Osteochondral Grafting for Treatment of a Massive Chondral Defect in the Knee of a Young Adult With Anterior Cruciate Ligament Deficit

We report the case of a 28-year-old woman who underwent osteochondral grafting and anterior cruciate ligament (ACL) reconstruction for treatment of a massive cartilage defect in a knee joint with ACL deficit. Arthroscopy showed a full-thickness degenerative cartilage defect measuring 22 × 35 mm in the weight-bearing area of the medial femoral condyle, a totally resected lateral meniscus, and a loosened ACL. Therefore we performed osteochondral autograft transplantation and ACL reconstruction. Osteochondral plugs were harvested from a donor site in the patellofemoral joint of the contralateral knee and grafted into the recipient site in a “skipping” manner. Arthroscopic examination 1 year after surgery showed good preservation of the grafts and satisfactory bridging of the gaps between the plugs with fibrocartilage-like tissue. A recent follow-up examination, performed 36 months after surgery, has shown an excellent result, with a Lysholm score of 100, an International Knee Documentation Committee score of 95.4, and full range of knee motion with no symptoms. Plain radiographs at that time showed preservation of the medial joint space on the weighted anteroposterior view. No osteoarthritic changes were evident in the patellofemoral joint.     

孔数不同的软骨下骨钻孔术对兔软骨缺损修复的影响

目的：为了观察软骨缺损的修复过程，比较不同数目钻孔术对软骨缺损的修复效果。方法：用中国白兔２４只，在股骨关节面造成６ｍｍ×８ｍｍ全层软骨缺损，分别施行１０孔及５孔钻孔术，术后４、８周取材，做组织学及电镜观察，并进行评估。结果：（１）１０孔、５孔和对照组的优势修复组织分别以类透明软骨，类透明软骨加纤维软骨和纤维组织为主。（２）修复组织厚度１０孔及５孔无显著差异。（３）修复组织覆盖缺损的面积，１０孔＞５孔＞对照组。初步结论：软骨下骨钻孔可修复关节软骨全层缺损；多孔比少孔修复好；非钻孔的缺损修复效果较差。     

Cartilage Tissue Engineering With Demineralized Bone Matrix Gelatin and Fibrin Glue Hybrid Scaffold: An In Vitro Study

To develop a cartilage‐like tissue with hybrid scaffolds of demineralized bone matrix gelatin (BMG) and fibrin, rabbit chondrocytes were cultured on hybrid fibrin/BMG scaffolds in vitro. BMG scaffolds were carefully soaked in a chondrocyte–fibrin suspension, which was polymerized by submerging the constructs into thrombin–calcium chloride solution. Engineered cartilage‐like tissue grown on the scaffolds was characterized by histology, immunolocalization, scanning electron microscopy, biochemical assays, and analysis of gene expression at different time points of the in vitro culture. The presence of proteoglycan in the fibrin/BMG hybrid constructs was confirmed by positive toluidine blue and alcian blue staining. Collagen type II exhibited intense immunopositivity at the pericellular matrices. Chondrogenic properties were further demonstrated by the expression of gene‐encoded cartilage‐specific markers, collagen type II, and aggrecan core protein. The glycosaminoglycan production and hydroxyproline content of tissue grown on the fibrin/BMG hybrid scaffolds were higher than that of the BMG group. In conclusion, the fibrin/BMG hybrid scaffolds may serve as a potential cell delivery vehicle and a structural basis for cartilage tissue engineering.     

骨骺软骨中的管状结构--软骨管

目的软骨管是发育时期骨骺软骨内的管状化疏松间质组织,对于软骨的生长发育有着重要意义。关于其形成、结构及功能等方面,目前尚有分歧,本文就此作一综述。     

Novel Strategy to Engineer Trachea Cartilage Graft With Marrow Mesenchymal Stem Cell Macroaggregate and Hydrolyzable Scaffold

Limited donor sites of cartilage and dedifferentiation of chondrocytes during expansion, low tissue reconstruction efficiency, and uncontrollable immune reactions to foreign materials are the main obstacles to overcome before cartilage tissue engineering can be widely used in the clinic. In the current study, we developed a novel strategy to fabricate tissue‐engineered trachea cartilage grafts using marrow mesenchymal stem cell (MSC) macroaggregates and hydrolyzable scaffold of polylactic acid–polyglycolic acid copolymer (PLGA). Rabbit MSCs were continuously cultured to prepare macroaggregates in sheet form. The macroaggregates were studied for their potential for chondrogenesis. The macroaggregates were wrapped against the PLGA scaffold to make a tubular composite. The composites were incubated in spinner flasks for 4 weeks to fabricate trachea cartilage grafts. Histological observation and polymerase chain reaction array showed that MSC macroaggregates could obtain the optimal chondrogenic capacity under the induction of transforming growth factor‐β. Engineered trachea cartilage consisted of evenly spaced lacunae embedded in a matrix rich in proteoglycans. PLGA scaffold degraded totally during in vitro incubation and the engineered cartilage graft was composed of autologous tissue. Based on this novel, MSC macroaggregate and hydrolyzable scaffold composite strategy, ready‐to‐implant autologous trachea cartilage grafts could be successfully fabricated. The strategy also had the advantages of high efficiency in cell seeding and tissue regeneration, and could possibly be used in future in vivo experiments.     

The use of a non-ionic surfactant (P188) to save chondrocytes from necrosis following impact loading of chondral explants.

While current injury criteria for the automotive industry are based on bone fracture, the majority of knee injuries suffered in collisions each year do not involve fracture of bone. Instead, clinical studies of traumatic joint injury often document early pain and development of chronic diseases, such as osteoarthritis. Previous studies suggest chronic disease can be initiated by cell death that occurs in articular cartilage during mechanical trauma to the joint. In the current investigation early necrosis of chondrocytes was investigated after blunt trauma to chondral explants. A non-ionic surfactant (P188) was explored as a potential tool for early intervention into the disease process, as this surfactant has been shown to repair damaged membranes in other cell lines. Three groups of adult bovine chondral explants were equilibrated for 48 h in culture media. Two groups were then loaded to 25 MPa in unconfined compression. Half the specimens in each group were incubated in media supplemented with 8 mg/ml P188 immediately after loading, while the other half was returned to standard media. At 1 and 24 h the percentages of live and dead cells in compressed and control groups were determined with a cell viability stain. At 1 h post-trauma, P188 incubated specimens had a significantly increased percentage of live cells in the superficial zone versus the no-P188 group. At 24 h the percentages of live cells in all three zones of the P188-treated explants were significantly greater than in the no treatment group. This study showed that P188 surfactant could help restore the integrity of cell membranes in cartilage damaged by blunt mechanical trauma. With the ability of P188 to "save" chondrocytes from early necrotic death using in vitro chondral explants, its role in prevention of a post-traumatic osteoarthritis in a diarthrodial joint should be further explored using in vivo animal models.     

Resorption of calcified and decalcified costal cartilage

Summary Cartilage is used in plastic and reconstructive surgery. Ageing of cartilage, followed by calcification, makes cartilage implants susceptible to resorption. However, it has been suggested that decalcified cartilage resists resorption. In the present work resorption of calcified and decalcified cartilage implants in isogenic and allogenic rats was studied in detail. Calcified implants were strongly resorbed and slightly ossified after 3 months. However, decalcified costal cartilage implants were not resorbed and ossified until the third month, i.e. at the end of the observation period, in iso- and allogenic transplants. Furthermore, there was no lymphocytic accumulation observed around decalcified implants as there was around untreated allogenic implants. It is suggested that screening of cartilage implant material for calcium salts with subsequent decalcification when necessary may decrease the number of resorbed and ossified implants. Further, it may protect against immunological response to allograft implantation.     

Periosteal chondroma of the rib--report of a case and literature review

Periosteal chondroma is a rare benign tumor of hyaline cartilage. It develops adjacent to the cortex of the bone and is rimmed by an intact periosteal membrane. Periosteal chondromas are most common in the metaphyses of long bones followed by the small tubular bones of the hands and feet. Periosteal chondroma arising in the rib is an extremely rare event. We could only find 10 reported cases in the English literature. We present a case of periosteal chondroma in the rib discovered incidentally on chest x-ray of an 11-year-old girl.     

骨关节炎软骨下骨研究进展

骨关节炎是最常见的关节疾病,其病理以关节软骨退变、软骨下骨硬化与骨赘形成为特点。目前骨关节炎的始发病理尚不明确,既往许多研究聚焦于关节软骨并认为软骨下骨的改变继发于关节软骨的退变;然而近年研究报道关节软骨下骨低骨密度,尤其是膝骨关节炎的软骨下骨,软骨下骨呈高转换,以及骨吸收抑制剂治疗骨关节炎有效,都提示软骨下骨在骨关节炎的病理机制中具有重要地位。本文就骨关节炎软骨下骨的研究进展做一综述。     

Induction of cartilage growth in a rabbit ear model: a pilot study

Identifying the control of cartilage regeneration is important both clinically and in tissue engineering research. A rabbit ear model was used to simulate surgery and trauma to explore the effect of perichondrial stripping on underlying cartilage in vivo. Ten rabbits (20 ears) formed four groups: two controls and two experimental groups. Group 1 served as the unoperated control group and underwent no treatment. Group 2 served as the operated control group and underwent elevation of auricular skin flaps without stripping the perichondrium. Groups 3 and 4 underwent increasing degrees of surgical insult. Group 3 underwent elevation of a skin flap with stripping of the perichondrium on both sides of the cartilage. Group 4 underwent both perichondrial stripping and the insertion of a thin silicone sheet as a barrier between the denuded cartilage and the skin flaps. At 3 months, punch biopsies of the cartilage were performed in each zone of insult, creating multiple thin sections. The results were analyzed using a computerized morphometry system. Histopathological examination of the groups revealed a regenerative layer of neocartilage which showed distinct hypercellular features of regeneration. The thickness of the new layer was proportional to the degree of the insult (p<0.01). A controlled insult to the perichondrium created a regenerative layer of cartilage; it seems that this layer of neocartilage is proportional to the insult. Further studies are in progress to clarify these findings.     

Bone morphogenetic protein 9 is a potent anabolic factor for juvenile bovine cartilage, but not adult cartilage.

Members of the bone morphogenetic protein (BMP) group of the TGF-beta superfamily have been shown to enhance matrix synthesis and maintain cartilage phenotype in long-term culture. These proteins have also been shown to augment cartilage repair in vivo, and may be of potential therapeutic benefit in the treatment of damaged articular cartilage. The present study was undertaken to examine the effects of BMP-9 on the metabolism of juvenile and adult bovine cartilage in vitro, and to compare the effects to those produced by two previously characterized BMPs: BMP-2 and 13 (CDMP-2). BMP-9 lead to a 7-8-fold stimulation of proteoglycan synthesis at the highest concentration tested, and a 6.4-fold stimulation of collagen synthesis at a concentration of 50 ng/mL in juvenile cartilage. BMP-2 also lead to a 7-8-fold increase in proteoglycan synthesis at the highest concentration tested, and was able to induce collagen synthesis 6.4-fold, but at a concentration of 1000 ng/mL. Proteoglycans isolated from BMP-9 treated cartilage exhibited an increased hydrodynamic size possibly due to increased glycosaminoglycan substitution or decreased C-terminal proteolysis. Consistent with the idea of limited C-terminal proteolysis, BMP-9 treatment lead to a significant reduction in the turnover rate of proteoglycans in juvenile explants. Interestingly, all three BMPs were unable to induce a measurable anabolic response in adult cartilage explants.     

Shaping of nasal septal cartilage with the carbon dioxide laser—a preliminary report of an experimental study

Pieces of cartilage 0.5–1 mm thick taken from patients undergoing nasal septal surgery and from the nasal septum and auricle of the rabbit were irradiated using a carbon dioxide laser at 10.6 μm wavelength and a spot size of 1–2 mm. The laser was used both in the pulsed and the continuous wave (cw) mode. In the pulsed mode the pulse length varied from 0.05 to 0.5 s with an average power output of between 1 and 5 W. In cw mode the power varied between 1 and 6 W. It was possible to use the laser energy to mould the cartilage into different shapes which were then maintained after irradiation. These observations have not previously been reported. The clinical significance of this experiment for plastic surgery in the head and neck is discussed.     

骨保护素对兔骨关节炎关节软骨的保护效应

目的 观察关节腔内注射骨保护素对兔骨关节炎关节软骨组织形态的保护作用.方法 将60只雄性新西兰大白兔随机分为三组,每组20只.骨保护素组行左侧膝关节前十字韧带离断术,术后4周于左膝关节腔内注射骨保护素溶液0.1 ml,每周注射5次,共注射8周;磷酸盐缓冲液组于前十字韧带离断术后4周注射等剂量磷酸盐缓冲液;假手术组显露前十字韧带后缝合切口.术后12周处死动物取左膝关节标本,行大体形态学Pelletier评分,切片番红染色后行Mankin软骨评分并测量软骨厚度.结果 大体观察骨保护素组股骨髁软骨评分(1.80±0.89)分,胫骨平台软骨评分(1.80±0.77)分,均低于磷酸盐缓冲液组[分别为(3.10±0.97)、(3.20±0.77)分],与假手术组比较差异无统计学意义.组织学观察骨保护素组的软骨结构(2.65±0.88)分、软骨细胞(1.35±0.71)分、番红染色(1.83±0.83)分、潮线完整性(0.30±0.47)分及Mankin软骨评分总分(6.13±1.97)分,均低于磷酸盐缓冲液组[分别为(4.52±1.09)、(1.85±0.63)、(2.80±0.75)、(0.65±0.49)、(9.83±1.98)分].骨保护素组Mankin评分总分高于假手术组,但四个分项评分与假手术组的差异无统计学意义.骨保护素组软骨厚度(371.84±38.94)μm,大于磷酸盐缓冲液组(255.09±74.82)μm,小于假手术组(404.68±15.97)μm,差异均有统计学意义.结论 骨保护素对关节软骨具有保护效应,可延缓骨关节炎进展.保护效应表现为减轻滑膜炎症反应、减少关节边缘骨赘形成及在一定程度上阻止软骨厚度丢失.     

不同时期胎儿长骨骨骺软骨管形态学研究

目的：研究骨骺软骨管的形态结构。方法：胎儿和新生儿胫骨近端骨骺标本,用组化染色方法及电镜观察。结果：胎儿８周时无软骨管,１４周软骨管数目少,２２周增多,２９周最多,分支复杂,新生儿软骨管数目减少。软骨管除由动脉、静脉和毛细血管,还包含淋巴管。结论：胎儿胫骨近端骨骺软骨中存在淋巴管,淋巴管是办骨管的重要组成成分。     

跖趾关节软骨移植修复掌指关节面缺损

目的　利用自体跖趾关节软骨移植修复掌指关节缺损的软骨面,为掌指关节创伤性关节炎提供简便、可靠的方法。方法　1990 年以来,应用改良处理后的自体跖趾关节面软骨移植修复9 例11 侧掌指关节面,通过内固定、侧副韧带修复并提供适宜的生物力学和营养环境。结果　经6 个月7 年随访,关节活动度平均增加35-1°,供趾骨融合良好,成形术后关节活动度减少甚至强直,但无疼痛,对行走无明显影响。结论　软骨面匹配良好,可靠的内固定、重建韧带、供区薄的软骨面和少的骨量及适宜的生物力学环境是手术成功的关键     

胶原-透明质酸支架的制备及其与软骨细胞复合培养的实验研究

目的制备胶原-透明质酸支架,评价其与兔髁状突软骨细胞的生物相容性,探讨其应用于关节软骨组织工程的可行性。方法冷冻干燥法制备胶原-透明质酸复合多孔海绵支架材料,将其与碳化二亚胺[1-ethyl-3-（3-dimethyl aminopropyl）carbodiimide,EDC]进行化学交联。分别采用体积法和体外酶解实验测定支架材料孔隙率和降解率,扫描电镜观察交联前后支架材料的形态变化。取3周龄新西兰兔髁状突软骨细胞,体外培养5d后,甲苯胺蓝染色,倒置相差显微镜下观察行细胞鉴定。取消化后第2代软骨细胞接种至支架材料复合培养,倒置相差显微镜下观察细胞生长情况。复合培养1、3、5、7和10d后,PBS液清洗3次,置入24孔板并以0.25%胰酶和0.1%EDTA消化细胞,采集细胞进行细胞计数并绘制细胞生长曲线。另取部分样本继续培养5d,行组织学和扫描电镜观察。结果胶原-透明质酸支架材料经化学交联后,具有合适的三维多孔结构,孔隙率为83.7%,孔径100-120μm;交联后抗酶解能力显著增加。髁状突软骨细胞在其表面和内部贴附良好,形成细胞-材料复合体,细胞增殖实验显示,复合培养1d,材料中细胞数为3.7×104/支架,10d后增至8.2×104/支架。电镜观察见细胞周围有基质分泌。结论EDC交联后的胶原-透明质酸支架具有良好空间结构和生物相容性,可作为支架材料用于髁状突软骨组织工程的研究。