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AOSSM 2022 Annual Meeting Recordings - no CME
Improved Cartilage Healing with Microfracture Augm ...
Improved Cartilage Healing with Microfracture Augmented with Fisetin & Bone Marrow Aspirate Concentrate in Acute Osteochondral Defect
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Video Transcription
Micro-fractures are commonly the first choice of treatment for cartilage injuries. It is minimally invasive, cost-effective, and evidence-based treatment. Long-term results of micro-fractures have limited evidence for older patients with larger defects. Fibro-cartilage, not hyaline cartilage, has been reported after micro-fracture treatment. Here is a challenge. Can we improve micro-fracture? Here we have phytocin and BMAC. Phytocin is a synolytic flavonoid known for its ability to reduce sensing cells and for its antioxidant and anti-inflammatory functions. BMACs are originally expected to be a source of MSCs and growth factors. Recently, it has been attracting much attention for its potential as an anti-inflammatory agent. We hypothesize that phytocin and BMAC, or a combination of the two, can enhance cartilage repair of micro-fracture-treated osteochondral defects in rabbits. Osteochondral defects of 5 mm in diameter and 2 mm in depth were created in the patellar groove of each rabbit, and at 2 mm depth, micro-fracture was performed to create 5 holes. Before surgery, bone marrow aspirate was harvested in each rabbit and processed to prepare BMAC. After micro-fracture treatment, BMAC was injected into the knee joint. Rabbits were further assigned to a group with or without post-operative treatment with phytocin. Rabbits were then divided into four groups, micro-fracture alone group, micro-fracture plus phytocin group, micro-fracture plus BMAC group, micro-fracture plus phytocin plus BMAC group. Microscopic appearance, micro-CT histology, QPCR, and biomechanical tests were done for analysis. In the micro-fracture plus BMAC and micro-fracture plus phytocin plus BMAC group, the ICRS macroscopic score was significantly increased compared to micro-fracture alone group. In micro-CT, you can see the subchondral bone here is better in micro-fracture plus phytocin, micro-fracture plus BMAC, and micro-fracture plus phytocin plus BMAC group compared to micro-fracture alone group. Combined use of phytocin and BMAC after micro-fracture achieved significantly higher macroscopic findings. In the micro-fracture plus BMAC and micro-fracture plus phytocin plus BMAC groups, the histological score increased significantly compared to micro-fracture alone group, indicating better hyaline carotid regeneration. Our results indicate that combined use of phytocin and BMAC after micro-fracture resulted in significantly higher quality carotid regeneration. In addition, strong stain on type 2 collagen observed in micro-fracture plus phytocin, micro-fracture plus BMAC, and micro-fracture plus phytocin plus BMAC groups, with a strong decrease in staining of B16, a sensitive cell marker, in phytocin-treated groups. We performed biomechanical analysis to determine the strength of the regenerated carotid and found that micro-fracture plus phytocin plus BMAC groups showed significant increase compared to micro-fracture alone group. QPCR showed the expression level of SOD1, a frontline antioxidant enzyme, in synovium was significantly higher in micro-fracture phycidin plus BMAC group than in phycidin micro-fracture alone group, indicating that antioxidant effect of phycidin may promote carotid regeneration. Chondrocyte senescence has been shown to contribute to the risk of carotid degeneration by reducing the ability to maintain and repair the tissue. So, strategy to delay the onset of chondrocyte senescence and replace senescent cells would be promising strategy for carotid repair. Phycidin has recently been shown to have strong signaling activity and to inhibit the progression of osteoarthritis in aged mice. Our research revealed that phycidin may improve carotid healing by acting as an antioxidant to reduce cellular senescence. In conclusion, the addition of BMAC enhanced healing of micro-fracture-treated osteochondral defects. Furthermore, supplementation with phycidin further accelerated carotid repair, resulting in significantly higher quality carotid regeneration with stronger mechanical properties. Thank you for your attention.
Video Summary
In this video, the speaker discusses the treatment of cartilage injuries using micro-fractures. They explain that while micro-fractures are often used and have benefits, there is limited evidence for older patients with larger defects. The speaker then introduces two potential improvements to micro-fracture treatment: phytocin, a flavonoid with anti-inflammatory properties, and BMAC, which has anti-inflammatory benefits. The speaker presents an experiment conducted on rabbits with osteochondral defects, where micro-fracture treatment was combined with either phytocin, BMAC, or both. The results showed that the combination of phytocin and BMAC led to better macroscopic and histological scores, indicating improved cartilage regeneration. Biomechanical analysis also showed stronger regenerated cartilage in this group. The video concludes by suggesting that phytocin may delay chondrocyte senescence and improve cartilage healing.
Asset Caption
Naomasa Fukase, MD, PhD
Keywords
cartilage injuries
micro-fractures
phytocin
BMAC
cartilage regeneration
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