The treatment of cartilage defects in trauma injuries and degenerative diseases represents a challenge for orthopedists. Advanced mesenchymal stromal cell (MSC)-based therapies are currently of interest for the repair of damaged cartilage. However, an approved system for MSC delivery and maintenance in the defect is still missing. This study aimed to evaluate the effect of autologous porcine bone marrow MSCs anchored in a commercially available polyglycolic acid-hyaluronan scaffold (Chondrotissue®) using autologous blood plasma-based hydrogel in the repair of osteochondral defects in a large animal model. The osteochondral defects were induced in twenty-four minipigs with terminated skeletal growth. Eight animals were left untreated, eight were treated with Chondrotissue® and eight received Chondrotissue® loaded with MSCs. The animals were terminated 90 days after surgery. Macroscopically, the untreated defects were filled with newly formed tissue to a greater extent than in the other groups. The histological evaluations showed that the defects treated with Chondrotissue® and Chondrotissue® loaded with pBMSCs contained a higher amount of hyaline cartilage and a lower amount of connective tissue, while untreated defects contained a higher amount of connective tissue and a lower amount of hyaline cartilage. In addition, undifferentiated connective tissue was observed at the edges of defects receiving Chondrotissue® loaded with MSCs, which may indicate the extracellular matrix production by transplanted MSCs. The immunological analysis of the blood samples revealed no immune response activation by MSCs application. This study demonstrated the successful and safe immobilization of MSCs in commercially available scaffolds and defect sites for cartilage defect repair.
- MeSH
- hydrogely MeSH
- kloubní chrupavka * chirurgie MeSH
- krevní plazma MeSH
- mezenchymální kmenové buňky * fyziologie MeSH
- miniaturní prasata MeSH
- modely u zvířat MeSH
- prasata MeSH
- tkáňové inženýrství MeSH
- transplantace mezenchymálních kmenových buněk * MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
Úvod: Temporerní epifyzeodéza Blountovou technikou je již mnoho let užívanou metodou k léčbě úhlových deformit a délkových diskrepancí u dětí. Tato práce vyhodnocuje výsledky léčby našich pacientů s valgózní deformitou v oblasti kolenního kloubu mezi lety 2010 a 2017. Materiál a metodika: Vyhodnocovali jsme soubor 29 pacientů, kteří podstoupili léčbu úhlové deformity genu varum různé etiologie. Průměrný věk pacienta v době operace byl 12 let a 6 měsíců. U většiny pacientů byly Blountovy skobky implantovány v oblasti mediálního distálního femuru. Pacienti byli sledováni aspoň jeden rok od dokončení korekce (odstranění implantátů). Výsledky: Skobky byly implantovány v průměru 12 měsíců. Byly odstraňovány po korekci mechanické osy s jejím mírným překorigováním (maximálně 2 stupně). U dvou pacientů nebylo dosaženo úplné korekce z důvodu vyčerpání růstového potenciálu. U čtyřech pacientů (13,8 % pacientů ze souboru) došlo k migraci implantátů. Závěr: Dle našeho názoru je Blountova technika nadále velmi efektivní metodou léčby úhlových deformit v oblasti kolenního kloubu u dětí. Její největší nevýhodu spatřujeme v riziku migrace skobek, a tím selhání epifyzeodézy.
Introduction: Blount staples technique is a traditional method used for treating angular deformities or length difference in children. This study evaluates results of our patients treated between 2010 and 2017 with knee valgus deformity. Methods: We evaluated our series of 29 patients who underwent treatment of valgus angular deformity of various origins. The average age at the time of operation was 12 years and 6 months. In majority of patients the staples were inserted in medial distal femur. The patients were followed at least one year after completion of correction (removing of staples). Results: The staples were inserted for an average of 12 months. They were removed after improving mechanical axis with slight overcorrection (maximum of 2 degrees). In two patients the full correction was not reached due to depletion of growth potential. In four patients (13,8% patients from our series) staples extrusion occured. Conclusions: We consider Blount staple technique to be still very effective method for treatment of angular deformities. The main disadvantage of this method is staples migration – extrusion.
Závěrečná zpráva o řešení grantu Agentury pro zdravotnický výzkum MZ ČR
nestr.
The current cartilage defect treatment methods are limited and there is no treatment available to ensure long-term improvement of joint function. Recently, autologous mesenchymal stem cells (MSCs) are being used clinically to improve cartilage regeneration, but they have several limitations such as high price of the product, invasive method of collection and reduced functionality in elderly patients. MSCs derived from umbilical cord tissue (WJ) represent an alternative allogeneic cell source giving cells with high growth capacity and controlled quality. The aim of this project is to evaluate safety and efficacy of transplantation of allogeneic porcine WJ-MSCs for the repair of articular cartilage defects in a pilot preclinical study. The cells will be seeded on a biocompatible scaffold and their effect will be compared with the autologous bone marrow MSCs. In addition, the safety and efficacy of human WJ-MSCs will be assessed. The results will provide considerably valuable preclinical data, which are important for the implementation of allogenic MSCs into the clinical trials.
Současné metody léčby defektů chrupavky jsou limitovány a zatím není k dispozici léčba zajišťující dlouhodobé zlepšení funkce kloubů. V poslední době jsou jako přípravek moderní terapie v klinické medicíně aplikovány autologní mezenchymální kmenové buňky (MSCs), nicméně jejich použití má celou řadu limitací včetně vysoké ceny produktu, invazivní metody odběru a snížené funkčnosti u starších pacientů. Jako alternativní zdroj kmenových buněk lze využít MSCs izolované z pupečníkové tkáně (WJ), která poskytuje kmenové buňky s velkou růstovou kapacitou v kontrolované kvalitě. Cílem projektu je vyhodnotit bezpečnost a účinnost aplikace alogenních prasečích WJ-MSC v reparaci defektu kolenní chrupavky v pilotní preklinické studii. Buňky budou transplantovány do defektu spolu s biokompatibilním nosičem a jejich účinek bude srovnáván s efektem autologních MSCs izolovaných z kostní dřeně. Kromě toho bude sledována i bezpečnost a účinnost lidských WJ-MSCs. Výsledky studie poskytnou cenná preklinická data, která jsou nezbytná pro následnou implementaci alogenních MSCs do klinických studií.
- Klíčová slova
- Animal model, transplantace, transplantation, mesenchymal stem cells, defekt chrupavky, alogenní, bone marrow, cartilage defect, allogeneic, mesenchymové buňky, zvířecí model, kostní dreň,
- NLK Publikační typ
- závěrečné zprávy o řešení grantu AZV MZ ČR
PURPOSE OF THE STUDY Osgood-Schlatter disease develops secondary to chronic patellar tendon overloading. The present study was designed to determine whether athletes with Osgood-Schlatter disease perform significantly worse in the Y-Balance Test compared to healthy subjects in a control group. MATERIAL AND METHODS The study involved ten boys (average age 13.7 years). Seven participants had bilateral knee pain, swelling and tenderness whereas three had unilateral knee pain, swelling and tenderness (left knee in two cases, and right knee in one). Overall, 17 knees were assessed (left knee in nine cases and right knee in eight).Ten healthy adolescent professional football players (mean age 14.6 years) were selected as a control group. In both groups, complex knee stability was assessed using the Y-Balance Test and their data were analyzed using the methodology developed by Plisky et al. The test outcome was expressed in indexed (normalized) values for the right and left lower extremities, and averaged values for the individual directions were compared. RESULTS Significant differences between both groups were shown in the posteromedial and posterolateral directions. CONCLUSIONS Using the Y-Balance Test, our study documented reduced performance in the above directions in patients with OsgoodSchlatter disease. Key words: Osgood-Schlatter disease, knee, balance test, movement patterns patellar tendon overload.
- MeSH
- bolest MeSH
- dolní končetina MeSH
- kolenní kloub * MeSH
- lidé MeSH
- mladiství MeSH
- osteochondróza * diagnóza MeSH
- sportovci MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY Fixation of osteochondral fragments are relatively common procedures in pediatric orthopaedic surgery. The use of biodegradable magnesium implants in these indications appears to be a promising alternative to polymer implants due to their favorable mechanical properties and biological behavior. The purpose of this study is to evaluate the short-term clinical and radiological outcomes of the fixation of unstable or displaced osteochondral fractures and osteochondritis dissecans lesions in the knee joint using MAGNEZIX® screws and pins in pediatric patients. MATERIAL AND METHODS In this study, 12 patients (5 girls, 7 boys) were included. The inclusion criteria were as follows (1) age below 18 years; (2) unstable or displaced osteochondral fragments secondary to trauma or as a result of osteochondritis dissecans, Grades III and IV in the ICRS (International Cartilage Repair Society) score, confirmed by imaging methods and indicated for surgical fixation; (3) fixation performed using screws or pins made of the magnesium-based MAGNEZIX® alloy; (4) minimum postoperative interval of 12 months. X-rays and clinical evaluation were assessed 1 day, 6 weeks, 3, 6, and 12 months after the operation. MRIs were performed 1-year postoperatively for evaluation of bone response and degradation behavior of implants. RESULTS The mean age at surgery was 13.3 ± 1.6 years. A total of 25 screws were used in 11 patients, a mean of 2.4 ± 1 per patient, 4 pins were used in 1 patient. In 2 patients, fixation with screws was complemented with fibrin glue. The mean follow-up was 14.2 ± 3.3 months. All patients exhibited complete functional recovery while showing no signs of pain at 6 months postoperatively. No adverse local reactions were observed. At 1-year follow-up, no implant failure has been reported. Complete radiographic healing occurred in 12 cases. Mild radiolucent zones were observed around the implants. CONCLUSIONS The use of screws and pins MAGNEZIX® has been found to provide satisfactory outcomes in terms of fracture healing and very good functional outcomes at 1 year postoperatively. Key words: biodegradable implants, magnesium-based implants, osteochondral fracture, osteochondritis dissecans, MAGNEZIX®.
- MeSH
- dítě MeSH
- fraktury kostí * MeSH
- hojení fraktur MeSH
- hořčík MeSH
- kolenní kloub diagnostické zobrazování chirurgie MeSH
- kostní hřeby MeSH
- lidé MeSH
- mladiství MeSH
- následné studie MeSH
- osteochondritis dissecans * diagnostické zobrazování chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Klíčová slova
- trampolína,
- MeSH
- dítě MeSH
- fraktury kostí epidemiologie etiologie prevence a kontrola MeSH
- lidé MeSH
- nebezpečné chování MeSH
- prevence úrazů MeSH
- rekreační hry * zranění MeSH
- sportovní úrazy * epidemiologie etiologie prevence a kontrola MeSH
- sportovní vybavení škodlivé účinky MeSH
- úrazy pádem prevence a kontrola MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
PURPOSE OF THE STUDY Our study aimed to assess the mid-term outcomes and complications with the ICON hip resurfacing system and to carry out a detailed analysis of pitfalls and risks associated with pairing the bearing surfaces of metal-on-metal hip implants. MATERIAL AND METHODS A total of 52 hip joints were assessed in 43 patients who received the ICON hip resurfacing system at our department between 2009 and 2013. The cohort included 34 men and 9 women. Their age at the time of primary surgery ranged from 34 to 67 years, with the mean age of 51.8 years. The mean follow-up was 7.6 years. The evaluation focused on the position and osseointegration of both components, bone remodelling around the implant, and signs of potential aseptic loosening. The functional status of the hip was assessed by Harris Hip Score. RESULTS The primary stability of both components was always good, there were no femoral neck fractures reported in our cohort. All the acetabular components were stable, showing appropriate osseointegration, with no radiolucent zones or signs of osteolysis around them. There was not a single case of the femoral component stem being in a biomechanically disadvantageous varus position. In zone I and III according to Beaulé, cancellous bone osteolysis developed in two patients. The narrowing of the femoral neck below the end of the femoral component, compared to postoperative X-rays, achieved the mean value of 1.3% according to Grammatopolouse. The HHS increased from 64 to 95.5 points. An excellent outcome was observed in 48 joints, whereas the outcome of the remaining 4 joints was very good. The mean survival rate of the resurfacing hip implant calculated using the Kaplan-Meier analysis achieved 100%. The cobalt and chromium levels in the blood of patients did not exceed the reference physiological value. DISCUSSION The resurfacing system enables to preserve the bone tissue of the metaphysis and a part of the femoral head. The reduced mechanical endurance of the peripheral part of femoral components smaller in size caused by implant malposition resulted in fatal consequences in the ASR system. Greater range of motion conditioned by the design of the resurfacing system led to a mechanical wear, with a significant increase in the concentration of metal particles in the effective joint space. The elevated levels of cobalt and chromium ions in some patients induced delayed-type hypersensitivity with subsequent development of aseptic lymphocyte-dominated vasculitis associated lesions presented as peri-acetabular changes (pseudotumors to osteolysis) with subsequent failure of implant fixation. We have not observed this complication in the ICON system as yet. In patients suffering from hip pain after the resurfacing hip arthroplasty and simultaneous high chromium and cobalt blood levels, pelvic CT/MRI is indicated with reduction of artefacts around the metal material. Surgical treatment of soft tissue affections, bone defects and reimplantation using conventional or revisioncementless components is a possible treatment option. CONCLUSIONS The ideal patient indicated for hip resurfacing is a physically active man under 60 years of age (with a femoral head size of 54-60 mm), with primary or secondary osteoarthritis, no joint deformity, with a good quality bone tissue in the femoral neck and head region. As for the functional performance, the resurfacing system allows the patients a large range of motion with very good joint stability immediately after surgery. Despite that, the metal-on-metal tribological pairing must be approached with caution. The risk of developing lesions associated with ALVAL is unpredictable. In our cohort of patients with ICON hip resurfacing system, mostly excellent outcomes with minimum complications were reported provided the indication criteria and the correct surgical procedure had been complied with. Key words: hip resurfacing system, metal articulating surfaces, adverse reaction to metal particles, aseptic lymphocytedominated vasculitis associated lesions, pseudotumor.
- MeSH
- chrom MeSH
- dospělí MeSH
- kobalt MeSH
- kovy MeSH
- kyčelní kloub diagnostické zobrazování chirurgie MeSH
- kyčelní protézy * škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- náhrada kyčelního kloubu * metody MeSH
- osteolýza * etiologie chirurgie MeSH
- protézy - design MeSH
- reoperace MeSH
- selhání protézy MeSH
- senioři MeSH
- vaskulitida * komplikace chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
PURPOSE: Treatment outcomes of conservative and surgical treatment of Legg-Calvé-Perthes disease (LCPD) have been shown to be conditioned by a number of factors that may vary across different populations. This retrospective study aimed to evaluate factors affecting radiographically assessed treatment outcomes in patients treated surgically or conservatively for LCPD at Faculty Hospital Motol, Prague, Czech Republic, between the years 2006 and 2019. METHODS: Data of forty-seven children comprising 52 hips were analysed. Treatment outcomes were evaluated according to Stulberg classification. Predictors included the initial stage of fragmentation of the hip joint according to Herring classification, type of treatment (conservative or surgical), age at the time of diagnosis and sex. RESULTS: Older age and severity of LCPD according to Herring classification but not the type of treatment were the strongest factors determining treatment outcomes. Treatment outcomes were comparable in patients treated conservatively or surgically both across the whole cohort of patients and a group of young children < six years of age. CONCLUSIONS: Results strengthen the roles of severity of the LCPD at onset of treatment and age of the patient in predicting treatment outcomes in patients with LCPD. Conservative and surgical treatments appear to yield similar treatment outcomes irrespective of age of patients.
- MeSH
- dítě MeSH
- kyčelní kloub MeSH
- lidé MeSH
- osteotomie metody MeSH
- Perthesova nemoc * diagnostické zobrazování chirurgie MeSH
- předškolní dítě MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- předškolní dítě MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
The regulatory requirements in cell processing, in the choice of a biomaterial scaffold and in quality control analysis, have to be followed in the clinical application of tissue-engineered grafts. Confirmation of sterility during quality control studies requires prolonged storage of the cell-based construct. After storage, preservation of the functional properties of the cells is an important prerequisite if the cells are to be used for cell-based tissue therapies. The study presented here shows the generation of 3D constructs based on Wharton's jelly multipotent mesenchymal stromal cells (WJ-MSCs) and the clinically-acceptable HyaloFast® scaffold, and the effect of two- and six-day hypothermic storage of 3D cell-based constructs on the functional properties of populated cells. To study the viability, growth, gene expression, and paracrine secretion of WJ-MSCs within the scaffolds before and after storage, xeno-free culture conditions, metabolic, qPCR, and multiplex assays were applied. The WJ-MSCs adhered and proliferated within the 3D HyaloFast®. Our results show different viability of the cells after the 3D constructs have been stored under mild (25 °C) or strong (4 °C) hypothermia. At 4 °C, the significant decrease of metabolic activity of WJ-MSCs was detected after 2 days of storage, with almost complete cell loss after 6 days. In mild hypothermia (25 °C) the decrease in metabolic activity was less remarkable, confirming the suitability of these conditions for cell preservation in 3D environment. The significant changes were detected in gene expression and in the paracrine secretion profile after 2 and 6 days of storage at 25 °C. The results presented in this study are important for the rapid transfer of tissue engineering approaches into clinical applications.
- Publikační typ
- časopisecké články MeSH
