Effect of microfracture and autologous-conditioned plasma application in the focal full-thickness chondral defect of the knee: an experimental study on rabbits

Journal of Orthopaedic Surgery and Research, Jul 2015

Purpose The aim of the present study was to evaluate the effect of microfracture and intraarticular autologous conditioned plasma (ACP) injection on cartilage regeneration in a focal full-thickness chondral defect model created in the knee joint. Methods Full-thickness chondral defects of 3 × 6 mm 2 were surgically created in right medial femoral condyles (MFC) of New Zealand rabbits, and the rabbits were then divided into three groups according to treatment: Group 1 received only microfracture (mfx), Group 2 received mfx plus intraarticular ACP, and Group 3 received mfx; the defect was covered by the periosteum, and then, ACP was applied subperiosteally and intraarticularly. Twelve weeks after injection, the animals were sacrificed and the femoral condyles were evaluated macroscopically and histologically by hematoxylin-eosin staining. Then, histological sections were scored using the International Cartilage Repair Society (ICRS) visual histological scale. Results Findings showed that in both mfx/ACP-treated groups, the defects were filled regularly and smoothly, the defects had a greater fill and good integration into the surrounding host tissue, and the repair matrix had more hyaline-like character. On the other hand, defects were filled with an irregular, fibrous cartilage in the mfx-treated group. Histological scores in Group 2 and Group 3 were better compared to Group 1. Conclusion In the present study, we were able to demonstrate a beneficial effect of intraarticular administration of ACP as a coadjuvant of microfractures in order to regenerate hyaline-like cartilage in full-thickness chondral lesions in a rabbit model.

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Effect of microfracture and autologous-conditioned plasma application in the focal full-thickness chondral defect of the knee: an experimental study on rabbits

Karakaplan et al. Journal of Orthopaedic Surgery and Research Effect of microfracture and autologous-conditioned plasma application in the focal full-thickness chondral defect of the knee: an experimental study on rabbits Mustafa Karakaplan 0 Nurzat Elmalı 2 Efe Mirel 1 Nurhan Şahin 4 Emre Ergen 0 Candan Elmalı 3 0 Orthopaedics and Traumatology Department, Turgut Ozal Medical Center, Inonu University Medical School , Malatya 44100 , Turkey 1 Kelkit State Hospital, Orthopaedics and Traumatology Department , Gumushane , Turkey 2 Bezmialem Vakıf University, Orthopaedics and Traumatology Clinic , Istanbul , Turkey 3 Süreyya Pasa Hospital Pathology Clinic , Istanbul , Turkey 4 Pathology Department, Turgut Ozal Medical Center, Inonu University Medical School , Inonu, Malatya , Turkey Purpose: The aim of the present study was to evaluate the effect of microfracture and intraarticular autologous conditioned plasma (ACP) injection on cartilage regeneration in a focal full-thickness chondral defect model created in the knee joint. Methods: Full-thickness chondral defects of 3 × 6 mm2 were surgically created in right medial femoral condyles (MFC) of New Zealand rabbits, and the rabbits were then divided into three groups according to treatment: Group 1 received only microfracture (mfx), Group 2 received mfx plus intraarticular ACP, and Group 3 received mfx; the defect was covered by the periosteum, and then, ACP was applied subperiosteally and intraarticularly. Twelve weeks after injection, the animals were sacrificed and the femoral condyles were evaluated macroscopically and histologically by hematoxylin-eosin staining. Then, histological sections were scored using the International Cartilage Repair Society (ICRS) visual histological scale. Results: Findings showed that in both mfx/ACP-treated groups, the defects were filled regularly and smoothly, the defects had a greater fill and good integration into the surrounding host tissue, and the repair matrix had more hyaline-like character. On the other hand, defects were filled with an irregular, fibrous cartilage in the mfx-treated group. Histological scores in Group 2 and Group 3 were better compared to Group 1. Conclusion: In the present study, we were able to demonstrate a beneficial effect of intraarticular administration of ACP as a coadjuvant of microfractures in order to regenerate hyaline-like cartilage in full-thickness chondral lesions in a rabbit model. Microfracture; Cartilage; Platelet-rich plasma; Periosteum - Background It has been well established that articular cartilage has poor intrinsic capacity for self-repair due to the low cellular mitotic activity of chondrocytes and its avascularity [1]. Although many treatment options are currently available, such as microfracture, osteochondral grafting, and autologous chondrocyte implants, none of these options fulfill the criteria for an ideal repair solution, including a hyaline repair tissue that completely fills the defect and integrates well with the surrounding normal cartilage [2, 3]. The microfracture technique is currently a common first-line treatment for patients with cartilage defects of the knee, resulting in the formation of a fibrocartilaginous repair tissue with inferior biomechanical properties compared to normal hyaline cartilage [4–6]. Therefore, research is continually being conducted in an attempt to find biological adjuvant treatments to improve the quality of the microfracture repair tissue, with the goal of producing a more hyaline-like repair, capable of durable, long-term functional improvement [7–13]. The original concept for clinical application of platelet-rich plasma (PRP) focused only on the concentration of platelets because platelets are a natural reservoir of many growth factors important for tissue healing. More recently, it is accepted that PRP, like all of the blood-derived biologics discussed herein, is a milieu of bioactive factors. Broadly, PRP preparations can be defined as buffy coat or plasma based. Autologous conditioned plasma (ACP) is a form of PRP that belongs in the plasma-based group. ACP, which is an autologous blood product produced by the centrifugation of whole blood, thereby yielding 2–8 times higher than baseline concentration of platelets, has produced various effects on sports injuries and cartilage [14–27]. The advantages of the use of ACP as an adjuvant to microfracture are the sealant properties for the implant, the capacity to promote cellular implantation, and the presence of growth factors that are involved in mesenchymal stem cells (MSC) chondrogenic differentiation [28]. The aim of the present study was to investigate the effect of intraarticular ACP injection, and intraarticular and subperiosteal ACP injections into the defect covered by periosteum on cartilage repair, and compare the results with the results of microfracture alone. Materials and methods In this study, “Principles of laboratory animal care” (NIH publication No. 86–23, (...truncated)


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Mustafa Karakaplan, Nurzat Elmalı, Efe Mirel, Nurhan Şahin, Emre Ergen, Candan Elmalı. Effect of microfracture and autologous-conditioned plasma application in the focal full-thickness chondral defect of the knee: an experimental study on rabbits, Journal of Orthopaedic Surgery and Research, 2015, pp. 110, 10, DOI: 10.1186/s13018-015-0254-0