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Good clinical results but moderate osseointegration and defect filling of a cell-free multi-layered nano-composite scaffold for treatment of osteochondral lesions of the knee

  • Knee
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of this retrospective study was to evaluate the clinical and radiological results of a nano-composite multi-layered three-dimensional biomaterial scaffold for treatment of osteochondral lesions (OCL) of the knee. It was a particular radiological interest to analyse the osseointegration, filling of the defects and the bone tracer uptake (BTU), and it was hypothesised that this scaffold, which was created to mimic the entire osteo-cartilaginous unit, is integrated within the bone 12 months postoperatively and comes along with improved patients symptoms and function.

Methods

Fourteen patients (male:female = 11:3, mean age ± SD 33.1 ± 10.7 years) treated for OCL (size 1.0–3.5 cm2) were clinically and radiologically evaluated at 1 year postoperatively. The data were prospectively collected including SPECT/CT, Tegner and Lysholm scores. BTU was anatomically localised and volumetrically quantified in SPECT/CT. Defect filling was analysed in CT. Spearman’s rho and Wilcoxon test were used for correlation of BTU in SPECT/CT and clinical scores (p < 0.05).

Results

A significant improvement in Lysholm knee score (p < 0.001) and slight deterioration in Tegner score were found (p < 0.01). A complete filling of the defect was shown in 14%, a partial filling in 14% and only minor filling was seen in 72%. A significant correlation (p < 0.001) was found between location of osteochondral lesions and increased BTU. At the lesion sites pre- and postoperative BTU was markedly increased and did not show any decrease at 12-month follow-up. Median Tegner and mean Lysholm scores did not correlate with BTU at any time.

Conclusions

Treatment of OCL in the knee joint with a nano-composite multi-layered three-dimensional biomaterial scaffold resulted in a significant clinical improvement at 1-year follow-up. However, osseointegration was still ongoing at 12-month follow-up.

Level of evidence

Case series, Level IV.

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References

  1. Aglietti P, Buzzi R, Bassi PB, Fioriti M (1994) Arthroscopic drilling in juvenile osteochondritis dissecans of the medial femoral condyle. Arthroscopy 10:286–291

    Article  CAS  PubMed  Google Scholar 

  2. Aichroth P (1971) Osteochondritis dissecans of the knee. A clinical survey. J Bone Joint Surg Br 53:440–447

    Article  CAS  PubMed  Google Scholar 

  3. Al-Nabhani K, Michopoulou S, Allie R, Alkalbani J, Saad Z, Sajjan R, Syed R, Bomanji J (2014) Painful knee prosthesis: can we help with bone SPECT/CT? Nucl Med Commun 35:182–188

    Article  PubMed  Google Scholar 

  4. Anderson AF, Pagnani MJ (1997) Osteochondritis dissecans of the femoral condyles. Long-term results of excision of the fragment. Am J Sports Med 25:830–834

    Article  CAS  PubMed  Google Scholar 

  5. Bentley G, Bhamra JS, Gikas PD, Skinner JA, Carrington R, Briggs TW (2013) Repair of osteochondral defects in joints—how to achieve success. Injury 44(Suppl 1):S3–S10

    Article  PubMed  Google Scholar 

  6. Boegard T, Rudling O, Dahlstrom J, Dirksen H, Petersson IF, Jonsson K (1999) Bone scintigraphy in chronic knee pain: comparison with magnetic resonance imaging. Ann Rheum Dis 58(1):20–26

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L (1994) Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med 331:889–895

    Article  CAS  PubMed  Google Scholar 

  8. Brix M, Kaipel M, Kellner R, Schreiner M, Apprich S, Boszotta H, Windhager R, Domayer S, Trattnig S (2016) Successful osteoconduction but limited cartilage tissue quality following osteochondral repair by a cell-free multilayered nano-composite scaffold at the knee. Int Orthop 40:625–632

    Article  PubMed  Google Scholar 

  9. Buck FM, Hoffmann A, Hofer B, Pfirrmann CW, Allgayer B (2009) Chronic medial knee pain without history of prior trauma: correlation of pain at rest and during exercise using bone scintigraphy and MR imaging. Skelet Radiol 38:339–347

    Article  Google Scholar 

  10. Cahill B (1985) Treatment of juvenile osteochondritis dissecans and osteochondritis dissecans of the knee. Clin Sports Med 4(2):367–384

    CAS  PubMed  Google Scholar 

  11. Cain EL, Clancy WG (2001) Treatment algorithm for osteochondral injuries of the knee. Clin Sports Med 20:321–342

    Article  CAS  PubMed  Google Scholar 

  12. Chopra A (2007) 99mTc-methyl diphosphonate. In: Molecular imaging and contrast agent database (MICAD). National Center for Biotechnology Information (US) 2004–2013, Bethesda, MD

  13. Christensen BB, Foldager CB, Jensen J, Jensen NC, Lind M (2016) Poor osteochondral repair by a biomimetic collagen scaffold: 1- to 3-year clinical and radiological follow-up. Knee Surg Sports Traumatol Arthrosc 24:2380–2387

    Article  PubMed  Google Scholar 

  14. Cook GJ, Ryan PJ, Clarke SE, Fogelman I (1996) SPECT bone scintigraphy of anterior cruciate ligament injury. J Nucl Med 37:1353–1356

    CAS  PubMed  Google Scholar 

  15. de Windt TS, Welsch GH, Brittberg M, Vonk LA, Marlovits S, Trattnig S, Saris DB (2013) Is magnetic resonance imaging reliable in predicting clinical outcome after articular cartilage repair of the knee? A systematic review and meta-analysis. Am J Sports Med 41:1695–1702

    Article  PubMed  Google Scholar 

  16. Delcogliano M, de Caro F, Scaravella E, Ziveri G, De Biase CF, Marotta D, Marenghi P, Delcogliano A (2014) Use of innovative biomimetic scaffold in the treatment for large osteochondral lesions of the knee. Knee Surg Sports Traumatol Arthrosc 22:1260–1269

    PubMed  Google Scholar 

  17. Donaldson LD, Wojtys EM (2008) Extraarticular drilling for stable osteochondritis dissecans in the skeletally immature knee. J Pediatr Orthop 28:831–835

    Article  PubMed  Google Scholar 

  18. Dordevic M, Hirschmann MT, Rechsteiner J, Falkowski A, Testa E, Hirschmann A (2016) Do chondral lesions of the knee correlate with bone tracer uptake by using SPECT/CT? Radiology 278:223–231

    Article  PubMed  Google Scholar 

  19. Dye SF, Chew MH (1994) The use of scintigraphy to detect increased osseous metabolic activity about the knee. Instr Course Lect 43:453–469

    CAS  PubMed  Google Scholar 

  20. Emmerson BC, Gortz S, Jamali AA, Chung C, Amiel D, Bugbee WD (2007) Fresh osteochondral allografting in the treatment of osteochondritis dissecans of the femoral condyle. Am J Sports Med 35:907–914

    Article  PubMed  Google Scholar 

  21. Filardo G, Kon E, Di Martino A, Busacca M, Altadonna G, Marcacci M (2013) Treatment of knee osteochondritis dissecans with a cell-free biomimetic osteochondral scaffold: clinical and imaging evaluation at 2-year follow-up. Am J Sports Med 41:1786–1793

    Article  PubMed  Google Scholar 

  22. Gomoll AH, Madry H, Knutsen G, van Dijk N, Seil R, Brittberg M, Kon E (2010) The subchondral bone in articular cartilage repair: current problems in the surgical management. Knee Surg Sports Traumatol Arthrosc 18:434–447

    Article  PubMed  PubMed Central  Google Scholar 

  23. Henckel JRR, Lozhkin K, Harris S, Baena FM, Barrett AR, Cobb JP (2006) Very low-dose computed tomography for planning and outcome measurement in knee replacement. The imperial knee protocol. J Bone Joint Surg Br 88:1513–1518

    Article  CAS  PubMed  Google Scholar 

  24. Hirschmann A, Hirschmann MT (2016) Chronic knee pain: clinical value of MRI versus SPECT/CT. Semin Musculoskelet Radiol 20:3–11

    Article  PubMed  Google Scholar 

  25. Hirschmann MT, Adler T, Rasch H, Hugli RW, Friederich NF, Arnold MP (2010) Painful knee joint after ACL reconstruction using biodegradable interference screws—SPECT/CT a valuable diagnostic tool? A case report. Sports Med Arthrosc Rehabil Ther Technol 2:24

    PubMed  PubMed Central  Google Scholar 

  26. Hirschmann MT, Davda K, Iranpour F, Rasch H, Friederich NF (2011) Combined single photon emission computerised tomography and conventional computerised tomography (SPECT/CT) in patellofemoral disorders: a clinical review. Int Orthop 35:675–680

    Article  PubMed  Google Scholar 

  27. Hirschmann MT, Davda K, Rasch H, Arnold MP, Friederich NF (2011) Clinical value of combined single photon emission computerized tomography and conventional computer tomography (SPECT/CT) in sports medicine. Sports Med Arthrosc 19:174–181

    Article  PubMed  Google Scholar 

  28. Hirschmann MT, Henckel J, Rasch H (2013) SPECT/CT in patients with painful knee arthroplasty—what is the evidence? Skelet Radiol 42:1201–1207

    Article  Google Scholar 

  29. Hirschmann MT, Iranpour F, Davda K, Rasch H, Hugli R, Friederich NF (2010) Combined single-photon emission computerized tomography and conventional computerized tomography (SPECT/CT): clinical value for the knee surgeons? Knee Surg Sports Traumatol Arthrosc 18:341–345

    Article  PubMed  Google Scholar 

  30. Hirschmann MT, Konala P, Iranpour F, Kerner A, Rasch H, Friederich NF (2011) Clinical value of SPECT/CT for evaluation of patients with painful knees after total knee arthroplasty—a new dimension of diagnostics? BMC Musculoskelet Disord 12:36

    Article  PubMed  PubMed Central  Google Scholar 

  31. Hirschmann MT, Mathis D, Afifi FK, Rasch H, Henckel J, Amsler F, Wagner CR, Friederich NF, Arnold MP (2013) Single photon emission computerized tomography and conventional computerized tomography (SPECT/CT) for evaluation of patients after anterior cruciate ligament reconstruction: a novel standardized algorithm combining mechanical and metabolic information. Knee Surg Sports Traumatol Arthrosc 21:965–974

    Article  PubMed  Google Scholar 

  32. Hirschmann MT, Mathis D, Rasch H, Amsler F, Friederich NF, Arnold MP (2013) SPECT/CT tracer uptake is influenced by tunnel orientation and position of the femoral and tibial ACL graft insertion site. Int Orthop 37:301–309

    Article  PubMed  Google Scholar 

  33. Hirschmann MT, Schon S, Afifi FK, Amsler F, Rasch H, Friederich NF, Arnold MP (2013) Assessment of loading history of compartments in the knee using bone SPECT/CT: a study combining alignment and 99mTc-HDP tracer uptake/distribution patterns. J Orthop Res 31:268–274

    Article  CAS  PubMed  Google Scholar 

  34. Hirschmann MT, Wagner CR, Rasch H, Henckel J (2012) Standardized volumetric 3D-analysis of SPECT/CT imaging in orthopaedics: overcoming the limitations of qualitative 2D analysis. BMC Med Imaging 12:5

    Article  PubMed  PubMed Central  Google Scholar 

  35. Hughston JC, Hergenroeder PT, Courtenay BG (1984) Osteochondritis dissecans of the femoral condyles. J Bone Joint Surg Am 66:1340–1348

    Article  CAS  PubMed  Google Scholar 

  36. Kivisto R, Pasanen L, Leppilahti J, Jalovaara P (2002) Arthroscopic repair of osteochondritis dissecans of the femoral condyles with metal staple fixation: a report of 28 cases. Knee Surg Sports Traumatol Arthrosc 10:305–309

    Article  CAS  PubMed  Google Scholar 

  37. Kon E, Delcogliano M, Filardo G, Altadonna G, Marcacci M (2009) Novel nano-composite multi-layered biomaterial for the treatment of multifocal degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc 17:1312–1315

    Article  PubMed  PubMed Central  Google Scholar 

  38. Kon E, Delcogliano M, Filardo G, Fini M, Giavaresi G, Francioli S, Martin I, Pressato D, Arcangeli E, Quarto R, Sandri M, Marcacci M (2010) Orderly osteochondral regeneration in a sheep model using a novel nano-composite multilayered biomaterial. J Orthop Res 28:116–124

    PubMed  Google Scholar 

  39. Kon E, Delcogliano M, Filardo G, Pressato D, Busacca M, Grigolo B, Desando G, Marcacci M (2010) A novel nano-composite multi-layered biomaterial for treatment of osteochondral lesions: technique note and an early stability pilot clinical trial. Injury 41:693–701

    Article  CAS  PubMed  Google Scholar 

  40. Kon E, Filardo G, Di Martino A, Busacca M, Moio A, Perdisa F, Marcacci M (2014) Clinical results and MRI evolution of a nano-composite multilayered biomaterial for osteochondral regeneration at 5 years. Am J Sports Med 42:158–165

    Article  PubMed  Google Scholar 

  41. Kon E, Vannini F, Buda R, Filardo G, Cavallo M, Ruffilli A, Nanni M, Di Martino A, Marcacci M, Giannini S (2012) How to treat osteochondritis dissecans of the knee: surgical techniques and new trends: AAOS exhibit selection. J Bone Joint Surg Am 94:e1–e8

    Article  PubMed  Google Scholar 

  42. Konala P, Iranpour F, Kerner A, Rasch H, Friederich NF, Hirschmann MT (2010) Clinical benefit of SPECT/CT for follow-up of surgical treatment of osteochondritis dissecans. Ann Nucl Med 24:621–624

    Article  PubMed  Google Scholar 

  43. Maas O, Joseph GB, Sommer G, Wild D, Kretzschmar M (2015) Association between cartilage degeneration and subchondral bone remodeling in patients with knee osteoarthritis comparing MRI and (99 m)Tc-DPD-SPECT/CT. Osteoarthr Cartil 23(10):1713–1720

    Article  CAS  PubMed  Google Scholar 

  44. Magnussen RA, Dunn WR, Carey JL, Spindler KP (2008) Treatment of focal articular cartilage defects in the knee: a systematic review. Clin Orthop Relat Res 466:952–962

    Article  PubMed  PubMed Central  Google Scholar 

  45. Marlovits S, Striessnig G, Resinger CT, Aldrian SM, Vecsei V, Imhof H, Trattnig S (2004) Definition of pertinent parameters for the evaluation of articular cartilage repair tissue with high-resolution magnetic resonance imaging. Eur J Radiol 52:310–319

    Article  PubMed  Google Scholar 

  46. Mathis DT, Hirschmann A, Falkowski AL, Kiekara T, Amsler F, Rasch H, Hirschmann MT (2017) Increased bone tracer uptake in symptomatic patients with ACL graft insufficiency: a correlation of MRI and SPECT/CT findings. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-017-4588-5

    Google Scholar 

  47. Mathis DT, Rasch H, Hirschmann MT (2015) In vivo bone tunnel remodeling in symptomatic patients after ACL reconstruction: a retrospective comparison of articular and extra-articular fixation. Muscles Ligaments Tendons J 5:316–324

    PubMed  Google Scholar 

  48. McCoy B, Miniaci A (2012) Osteochondral autograft transplantation/mosaicplasty. J Knee Surg 25:99–108

    Article  PubMed  Google Scholar 

  49. Mucha A, Dordevic M, Hirschmann A, Rasch H, Amsler F, Arnold MP, Hirschmann MT (2015) Effect of high tibial osteotomy on joint loading in symptomatic patients with varus aligned knees: a study using SPECT/CT. Knee Surg Sports Traumatol Arthrosc 23:2315–2323

    Article  PubMed  Google Scholar 

  50. Mucha A, Dordevic M, Testa EA, Rasch H, Hirschmann MT (2013) Assessment of the loading history of patients after high tibial osteotomy using SPECT/CT—a new diagnostic tool and algorithm. J Orthop Surg Res 8:46

    Article  PubMed  PubMed Central  Google Scholar 

  51. Pallante AL, Bae WC, Chen AC, Gortz S, Bugbee WD, Sah RL (2009) Chondrocyte viability is higher after prolonged storage at 37 °C than at 4 °C for osteochondral grafts. Am J Sports Med 37(Suppl 1):24S–32S

    Article  PubMed  PubMed Central  Google Scholar 

  52. Pascual-Garrido C, Friel NA, Kirk SS, McNickle AG, Bach BR Jr, Bush-Joseph CA, Verma NN, Cole BJ (2009) Midterm results of surgical treatment for adult osteochondritis dissecans of the knee. Am J Sports Med 37(Suppl 1):125S–130S

    Article  PubMed  Google Scholar 

  53. Peterson L, Minas T, Brittberg M, Lindahl A (2003) Treatment of osteochondritis dissecans of the knee with autologous chondrocyte transplantation: results at two to ten years. J Bone Joint Surg Am 85-A(Suppl 2):17–24

    Article  Google Scholar 

  54. Ramirez A, Abril JC, Chaparro M (2010) Juvenile osteochondritis dissecans of the knee: perifocal sclerotic rim as a prognostic factor of healing. J Pediatr Orthop 30:180–185

    Article  PubMed  Google Scholar 

  55. Rasch H, Falkowski AL, Forrer F, Henckel J, Hirschmann MT (2013) 4D-SPECT/CT in orthopaedics: a new method of combined quantitative volumetric 3D analysis of SPECT/CT tracer uptake and component position measurements in patients after total knee arthroplasty. Skelet Radiol 42:1215–1223

    Article  Google Scholar 

  56. Schon SN, Afifi FK, Rasch H, Amsler F, Friederich NF, Arnold MP, Hirschmann MT (2014) Assessment of in vivo loading history of the patellofemoral joint: a study combining patellar position, tilt, alignment and bone SPECT/CT. Knee Surg Sports Traumatol Arthrosc 22:3039–3046

    Article  PubMed  Google Scholar 

  57. Shimomura K, Moriguchi Y, Ando W, Nansai R, Fujie H, Hart DA, Gobbi A, Kita K, Horibe S, Shino K, Yoshikawa H, Nakamura N (2014) Osteochondral repair using a scaffold-free tissue-engineered construct derived from synovial mesenchymal stem cells and a hydroxyapatite-based artificial bone. Tissue Eng Part A 20:2291–2304

    Article  CAS  PubMed  Google Scholar 

  58. Tampieri A, Sandri M, Landi E, Pressato D, Francioli S, Quarto R, Martin I (2008) Design of graded biomimetic osteochondral composite scaffolds. Biomaterials 29:3539–3546

    Article  CAS  PubMed  Google Scholar 

  59. Wasiak J, Clar C, Villanueva E (2006) Autologous cartilage implantation for full thickness articular cartilage defects of the knee. Cochrane Database Syst Rev 3:CD003323

    Google Scholar 

  60. Wright RW, McLean M, Matava MJ, Shively RA (2004) Osteochondritis dissecans of the knee: long-term results of excision of the fragment. Clin Orthop Relat Res 424:239–243

    Article  Google Scholar 

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Acknowledgements

The authors would like to thank Mr. Patrick Jaeger for the graphical formatting.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland

    Dominic T. Mathis & Michael T. Hirschmann

  2. LEONARDO, Hirslanden Klinik Birshof, 4142, Münchenstein, Switzerland

    Raphael Kaelin & Markus P. Arnold

  3. Institute of Radiology and Nuclear Medicine, Kantonsspital Baselland, 4101, Bruderholz, Switzerland

    Helmut Rasch

  4. University of Basel, Basel, Switzerland

    Helmut Rasch, Markus P. Arnold & Michael T. Hirschmann

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  1. Dominic T. Mathis
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Correspondence to Michael T. Hirschmann.

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The authors have no conflict of interest.

Funding

A financial grant from Fin-ceramica faenza spa, Faenza RA, Italia was recieved for statistical analysis.

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Ethical approval was obtained from the Ethikkommission Nordwest- und Zentralschweiz (EKNZ, Basel EK 2015-396). All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Mathis, D.T., Kaelin, R., Rasch, H. et al. Good clinical results but moderate osseointegration and defect filling of a cell-free multi-layered nano-composite scaffold for treatment of osteochondral lesions of the knee. Knee Surg Sports Traumatol Arthrosc 26, 1273–1280 (2018). https://doi.org/10.1007/s00167-017-4638-z

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