Name: autologous microfractured and purified adipose tissue for arthroscopic management of osteochondral lesions of the talus
Uploaded: 2018-01-23T13:00:00.000+00:00
Duration: 7 min 24 s
Description: Watch this Scientific Journal Video about Autologous Microfractured and Purified Adipose Tissue for Arthroscopic Management of Osteochondral Lesions of the Talus at JoVE.com

Yordamlar Lipogems sistemini kullanarak gerçekleştirilir.

Çalışmalarda etik standartlarına kurumsal ve/veya Ulusal Araştırma Komitesi ve 1964 Helsinki Bildirisi'ne ve daha sonraki değişiklikler veya karşılaştırılabilir etik ile ilgili insan katılımcılar vardı tüm yordamları gerçekleştirilen standartları.
1. tıbbi geçmişi
<ol><li>Klinik muayene ile ayrıntılı bir hasta Tarih başlatın. Not: Bir OLT her zaman ayak bileği istikrarsızlık durumunda tekrarlanan burkulma şişme, sertlik, ağrı ve eklem tıkanıklık ile ilişkili ile şüpheli gerekir. Ayrıca, birçok durumda OLT enflamatuar veya vasküler hastalıklar, nöropati veya nörolojik hastalık ve diyabet gibi sistemik hastalığı öyküsü ile iliskili olabilir. Uyuşturucu veya şifa etkileyebilecek tıbbi sorunları değerlendirilecek ve dikkate alınır.</li>
</ol>2. klinik muayene
<ol><li>Ortostatik bir pozisyon hastanın ayak bileği veya hind-ayak deformitesi vurgulamak için değerlendirin. Kas ve tendon işlev ve ayak bileği aralığı hareketi (ROM) değerlendirmek. Diffüz hassasiyet kez en fazla fleksiyon ve uzantısı özellikle sırasında mevcut, ve dokunmatik alanı parçalanmõ * eklem düzeyinde karşılaşmaya nadir değildir.</li>
	<li>Eşlik eden yanal ayak bileği istikrarsızlık tanımlamak için bir anterior ve posteiror çekmece testi gerçekleştirin.</li>
	<li>Ameliyat öncesi Danışma sırasında aşağıdaki klinik ve fonksiyonel skorları kaydetmek: Amerikan ortopedik ayak ve ayak bileği Derneği (AOFAS) ayak bileği ve hind-ayak puanları15, görsel analog ölçek (VAS) ağrı Puan16ve 12 maddelik kısa formu Sağlık Anketi (SF-12)17.</li>
</ol>3. radyolojik değerlendirme
<ol><li>İkili bir ağırlık ayak ve ayak bileği grafisi taşıyan gerçekleştirin. Bu geleneksel ağırlık taşıyan hastanın (AP) gömme ve ayak bileği lateral ağırlık taşıyan sayısı oluşur. AP gömme nötr konumda ve iç rotasyon talus bir daha iyi görselleştirme için 15 derece ile gerçekleştirin. Not: OLT sadece % 50 grafisi ile teşhis edilebilir; Büyük lezyonlar halinde müstakil kemik radiolucency tarafından çevrili bir alan ünlü18olabilir.</li>
	<li>Geleneksel hesaplanan tomografi-tomografi (tomografi) ayak bileği gerçekleştirin. Tomografi tam yerini ve boyutunu lezyon, Ayrıca kemik parçaları dekolmanı durumunda tanımlama sağlar. Zayıf nokta CT kıkırdak durumunu göstermek için yeteneğidir. Bir önceki çalışmada bir duyarlılık ve özgüllük 0,81 ve 0,99, sırasıyla, CT19,20OLTs algılamak için gösterdi.</li>
	<li>Manyetik rezonans görüntüleme (MRG) ayak bileği gerçekleştirin. MRI kıkırdak ve subchondral kemik değerlendirme esastır. Ayrıca, Mr'ı iyonizan radyasyon içermeyen ve yumuşak doku daha iyi görselleştirme sağlar. Belgeleri bir duyarlılık ve özgüllük % 96 içinde OLTs21,22hafiye raporları.</li>
</ol>4. Cerrahi teknik
<ol><li>Hasatı ve işlenmesi yağ dokusu
	<ol>
<li>Klein çözüm hazırlamak: 1 L 9 g/L serum, %1 lidokain 50 mL, 1 mL 1: 1000 epinefrin, 10 mL % 8.4 sodyum bikarbonat ve triamsinolon acetonide 10 mg/mL 0.1 mL.</li>
		<li>İki para-göbek insizyon yaklaşık 0.5 cm bir neşter bıçakla oluşturun. Cilt altı yağ dokusu 18 G iğne (şekil 1) 60 mL şırınga kullanarak insizyon ile karın içine yaklaşık 300 mL Klein çözeltisi enjekte.</li>
		<li>40-45 mL 20 mL şırınga bağlı ve işleme Kiti (Şekil 2) tanıttı 13 G künt kanül kullanılarak ADSCs hasat. Genellikle, peri-göbek alanında hasat gerçekleştirin.</li>
		<li>Lipoaspirate 100-130 mL kapalı sistemde yerleştirin. Lipoaspirate ilk küme azaltma elde etmek için büyük bir filtre cihazın içine itin; aynı zamanda, karşılık gelen bir miktar tuzlu çözüm doğru israf çanta çıkar. Yağ, kan ve serum arasında geçici bir emülsiyon elde etmek için paslanmaz çelik mermer tarafından önemli bir rol oynadı. Yağ artıkları ve kirli kan yerçekimi bir karşı akış tuzlu çözüm tarafından kaldırın.</li>
		<li>(Akan çözüm görünür açık ve lipoaspirate sarı) bu çamaşır adım sonra tuzlu su akışı durdurmak ve ikinci adipose küme azaltılması için önde gelen aygıt (gri kap kadar), ters. Azaltılması yoluyla sıvı aşağıdan bir 10 mL şırınga ile iterek ikinci kesim altıgen filtre, yüzen yağ kümeleri iterek edinin. Cihazın üst açılışına bağlı bir 10 mL şırınga içine nihai ürün toplamak. Not: Yağ dokusu için işleme Seti standart lipofilling tekniği geliştirir: Aslında, perisitlerden çok sayıda içeren akıcı ve düzgün bir ürün elde etmek için bir kapalı, tam-daldırma, alçak basınç silindirik bir sistem, sistem oluşur. Bu yordam sadece hafif mekanik kuvvetleri ile yağ hücreleri işleme ve stromal vasküler niş bütünlüğünü koruyarak sağlar. İşlemin mümkün olan en az travmatik ve nihai ürün enzimatik tedaviler veya genişleme olmadan kısa sürede (15-20 dk), kullanılabilir hale getirir. Hasarsız vasculostromal niş iyileşme sürecine yardımcı.</li>
		<li>Bir kez ADSCs hasat, karın bölgesinde bir sıkıştırma bandaj uygulanır.</li>
	</ol></li>
	<li>Cerrahi müdahale ve yağ dokusu enjeksiyonu
	<ol>
<li>Hasta sırtüstü pozisyonda kanamayı azaltmak ve daha iyi artroskopik görselleştirme1izin vermek için uyluk düzeyde 250 mmHg basınçta bir sargı bezi ile spinal anestezi altında yerleştirin.</li>
		<li>Ciltte anatomik yerlerinden dermographic kalemle işaretlemek. Simge yapılar iyatrojenik yaralanmaları önlemek için gereklidir. Şu işareti (şekil 3): Her iki malleoli ((LM) lateral ve medial (MM)) dorsi - ve plantar-fleksiyon ile ayak bileği eklemin tanımlanan ön ortak satıra (JL), tibialis anterior tendon (TAT) ve Aşil tendonu büyük Safen ven, sadece bileşenleri öncesinde çalıştığı Yüzeysel peroneal sinir (SPN)</li>
		<li>İlk olarak, sadece yumuşak bir nokta ile rastlayan tibialis anterior tendon medial anteromedial portal gerçekleştirin. Bu portal yaklaşım portal temsil eder. Çoğu durumda, bir depresyon dorsiflexion bileğinden ile görünür ve elle tutulur.<ol>
<li>Sadece deriyi bir bıçak ile kesme ve künt diseksiyon tarafından kapsül sorgulamaktı. Safen sinir ve büyük Safen ven kaçının için dikkat ediniz. Sinir 7.4 mm portala yanal olmakla Safen ven yanal portala bulunduğu 9 mm olduğunu. Bu iki birincil izleme portalları birini oluşturmaktadır.</li>
		</ol>
</li>
		<li>Ortak satırı denetleyin, anterolateral portal için yanal fibula, medial yerleştirin ve ekstansiyon digitorum tendonu lateral. Not: anterolateral portal gerçekleştirirken, engel herhangi bir yaralanma ara dorsal Kutanöz sinir (yüzeysel peroneal sinir lateral dalı); Bu nedenle, kesme sonra cilt künt diseksiyon tarafından izlenmesi gerekir.</li>
		<li>Boyutunu ve konumunu değerlendirmek için eklem kıkırdak bakarak kontrol edin. Koşul ve kıkırdak palpator ile kalitesini değerlendirmek. Talus osteokondral lezyon genellikle ya posteromedially ya da anterolaterally.<ol>
<li>Artroskopik tedavi bazı cerrahlar bir daha büyük 4 mm arthroscope kullanabilir ve araç eklem ön duruşmaya ara tutabilirsiniz 30 ° görüş açısı ile geniş açılı 2.7 mm arthroscopes kullanarak gerçekleştirin. Non-invaziv ortak oyalama teknikleri ve hiper plantar fleksiyon talar kubbe çoğuna erişim için kullanılabilir.</li>
			<li>Posterior bir lezyon halinde iğneyle ortak dikkatini dağıtmak ve lezyon maruz izin vermek için bir Hintermann dağıtıcı yerleştirin. Hintermann dağıtıcı bir açılış kolu vardır daha önce hemen veya yanal, lezyon tarafında göre tibia ve talar kemik konumlandırılmış iki K-telleri üzerinde uygulanan kol. Yanal bir lezyon söz konusu olduğunda, tibial kemik eklem daha iyi dikkat dağıtıcı ulaşmak için fibula, kaçınarak, proksimal K-tel eklemek için dikkat ediniz.</li>
		</ol>
</li>
		<li>Lezyon ile bir küret hazırlamak, hasarlı ve kararsız kıkırdak kaldırma, kalsifiye katman ve düzenli şeklindeki oluşturmak için nekrotik ve sklerotik kemik bulunan omuzlu kenarlıklı bir lezyon. Bu adımda, bir standart artroskopik küret (şekil 4) kullanın.</li>
		<li>Kemik iliği kök hücrelerden subchondral kemik microperforations yuvarlak sıra dışarıdan lezyon içine gerçekleştirme. teşvik.<ol>
<li>Aralarında yaklaşık 3 mm aralıklarla delikler yerine getirir. Kusur (şekil 5) altında sağlıklı subchondral kemik kıkırdak Pick kullanarak mikro çatlaklar neden. Not: Bir kanama fibrin pıhtısı oluşumunda sonuçları. Ürünler, inflamatuar cascade etkinleştirme, pıhtılaşma kan vazoaktif arabulucu, büyüme faktörleri ve sitokinler bırakın. Bu faktörlerin damar işgali ve lezyon kıkırdak kısmı içine Mezenkimal kök hücrelerin göç teşvik gücüne sahip. Bu pluripotent hücreler fibroblastlar, kondrosit ve dokusunu ayırmak ve lezyon tamiri uyarılması içinde önemli bir rol oynamak için uyarılır. Parakrin büyüme faktörleri artiküler ortamında hücre dışı matriks oluşumu ve fibrocartilage üretimi teşvik. Aynı zamanda, lezyon kemik parçası hücreleri aşamalı olarak olgun kemik tarafından değiştirilir bir olgunlaşmamış kemik dokusu üretmek.</li>
		</ol>
</li>
		<li>İntra artiküler su aspirasyon ve eklem tamamen kuru olana bir pamuk sünger kullanarak kalan sıvı tıraş makinesi kullanarak kaldırın.</li>
	</ol></li>
	<li>Yağ kaynaklı kök hücre enjeksiyon
	<ol>
<li>5-7 mL yağ kaynaklı kök hücre, önceden hazırlanmış adım 4.1.3, iki portalları (anteromedial veya anterolateral) birini kullanarak ayak bileği eklem enjekte.</li>
		<li>Turnikeyi serbest bırakın.</li>
	</ol></li>
</ol>5. ameliyat sonrası bakım
<ol><li>Tam deşarj işletilen uzuv ile 15 gündür ayak bileği hareketleri önlemek.</li>
	<li>Tam kurtarma ve hareket aralığı ulaşılana kadar 15 gün sonra ameliyat, ayak bileği, aktif ve pasif hareketler sağlar.</li>
	<li>Şarj ameliyattan sonra 30 gün izin verir.</li>
</ol>6. klinik ve radyografik takip
<ol><li>Hastaların klinik ve radiologically altı ve on iki ay ve, bundan sonra her yıl değerlendirin. İzleme protokolü her son nokta15,16,17, AOFAS ayak bileği ve hind-ayak puanları, VAS ağrı puan ve SF-12 oluşur. Radyografik muayene bir Mr ve tomografi işletilen ayak bileği içerir.</li>
</ol>

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G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+outcomes+of+mesenchymal+stem+cell+injection+with+arthroscopic+treatment+in+older+patients+with+osteochondral+lesions+of+the+talus.">Clinical outcomes of mesenchymal stem cell injection with arthroscopic treatment in older patients with osteochondral lesions of the talus.</a> Am. J. Sports Med. 41 (5), 1090-1099 (2013).</li><li>Kim, Y. S., Lee, H. J., Choi, Y. J., Kim, Y. I., Koh, Y. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Does+an+injection+of+a+stromal+vascular+fraction+containing+adipose-derived+mesenchymal+stem+cells+influence+the+outcomes+of+marrow+stimulation+in+osteochondral+lesions+of+the+talus?+A+clinical+and+magnetic+resonance+imaging+study.">Does an injection of a stromal vascular fraction containing adipose-derived mesenchymal stem cells influence the outcomes of marrow stimulation in osteochondral lesions of the talus? A clinical and magnetic resonance imaging study.</a> Am. J. Sports Med. 42 (10), 2424-2434 (2014).</li><li>Kim, Y. S., Koh, Y. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Injection+of+Mesenchymal+Stem+Cells+as+a+Supplementary+Strategy+of+Marrow+Stimulation+Improves+Cartilage+Regeneration+After+Lateral+Sliding+Calcaneal+Osteotomy+for+Varus+Ankle+Osteoarthritis:+Clinical+and+Second-Look+Arthroscopic+Results.">Injection of Mesenchymal Stem Cells as a Supplementary Strategy of Marrow Stimulation Improves Cartilage Regeneration After Lateral Sliding Calcaneal Osteotomy for Varus Ankle Osteoarthritis: Clinical and Second-Look Arthroscopic Results.</a> Arthroscopy. 32 (5), 878-889 (2016).</li><li>Kim, Y. S., Lee, M., Koh, Y. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Additional+mesenchymal+stem+cell+injection+improves+the+outcomes+of+marrow+stimulation+combined+with+supramalleolar+osteotomy+in+varus+ankle+osteoarthritis:+short-term+clinical+results+with+second-look+arthroscopic+evaluation.">Additional mesenchymal stem cell injection improves the outcomes of marrow stimulation combined with supramalleolar osteotomy in varus ankle osteoarthritis: short-term clinical results with second-look arthroscopic evaluation.</a> J. Exp. Orthop. 3 (1), 12 (2016).</li><li>Hanke, C. W., Bernstein, G., Bullock, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Safety+of+tumescent+liposuction+in+15,336+patients.+National+survey+results.">Safety of tumescent liposuction in 15,336 patients. National survey results.</a> Dermatol Surg. 21 (5), 459-462 (1995).</li><li>Illouz, Y. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complications+of+liposuction.">Complications of liposuction.</a> Clin Plast Surg. 33 (1), 129-163 (2006).</li><li>Dixit, V. V., Wagh, M. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Unfavourable+outcomes+of+liposuction+and+their+management.">Unfavourable outcomes of liposuction and their management.</a> Indian J Plast Surg. 46 (2), 377-392 (2013).</li><li>Lehnhardt, M., Homann, H. H., Daigeler, A., Hauser, J., Palka, P., Steinau, H. U. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Major+and+lethal+complications+of+liposuction:+review+of+72+cases+in+Germany+between+1998+and+2002.">Major and lethal complications of liposuction: review of 72 cases in Germany between 1998 and 2002.</a> Plast Reconstr Surg. 121 (6), 396e-403e (2008).</li><li>Usuelli, F. G., de Girolamo, L., Grassi, M., D'Ambrosi, R., Montrasio, U. A., Boga, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=All-Arthroscopic+Autologous+Matrix-Induced+Chondrogenesis+for+the+Treatment+of+Osteochondral+Lesions+of+the+Talus.">All-Arthroscopic Autologous Matrix-Induced Chondrogenesis for the Treatment of Osteochondral Lesions of the Talus.</a> Arthrosc Tech. 4 (3), e255-e259 (2015).</li><li>Simonson, D. C., Roukis, T. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Safety+of+ankle+arthroscopy+for+the+treatment+of+anterolateral+soft-tissue+impingement.">Safety of ankle arthroscopy for the treatment of anterolateral soft-tissue impingement.</a> Arthroscopy. 30 (2), 256-259 (2014).</li><li>Suzangar, M., Rosenfeld, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ankle+arthroscopy:+is+preoperative+marking+of+the+superficial+peroneal+nerve+important?.">Ankle arthroscopy: is preoperative marking of the superficial peroneal nerve important?.</a> J. Foot. Ankle Surg. 51 (2), 179-181 (2012).</li><li>Kraeutler, M. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Current+Concepts+Review+Update:+Osteochondral+Lesions+of+the+Talus.">Current Concepts Review Update: Osteochondral Lesions of the Talus.</a> Foot Ankle Int. 38 (3), 331-342 (2017).</li><li>Looze, C. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluation+and+Management+of+Osteochondral+Lesions+of+the+Talus.">Evaluation and Management of Osteochondral Lesions of the Talus.</a> Cartilage. 8 (1), 19-30 (2017).</li><li>Dragoo, J. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Healing+full-thickness+cartilage+defects+using+adipose-derived+stem+cells.">Healing full-thickness cartilage defects using adipose-derived stem cells.</a> Tissue Eng. 13 (7), 1615-1621 (2007).</li><li>Lee, S. Y., Kim, W., Lim, C., Chung, S. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+of+Lateral+Epicondylosis+by+Using+Allogeneic+Adipose-Derived+Mesenchymal+Stem+Cells:+A+Pilot+Study.">Treatment of Lateral Epicondylosis by Using Allogeneic Adipose-Derived Mesenchymal Stem Cells: A Pilot Study.</a> Stem Cells. 33 (10), 2995-3005 (2015).</li><li>Feisst, V., Meidinger, S., Locke, M. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=From+bench+to+bedside:+use+of+human+adipose-derived+stem+cells.">From bench to bedside: use of human adipose-derived stem cells.</a> Stem Cells Cloning. 8, 149-162 (2015).</li></ol>

Federico Giuseppe Usuelli, MD, kişisel ücretleri Integra ve Geistlich, ve hibe ve kişisel Zimmer, gönderilen iş dışında ücretleri bildirir.

Son yıllarda preklinik ve klinik denemeler farklı kas-iskelet patolojiler tedavisinde ADSCs etkisi onların dikkatini odaklanmıştır. Bu makalenin amacı Protokolü osteokondral lezyon artroskopik microperforations birlikte microfractured ve saf yağ dokusu kullanarak talus, tedavisi için tarif etmektir. Protokol komplikasyonların yüksek risk ile birkaç kritik adımları içerir. Şişman hasat sırasında komplikasyon lokal veya sistemik sorunlar ayrılabilir.
En yaygın ameliyat sonr...

Artroskopi altın osteokondral lezyonlari talus (OLTs) tedavisinde ağrı kesici, işlevselliği geri yükleme ve genç ve aktif hastalarda özellikle yaşam kalitesini artırma amacı ile standarttır.
Şu anda, artroskopik teknikleri üç şekilde sınıflandırılabilir. Onarıcı tekniği kemik iliği debridman ve microperforations lezyon düzeyde yoluyla elde hücreleri uyarır. Estetik tekniği bir Otolog veya kapaklı ostechondral greft kullanarak lezyon yerini alır. Rejeneratif tekniği ayırt etmek ve çoğaltmak için multipotent hücreler hasarlı doku1,2,3,4,5,6 yeniden yeteneği olağanüstü başarı .
Son yıllarda yeniden üretim teknikleri çok sayıda vitro ve in vivo çalışmalar OLTs ve yağ dokusu (ADSCs)7,8 ' den türetilmiş özellikle Mezenkimal Kök hücre tedavisi için konu oldu , 9. bu Mezenkimal Kök hücre morfolojik ve fonksiyonel özellikleri diğer dokulardan; izole multipotent diğer hücrelere benzer sergi Onlar da birkaç ayırt etmek için yeteneği var ve farklı cep satırları içinde in vitro ve in vivo10,11,12,13. Bu hücreler araştırmalarına odaklanmak çoğunlukla onların yerelleştirme nedeniyle, aslında temsil ettikleri % 10 dan 5000 hücre, doku13,14gram başına bir konsantrasyon ile normal vücut ağırlığının % 30. Öte yandan, bu hücreler kısıtlar bir faktör kullandıklarında daha laboratuvar işlemleri sırasında ilişkili. Toplamları adipositler, kollajen lifleri ve normal vasküler bileşenleri içeren lipoaspirate enzimatik A tip ı ve hemoliz kültür önce tabi kollajen ile işlenir. Burada amaç Protokolü osteokondral lezyon microfractured ve saf yağ dokusu kullanarak talus, tedavisi için tarif etmektir.

<table><tbody><tr><td>PROCESS KIT - PROCESSING KIT FOR FAT TISSUE</td><td>LIPOGEMS</td><td>LG PK 60</td><td>Lipogems Kit to obtain microfractured and purified ADSCs</td></tr><tr><td>HINTERMANN SPREADER</td><td>INTEGRA</td><td>119654</td><td>The spreader allow to access most of the talar dome, in particular in case of posterior lesion</td></tr><tr><td>CUP CURETTE</td><td>ARTHREX</td><td>AR-8655-02</td><td>To remove the damaged cartilage and necrotic and sclerotic bone</td></tr><tr><td>CHONDRAL PICK 30&amp;deg; TIP / 60&amp;deg; TIP</td><td>ARTHREX</td><td>AR-8655-05&lt;br/&gt; AR-8655-06</td><td>To perfrom microperforation at the level of the lesion, stimulating bleeding from the subchondral bone</td></tr><tr><td>SHAVER</td><td>ARTHREX</td><td>AR-7300SR</td><td>To clean the joint and aspirate water</td></tr></tbody></table>

autologous microfractured and purified adipose tissue for arthroscopic management of osteochondral lesions of the talus

Son yıllarda yeniden üretim teknikleri edilmiş giderek okudu ve osteokondral lezyon talus, tedavi etmek için kullanılır. Özellikle, çeşitli çalışmalarda dikkatlerini Yağ dokusundan elde edilen Mezenkimal Kök hücre üzerinde odaklanmıştır. Yağ kaynaklı kök hücreler (ADSCs) Morfolojik özellikleri ve özellikleri diğer Mezenkimal hücrelerin benzer sergi ve birkaç hücresel hattı ayırt edebiliyoruz. Ayrıca, bu hücreler de yaygın olarak normal vücut ağırlığının 10-%30 5000 hücre, doku gram başına bir konsantrasyon ile temsil eden subkutan doku mevcuttur.
Sunulan teknikte ilk adım ADSCs karın ve mikro çatlak ve arıtma süreci hasat içerir; ardından, cerrahi prosedür tamamen arthroscopically, daha az yumuşak doku diseksiyon, daha iyi ortak görselleştirme ve standart açık prosedürler ile karşılaştırıldığında daha hızlı bir iyileşme ile gerçekleştirilir. Artroskopi içinde lezyon tespit, izole ve microperforations ile hazırlanan ilk aşaması ile karakterizedir; İkinci adım, gerçekleştirilen kuru, enjeksiyon lezyon düzeyde yağ dokusunun içerir.
Ocak 2016 ve Eylül 2016 arasında dört hasta osteokondral lezyon microfractured ve saf yağ dokusu ile talus, artroskopik tedavi uygulandı. Tüm hastalar klinik iyileşme bildirilen komplikasyon ile altı ay ameliyat sonrası bildirdi. En son takip fonksiyonel sonuçlarına ümit verici ve tekniği güvenilir ağrı ve talus osteokondral lezyon olan hastalarda iyileştirmeler sağlar onaylayın.

Ocak 2016 ve Eylül 2016 arasında dört hasta osteokondral lezyon microfractured ve saf yağ dokusu ile talus, artroskopik tedavi uygulandı. Tüm hastalar klinik iyileşme altı ay ameliyat sonrası bildirdi. İlk klinik sonuçlar Tablo 1' de rapor edilir. Herhangi bir komplikasyon bildirildi.
Son yıllarda, ayak ve ayak bileği patolojiler tedavisi için ADSCs kullanımı artmıştır. 2013 yılında, Kim <em...

Watch this Scientific Journal Video about Autologous Microfractured and Purified Adipose Tissue for Arthroscopic Management of Osteochondral Lesions of the Talus at JoVE.com

Autologous Microfractured and Purified Adipose Tissue for Arthroscopic Management of Osteochondral Lesions of the Talus

Bu çalışmada microfractured ve saf yağ kaynaklı kök hücre kullanarak talus osteokondral lezyon artroskopik tedavi için bir protokol rapor etmektir.

Otolog Microfractured ve saf yağ dokusu osteokondral lezyon Talus, artroskopik yönetimi için

In recent years, regenerative techniques have been increasingly studied and used to treat osteochondral lesions of the talus. In particular, several ...

autologous-microfractured-purified-adipose-tissue-for-arthroscopic

Research

JoVE Journal

Medicine

10.2K Görüntüleme.  IRCCS Istituto Ortopedico Galeazzi - C.A.S.C.O. Piede e Caviglia. Bu çalışmada microfractured ve saf yağ kaynaklı kök hücre kullanarak talus osteokondral lezyon artroskopik tedavi için bir protokol rapor etmektir.

Video: Autologous Microfractured and Purified Adipose Tissue for Arthroscopic Management of Osteochondral Lesions of the Talus

Repair of a Critical-sized Calvarial Defect Model Using Adipose-derived Stromal Cells Harvested from Lipoaspirate

Craniofacial skeletal repair and regeneration offers the promise of de novo tissue formation through a cell-based approach utilizing stem cells. Adipose-derived stromal cells (ASCs) have proven to be an abundant source of multipotent stem cells capable of undergoing osteogenic, chondrogenic, adipogenic, and myogenic differentiation. Many studies have explored the osteogenic potential of these cells in vivo with the use of various scaffolding biomaterials for cellular delivery. It has been demonstrated that by utilizing an osteoconductive, hydroxyapatite-coated poly(lactic-co-glycolic acid) (HA-PLGA) scaffold seeded with ASCs, a critical-sized calvarial defect, a defect that is defined by its inability to undergo spontaneous healing over the lifetime of the animal, can be effectively show robust osseous regeneration. This in vivo model demonstrates the basis of translational approaches aimed to regenerate the bone tissue - the cellular component and biological matrix. This method serves as a model for the ultimate clinical application of a progenitor cell towards the repair of a specific tissue defect.

This protocol describes the isolation of adipose-derived stromal cells from lipoaspirate and the creation of a 4 mm critical-sized calvarial defect to evaluate skeletal regeneration.

Lipoaspirate itibaren hasat Yağ kaynaklı stromal hücreler kullanarak Kritik ölçekli Kalvaryum Defekt Model tamiri

Craniofacial skeletal repair and regeneration offers the promise of de novo tissue formation through a cell-based approach utilizing stem cells. ...

Tıp

Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach

Total ankle replacement (TAR) is a valid option for the treatment of ankle osteoarthritis. The traditional surgical approach for TAR is the anterior approach. Recently, the lateral transfibular approach to the ankle has gained popularity since a new TAR implant was designed to be performed via this approach that results in an ideal visualization of the center of rotation of the ankle and curved resections that allow for sparing bone cuts. The aim of the present paper is to present our preoperative, operative, and postoperative protocols for the treatment of the osteoarthritis of the ankle with TAR via lateral approach. We present our preoperative clinical and radiographic protocol. In addition, we describe our surgical technique with some technical tips. Finally, we report our follow-up schedule that includes the collection of clinical, functional, and radiographic data. The results of this procedure are encouraging: TAR through a lateral transfibular approach provides reliable pain relief and improvements in functional outcomes in patients with ankle osteoarthritis.

We present our preoperative, operative, and postoperative protocols for the treatment of osteoarthritis of the ankle with total ankle replacement via lateral transfibular approach.

Yanal bir Transfibular yaklaşımla Total ayak bileği replasmanı ile ayak bileği osteoartrit tedavisinde

Total ankle replacement (TAR) is a valid option for the treatment of ankle osteoarthritis. The traditional surgical approach for TAR is the anterior ...

Davranış

Matrix-assisted Autologous Chondrocyte Transplantation for Remodeling and Repair of Chondral Defects in a Rabbit Model

Articular cartilage defects are considered a major health problem because articular cartilage has a limited capacity for self-regeneration 1. Untreated cartilage lesions lead to ongoing pain, negatively affect the quality of life and predispose for osteoarthritis. During the last decades, several surgical techniques have been developed to treat such lesions. However, until now it was not possible to achieve a full repair in terms of covering the defect with hyaline articular cartilage or of providing satisfactory long-term recovery 2-4. Therefore, articular cartilage injuries remain a prime target for regenerative techniques such as Tissue Engineering. In contrast to other surgical techniques, which often lead to the formation of fibrous or fibrocartilaginous tissue, Tissue Engineering aims at fully restoring the complex structure and properties of the original articular cartilage by using the chondrogenic potential of transplanted cells. Recent developments opened up promising possibilities for regenerative cartilage therapies.
The first cell based approach for the treatment of full-thickness cartilage or osteochondral lesions was performed in 1994 by Lars Peterson and Mats Brittberg who pioneered clinical autologous chondrocyte implantation (ACI) 5. Today, the technique is clinically well-established for the treatment of large hyaline cartilage defects of the knee, maintaining good clinical results even 10 to 20 years after implantation 6. In recent years, the implantation of autologous chondrocytes underwent a rapid progression. The use of an artificial three-dimensional collagen-matrix on which cells are subsequently replanted became more and more popular 7-9.
MACT comprises of two surgical procedures: First, in order to collect chondrocytes, a cartilage biopsy needs to be performed from a non weight-bearing cartilage area of the knee joint. Then, chondrocytes are being extracted, purified and expanded to a sufficient cell number in vitro. Chondrocytes are then seeded onto a three-dimensional matrix and can subsequently be re-implanted. When preparing a tissue-engineered implant, proliferation rate and differentiation capacity are crucial for a successful tissue regeneration 10. The use of a three-dimensional matrix as a cell carrier is thought to support these cellular characteristics 11.
The following protocol will summarize and demonstrate a technique for the isolation of chondrocytes from cartilage biopsies, their proliferation in vitro and their seeding onto a 3D-matrix (Chondro-Gide, Geistlich Biomaterials, Wollhusen, Switzerland). Finally, the implantation of the cell-matrix-constructs into artificially created chondral defects of a rabbit's knee joint will be described. This technique can be used as an experimental setting for further experiments of cartilage repair.

An experimental technique for the treatment of chondral defects in the rabbit's knee joint is described. The implantation of autologous chondrocytes seeded on a matrix is a well-accepted method for the remodeling and repair of articular cartilage lesions providing satisfying long-term results. Matrix-assisted autologous chondrocyte transplantation (MACT) offers a standardized and clinically established implantation method.

Bir Tavşan Modelinde Kondral Kusurların Tadilat ve Onarım için matris destekli Otolog Kondrosit Nakli

Articular cartilage defects are considered a major health problem because articular cartilage has a limited capacity for self-regeneration 1. Untreated ...

Treatment of Osteochondral Defects in the Rabbit's Knee Joint by Implantation of Allogeneic Mesenchymal Stem Cells in Fibrin Clots

The treatment of osteochondral articular defects has been challenging physicians for many years. The better understanding of interactions of articular cartilage and subchondral bone in recent years led to increased attention to restoration of the entire osteochondral unit. In comparison to chondral lesions the regeneration of osteochondral defects is much more complex and a far greater surgical and therapeutic challenge. The damaged tissue does not only include the superficial cartilage layer but also the subchondral bone. For deep, osteochondral damage, as it occurs for example with osteochondrosis dissecans, the full thickness of the defect needs to be replaced to restore the joint surface 1. Eligible therapeutic procedures have to consider these two different tissues with their different intrinsic healing potential 2. In the last decades, several surgical treatment options have emerged and have already been clinically established 3-6.
Autologous or allogeneic osteochondral transplants consist of articular cartilage and subchondral bone and allow the replacement of the entire osteochondral unit. The defects are filled with cylindrical osteochondral grafts that aim to provide a congruent hyaline cartilage covered surface 3,7,8. Disadvantages are the limited amount of available grafts, donor site morbidity (for autologous transplants) and the incongruence of the surface; thereby the application of this method is especially limited for large defects.
New approaches in the field of tissue engineering opened up promising possibilities for regenerative osteochondral therapy. The implantation of autologous chondrocytes marked the first cell based biological approach for the treatment of full-thickness cartilage lesions and is now worldwide established with good clinical results even 10 to 20 years after implantation 9,10. However, to date, this technique is not suitable for the treatment of all types of lesions such as deep defects involving the subchondral bone 11.
The sandwich-technique combines bone grafting with current approaches in Tissue Engineering 5,6. This combination seems to be able to overcome the limitations seen in osteochondral grafts alone. After autologous bone grafting to the subchondral defect area, a membrane seeded with autologous chondrocytes is sutured above and facilitates to match the topology of the graft with the injured site. Of course, the previous bone reconstruction needs additional surgical time and often even an additional surgery. Moreover, to date, long-term data is missing 12.
Tissue Engineering without additional bone grafting aims to restore the complex structure and properties of native articular cartilage by chondrogenic and osteogenic potential of the transplanted cells. However, again, it is usually only the cartilage tissue that is more or less regenerated. Additional osteochondral damage needs a specific further treatment. In order to achieve a regeneration of the multilayered structure of osteochondral defects, three-dimensional tissue engineered products seeded with autologous/allogeneic cells might provide a good regeneration capacity 11.
Beside autologous chondrocytes, mesenchymal stem cells (MSC) seem to be an attractive alternative for the development of a full-thickness cartilage tissue. In numerous preclinical in vitro and in vivo studies, mesenchymal stem cells have displayed excellent tissue regeneration potential 13,14. The important advantage of mesenchymal stem cells especially for the treatment of osteochondral defects is that they have the capacity to differentiate in osteocytes as well as chondrocytes. Therefore, they potentially allow a multilayered regeneration of the defect.
In recent years, several scaffolds with osteochondral regenerative potential have therefore been developed and evaluated with promising preliminary results 1,15-18. Furthermore, fibrin glue as a cell carrier became one of the preferred techniques in experimental cartilage repair and has already successfully been used in several animal studies 19-21 and even first human trials 22.
The following protocol will demonstrate an experimental technique for isolating mesenchymal stem cells from a rabbit's bone marrow, for subsequent proliferation in cell culture and for preparing a standardized in vitro-model for fibrin-cell-clots. Finally, a technique for the implantation of pre-established fibrin-cell-clots into artificial osteochondral defects of the rabbit's knee joint will be described.

An experimental technique for the treatment of osteochondral defects in the rabbit's knee joint is described. The implantation of allogeneic mesenchymal stem cells into osteochondral defects provides a promising development in the field of tissue engineering. The preparation of fibrin-cell-clots in vitro offers a standardized method for implantation.

Fibrin pıhtısı içinde allojenik Mezenkimal Kök Hücre implantasyonu ile Tavşan Diz Eklemi içinde Osteokondral Kusur tedavisi

The treatment of osteochondral articular defects has been challenging physicians for many years. The better understanding of interactions of articular ...

Application of Atomic Force Microscopy to Detect Early Osteoarthritis

Biomechanical properties of cells and tissues not only regulate their shape and function but are also crucial for maintaining their vitality. Changes in elasticity can propagate or trigger the onset of major diseases like cancer or osteoarthritis (OA). Atomic force microscopy (AFM) has emerged as a strong tool to qualitatively and quantitatively characterize the biomechanical properties of specific biological target structures on a microscopic scale, measuring forces in a range from as small as the piconewton to the micronewton. Biomechanical properties are of special importance in musculoskeletal tissues, which are subjected to high levels of strain. OA as a degenerative disease of the cartilage results in the disruption of the pericellular matrix (PCM) and the spatial rearrangement of the chondrocytes embedded in their extracellular matrix (ECM). Disruption in PCM and ECM has been associated with changes in the biomechanical properties of cartilage. In the present study we used AFM to quantify these changes in relation to the specific spatial pattern changes of the chondrocytes. With each pattern change, significant changes in elasticity were observed for both the PCM and ECM. Measuring the local elasticity thus allows for drawing direct conclusions about the degree of local tissue degeneration in OA.

We present a method to investigate early osteoarthritic changes at the cellular level in articular cartilage by using atomic force microscopy (AFM).

Erken Osteoartrit tespit etmek için Atomik Kuvvet Mikroskobu Uygulaması

Biomechanical properties of cells and tissues not only regulate their shape and function but are also crucial for maintaining their vitality. Changes in ...

Biyomühendislik

Clinical Protocol of Producing Adipose Tissue-Derived Stromal Vascular Fraction for Potential Cartilage Regeneration

Osteoarthritis (OA) is one of the most common debilitating disorders.&#160;Recently, numerous attempts have been made to improve the functions of the knees by using different forms of mesenchymal stem cells (MSCs). In Korea, bone marrow concentrates and cord blood-derived stem cells have been approved by the Korean Food and Drug Administration (KFDA) for cartilage regeneration. In addition, an adipose tissue-derived stromal vascular fraction (SVF) has been allowed by the KFDA for joint injections in human patients. Autologous adipose tissue-derived SVF contains extracellular matrix (ECM) in addition to mesenchymal stem cells. ECM excretes various cytokines that, along with hyaluronic acid (HA) and platelet-rich plasma (PRP) activated by calcium chloride, may help MSCs to regenerate cartilage and improve knee functions. In this article, we presented a protocol to improve knee functions by regenerating cartilage-like tissue in human patients with OA. The result of the protocol was first reported in 2011 followed by a few additional publications. The protocol involves liposuction to obtain autologous lipoaspirates that are mixed with collagenase. This lipoaspirates-collagenase mixture is then cut and homogenized to remove large fibrous tissue that may clog up the needle during the injection. Afterwards, the mixture is incubated to obtain adipose tissue-derived SVF. The resulting adipose tissue-derived SVF, containing both adipose tissue-derived MSCs and remnants of ECM, is injected into knees of patients, combined with HA and calcium chloride activated PRP. Included are three cases of patients who were treated with our protocol resulting in improvement of knee pain, swelling, and range of motion along with MRI evidence of hyaline cartilage-like tissue.

Here, we present a protocol to produce an adipose tissue-derived stromal vascular fraction and its application to improve knee functions by regenerating cartilage-like tissue in human patients with osteoarthritis.

Yağ dokusundan elde edilen Stromal vasküler kesir için potansiyel kıkırdak rejenerasyon üreten klinik protokol

Osteoarthritis (OA) is one of the most common debilitating disorders.&#160;Recently, numerous attempts have been made to improve the functions of the ...

<meta charset="utf8"></head><body>Eksplant Modelleri Kullanılarak Kemik Oluşumunun Multimodal Analizi

Comprehensive Characterization of Tissue Mineralization in an Ex Vivo Model

The extensive characterization of tissue mineralization in the context of bone regeneration represents a significant challenge, given the numerous modalities that are currently available for analysis. Here, we propose a workflow for a comprehensive evaluation of new bone formation using a relevant large animal osseous ex vivo explant. A bone defect (diameter = 3.75 mm; depth = 5.0 mm) is created in an explanted sheep femoral head and injected with a macroporous bone substitute loaded with a pro-osteogenic growth factor (bone morphogenetic protein 2 - BMP2). Subsequently, the explant is maintained in culture for a 28-day period, allowing cellular colonization and subsequent bone formation. To evaluate the quality and structure of newly mineralized tissue, the following successive methods are set up: (i) Characterization and high-resolution 3D images of the entire explant using micro-CT, followed by deep learning image analyses to enhance the discrimination of mineralized tissues; (ii) Nano-indentation to determine the mechanical properties of the newly formed tissue; (iii) Histological examinations, such as Hematoxylin/Eosin/Saffron (HES), Goldner's trichrome, and Movat's pentachrome to provide a qualitative assessment of mineralized tissue, particularly with regard to the visualization of the osteoid barrier and the presence of bone cells; (iv) Back-scattering scanning electron microscopy (SEM) mapping with internal reference to quantify the degree of mineralization and provide detailed insights into surface morphology, mineral composition, and bone-biomaterial interface; (v) Raman spectroscopy to characterize the molecular composition of the mineralized matrix and to provide insights into the persistence of BMP2 within the cement through the detection of peptide bonds. This multimodal analysis will provide an effective assessment of newly formed bone and comprehensive qualitative and quantitative insights into mineralized tissues. Through the standardization of these protocols, we aim to facilitate interstudy comparisons and improve the validity and reliability of research findings.

<meta charset="utf8"></head><body>Yazar Spotlight: Kemik Rejenerasyon Araştırmalarında Doku Mineralizasyonunu Karakterize Etmek için İleri Teknikler

The proposed protocol entails a global approach to assess bone formation in the context of bone regeneration using multimodal analyses. It aims to provide qualitative and quantitative information on new bone formation, enhancing the rigor and validity of basic and pre-clinical investigations.

Ex Vivo Modelde Doku Mineralizasyonunun Kapsamlı Karakterizasyonu

The extensive characterization of tissue mineralization in the context of bone regeneration represents a significant challenge, given the numerous ...

Destabilization of the Medial Meniscus and Cartilage Scratch Murine Model of Accelerated Osteoarthritis

Osteoarthritis is the most prevalent musculoskeletal disease in people over 45, leading to an increasing economic and societal cost. Animal models are used to mimic many aspects of the disease. The present protocol describes the destabilization and cartilage scratch model (DCS) of post-traumatic osteoarthritis. Based on the widely used destabilization of the medial meniscus (DMM) model, DCS introduces three scratches on the cartilage surface. The current article highlights the steps to destabilize the knee by transecting the medial meniscotibial ligament followed by three intentional superficial scratches on the articular cartilage. The possible analysis methods by dynamic weight-bearing, microcomputed tomography, and histology are also demonstrated. While the DCS model is not recommended for studies that focus on the effect of osteoarthritis on the cartilage, it enables the study of osteoarthritis development in a shorter time window, with special focus on (1) osteophyte formation, (2) osteoarthritic and injury pain, and (3) the effect of cartilage damage in the whole joint.

The present protocol describes the controlled microblade scratches on the surface of the articular cartilage after destabilizing the mouse knee by cutting the medial miniscotibial ligament. This animal model presents an accelerated form of osteoarthritis (OA) suitable for studying osteophyte formation, osteosclerosis, and early-stage pain.

Hızlandırılmış Osteoartritin Medial Menisküs ve Kıkırdak Çizik Murin Modelinin Destabilizasyonu

Osteoarthritis is the most prevalent musculoskeletal disease in people over 45, leading to an increasing economic and societal cost. Animal models are ...

Otolog Microfractured ve saf yağ dokusu osteokondral lezyon Talus, artroskopik yönetimi için

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Erken Osteoartrit tespit etmek için Atomik Kuvvet Mikroskobu Uygulaması

Yağ dokusundan elde edilen Stromal vasküler kesir için potansiyel kıkırdak rejenerasyon üreten klinik protokol

Ex Vivo Modelde Doku Mineralizasyonunun Kapsamlı Karakterizasyonu

Ex Vivo Modelde Doku Mineralizasyonunun Kapsamlı Karakterizasyonu

Ex Vivo Modelde Doku Mineralizasyonunun Kapsamlı Karakterizasyonu

Hızlandırılmış Osteoartritin Medial Menisküs ve Kıkırdak Çizik Murin Modelinin Destabilizasyonu