Name: autologous microfractured and purified adipose tissue for arthroscopic management of osteochondral lesions of the talus
Uploaded: 2018-01-23T13:00:00
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

Os procedimentos são realizados utilizando o sistema de Lipogems.

Todos os procedimentos realizados nos estudos envolvendo participantes humanos estavam em conformidade com os padrões éticos do Comitê de pesquisa institucional e/ou nacional e com a declaração de Helsinque 1964 e suas alterações posteriores ou ético comparável padrões.
1. o histórico
<ol><li>Inicie o exame clínico com um histórico detalhado do paciente. Nota: Um OLT sempre deve ser suspeitado em caso de instabilidade do tornozelo com entorses repetidas associadas com inchaç...

<ol>
	<li>D'Ambrosi, R., Maccario, C., Serra, N., Liuni, F., Usuelli, F. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Osteochondral+Lesions+of+the+Talus+and+Autologous+Matrix-Induced+Chondrogenesis:+Is+Age+a+Negative+Predictor+Outcome?.">Osteochondral Lesions of the Talus and Autologous Matrix-Induced Chondrogenesis: Is Age a Negative Predictor Outcome?.</a> Arthroscopy. 33 (2), 428-435 (2017).</li><li>Becher, C., 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=T2-mapping+at+3+T+after+microfracture+in+the+treatment+of+osteochondral+defects+of+the+talus+at+an+average+follow-up+of+8+years.">T2-mapping at 3 T after microfracture in the treatment of osteochondral defects of the talus at an average follow-up of 8 years.</a> Knee Surg. SportsTraumatol. Arthrosc. 23 (8), 2406-2412 (2015).</li><li>Polat, G., 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=Long-term+results+of+microfracture+in+the+treatment+of+talus+osteochondral+lesions.">Long-term results of microfracture in the treatment of talus osteochondral lesions.</a> Knee Surg. Sports Traumatol. Arthrosc. 24 (4), 1299-1303 (2016).</li><li>van Bergen, C. 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=Arthroscopic+treatment+of+osteochondral+defects+of+the+talus:+outcomes+at+eight+to+twenty+years+of+follow-up.">Arthroscopic treatment of osteochondral defects of the talus: outcomes at eight to twenty years of follow-up.</a> J. Bone Joint Surg. Am. 95 (6), 519-525 (2013).</li><li>van Eekeren, I. C., 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=Return+to+sports+after+arthroscopic+debridement+and+bone+marrow+stimulation+of+osteochondral+talar+defects:+a+5-+to+24-year+follow-up+study.">Return to sports after arthroscopic debridement and bone marrow stimulation of osteochondral talar defects: a 5- to 24-year follow-up study.</a> Knee Surg Sports Traumatol Arthrosc. 24 (4), 1311-1315 (2016).</li><li>D'Ambrosi, R., Maccario, C., Ursino, C., Serra, N., Usuelli, F. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Combining+Microfractures,+Autologous+Bone+Graft,+and+Autologous+Matrix-Induced+Chondrogenesis+for+the+Treatment+of+Juvenile+Osteochondral+Talar+Lesions.">Combining Microfractures, Autologous Bone Graft, and Autologous Matrix-Induced Chondrogenesis for the Treatment of Juvenile Osteochondral Talar Lesions.</a> Foot Ankle Int. 38 (5), 485-495 (2017).</li><li>Usuelli, F. G., D'Ambrosi, R., Maccario, C., Indino, C., Manzi, L., Maffulli, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Adipose-derived+stem+cells+in+orthopaedic+pathologies.">Adipose-derived stem cells in orthopaedic pathologies.</a> British Medical Bulletin. , (2017).</li><li>Kim, Y. S., 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=Assessment+of+clinical+and+MRI+outcomes+after+mesenchymal+stem+cell+implantation+in+patients+with+knee+osteoarthritis:+a+prospective+study.">Assessment of clinical and MRI outcomes after mesenchymal stem cell implantation in patients with knee osteoarthritis: a prospective study.</a> Osteoarthr Cartilage. 24 (2), 237-245 (2016).</li><li>Koh, Y. G., Choi, Y. J., Kwon, S. K., Kim, Y. S., Yeo, J. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+results+and+second-look+arthroscopic+findings+after+treatment+with+adipose-derived+stem+cells+for+knee+osteoarthritis.">Clinical results and second-look arthroscopic findings after treatment with adipose-derived stem cells for knee osteoarthritis.</a> Knee Surg. Sports Traumatol. Arthrosc. 23 (5), 1308-1316 (2015).</li><li>Zuk, P. 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=Human+adipose+tissue+is+a+source+of+multipotent+stem+cells.">Human adipose tissue is a source of multipotent stem cells.</a> Mol. Biol. Cell. 13 (12), 4279-4295 (2002).</li><li>Tal&#233;ns-Visconti, R., 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=Human+mesenchymal+stem+cells+from+adipose+tissue:+Differentiation+into+hepatic+lineage.">Human mesenchymal stem cells from adipose tissue: Differentiation into hepatic lineage.</a> Toxicol. In Vitro. 21 (2), 324-329 (2007).</li><li>Timper, K., 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=Human+adipose+tissue-derived+mesenchymal+stem+cells+differentiate+into+insulin,+somatostatin,+and+glucagon+expressing+cells.">Human adipose tissue-derived mesenchymal stem cells differentiate into insulin, somatostatin, and glucagon expressing cells.</a> Biochem. Biophys. Res. Commun. 341 (4), 1135-1140 (2006).</li><li>Tremolada, C., Palmieri, G., Ricordi, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Adipocyte+transplantation+and+stem+cells:+plastic+surgery+meets+regenerative+medicine.">Adipocyte transplantation and stem cells: plastic surgery meets regenerative medicine.</a> Cell. Transplant. 19 (10), 1217-1223 (2010).</li><li>Keramaris, N. C., 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=Endothelial+progenitor+cells+(EPCs)+and+mesenchymal+stem+cells+(MSCs)+in+bone+healing.">Endothelial progenitor cells (EPCs) and mesenchymal stem cells (MSCs) in bone healing.</a> Curr. Stem Cell. Res. Ther. 7 (4), 293-301 (2012).</li><li>Leigheb, M., 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=Italian+translation,+cultural+adaptation+and+validation+of+the+American+Orthopaedic+Foot+and+Ankle+Society's+(AOFAS)+ankle-hindfoot+scale.">Italian translation, cultural adaptation and validation of the American Orthopaedic Foot and Ankle Society's (AOFAS) ankle-hindfoot scale.</a> Acta Biomed. 87 (1), 38-45 (2016).</li><li>Ware, J., Kosinski, M., Keller, S. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+12-Item+Short-Form+Health+Survey:+construction+of+scales+and+preliminary+tests+of+reliability+and+validity.">A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity.</a> Med. Care. 34 (3), 220-233 (1996).</li><li>Hawker, G. A., Mian, S., Kendzerska, T., French, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Measures+of+adult+pain:+Visual+Analog+Scale+for+Pain+(VAS+Pain),+Numeric+Rating+Scale+for+Pain+(NRS+Pain),+McGill+Pain+Questionnaire+(MPQ),+Short-Form+McGill+Pain+Questionnaire+(SF-MPQ),+Chronic+Pain+Grade+Scale+(CPGS),+Short+Form-36+Bodily+Pain+Scale+(SF-36+BPS),+and+Measure+of+Intermittent+and+Constant+Osteoarthritis+Pain+(ICOAP).">Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP).</a> Arthritis Care (Hoboken). 63, S240-S252 (2011).</li><li>Bergen, C. J., Gerards, R. M., Opdam, K. T., Terra, M. P., Kerkhoffs, G. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnosing,+planning+and+evaluating+osteochondral+ankle+defects+with+imaging+modalities.">Diagnosing, planning and evaluating osteochondral ankle defects with imaging modalities.</a> World. J. Orthop. 6 (11), 944-953 (2015).</li><li>van Dijk, C. N., Reilingh, M. L., Zengerink, M., van Bergen, C. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Osteochondral+defects+in+the+ankle:+why+painful?.">Osteochondral defects in the ankle: why painful?.</a> Knee Surg. Sports Traumatol. Arthrosc. 18 (5), 570-580 (2010).</li><li>Madry, H., van Dijk, C. N., Mueller-Gerbl, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+basic+science+of+the+subchondral+bone.">The basic science of the subchondral bone.</a> Knee Surg. Sports Traumatol. Arthrosc. 18 (4), 419-433 (2010).</li><li>Mintz, D. N., Tashjian, G. S., Connell, D. A., Deland, J. T., O'Malley, M., Potter, H. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Osteochondral+lesions+of+the+talus:+a+new+magnetic+resonance+grading+system+with+arthroscopic+correlation.">Osteochondral lesions of the talus: a new magnetic resonance grading system with arthroscopic correlation.</a> Arthroscopy. 19 (4), 353-359 (2003).</li><li>Leumann, 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=A+novel+imaging+method+for+osteochondral+lesions+of+the+talus--comparison+of+SPECT-CT+with+MRI.">A novel imaging method for osteochondral lesions of the talus--comparison of SPECT-CT with MRI.</a> Am. J. Sports Med. 39 (5), 1095-1101 (2011).</li><li>Kim, Y. S., Park, E. H., Kim, Y. C., 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=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>

Nos últimos anos, ensaios pré-clínicos e clínicos têm focado sua atenção o efeito da ADSCs para tratar diferentes patologias músculo-esqueléticas. O objetivo deste artigo é descrever o protocolo para o tratamento das lesões osteocondrais do tálus usando microfractured e purificado de tecido adiposo em associação com microperfurações artroscópica. O protocolo envolve várias etapas críticas com alto risco de complicações. Durante a colheita de gordura, as complicações podem ser divididas em complica?...

Artroscopia é o padrão ouro para o tratamento de lesões osteocondrais do tálus (OLTs) com o objetivo de alívio da dor, restaurando a funcionalidade e melhorando a qualidade de vida, especialmente em pacientes jovens e ativos.
Atualmente, técnicas artroscópicas podem ser classificadas de três maneiras. A técnica reparativa estimula células derivadas da medula óssea através de um desbridamento e microperfurações ao nível da lesão. A técnica reconstrutiva substitui a lesão utilizando um enxerto autólogo ou heterólogo ostechondral. A técnica regenerativa explora a capacidade das células multipotentes diferenciar e replicar para reconstruir o tecido danificado1,2,3,4,5,6 .
Nos últimos anos, técnicas regenerativas têm sido objecto de numerosos estudos in vitro e in vivo para o tratamento de OLTs e particularmente mesenquimais células-tronco derivadas de tecido adiposo (ADSCs)7,8 , 9. essas células-tronco mesenquimais apresentam características morfológicas e funcionais semelhantes a outras células multipotentes, isoladas de outros tecidos; Eles também têm a capacidade de se diferenciarem em vários e celulares diferentes linhas em vitro e em vivo10,11,12,13. O foco na pesquisa sobre essas células é principalmente devido à sua localização, na verdade, eles representam de 10% a 30% do peso corporal normal, com uma concentração de 5.000 células por grama de tecido13,14. Por outro lado, um fator que limita o uso dessas células está relacionado ao seu manuseamento durante os procedimentos de laboratório. O lipoaspirate contendo agregados de adipócitos, fibras de colágeno e componentes vasculares normais é enzimaticamente processada com colágeno A tipo I e submetido a hemólise antes de cultura. O objetivo aqui é descrever o protocolo para o tratamento das lesões osteocondrais do tálus usando microfractured e purificado de tecido adiposo.

<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&#176; TIP / 60&#176; TIP</td>
			<td>ARTHREX</td>
			<td>AR-8655-05 
			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

Nos últimos anos, técnicas regenerativas foram cada vez mais estudadas e usadas para tratar lesões osteocondrais do tálus. Em particular, vários estudos têm focado sua atenção as células-tronco mesenquimais derivadas de tecido adiposo. Células-tronco adiposo-derivado (ADSCs) exibem características morfológicas e propriedades semelhantes a outras células mesenquimais e são capazes de se diferenciar em várias linhas celulares. Além disso, essas células também são amplamente disponíveis no tecido subcutâneo, representando 10-30% do peso corporal normal, com uma concentração de 5.000 células por grama de tecido.
A técnica apresentada, a primeira etapa envolve a colheita ADSCs do abdômen e um processo de microfratura e purificação; em seguida, o procedimento cirúrgico é realizado inteiramente artroscopicamente, com menos dissecção de tecidos moles, melhor visualização conjunta e uma recuperação mais rápida em comparação com os procedimentos padrão de abrir. Artroscopia é caracterizada por uma primeira fase em que a lesão é identificada, isolada e preparada com microperfurações; a segunda etapa, realizada a seco, envolve a injeção de tecido adiposo a nível da lesão.
Entre janeiro de 2016 e setembro de 2016, quatro pacientes foram submetidos a tratamento artroscópico da lesão osteocondral do tálus com microfractured e purificado de tecido adiposo. Todos os pacientes relataram melhora clínica, seis meses após a cirurgia sem complicações relatadas. Resultados funcionais no seguimento mais recente são encorajadores e confirmam que a técnica proporciona alívio da dor confiável e melhorias em pacientes com lesão osteocondral do tálus.

Entre janeiro de 2016 e setembro de 2016, quatro pacientes foram submetidos a tratamento artroscópico da lesão osteocondral do tálus com microfractured e purificado de tecido adiposo. Todos os pacientes relataram melhora clínica, seis meses após a cirurgia. Os resultados clínicos preliminares são relatados na tabela 1. Sem complicações foram relatadas.
Nos últimos anos, aumentou-se o uso de ADSCs para ...

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

O objetivo deste estudo é relatar um protocolo para o tratamento artroscópico das lesões osteocondrais do tálus usando microfractured e células-tronco adiposo-derivado purificadas.

Microfractured autólogo e purificado tecido adiposo para gestão artroscópica das lesões osteocondrais do tálus

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

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