Minimally Manipulated Bone Marrow Concentrate Compared with Microfracture Treatment of Full-Thickness Chondral Defects A One-Year Study in an Equine Model
Minimally Manipulated Bone Marrow Concentrate Compared with Microfracture Treatment of Full-Thickness Chondral Defects A One-Year Study in an Equine Model
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DOI：
10.2106/jbjs.17.00132
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发表时间：
2018-01-17
影响因子：
5.3
通讯作者：
Jaramillo, Diego
中科院分区：
文献类型：
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作者：
Chu, Constance R.;Fortier, Lisa A.;Jaramillo, Diego
背景：微骨折通常用于软骨修复，但通常会导致纤维软骨。先前在马模型中，与单独微骨折相比，自体骨髓浓缩物（BMC）增强的微骨折在结构上产生更好的上级软骨修复。目前的研究是进行测试的假设，自体BMC没有伴随microfracture提高软骨修复相比microfracture单独。方法：autobiasternal骨髓穿刺液（BMA）使用商业系统进行浓缩。在体外和体内评价来自BMC的细胞的软骨形成潜力。在8匹马的中外侧滑车嵴上创建双侧全层软骨缺损（直径15 mm）。成对的缺损被随机分配到BMC治疗组（不伴有微骨折）或单独微骨折组。通过体外评估、关节镜检查、形态磁共振成像（MRI）、定量T2加权和超短回波时间增强T2 *（UTE-T2 *）MRI成像以及组织学评估，在1年时对修复进行评估。结果：培养扩增但不是新鲜分离的细胞来自BMA和BMC在体外进行软骨分化。在体内，随访1年时，两组的软骨修复均为纤维软骨修复，关节镜检查、T2和UTE-T2 * MRI值以及组织学评估显示BMC和微骨折之间无差异（p> 0.05）。形态MRI显示关节镜未观察到的软骨下骨变化，BMC修复的总体结局改善（p = 0.03）。两组修复组织的UTE-T2 * 纹理特征存在差异（p <0.05）。结论：当BMC直接应用于马模型中临界尺寸的全层软骨缺损时，软骨修复结果与微骨折的结果相似。我们的数据表明，鉴于在最低限度操作的BMC中的间充质干细胞很少，其他机制，如旁分泌，抗炎或免疫调节作用可能是以前研究中BMC应用于微骨折修复的组织再生的原因。虽然我们的结论受到数量较少的限制，但BMC修复的更好MRI结局可能与减少软骨下骨的手术创伤有关。
Background: Microfracture is commonly performed for cartilage repair but usually results in fibrocartilage. Microfracture augmented by autologous bone marrow concentrate (BMC) was previously shown to yield structurally superior cartilage repairs in an equine model compared with microfracture alone. The current study was performed to test the hypothesis that autologous BMC without concomitant microfracture improves cartilage repair compared with microfracture alone.Methods: Autologous sternal bone marrow aspirate (BMA) was concentrated using a commercial system. Cells from BMC were evaluated for chondrogenic potential in vitro and in vivo. Bilateral full-thickness chondral defects (15-mm diameter) were created on the midlateral trochlear ridge in 8 horses. Paired defects were randomly assigned to treatment with BMC without concomitant microfracture, or to microfracture alone. The repairs were evaluated at 1 year by in vitro assessment, arthroscopy, morphological magnetic resonance imaging (MRI), quantitative T2-weighted and ultrashort echo time enhanced T2* (UTE-T2*) MRI mapping, and histological assessment.Results: Culture-expanded but not freshly isolated cells from BMA and BMC underwent cartilage differentiation in vitro. In vivo, cartilage repairs in both groups were fibrous to fibrocartilaginous at 1 year of follow-up, with no differences observed between BMC and microfracture by arthroscopy, T2 and UTE-T2* MRI values, and histological assessment (p > 0.05). Morphological MRI showed subchondral bone changes not observed by arthroscopy and improved overall outcomes for the BMC repairs (p = 0.03). Differences in repair tissue UTE-T2* texture features were observed between the treatment groups (p < 0.05).Conclusions: When BMC was applied directly to critical-sized, full-thickness chondral defects in an equine model, the cartilage repair results were similar to those of microfracture. Our data suggest that, given the few mesenchymal stem cells in minimally manipulated BMC, other mechanisms such as paracrine, anti-inflammatory, or immunomodulatory effects may have been responsible for tissue regeneration in a previous study in which BMC was applied to microfractured repairs. While our conclusions are limited by small numbers, the better MRI outcomes for the BMC repairs may have been related to reduced surgical trauma to the subchondral bone.