Knee Osteoarthritis Treated with Percutaneous Chondral-Bone Interface Optimization: A Pilot Trial

Objective: The objective is to evaluate the efficacy of using tibial bone marrow delivered to the chondral-bone interface (CBI) via percutaneous chondral bone interface optimization (PeCaBoo) as a therapy for knee osteoarthritis (OA). Study Design: A series of prospective cases were presented. Participants: Our study included 10 patients with medial or lateral compartment knee OA. Methods: With 1 cc of heparin pre-loaded in the syringe, 5 cc of tibial bone marrow was withdrawn from the proximal tibia. The resultant 6 cc of aspirate in the syringe was injected via PeCaBoo, 2 cc at a time, into the superior CBI and inferior CBI. The remaining 2 cc was injected via needle into the intra-articular joint space. Main Outcome Measurements: Patients had MRIs taken pre-procedure and 3 months post-procedure to measure bone edema and intra-articular matrix thickness. Patient-reported outcomes recorded included the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and the Numeric Paint Rating Scale (NRS), which were both obtained pre-procedure and post-procedure at 3, 6, and 12 months. Use of non-steroidal anti-inflammatories (NSAIDs) was recorded pre- and post-procedure as well. Results: Our study included 4 males and 6 females, with an average age of 63.5 years. The average follow-up time was 14 months, with a range of 13 - 15 months. The mean WOMAC score was 58.2 points pre-procedure and 35.3 points post-procedure (p < 0.01). The mean NRS-Pain score was 8.6 points pre-procedure and 2.8 points post-procedure (p < 0.01). The matrix thickness increased by 14% on average at 3 months post-procedure (p < 0.01). The proportion of patients taking NSAIDs decreased by 60% after the PeCaBoo procedure. The subgroup of patients with tibial edema and knee OA had optimal outcomes. Conclusions: Tibial bone marrow stem cell delivered via PeCaBoo is a novel minimally-invasive treatment for knee OA, with potential to repair cartilage and improve knee pain and function.

关节镜下骨髓间充质干细胞复合纤维蛋白封闭剂治疗膝关节软骨缺损

目的：比较关节镜下关节清理术联合注射骨髓间充质干细胞复合纤维蛋白封闭剂与关节清理灌洗术治疗膝关节软骨全层缺损的临床疗效。方法：对2002年1月-2005年5月膝关节全层软骨缺损患者，分别行膝关节镜下关节清理术联合注射骨髓间充质干细胞复合纤维蛋白封闭剂（实验组24例）与关节清理灌洗术（对照组21例），根据临床症状及Tenner运动评级判定疗效，随访观察6～24个月。结果：关节镜下关节清理术联合注射骨髓间充质干细胞复合纤维蛋白封闭剂总有效率91．7％，关节清理灌洗术总有效率66．7％，组间比较有统计学意义（P〈0．05）。结论：关节镜下关节清理术联合注射骨髓间充质干细胞复合纤维蛋白封闭剂治疗膝关节软骨全层缺损优于关节清理灌洗术。

Update on mesenchymal stem cell therapies for cartilage disorders

Cartilage disorders, including focal cartilage lesions, are among the most common clinical problems in orthopedic practice. Left untreated, large focal lesions may result in progression to osteoarthritis, with tremendous impact on the quality of life of affected individuals. Current management strategies have shown only a modest degree of success, while several upcoming interventions signify better outcomes in the future. Among these, stem cell therapies have been suggested as a promising new era for cartilage disorders. Certain characteristics of the stem cells, such as their potential to differentiate but also to support healing made them a fruitful candidate for lesions in cartilage, a tissue with poor healing capacity. The aim of this editorial is to provide an update on the recent advancements in the field of stem cell therapy for the management of focal cartilage defects. Our goal is to present recent basic science advances and to present the potential of the use of stem cells in novel clinical interventions towards enhancement of the treatment armamentarium for cartilage lesions. Furthermore, we highlight some thoughts for the future of cartilage regeneration and repair and to explore future perspectives for the next steps in the field.

细胞共培养技术及其在骨软骨组织工程中的应用

目的：探讨细胞共培养技术及其在骨软骨组织工程中的应用。方法：在CNKI数据库和Pubmed中检索近年来有关细胞共培养技术及其在骨软骨组织工程中应用的相关文献，进行汇总分析。结果：细胞共培养技术诱导干细胞向体细胞分化、维持细胞的功能和活力、对细胞增殖进行调控，有效地扩大了骨软骨损伤修复所需的种子细胞源。结论：细胞共培养技术充分模拟了体内环境，使细胞间能相互沟通信息，相互支撑生长增殖，使其成为组织工程领域一种新兴而很有发展前景的技术。

石榴籽油对骨性关节炎大鼠软骨和软骨下骨元素及血清氧化应激指标的影响及意义

目的:研究不同剂量的石榴籽油对骨性关节炎(OA)大鼠股骨髁软骨和软骨下骨钙(Ca)、磷(P)等元素含量,血清碱性磷酸酶(ALP)、超氧化物歧化酶(SOD)活性及丙二醛(MDA)含量的影响,找到促进软骨生成和有效抑制关节退变的实验依据。方法:8周SD大鼠108只,分成空白组、模型对照组、实验1组、实验2组和实验3组,其中空白组20只,模型对照组和实验1组、实验2组、实验3组各22只。除空白组实施假手术外,其余4组均通过改良Hulth法建立OA动物模型,驱赶4周后每组随机挑选2只大鼠断颈处死,通过MicroCT参数分析确认建模成功。除喂食普通饲料外,每天给予模型对照组大鼠1.59 g·kg^-1纯玉米油灌胃,实验1、2、3组大鼠分别给予0.95、1.27和1.59 g·kg^-1纯石榴籽油(PSO)灌胃,各组大鼠均在相同条件下喂养,自由饮水和进食,每7 d称重1次,以调整PSO剂量。继续喂养12周后用1%的戊巴比妥钠按90 mg·kg^-1剂量给大鼠腹腔注射,使大鼠麻醉致死,取腹腔静脉血6 ml,3000 r·min^-1离心10 min后取上清液用原子吸收分光光度计分别检测大鼠血清MDA水平及ALP、SOD活性。取出股骨髁标本纵切,干燥后用EDX4500H能量色散X荧光光谱仪和JEM-4000EX能量选择电子显微镜观察切面,根据元素对电子束的吸收光谱计算Ca、P等元素的含量。结果:经玉米油干预后的模型对照组大鼠软骨和软骨下骨Ca、P含量以及血清MDA、ALP、SOD活性与空白组相比差异无统计学意义(P>0.05);经PSO干预后的3个实验组与模型对照组相比除SOD活性升高外其余指标均降低,差异有统计学意义(P<0.05)。与实验1组相比,实验2、3组Ca含量以及血清MDA活性降低,SOD活性升高,差异有统计学意义(P<0.05)。结论:玉米油对OA软骨退变及软骨下骨硬化增生无抑制作用。PSO能有效降低OA大鼠软骨及软骨下骨Ca、P含量,减弱软骨转化活性,对软骨退变及软骨下骨硬化、增生具有抑制作用;同时PSO能降低ALP活性,提示其具有雌激素活性,可阻碍ALP活性升高而改善软骨高转化状态;另外PSO能有效减弱氧化应激反应代谢产物MDA活性,对氧自由基产生淬灭作用。