Volume 29, Issue 6, Pages (June 2013)

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Volume 29, Issue 6, Pages 1034-1046 (June 2013) Synovial Membrane–Derived Mesenchymal Stem Cells Supported by Platelet-Rich Plasma Can Repair Osteochondral Defects in a Rabbit Model Jae-Chul Lee, Ph.D., Hyun Jin Min, M.S., Hee Jung Park, M.S., Sahnghoon Lee, M.D., Ph.D., Sang Cheol Seong, M.D., Ph.D., Myung Chul Lee, M.D., Ph.D. Arthroscopy Volume 29, Issue 6, Pages 1034-1046 (June 2013) DOI: 10.1016/j.arthro.2013.02.026 Copyright © 2013 Arthroscopy Association of North America Terms and Conditions

Fig 1 Components and structure of PRP gel. (A) Gross appearance of PRP gel. (B) H&E staining of a cryosection of PRP gel showed a mesh-like microstructure (original magnification x100). (C) Immunofluorescence analysis for distribution of SDSCs (scale bar, 50 μm). (D) Histologic appearance of SDSC-encapsulated PRP gel at day 28 of cultivation (scale bar, 100 μm). The presence of GAGs was investigated by safranin O staining. Arthroscopy 2013 29, 1034-1046DOI: (10.1016/j.arthro.2013.02.026) Copyright © 2013 Arthroscopy Association of North America Terms and Conditions

Fig 2 Macroscopic appearance of defects in trochlear groove (4 mm in diameter) at 1 week (1 W) after surgery in (A) control group, in which transplantation was not performed; (B) PRP group; and (C) PRP-SDSC group (scale bar, .7 mm). Arthroscopy 2013 29, 1034-1046DOI: (10.1016/j.arthro.2013.02.026) Copyright © 2013 Arthroscopy Association of North America Terms and Conditions

Fig 3 Macroscopic appearance of (A-C) defects in trochlear groove (4 mm in diameter) at 4 weeks (4 W), (D-F) 12 weeks (12 W), and (G-I) 24 weeks (24 W) after surgery in (A, D, G) control group, in which transplantation was not performed; (B, E, H) PRP group; and (C, F, I) PRP-SDSC group (scale bar, .7 mm). Arthroscopy 2013 29, 1034-1046DOI: (10.1016/j.arthro.2013.02.026) Copyright © 2013 Arthroscopy Association of North America Terms and Conditions

Fig 4 Histologic appearance of defects in trochlear groove (4 mm in diameter) at 4 weeks after surgery in (A-C) control group, in which transplantation was not performed; (D-F) PRP group; and (G-I) PRP-SDSC group. B, C, E, F, H, and I are magnified views of the boxes in A, D, and G. The scale bar equals 2 mm for A, D, and G and 100 μm for B, C, E, F, H, and I. Arthroscopy 2013 29, 1034-1046DOI: (10.1016/j.arthro.2013.02.026) Copyright © 2013 Arthroscopy Association of North America Terms and Conditions

Fig 5 Histologic appearance with H&E staining (A) (scale bar, 2 mm) and confocal images of DiI-labeled SDSC distribution (B) (scale bar, 100 μm) in trochlear groove at 4 weeks after surgery in PRP-SDSC group. B is a magnified view of the small box in A. Arthroscopy 2013 29, 1034-1046DOI: (10.1016/j.arthro.2013.02.026) Copyright © 2013 Arthroscopy Association of North America Terms and Conditions

Fig 6 Histologic appearance of defects in trochlear groove (4 mm in diameter) at 24 weeks after surgery in (A-C) control group, in which transplantation was not performed; (D-F) PRP group; and (G-I) PRP-SDSC group. B, C, E, F, H, and I are magnified views of the boxes in A, D, and G. The scale bar equals 2 mm for A, D, and G; 200 μm for B, E, and H; and 100 μm for F, C, and I. Arthroscopy 2013 29, 1034-1046DOI: (10.1016/j.arthro.2013.02.026) Copyright © 2013 Arthroscopy Association of North America Terms and Conditions

Fig 7 Histochemical and immunohistochemical appearance of defects in trochlear groove (4 mm in diameter) at 4 weeks (4 w) and 24 weeks (24 w) after surgery, showing safranin O staining of hyaline cartilage in (A and D) control group, (B and E) PRP group, and (C and F) PRP-SDSC group at (A-C) 4 weeks and (D-F) 24 weeks after surgery, as well as immunostaining of type II collagen in repaired tissues in (G and J) control group, (H and K) PRP group, and (I and L) PRP-SDSC group (I and L) at (G-I) 4 weeks and (J-L) 24 weeks after surgery (scale bar, 200 μm). Arthroscopy 2013 29, 1034-1046DOI: (10.1016/j.arthro.2013.02.026) Copyright © 2013 Arthroscopy Association of North America Terms and Conditions

Fig 8 GAG content and PCNA immunohistochemical data of defects in trochlear groove (4 mm in diameter). (A) GAG content at 24 weeks after surgery in control group, PRP group, PRP-SDSC group, and intact cartilage group. The data presented in the line graph represent the mean value with the standard deviation from 3 independent experiments. One asterisk, P < .05 for comparison between indicated groups. Two asterisks, P < .01 for comparison between indicated groups. (B) Number of PCNA-positive cells 1 week after surgery in control group, PRP group, and PRP-SDSC group. Five fields were randomly selected at a magnification of ×200, and the number of positive cells was expressed as mean number ± standard deviation per optical field from 5 independent experiments. Two asterisks, P < .01 for comparison between indicated groups. Three asterisks, P < .001 for comparison between indicated groups. (C) Immunohistochemical staining for PCNA in control group (a), PRP group (b), and PRP-SDSC group (c) at 1 week after surgery (scale bar, 200 μm). Arthroscopy 2013 29, 1034-1046DOI: (10.1016/j.arthro.2013.02.026) Copyright © 2013 Arthroscopy Association of North America Terms and Conditions

Fig 9 (A) ICRS macroscopic and (B) histologic scores for control group (CNT), osteochondral defects treated with PRP gel, and osteochondral defects treated with SDSCs embedded in PRP gel at weeks 4, 12, and 24 postoperatively. The treatment groups that showed significant improvement compared with the control group at P < .05 and P < .01 are marked with 1 asterisk and 2 asterisks, respectively. Arthroscopy 2013 29, 1034-1046DOI: (10.1016/j.arthro.2013.02.026) Copyright © 2013 Arthroscopy Association of North America Terms and Conditions