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1
Ebert, Jay Robert. "Post-operative load bearing rehabilitation following autologous chondrocyte implantation." University of Western Australia. School of Sport Science, Exercise and Health, 2008. http://theses.library.uwa.edu.au/adt-WU2008.0196.
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[Truncated abstract] Autologous Chondrocyte Implantation (ACI) has shown early clinical success as a repair procedure to address focal articular cartilage defects in the knee, and involves isolating and culturing a patient's own chondrocytes in vitro and re-implantation of those cells into the cartilage defect. Over time, repair tissue can develop and remodel into hyaline-like cartilage. A progressive partial weight bearing (PWB) program becomes the critical factor in applying protection and progressive stimulation of the implanted cells, to promote best chondrocyte differentiation and development, without overloading the graft. The aim of this thesis was to investigate whether patients could replicate this theoretical load bearing model to possibly render the best quality tissue development. In addition, this proposed external load progression is only a means to loading the articular surface. Several factors, including those that may result from pathology, have the potential to influence gait patterns, and therefore, articular loading. The association between increasing external loads (ground reaction forces - GRF) and knee joint kinetics during partial and full weight bearing gait was, therefore, investigated in the ACI patient group, as was the contribution of other gait variables to these knee joint kinetics which may be modified by the clinician. Finally, current weight bearing (WB) protocols have been based on early ACI surgical techniques. With advancement in the surgical procedure and ongoing clinical experience, we employed a randomised controlled clinical trial to assess the effectiveness of an 'accelerated' load bearing program, compared with the traditionally 'conservative' post-operative protocol. ... Although similar spatio-temporal, knee kinematic and external loading parameters were observed between the traditional and accelerated rehabilitation groups, the accelerated group was 'more comparable' to the controls in their external knee adduction and flexion moments, where the traditional group had lower knee moments. Knee moments greatly affect knee articular loading, and large adduction moments have been related to poor clinical outcomes after surgery. Therefore, the return of normal levels may be ideal for graft stimulation, however, may overload the immature chondrocytes. Acceleration of the intensive rehabilitation program will enable the patient to return to normal activities earlier, whilst reducing time and expenses associated with the rehabilitative process, and may enhance long-term tissue development. However, continued follow-up is required to determine if there are any detrimental effects that may emerge as a result of the accelerated load bearing program, and assess the recovery of normal gait patterns and whether longer term graft outcomes are affected by the recovery time course of normal gait function, and/or abnormal loading mechanics in gait. Furthermore, analysis at all levels of PWB is needed to identify a more complete set of variables attributing to the magnitude of external knee joint kinetics and, therefore, knee articular loading, while the influence muscle activation patterns may have on articular loading needs to be investigated. This becomes critical when you consider loads experienced by the articular surface throughout the early post-operative period following ACI may be important to short- and long-term graft development.
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Kobayashi, Tomohito. "A-674563 increases chondrocyte marker expression in cultured chondrocytes by inhibiting Sox9 degradation." Kyoto University, 2018. http://hdl.handle.net/2433/232130.
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Briggs, T. W. R. "Autologous chondrocyte implantation of the knee using an inert collagen membrane." Thesis, University College London (University of London), 2009. http://discovery.ucl.ac.uk/17271/.
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The hypothesis for this thesis was that using cultured autologous chondrocytes would lead to repair of full thickness defects with a hyaline type cartilage reparative tissue producing a significant improvement in pain and joint function in both the short and medium term. It was also hypothesised that the cover to contain the implanted cells is only a containment device so can be biologically inert resulting in no difference between Autologous Chondrocyte Implantation (ACI) and Matrix Assisted Chondrocyte Implantation (MACI). For this study autologous cultured chondrocytes were re-implanted under (ACI) or within (MACI) an inert type I/III collagen membrane. Patients were clinically assessed for up to seven years by standardised objective and subjective scores, as well as undergoing a second arthroscopy at one year to assess the regenerating tissue within the defect. All patients treated had full thickness chondral defects (1-12 cm^2).and were aged between .15-55 years age. The majority of patients had undergone at least one surgical procedure prior to referral for this technique, most commonly arthroscopy. The objective and subjective scores used showed a significant improvement post-surgery and the Short Form 36 proved to be sufficiently sensitive to demonstrate perceived health benefit from ACI at one year. ACI also resulted in an increase in post-operative score in patient previously treated with microfracture. The study showed that defect site, duration of symptoms, gender, defect size, and pre-operative score all affected the post-operative score. Histological assessment of the repair tissue showed that the regenerate is fibrocartilaginous but continues to adapt with time post-surgery resulting in a tissue more like normal articular cartilage. However, the type of regenerate does not significantly affect the post-operative patient score. Standard histological techniques showed that the regenerate contained collagen type IIA and B, collagen X, proteoglycans and S100. The results showed that the reparative tissue is showing features of hyaline cartilage but its architectural structure is not yet formed and the on the superficial surface only fibrous tissue is found architectural structure is not yet formed and the on the superficial surface only fibrous tissue is found. Both ACI and MACI produced significant improvements in knee function when compared to pre-operative levels (p<0.0001), with continued improvement in outcome for up to seven years, but the rate of clinical improvement in the MACI group was superior. There was, however, a greater tendency in the MACI group for fibrocartilaginous repair. This may be the reason why the MACI group had an inferior post-operative score at one year post-implantation compared to ACI group. However, by two years the MACI score surpassed the ACI group, possibly indicating a slower rate of maturation of the MACI regenerate. In summary, ACI for the repair of full thickness defects of the knee produces a repair with a tendency to form hyaline-like articular cartilage. Subjective and objective scores demonstrate sequential improvement for up to seven years demonstrating the durability of this technique in this group of patients.
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Walker, Robert William. "The contact stress in the natural knee following autologous chondrocyte implantation." Thesis, Anglia Ruskin University, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.440249.
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Bhosale, Abjijit. "Assessment of outcome measure of autologous chondrocyte implantation of the knee joint." Thesis, Keele University, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.540618.
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Gooding, Christopher Rees. "A clinical and histopathological review of autologous chondrocyte implantation in the knee." Thesis, University College London (University of London), 2008. http://discovery.ucl.ac.uk/1444392/.
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Osteochondral defects in the knee can be disabling causing persistent pain, giving way, locking, catching and swelling and a reduction in activities including sport. Traditionally symptomatic defects were treated with marrow stimulation techniques such as drilling, abrasion and microfracture of the subchondral bone which have had limited success with usually the production of a fibrocartilage repair. This repair tissue tends to be soft and degenerates over a period of time. Autologous chondrocyte implantation (ACI) has produced hyaline or hyaline-like repair tissue in experimental models and in the clinical setting in early studies, with the potential for permanent regeneration of articular cartilage, thus preventing early onset osteoarthritis. This study reviews the clinical results of 3 techniques of autologous chondrocyte implantation (ACI): the more traditional periosteum covered ACI (ACI-P) implant, the collagen-covered ACI (ACI-C) and the matrix carried autologous chondrocyte implantation (MACI). Single cohort studies of ACI-P and ACI-C over a 4 year period were made together with the provisional results of the MACI procedure at 1 year. Then 2 prospectively randomized studies were performed to compare ACI-C with ACI-P and MACI with ACI-C. Finally a small series of patients were reviewed who had a chondrocyte implantation combined with other surgical techniques such as an anterior cruciate ligament reconstruction or tibial osteotomy. A review of these patients revealed a significant improvement in their clinical scores over 4 years for the ACI-C and ACI-P technique in keeping with previously published data and also for the MACI technique at 1 year. Interestingly, a large number of the ACI-P patients developed graft hypertrophy which required arthroscopic debridement since patients complained of pain and catching. However, the ACI-C and MACI patients rarely developed this problem. The prospectively randomised study did not show any difference in terms of clinical and histological assessment at 2 years between the ACI-C and ACI-P patients. The early results for the MACI technique are also comparable. Based on this data it is proposed that collagen-covered ACI is the present 'gold standard' in chondrocyte implantation rather than periosteum-covered ACI.
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Willers, Craig Robert. "Matrix-induced autologous chondrocyte implantation for articular cartilage injury : biology, histology and clinical outcomes." University of Western Australia. School of Surgery, 2008. http://theses.library.uwa.edu.au/adt-WU2008.0227.
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[Truncated abstract] Articular cartilage has no vascular, neural, or lymphatic supply, and hence no intrinsic capacity to self-repair following injury. These physiological limitations, combined with the inability of local chondrocytes to contribute to the repair process, translate to poor structural and functional outcomes in these troublesome defects, and osteoarthritic deterioration with time. Subsequently, many surgical therapies have been trialed to stimulate cartilage repair, but none have produced reliable outcomes. Hence, cartilage repair research has been broadened, with many investigators now focused on cell-based treatment. Smith began a revolution of autologous cell research when in 1965 she isolated chondrocytes from articular cartilage and transplanted them into fresh cartilage nodules (Smith, 1965). Since, new technologies and improved techniques have seen autologous chondrocyte implantation (ACI) widely accepted for use in clinical orthopaedics (Bentley et al., 2003; Brittberg et al., 1994; Grande et al., 1989; Peterson et al., 2002). At present, matrix-induced autologous chondrocyte implantation (MACI) is the most surgically simple form of ACI, boasting clinical outcomes comparable to any technique on the market, and far less complications compared to the first generation of ACI - periosteal ACI (Bartlett et al., 2005; Behrens et al., 2006; Gigante et al., 2006; Henderson et al., 2004; Marlovits et al., 2005; Minas, 2001; Willers et al., 2007; Zheng et al., 2007). But whilst MACI has been adopted by the orthopaedic surgeon for articular cartilage repair, many of the molecular, histological, and clinical factors governing patient outcomes are still largely understudied. Firstly we assessed the bioactivity of fibrin sealant (FS - Tisseel®), a critical component of MACI, on the migration and proliferation of human articular chondrocytes in vitro. We also looked to elucidate the associated molecular mechanisms of thrombin, a key active ingredient in FS, by examining the expression and activation of proteaseactivated receptors (PARs), established thrombin receptors. All four PAR isoforms were detected in human chondrocytes, with PAR-1 being the major isoform expressed. '...' This thesis has demonstrated biological, histological, and clinical features of the MACI technique. Our in vitro has supported the use of fibrin sealant and collagen membrane as the major material components of MACI, illustrating improved chondrocyte proliferation, migration, and chondrogenic differentiation. We have evidenced that MACI stimulates successful production of hyaline-like cartilage by 6 months, while also showing that revised and clinically failed repair tissues are predominantly hyaline-like and fibrocartilage with inferior composition. Clinically, we have documented significant improvements in patient repair structure, function, symptoms, quality of life, and satisfaction, whilst concurrently confirming sentiment within the literature regarding the importance of exercise/ rehabilitation for maximising MACI outcome. In summary, the findings presented in this thesis suggest that MACI is a biologically sound and clinically efficacious cell-based treatment option for repairing articular cartilage defects.
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Steika, Nils A. "A Comparison of the Wear Resistance of Normal, Degenerate, and Repaired Human Articular Cartilage." Thesis, Virginia Tech, 2004. http://hdl.handle.net/10919/35664.
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In our aging population, arthritis is becoming an increasingly common problem. Pain, loss of joint function and other negative affects make arthritis a major health problem. The most common form of arthritis, osteoarthritis, is caused by the "wear and tear" of articular cartilage on the surface of bones in synovial joints. It is a chronic problem that is slowed with different types of therapies, including pharmaceutical, nutritional and surgical, but to date the wearing down of the cartilage cannot be stopped or reversed.
Normal, mature, articular cartilage does not spontaneously repair itself after an injury. In light of this, several surgical techniques are being developed to repair degenerate and/or osteoarthritic cartilage. One such approach uses Autologous Chondrocyte Implantation (ACI). Dr. Mats Brittberg, and associates at Goteborg University in Sweden began using this cartilage repair procedure in 1987. Other techniques attempt to stimulate the subchondral bone to generate cartilage, such as Abrasion Arthroplasty. Still others use tissue grafts to attempt to repair lesions in cartilage. The surface biomechanics of these repaired tissues have not yet been studied. How well does the repaired cartilage resist wear? How long will it last? How does the repaired cartilage compare to "normal" cartilage in terms of wear-resistance? It is the goal of this research to gain initial knowledge to help answer these questions. Dr. Brittberg has provided 17 sample of cartilage, from 9 Swedish patients, including repaired and normal pairs using the aforementioned repair techniques and others, as well as a degenerate and normal cartilage pair. The intention of this paper is to report the findings of experiments performed using these samples, and compare the wear-resistance of repaired and degenerate cartilage to that of normal cartilage.
Wear and friction tests were carried out on 2 mm diameter specimens using a biotribology device and a new, modified technique developed specifically for these small samples. The cartilage samples were mounted, using specially designed adapters, in our biotribology device for oscillating contact against polished stainless steel disks at a constant applied normal load, oscillating frequency, and test time. A buffered saline solution was used as the lubricant. Cartilage wear was determined from hydroxyproline analysis of the test fluid and washings from the wear test. Thin layers of transferred cartilage-like films to the stainless steel disks were also analyzed. Also, friction data was recorded throughout the tests.
The results of these experiments show that:
1)For the two pairs of ACI repaired cartilage, the repaired cartilage gave substantially less wear than that of normal cartilage.
2)For all other repair techniques tested, the repaired cartilage produced more wear than normal cartilage.
3)The single osteoarthritic cartilage tested produced similar wear to that of normal cartilage. This is surprising since the current thought is osteoarthritic cartilage is more susceptible to wear.
4)The hydroxyproline concentration, by weight, of cartilage increases after the wear test.
5)Friction levels were in the boundary lubrication regime, and had no correlation with the amount of wear.
To our knowledge, this research represents the first controlled "in vitro" study of an important unknown in cartilage repair, i.e., the wear-resistance of the repaired cartilage. It shows that ACI produces a cartilage with very good wear-resistance, better than that of other repair techniques, and possibly better than normal, healthy cartilage. ACI and its applications to the treatment of degenerate and osteoarthritic joints are promising, and studies will continue to investigate this and other types of cartilage repair.Master of Science
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Jaiswal, P. K. "Factors affecting outcome after autologous chondrocyte implantation for the treatment of osteochondral defects of the knee." Thesis, University College London (University of London), 2015. http://discovery.ucl.ac.uk/1467124/.
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Some studies on autologous chondrocyte implantation (ACI) have demonstrated little benefit over other techniques and few have demonstrated a lasting benefit. A number of factors can contribute to failure and a scientific approach to elucidate these variables has not been reported. This thesis reports on the use of a statistical approach - the Generalised Linear Model (GLM) to quantify the effect each factor has whilst considering the interplay of other variables. Data from a randomised controlled trial and several case-controlled studies will assess the efficacy of 2 different types of ACI, the influence of smoking, BMI, and physical activity. Non-modifiable risk factors that were assessed include the aetiology, site and size of the lesion, the duration of symptoms and number of previous operations prior to the index procedure and the presence of early osteoarthritis. Site had a significant effect on outcome but size did not. The GLM predicted a point increase in the Modified Cincinnati Score (MCS) before surgery (MCS 0) would lead to a further 0.5 point increase in MCS 2 years postoperatively (MCS 24) (p=0.001). Other significant non-modifiable risk factors include age and sex of the patient. When treating lesions in the patella, duration of symptoms was a significant factor, but age was not. The GLM predicted that smokers’ MCS 24 (the Modified Cincinnati Score 2 years after surgery) was likely to be 15 less than non-smokers (p=0.002). Patients playing no sports experienced an 11.4 point decrease. For each increase in BMI, the MCS 24 was 2.4 less (p=0.001). Factors that optimise outcome following surgery are; avoidance of numerous procedures prior to ACI and delay of more than one year before undergoing ACI. Current NICE guidelines prohibit the use of ACI as the first-line surgical procedure and prevent addressing the above 2 issues. Poorer results were observed in obese patients. Weight loss and active lifestyle are essential pre-operatively. Furthermore, we recommend that pre-operative counselling for smokers is essential and that all smokers be offered a cessation programme.
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ISHIGURO, NAOKI, HIROHITO MITSUYAMA, YOHEI ONO, MOTOSHIGE NAKASHIMA, HIDEKI HIRAIWA, TADAHIRO SAKAI, and TAKASHI HAMADA. "Surface Markers and Gene Expression to Characterize the Differentiation of Monolayer Expanded Human Articular Chondrocytes." Nagoya University School of Medicine, 2013. http://hdl.handle.net/2237/17606.
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Jones, Christopher Wynne. "Laser scanning confocal arthroscopy in orthopaedics : examination of chondrial and connective tissues, quantification of chondrocyte morphology, investigation of matirx-induced autologous chondrocyte implantation and characterisation of osteoarthritis." University of Western Australia. School of Mechanical Engineering, 2007. http://theses.library.uwa.edu.au/adt-WU2008.0061.
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[Truncated abstract] Articular cartilage (AC) covers the surface of synovial joints providing a nearly frictionless bearing surface and distributing mechanical load. Joint trauma can damage the articular surface causing pain, loss of mobility and deformation. Currently there is no uniform treatment protocol for managing focal cartilage defects, with most treatment options targeted towards symptomatic relief but not limiting the progression into osteoarthritis (OA). Autologous chondrocyte implantation (ACI) and more recently matrix-induced autologous chondrocyte implantation (MACI), have emerged as promising methods for producing hyaline or hyaline-like repair tissue, however there remains some controversy regarding the exact histological nature of the tissue formed. Histological characterisation of AC repairs requires destructive tissue biopsy potentially inducing further joint pathology thereby negating the treatment effect. OA is recognised as a major cause of pain, loss of function and disability in Western populations, however the exact aetiology is yet to be elucidated. The assessment of both OA and cartilage repair has been limited to macroscopic observation, radiography, magnetic resonance imaging (MRI) or destructive biopsy. The development of non-destructive AC assessment modalities will facilitate further development of AC repair techniques and enable early monitoring of OA changes in both experimental animal models and clinical subjects. Confocal laser scanning microscopy (CLSM) is a type of fluorescence microscopy that generates high-resolution three-dimensional images from relatively thick sections of tissue. ... Biomechanical analysis suggested that the mechanical properties of MACI tissue remain inferior for at least three months. This study showed the potential of a multi-site sheep model of articular cartilage defect repair and validated its assessment via LSCA. Finally, the LSCA was used to arthroscopically image the cartilage of an intact fresh frozen cadaveric knee from a patient with clinically diagnosed OA. Images were correlated to ICRS (Outerbridge) Grades I-IV and histology. The LSCA gave excellent visualization of cell morphology and cell density to a depth of up to 200'm. Classical OA changes including clustering chondrocytes, surface fibrillation and fissure formation were imaged. Fair to moderate agreement was demonstrated with statistically significant correlations between all modalities. This study confirmed the viability of the LSCA for non-destructive imaging of the microstructure of the OA cartilage. In conclusion, the LSCA identified histological features of orthopaedic tissues, accurately quantified chondrocyte morphology and demonstrated classical OA changes. While the development and investigation of an ovine model of cartilage repair showed the treatment benefit of MACI, some biomechanical issues remain. Ultimately, the LSCA has been demonstrated as a reliable nondestructive imaging modality capable of providing optical histology without the need for mechanical biopsy. Medical Subject Headings (MESH): articular cartilage; autologous chondrocyte implantation; matrix-induced autologous chondrocyte implantation; biomechanics; cartilage; confocal microscopy; diagnosis; histology; image analysis; immunohistochemistry; magnetic resonance imaging; microscopy; osteoarthritis
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Robertson, William Brett. "Functional and radiological evaluation of autologous chondrocyte implantation using a type I/III collagen membrane: from single defect treatment to early osteoarthritis." University of Western Australia. Orthopaedics Unit, 2007. http://theses.library.uwa.edu.au/adt-WU2007.0172.
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[Truncated abstract] Hyaline articular cartilage is a highly specialised tissue consisting of chondrocytes embedded in a matrix of proteoglycan and collagens. Hyaline articular cartilage withstands high levels of mechanical stress and continuously renews its extracellular matrix. Despite this durability, mature articular cartilage is vulnerable to injury and disease processes that cause irreparable tissue damage. Native hyaline articular cartilage has poor regenerative capacity following injury, largely due to the tissue's lack of blood and lymphatic supply, as well as the inability of native chondrocytes to migrate through the dense extracellular matrix into the defect site. Articular cartilage injuries that fail to penetrate the subchondral bone plate evoke only a short-lived metabolic and enzymatic response, which fails to provide sufficient new cells or matrix to repair even minimal damage. Clinically, it has previously been accepted that treatment of such defects does not result in the restoration of normal hyaline articular cartilage, which is able to withstand the mechanical demands that are placed on the joint during every day activities of daily living. ... Historically, rehabilitation following ACI has not kept pace with the advances in cell culture and surgical technique. Subsequently, there exists a significant gap in knowledge regarding `best practice' in post operative rehabilitation following ACI. The importance of structured rehabilitation in ACI should not be underestimated when evaluating the clinical success of this chondral treatment. Patients should not be left to their own devices following ACI surgery, as the risk of damage to their implant (via delamination) is high if immediate postoperative movement is not controlled. Furthermore, the biological longevity and clinical success of the graft is dependent on a controlled and graduated return to ambulation and physical activity, and the biomechanical stimulation of the implanted chondrocytes.
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Robertson, William Brett. "Functional and radiological evaluation of autologous chondrocyte implantation using a type I/III collagen membrane : from single defect treatment to early osteoarthritis /." Connect to this title, 2006. http://theses.library.uwa.edu.au/adt-WU2007.0172.
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Howard, Jennifer Sebert. "CLINICAL AND FUNCTIONAL ASSESSMENT FOLLOWING AUTOLOGOUS CHONDROCYTE IMPLANTATION TO THE KNEE: THE ROLE OF PATIENT REPORTED OUTCOMES, PERFORMANCE BASED ASSESSMENT, AND RESPONSE SHIFT." UKnowledge, 2011. http://uknowledge.uky.edu/rehabsci_etds/1.
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Autologous chondrocyte implantation (ACI) is a cell based therapy for the treatment of articular cartilage defects. Numerous studies have reported outcomes following ACI using a variety of patient reported outcomes (PROs), but no clear recommendations exist regarding which PRO is the most responsive to changes following ACI. Few studies have documented changes in performance based assessments (PBAs) following ACI. Response shift theory proposes that residual changes in self-report measures occur over time. Failing to account for response shift may result in over or under reporting of outcomes from which clinical decisions are made. The purposes of this dissertation were 1) review the literature concerning ACI outcomes to determine the responsiveness of PROs to changes in self-reported function following ACI, 2) evaluate the reliability of PBAs among ACI patients, 3) develop a descriptive timeline for the return of function 1 year following ACI using both PROs and PBAs, and 4) utilize PROs and PBAs to evaluate patients undergoing ACI for evidence of response shift.
All PRO and PBA measures were collected preoperatively and 3, 6, and 12 months postoperatively. A retrospective then-test PRO evaluation of function prior to surgery was completed at 6 and 12 months. Response shift was calculated by subtracting the original pre-test score from the then-test score.
A systematic review and meta-analyses of existing ACI outcome studies resulted in the recommendation of the International Knee Documentation Committee Subjective Knee Form (IKDC) and Lysholm Knee Scale as highly responsive PROs among ACI patients of varying activity levels. Despite significant increases in PRO scores as early as 6 months following ACI, improvement in PBAs at 12 months following ACI were limited to stride length, walking speed, and step-up force. Finally, no evidence of a group level effect for response shift was observed. These results support the validity of traditional pre-test/post-test research designs with no need to account for response shift when evaluating treatment effects of ACI on the group level. However, the Western Ontario and McMasters University Osteoarthritis Index (WOMAC) did show evidence of a measurable response shift on a patient by patient basis.
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Toonstra, Jenny L. "THE RELATIONSHIP BETWEEN PATIENT EXPECTATIONS, FUNCTIONAL OUTCOME, SELF-EFFICACY, AND REHABILITATION ADHERENCE FOLLOWING CARTILAGE REPAIR OF THE KNEE: A SEQUENTIAL EXPLANATORY ANALYSIS." UKnowledge, 2014. http://uknowledge.uky.edu/rehabsci_etds/20.
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Patient expectations have been shown to be a major predictor of outcomes. Furthermore, fulfilled expectations have been linked to increased patient satisfaction and rehabilitation adherence. Expectations may be influenced by a variety of factors, including patient characteristics, pre-operative function, or disease characteristics. However, it is currently unknown what factors and to what degree they may influence patient expectations prior to knee surgery. Furthermore, understanding the importance and values of those expectations for recovery using qualitative methods has not previously been conducted in this patient population.
A mixed methods design was used. Twenty-one participants scheduled to undergo cartilage repair of the knee, including autologous chondrocyte implantation, osteochondral allograft transplantation, or meniscal transplant were included. During their pre-operative visit, participants completed an expectations survey (Hospital for Special Surgery (HSS) Knee Surgery Expectations Survey) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) as a measure of functional ability. At their first post-operative visit, patients completed the Self-Efficacy for Rehabilitation Scale (SER). Rehabilitation adherence was collected by the participant’s rehabilitation provider. A selected sample of 6 participants participated in a semi-structured interview 6 months following surgery to better understand their expectations for recovery. Pearson correlation coefficients were used to determine relationships between expectations and KOOS scores, SER scores, and measures of adherence.
Results demonstrated that patients have moderate expectations for recovery and these expectations were positively associated with pre-operative pain, activities of daily living, and knee-related quality of life as measured by the KOOS. In addition, a negative relationship was found between patient expectations and adherence with home exercises, use of a brace, and weight-bearing restrictions. Four qualitative themes emerged as participants’ described how previous recovery experiences shaped their recovery following cartilage repair of the knee. Patient education, pre-habilitation, and the use of psychological skills during rehabilitation may help to manage patient expectations, improve rehabilitation adherence, and assist clinicians in providing more focused and individualized patient care.
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Whale, Conley Caitlin E. "EFFECT OF A 12-WEEK HOME-BASED NEUROMUSCULAR ELECTRICAL STIMULATION TREATMENT ON CLINICAL OUTCOMES FOLLOWING ARTICULAR CARTILAGE KNEE SURGERY." UKnowledge, 2017. http://uknowledge.uky.edu/rehabsci_etds/40.
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Articular cartilage defects in the knee are common, and can result in pain, decreased function and decreased quality of life. Untreated defects are considered to be a risk factor for developing osteoarthritis, a progressive degenerative joint disease with minimal treatment options. To address these issues, various surgical procedures are available to treat articular cartilage defects in the knee. While these procedures overall have positive results, after surgery patients experience large and persistent deficits in quadriceps strength. A contributing factor to this post-surgical weakness is believed to be the extended post-operative non-weight bearing period, with full weight bearing not initiated until approximately 4 – 6 weeks after surgery. During this non-weight bearing period a minimal amount of demand is placed upon the muscle. Subsequently, the quadriceps muscle undergoes a large degree of atrophy with a significant decrease in muscle strength. Muscular strength deficits reduce the knee joint stability, also increasing the risk of osteoarthritis development. Interventions that can be used to facilitate quadriceps strength while protecting the articular cartilage repair are needed. Neuromuscular electrical stimulation (NMES) is an effective post-knee surgery rehabilitation technique to regain quadriceps musculature. In recent years manufactures have been developing knee sleeve garments integrated with NMES allowing for portability of the NMES treatment.
The primary aim of this study was to evaluate the effectiveness of a 12-week home-based neuromuscular electrical stimulation treatment on post-surgical clinical outcomes (quadriceps strength, lower extremity function, and patient reported outcomes) after articular cartilage knee surgery. Patients were randomized between a standard of care home-treatment group and a NMES home-treatment group. Patients completed isometric quadriceps strength testing, the Y-balance test, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) before surgery and at 3-months after surgery. The secondary aims of this study were to determine the most effective NMES parameters for post-surgical quadriceps strength; and to develop a framework to identify factors that may influence a patient’s adherence to a prescribed therapy program.
From our results we can make several conclusions. First, we found only a small number of studies utilize similar parameters for post-surgical quadriceps strength treatments. The majority of the parameters reported in the literature were highly variable between studies. Second, clinicians can utilize the expanded Health Belief Model to identify situational and personal factors unique to a patient that may impact adherence to a prescribed treatment. Clinicians can then implement the proposed interventional strategies to address the identified situational and personal factors. Finally, there was no difference in quadriceps strength, lower extremity function, or self-reported scores at 3-month between a home-based NMES treatment and a standard of care home-based treatment. Patients’ adherence to the treatment protocols may have been a major factor contributing to these results. Utilizing a model, such as the proposed expanded Health Belief Model, may assist clinicians in improving a patients’ adherence to future prescribed home-treatment programs.
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Rakic, Rodolphe. "Nouvelles stratégies thérapeutiques des affections articulaires du cheval : évaluation du potentiel thérapeutique des chondrocytes autologues et des cellules souches de cordon ombilical (sang et gelée de Wharton) : vers l'industrialisation de cellules médicaments." Thesis, Normandie, 2017. http://www.theses.fr/2017NORMC406/document.
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Les affections articulaires touchant le cartilage, telles que les lésions focales et l’arthrose, correspondent aux principales causes de baisse de performance et d’arrêt prématuré de la carrière sportive du cheval. Ainsi, le traitement des affections du cartilage représente un enjeu vétérinaire majeur dans le monde équin, du fait des importantes pertes financières qu’elles occasionnent à la filière. Les faibles capacités de réparation intrinsèque du cartilage, ainsi que l’absence de thérapie à long terme des dommages cartilagineux, nécessitent le recours à des thérapies de nouvelles générations telle que l’ingénierie tissulaire du cartilage. Dans ce cadre, notre étude s’est attachée à comparer différents types cellulaires pour la génération de cartilage in vitro, afin d’envisager une implantation pour traiter les atteintes cartilagineuses chez le cheval. Une technique initialement développée chez l’Homme, la transplantation de chondrocytes autologues, représente toujours un « gold standard » en ingénierie tissulaire du cartilage. Dans ce travail de thèse, après avoir développé une nouvelle génération de substitut cartilagineux de haute qualité biologique, à partir de chondrocytes articulaires équins, des limites techniques et biologiques inhérentes au type cellulaire persistent. Ainsi, nos travaux se sont tournés vers la recherche de types cellulaires alternatifs. Les cellules souches/stromales mésenchymateuses (CSM) néonatales issues de cordon ombilical telles que les CSM de sang placentaire (CSM-SPL) et les CSM de gelée de Wharton (CSM-GW) pourraient représenter un avantage thérapeutique du fait de leur isolement non-invasif, de leur forte prolifération cellulaire et de leur capacité de différenciation en chondrocyte. Il est néanmoins indispensable de définir le meilleur candidat thérapeutique, parmi ces deux sources cellulaires, pour l’obtention d’un substitut cartilagineux de qualité biologique optimale. Ces résultats de thèse ont montré d’importantes différences dans le processus de chondrogenèse de ces deux sources de CSM néonatales et plaident en faveur de l’utilisation des CSM-SPL dans le cadre d’une stratégie thérapeutique d’ingénierie tissulaire du cartilage équin. Ces travaux ont permis une meilleure compréhension de la biologie du chondrocyte et des CSM. De surcroît, ces travaux permettent d’envisager de futurs essais cliniques chez le cheval, afin de traiter les affections articulaires de ce modèle gros animalArticular cartilage disorders, such as focal defects and osteoarthritis, are the main causes of decreased performance or early retirement of sport- and racehorses. Thus, cartilage disorders represent a major veterinary issue in the equine industry, due to significant financial losses. Poor intrinsic cartilage repair properties and the absence of long- term therapy for cartilage defects lead to the development and use of new generation therapies such as autologous chondrocytes implantation. In this context, our study aimed to compare different cell types for the in vitro cartilage generation, in order to implant the biological substitute to treat cartilage defects in the horse. A therapeutic strategy initially developed in human medicine, the autologous chondrocytes transplantation, always represents a "gold standard" in cartilage tissue engineering. In the present study, after developing a new generation of cartilaginous substitute of high biological quality, composed of equine articular chondrocytes, technical and biological limits inherent to the cell type persist. Thus, we have used alternative cell types such as neonatal mesenchymal stem/stromal cells (MSCs) from umbilical cord, such as umbilical cord blood MSC (UCB-MSCs) and umbilical cord matrix or Wharton jelly MSCs (UCM- MSCs). These MSCs sources could represent a therapeutic advantage due to their non-invasive isolation, their high cell proliferation and their ability to differentiate into chondrocytes. Nevertheless, it is essential to define the best therapeutic candidate between these two MSCs sources, to obtain an optimal quality for the neocartilaginous substitute. Our data highlighted important differences in the chondrogenesis process of these two neonatal MSCs sources, allowing us to consider UCB-MSCs as the best therapeutic candidate for equine cartilage tissue engineering. This work allows a better understanding of the chondrocyte and MSCs biology. Moreover, this work leads the way to setting-up future clinical trials in the horse, in order to treat articular defects of this large animal model
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Cathelinaud, Olivier. "Implantation de chondrocytes autologues pour lésions cartilagineuses du genou du sujet jeune : rapport préliminaire à propos de 25 cas." Bordeaux 2, 1999. http://www.theses.fr/1999BOR2M023.
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Gehmlich, Jan. "Preclinical trial to examine the efficacy and safety of the treatment with the autologous chondrocyte transplantation ovine test sample co.don chondrosphere® (ACT3D-S)." 2018. https://ul.qucosa.de/id/qucosa%3A35881.
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Purpose of this study was to show the efficacy and safety of the investigational product co.don chondrosphere® (ACT3D-S). ACT3D-S is a product for autologous chondrocyte transplantation that we used in an animal model, the merino land sheep. We compared the treatment of ACT3D-S (Group A: Investigational product) with an untreated control (Group B: Control Intervention) in a bilateral model, what means that by randomization one hind limb was chosen to be treated with ACT3D-S while the remaining hind limb was left without treatment.
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Michalak, Milosch. "Therapie osteochondraler Defekte des Kniegelenks unter Verwendung des Knorpel-Knochen-Ersatzmaterials (TruFit®) in Kombination mit einer einzeitigen autologen Knorpelzelltransplantation im Langzeittierversuch." Doctoral thesis, 2015. http://hdl.handle.net/11858/00-1735-0000-0022-5FB0-A.
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Knorpeldefekte des Kniegelenks zeichnen sich durch eine sehr begrenzte spontane Heilungstendenz aus und führen im Verlauf häufig zur Arthrose. Trotz intensiver Forschungsbemühungen konnte bisher keine neue Therapieoption eine zufrieden-stellende Alternative zu den bisherigen Therapien hervorbringen. Eine ACI in Kombination mit einem künstlich hergestellten Knorpel-Knochen-Ersatzmaterial scheint jedoch großes Potential für die Therapie von Knorpel-Knochen-Schäden zu besitzen.
Im vorliegenden Langzeittierversuch mit Kaninchen wurde eine einzeitige ACI mit einem biphasischen Ersatzmaterial (TruFit®) und platelet-rich-plasma (PRP) kombiniert. Zu diesem Zweck wurde in der medialen Femurkondyle ein critical-size-Defekt mit einem Durchmesser von 4,5 mm gesetzt. In der ersten Versuchsgruppe blieb der Defekt unbehandelt (Leer). Bei der zweiten Gruppe wurde die Defekthöhle mit einem TruFit®-Zylinder aufgefüllt (TFP). Gruppe drei erhielt zusätzlich PRP (TFP+PRP) und Gruppe vier wurde darüber hinaus mit einer einzeitigen ACI kombiniert (TFP+PRP+C), bei der Chondrozyten mit Hilfe eines speziellen Kollagenase-Schnellverdaus isoliert werden konnten.
Die Auswertung der Knorpel-Knochen-Regeneration erfolgte nach 12 Monaten durch eine Mikroradiographie, eine intravitale Fluoreszenzmarkierung des Knochens und durch Toluidinblau-O- und Safranin-O-Färbungen. Verwendet wurden die Scores nach Wakitani und O’Driscoll.
Dabei konnte gezeigt werden, dass eine TruFit®-Therapie die Knochenregeneration positiv beeinflussen kann. Die Zugabe von PRP bewirkte die Bildung von zahlreichen dünnen Trabekeln mit einer erhöhten Anzahl trabekulärer Verbindungen, allerdings auch eine schlechtere Rekonvaleszenz der subchondralen Knochenschicht. Bezüglich der Knorpelheilung schnitt die Gruppe TFP+PRP+C am besten ab, wobei die Unterschiede nicht signifikant waren. Insgesamt zeigten alle Versuchsgruppen eine unzureichende osteochondrale Regeneration, so dass für die Therapie am Menschen zunächst weitere Studien nötig sind, die sowohl ossär als auch chondral eine verbesserte Heilungspotenz demonstrieren können. Bisher fehlen groß angelegte Studien um Therapieempfehlungen bezüglich des Ersatzmaterials, der genauen Durchführung der einzeitigen ACI und Zusätzen wie Wachstumsfaktoren zu machen.
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Kaňa, Radim. "Histomorfologické změny chrupavkových tkání za patologických stavů i po transplantaci u lidí a v experimentu." Doctoral thesis, 2011. http://www.nusl.cz/ntk/nusl-299425.
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1 Abstract Introduction Autologous transplants of the cartilage tissue from the pinna is commonly used in reconstructive surgery of the nasal skeleton. The present study used animal models to elucidate responses of the auricular cartilage to its damage or transplantation to ectopic sites. Histomorphological analysis of changes observed in auricular cartilage including immunohistochemical study of different isoforms of actin and S-100 proteins was performed. Human articular cartilage prepared by in vitro cultivation using artificial scaffolds was also studied after its transplantation. Aims of the study The aim was to study histological changes and expression of chondrocytic markers (α- SMA and S-100 proteins) in intact, artificially traumatised, or in a human auricular cartilage cultivated in culture medium. An attempt to grow human auricular cartilage chondrocytes implanted in vitro into various types of three dimensional scaffolds aimed at testing chondrocyte survival and phenotype both in the culture and after transplantation to immunodeficient mice. A human auricular cartilage transplanted into the nasal skeleton of patients during a reconstruction surgery should be submitted to a histomorphological examination. Research assumed also comparison of the auricular cartilage responses to a damage,...