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
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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)