Trombositten zengin plazma kronik fokal kondral defektlerin mikrofraktür ile tedavisini daha etkin kılar mı? Sıçan modelli in vivo çalışma

Öz

Amaç: Mevcut çalışmanın amacı trombositten zengin plazma (platelet-rich plasma, PRP) + mikrofraktür ile mikrofraktür tedavilerinin kronik fokal kondral defekt iyileşmesine etkisini karşılaştırmaktı. Çalışma planı: Bu çalışmada 57 adet erişkin erkek Sprague-Dawley sıçanı kullanıldı. Kırk iki sıçan kondral defekt oluşturulduktan sonra 14’erlikten 3 gruba (kontrol, sadece mikrofraktür, PRP+mikrofraktür) ayrıldı. Kalan 15 sıçan PRP hazırlanmasında kullanıldı. Tedaviden 3 ve 6 hafta sonra sıçanlara ötenazi uygulandı ve incelemeleri yapıldı. Uyarlanmış Pineda skorlama sistemi ile histolojik analiz ve Tip 2 kollajen için immünohistokimyasal boyama yapıldı. Bulgular: Her iki zaman aralığında da, kontrol grubu histolojik skorları (3. hafta: 8.8±1.2, 6. hafta: 8.5±0.7) mikrofraktür (3. hafta: 6.8±1.0, 6. hafta: 7.1±0.6) ve PRP+mikrofraktür (3. hafta: 6.4±1.3, 6. hafta: 5.7±1.2) gruplarından daha yüksekti (p<0.05). Altıncı hafta mikrofraktür grup skoru, 6. hafta PRP+mikrofraktür grubundan daha yüksekti (p<0.05). Tip 2 kollajen boyanma derecesi 6. haftada PRP+mikrofraktür grubunda daha yüksekti ve hücre membranında membranöz boyama gözlendiğinden benzersizdi. Çıkarımlar: Kronik fokal kondral defekt tedavisi için mikrofraktürlerle birlikte PRP uygulamasının kıkırdak iyileşmesini daha etkin kıldığı gözükmektedir.

Anahtar Kelimeler

• Kıkırdak onarımı; mikrofraktür; trombositten zengin plazma.

Does platelet-rich plasma enhance microfracture treatment for chronic focal chondral defects? An in-vivo study performed in a rat model

Öz

Objective: The purpose of the present study was to compare the effectiveness of platelet-rich plasma (PRP) + microfracture and microfracture treatments in the healing of chronic focal chondral defects.
Methods: The study included 57 adult male Sprague-Dawley rats. Forty-two rats were divided into three groups of 14 rats with a chondral defect (control, microfracture only, PRP+microfracture). The remaining 15 rats were used to produce the PRP preparation. The rats were then euthanatized at 3 and 6 weeks after treatment and examined. Histological analysis using the modified Pineda scoring system and immunohistochemical staining for Type 2 collagen were performed.
Results: At both time intervals, control group histological scores (Week 3: 8.8±1.2, Week 6: 8.5±0.7) were higher than microfracture (Week 3: 6.8±1.0, Week 6: 7.1±0.6) and PRP+microfracture (Week 3: 6.4±1.3, Week 6: 5.7±1.2) scores (p<0.05). The microfracture group score was higher at Week 6 than the PRP+microfracture group (p<0.05). The degree of Type 2 collagen staining was higher at Week 6 in the PRP+microfracture group and was unique in showing staining at the cell membrane.
Conclusion: The addition of PRP application to microfracture treatment appears to enhance cartilage healing in chronic focal chondral defects.

Anahtar Kelimeler

• Cartilage repair
• microfracture
• platelet-rich plasma

Kaynakça

1. Knutsen G, Engebretsen L, Ludvigsen TC, Drogset JO, Grİntvedt T, Solheim E, et al. Autologous chondrocyte implantation versus microfracture in the knee. A randomized trial. J Bone Joint Surg Am 2004;86-A:455-64.
2. Zaslav K, Cole B, Brewster R, DeBerardino T, Farr J, Fowler P, et al. A prospective study of autologous chondrocyte implantation in patients with failed prior treatment for articu- lar cartilage defect of the knee: results of the Study of the Treatment of Articular Repair (STAR) clinical trial. Am J Sports Med 2009;37:42-55.
3. Mithoefer K, Williams RJ 3rd, Warren RF, Potter HG, Spock CR, Jones EC, et al. The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospec- tive cohort study. J Bone Joint Surg Am 2005;87:1911-20.
4. Nehrer S, Spector M, Minas T. Histologic analysis of tissue after failed cartilage repair procedures. Clin Orthop Relat Res 1999;(365):149-62.
5. Gobbi A, Nunag P, Malinowski K. Treatment of full thickness chondral lesions of the knee with microfracture in a group of athletes. Knee Surg Sports Traumatol Arthrosc 2005;13:213- 21.
6. Kreuz PC, Erggelet C, Steinwachs MR, Krause SJ, Lahm A, Niemeyer P, et al. Is microfracture of chondral defects in the knee associated with different results in patients aged 40 years or younger? Arthroscopy 2006;22:1180-6.
7. Kreuz PC, Steinwachs MR, Erggelet C, Krause SJ, Konrad G, Uhl M, et al. Results after microfracture of full-thickness chondral defects in different compartments in the knee. Osteoarthritis Cartilage 2006;14:1119-25.
8. Lopez-Vidriero E, Goulding KA, Simon DA, Sanchez M, Johnson DH. The use of platelet-rich plasma in arthroscopy and sports medicine: optimizing the healing environment. Arthroscopy 2010;26:269-78.

9. Anitua E, Andía I, Sanchez M, Azofra J, del Mar Zalduendo M, de la Fuente M, et al. Autologous preparations rich in growth factors promote proliferation and induce VEGF and HGF production by human tendon cells in culture. J Orthop Res 2005;23:281-6.
10. De Mos M, van der Windt AE, Jahr H, van Schie HT, Weinans H, Verhaar JA, et al. Can platelet-rich plasma enhance tendon repair? A cell culture study. Am J Sports Med 2008;36:1171-8.
11. Mishra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med 2006;34:1774-8.
12. Kon E, Filardo G, Delcogliano M, Presti ML, Russo A, Bondi A, et al. Platelet-rich plasma: new clinical application: a pilot study for treatment of jumper's knee. Injury 2009;40:598-603.
13. Barber FA, Hrnack SA, Snyder SJ, Hapa O. Rotator cuff repair healing influenced by platelet-rich plasma construct augmentation. Arthroscopy 2011;27:1029-35.
14. Sánchez M, Anitua E, Azofra J, Andía I, Padilla S, Mujika I. Comparison of surgically repaired Achilles tendon tears using platelet-rich fibrin matrices. Am J Sports Med 2007;35:245- 51.
15. Sanchez M, Anitua E, Cugat R, Azofra J, Guadilla J, Seijas R, et al. Nonunions treated with autologous preparation rich in growth factors. J Orthop Trauma 2009;23:52-9.
16. Sun Y, Feng Y, Zhang CQ, Chen SB, Cheng XG. The regen- erative effect of platelet-rich plasma on healing in large osteo- chondral defects. Int Orthop 2010;34:589-97.
17. Tetik O, Doral MN, Atay AO, Leblebicio¤lu G. Influence of irrigation solutions combined with colchicine and diclofenac sodium on articular cartilage in a rat model. Knee Surg Sports Traumatol Arthrosc 2004;12:503-9.
18. Nishimori M, Deie M, Kanaya A, Exham H, Adachi N, Ochi M. Repair of chronic osteochondral defects in the rat. A bone marrow-stimulating procedure enhanced by cultured allo- genic bone marrow mesenchymal stromal cells. J Bone Joint Surg Br 2006;88:1236-44.
19. Virchenko O, Grenegård M, Aspenberg P. Independent and additive stimulation of tendon repair by thrombin and platelets. Acta Orthop 2006;77:960-6.
20. Milano G, Sanna Passino E, Deriu L, Careddu G, Manunta L, Manunta A, et al. The effect of platelet rich plasma combined with microfractures on the treatment of chondral defects: an experimental study in a sheep model. Osteoarthritis Cartilage 2010;18:971-80.
21. Milano G, Deriu L, Sanna Passino E, Masala G, Saccomanno MF, Postacchini R, et al. The effect of autologous conditioned plasma on the treatment of focal chondral defects of the knee. An experimental study. Int J Immunopathol Pharmacol 2011;24:117-24.
22. Milano G, Deriu L, Sanna Passino E, Masala G, Manunta A, Postacchini R, et al. Repeated platelet concentrate injections enhance reparative response of microfractures in the treat- ment of chondral defects of the knee: an experimental study in an animal model. Arthroscopy 2012;28:688-701.
23. Miyamoto A, Deie M, Yamasaki T, Nakamae A, Shinomiya R, Adachi N, et al. The role of the synovium in repairing carti- lage defects. Knee Surg Sports Traumatol Arthrosc 2007;15:1083-93.
24. Krüger JP, Hondke S, Endres M, Pruß A, Siclari A, Kaps C. Human platelet-rich plasma stimulates migration and chon- drogenic differentiation of human subchondral progenitor cells. J Orthop Res 2012;30:845-52.
25. Bos PK, van Osch GJ, Frenz DA, Verhaar JA, Verwoerd- Verhoef HL. Growth factor expression in cartilage wound healing: temporal and spatial immunolocalization in a rabbit articular cartilage wound model. Osteoarthritis Cartilage 2001;9:382-9.
26. Dausse Y, Grossin L, Miralles G, Pelletier S, Mainard D, Hubert P, et al. Cartilage repair using new polysaccharidic biomaterials: macroscopic, histological and biochemical approaches in a rat model of cartilage defect. Osteoarthritis Cartilage 2003;11:16-28.
27. Harada Y, Tomita N, Nakajima M, Ikeuchi K, Wakitani S. Effect of low loading and joint immobilization for sponta- neous repair of osteochondral defect in the knees of weightless (tail suspension) rats. J Orthop Sci 2005;10:508-14.
28. Anraku Y, Mizuta H, Sei A, Kudo S, Nakamura E, Senba K, et al. The chondrogenic repair response of undifferentiated mesenchymal cells in rat full-thickness articular cartilage defects. Osteoarthritis Cartilage 2008;16:961-4.
29. Kuroda R, Usas A, Kubo S, Corsi K, Peng H, Rose T, et al. Cartilage repair using bone morphogenetic protein 4 and muscle-derived stem cells. Arthritis Rheum 2006;54:433-42.
30. Strauss E, Schachter A, Frenkel S, Rosen J. The efficacy of intra-articular hyaluronan injection after the microfracture technique for the treatment of articular cartilage lesions. Am J Sports Med 2009;37:720-6.