Original Article · Open access
A comparative analysis of 3D bioprinted gelatin-hyaluronic acid-alginate scaffold and microfracture for the management of osteochondral defects in the rabbit knee joint
Abstract
Objectives: This study aims to compare the radiological, biomechanical, and histopathological results of microfracture treatment and osteochondral damage repair treatment with a new scaffold product produced by the three-dimensional (3D) bioprinting method containing gelatin-hyaluronic acid-alginate in rabbits with osteochondral damage.
Materials and methods: A new 3D bioprinted scaffold consisting of gelatin, hyaluronic acid, and alginate designed by us was implanted into the osteochondral defect created in the femoral trochlea of 10 rabbits. By randomization, it was determined which side of 10 rabbits would be repaired with a 3D bioprinted scaffold, and microfracture treatment was applied to the other knees of the rabbits. After six months of follow-up, the rabbits were sacrificed. The results of both treatment groups were compared radiologically, biomechanically, and histopathologically.
Results: None of the rabbits experienced any complications. The magnetic resonance imaging evaluation showed that all osteochondral defect areas were integrated with healthy cartilage in both groups. There was no significant difference between the groups in the biomechanical load test (p=0.579). No statistically significant difference was detected in the histological examination using the modified Wakitani scores (p=0.731).
Conclusion: Our study results showed that 3D bioprinted scaffolds exhibited comparable radiological, biomechanical, and histological properties to the conventional microfracture technique for osteochondral defect treatment.
Declarations
Ethics Committee Approval
The study protocol was approved by the Marmara University Animal Experiments Local Ethics Committee (date: 14.12.2021, no: 99.2021mar). The study was conducted in accordance with the principles of the Declaration of Helsinki.
Author Contributions
Idea/concept: M.M., M.H.C.; Design: M.A., M.O.; Data collection/processing: M.A., M.H.C.; Analysis/interpretation: S.S., M.A.; Literature review: R.D., M.A., Drafting/writing: M.O., M.H.C., M.A.; Critical review: M.A., S.S., M.M.
Conflict of Interest
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
Financial Disclosure
The authors received no financial support for the research and/or authorship of this article.
Data Sharing Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
References
- Uzun E, Güvercin S, Günay AE, Kafadar İH, Bolat D, Yay AH, et al. The effect of oral hydroxychloroquine on chondral defect: An experimental study. Jt Dis Relat Surg 2023;34:628- 39. DOI: 10.52312/jdrs.2023.1114.
- Baghaban Eslaminejad M, Malakooty Poor E. Mesenchymal stem cells as a potent cell source for articular cartilage regeneration. World J Stem Cells 2014;6:344-54. DOI: 10.4252/wjsc.v6.i3.344.
- Kekeç AF, Yıldırım A. Mid-term results of autologous matrixinduced chondrogenesis surgery with or without scaffolds for arthroscopic treatment of deep talus osteochondral lesions: A comparative study. Jt Dis Relat Surg 2023;34:613-9. DOI: 10.52312/jdrs.2023.1197.
- Wakitani S, Goto T, Pineda SJ, Young RG, Mansour JM, Caplan AI, et al. Mesenchymal cell-based repair of large, fullthickness defects of articular cartilage. J Bone Joint Surg [Am] 1994;76:579-92. DOI: 10.2106/00004623-199404000-00013.
- Szerb I, Hangody L, Duska Z, Kaposi NP. Mosaicplasty: Long-term follow-up. Bull Hosp Jt Dis 2005;63:54-62.
- Mithoefer K, McAdams T, Williams RJ, Kreuz PC, Mandelbaum BR. Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: An evidence-based systematic analysis. Am J Sports Med 2009;37:2053-63. DOI: 10.1177/0363546508328414.
- Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med 1994;331:889-95. DOI: 10.1056/NEJM199410063311401.
- Georgi N, van Blitterswijk C, Karperien M. Mesenchymal stromal/stem cell-or chondrocyte-seeded microcarriers as building blocks for cartilage tissue engineering. Tissue Eng Part A 2014;20:2513-23. DOI: 10.1089/ten.TEA.2013.0681.
- Bahadır B, Atik OŞ, Kanatlı U, Sarıkaya B. A brief introduction to medical image processing, designing and 3D printing for orthopedic surgeons. Jt Dis Relat Surg 2023;34:451-4. DOI: 10.52312/jdrs.2023.57912.
- Garretson RB 3rd, Katolik LI, Verma N, Beck PR, Bach BR, Cole BJ. Contact pressure at osteochondral donor sites in the patellofemoral joint. Am J Sports Med 2004;32:967-74. DOI: 10.1177/0363546503261706.
- Ahmad CS, Cohen ZA, Levine WN, Ateshian GA, Mow VC. Biomechanical and topographic considerations for autologous osteochondral grafting in the knee. Am J Sports Med 2001;29:201-6. DOI: 10.1177/03635465010290021401.
- Ghazavi MT, Pritzker KP, Davis AM, Gross AE. Fresh osteochondral allografts for post-traumatic osteochondral defects of the knee. J Bone Joint Surg [Br] 1997;79:1008-13. DOI: 10.1302/0301-620x.79b6.7534.
- Yang Y, Yang G, Yongfei S, Xu Y, Zhao S, Wenyuan Z. 3D bioprinted integrated osteochondral scaffold-mediated repair of articular cartilage defects in the rabbit knee. J Med Biol Eng 2020;40:71-81. doı: 10.1007/s40846-019-00481-y.
- Goebel L, Zurakowski D, Müller A, Pape D, Cucchiarini M, Madry H. 2D and 3D MOCART scoring systems assessed by 9.4 T high-field MRI correlate with elementary and complex histological scoring systems in a translational model of osteochondral repair. Osteoarthritis Cartilage 2014;22:1386- 95. DOI: 10.1016/j.joca.2014.05.027.
- Yamaguchi S, Aoyama T, Ito A, Nagai M, Iijima H, Tajino J, et al. The effect of exercise on the early stages of mesenchymal stromal cell-induced cartilage repair in a rat osteochondral defect model. PLoS One 2016;11:e0151580. DOI: 10.1371/journal.pone.0151580.
- Xue D, Zheng Q, Zong C, Li Q, Li H, Qian S, et al. Osteochondral repair using porous poly(lactide-coglycolide)/nano-hydroxyapatite hybrid scaffolds with undifferentiated mesenchymal stem cells in a rat model. J Biomed Mater Res A 2010;94:259-70. DOI: 10.1002/jbm.a.32691.