Kompendium 2020 Forschung & Klinik

More documents

Info

TOP-Studien 46 Biological Regeneration in Early Osteoarthritis In <strong>2020</strong>, researchers of the Department of Orthopedics and Trauma Surgery published an article entitled „Biological Regeneration of Articular Cartilage in an Early Stage of Compartmentalized Osteoarthritis: 12-Month Results“ in the American Journal of Sports Medicine 1 . The paper was the result from fruitful interdisciplinary cooperation between clinical scientists, orthopedic surgeons, and basic researchers. For her work, Dr. Martina Hauser-Schinhan was awarded the Research Award of the „Österreichische Gesellschaft für Orthopädie und Orthopädische Chirurgie (ÖGO)“ which honors outstanding scientific contributions that have an impact on the entire field of orthopedics. Background Osteoarthritis is the most common joint disease in the western world. It is characterized by degenerative chondropathy, subchondral bone sclerosis, and the presence of osteophytes. In contrast to focal cartilage defects, osteoarthritis affects the entire joint. To date, the curative treatment of osteoarthritis is limited to joint replacement surgery. However, this entails certain surgical risks and limited implant survival, especially in young sportive patients. The demands regarding regeneration, which are also made more and more by older patients due to their increased activity, can often not be met with artificial joints. In localized cartilage defects without osteoarthritis, cartilage regeneration using different methods depending on the size of the defect has already become clinical reality 2 . Study: Schinhan M, Toegel S, Weinmann D, Schneider E, Chiari C, Gruber M, Nehrer S, Windhager R. Biological Regeneration of Articular Cartilage in an Early Stage of Compartmentalized Osteoarthritis: 12-Month Results. Am J Sports Med. <strong>2020</strong> May;48(6):1338–1346. The autologous chondrocyte transplantation technique was already described in 1994 by Brittberg et al. 3 . A further development of this approach is MACT (matrix-assisted autologous chondrocyte transplantation), in which chondrocytes are inserted into the cartilage defect on a carrier matrix. Due to the poor results of this technique in arthritic joint conditions 4 , the patient group with early osteoarthritis can only be treated with symptomatic therapy. Methods To find a solution for this group of patients, two large animal studies with follow-up periods of 4 and 12 months, respectively, were carried out as part of an EU-funded project 1,5 . In total, 48 Austrian mountain sheep were operated twice. First, unicompartmental osteoarthritis was induced in the stable joint by removing a standardized cartilage cylinder (7 mm defect with a loading time of 12 weeks). The removed cartilage was used for the isolation and cultivation of autologous chondrocytes. In a second procedure, the sheep
TOP-Studien 47 Figure 1. (A) Intraoperative picture of the medial femoral condyle after spongialization. The size of the defect was standardized to remove the most degenerated cartilage areas. Macroscopic image of the (B) MACT group at the 12-month follow-up. were separated into three different treatment groups (SPONGIO, MATRIX, MACT) and one control group in which the cartilage defect and the surrounding tissue were not treated. In the sheep of the SPONGIO group, the cartilage of the load-bearing zone of the medial femoral condyle was removed with a standardized oval punch and a curette. The bone was then removed to a depth of 2.5 mm using a burr with a spherical and a cylindrical attachment. This technique is called „spongialization“ 6 . Bleeding was stopped with a thin layer of fibrin glue (Figure 1A). „To date, the curative treatment of osteoarthritis is limited to joint replacement surgery. However, this entails certain surgical risks and limited implant survival, especially in young sportive patients.“ Stefan Toegel The animals in the MATRIX group received the same treatment as those in the SPONGIO group, with the difference that a hyaluronic acid matrix was applied on top of the fibrin layer. In the MACT group, the procedure was similar to that in the MATRIX group. The difference was that the hyaluronic acid matrix was colonized with autologous cultured chondrocytes (1 x 10 6 cells per cm 2 ) before implantation. The macroscopic evaluation of the cartilage regeneration was carried out using the Brittberg Score, whereas the histological evaluation was performed using the Mankin Score and the O’Driscoll Score. Results Results of the control group showed a gradual, significant deterioration of osteoarthritis over 4 and 12 months. There was no regeneration in the defect area, and the adjacent cartilage showed increasing degeneration both macroscopically and histologically. In all treatment groups, the regenerated cartilage showed a zonal structure. After 4 months, the MACT group yielded significantly better results than the other two regeneration groups (MATRIX, SPONGIO) regarding macroscopic and histological parameters. The SPONGIO group showed good chondrocyte quality after 4 months, but the cartilage surface was very uneven. The MATRIX group was dominated by the formation of regenerated tissue, which did not correspond to hyaline cartilage. In the course of 4 to 12 months, an improvement in all regeneration groups was detected. In 4 out of 6 sheep of the MACT group, the regenerate filled the full height of the 2.5 mm deep and 20x10 mm large defect (Figure 1B). Excessive regeneration above the normal cartilage cell height was not present in any of the animals. Safranin O staining of the regenerated mate-
Page 1 and 2: Kompendium 2020 Forschung & Klinik
Page 3 and 4: Inhalt/Impressum 3 Die Klinik 4 Edi
Page 6 and 7: Zahlen und Fakten 6 Klinische Leist
Page 9 and 10: Zahlen und Fakten 9 Hohe Ambulanzfr
Page 11 and 12: Klinik 11 Neben der Polytrauma-Vers
Page 13 and 14: Die Meniskusversorgung Alle Möglic
Page 15 and 16: Das ÄrztInnenteam 15 Universitäts
Page 17 and 18: Spherox ist das einzig EMA-zugelass
Page 19 and 20: Das ÄrztInnenteam 19 Medizinische
Page 21 and 22: Ambulanzen 21 Spezialambulanzen Kli
Page 23 and 24: TOP-Studien 23 defects (≤ Interna
Page 25 and 26: WE LENGTHEN, TRANSPORT AND GROW BON
Page 27 and 28: TOP-Studien 27 5 5 Patients (-) 10
Page 29 and 30: FRESH AIR FRESH PERSPECTIVE Remove
Page 31 and 32: TOP-Studien 31 Aseptic loosening is
Page 33 and 34: Integriertes Patientenversorgungsko
Page 35 and 36: TOP-Studien 35 Figure 1: Bone miner
Page 37 and 38: TOP-Studien 37 A Prediction Model f
Page 39 and 40: TOP-Studien 39 Figure 2: Graphic vi
Page 41 and 42: TOP-Studien 41 Figure 1: Individual
Page 43 and 44: 3D Biochips for Research on Inflamm
Page 45: TOP-Studien 45 Chondro-Synovial Cro
Page 49 and 50: TOP-Studien 49 Total Hip Arthroplas
Page 51 and 52: TOP-Studien 51 nerve lesions (1 N.
Page 53 and 54: TOP-Studien 53 1 Volume fill of car
Page 55 and 56: TOP-Studien The Genetic Landscape o
Page 57 and 58: TOP-Studien 57 rare heterozygous lo
Page 59 and 60: TOP-Studien 59 Figure 1: Example of
Page 61 and 62: COPAL ® - ERFOLGREICH GEGEN INFEKT
Page 63 and 64: TOP-Studien 63 Figure 1: Biomechani
Page 65 and 66: TOP-Studien 65 Development of a New
Page 67 and 68: TOP-Studien 67 Table 1: Relative ro
Page 69 and 70: Publikationen 69 Bumberger A, Kolle
Page 71 and 72: Publikationen 71 sou NA, McNally MA
Page 73 and 74: Publikationen 73 Propensity-Matched
Page 75 and 76: Publikationen 75 novel hypothetical
Page 77 and 78: Publikationen 77 ritisches Denken.
Page 79 and 80: Publikationen 79 Zuteilungsdatum: 2
Page 81 and 82: Publikationen 81 Payr S: Reviewer J
Page 83 and 84: Publikationen 83 fracture, Wrist Ar
Page 85 and 86: Kundenkompetenzzentrum mit Shop & W
Page 87: ·

Kompendium 2020 Forschung & Klinik

Create successful ePaper yourself

Delete template?

Save as template?