Short-term radiological results after spheroid-based autologous chondrocyte implantation in the knee are independent of defect localisation

2021 ◽  
pp. 1-9
Author(s):  
David Grevenstein ◽  
Darius Schafigh ◽  
Stavros Oikonomidis ◽  
Peer Eysel ◽  
Christoph Brochhausen ◽  
...  
Keyword(s):  
Autologous Chondrocyte Implantation ◽  
Femoral Condyle ◽  
Defect Size ◽  
Radiological Outcome ◽  
Short Term ◽  
Radiological Results ◽  
Defect Localization ◽  
Chondrocyte Implantation ◽  
The Mean ◽  
Autologous Chondrocyte

BACKGROUND: Lesions of articular cartilage represent a crucial risk factor for the early development of osteoarthritis. Autologous chondrocyte implantation (ACI) is a well-established procedure in therapy of those lesions in the knee. The aim of the presented study is to detect differences in short-term radiological outcome depending on defect localization (femoral condyle vs. retropatellar) after spheroid-based ACI. OBJECTIVE: This study aimed to demonstrate that radiological outcome after spheroid-based ACI in the knee is independent of defect localization. METHODS: MRI-scans after retropatellar ACI and ACI of the medial/lateral femoral condyle, with a preoperative Outerbridge grade of III or IV were evaluated regarding MOCART 2.0. RESULTS: The mean defect-size was 5.0 ± 1.8 cm2, with a minimum size of 2 cm2 and a maximum size of 9 cm2. Scans were performed 7.7 months (± 3.1 months) postoperatively. The mean MOCART 2.0 score was 78.5 ± 15.6. No statistically significant influence neither of the localization (p= 0.159), the gender (p= 0.124) nor defect size (< 5 cm2 vs. ⩾ 5 cm2; p= 0.201) could be observed. CONCLUSIONS: The presented data demonstrate good to excellent radiological short-term results after spheroid-based ACI. Data indicates, that at least radiological results are independent of gender, defect-size and defect-localization.

scholarly journals Immunohistological Localization of BMP-2, BMP-7, and Their Receptors in Knee Joints with Focal Cartilage Lesions

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Hagen Schmal ◽  
Alexander T. Mehlhorn ◽  
Ingo H. Pilz ◽  
David Dovi-Akue ◽  
Christina Kirchhoff ◽  
...  
Keyword(s):  
Protein Expression ◽  
Autologous Chondrocyte Implantation ◽  
Defect Size ◽  
Knee Joints ◽  
Duration Of Symptoms ◽  
Cartilage Lesions ◽  
Defect Localization ◽  
Chondrocyte Implantation ◽  
Immunohistological Staining ◽  
Autologous Chondrocyte

Introduction. Although it is well known that BMP-2 and BMP-7 play significant roles in cartilage metabolism, data about intra-articular expression and localization of these proteins and their receptors in humans are rare.Methods. Biopsies of synovia and debrided cartilage were taken in patients undergoing autologous chondrocyte implantation. Expression of BMP-2, BMP-7, and their receptors BMPR-1A, BMPR-1B and BMPR-2 were semiquantitatively evaluated by immunohistological staining.Results. BMP-7 was equally highly expressed in all cartilage and synovial biopsies. Increased levels of BMPR-1A, but not of BMPR-1B, and BMPR-2, were found in all synovial and 47% of all cartilage samples (P=0.002). BMP-2 was positively scored in 47% of all cartilage and 40% of all synovial specimens. Defect size, KOSS, Henderson or Kellgren-Lawrence score did not statistically significant correlate with the expression of the analyzed proteins or Mankin and Pritzker scores. Duration of symptoms and localization of lesions were associated with KOSS (P<0.02), but there was no influence of these parameters on protein expression.Conclusions. BMP-2, BMP-7, and BMPR-1A were expressed in cartilage and synovia of knees with focal cartilage lesions. Although defect localization and duration of symptoms decisively influence KOSS, there was no associated alteration of protein expression observed.

scholarly journals Sporting participation following the operative management of chondral defects of the knee at mid-term follow up: a systematic review and meta-analysis

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
P. G. Robinson ◽  
T. Williamson ◽  
I. R. Murray ◽  
K. Al-Hourani ◽  
T. O. White
Keyword(s):  
Systematic Review ◽  
Autologous Chondrocyte Implantation ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Osteochondral Allograft ◽  
Chondral Defects ◽  
Chondrocyte Implantation ◽  
The Mean ◽  
Autologous Chondrocyte

Abstract Purpose The purpose of this study was to perform a systematic review of the reparticipation in sport at mid-term follow up in athletes who underwent biologic treatment of chondral defects in the knee and compare the rates amongst different biologic procedures. Methods A search of PubMed/Medline and Embase was performed in May 2020 in keeping with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The criteria for inclusion were observational, published research articles studying the outcomes and rates of participation in sport following biologic treatments of the knee with a minimum mean/median follow up of 5 years. Interventions included microfracture, osteochondral autograft transfer (OAT), autologous chondrocyte implantation (ACI), matrix-induced autologous chondrocyte implantation (MACI), osteochondral allograft, or platelet rich plasma (PRP) and peripheral blood stem cells (PBSC). A random effects model of head-to-head evidence was used to determine rates of sporting participation following each intervention. Results There were twenty-nine studies which met the inclusion criteria with a total of 1276 patients (67% male, 33% female). The mean age was 32.8 years (13–69, SD 5.7) and the mean follow up was 89 months (SD 42.4). The number of studies reporting OAT was 8 (27.6%), ACI was 6 (20.7%), MACI was 7 (24.1%), microfracture was 5 (17.2%), osteochondral allograft was 4 (13.8%), and one study (3.4%) reported on PRP and PBSC. The overall return to any level of sport was 80%, with 58.6% returning to preinjury levels. PRP and PBSC (100%) and OAT (84.4%) had the highest rates of sporting participation, followed by allograft (83.9%) and ACI (80.7%). The lowest rates of participation were seen following MACI (74%) and microfracture (64.2%). Conclusions High rates of re-participation in sport are sustained for at least 5 years following biologic intervention for chondral injuries in the knee. Where possible, OAT should be considered as the treatment of choice when prolonged participation in sport is a priority for patients. However, MACI may achieve the highest probability of returning to the same pre-injury sporting level. Level of evidence IV

Matrix-Induced Autologous Chondrocyte Implantation (MACI) Grafting for Osteochondral Lesions of the Talus

2020 ◽  
Vol 41 (9) ◽  
pp. 1099-1105 ◽  
Author(s):  
Christopher G. Lenz ◽  
Shu Tan ◽  
Andrew L. Carey ◽  
Kaenson Ang ◽  
Timothy Schneider
Keyword(s):  
Autologous Chondrocyte Implantation ◽  
Treatment Method ◽  
Osteochondral Lesions ◽  
Osteochondral Defects ◽  
Long Term Follow Up ◽  
Chondrocyte Implantation ◽  
The Mean ◽  
Autologous Chondrocyte

Background: Matrix-induced autologous chondrocyte implantation (MACI) is an established treatment method for larger joints and has shown promising results in the ankle as well. We present a series of patients after ankle MACI with long-term follow-up of clinical and radiological outcomes. Methods: We present the follow-up of 15 patients who underwent MACI grafting from August 2003 to February 2006. The mean follow-up was 12.9 years. Clinical evaluations were conducted using the American Orthopaedic Foot & Ankle Society (AOFAS), Foot and Ankle Activity Measurement (FAAM), and visual analog scale (VAS) scoring systems and the magnetic resonance observation of cartilage repair tissue (MOCART) scoring system for radiological evaluation. Results: The mean size of the talar osteochondral defects was 204 mm2. We found a significant improvement in mean AOFAS score from 60 preoperatively to a mean of 84 at 12 years postoperatively. The 12-year FAAM score for Activities of Daily Living was 89% (range, 62%-99%). The mean 12-year MOCART score was 65 points (range, 30-100 points) with significant agreement between assessors ( P < .001). However, the MOCART scores did not correlate with the FAAM scores ( P = .86). Conclusion: Considering our long-term follow-up, we believe MACI is a reliable treatment method for talar osteochondral defects providing lasting pain relief and satisfying clinical results. However, with an equivalent outcome, but at higher costs, and the requirement for 2 operative procedures, the results do not seem to be superior to other established methods. The clinical utility of the MOCART score requires further scrutiny since we were not able to show any correlation between the score and clinical outcome. Level of Evidence: Level IV, case series.

scholarly journals Analysis of graft maturation after autologous chondrocyte implantation with T2 mapping

2017 ◽  
Vol 5 (4_suppl4) ◽  
pp. 2325967117S0015
Author(s):  
Thomas R. Niethammer ◽  
Ansgar Loitzsch ◽  
Matthias F. Pietschmann ◽  
Peter E. Müller ◽  
Annie Horng
Keyword(s):  
Relaxation Time ◽  
Autologous Chondrocyte Implantation ◽  
T2 Mapping ◽  
Cartilage Defects ◽  
T2 Relaxation Time ◽  
T2 Relaxation ◽  
Postoperative Course ◽  
Defect Localization ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

Aims and Objectives: It has been shown in numerous clinical studies that matrix-based autologous chondrocyte implantation (mb-ACI) leads to good clinical results in the medium-term course. But chondrogenic development of ACI grafts and the time of graft maturation are still unclear. The aim of this study was to investigate the graft maturation after mb-ACI with T2 mapping in the postoperative course of four years. Materials and Methods: In a total of 90 patients could be included after matrix-based autologous chondrocyte transplantation of the knee. All cartilage defects were treated with NOVOCART® 3D. The evaluation of the ACI grafts was conducted after 3, 6, 12, 24, 36 and 48 months by MRI. The T2 relaxation time values of the ACI graft and healthy native cartilage areas were determined to assess graft maturation using T2 mapping. MOCART score were used for morphological evaluation of ACI grafts. Results: The T2 relaxation time of ACI grafts showed a significant improvement during the postoperative course at all time points. The T2 relaxation improved from 48.0 ms after 3 months to 34.6 ms after four years. We found a significant influence of the patient’s age and the defect localization on the T2 relaxation time measuring. It could be detected an increasing integration of the ACI grafts into the healthy surrounding cartilage. No significant differences between the T2 relaxation time of ACI grafts and the surrounding healthy cartilage were found after 12 months postoperatively. Conclusion: Graft maturation after ACI in the knee joint needs at least 1 year, with ongoing adjustment of the T2 relaxation time values compared with native surrounding cartilage. Regarding the age and defect localization, significantly worse T2 relaxation times of the ACI grafts could be found with higher age and in cases with treated patellar defects.

The Role of Hypertension in Cartilage Restoration: Increased Failure Rate After Autologous Chondrocyte Implantation but Not After Osteochondral Allograft Transplantation

Cartilage ◽  
2020 ◽  
pp. 194760351990079 ◽  
Author(s):  
Gergo Merkely ◽  
Jakob Ackermann ◽  
Andreas H. Gomoll
Keyword(s):  
Graft Failure ◽  
Autologous Chondrocyte Implantation ◽  
Female Gender ◽  
Defect Size ◽  
Osteochondral Allograft ◽  
Multivariate Logistic Regression ◽  
Chondrocyte Implantation ◽  
Independent Risk Factors ◽  
Available Information ◽  
Autologous Chondrocyte

Objectives. The purpose of this study was to examine whether patients with diagnosed hypertension have an increased risk of graft failure following cartilage repair with either autologous chondrocyte implantation (ACI) or osteochondral allograft transplantation (OCA). We hypothesized that hypertension is related to higher ACI and OCA graft failure. Design. Patients who underwent ACI or OCA transplantation between February 2009 and December 2016 were included in this study. Inclusion criteria were (1) at least 2 years’ follow-up, (2) available information related to the living habits (smoking and medication status), and (3) available information related to the presence of hypertension, diabetes mellitus, or hyperlipidemia. To identify potential independent risk factors of graft failure, univariate screening was performed and factors with significance at a level of P < 0.1 were entered in multivariate logistic regression models. Results. A total of 368 patients (209 ACI and 159 OCA) were included into our study. In the ACI group, 61 patients’ (29.1%) graft failed. Univariate screening identified older age, female gender, defect size, higher prevalence of hypertension, and smoking as a predictor of graft failure. Following, multivariate logistic regression revealed female gender (odds ratio [OR] 1.02, P = 0.048), defect size (OR 1.07, P = 0.035), and hypertension (OR 3.73, P = 0.023) as significant independent risk factors predicting graft failure after ACI. In the OCA group, 29 patients’ (18.2%) graft failed and none of the included factors demonstrated to be a potential risk factor for graft failure. Conclusion. Hypertension, defect size, and female gender seem to predict ACI graft failure but not OCA failure.

scholarly journals Return to Sports After Surgical Treatment of Osteochondral Defects of the Talus: A Systematic Review of 2347 Cases

2019 ◽  
Vol 7 (10) ◽  
pp. 232596711987623 ◽  
Author(s):  
Jason A.H. Steman ◽  
Jari Dahmen ◽  
Kaj T.A. Lambers ◽  
Gino M.M.J. Kerkhoffs
Keyword(s):  
Surgical Treatment ◽  
Autologous Chondrocyte Implantation ◽  
Case Series ◽  
Osteochondral Defects ◽  
Bone Marrow Stimulation ◽  
Marrow Stimulation ◽  
Chondrocyte Implantation ◽  
The Mean ◽  
Mean Time ◽  
Autologous Chondrocyte

Background: Osteochondral defects (OCDs) of the talus are found subsequent to ankle sprains and ankle fractures. With many surgical treatment strategies available, there is no clear evidence on return-to-sport (RTS) times and rates. Purpose: To summarize RTS times and rates for talar OCDs treated by different surgical techniques. Study Design: Systematic review; Level of evidence, 4. Methods: The literature from January 1996 to November 2018 was screened, and identified studies were divided into 7 different surgical treatment groups. The RTS rate, with and without associated levels of activity, and the mean time to RTS were calculated per study. When methodologically possible, a simplified pooling method was used to combine studies within 1 treatment group. Study bias was assessed using the MINORS (Methodological Index for Non-Randomized Studies) scoring system. Results: A total of 61 studies including 2347 talar OCDs were included. The methodological quality of the studies was poor. There were 10 retrospective case series (RCSs) that investigated bone marrow stimulation in 339 patients, with a pooled mean rate of RTS at any level of 88% (95% CI, 84%-91%); 2 RCSs investigating internal fixation in 47 patients found a pooled RTS rate of 97% (95% CI, 85%-99%), 5 RCSs in which autograft transplantation was performed in 194 patients found a pooled RTS rate of 90% (95% CI, 86%-94%), and 3 prospective case series on autologous chondrocyte implantation in 39 patients found a pooled RTS rate of 87% (95% CI, 73%-94%). The rate of return to preinjury level of sports was 79% (95% CI, 70%-85%) for 120 patients after bone marrow stimulation, 72% (95% CI, 60%-83%) for 67 patients after autograft transplantation, and 69% (95% CI, 54%-81%) for 39 patients after autologous chondrocyte implantation. The mean time to RTS ranged from 13 to 26 weeks, although no pooling was possible for this outcome measure. Conclusion: Different surgical treatment options for talar OCDs allow for adequate RTS times and rates. RTS rates decreased when considering patients’ return to preinjury levels versus return at any level.

Cell-Seeded Autologous Chondrocyte Implantation: A Simplified Implantation Technique That Maintains High Clinical Outcomes

2017 ◽  
Vol 45 (5) ◽  
pp. 1028-1036 ◽  
Author(s):  
Andreas H. Gomoll ◽  
Luiz Felipe Ambra ◽  
Amy Phan ◽  
Marissa Mastrocola ◽  
Nehal Shah
Keyword(s):  
Failure Rate ◽  
Autologous Chondrocyte Implantation ◽  
Defect Size ◽  
Lysholm Score ◽  
Collagen Membrane ◽  
Chondrocyte Implantation ◽  
Ikdc Score ◽  
Tegner Score ◽  
Autologous Chondrocyte

Background: The use of autologous chondrocyte implantation (ACI) remains limited, even though multiple studies have demonstrated success rates exceeding 75%. The procedure is perceived as invasive and technically challenging, presenting barriers to more widespread adoption. Purpose/Hypothesis: The objective of this study was to investigate whether outcomes and the failure rate of a simplified ACI technique (cs-ACI) were comparable with those of the more complicated traditional technique of a chondrocyte suspension injected under a collagen membrane (cACI). We hypothesized that the change in technique would not negatively affect outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: Thirty-nine patients treated with the cs-ACI technique fulfilled the inclusion requirements. A group of 45 patients treated previously with standard cACI was used as a comparison. The functional outcomes were prospectively collected both preoperatively and postoperatively at the last follow-up. Failure was defined as any graft removal of more than 25% of the original defect size. Magnetic resonance imaging was performed postoperatively, and scans were assessed using a modified MOCART (magnetic resonance observation of cartilage repair tissue) scoring system. Results: Group demographics were not significantly different, except for the defect size and mean follow-up: 4.09 years in the cACI group and 2.46 years in the cs-ACI group. Significant improvements were seen in all outcome measures except the Tegner score from the preoperative baseline to the latest follow-up for both the cACI group (International Knee Documentation Committee [IKDC] score, from 42.0 to 63.4; Knee injury and Osteoarthritis Outcome Score [KOOS]–Pain subscore, from 58.7 to 77.1; Lysholm score, from 57.2 to 69.7; and Tegner score, from 3.5 to 4.2) and the cs-ACI group (IKDC score, from 45.6 to 68.0; KOOS-Pain subscore, from 66.6 to 84.7; Lysholm score, from 53.7 to 75.4; and Tegner score, from 3.2 to 3.8). No significant difference was found between the groups at the latest follow-up. The failure rate at 2 years was not significantly different, while the total failure rate over the entire study period was significantly lower in the cs-ACI group than the cACI group (5% vs 24%, respectively). The overall MOCART score was not significantly different between the groups. Conclusion: The treatment of full-thickness articular cartilage defects with a simplified cell-seeded ACI technique demonstrated no significant differences in the failure rate and patient-reported outcomes when compared with a standard technique utilizing interrupted sutures and the injection of a cell suspension under a collagen membrane.

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