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

Förfaranden som utförs med hjälp av Lipogems systemet.

Alla ingrepp i de studier som inbegriper mänskliga deltagare var i enlighet med de etiska normerna för forskningsutskottet för institutionella eller nationell och med 1964 Helsingforsdeklarationen och dess senare ändringar eller jämförbara etiska standarder.
1. medicinsk historia
<ol><li>Börja klinisk undersökning med en detaljerad anamnes. Obs: En OLT måste alltid misstänkas vid instabilitet i fotleden med upprepade stukningar är associerad med svullnad, stelhet, smärta och g...

<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. 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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. 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Under de senaste åren har kliniska och prekliniska studier fokuserat sin uppmärksamhet på effekten av ADSCs att behandla olika muskuloskeletala sjukdomar. Syftet med denna artikel är att beskriva protokollet för behandling av osteokondrala lesioner av talus med hjälp av microfractured och renat fettvävnad i samband med artroskopisk microperforations. Protokollet omfattar flera kritiska steg med höga risker för komplikationer. Under fett skörd, kan komplikationer delas in i lokala eller systemiska komplikationer...

Artroskopi är den gyllene standarden för behandling av osteokondrala lesioner av talus (OLTs) med syftet att smärtlindring, återställa funktioner och förbättrad livskvalitet, särskilt hos unga och aktiva patienter.
För närvarande kan artroskopisk teknik klassificeras på tre sätt. Den reparativa tekniken stimulerar celler från benmärgen genom en debridering och microperforations på nivån av lesionen. Rekonstruktiv tekniken ersätter lesionen använder en autolog eller heterologt ostechondral graft. Den regenerativa tekniken utnyttjar multipotenta celler att differentiera och replikera förmåga att rekonstruera den skadade vävnad1,2,3,4,5,6 .
Under de senaste åren, har regenerativ tekniker varit föremål för talrika in vitro- och in-vivo studier för behandling av OLTs och särskilt mesenkymala stamceller som härrör från fettvävnad (ADSCs)7,8 , 9. dessa mesenkymala stamceller uppvisar morfologiska och funktionella egenskaper liknar andra multipotenta celler, isolerade från andra vävnader; de har också förmåga att differentieras till flera och olika cellulära linjer både in vitro och i vivo10,11,12,13. Fokus på forskning om dessa celler är främst på grund av sin lokalisering, i själva verket de representerar från 10% till 30% av normal kroppsvikt med en koncentration av 5 000 celler per gram vävnad13,14. Däremot, är en faktor som begränsar användningen av dessa celler relaterad till deras hantering under laboratorierutiner. Den lipoaspirate som innehåller aggregat av adipocyter, kollagenfibrer och normala vaskulära komponenter bearbetas enzymatiskt med kollagen A typ I och utsätts för hemolys innan kultur. Syftet här är att beskriva protokollet för behandling av osteokondrala lesioner av talus med microfractured och renat fettvävnad.

<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

Under de senaste åren har regenerativa tekniker alltmer studerats och används för att behandla osteokondrala lesioner av talus. I synnerhet har flera studier fokuserat sin uppmärksamhet på mesenkymala stamceller som härrör från fettvävnad. Adipose-derived stamceller (ADSCs) uppvisar morfologiska kännetecken och egenskaper som liknar andra mesenkymala celler och kan skilja i flera cellulära linjer. Dessutom, dessa celler är också allmänt tillgängliga i den subkutana vävnaden, motsvarande 10-30% av normal kroppsvikt, med en koncentration av 5 000 celler per gram vävnad.
I presenteras tekniken innebär det första steget skörd ADSCs från buken och en process av mikrofraktur och rening; Nästa, det kirurgiska ingreppet utförs helt arthroscopically, med mindre mjuk vävnad dissektion, bättre gemensamma visualisering och en snabbare återhämtning jämfört med öppen standardförfaranden. Artroskopi är kännetecknas av en första fas där lesionen är identifierade, isolerade och förberedda med microperforations; det andra steget, utfört Kemtvätt, innebär injektion av fettvävnad i nivå med lesionen.
Mellan januari 2016 och September 2016 genomgick fyra patienter artroskopisk behandling av osteokondrala lesioner av talus med microfractured och renat fettvävnad. Alla patienter rapporterade klinisk förbättring sex månader efter operation med inga rapporterade komplikationer. Funktionella Poäng vid senaste uppföljningen är uppmuntrande och bekräfta att tekniken ger tillförlitlig smärtlindring och förbättringar hos patienter med osteokondrala lesioner av talus.

Mellan januari 2016 och September 2016 genomgick fyra patienter artroskopisk behandling av osteokondrala lesioner av talus med microfractured och renat fettvävnad. Alla patienter rapporterade klinisk förbättring sex månader efter operationen. Preliminära kliniska resultat redovisas i tabell 1. Inga komplikationer har rapporterats.
Under de senaste åren ökat användningen av ADSCs för behandling av fot oc...

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

Syftet med denna studie är att rapportera ett protokoll för artroskopisk behandling av osteokondrala lesioner av talus med hjälp av microfractured och renat adipose-derived stamceller.

Autolog Microfractured och renat fettvävnad för artroskopisk hantering av osteokondrala lesioner av Talus

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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