T. Tischer (Erlangen, DE)
Malteser Waldkrankenhaus Department of Orthopaedic and Trauma SurgeryPresenter Of 3 Presentations
10.1.6 - Autologous Chondrocyte Implantation With Spheroids is Safe and Effective in Adolescent Patients With a Closed Growth Plate
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.
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.
13.3.3 - PRP & Biomaterials
Abstract
Introduction
Platelet-rich plasma (PRP) is commonly used in orthopaedic sports medicine. One main application is in the field of treatment of osteoarthritis (OA) and to imnprove outcome after cartilage regeneration procedures (Fice 2019). Positive disease modifying effects of PRP in the treatment of osteoarthritis have been described in animal models (Boffa 2021) and basic science rational for cartilage regeneration have been shown (Fice 2019). However, neither PRP preparation or clinical application (preparation, concentration, timing, number of PRP applications, ...) are standardized, making both basic science as well as clinical research challenging, not to mention the clinical application (Kieb 2017). Therefore, guidelines from scientific societies and consensus projects like the ESSKA orthobiologics initiative try to fill the gap between basic science research and clinical use in order to better standardize PRP application.
Content
A characterized, lyophilized platelet growth factor preparation (PRP powder) can overcome limitations regarding standardized growth factor content (Kieb 2017). Positive dose-dependent effects of PRP have been described on chondrocytes in a standardized cell culture model (Hahn 2020). Current problems with PRP such as absent standardization, lack of consistency among studies, and black box dosage could be solved by using a characterized PRP powder made by pooling and lyophilizing multiple platelet concentrates, which gives a hugh amount of exactely the same PRP preparations. Research is ongoing if lyophilized PRP can be used as a coating of implants to biofunctionalize them.
Also PRP is used with many other biomaterials in order to improve tissue regeneration, especially in the field of cartilage research (Chang 2018). This talk will introduce briefly the advantages of combining biomaterials with PRP, with a special focus on the new trend of using minced cartilage (Salzmann 2021).
References
The Role of Platelet-Rich Plasma in Cartilage Pathology: An Updated Systematic Review of the Basic Science Evidence.
Fice MP, Miller JC, Christian R, Hannon CP, Smyth N, Murawski CD, Cole BJ, Kennedy JG.
Arthroscopy. 2019 Mar;35(3):961-976.e3. doi: 10.1016/j.arthro.2018.10.125.
Platelet-rich plasma injections induce disease-modifying effects in the treatment of osteoarthritis in animal models.
Boffa A, Salerno M, Merli G, De Girolamo L, Laver L, Magalon J, Sánchez M, Tischer T, Filardo G.
Knee Surg Sports Traumatol Arthrosc. 2021 Dec;29(12):4100-4121. doi: 10.1007/s00167-021-06659-9.
Platelet-Rich Plasma Powder: A New Preparation Method for the Standardization of Growth Factor Concentrations.
Kieb M, Sander F, Prinz C, Adam S, Mau-Möller A, Bader R, Peters K, Tischer T.
Am J Sports Med. 2017 Mar;45(4):954-960. doi: 10.1177/0363546516674475.
Dose-Dependent Effects of Platelet-Rich Plasma Powder on Chondrocytes In Vitro.
Hahn O, Kieb M, Jonitz-Heincke A, Bader R, Peters K, Tischer T.
Am J Sports Med. 2020 Jun;48(7):1727-1734. doi: 10.1177/0363546520911035.
Therapeutic Effects of the Addition of Platelet-Rich Plasma to Bioimplants and Early Rehabilitation Exercise on Articular Cartilage Repair. Nai-Jen Chang, Yanjmaa Erdenekhuyag, Pei-Hsi Chou, Chih-Jou Chu, Chih-Chan Lin, Ming-You Shie. Am J Sports Med. 2018 Jul;46(9):2232-2241. doi: 10.1177/0363546518780955. Epub 2018 Jun 21. DOI: 10.1177/0363546518780955
Autologous Minced Cartilage Implantation for Treatment of Chondral and Osteochondral Lesions in the Knee Joint: An Overview.
Salzmann GM, Ossendorff R, Gilat R, Cole BJ.
Cartilage. 2021 Dec;13(1_suppl):1124S-1136S. doi: 10.1177/1947603520942952. Epub 2020 Jul 25.
15.3.4 - OA & Sports
Abstract
Introduction
Sport shows many positive effects on the general health. However, the effects of sports participation on joints and especially on osteoarthritic joints are still under debate. Intense sports participation leads to a marked increase in joint loading. During jogging a force of 3-5x times body weight is absorbed in the hip with every step. In a 70kg runner with a speed of 7km/h and a body height of around 170cm about 1250 steps are made per km, resulting in an absorption between 1300-2100 tons in each hip in a 10km run (Bergmann 1993). Nonetheless, low impact sports does not seem to have adverse effects on healthy joints and even high level runners do most likely not show increased osteoarthritis (OA) rates (Timmins 2016) in contrast for example to professional soccer players (Freiberg 2021). The development of OA is multifactorial and depended on many factors (e.g. age, body weight, joint injury, joint loading, quadriceps weakness, genetics, …) and many studies showed a higher incidence of OA in knees of former high-impact sports players compared to the normal population (e.g. Kujala 1995).
Content
Sport in osteoarthritic joints can reduce pain, restore joint motion and strengthen surrounding muscles and is an important part of conservative therapy (Fransen 2015). A recent systematic review has shown, that active exercise and sport are effective to improve pain and physical function in elderly people with osteoarthritis (Zampogna 2020). Additional weight loss and positive effects on body metabolism (diabetes, hypertension, fat) are reported in newer studies. Weight loss is an important modifiable risk factor for progression of osteoarthritis in the knee. Thereby, it is hoped that low impact sport can slow down progression of osteoarthritis. Numerous studies show the detrimental effect of meniscal, cartilage and ligamentous instability as well as malalignment on the development of (post-traumatic) osteoarthritis. To improve the outcome, joint integrity should be restored as good as possible before participating in sports. Whether osteoarthritis and sports are possible, depends on many factors. It is important to know, that osteoarthritis and well selected sports can delay the progression of osteoarthritis. An individualized approach to sports participation for each patient is necessary, no performance goals and good technique and equipment are important.
References
Hip joint loading during walking and running, measured in two patients. Bergmann G, Graichen F, Rohlmann A. J Biomech. 1993 Aug;26(8):969-90. doi: 10.1016/0021-9290(93)90058-m.
Running and Knee Osteoarthritis: A Systematic Review and Meta-analysis. Timmins KA, Leech RD, Batt ME, Edwards KL. Am J Sports Med. 2017 May;45(6):1447-1457. doi: 10.1177/0363546516657531. Epub 2016 Aug 20.
The Risk of Knee Osteoarthritis in Professional Soccer Players-a Systematic Review With Meta-Analyses. Freiberg A, Bolm-Audorff U, Seidler A.Dtsch Arztebl Int. 2021 Jan 29;118(4):49-55. doi: 10.3238/arztebl.m2021.0007.
Knee osteoarthritis in former runners, soccer players, weight lifters, and shooters. Kujala UM, Kettunen J, Paananen H, Aalto T, Battié MC, Impivaara O, Videman T, Sarna S. Arthritis Rheum. 1995 Apr;38(4):539-46. doi: 10.1002/art.1780380413.
Exercise for osteoarthritis of the knee: a Cochrane systematic review. Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL. Br J Sports Med. 2015 Dec;49(24):1554-7. doi: 10.1136/bjsports-2015-095424. Epub 2015 Sep 24.
The Role of Physical Activity as Conservative Treatment for Hip and Knee Osteoarthritis in Older People: A Systematic Review and Meta-Analysis. Zampogna B, Papalia R, Papalia GF, Campi S, Vasta S, Vorini F, Fossati C, Torre G, Denaro V. J Clin Med. 2020 Apr 18;9(4):1167. doi: 10.3390/jcm9041167.