Fokal kondral defektlerin mikro kırık tedavisinde sentetik peptit, trombositten zengin plazma ve hyaluronik asidin tek başına veya kombinasyon halinde karşılaştırmalı etkinliği

Year 2024, , 426 - 434, 30.09.2024

Demet Pepele , Erkan Akgün , Barış Yılmaz , Ahmet Midi , Ahmet Onur Akpolat

https://doi.org/10.18663/tjcl.1544301

Abstract

Amaç: Daha önceki sınırlı çalışmalarda, fokal kondral defektlerin mikrokırık (MF) tedavisini güçlendirmek için tek başına veya kombinasyon halinde kullanılan adjuvanların etkinliği değerlendirilmiş olsa da, sentetik peptidin (SP) diğer adjuvanlar olan plazma zengin protein (PRP), hyaluronik asit (HA) ve bunların kombinasyonlarıyla sonuçlarını karşılaştıran bir çalışma bulunmamaktadır. Bu çalışmada fokal kondral defektlerde MF tedavisinin etkinliğinin adjuvanların tek başına veya kombinasyon halinde kullanılmasıyla etkilenip etkilenmediğini değerlendirmeyi amaçladık.
Gereç ve Yöntemler: Çalışmaya 36 sıçan dahil edilmiştir. Grup 1’e yalnızca MF uygulandı, Grup 2’ye MF sonrası PRP, Grup 3’e MF sonrası HA, Grup 4’e MF sonrası SP, Grup 5’e MF sonrası SP ve PRP kombinasyonu ve Grup 6’ya MF sonrası SP ve HA kombinasyonu uygulandı. Sıçanların dizleri, Uluslararası Kıkırdak Onarım Derneği (ICRS) Kıkırdak Onarım Değerlendirmesi 1 (ICRS-1) ve 2 (ICRS-2) kriterlerine göre değerlendirildi.
Bulgular: Grup 1'de medyan ICRS-1 ve ICRS-2 skorları diğer gruplara göre daha düşüktü, Grup 2 ve Grup 4'te ise bu skorlar benzer olup diğer gruplara kıyasla daha yüksekti. Ayrıca, Grup 5 ve Grup 6'daki bu skorlar benzerdi, ancak Grup 3'e kıyasla daha düşüktü (ICRS-1 skorları için: Grup 1: 1 vs. Grup 2: 12 vs. Grup 3: 9 vs. Grup 4: 11 vs. Grup 5: 7 vs. Grup 6: 7, p < 0,001; ICRS-2 skorları için; Grup 1: 0 vs. Grup 2: 85 vs. Grup 3: 70 vs. Grup 4: 80 vs. Grup 5: 45 vs. Grup 6: 45, p < 0,001).
Sonuç: Fokal kondral defektlerin MF tedavisinde SP, PRP ve HA enjeksiyonlarının makroskopik ve histopatolojik bulgulara dayalı olarak yararlı bir adjuvan etkisi vardır. Ancak, bu adjuvanların kombinasyonları, tek başına kullanımlarına göre daha az fayda sağlamaktadır.

Keywords

hyaluronik asit, mikrokırık, kıkırdak defektleri, plazma zengin protein, sentetik peptit

Comparative efficacy of synthetic peptide, platelet-rich plasma, and hyaluronic acid alone or in combination in microfracture treatment of focal chondral defects

Abstract

Aim: Although previous limited studies have evaluated the efficacy of adjuvants used alone or in combination to augment microfracture (MF) treatment for focal chondral defects, there are no studies comparing the outcomes of the synthetic peptide (SP) with other adjuvants such as platelet-rich plasma (PRP), hyaluronic acid (HA), or their combinations. This study aimed to evaluate whether the efficacy of MF treatment in focal chondral defects is influenced by the use of adjuvants either alone or in combination.
Material and Methods: Thirty-six rats were included in the study. Group 1 received MF alone, Group 2 received PRP after MF, Group 3 received HA after MF, Group 4 received a SP after MF, Group 5 received a SP plus PRP therapy after MF, and Group 6 received a SP plus HA therapy. The knees of the rats were assessed according to the International Cartilage Repair Society (ICRS) Cartilage Repair Assessment 1 (ICRS-1) and 2 (ICRS-2).
Results: The median ICRS-1 and ICRS-2 scores in Group 1 were lower compared to the other groups, while these scores in Group 2 and Group 4 were similar and higher than the other groups. Also, these scores in Group 5 and Group 6 were similar and lower compared to Group 3 (Group 1: 1 vs. Group 2: 12 vs. Group 3: 9 vs. Group 4: 11 vs. Group 5: 7 vs. Group 6: 7, p < 0.001 for ICRS-1 scores; Group 1: 0 vs. Group 2: 85 vs. Group 3: 70 vs. Group 4: 80 vs. Group 5: 45 vs. Group 6: 45, p < 0.001 for ICRS-2 scores).
Conclusion: In the MF treatment of focal chondral defects, SP, PRP, and HA injections have a beneficial adjuvant effect based on macroscopic and histopathological findings. However, the combination of these adjuvants is less beneficial than their individual usage.

Keywords

cartilage defects, hyaluronic acid, microfracture, plasma rich protein, synthetic peptide

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