Displaying One Session

Potsdam 1 Free Papers
Session Type
Free Papers
Date
13.04.2022
Time
13:00 - 14:30
Room
Potsdam 1
CME Evaluation
Podium Presentation Osteochondral Grafts

10.1.2 - Increased MFC Width and Osteochondritis Dissecans: Cause or Effect and Implications for Osteochondral Allograft Transplantation

Presentation Topic
Osteochondral Grafts
Date
13.04.2022
Lecture Time
13:00 - 13:09
Room
Potsdam 1
Session Type
Free Papers
Disclosure
T. Mologne, JRF Ortho, consultant/research support, Samumed, consultant M. Provencher, AAOS/AOSSM/ASES/AANA/SOMOS/San Diego Shoulder Institute/ISAKOS: board member; SLACK/Arthroscopy/Knee/Orthopedics: Editorial board; Arthrex, IP Royalties& consultant; A

Abstract

Purpose

Evaluate the relationship between MFC width and osteochondritis dissecans and assess whether increased MFC width is a cause or effect of OCD.

Methods and Materials

MRIs of 112 patients with osteochondritis dissecans of the MFC and age and gender matched control MRIs were reviewed. MFC width and tibial plateau width were recorded. T-test statistic was used to compare OCD patients with controls. Data was also assessed to determine effects of age and gender.

Results

The mean MFC width in OCD patients was 29.2 mm, which was statistically greater than controls ( p<0.001 ). Age did not have any statistical effect on MFC width in OCD patients. Men had wider MFCs as compared to women in all age groups in OCD patients and controls. Tibial plateau width did not differ between OCD patients and controls when matched by gender. Age had no effect on tibial plateau width.

Conclusion

The MFC is wider than normal in patients wtih osteochondritis dissecans of the MFC. Wider MFCs are seen even in young OCD patients, suggesting that it may play a role in the development of OCD. When considering an osteochondral allograft transplant, surgeons must keep in mind that 29 mm wide MFCs are very uncommon and if size matching is desired, other graft options like LFCs should be considered.

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Podium Presentation Biomaterials and Scaffolds

10.1.3 - Presence of Mild-Moderate Knee Osteoarthritis Does Not Affect the Clinical Outcome Using an Aragonite-Based Implant

Presentation Topic
Biomaterials and Scaffolds
Date
13.04.2022
Lecture Time
13:09 - 13:18
Room
Potsdam 1
Session Type
Free Papers
Disclosure
Peter Verdonk, CartiHeal, Consultant

Abstract

Purpose

OA has been considered a contra-indication for cartilage regenerative procedures. The objective of this study is to present the outcome following implantation of an aragonite-based implant (Agili-C™, CartiHeal Ltd, Israel) for the treatment of chondral/osteochondral defects in subjects with or without knee osteoarthritis (OA).

Methods and Materials

251 subjects suffering from knee chondral/osteochondral defects, with different grades of concurrent knee OA (Kellgren Lawrence score 0-3), were treated in a large multicenter, randomized, controlled trial: 167 subjects received the aragonite-based implant, and 84 subjects were treated by debridement/microfracture (control group). Clinical evaluation was performed using the KOOS score at 6, 12, 18 and 24 months. Subjects were stratified according to the grade of joint degeneration: none or minimal OA (K/L 0-1) vs. mild or moderate OA (K/L2-3). Results were then compared to assess whether the OA grade had an impact on the clinical outcome and to identify difference in performance between the implant and control group.

Results

In the implant group, 91 subjects had K/L 0-1, whereas 76 had K/L 2-3. At 6 months, the overall increase in KOOS score from baseline was 27.5 and 27.6 points respectively, well beyond the MCID. At the final 24 month follow-up, the increase was 43.9 points in K/L 0-1 and 41.9 points in K/L 2-3, without significant difference between these subgroups. Conversely, in the control group, the increase at 24 months was significantly lower: 23.2 points in K/L 0-1 subjects and 19 points in K/L 2-3 subjects. The scaffold group showed, therefore, superior outcome (p<0.0001), with a positive clinical trend throughout the entire study period.

Conclusion

The presence of mild-moderate OA did not impact the efficacy of the aragonite-based implant, which was able to provide significant clinical benefit even in patients with mild-moderate OA.

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Podium Presentation Osteochondral Grafts

10.1.5 - Effect of a Hyaluronic Acid and Glucocorticoid Combination in a Cytokine-Treated Explant Culture Using Osteochondral Grafts

Presentation Topic
Osteochondral Grafts
Date
13.04.2022
Lecture Time
13:27 - 13:36
Room
Potsdam 1
Session Type
Free Papers
Disclosure
No Significant Commercial Relationship

Abstract

Purpose

The intra-articular injection of glucocorticoids (GC) is an effective method to shortly reduce pain and inflammation in patients suffering from knee osteoarthritis. Also, hyaluronic acid (HA) is used to restore lubrication within the joint, acting as a chondroprotective agent. The combination of HA and GC showed benefits in clinical studies, but data on the cellular level and tissue are lacking. Therefore, the study aimed to investigate the chondroprotective and anti-inflammatory effect of GC and HA alone and in combination on cytokine-treated osteochondral (OC) plugs.

Methods and Materials

OC plugs (diameter 8 and 10 mm) were harvested from bovine knee joints and treated with pro-inflammatory cytokines (IL-1β, IL-17) for three days before 10% of the test substances (GC, HA, GC/HA) were added to the culture medium. Then, incubation was performed for additional 11 days. Finally, after 14 days, cells within the tissue were analyzed concerning their metabolic activity and expression of anabolic and catabolic genes. One OC plug of each condition was used for histological analysis, while the supernatant was used to determine sulfated glycosaminoglycans (sGAG) and pro-inflammatory cytokines. Also, coefficient of friction (COF) was measured using a cartilage-on-cartilage tribological test system.

Results

The expression of anabolic genes was increased by treating OC plugs with GC or the GC/HA combination. Also, the two substances led to a substantial reduction of catabolic gene expression. The metabolic activity of chondrocytes was on the same level in each condition. Treatment with cytokines resulted in a loss of proteoglycan content of the cartilage tissue, which was improved by adding GC or GC/HA to the culture medium. The addition of HA to the culture medium resulted in a lower COF than using GC or GC/HA.

Conclusion

Supplementing cytokine-treated OC plugs with a combination of GC and HA showed higher anti-inflammatory and chondroprotective properties in an explant culture model than single supplementation.

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Podium Presentation Cartilage /Cell Transplantation

10.1.6 - Autologous Chondrocyte Implantation With Spheroids is Safe and Effective in Adolescent Patients With a Closed Growth Plate

Presentation Topic
Cartilage /Cell Transplantation
Date
13.04.2022
Lecture Time
13:36 - 13:45
Room
Potsdam 1
Session Type
Free Papers
Disclosure
The study was sponsored by CO.DON AG

Abstract

Purpose

The aim of this study was to investigate the safety and clinical effectiveness of ACI in adolescent patients with a closed growth plate.

Methods and Materials

A total of 102 patients (60 adolescents (15 to <18 years) with a closed epiphysial growth plate in the affected joint and 42 young adults (18 to <35 years)) treated with ACI with spheroids for focal cartilage defects (ICRS grade 3 or 4) in the knee, were retrospectively included in a multicentre study.

Primary outcome was the Knee injury and osteoarthritis outcome score (KOOS) and secondary KOOS subscores. Other secondary outcomes were the International Knee Documentation Committee (IKDC) examination form, modified Lysholm, and magnetic resonance observation of cartilage repair tissue (MOCART). Outcomes were analyzed descriptively using 95% confidence intervals for the mean difference. Safety data consisted of treatment failure and adverse events related to the study treatment at 4 years follow-up.

Results

Adolescents had a defect size of 3.85 ± 2.18 cm2 and a follow-up of 48.39 ± 19.45 months. Young adults had a defect size of 4.98 ± 1.27 cm2 and a follow-up of 39.65 ± 15.23 months.

No significant differences between the adolescents and young adults were observed for the overall KOOS, most KOOS subscores (except for KOOS symptoms), IKDC, modified Lysholm and MOCART scores, with all patients achieving absolute good values (Table 1). Treatment failure rates were comparable with 3.3% for the adolescents and 4.8% for the young adults. In addition, the overall safety profile based on adverse events related to the study treatment of adolescent patients was comparable to young adult patients.

table1.png

Conclusion

ACI using spheroids is a safe and effective treatment for large cartilage defects in the knee of adolescent patients with a closed growth plate. Furthermore, clinical and safety outcomes in adolescent patients are comparable to those of young adults.

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Podium Presentation Cartilage /Cell Transplantation

10.1.7 - Clinical Outcomes and Patient Satisfaction After Matrix Autologous Chondrocyte Implantation (MACI) in Patients Over the Age of 40

Presentation Topic
Cartilage /Cell Transplantation
Date
13.04.2022
Lecture Time
13:45 - 13:54
Room
Potsdam 1
Session Type
Free Papers
Disclosure
The authors declare the following financial interests which may be considered as potential competing interests: Vericel Corporation.

Abstract

Purpose

Cartilage restoration in the middle-aged population (40 - 65 years) is understudied. The purpose of this study is to report the clinical outcomes and satisfaction of patients over the age of 40 years who underwent matrix autologous chondrocyte implantation (MACI) for the treatment of focal articular cartilage lesions.

Methods and Materials

The study included 25 patients who were over 40 years of age (mean 49 ± 5.5 years, range 41-60 years). Clinical outcome data was available for all 25 patients at a minimum 2-year follow-up (mean 3.3 ± 0.7 years). Of the 25 patients, 19 completed patient satisfaction questionnaires. The mean defect size was 4.7 ± 1.8 cm2. The mean number of defects transplanted was 2.5 ± 1.0. Graft failure was defined as delamination of the MACI graft with associated clinical symptoms and/or removal of 20-25% of the graft due to persistent symptoms.

Results

Of the 25 patients, 5 (20%) had a graft failure. Two patients went on to osteochondral allograft transplantation, 1 patient experienced symptomatic improvement with debridement, and 2 patients went on to total knee replacement. Twenty-three of the 25 patients (92%) maintained their native knee. Of those who responded to the questionnaires (19/25, 76%), 68% (n = 13) rated their knee as “good” or “excellent,” and 63% (n = 12) were satisfied with their surgery.

Conclusion

MACI is effective in the short term in patients over the age of 40 years to maintain their native knee. Patient satisfaction is moderate.

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Podium Presentation Cartilage /Cell Transplantation

10.1.8 - Autologous Minced Cartilage as a One-Step Procedure for (Osteo)Chondral Lesions of the Knee: 12-Month Radiological & Clinical Results

Presentation Topic
Cartilage /Cell Transplantation
Date
13.04.2022
Lecture Time
13:54 - 14:03
Room
Potsdam 1
Session Type
Free Papers
Disclosure
No Significant Commercial Relationship

Abstract

Purpose

The aim of this study was to investigate early radiological and clinical outcome of autologous minced cartilage treatment as a single-step, low-cost treatment option in patients suffering from an osteochondral or chondral lesion of the knee.

Methods and Materials

This study was approved by the local ethical committee METC 2021-2898. 18 patients with an osteochondral or chondral lesion in the knee were included. Cartilage from healthy appearing loose bodies and/or the periphery of the defect were minced into small chips and sealed in the defect using fibrin glue (Figure 1). Magnetic resonance imaging (MRI) was performed preoperatively and at 3 and 12 months follow-up. The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 score was used to assess the cartilage repair tissue at 12 months. The International Knee Documentation Score (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), EuroQoL-5D (EQ-5D) , and Visual Analogue Scale pain (VAS) were collected preoperatively and 12 months after surgery.minced per operative.png

Results

MRI showed complete defect filling in 11 out of 14 patients who underwent MRI 3 months postoperatively. Mean MOCART 2.0 score at 12 months was 65±18.9 in 18 patients, with higher scores for lateral femoral chondral lesions compared to medial femoral chondral lesions (75.8±14.3, 52.5±15.8 respectively, P=0.02) (Figure 2). Clinical scores significantly improved from preoperative to 12 months postoperative: from 41.6±17.5 to 66.3±20.2 for IKDC (P= 0.005), from 46.7±16.5 to 72.4±15.6 for KOOS (P<0.001), and from 69.3±15.4 to 84.3±12.8 for EQ-5D (P=0.03). A significant decrease in VAS pain from 44 to 14 was measured (P=0.001).

mri minced cartilage.png

Conclusion

Treatment of chondral and osteochondral lesions using the autologous minced cartilage procedure resulted in good cartilage repair measured with MOCART 2.0. Significant improvements were observed in clinical scores. This study suggests autologous minced cartilage as a promising, single-step treatment for (osteo)chondral lesions.

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Podium Presentation Platelet Rich Plasma and Growth factors

10.1.10 - Cytokine Analysis and Clinical Outcome After Intraarticular Hyperacute Serum Injections in Osteoarthritic Knee Joints

Presentation Topic
Platelet Rich Plasma and Growth factors
Date
13.04.2022
Lecture Time
14:03 - 14:12
Room
Potsdam 1
Session Type
Free Papers
Disclosure
E.Fodor, OrthoSera GmbH, employee I. Olmos Calvo, OrthoSera GmbH, employee O. Kuten-Pella, OrthoSera GmbH, employee Z. Lacza, OrthoSera GmbH, CEO

Abstract

Purpose

Platelet-rich plasma (PRP) has shown to induce improvements in pain and mobility of osteoarthritic (OA) joints. However, PRP present high variability during manufacturing, making it not an optimal therapeutic. Hyperacute serum is a standarized and stable blood-derived product obtained from the serum fraction of platelet rich fibrin. Our aim is to test if intraarticular hyperacute serum injections result in an improved outcome for OA patients.

Methods and Materials

24 OA patients underwent 3 autologous intraarticular injections of hyperacute serum in OA knees. Clinical monitoring was followed up to 3 and 6 months and the outcome was validated by VAS, KOOS and Lysholm-Tegner scores. Synovial fluid (n=9) was collected prior hyperacute serum injection and cytokine profile was analyzed in order to understand the dynamic behaviour of the cytokines.

Results

VAS, KOOS and Lysholm-Tegner scores showed an important improvement in pain and mobility of OA knees during the follow-up after hyperacute serum treatment. Patients with knee effusion showed more severe symptoms than patients without effusion; however, after 6 months, both groups equalized and improved notably. Multivariate factor analysis of cytokine levels revealed that instead of having an individual reaction to hyperacute serum, fluctuation was grouped. Two subgroups with a high correlation between the proteins included were identified. Group A consisted on: IL-8, MMP-9, fractalkine, IFNγ, IL-1β, IL-10, IL-1ra, IL-33, resistin and RANKL. Group B included MMP-3, IL-2, IL-5, VEGF-A, aggrecan, CCL-3, COL1a, IL-12p70, IL-2, IL-23, LIF, OSM and TNFα.

Conclusion

OA patiens who received hyperacute serum intraarticularly, reported pain decrease, together with improvement of knee mobility and stability after 6 months of treatment. Cytokine analysis from synovial fluids showed two patterns of cytokine expression. The high correlation within each subgroup suggests that by measuring a few cytokines, the expression of the whole subgroup may be predictable.

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