Repair of large full-thickness articular cartilage defects with allograft articular chondrocytes embedded in a collagen gel
Repair of large full-thickness articular cartilage defects with allograft articular chondrocytes embedded in a collagen gel
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DOI：
10.1089/ten.1998.4.429
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发表时间：
1998-12-01
影响因子：
--
通讯作者：
Caplan, AI
中科院分区：
文献类型：
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作者：
Wakitani, S;Goto, T;Caplan, AI
全层关节软骨缺损是一个主要的临床问题，然而，目前还没有可用的治疗方法来再生修复这些病变。目前的治疗方法是在缺损的底部钻孔，暴露软骨下骨及其细胞和生长因子。这通常导致纤维软骨修复组织在负荷关节环境中功能较差。使用包埋在胶原凝胶递送载体中的表型适当的软骨细胞可以提供一种方法，该方法可以用于修复具有功能上令人满意的透明软骨的全层关节软骨缺损。将包埋在I型胶原凝胶中的同种异体关节软骨细胞移植到髁状突和髌骨承重表面的大的（6 x 3 x 3 mm）全层关节软骨缺损中，以开发临床适用的方法来修复关节软骨缺损。从4周龄新西兰兔的关节软骨中分离软骨细胞，并包埋在I型胶原凝胶中。将该复合材料移植到青春期宿主兔股骨内侧髁和髌骨沟的全层缺损中。软骨细胞移植后4-48周，通过半定量评分系统对修复软骨进行组织学评估，并通过显微压痕技术对标本进行生物力学评估。在这两个位置的缺陷修复与组织学上明显的透明软骨观察，从早在移植后4周，直到48周。股骨内侧髁的修复软骨比髌骨沟更不规则，但在所有其他方面相似。移植组织没有重塑和分化成正常关节软骨中所见的形态区。移植后48周仍无潮标或软骨下骨板形成。在生物力学方面，移植后12周，修复的软骨表现出与正常关节软骨相似的压痕值，并在移植后48周保持相同。相比之下，对照（即，空的）缺损用表现出非常差的异染性染色和表现出非常高的压痕值的组织愈合。观察到修复组织与正常软骨的不完全结合，并且表面明显不规则，具有重大不连续性。这些观察结果为考虑使用同种异体关节软骨细胞修复膝关节负重区的关节软骨缺损提供了基础。
Full-thickness articular cartilage defects are a major clinical problem; however, presently there is no treatment available to regeneratively repair these lesions. The current therapeutic approach is to drill the base of the defect to expose the subchondral bone with its cells and growth factors. This usually results in a repair tissue of fibrocartilage that functions poorly in the loaded joint environment. The use of phenotypically appropriate chondrocytes embedded in a collagen gel delivery vehicle may provide a method that could be used to repair full-thickness articular cartilage defects with functionally satisfactory hyaline cartilage. Allograft articular chondrocytes embedded in a type I collagen gel were transplanted into large (6 x 3 x 3 mm), full-thickness articular cartilage defects in condylar and patellar weightbearing surfaces to develop clinically applicable methods to repair articular cartilage defects. Chondrocytes were isolated from the articular cartilage of 4-week-old New Zealand rabbits and embedded in type I collagen gels. This composite was transplanted into a full-thickness defect on the medial femoral condyle and patellar groove of adolescent host rabbits. The repair cartilage was assessed histologically by a semiquantitative scoring system and biomechanically with a microindentation technique of specimens 4-48 weeks after chondrocyte transplantation. Defects in both locations were repaired with histologically apparent hyaline cartilage observed from as early as 4 weeks until 48 weeks after transplantation. The repair cartilage in the medial femoral condyle was more irregular than in the patellar groove, but in all other respects was similar. The grafted tissue did not remodel and differentiate into the morphological zones seen in normal articular cartilage. No tidemark or subchondral bony plate formed even 48 weeks after transplantation. Biomechanically, the repaired cartilage demonstrated indentation values similar to normal articular cartilage 12 weeks after transplantation and remained the same 48 weeks after transplantation. By contrast, the control (i.e., empty) defects healed with tissue that exhibited very poor metachromatic staining and exhibited very high indentation values. Incomplete bonding of the repair tissue to the normal cartilage was seen, and the surface was significantly irregular with major discontinuities. These observations provide the basis for considering the use of allograft articular chondrocytes to repair articular cartilage defects in the weight-bearing regions of the knee.