Debridement of cartilage lesions before autologous chondrocyte implantation by open or transarthroscopic techniques: a comparative study using post-mortem materials.
Abstract: We compared the quality of debridement of chondral lesions performed by four arthroscopic (SH, shaver; CU, curette; SHCU, shaver and curette; BP, bipolar electrodes) and one open technique (OPEN, scalpel and curette) which are used prior to autologous chondrocyte implantation (ACI). The ex vivo simulation of all five techniques was carried out on six juvenile equine stifle joints. The OPEN, SH and SHCU techniques were tested on knees harvested from six adult human cadavers. The most vertical walls with the least adjacent damage to cartilage were obtained with the OPEN technique. The CU and SHCU methods gave inferior, but still acceptable results whereas the SH technique alone resulted in a crater-like defect and the BP method undermined the cartilage wall. The subchondral bone was severely violated in all the equine samples which might have been peculiar to this model. The predominant depth of the debridement in the adult human samples was at the level of the calcified cartilage. Some minor penetrations of the subchondral end-plate were induced regardless of the instrumentation used. Our study suggests that not all routine arthroscopic instruments are suitable for the preparation of a defect for ACI. We have shown that the preferred debridement technique is either open or arthroscopically-assisted manual curettage. The use of juvenile equine stifles was not appropriate for the study of the cartilage-subchondral bone interface.
Publication Date: 2010-04-02 PubMed ID: 20357342DOI: 10.1302/0301-620X.92B3.22558Google Scholar: Lookup
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- Comparative Study
- Journal Article
- Research Support
- Non-U.S. Gov't
Summary
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The research compares the effectiveness of four arthroscopic and one open technique used for the debridement of cartilage lesions before autologous chondrocyte implantation (ACI). The open technique was found to produce higher quality results in comparison to the others, particularly in regards to maintaining the integrity of the cartilage and subchondral bone.
Methods and Materials
- The researchers evaluated four arthroscopic techniques (Shaver, Curette, Shaver and Curette, and Bipolar Electrodes) as well as one open technique (Scalpel and Curette).
- The techniques were performed ex vivo on six juvenile equine stifle joints (knee joints of young horses).
- The open technique, as well as the Shaver and the combination of the Shaver and Curette, were also tested on the knees from six adult human cadavers.
Findings
- The open technique was found to produce the most vertical walls with the least adjacent damage to the cartilage, proving to be the most efficient option.
- Among the arthroscopic procedures, the Curette and the combination of the Shaver and Curette gave inferior but acceptable results, while the Shaver method resulted in a “crater-like” defect and the Bipolar Electrodes technique undermined the cartilage wall.
- The subchondral bone was severely violated in all the equine samples, which the researchers noted could be unique to this specific model.
- In the human samples, the primary depth of the debridement was at the calcified cartilage level regardless of the instrumentation used. Some minor penetrations of the subchondral end-plate were observed in all cases.
Conclusions
- The study concluded that not all routine arthroscopic instruments are suitable for the preparation of a defect for ACI and recommends selecting the debridement technique carefully.
- It was suggested that either the open technique or arthroscopically-assisted manual curettage might be the better options for debridement before ACI.
- Finally, the researchers concluded that utilizing juvenile equine stifles was not appropriate for studying the cartilage-subchondral bone interface due to the severity of the violation to the subchondral bone.
Cite This Article
APA
Drobnic M, Radosavljevic D, Cör A, Brittberg M, Strazar K.
(2010).
Debridement of cartilage lesions before autologous chondrocyte implantation by open or transarthroscopic techniques: a comparative study using post-mortem materials.
J Bone Joint Surg Br, 92(4), 602-608.
https://doi.org/10.1302/0301-620X.92B3.22558 Publication
Researcher Affiliations
- Department of Orthopaedic Surgery, University Medical Centre, Zaloska ulica 9, SI-1000 Ljubljana, Slovenia. matej.drobnic@mf.uni-lj.si
MeSH Terms
- Adult
- Animals
- Arthroscopy / methods
- Cartilage, Articular / injuries
- Cartilage, Articular / pathology
- Cartilage, Articular / surgery
- Chondrocytes / transplantation
- Curettage / methods
- Debridement / instrumentation
- Debridement / methods
- Disease Models, Animal
- Horses
- Humans
- Male
- Middle Aged
- Species Specificity
- Stifle / surgery
Citations
This article has been cited 12 times.- Yu L, Cavelier S, Hannon B, Wei M. Recent development in multizonal scaffolds for osteochondral regeneration.. Bioact Mater 2023 Jul;25:122-159.
- Peng L, Zhang B, Luo X, Huang B, Zhou J, Jiang S, Guo W, Tian G, Tian Z, Shen S, Li Y, Sui X, Liu S, Guo Q, Li H. Small Ruminant Models for Articular Cartilage Regeneration by Scaffold-Based Tissue Engineering.. Stem Cells Int 2021;2021:5590479.
- Gao L, Cucchiarini M, Madry H. Cyst formation in the subchondral bone following cartilage repair.. Clin Transl Med 2020 Dec;10(8):e248.
- Acevedo L, Iselin L, Berkelaar MHM, Salzmann GM, Wolf F, Feliciano S, Vogel N, Pagenstert G, Martin I, Pelttari K, Barbero A, Arnold MP. Comparison of Human Articular Cartilage Tissue and Chondrocytes Isolated from Peripheral versus Central Regions of Traumatic Lesions.. Cartilage 2021 Dec;13(2_suppl):68S-81S.
- Bell AD, Hurtig MB, Quenneville E, Rivard GÉ, Hoemann CD. Effect of a Rapidly Degrading Presolidified 10 kDa Chitosan/Blood Implant and Subchondral Marrow Stimulation Surgical Approach on Cartilage Resurfacing in a Sheep Model.. Cartilage 2017 Oct;8(4):417-431.
- Mika J, Clanton TO, Ambrose CG, Kinne RW. Surgical Preparation for Articular Cartilage Regeneration in the Osteoarthritic Knee Joint.. Cartilage 2017 Oct;8(4):365-368.
- York PJ, Wydra FB, Belton ME, Vidal AF. Joint Preservation Techniques in Orthopaedic Surgery.. Sports Health 2017 Nov Dec;9(6):545-554.
- Gao L, Orth P, Müller-Brandt K, Goebel LK, Cucchiarini M, Madry H. Early loss of subchondral bone following microfracture is counteracted by bone marrow aspirate in a translational model of osteochondral repair.. Sci Rep 2017 Mar 27;7:45189.
- Whyte GP, Gobbi A, Sadlik B. Dry Arthroscopic Single-Stage Cartilage Repair of the Knee Using a Hyaluronic Acid-Based Scaffold With Activated Bone Marrow-Derived Mesenchymal Stem Cells.. Arthrosc Tech 2016 Aug;5(4):e913-e918.
- Madry H, Ochi M, Cucchiarini M, Pape D, Seil R. Large animal models in experimental knee sports surgery: focus on clinical translation.. J Exp Orthop 2015 Dec;2(1):9.
- Schwarz ML, Schneider-Wald B, Brade J, Schleich D, Schütte A, Reisig G. Instruments for reproducible setting of defects in cartilage and harvesting of osteochondral plugs for standardisation of preclinical tests for articular cartilage regeneration.. J Orthop Surg Res 2015 Jul 28;10:117.
- Van Wilder P. Advanced Therapy Medicinal Products and Exemptions to the Regulation 1394/2007: How Confident Can We be? An Exploratory Analysis.. Front Pharmacol 2012;3:12.
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