Long term outcomes of biomaterial-mediated repair of focal cartilage defects in a large animal model.
Long term outcomes of biomaterial-mediated repair of focal cartilage defects in a large animal model.
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DOI：
10.22203/ecm.v041a04
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发表时间：
2021-01-07
影响因子：
3.1
通讯作者：
Dodge GR
中科院分区：
文献类型：
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作者：
Sennett ML;Friedman JM;Ashley BS;Stoeckl BD;Patel JM;Alini M;Cucchiarini M;Eglin D;Madry H;Mata A;Semino C;Stoddart MJ;Johnstone B;Moutos FT;Estes BT;Guilak F;Mauck RL;Dodge GR
软骨局灶性缺损的修复一直是骨科领域的前沿课题之一。软骨缺陷可能由各种关节病变引起，如果不加以治疗，很可能会发展为骨性关节炎。目前的修复技术，如微骨折，可以带来短期的临床改善，但长期效果不佳。新兴的基于支架的修复策略已经报道了与微骨折相比的更好的结果，并推动了为此而开发的新的生物材料。在这项研究中，我们对一种独特的复合种植体进行了评估，该复合体由基础多孔增强成分(编织聚(ε-己内酯))和2种水凝胶(自组装肽或热凝胶透明质酸)或骨髓抽吸物中的一种渗透而成。目的是评估复合支架治疗的软骨修复与目前的护理标准(微骨折)在翻译相关的大型动物模型尤卡坦小型猪中的比较。虽然许多软骨修复研究在体内取得了一些成功，但大多数都是短期的，与临床无关。在有希望的6周研究结果的启发下，进行了一项为期12个月的研究，并将这些结果呈现在这里。为了帮助在不同平台上进行比较，执行了几项结构和功能相关的结果衡量标准。尽管早期发现是积极的，但长期结果表明，在软骨修复方面，结构和机械效果并不理想，所有治疗组的表现都低于护理标准。这项研究很重要，因为它引起了人们对在开发新的临床软骨修复方法时在适当的动物模型中进行翻译相关的长期研究的重要性的迫切需要的关注。
The repair of focal cartilage defects remains one of the foremost issues in the field of orthopaedics. Chondral defects may arise from a variety of joint pathologies and left untreated, will likely progress to osteoarthritis. Current repair techniques, such as microfracture, result in short-term clinical improvements but have poor long-term outcomes. Emerging scaffold-based repair strategies have reported superior outcomes compared to microfracture and motivate the development of new biomaterials for this purpose. In this study, unique composite implants consisting of a base porous reinforcing component (woven poly(ε-caprolactone)) infiltrated with 1 of 2 hydrogels (self-assembling peptide or thermo-gelling hyaluronan) or bone marrow aspirate were evaluated. The objective was to evaluate cartilage repair with composite scaffold treatment compared to the current standard of care (microfracture) in a translationally relevant large animal model, the Yucatan minipig. While many cartilage-repair studies have shown some success in vivo, most are short term and not clinically relevant. Informed by promising 6-week findings, a 12-month study was carried out and those results are presented here. To aid in comparisons across platforms, several structural and functionally relevant outcome measures were performed. Despite positive early findings, the long-term results indicated less than optimal structural and mechanical results with respect to cartilage repair, with all treatment groups performing worse than the standard of care. This study is important in that it brings much needed attention to the importance of performing translationally relevant long-term studies in an appropriate animal model when developing new clinical cartilage repair approaches.