Shock Waves and Injectable Gelatin Matrix for Cartilage Repair

这个为期3年的项目的总体目标是改善对 软骨修复(即“微骨折”)通过使用：1)体外冲击波(ESW)治疗 增强骨髓刺激；和2)可注射的透明质酸-明胶(HA-GTN)基质，以最初包含 纤维蛋白凝块和细胞从受刺激的软骨下骨髓中渗入缺损处。这项建议是基于 关于先前的研究结果，在这些研究结果中，ESWs被发现显著增强了关键过程 微骨折的成功：新生血管和骨髓间充质干细胞的刺激。这样做的主要目的是 本研究旨在探讨体外冲击波在提高微型骨折患者软骨修复效果中的作用。 山羊模型，选择2个剂量的SWS。第二个目标是确定注射到心脏是否有好处 微断裂处理的缺陷是可吸收的GTN基质，无论是否进行ESW处理。第三个目标是 测定两种基底膜蛋白--层粘连蛋白和IV型的分布随时间的变化 胶原蛋白，最近在关节软骨中被描述。第四个目标是关联材料的机械性能 微骨折治疗部位的修复组织，其组织类型包括修复材料，12 治疗后一个月。 共有66只成年山羊将用于研究，分成11组，每组6只。两个圆柱形 股骨远端髌沟的关节软骨会产生全层软骨缺损。 每只动物的左侧窒息(膝关节)关节，所有的缺损处都将接受微骨折。近端和远端 每只动物的左膝关节缺陷都将接受相同的治疗，并接受两种缺陷的结果 用于统计分析的平均值。研究对象包括3个变量：体外冲击波治疗(0、SW1、SW2)； 有无GTN基质；以及生存时间(2周、3个月和12个月)。所有的缺陷 将分配小组进行组织形态计量学评估。另一组动物将被包括在 术后12个月取材进行力学测试。右膝关节都将经历假手术 操作，并作为控件。

The overall goal of this 3-year project is to improve the outcome of a “marrow stimulation” procedure for cartilage repair (viz., “microfracture”) through the use of: 1) extracorporeal shock wave (ESW) treatment to enhance marrow stimulation; and 2) an injectable hyaluronic acid-gelatin (HA-Gtn) matrix to initially contain the fibrin clot and cells infiltrating the defect from the stimulated subchondral bone marrow. This proposal is based on the prior findings in which ESWs have been found to substantially enhance the critical processes underlying the success of microfracture: neovascularization and the stimulation of MSCs. The principal objective of this study is to investigate the effects of ESWs in enhancing the outcome of microfracture for cartilage repair in a goat model, for 2 select doses of SWs. A 2nd objective is to determine if there is a benefit to injecting into the microfracture-treated defects an absorbable Gtn matrix, with and without ESW treatment. A 3rd objective is to determine the change with time in the distribution of two basement membrane proteins, laminin and type IV collagen, recently described in articular cartilage. A 4th objective is to correlate the mechanical properties of reparative tissue in microfracture-treated sites with the types of tissues comprising the reparative material, 12 month after treatment. A total of 66 adult goats will be used in the study, allocated to 11 groups of 6 animals each. Two cylindrical full-thickness chondral defects will be produced in the articular cartilage in the patella groove of distal femur of the left stifle (knee) joint of each animal, and all defects will receive microfracture. The proximal and distal defects of the left knee joint of each animal will receive the same treatment and the results from the 2 defects averaged for the statistical analysis. There will be 3 variables investigated: ESW treatment (0, SW1 and SW2); the presence or absence of a Gtn matrix; and survival time (2 wks, and 3 and 12 months). The defects in all groups will be allocated for histomorphometric evaluation. An additional group of animals will be included to generate samples for mechanical testing 12 months postoperative. The right knee joints will all undergo sham operation and serve as controls.