Dwikora Novembri Utomo

Early Graft Tunnel Healing After Anterior Cruciate Ligament Reconstruction With Intratunnel Injection of Bone Marrow Mesenchymal Stem Cells and Vascular Endothelial Growth Factor

Background: Bone marrow mesenchymal stem cells (BM-MSCs) are multipotent adult stem cells and have become an important source of cells for engineering tissue repair and cell therapy. Vascular endothelial growth factor (VEGF) promotes angiogenesis and contributes fibrous integration between tendon and bone during the early postoperative stage. Both MSCs and VEGF can stimulate cell proliferation, differentiation, and matrix deposition by enhancing angiogenesis and osteogenesis of the graft in the tunnel. Hypothesis: Injection of intratunnel BM-MSCs and VEGF enhances the early healing process of a tendon graft. Study Design: Controlled laboratory study. Methods: In this controlled animal laboratory study, each of 4 groups of rabbits underwent unilateral anterior cruciate ligament (ACL) reconstruction with use of the ipsilateral semitendinosus tendon. The rabbits received intratunnel injection of BM-MSCs and VEGF with a fibrin glue seal covering the distal tunnel at the articular site. Evaluation using magnetic resonance imaging (MRI), collagen type III expression, and biomechanical analyses were performed at 3- and 6-week intervals. Results: All parameters using MRI, collagen type III expression, and biomechanical analysis of pullout strength of the graft showed that application of intratunnel BM-MSCs and VEGF enhanced tendon-to-bone healing after ACL reconstruction. Conclusion: Intratunnel injections of BM-MSCs and VEGF after ACL reconstruction enhanced graft tunnel healing. Overall, the femoral tunnel that received BM-MSCs and VEGF had better advanced healing with increased collagen type III fibers and better outcomes on MRI and biomechanical analysis. MRI is the most reliable tool for clinical use in evaluating stages of ACL healing after reconstruction, since biopsy is an invasive procedure.

Comparative Effectiveness of Bone Grafting Using Xenograft Freeze-Dried Cortical Bovine, Allograft Freeze-Dried Cortical New Zealand White Rabbit, Xenograft Hydroxyapatite Bovine, and Xenograft Demineralized Bone Matrix Bovine in Bone Defect of Femoral Diaphysis of White Rabbit: Experimental Study In Vivo

Autogenous bone graft is gold standard in treating bone defects, but it might have difficulty in corporation and rejection reaction. This study is to compare the effectiveness among freeze-dried xenograft, freeze-dried allograft, hydroxyapatite xenograft, and demineralized bone matrix xenograft as bone graft to fill bone defect in femoral diaphysis of white rabbit. Thirty male New Zealand white rabbits were distributed into five groups. Bone defect was filled correspondingly with xenograft freeze-dried cortical bovine, allograft freeze-dried cortical New Zealand white rabbit, xenograft hydroxyapatite bovine, and xenograft demineralized bone matrix bovine. No graft was used in control group. VEGF, osteoblast, and woven bone were higher in allograft freeze-dried cortical New Zealand white rabbit (mean 5.6625 (p < 0.05)) and xenograft demineralized bone matrix bovine (mean 5.2475 (p < 0.05)) with calcification of woven bone was already seen in week 2 in the latter group. There was a decrease of woven bone (mean 4.685 (p < 0.05)) fibrous tissue (mean 41.07 (p < 0.05)) in xenograft demineralized bone matrix bovine. The Immunoglobulin-G was elevated in control and all study groups but not significantly (p = 0.07855). Bone healing process in xenograft demineralized bone matrix bovine is more effective than in xenograft hydroxyapatite bovine, allograft freeze-dried New Zealand white rabbit, xenograft freeze-dried cortical bovine, and control.

Comparative Study: The Role of Stem Cell In Damaged Cell

Stem cell is undifferentiated cell that have some properties like self renewal and plasticity. The other properties are can differentiate into some the specific cell. Stem cell is divided into two kinds of cell base on the resource of stem cell are embryonic stem cell and adult stem cell. Base on the plasticity of stem cell can be divided into some types of cell as well as Totipotent, pluripotent, multipotent, oligopotent and unipotent. Cell type is product from the process of proliferation and differentiation from stem cell. This way the stem cell can be used to develop as comparative medicine base on the properties and function stem cell, and for therapy to repair of cell defect, tissue and organs defect, that finally can inhibit leading to the degenerative disease. Degenerative disease is tissue or organ function lost due to injury, disease, age or congenital defects without infectious disease. To make regeneration and function of cells, tissue, and organs have needed new cells from endogenous or exogenous stem cell, that can self renewal, proliferation, and differentiation, that call stem cell. Stem cells can be isolated from bone marrow, but at the last decade that stem cells can be explored from different resources like umbilical cord blood (UCB), placenta, hair follicle, adipose tissue, and dental pulp as resource stem cell for therapy. Finally, the stem cell have important role in degenerative medicine disease and also including damaged cell.

Proximal fibula osteotomy as an alternative to TKA and HTO in late-stage varus type of knee osteoarthritis

Background Knee osteoarthritis has a high prevalence in Indonesia. Aim of this research is knowing the outcome of knee osteoarthritis patient after PFO procedure. Methods Data collected and analyzed in hospitals in Surabaya from July to December 2017. This study compares preoperative and postoperative outcome on radiological evaluation, patient satisfaction, and clinical function. Results The study includes 15 patients. Radiological evaluation on Tibiofemoral Angle and Joint Space Ratio increases significantly. Patient satisfaction evaluation using SF12 significantly improve. Evaluation using KOOS and Oxford Knee Score also increase significantly. Conclusion PFO could become an alternative treatment for last stage knee osteoarthritis.

Clinical and radiological evaluation of post total hip arthroplasty patients with acetabulum defect

Background Total Hip Arthroplasty (THA) is one of many therapies given to hip joint injury patients. The main indication for THA in elderly patients is degenerative diseases of the joints. One of the difficulties encountered in this THA procedure is to overcome the acetabulum deficiency, with Paprosky Classification. This study aims to evaluate patients with acetabulum defect that have undergone THA at Dr. Soetomo Hospital in 2014-2016. Methods This was an observational retrospective study with descriptive analysis. The sample amount was 20 patients, from 80 patients who had THA procedure. Patients were evaluated based on the wear from acetabulum, migration from a cup, the presence of bone loss, heterotopic ossification, and also clinical condition based on Harris Hip Score. The presented results were analyzed by using Kruskal-Wallis on SPSS 19.0 for Windows Program. Results Hypothesis testing was performed on THA patients based on acetabulum defect type I, II, and III in one, two, and three years after surgery respectively. Massin Score resulted no differences with p = 0.156, p = 0.574, and p = 0223. Bone Loss Classification resulted no differences with p = 0.296, p = 0.287, and p = 0223. No difference on Wear Rate with p = 0.072, p = 0.110, and p = 0.325. There was no difference of Harris Hip Score with p = 0.320, p = 0.082, and p = 0.472. Conclusion There were no significant differences in radiological evaluation of the Migration Rate, Heterotopic Ossification or Bone Loss, Wear Rate, and on clinical evaluation of Harris Hip Score in all three groups of evaluated acetabulum defects.

In Vitro Comparative Study of Osteogenic Differentiation Ability between Adipose and Bone Marrow Mesenchymal Stem Cell Applied to Bovine Demineralized Bone Matrix

Ideal bone graft must possess the desirable trait such as osteoconductive, osteoinductive and osteogenesis. Demineralized Bone Matrix (DBM) provides both osteoconductive and osteoinductive trait. Referring to the tissue engineering principle, the addition of mesenchymal stem cell would add the osteogenic trait to this procedure. The design of this study is experimental using Bovine DBM. Bone Marrow Mesenchymal Stem Cell (BMSCs) and Adipose Mesenchymal Stem Cells (ASCs) were taken from New Zealand white rabbit. There are two groups of treatment, divided into DBM implanted with BMSCs and DBM implanted with ASCs. Each BMSCs and ASCs groups is incubated in the normal and osteogenic culture plate. Evaluation is performed by counting the osteoblast and immunohistochemistry stain using Alkaline Phosphate and Osteocalcin. After 4 weeks of incubation, we found that the osteoblast count in BMSCs groups is higher compared to the ASCs groups in both culture condition (p<0.01) along with Alkaline Phosphate staining (p<0.05), while the Osteocalcin staining showed insignificant differences (p>0.05). This study revealed that xenogenic bovine DBM can act as the potential osteoinductive scaffold for the MSCs to differentiate. The tissue engineering application by combining MSCs and Bovine DBM can be considered as an alternative in managing bone defect cases.

Effect of Decellularized Cartilage Bovine Scaffold and Hypoxic Condition on Stem Cell Differentiation to Chondrocyte: An In Vitro Study

Autologous Chondrocyte Implantation (ACI) has been established for years to treat cartilage defect. Application of tissue engineering has advantages over ACI as tissue engineering requires simpler procedures without leaving morbidity at the donor site. Decellularized bovine cartilage scaffold and hypoxic stem cell differentiation were used in this in vitro experimental study. Comparative test was done between three study groups using bone marrow mesenchymal stem cells treated in three different conditions: growth factor-rich chondrogenic medium, scaffold without growth factor, and combination of both. Each group was given two oxygen tension conditions of normoxia and hypoxic within phase of stem cell differentiation. Immunohistochemical examinations on SOX9, RUNX2, and collagen type II were done for evaluation. After 5-week treatment, the result showed that the highest expression SOX9 and collagen type II were found within the group that used the combination of both scaffold and chondrogenic medium in hypoxic condition. Collagen type II expression in scaffold without additional growth factor showed no statistically significant difference compared with the combination group in hypoxic condition. Cartilage tissue engineering has proven its effectiveness for cartilage regeneration. Decellularized biomaterial scaffold limited the use of growth factor resulting in better cost and resource efficiency.

Regeneration Mechanism of Full Thickness Cartilage Defect Using Combination of Freeze Dried Bovine Cartilage Scaffold - Allogenic Bone Marrow Mesenchymal Stem Cells - Platelet Rich Plasma Composite (SMPC) Implantation

Cartilage defect has become serious problem for orthopaedic surgeon and patients because of its difficult healing that might occur when articular cartilage damage never reach subchondral layer. In this study, we used combination of freeze dried bovine cartilage (FDBC) scaffold, bone marrow mesenchymal stem cells (BM-MSCs), and platelet rich plasma (PRP) composite (SMPC) implanted in full thickness cartilage defect. This study is to explain its regeneration mechanism. This is true experimental research with post-test only control group design using New Zealand White Rabbit. 50 rabbits is divided into three groups of SMPC, BM-MSCs and FDBC. 37 rabbits evaluated after twelve weeks. Histopathologic examination showed the number of chondrocytes, collagen thickness and cartilage width are highest on SMPC group. Immunohistochemical examination showed SMPC group has the highest number of chondroprogenitor cells express FGF-2R, Sox-9, and MAPK. Brown Forsythe test resulted in significant increase the number of chondrocytes (p=0,010), collagen thickness (p=0,000), and cartilage surface width (p=0,015), and increase FGF-2R (p=0,000), MAPK (p=0,000), and Sox-9 (p=0,000) on SMPC group. Using path analysis, there is strong influence from FGF-2R, MAPK, and Sox-9 to the increase of chondrocytes, collagen thickness, and cartilage surface width. Hence, SMPC implantation mechanism of full thickness cartilage defect regeneration can be explained.

The Effect of Platelet Rich Plasma (PRP) in Anterior Cruciate Ligament (ACL) Reconstruction Surgery

A torn in anterior cruciate ligament (ACL) caused by interference with the proprioceptive function of the knee joint can result in decreased function and other joint structure degradation that ultimately affect to daily activities. Platelet rich plasma (PRP) is widely used in recent studies to improve the healing of soft tissue injuries because it contains a lot of growth factor. This study was to determine the effect of platelet rich plasma in ACL reconstruction surgery. ACL reconstruction patients either with or without PRP were evaluated with Joint Position Sense (JPS) and Threshold To Detection of Passive Motion (TTDPM) measurements and the results were compared. From this study found 20 patients who had ACL reconstruction performed either with or without PRP. The test results showed statistically significant differences JPS in patients with ACL reconstruction who given PRP and not, at angle of 30˚ (p=0,037) and 45˚ (p=0,034). It also obtained a non-significant difference TTDPM in both groups (p=0,172). The conclusion obtained in this study is the addition of platelet rich plasma in patients with ACL reconstruction of knee joint can improve the function of JPS at an angle of 30˚ and 45˚, while the function of TTDPM is not increased significantly.