title: Surgical suturing of articular cartilage induces osteoarthritis-like changes.
abstract: BACKGROUND
  In clinical tissue-engineering-based approaches to articular cartilage repair, various types of flap are frequently used to retain an implanted construct within the defect, and they are usually affixed by suturing. We hypothesize that the suturing of articular cartilage is associated with a loss of chondrocytes from, and osteoarthritis-like changes within, the perisutural area.
  
  
  METHODS
  We established a large, partial-thickness defect model in the femoral groove of adult goats. The defects were filled with bovine fibrinogen to support a devitalized flap of autologous synovial tissue, which was sutured to the surrounding articular cartilage with single, interrupted stitches. The perisutural and control regions were analyzed histologically, histochemically and histomorphometrically shortly after surgery and 3 weeks later.
  
  
  RESULTS
  Compared to control regions, chondrocytes were lost from the perisutural area even during the first few hours of surgery. During the ensuing 3 weeks, the numerical density of cells in the perisutural area decreased significantly. The cell losses were associated with a loss of proteoglycans from the extracellular matrix. Shortly after surgery, fissures were observed within the walls of the suture channels. By the third week, their surface density had increased significantly and they were filled with avascular mesenchymal tissue.
  
  
  CONCLUSIONS
  The suturing of articular cartilage induces severe local damage, which is progressive and reminiscent of that associated with the early stages of osteoarthritis. This damage could be most readily circumvented by adopting an alternative mode of flap affixation, such as gluing with a biological adhesive.
authors.affiliation: DST Research Center, Department of Clinical Research, University of Bern, Murtenstrasse 35, P.O. Box 54, 3010 Bern, Switzerland. ernst.hunziker@dkf.unibe.ch
authors.forename: E B
authors.initials: EB
authors.lastname: Hunziker
authors.forename: A
authors.initials: A
authors.lastname: Stähli
mesh_terms: D000328:Adult; D000818:Animals; D002358:Cartilage, Articular / Q000473:pathology / Q000601:surgery* / Q000637:transplantation; D019902:Chondrocytes / Q000378:metabolism* / Q000637:transplantation; D005269:Femur / Q000473:pathology / Q000601:surgery* / Q000637:transplantation; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D006041:Goats; D006801:Humans; D008859:Microscopy, Polarization / Q000379:methods; D023421:Models, Animal; D010003:Osteoarthritis / Q000503:physiopathology / Q000601:surgery*; D013524:Surgical Flaps; D013536:Suture Techniques / Q000009:adverse effects; D023822:Tissue Engineering / Q000379:methods*; D014945:Wound Healing / Q000502:physiology
chemical_list: D015718:Fibrin Tissue Adhesive