Aims

Implantation of ultra-purified alginate (UPAL) gel is safe and effective in animal osteochondral defect models. This study aimed to examine the applicability of UPAL gel implantation to acellular therapy in humans with cartilage injury.

Introduction. Autologous chondrocyte implantation presents a viable alternative to microfracture in the repair of damaged articular cartilage of the knee; however, outcomes for patellar lesions have been less encouraging. ChondroCelect (CC) is an innovative, advanced cell therapy product consisting of autologous cartilage cells expanded ex vivo through a highly controlled and consistent manufacturing process. Purpose. To assess the effect of CC in the treatment of patellofemoral lesions, for which standard treatment options had failed and/or no other treatment options were considered feasible. Methods. CC was administered to 61 patients with patellar lesions (predominantly secured with a biological membrane; mean lesion size: 3.6 cm. 2. ; aged 32.4 years). Efficacy was assessed with validated scales of Clinical Global Impression for Improvement (CGI-I) and Therapeutic Effect (CGI-E) and stratified by the postoperative follow-up period (<18 months vs >18 months). Results. CC resulted in therapeutic and clinical improvement in 87% of patients. Long-term follow-up showed a modest shift towards worse CGI-I and CGI-E scores, with the ‘very much improved’ subgroup (CGI-I) during the first 18 months (38.5%) moderately reduced after 18 months (25.0%); however, the proportion of improved patients remained consistent. The most commonly reported adverse events (knee pain [23%], joint crepitation [13.1%], joint range of motion decreased [13.1%], arthrofibrosis [8.2%] and tendon disorder [8.2%]) were reported at incidences higher than those associated with femoral condyle and trochlea lesions. There were no reports of cartilage hypertrophy. Conclusion. CC was effective in the treatment of patellofemoral lesions, with results comparable to outcomes for femoral condyle and trochlear lesions. The higher incidence of some adverse events suggests that the risk-benefit balance of CC varies with lesion location. However, there were no major safety concerns and the safety profile of CC was greatly enhanced by absence of cartilage hypertrophy, demonstrating that collagen membranes can eliminate periosteum-associated events

Aims

Meniscal injuries are common and often induce knee pain requiring surgical intervention. To develop effective strategies for meniscus regeneration, we hypothesized that a minced meniscus embedded in an atelocollagen gel, a firm gel-like material, may enhance meniscus regeneration through cell migration and proliferation in the gel. Hence, the objective of this study was to investigate cell migration and proliferation in atelocollagen gels seeded with autologous meniscus fragments in vitro and examine the therapeutic potential of this combination in an in vivo rabbit model of massive meniscus defect.

Injury to the anterior cruciate ligament (ACL) is one of the most devastating and frequent injuries of the knee. Surgical reconstruction is the current standard of care for treatment of ACL injuries in active patients. The widespread adoption of ACL reconstruction over primary repair was based on early perception of the limited healing capacity of the ACL. Although the majority of ACL reconstruction surgeries successfully restore gross joint stability, post-traumatic osteoarthritis is commonplace following these injuries, even with ACL reconstruction. The development of new techniques to limit the long-term clinical sequelae associated with ACL reconstruction has been the main focus of research over the past decades. The improved knowledge of healing, along with recent advances in tissue engineering and regenerative medicine, has resulted in the discovery of novel biologically augmented ACL-repair techniques that have satisfactory outcomes in preclinical studies. This instructional review provides a summary of the latest advances made in ACL repair.

Cite this article: Bone Joint Res 2014;3:20–31.