PMC9679023_01
Fabrication of the patch. Healthy cartilage was harvested from the intercondylar fossa. Chondrocytes were isolated enzymatically. The cartilage used for the fabrication of acellular cartilage sheets was harvested from the ears of adult pigs. It was cut into sheets, and the sheets were decellularized. Chondrocytes were seeded on the sheet. Then, another acellular cartilage sheet was superposed on the first sheet, and these procedures were continued until ten sheets were stacked together. The construct was cultured at 37 C in an atmosphere of 5% CO2 and 95% relative humidity for 4 weeks before implantation.
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F1
Figure 1 provides a brief summary of the construction process of implantation patch.
Mini-arthrotomy, curettage, and implantation in a patient (female; 36 years; left knee; BMI = 19.05 kg/m2; other surgery: bone grafting). (A) The cartilage defect was exposed. (B,C) The unhealthy cartilage was marked and removed. (D) The subchondral bone was exposed, and cystic degeneration could be seen. (E) The cystic degeneration in subchondral bone was removed, and blood effusion could be observed. (F) The patch was placed in 0.9% saline <5 min before transplantation. (G) A contralateral autogenous posterior iliac bone graft was made. (H) The patch was placed into the defect. Fibrin glue was applied to the surface to fix the patch to the defect without suturing.
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F2
During this step (Figure 2), the unhealthy cartilage and subchondral bone plate were cleaned carefully to ensure blood exudation was absent and to leave the base smooth.
Variation in the trend of (A) international knee documentation committee subjective knee evaluation form (IKDC-SKEF), lysholm scale, western Ontario and mcMaster universities osteoarthritis Index (WOMAC), (B) knee injury and osteoarthritis outcome score (KOOS), and (C) magnetic resonance observation of cartilage repair tissue (MOCART) scores.
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F3
All patients showed improvements on all clinical outcomes over the time (Figures 3A,B). The MOCART scores increased gradually after procedure (Figure 3C) for all patients.
Arthroscopic view and MR images of four patients. The first column: arthroscopic view of cartilage defect. The second to fifth columns: Sagittal T2-weighted, coronal, or axial PD-weighted MR images of four patients from pre to 18 months after procedure.
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F4
The MR images of patients are shown in Figure 4.