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The Journal of bone and joint surgery. American volume2014; 96(19); 1601-1609; doi: 10.2106/JBJS.M.01408

Effects of the combination of microfracture and self-assembling Peptide filling on the repair of a clinically relevant trochlear defect in an equine model.

Abstract: The goal of this study was to test the ability of an injectable self-assembling peptide (KLD) hydrogel, with or without microfracture, to augment articular cartilage defect repair in an equine cartilage defect model involving strenuous exercise. Methods: Defects 15 mm in diameter were created on the medial trochlear ridge and debrided down to the subchondral bone. Four treatment groups (n = 8 each) were tested: no treatment (empty defect), only defect filling with KLD, only microfracture, and microfracture followed by filling with KLD. Horses were given strenuous exercise throughout the one-year study. Evaluations included lameness, arthroscopy, radiography, and gross, histologic, immunohistochemical, biochemical, and biomechanical analyses. Results: Overall, KLD-only treatment of defects provided improvement in clinical symptoms and improved filling compared with no treatment, and KLD-only treatment protected against radiographic changes compared with microfracture treatment. Defect treatment with only microfracture also resulted in improved clinical symptoms compared with no treatment, and microfracture treatment resulted in repair tissue containing greater amounts of aggrecan and type-II collagen compared with KLD-only treatment. Microfracture treatment also protected against synovial fibrosis compared with no treatment and KLD-only treatment. Treatment with the self-assembling KLD peptide in combination with microfracture resulted in no additional improvements over microfracture-only treatment. In general, the nature of the predominant tissue in the defects was a mix of noncartilaginous and fibrocartilage tissue, with no significant differences among the treatments. Conclusions: Treatment of defects with only KLD or with only microfracture resulted in an improvement in clinical symptoms compared with no treatment; the improvement likely resulted from different causes depending on the treatment. Whereas microfracture improved the quality of repair tissue, KLD improved the amount of filling and protected against radiographic changes. Conclusions: Treatment of defects with only microfracture and with KLD only resulted in clinical improvements compared with untreated defects, despite differing with respect to the structural improvements that they induced.
Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.
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Publication Date: 2014-10-03 PubMed ID: 25274785PubMed Central: PMC4179451DOI: 10.2106/JBJS.M.01408Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

This research article discusses a study examining how an injectable self-assembling peptide (KLD hydrogel) used alongside or without microfracture enhances the repair of cartilage defects in horses. The study found that both methods improved the symptoms but differed in the scope of the repair they facilitated.

Experimental Design

  • Defects were created on a particular area (medial trochlear ridge) in a cohort of horses and cleaned down to the bone beneath the cartilage (subchondral bone).
  • The study then divided the horses into four groups – one that received no treatment, one that only received the KLD hydrogel, one that was only subjected to a microfracture, and a group that underwent a microfracture treatment followed by the KLD hydrogel.
  • The horses were made to exercise heavily over the one-year course of the study.
  • Various assessment methods were used to evaluate the outcomes, which included examining for lameness, using arthroscopy and radiography techniques, and carrying out gross, histologic, immunohistochemical, biochemical, and biomechanical analyses.

Results

  • The treatment of cartilage defects solely with KLD hydrogel provided a notable improvement in clinical symptoms and the lesion’s filling compared to no treatment. This method also safeguarded against radiographic changes compared to microfracture treatment.
  • In comparison, microfracture treatment alone was found to provide better clinical symptoms than having no treatment. Additionally, the repair tissue following microfracture treatment comprised higher amounts of specific compounds (aggrecan and type-II collagen) compared to the KLD-only treatment. This technique also inhibited synovial fibrosis compared to no treatment and KLD-only treatment.
  • The implementation of the self-assembling KLD peptide alongside microfracture did not bring about any enhancements over using microfracture treatment alone.
  • In general, the key tissue in the lesions was a combination of noncartilaginous and fibrocartilage tissue, and the contribution of each treatment was not statistically significant.

Conclusion

  • The use of KLD-only treatment or microfracture-only treatment demonstrated improved clinical symptoms against not receiving any treatment.
  • Interestingly, while the microfracture enhanced the quality of the repair tissue, KLD improved the degree of filling and helped protect against radiographic changes.
  • Despite these variations, both treatments resulted in noticeable clinical improvements compared to untreated defects. However, they differed in the structural improvements they induced.

Cite This Article

APA
Miller RE, Grodzinsky AJ, Barrett MF, Hung HH, Frank EH, Werpy NM, McIlwraith CW, Frisbie DD. (2014). Effects of the combination of microfracture and self-assembling Peptide filling on the repair of a clinically relevant trochlear defect in an equine model. J Bone Joint Surg Am, 96(19), 1601-1609. https://doi.org/10.2106/JBJS.M.01408

Publication

The Journal of bone and joint surgery. American volume
ISSN: 1535-1386
NlmUniqueID: 0014030
Country: United States
Language: English
Volume: 96
Issue: 19
Pages: 1601-1609

Researcher Affiliations

Miller, Rachel E
  • Department of Internal Medicine, Rush University Medical Center, 1735 West Harrison Street, Room 553A, Chicago, IL 60612.
Grodzinsky, Alan J
  • Massachusetts Institute of Technology, 77 Massachusetts Avenue, MIT NE47-377, Cambridge, MA 02139.
Barrett, Myra F
  • Department of Environmental and Radiological Health Sciences (M.F.B.) and Orthopaedic Research Center, Department of Clinical Sciences (C.W.M. and D.D.F.), College of Veterinary Medicine and Biological Sciences, Colorado State University, 300 West Drake Road, Fort Collins, CO 80523. E-mail address for D.D. Frisbie: david.frisbie@colostate.edu.
Hung, Han-Hwa
  • Massachusetts Institute of Technology, 77 Massachusetts Avenue, MIT NE47-377, Cambridge, MA 02139.
Frank, Eliot H
  • Massachusetts Institute of Technology, 77 Massachusetts Avenue, MIT NE47-377, Cambridge, MA 02139.
Werpy, Natasha M
  • Department of Radiology, College of Veterinary Medicine, University of Florida, PO Box 100126, Gainesville, FL 32610.
McIlwraith, C Wayne
  • Department of Environmental and Radiological Health Sciences (M.F.B.) and Orthopaedic Research Center, Department of Clinical Sciences (C.W.M. and D.D.F.), College of Veterinary Medicine and Biological Sciences, Colorado State University, 300 West Drake Road, Fort Collins, CO 80523. E-mail address for D.D. Frisbie: david.frisbie@colostate.edu.
Frisbie, David D
  • Department of Environmental and Radiological Health Sciences (M.F.B.) and Orthopaedic Research Center, Department of Clinical Sciences (C.W.M. and D.D.F.), College of Veterinary Medicine and Biological Sciences, Colorado State University, 300 West Drake Road, Fort Collins, CO 80523. E-mail address for D.D. Frisbie: david.frisbie@colostate.edu.

MeSH Terms

  • Animals
  • Arthroscopy
  • Biomechanical Phenomena
  • Cartilage, Articular / diagnostic imaging
  • Cartilage, Articular / injuries
  • Cartilage, Articular / pathology
  • Disease Models, Animal
  • Dogs
  • Horses
  • Hydrogel, Polyethylene Glycol Dimethacrylate / therapeutic use
  • Immunohistochemistry
  • Magnetic Resonance Imaging
  • Orthopedic Procedures / methods
  • Peptides / therapeutic use
  • Radiography
  • Random Allocation

Grant Funding

  • R01 AR060331 / NIAMS NIH HHS

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Citations

This article has been cited 13 times.
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