Autologous Chondrocyte Implantation

Objective To determine the relationship between cartilage lesion etiology and clinical outcomes after second-generation autologous chondrocyte implantation (ACI) in the patellofemoral joint (PFJ) with a minimum of 2 years’ follow-up. Methods A retrospective review of all patients that underwent ACI in the PFJ by a single surgeon was performed. Seventy-two patients with a mean follow-up of 4.2 ± 2.0 years were enrolled in this study and were stratified into 3 groups based on the etiology of PFJ cartilage lesions: patellar dislocation (group 1; n = 23); nontraumatic lesions, including chondromalacia, osteochondritis dissecans, and degenerative defects (group 2; n = 28); and other posttraumatic lesions besides patellar dislocations (group 3; n = 21). Patient’s mean age was 29.6 ± 8.7 years. Patients in group 1 were significantly younger (25.4 ± 7.9 years) than group 2 (31.7 ± 9.6 years; P = 0.025) and group 3 (31.5 ± 6.6 years; P = 0.05). Body mass index averaged 26.2 ± 4.3 kg/m2, with a significant difference between group 1 (24.4 ± 3.2 kg/m2) and group 3 (28.7 ± 4.5 kg/m2; P = 0.005). A clinical comparison was established between groups based on patient-reported outcome measures (PROMs) and failure rates. Results Neither pre- nor postoperative PROMs differed between groups ( P > 0.05). No difference was seen in survivorship between groups (95.7% vs. 82.2% vs. 90.5%, P > 0.05). Conclusion Cartilage lesion etiology did not influence clinical outcome in this retrospective study after second generation ACI in the PFJ. Level of Evidence Level III, retrospective comparative study.

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

Journal of Experimental Orthopaedics ◽

10.1186/s40634-020-00295-x ◽

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

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Intralesional Osteophyte Regrowth Following Autologous Chondrocyte Implantation after Previous Treatment with Marrow Stimulation Technique

Cartilage ◽

10.1177/1947603516653208 ◽

2016 ◽

Vol 8 (2) ◽

pp. 131-138 ◽

Cited By ~ 19

Author(s):

Marco Kawamura Demange ◽

Tom Minas ◽

Arvind von Keudell ◽

Sonal Sodha ◽

Tim Bryant ◽

...

Keyword(s):

Autologous Chondrocyte Implantation ◽

Previous Treatment ◽

Control Group ◽

Collagen Membrane ◽

Bone Marrow Stimulation ◽

Marrow Stimulation ◽

Chondrocyte Implantation ◽

And Control ◽

Stimulation Technique ◽

Autologous Chondrocyte

Objective Bone marrow stimulation surgeries are frequent in the treatment of cartilage lesions. Autologous chondrocyte implantation (ACI) may be performed after failed microfracture surgery. Alterations to subchondral bone as intralesional osteophytes are commonly seen after previous microfracture and removed during ACI. There have been no reports on potential recurrence. Our purpose was to evaluate the incidence of intralesional osteophyte development in 2 cohorts: existing intralesional osteophytes and without intralesional osteophytes at the time of ACI. Study Design We identified 87 patients (157 lesions) with intralesional osteophytes among a cohort of 497 ACI patients. Osteophyte regrowth was analyzed on magnetic resonance imaging and categorized as small or large (less or more than 50% of the cartilage thickness). Twenty patients (24 defects) without intralesional osteophytes at the time of ACI acted as control. Results Osteophyte regrowth was observed in 39.5% of lesions (34.4% of small osteophytes and 5.1% of large osteophytes). In subgroup analyses, regrowth was observed in 45.8% of periosteal-covered defects and in 18.9% of collagen membrane–covered defects. Large osteophyte regrowth occurred in less than 5% in either group. Periosteal defects showed a significantly higher incidence for regrowth of small osteophytes. In the control group, intralesional osteophytes developed in 16.7% of the lesions. Conclusions Even though intralesional osteophytes may regrow after removal during ACI, most of them are small. Small osteophyte regrowth occurs almost twice in periosteum-covered ACI. Large osteophytes occur only in 5% of patients. Intralesional osteophyte formation is not significantly different in preexisting intralesional osteophytes and control groups.

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Autologous chondrocyte implantation: a systematic review

Osteoarthritis and Cartilage ◽

10.1016/j.joca.2005.07.017 ◽

2006 ◽

Vol 14 (1) ◽

pp. 47-51 ◽

Cited By ~ 69

Author(s):

A. Ruano-Ravina ◽

M. Jato Díaz

Keyword(s):

Systematic Review ◽

Autologous Chondrocyte Implantation ◽

Chondrocyte Implantation ◽

Autologous Chondrocyte

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Clinical feasibility of a novel biphasic osteochondral composite for matrix-associated autologous chondrocyte implantation

Osteoarthritis and Cartilage ◽

10.1016/j.joca.2013.01.004 ◽

2013 ◽

Vol 21 (4) ◽

pp. 589-598 ◽

Cited By ~ 29

Author(s):

H. Chiang ◽

C.-J. Liao ◽

C.-H. Hsieh ◽

C.-Y. Shen ◽

Y.-Y. Huang ◽

...

Keyword(s):

Autologous Chondrocyte Implantation ◽

Chondrocyte Implantation ◽

Autologous Chondrocyte

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Second-generation arthroscopic autologous chondrocyte implantation for the treatment of degenerative cartilage lesions

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-011-1732-5 ◽

2011 ◽

Vol 20 (9) ◽

pp. 1704-1713 ◽

Cited By ~ 58

Author(s):

Giuseppe Filardo ◽

Elizaveta Kon ◽

Alessandro Di Martino ◽

Silvio Patella ◽

Giulio Altadonna ◽

...

Keyword(s):

Autologous Chondrocyte Implantation ◽

Second Generation ◽

Cartilage Lesions ◽

Chondrocyte Implantation ◽

Degenerative Cartilage ◽

Autologous Chondrocyte

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A Prospective Clinical and Radiological Evaluation at 5 Years After Arthroscopic Matrix-Induced Autologous Chondrocyte Implantation

The American Journal of Sports Medicine ◽

10.1177/0363546516663493 ◽

2016 ◽

Vol 45 (1) ◽

pp. 59-69 ◽

Cited By ~ 32

Author(s):

Jay R. Ebert ◽

Michael Fallon ◽

David J. Wood ◽

Gregory C. Janes

Keyword(s):

Autologous Chondrocyte Implantation ◽

Knee Extension ◽

Composite Score ◽

Physical Component Score ◽

Knee Extension Strength ◽

Sf 36 ◽

Peak Knee ◽

Chondrocyte Implantation ◽

Minute Walk ◽

Autologous Chondrocyte

Background: While midterm outcomes after matrix-induced autologous chondrocyte implantation (MACI) are encouraging, the procedure permits an arthroscopic approach that may reduce the morbidity of arthrotomy and permit accelerated rehabilitation. Hypothesis: A significant improvement in clinical and radiological outcomes after arthroscopic MACI will exist through to 5 years after surgery. Study Design: Case series; Level of evidence, 4. Methods: We prospectively evaluated the first 31 patients (15 male, 16 female) who underwent MACI via arthroscopic surgery to address symptomatic tibiofemoral chondral lesions. MACI was followed by a structured rehabilitation program in all patients. Clinical scores were administered preoperatively and at 3 and 6 months as well as 1, 2, and 5 years after surgery. These included the Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm knee scale (LKS), Tegner activity scale (TAS), visual analog scale for pain, Short Form–36 Health Survey (SF-36), active knee motion, and 6-minute walk test. Isokinetic dynamometry was used to assess peak knee extension and flexion strength and limb symmetry indices (LSIs) between the operated and nonoperated limbs. High-resolution magnetic resonance imaging (MRI) was performed at 3 months and at 1, 2, and 5 years postoperatively to evaluate graft repair as well as calculate the MRI composite score. Results: There was a significant improvement ( P < .05) in all KOOS subscale scores, LKS and TAS scores, the SF-36 physical component score, pain frequency and severity, active knee flexion and extension, and 6-minute walk distance. Isokinetic knee extension strength significantly improved, and all knee extension and flexion LSIs were above 90% (apart from peak knee extension strength at 1 year). At 5 years, 93% of patients were satisfied with MACI to relieve their pain, 90% were satisfied with improving their ability to undertake daily activities, and 80% were satisfied with the improvement in participating in sport. Graft infill ( P = .033) and the MRI composite score ( P = .028) significantly improved over time, with 90% of patients demonstrating good to excellent tissue infill at 5 years. There were 2 graft failures at 5 years after surgery. Conclusion: The arthroscopically performed MACI technique demonstrated good clinical and radiological outcomes up to 5 years, with high levels of patient satisfaction.

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