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Abstract
Background The intrinsic healing capacity of articular cartilage remains poor, despite various attempts that have been undertaken to treat cartilage defects. This study describes the experimental use of a double-layer bioimplant consisting of a bone-substitute layer and a cartilage-substitute layer.
Animals and methods In group A, 12 implants were placed into osteochondral defects of the load-bearing area of rabbit femoral condyles. In group B, 12 implantations were done in the same manner, with a separating membrane consisting of cement between both layers to investigate ingrowth of mesenchymal stem cells from the subchondral marrow space. Group C, with 12 similar defects but without treatment, served as control. Investigations by microscopy and immunohistochemistry were done after 12 weeks.
Results All bioimplants showed coverage of the defect with a regeneration tissue that contained cartilage-like regions. Implants with a cement layer showed less cartilage and more fibrous tissue. The bioimplant group showed more cartilage-like regeneration tissue than the control groups, which only showed incomplete fibrous filling of the defects. Results from the second group supported the hypothesis that the subchondral space must be opened for adequate regeneration. Additional examinations were done using an established semiquantitative score. The bioimplant group showed a significant improvement in results compared to the group with the separating layer and the control group.
Interpretation Our findings indicate that cartilage repair by resorbable bioimplants seems to be a promising new approach, especially if mesenchymal stem cells are present and can differentiate under mechanical load.
Contributions of authors
PEM: implant design, animal experiments, histological evaluation and editing of manuscript. FS: animal experiments, histological evaluation and editing of manuscript. SM: histological evaluation and editing of manuscript. JK: histological evaluation and statistical analysis. HRD: animal experiments and histology. BW: animal experiments and statistical analysis. CP: manufacture of implants. VJ implant design, animal experiments and editing of manuscript.