeneration. Hand Clin 10:211–219
doi: 10.1016/S0749-0712(21)01284-1
pubmed: 8040199
Detterline AJ, Goldstein JL, Rue JP, Bach BR Jr (2008) Evaluation and treatment of osteochondritis dissecans lesions of the knee. J Knee Surg 21(2):106–115
doi: 10.1055/s-0030-1247804
pubmed: 18500061
Ramirez A, Abril JC, Chaparro M (2010) Juvenile osteochondritis dissecans of the knee: perifocal sclerotic rim as a prognostic factor of healing. J Pediatr Orthop 30(2):180–185
doi: 10.1097/BPO.0b013e3181cfcd2e
pubmed: 20179567
Capone C, Frigerio S, Fumagalli S et al (2007) Neurosphere-derived cells exert a neuroprotective action by changing the ischemic microenvironment. PLoS One 2:e373
Clanton TO, DeLee JC (1982) Osteochondritis dissecans: history, pathophysiology and current treatment concepts. Clin Orthop Relat Res 167:50–64
doi: 10.1097/00003086-198207000-00009
Andriolo L, Crawford DC, Reale D, Zaffagnini S, Candrian C, Cavicchioli A, Filardo G (2018) Osteochondritis dissecans of the knee: etiology and pathogenetic mechanisms. a systematic review. Cartilage. https://doi.org/10.1177/1947603518786557
Tarabella V, Filardo G, Di Matteo B et al (2016) From loose body to osteochondritis dissecans: a historical account of disease definition. Joints 4(3):165–170
doi: 10.11138/jts/2016.4.3.165
pubmed: 27900309
pmcid: 5115241
Brittberg M, Lindahl A, Nilsson A et al (1994) Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med 331:889–895
doi: 10.1056/NEJM199410063311401
pubmed: 8078550
Cole BJ, DeBerardino T, Brewster R et al (2012) Outcomes of autologous chondrocyte implantation in Study of the Treatment of Articular Repair (STAR) patients with osteochondritis dissecans. Am J Sports Med 40(9):2015–2022
doi: 10.1177/0363546512453292
pubmed: 22822178
Moriya T, Wada Y, Watanabe A et al (2007) Evaluation of reparative cartilage after autologous chondrocyte implantation for osteochondritis dissecans: histology, biochemistry, and MR imaging. J Orthop Sci 12(3):265–273
doi: 10.1007/s00776-007-1111-8
pubmed: 17530379
Ferruzzi A, Buda R, Faldini C, Vannini F, Di Caprio F, Luciani D et al (2008) Autologous chondrocyte implantation in the knee joint: open compared with arthroscopic technique. J Bone Joint Surg Am 90(Suppl. 4):90–101
doi: 10.2106/JBJS.H.00633
pubmed: 18984722
Bentley G, Biant LC, Carrington RW, Akmal M, Goldberg A, Williams AM et al (2003) A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. J Bone Joint Surg Br 85:223–230
doi: 10.1302/0301-620X.85B2.13543
pubmed: 12678357
Bentley G, Biant LC, Vijayan S, Macmull S, Skinner JA, Carrington RW (2012) Minimum ten-year results of a prospective randomised study of autologous chondrocyte implantation versus mosaicplasty for symptomatic articular cartilage lesions of the knee. J Bone Joint Surg Br 94:504–509. https://doi.org/10.1302/0301-620X.94B4.27495
doi: 10.1302/0301-620X.94B4.27495
pubmed: 22434467
Niethammer TR, Pietschmann MF, Horng A, Rossbach BP, Ficklscherer A, Jansson V et al (2014) Graft hypertrophy of matrix-based autologous chondrocyte implantation: a two-year follow-up study of NOVOCART 3D implantation in the knee. Knee Surg Sports Traumatol Arthrosc 22:1329–1336
doi: 10.1007/s00167-013-2454-7
pubmed: 23455387
Vannini F, Battaglia M, Buda R, Cavallo M, Giannini S (2012) “One step” treatment of juvenile osteochondritis dissecans in the knee: clinical results and T2 mapping characterization. Orthop Clin North Am 43:237–244
doi: 10.1016/j.ocl.2012.02.003
pubmed: 22480472
Taichman RS (2005) Blood and bone: two tissues whose fates are intertwined to create the hematopoietic stem-cell niche. Blood 105:2631–2639
doi: 10.1182/blood-2004-06-2480
pubmed: 15585658
Lepore AC, Han SS, Tiler-Polsz CJ, Cai J, Rao MS, Fischer I (2004) Transplantation into the adult CNS. Neuron Glia Biol 1:113–126
doi: 10.1017/S1740925X04000213
pubmed: 16520830
pmcid: 1389711
Alparslan L, Winalski CS, Boutin RD et al (2001) Postoperative magnetic resonance imaging of articular cartilage repair. Semin Musculoskelet Radiol 5(4):345–363
doi: 10.1055/s-2001-19044
pubmed: 11745050
Olmsted-Davis EA, Gugala Z, Camargo F, Gannon FH, Jackson K, Kienstra KA, Shine HD, Lindsey RW, Hirschi KK, Goodell MA, Brenner MK, Davis AR (2003) Primitive adult hematopoietic stem cells can function as osteoblast precursors. Proc Natl Acad Sci U S A 100(26):15877–15882
doi: 10.1073/pnas.2632959100
pubmed: 14673088
pmcid: 307661
Caplan AI (2009) Why are MSCs therapeutic? New data: new insight J Pathol 217(2):318–324
pubmed: 19023885