Microfracture used to treat articular cartilage injuries can facilitate access to stem cells in the bone marrow and stimulate cartilage regeneration. However, the regenerated cartilage is fibrocartilage as opposed to hyaline articular cartilage and is thinner than native cartilage. Following microfracture in rabbit knee cartilage defects, application of hyaluronic acid gel resulted in regeneration of a thicker, more hyaline-like cartilage. The addition of transforming growth factor-beta3, an inducer of chondrogenic differentiation in mesenchymal stem cells, to the treatment with microfracture and hyaluronic acid did not significantly benefit cartilage regeneration.
"Takahashi et al.22) stated that HA produces therapeutic effects by suppressing the production of nitric oxide. Intra-articular injection of HA increases the lubrication in synovial joints, and increases the friability, which is lowered in empirically formed osteoarthritis23,24). Furthermore, it decreases the concentration of fibrolytic factors whose numbers rise during the progress of osteoarthritis, and it causes a rise in glycosaminoglycan levels that form the inner structure of the cartilage matrix. "
[Show abstract][Hide abstract] ABSTRACT: To evaluate the treatment results of intraarticular injection according to the frequency of hyaluronic acid with mesenchymal stem cells on the osteochondral defect of rabbits' medial femoral condyles.
A 5 mm diameter and 4 mm depth osteochondral defect was made on the medial femoral condyles of 18 rabbits, divided into six groups. One week after osteochondral defect, group B was injected intraarticularly with hyaluronic acid (HA), group C with mesenchymal stem cells (MSCs), and group D, E and F with both HA and MSCs. Group E and F received second HA injection a week after. Further, group F received third HA injection in the third week.
In a macroscopic evaluation, groups B (6; range, 5-8), C (6; range, 6-7), D (7; range, 6-7), E (6.5; range, 6-8) and F (7.5; range, 6-8) showed statistically significant improvements in osteochondral defect healing, compared with that of group A (4; range, 3-5) (p=0.002). In histological evaluation, groups B (11.5; range, 11-13), C (13; range, 12-18), D (16; range, 13-18), E (17.5; range, 13-20), and F (19.5; range, 12-22) showed statistically significant differences in osteochondral defect healing, compared with group A (8; range, 6-9) (p=0.006).
The intraarticular injections of MSCs or HA can play an effective role during the healing osteochondral defects in rabbits.
"Consequently , repair of full-thickness cartilage defects is still a challenge (Martin et al., 2007). Various tissue-engineering procedures have been developed and applied in an attempt to repair damaged articular cartilage (Yan and Yu, 2007; Kang et al., 2008; Wang et al., 2010). Implantation of autologous chondrocytes or undifferentiated bone marrow-derived stem cells (MSCs) has been subject to exhaustive investigation and/or even clinical application (Halem et al., 2010; Harris et al., 2010). "
"These results suggested that the usage of intraarticular HA prevents inflammation and catabolic degeneration in cartilage and synovial tissues. Kang et al. (2008) applied HA after an empirically-formed micro fracture. In this study, intraarticular injection of hyaluronic acid was applied twice with autogenetic cancellous grafts for rehabilitation of empirically formed osteochondral defects. "
[Show abstract][Hide abstract] ABSTRACT: The present study examined the results of using hyaluronic acid with autogenetic cancellous grafts in the treatment of experimentally induced osteochondral defects in the stifle joints of dogs. In this study, 10 mature dogs of different breeds, weights and of both sexes were used. General anesthesia and usual operation proce- dures were followed. A 10 mm deep defect was created on the femoral sulcus of the trochlea with a drill tip of 8 mm in diameter. The defects in the right and left legs were filled with autogenic cancellous grafts taken from the metaphysial region of the tibia. The left legs constituted the experimental group while the right legs served as control group. In the experimental group, 2 mg/kg intraarticular hyaluronic acid was twice administered into the stifle joint, i.e., immediately subsequent to the operation and 1 month afterwards. Parenteral antibiotics were prescribed postoperatively for ten days. Five animals were sacrificed at the third and sixth month after surgery. Macroscopic and microscopic findings obtained from each case were evaluated. On macroscopical examination, trochlear defects were determined to be incompletely filled at the third month in both control and experimental groups. On histopathologic examination, a loose fibrovascular formation in the area where the graft was applied was observed to be present in both control and experimental groups. However, in the experimental group this formation was more superficial, ossification activity was greater and trabeculous bone formation had been initi- ated. Macroscopical examination carried out in the sixth month determined that in the control group the defect surface did not fill up to the trochlear sulcus level. In the histopathologic examination, in control groups it was found that fibrocartilageous structures were developing in the fibrovascular space even though ossification was incomplete. The macroscopic examination showed that in the experimental group, the defect surface reached the trochlear sulcus level of defects in this month. The histopatologic examination revealed that fibrous tissue comprised a thin layer, under which ossification processes were complete and bone trabeculates fully formed. It was concluded that the usage of autogenic cancellous graft along with hyaluronic acid may be useful in the repair of large osteochondral defects.
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