Cartilage regeneration using a novel autologous growth factors-based matrix for full-thickness defects in sheep

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 27; no. 3; pp. 950 - 961
• Main Authors: Domínguez Pérez, Juan Manuel, Fernández-Sarmiento, José Andrés, Aguilar García, Daniel, Granados Machuca, María del Mar, Morgaz Rodríguez, Juan, Navarrete Calvo, Rocío, Pérez Arévalo, José, Carrillo Poveda, José María, Alentorn-Geli, Eduard, Laiz Boada, Patricia, Cugat Bertomeu, Ramón
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.03.2019; Springer Nature B.V
• Subjects: Animals; Biomaterials; Biomedical materials; Cartilage; Cartilage (articular); Cartilage, Articular - injuries; Cartilage, Articular - pathology; Cartilage, Articular - surgery; Chondrogenesis; Chondrogenesis - physiology; Collagen; Defects; Experimental Study; Femur; Fibers; Graft rejection; Growth factors; Hyaline Cartilage - transplantation; Implantation; Injections, Intra-Articular; Instrumentation; Intercellular Signaling Peptides and Proteins - blood; Intercellular Signaling Peptides and Proteins - pharmacology; Knee; Medicine; Medicine & Public Health; Microscopy; Microscopy, Electron, Transmission; Models, Animal; Orthopedics; Platelet-Rich Plasma; Platelets; Regeneration; Repair; Sheep; Surgery; Surgical implants; Transmission electron microscopy; Transplantation, Autologous; Weight; Cartilage regeneration; Chondral defect; Plasma rich in growth factors; Chondrogenesis
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-018-5107-z

Purpose To investigate the chondrogenic-regenerative properties of a novel autologous-made matrix composed of hyaline cartilage chips combined with a growth factors-based clot for full-thickness defects in sheep. Methods A full-thickness, 8-mm diameter cartilage defect was created in the weight-bearing area of the medial femoral condyle in 6 sheep. Treatment consisted of surgical implantation of an autologous-based matrix of hyaline cartilage chips combined with a clot of plasma poor in platelets and intraarticular injection of plasma rich in growth factors. Outcome measures at 1, 3 and 6 months included macroscopic International Cartilage Repair Society (ICRS) score, histological and immunohistochemical analysis for collagen expression, and transmission electron microscopy study. Results The 6-month macroscopic evaluation showed nearly normal (11.1 ± 0.7) cartilage repair assessment. The ICRS score was significantly higher at 6 months compared to 3 months (5.5 ± 1.3; p  < 0.0001) and 1 (1.1 ± 0.4; p  < 0.0001) month. At 6 months, hyaline cartilage tissue filling the defect was observed with adequate integration of the regenerated cartilage at the surrounding healthy cartilage margin. At 6 months, mature chondrons and cartilage matrix contained collagen fibers with masked fibrillary structure, and the expression of collagen in the newly formed cartilage was similar in intensity and distribution pattern compared to the healthy adjacent cartilage. Conclusions This novel treatment enhanced chondrogenesis and regenerated hyaline cartilage at 6 months with nearly normal macroscopic ICRS assessment. Histological analysis showed equivalent structure to mature cartilage tissue in the defect and a collagen expression pattern in the newly formed cartilage similar to that found in adjacent healthy articular cartilage. The present technique may have clinical application for chondral injuries in humans because this procedure is cheap (no need for allograft, or expensive instrumentation/biomaterials/techniques), easy and fast-performing through a small arthrotomy, and safe (no rejection possibility because the patients’ own tissue, cells, and plasma are used).