BioCartilage Improves Cartilage Repair Compared With Microfracture Alone in an Equine Model of Full-Thickness Cartilage Loss.
Abstract: Microfracture (MFx) remains a dominant treatment strategy for symptomatic articular cartilage defects. Biologic scaffold adjuncts, such as particulated allograft articular cartilage (BioCartilage) combined with platelet-rich plasma (PRP), offer promise in improving clinical outcomes as an adjunct to MFx. To evaluate the safety, biocompatibility, and efficacy of BioCartilage and PRP for cartilage repair in a preclinical equine model of full-thickness articular cartilage loss. Controlled laboratory study. Two 10-mm-diameter full-thickness cartilage defects were created in 5 horses in the trochlear ridge of both knees: one proximal (high load) and another distal (low load). Complete blood counts were performed on each peripheral blood and resultant PRP sample. In each horse, one knee received MFx with BioCartilage + PRP, and the other knee received MFx alone. Horses were euthanized at 13 months. Outcomes were assessed with serial arthroscopy, magnetic resonance imaging (MRI), micro-computed tomography (micro-CT), and histology. Statistics were performed using a mixed-effects model with response variable contrasts. No complications occurred. PRP generated in all subjects yielded an increase in platelet fold of 3.8 ± 4.7. Leukocyte concentration decreased in PRP samples by an average fold change of 5 ± 0.1. The overall International Cartilage Repair Society repair score in both the proximal and distal defects was significantly higher (better) in the BioCartilage group compared with MFx (proximal BioCartilage: 7.4 ± 0.51, MFx 4.8 ± 0.1, P = .041; distal BioCartilage: 5.6 ± 0.98, MFx 2.6 ± 1.5, P = .022). BioCartilage-treated proximal defects demonstrated improved histologic scores for repair-host integration (BioCartilage, 96 ± 9; MFx, 68 ± 18; P = .02), base integration (BioCartilage, 100 ± 0; MFx, 70 ± 37; P = .04), and formation of collagen type II (BioCartilage, 82 ± 8; MFx, 58 ± 11; P = .05) compared with the positive control. On MRI, T2 relaxation time was significantly shorter (better) in the superficial region of BioCartilage-treated distal defects compared with MFx (P = .05). There were no significant differences between BioCartilage and MFx on micro-CT analysis. BioCartilage with PRP safely improved cartilage repair compared with MFx alone in an equine model of articular cartilage defects up to 13 months after implantation. The 1-year results of BioCartilage + PRP suggest that homologous allograft tissue provides a safe and effective augmentation of traditional MFx.
© 2016 The Author(s).
Publication Date: 2016-06-13 PubMed ID: 27298478DOI: 10.1177/0363546516648644Google Scholar: Lookup
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- Journal Article
Summary
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This research study looked at the effects of BioCartilage combined with platelet-rich plasma (PRP) versus Microfracture alone in repairing cartilage loss on horses. The results showed that combining BioCartilage with PRP was safer and more effective in improving cartilage repair compared to Microfracture alone.
Study Methodology
- The researchers created two full-thickness cartilage defects in the knee joints of five horses to mimic conditions of high load and low load scenarios.
- One knee of each horse underwent Microfracture treatment supplemented with BioCartilage and PRP, while the other knee received Microfracture alone.
- The horses were monitored for 13 months, during which their outcomes were recorded through arthroscopy, magnetic resonance imaging (MRI), micro-computed tomography (micro-CT), and histology.
- A mixed-effects model was used for statistical analysis of the collected data.
Study Results
- All subjects successfully generated PRP, resulting in a 3.8 ± 4.7 fold increase in platelet count and a decrease of about 5 ± 0.1 average fold change in leukocyte concentration.
- No complications were recorded throughout the experiment.
- The International Cartilage Repair Society repair scores in both high and low load scenarios were notably higher in the BioCartilage group compared to the Microfracture alone group.
- On histological comparison, the defects treated with BioCartilage showed improved integration with the host and formed more type II collagen, which is critical for cartilage repair.
- Upon reviewing the MRI results, the relaxation time, denoting better repair, was shorter in the superficial region of the defects treated with BioCartilage.
- In contrast, the micro-CT analysis showed no significant differences between the BioCartilage-treated group and Microfracture alone group.
Study Conclusions
- Using BioCartilage along with PRP as an adjunct to Microfracture significantly enhanced cartilage repair, compared to using Microfracture alone.
- The combination therapy was also safe, with no reported complications during the 13-month study period.
- The findings suggest that homologous allograft tissue, like BioCartilage, could be a better augmentation for traditional Microfracture technique, specifically in osteochondral tissue engineering.
Cite This Article
APA
Fortier LA, Chapman HS, Pownder SL, Roller BL, Cross JA, Cook JL, Cole BJ.
(2016).
BioCartilage Improves Cartilage Repair Compared With Microfracture Alone in an Equine Model of Full-Thickness Cartilage Loss.
Am J Sports Med, 44(9), 2366-2374.
https://doi.org/10.1177/0363546516648644 Publication
Researcher Affiliations
- Department of Clinical Sciences, Cornell University, Ithaca, New York, USA.
- Department of Clinical Sciences, Cornell University, Ithaca, New York, USA.
- MRI Laboratory, Hospital for Special Surgery, New York, New York, USA.
- Arthrex Inc, Naples, Florida, USA.
- Department of Clinical Sciences, Cornell University, Ithaca, New York, USA.
- Comparative Orthopaedic Laboratory, University of Missouri, Columbia, Missouri, USA.
- Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA cole.research@rushortho.com.
MeSH Terms
- Animals
- Arthroscopy
- Cartilage Diseases / diagnostic imaging
- Cartilage Diseases / surgery
- Cartilage, Articular / diagnostic imaging
- Cartilage, Articular / surgery
- Disease Models, Animal
- Fractures, Stress / diagnostic imaging
- Fractures, Stress / surgery
- Horses
- Magnetic Resonance Imaging
- Platelet-Rich Plasma / metabolism
- X-Ray Microtomography
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