Biostimulation of Knee Cartilage Using Autologous Micro-Grafts: A Preliminary Study of the Rigenera Protocol in Osteochondral Lesions of the Knee
Volume 3, Issue 1, March 2018, Pages: 8-12
Received: Sep. 26, 2017;
Accepted: Jan. 23, 2018;
Published: Jan. 23, 2018
Views 1534 Downloads 83
Agustín Dorta Fernández, Hand Surgery and Microsurgery Unit, La Laguna, Spain
Ana Baroni Luengo, Department of Computer Science and Technology, International University of La Rioja, La Rioja, Spain
Osteochondral pathologies are associated with cartilage loss. Autologous micro-grafts, obtained from various tissues containing mesenchymal stem cells, has proven regenerative properties in various tissues. The study included patients with osteochondral pathology not responding to conventional therapies and considered suitable for treatment with autologous micro-graft. Fifteen days before the intervention, patients started treatment with chondroitin sulfate and supplementary vitamin C and zinc. Autologous micro-grafts were obtained from ear skin and cartilage, disaggregated using the Rigenera system, and injected into the knee under local anesthesia. After the intervention, patients underwent six-week rehabilitation program based on non-weight bearing exercises. Nine patients were enrolled into the study. The autologous graft transfer was successful in all patients, and no severe complications were recorded, including aesthetical defects in the donor site. Eight patients (88.9%) experienced an improvement in all subdomains of the WOMAC scale. The median (IR) improvement in the WOMAC scale was 22.0 (10.0 – 40.0) points. The MRI examination revealed the absence of space-occupying lesions in the knee and the surrounding soft tissues in all patients. An edema reduction was observed in 8 of 9 patients (88.9%); 3 patients (33.3%) showed a thickening of the cartilage line. Autologous micro-graft transfer using the Rigenera system is safe and has promising results in the treatment of chondral injuries associated with pain and function limiting.
Agustín Dorta Fernández,
Ana Baroni Luengo,
Biostimulation of Knee Cartilage Using Autologous Micro-Grafts: A Preliminary Study of the Rigenera Protocol in Osteochondral Lesions of the Knee, Rehabilitation Science.
Vol. 3, No. 1,
2018, pp. 8-12.
Chan VO, Moran DE, Mwangi I, Eustace SJ. Prevalence and clinical significance of chondromalacia isolated to the anterior margin of the lateral femoral condyle as a component of patellofemoral disease: Observations at MR imaging. Skeletal Radiol. 2013 Aug 21; 42(8):1127–33.
Kao YJ, Ho J, Allen CR. Evaluation and management of osteochondral lesions of the knee. Phys Sportsmed. 2011 Nov 13; 39(4):60–9.
Wang J, Han W, Wang X, Pan F, Liu Z, Halliday A, et al. Mass effect and signal intensity alteration in the suprapatellar fat pad: Associations with knee symptoms and structure. Osteoarthr Cartil. 2014 Oct; 22(10):1619–26.
Lankhorst NE, Damen J, Oei EH, Verhaar JAN, Bierma-Zeinstra SMA, van Middelkoop M. Incidence, prevalence, natural course and prognosis of patellofemoral osteoarthritis; data of cohort hip and cohort knee study. Osteoarthr Cartil. 2015 Dec; 23(2011):A42–3.
Anandacoomarasamy A, Smith G, Leibman S, Caterson I, Giuffre B, Fransen M, et al. Cartilage defects are associated with physical disability in obese adults. Rheumatology (Oxford). 2009 Oct; 48(10):1290–3.
Monllau JC, Leal J, Voss C, Pelfort X, Tey M, Pavlovich RI. Good Outcome After Meniscal Repair Using an All-Inside Suturing System in Combination with High-Frequency Biostimulation. Lindeque BGP, editor. Orthopedics. 2010 Jun 1; 33(6):407–12.
Torricelli P, Giavaresi G, Fini M, Guzzardella GA, Morrone G, Carpi A, et al. Laser biostimulation of cartilage: In vitro evaluation. Biomed Pharmacother. 2001 Mar; 55(2):117–20.
Morrone G, Guzzardella GA, Torricelli P, Rocca M, Tigani D, Brodano GB, et al. Osteochondral lesion repair of the knee in the rabbit after low-power diode Ga-Al-As laser biostimulation: an experimental study. Artif Cells Blood Substit Immobil Biotechnol. 2000 Jul; 28(4):321–36.
Macmull S, Jaiswal PK, Bentley G, Skinner JA, Carrington RWJ, Briggs TWR. The role of autologous chondrocyte implantation in the treatment of symptomatic chondromalacia patellae. Int Orthop. 2012 Jul; 36(7):1371–7.
Marmotti A, Rossi R, Castoldi F, Roveda E, Michielon G, Peretti GM. PRP and articular cartilage: a clinical update. Biomed Res Int. 2015; 2015:542502.
Goodell BMA, Brose K, Paradis G, Conner AS, Mulligan RC. Isolation and Functional Properties of Murine Hematopoietic Stem Cells that are Replicating In Vivo By Margaret A. Goodell, Katja Brose, Glenn Paradis,* A. Stewart Conner,* and Richard C. Mulligan. 1996; 183(April).
De Francesco F, Romano M, Zarantonello L, Ruffolo C, Neri D, Bassi N, et al. The role of adipose stem cells in inflammatory bowel disease: From biology to novel therapeutic strategies. Cancer Biol Ther. 2016 Sep 14; 17(9):889–98.
Trovato L, Monti M, del Fante C, Cervio M, Lampinen M, Ambrosio L, et al. A New Medical Device Rigeneracons Allows to Obtain Viable Micro-Grafts From Mechanical Disaggregation of Human Tissues. J Cell Physiol. 2015 Oct; 230(10):2299–303.
Purpura V, Bondioli E, Graziano A, Trovato L, Melandri D, Ghetti M, et al. Tissue Characterization after a New Disaggregation Method for Skin Micro-Grafts Generation. J Vis Exp. 2016 Mar 4;(109):e53579.
Giaccone M, Brunetti M, Camandona M, Trovato L, Graziano A. A new medical device, based on Rigenera protocol, in the management of complex wounds. J Stem Cells Res. Rev Rep. 2014; 1(3):3.
Marcarelli M, Trovato L, Novarese E, Riccio M, Graziano A. Rigenera protocol in the treatment of surgical wound dehiscence. International Wound Journal. 2016 Apr; 277–81.
Graziano A, Carinci F, Scolaro S, D’Aquino R. Periodontal tissue generation using autologous dental ligament micro-grafts: case report with 6 months follow-up. Ann Oral Maxillofac Surg. 2013; 1(2):20.
Capeci CM, Turchiano M, Strauss EJ, Youm T. Osteochondral Allografts. Applications in Treating Articular Cartilage Defects in the Knee. Bullettin th Hosp Jt Deseases. 2013; 71(1):60–70.
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988; 15(12):1833–40.
Metcalf KB, Mandelbaum BR, McIlwraith CW. Application of Platelet-Rich Plasma to Disorders of the Knee Joint. Cartilage. 2013 Oct; 4(4):295–312.
Baum T, Joseph GB, Arulanandan A, Nardo L, Virayavanich W, Carballido-Gamio J, et al. Association of magnetic resonance imaging-based knee cartilage t2 measurements and focal knee lesions with knee pain: Data from the osteoarthritis initiative. Arthritis Care Res. 2012 Feb; 64(2):248–55.
Gentile P, Scioli MG, Bielli A, Cervelli V. A combined use of Chondrocytes Micro Grafts (CMG) Mixed with Platelet Rich Plasma (PRP) in Patients Affected by Pinch Nose Deformity. J Regen Med. 2016; 2016.
Svolacchia F, De Francesco F, Trovato L, Graziano A, Ferraro GA. An innovative regenerative treatment of scars with dermal micrografts. J Cosmet Dermatol. 2016.
Batlle-Gualda E, Esteve-Vives J, Piera M, Hargreaves R, Cutts J. Adaptación transcultural del cuestionario WOMAC específico para artrosis de rodilla y cadera. Rev Española Traumatol. 1999; 26:38–45.
Escobar A, Quintana JM, Bilbao A, Azkárate J, Güenaga JI. Validation of the Spanish Version of the WOMAC Questionnaire for Patients with Hip or Knee Osteoarthritis. Clin Rheumatol. 2002 Nov 1; 21(6):466–71.