22.5 Arthroscopic mosaicplasty technique for cartilage knee lesions. Magnetic resonance observation of cartilage repair tissue (MOCART) at a minimum 7 years follow-up.

Background: Little is known regarding the optimal treatment for displaced, purely chondral fragments in the knee. Purpose: To report the clinical and radiographic outcomes of chondral fragment fixation in adolescents through use of autologous bone pegs. Study Design: Case series; Level of evidence, 4. Methods: This retrospective, single-center study evaluated 6 patients (mean age, 12.9 years) who underwent fixation of chondral fragments (no visualized bone attached) using autologous bone pegs (mean postoperative follow-up, 5.2 years; range, 1.4-10.9 years). The causes were trauma (n = 5) and osteochondritis dissecans (n = 1). Lesions were located in the trochlear groove (lateral, n = 3; medial, n = 2) or posterior part of the lateral femoral condyle (n = 1). The mean lesion size was 3.8 cm2 (range, 0.8-9.0 cm2). Patients were evaluated via physical examination and magnetic resonance imaging (MRI) using magnetic resonance observation of cartilage repair tissue scores. Results: In total, 5 patients successfully returned to sports without restrictions at a mean of 7 months (range, 6-8 months) postoperatively. At the latest follow-up, these 5 patients had full range of motion and no joint effusion. The mean magnetic resonance observation of cartilage repair tissue score was 85 (range, 70-95) at a mean duration of 3 years (range, 1-5 years). One patient experienced failure at 1.3 years postoperatively after a traumatic injury and subsequently underwent removal of the fixed fragment and a drilling procedure. Conclusion: In most adolescents, fixation of chondral fragments with no visualized bony portion using autologous bone pegs provided a satisfactory success rate and good healing of cartilage tissue confirmed on MRI scans.

Download Full-text

Combined Bone Marrow Aspirate and Platelet-Rich Plasma for Cartilage Repair: Two-Year Clinical Results

Cartilage ◽

10.1177/1947603519876329 ◽

2019 ◽

pp. 194760351987632 ◽

Cited By ~ 4

Author(s):

Kris Hede ◽

Bjørn B. Christensen ◽

Jonas Jensen ◽

Casper B. Foldager ◽

Martin Lind

Keyword(s):

Bone Marrow ◽

Magnetic Resonance ◽

Clinical Outcome ◽

Cartilage Repair ◽

Bone Marrow Aspirate ◽

Platelet Rich Plasma ◽

Collagen Scaffold ◽

Repair Tissue ◽

Outcome Scores

Purpose To evaluate the clinical and biological outcome of combined bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP) on a collagen scaffold for treating cartilage lesions in the knee. Methods and Materials Ten patients (mean age 29.4 years, range 18-36) suffering from large full-thickness cartilage in the knee were treated with BMAC and PRP from January 2015 to December 2016. In a 1-step procedure autologous BMAC and PRP was seeded onto a collagen scaffold and sutured into the debrided defect. Patients were evaluated by clinical outcome scores (IKDC [International Knee Documentation Committee Subjective Knee Form], KOOS [Knee Injury and Osteoarthritis Outcome Score], and pain score using the Numeric Rating Scale [NRS]) preoperatively, after 3 months, and after 1 and 2 years. Second-look arthroscopies were performed ( n = 7) with biopsies of the repair tissue for histology. All patients had magnetic resonance imaging (MRI) preoperatively, after 1 year, and after 2 to 3.5 years with MOCART (magnetic resonance observation of cartilage repair tissue) scores evaluating cartilage repair. Results After 1 year significant improvements were found in IKDC, KOOS symptoms, KOOS ADL (Activities of Daily Living), KOOS QOL (Quality of Life), and pain at activity. At the latest follow-up significant improvements were seen in IKDC, KOOS symptoms, KOOS QOL, pain at rest, and pain at activity. MRI MOCART score for cartilage repair improved significantly from baseline to 1-year follow-up. Histomorphometry of repair tissue demonstrated a mixture of fibrous tissue (58%) and fibrocartilage (40%). Conclusion Treatment of cartilage injuries using combined BMAC and PRP improved subjective clinical outcome scores and pain scores at 1 and 2 years postoperatively. MRI and histology indicated repair tissue inferior to the native hyaline cartilage.

Download Full-text

Chondral and Osteochondral Femoral Cartilage Lesions Treated with GelrinC: Significant Improvement of Radiological Outcome Over Time and Zonal Variation of the Repair Tissue Based on T2 Mapping at 24 Months

Cartilage ◽

10.1177/1947603520926702 ◽

2020 ◽

pp. 194760352092670

Author(s):

Markus M. Schreiner ◽

Marcus Raudner ◽

Pavol Szomolanyi ◽

Kitty Ohel ◽

Livnat Ben-Zur ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Cartilage Repair ◽

Osteochondral Lesions ◽

Resonance Imaging ◽

Repair Tissue ◽

Cartilage Lesions ◽

Femoral Cartilage ◽

Magnetic Resonance Imaging Mri

Objective To prospectively assess the efficacy of GelrinC in the treatment of chondral and osteochondral femoral cartilage lesions using morphological (Magnetic Resonance Observation of Cartilage Repair Tissue [MOCART]) and quantitative (T2-mapping) magnetic resonance imaging (MRI). Design This study was designed as a prospective single-arm, open label, multicenter study. Morphological magnetic resonance imaging (MRI) for MOCART assessment and T2 mapping was performed 1 week and 6, 12, 18, and 24 months after GelrinC implantation. Evaluation of T2 mapping was based on the assessment of global T2 indices (T2 of the repair tissue [RT] divided by T2 of healthy reference cartilage) and zonal variation. Results Fifty-six (20 female) patients were prospectively enrolled. The mean MOCART score significantly increased from baseline to the 24-month follow-up with 88.8 (95% CI, 85.8-91.9; P < 0.001) for all lesions combined as well as 86.8 (95% CI, 83.0-90.6) for chondral lesions and 94.1 (95% CI, 68.55-100) for osteochondral lesions. Furthermore, based on T2 mapping, significant zonal variation of the RT was observed at 24 months ( P = 0.039), which did not differ significantly from healthy reference cartilage ( P = 0.6). Conclusion Increasing MOCART scores were observed throughout the follow-up period, indicative of maturation of the cartilage repair. Significant zonal variation of the RT at 24 months might indicate the transformation into hyaline cartilage–like RT. Slightly differing morphological outcome between chondral and osteochondral lesions, but similar global and zonal T2 indices at 24 months, support the potential of GelrinC as a treatment option for both lesion types.

Download Full-text

Outcomes Following Microfracture for Osteochondral Lesions of the Talus in Female Patients

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00495 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0049

Author(s):

Emilie Williamson ◽

Arianna L. Gianakos ◽

Eoghan T. Hurley ◽

John G. Kennedy

Keyword(s):

Magnetic Resonance ◽

Cartilage Repair ◽

Short Form ◽

Osteochondral Lesions ◽

Bone Marrow Stimulation ◽

Repair Tissue ◽

Female Patients ◽

The Mean ◽

Magnetic Resonance Imaging Mri

Category: Ankle; Arthroscopy; Sports Introduction/Purpose: Microfracture (Mfx) is typically indicated for patients who have symptomatic osteochondral lesions of the talus (OLT) which are smaller in size. However, there is scant literature focusing exclusively on female patients, who may require specific consideration as compared to male counterparts. The purpose of this study was to evaluate the outcomes of Mfx in the treatment of OLT in the females population. Methods: A retrospective analysis comparing patients treated with Mfx for OLT was performed, to include all patients treated between 2007 and 2015. Clinical outcomes were evaluated using the Foot and Ankle Outcome Scores (FAOS) and Short-Form 12 (SF-12). Magnetic resonance imaging (MRI) at final follow-up was evaluated with the modified magnetic resonance observation of cartilage repair tissue (MOCART) score. Results: Thirty-one females were included. The mean patient age was 39.6 +- 17.2 years with mean follow-up of 48.4 +- 24.8 months. The mean preoperative and postoperative FAOS score was 53.3 +- 22.9 and 73.2 +- 18.2 (p < 0.001), and the mean preoperative and postoperative SF-12 score was 40.6 +- 11.1 and 56 +- 15.1 (p < 0.001). The final MOCART score was 59.3 +-24.5. Overall, 6 (19.4%) patients required a further surgery, 4 patients (12.9%) were considered failures, 2 (6.5%) patients required a distraction arthroplasty and 2 patients (6.5%) required a repeat bone marrow stimulation. Conclusion: The outcomes following Mfx for OLT in females were good at mid term follow up. However, the final MOCART scores were poor, indicating poor cartilage repair tissue and a poor harbinger for long term outcomes.

Download Full-text

All-Arthroscopic Autologous Matrix-Induced Chondrogenesis-Aided Repair of a Patellar Cartilage Defect Using Dry Arthroscopy and a Retraction System

The Journal of Knee Surgery ◽

10.1055/s-0037-1599246 ◽

2017 ◽

Vol 30 (09) ◽

pp. 925-929 ◽

Cited By ~ 8

Author(s):

Mariusz Puszkarz ◽

Lidia Kosmalska ◽

Martin Wiewiorski ◽

Boguslaw Sadlik

Keyword(s):

Magnetic Resonance ◽

Cartilage Repair ◽

Case Series ◽

Collagen Matrix ◽

International Knee Documentation Committee ◽

Level Of Evidence ◽

Patellar Cartilage ◽

Radiological Data ◽

Implantation Techniques

AbstractThe technique of all-arthroscopic autologous matrix-induced chondrogenesis (AMIC)-aided repair of patellar cartilage lesions using a retraction system and dry arthroscopy has been recently described. We report the first clinical and radiological data at a short-term follow-up. Twelve patients underwent AMIC-aided cartilage repair for a patellar lesion. All steps of the procedure were performed arthroscopically, which include the use of an intra-articularly placed retraction plate for distraction of the patellofemoral joint and evacuation of saline solution for collagen matrix insertion and fixation. Clinical assessment performed before surgery and at a mean follow-up time of 38 months (range: 24–70) included the following scores: Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC), and visual analog scale (VAS). Magnetic resonance imaging was performed at the follow-up examination, including the magnetic resonance observation of cartilage repair tissue (MOCART) score. The mean KOOS and IKDC scores increased significantly (p < 0.01) from 50.3 and 37.4 points preoperatively to 90.1 and 79.4 postoperatively. The VAS score decreased from 7.8 to 2.3 points. Mean MOCART score at follow-up was 58.3 points. Cartilage repair of patellar lesions aided by a retraction system in a dry arthroscopy setup is a promising approach. Further studies are needed to evaluate this procedure and compare it to existing matrix implantation techniques. The level of evidence for the study is 4 (case series).

Download Full-text

Autologous Matrix-Induced Chondrogenesis With Lateral Ligament Stabilization for Osteochondral Lesions of the Talus in Patients With Ankle Instability

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211007439 ◽

2021 ◽

Vol 9 (5) ◽

pp. 232596712110074

Author(s):

Jakob Ackermann ◽

Fabio A. Casari ◽

Christoph Germann ◽

Lizzy Weigelt ◽

Stephan H. Wirth ◽

...

Keyword(s):

Magnetic Resonance ◽

Clinical Outcomes ◽

Cartilage Repair ◽

Ankle Instability ◽

Lesion Size ◽

Lateral Ligament ◽

Osteochondral Lesions ◽

Level Of Evidence ◽

Radiographic Outcomes

Background: Autologous matrix-induced chondrogenesis (AMIC) has been shown to result in favorable clinical outcomes in patients with osteochondral lesions of the talus (OLTs). Though, the influence of ankle instability on cartilage repair of the ankle has yet to be determined. Purpose/Hypothesis: To compare the clinical and radiographic outcomes in patients with and without concomitant lateral ligament stabilization (LLS) undergoing AMIC for the treatment of OLT. It was hypothesized that the outcomes would be comparable between these patient groups. Study Design: Cohort study; Level of evidence, 3. Methods: Twenty-six patients (13 with and 13 without concomitant ankle instability) who underwent AMIC with a mean follow-up of 4.2 ± 1.5 years were enrolled in this study. Patients were matched 1:1 according to age, body mass index (BMI), lesion size, and follow-up. Postoperative magnetic resonance imaging and Tegner, American Orthopaedic Foot & Ankle Society (AOFAS), and Cumberland Ankle Instability Tool (CAIT) scores were obtained at a minimum follow-up of 2 years. A musculoskeletal radiologist scored all grafts according to the MOCART (magnetic resonance observation of cartilage repair tissue) 1 and MOCART 2.0 scores. Results: The patients’ mean age was 33.4 ± 12.7 years, with a mean BMI of 26.2 ± 3.7. Patients with concomitant LLS showed worse clinical outcome measured by the AOFAS (85.1 ± 14.4 vs 96.3 ± 5.8; P = .034) and Tegner (3.8 ± 1.1 vs 4.4 ± 2.3; P = .012) scores. Postoperative CAIT and AOFAS scores were significantly correlated in patients with concomitant LLS ( r = 0.766; P = .002). A CAIT score >24 (no functional ankle instability) resulted in AOFAS scores comparable with scores in patients with isolated AMIC (90.1 ± 11.6 vs 95.3 ± 6.6; P = .442). No difference was seen between groups regarding MOCART 1 and 2.0 scores ( P = .714 and P = .371, respectively). Conclusion: Concurrently performed AMIC and LLS in patients with OLT and ankle instability resulted in clinical outcomes comparable with isolated AMIC if postoperative ankle stability was achieved. However, residual ankle instability was associated with worse postoperative outcomes, highlighting the need for adequate stabilization of ankle instability in patients with OLT.

Download Full-text

Arthroscopic Matrix-Encapsulated Autologous Chondrocyte Implantation: A Pilot Multicenter Investigation in Latin America

Cartilage ◽

10.1177/1947603520918630 ◽

2020 ◽

pp. 194760352091863

Author(s):

Enrique Villalobos ◽

Antonio Madrazo-Ibarra ◽

Valentín Martínez ◽

Anell Olivos-Meza ◽

Cristina Velasquillo ◽

...

Keyword(s):

Magnetic Resonance ◽

Cell Viability ◽

Cartilage Repair ◽

Autologous Chondrocyte Implantation ◽

T2 Mapping ◽

Second Look ◽

Arthroscopic Evaluation ◽

Chondrocyte Implantation ◽

Autologous Chondrocyte

Objective. To evaluate minimum biosecurity parameters (MBP) for arthroscopic matrix-encapsulated autologous chondrocyte implantation (AMECI) based on patients’ clinical outcomes, magnetic resonance imaging (MRI) T2-mapping, Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score, and International Cartilage Repair Society (ICRS) second-look arthroscopic evaluation, laying the basis for a future multicenter study. Design. Pilot clinical study. We analyzed the logistics to perform AMECI to treat focal chondral lesions in different hospitals following strict biosecurity parameters related to tissue and construct transportation, chondrocyte isolation, and cell expansion. Patient progress was analyzed with patient-reported outcome measures, MRI T2-mapping, MOCART, and ICRS arthroscopic second-look evaluation. Results. Thirty-five lesions in 30 patients treated in 7 different hospitals were evaluated. Cell viability before implantation was >90%. Cell viability in construct remnants was 87% ± 11% at 24 hours, 75% ± 17.1% at 48 hours, and 60% ± 8% at 72 hours after implantation. Mean final follow-up was 37 months (12-72 months). Patients showed statistically significant improvement in all clinical scores and MOCART evaluations. MRI T2-mapping evaluation showed significant decrease in relaxation time from 61.2 ± 14.3 to 42.9 ± 7.2 ms ( P < 0.05). Arthroscopic second-look evaluation showed grade II “near normal” tissue in 83% of patients. Two treatment failures were documented. Conclusions. It was feasible to perform AMECI in 7 different institutions in a large metropolitan area following our biosecurity measures without any implant-related complication. Treated patients showed improvement in clinical, MRI T2-mapping, and MOCART scores, as well as a low failure rate and a favorable ICRS arthroscopic evaluation at a mid-term follow-up. Level of Evidence. 2b.

Download Full-text

First-in-Human Pilot Study of Implantation of a Scaffold-Free Tissue-Engineered Construct Generated From Autologous Synovial Mesenchymal Stem Cells for Repair of Knee Chondral Lesions

The American Journal of Sports Medicine ◽

10.1177/0363546518781825 ◽

2018 ◽

Vol 46 (10) ◽

pp. 2384-2393 ◽

Cited By ~ 20

Author(s):

Kazunori Shimomura ◽

Yukihiko Yasui ◽

Kota Koizumi ◽

Ryota Chijimatsu ◽

David A. Hart ◽

...

Keyword(s):

Stem Cells ◽

Mesenchymal Stem Cells ◽

Magnetic Resonance ◽

Cartilage Repair ◽

Femoral Condyle ◽

Chondral Lesions ◽

Repair Tissue ◽

Biopsy Specimens ◽

Implantation Procedure

Background: Articular cartilage has limited healing capacity, owing in part to poor vascularity and innervation. Once injured, it cannot be repaired, typically leading to high risk for developing osteoarthritis. Thus, cell-based and/or tissue-engineered approaches have been investigated; however, no approach has yet achieved safety and regenerative repair capacity via a simple implantation procedure. Purpose: To assess the safety and efficacy of using a scaffold-free tissue-engineered construct (TEC) derived from autologous synovial membrane mesenchymal stem cells (MSCs) for effective cartilage repair. Study Design: Case series; Level of evidence, 4. Methods: Five patients with symptomatic knee chondral lesions (1.5-3.0 cm2) on the medial femoral condyle, lateral femoral condyle, or femoral groove were included. Synovial MSCs were isolated from arthroscopic biopsy specimens and cultured to develop a TEC that matched the lesion size. The TECs were then implanted into chondral defects without fixation and assessed up to 24 months postoperatively. The primary outcome was the safety of the procedure. Secondary outcomes were self-assessed clinical scores, arthroscopy, tissue biopsy, and magnetic resonance image–based estimation of morphologic and compositional quality of the repair tissue. Results: No adverse events were recorded, and self-assessed clinical scores for pain, symptoms, activities of daily living, sports activity, and quality of life were significantly improved at 24 months after surgery. Secure defect filling was confirmed by second-look arthroscopy and magnetic resonance imaging in all cases. Histology of biopsy specimens indicated repair tissue approaching the composition and structure of hyaline cartilage. Conclusion: Autologous scaffold-free TEC derived from synovial MSCs may be used for regenerative cartilage repair via a sutureless and simple implantation procedure. Registration: 000008266 (UMIN Clinical Trials Registry number).

Download Full-text

Comparison of Bone Marrow Aspirate Concentrate and Allogenic Human Umbilical Cord Blood Derived Mesenchymal Stem Cell Implantation on Chondral Defect of Knee: Assessment of Clinical and Magnetic Resonance Imaging Outcomes at 2-Year Follow-Up

Cell Transplantation ◽

10.1177/0963689720943581 ◽

2020 ◽

Vol 29 ◽

pp. 096368972094358

Author(s):

Dong Jin Ryu ◽

Yoon Sang Jeon ◽

Jun Sung Park ◽

Gi Cheol Bae ◽

Jeong-seok Kim ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Stem Cells ◽

Bone Marrow ◽

Magnetic Resonance ◽

Cartilage Repair ◽

Bone Marrow Aspirate ◽

Human Umbilical Cord Blood ◽

Human Umbilical Cord ◽

Resonance Imaging

Biological repair of cartilage lesions remains a significant clinical challenge. A wide variety of methods involving mesenchymal stem cells (MSCs) have been introduced. Because of the limitation of the results, most of the treatment methods have not yet been approved by the Food and Drug Administration (FDA). However, bone marrow aspirate concentrate (BMAC) and human umbilical cord blood derived mesenchymal stem cells (hUCB-MSCs) implantation were approved by Korea FDA. The aim of this study was to evaluate clinical and magnetic resonance imaging (MRI) outcomes after two different types of MSCs implantation in knee osteoarthritis. Fifty-two patients (52 knees) who underwent cartilage repair surgery using the BMAC (25 knees) and hUCB-MSCs (27 knees) were retrospectively evaluated for 2 years after surgery. Clinical outcomes were evaluated according to the score of visual analogue scale (VAS), the International Knee Documentation Committee (IKDC) subjective, and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Cartilage repair was assessed according to the modified Magnetic Resonance Observation of Cartilage Repair Tissue (M-MOCART) score and the International Cartilage Repair Society (ICRS) cartilage repair scoring system. At 2-year follow-up, clinical outcomes including VAS, IKDC, and KOOS significantly improved ( P < 0.05) in both groups; however, there were no differences between two groups. There was no significant difference in M-MOCART [1-year ( P = 0.261), 2-year ( P = 0.351)] and ICRS repair score ( P = 0.655) between two groups. Both groups showed satisfactory clinical and MRI outcomes. Implantation of MSCs from BMAC or hUCB-MSCs is safe and effective for repairing cartilage lesion. However, large cases and a well-controlled prospective design with long-term follow-up studies are needed.

Download Full-text

One-Step Treatment for Patellar Cartilage Defects With a Cell-Free Osteochondral Scaffold: A Prospective Clinical and MRI Evaluation

The American Journal of Sports Medicine ◽

10.1177/0363546517694159 ◽

2017 ◽

Vol 45 (7) ◽

pp. 1581-1588 ◽

Cited By ~ 23

Author(s):

Francesco Perdisa ◽

Giuseppe Filardo ◽

Andrea Sessa ◽

Maurizio Busacca ◽

Stefano Zaffagnini ◽

...

Keyword(s):

Magnetic Resonance ◽

Clinical Outcome ◽

Cartilage Defects ◽

Osteochondral Lesions ◽

Repair Tissue ◽

Osteochondral Scaffold ◽

Patellar Cartilage ◽

A Cell ◽

Mri Evaluation

Background: The treatment of symptomatic cartilage defects of the patella is particularly challenging, and no gold standard is currently available. Purpose: To evaluate the clinical results of a biphasic cell-free collagen-hydroxyapatite scaffold and to evaluate osteochondral tissue regeneration with magnetic resonance imaging (MRI). Study Design: Case series; Level of evidence, 4. Methods: Thirty-four patients (18 men and 16 women; mean ± SD: age, 30.0 ± 10 years) were treated by scaffold implantation for knee chondral or osteochondral lesions of the patella (area, 2.1 ± 1 cm2). The clinical evaluation was performed prospectively at 12 and 24 months via the IKDC (International Knee Documentation Committee; objective and subjective) and Tegner scores. MRI evaluation was performed at both follow-ups in 18 lesions through the MOCART score (magnetic resonance observation of cartilage repair tissue) and specific subchondral bone parameters. Results: A statistically significant improvement in all the scores was observed at 12- and 24-month follow-up as compared with the basal evaluation. The IKDC subjective score improved from 39.5 ± 14.5 to 61.9 ± 14.5 at 12 months ( P > .0005) with a further increase to 67.6 ± 17.4 at 24 months of follow-up (12-24 months, P = .020). The MRI evaluation showed a stable value of the MOCART score between 12 and 24 months, with a complete filling of the cartilage in 87.0% of the lesions, complete integration of the graft in 95.7%, and intact repair tissue surface in 69.6% at final follow-up. The presence of osteophytes or more extensive bony overgrowth was documented in 47.8% of the patients of this series, but no correlation was found between MRI findings and clinical outcome. Conclusion: The implantation of a cell-free collagen-hydroxyapatite osteochondral scaffold provided a clinical improvement at short-term follow-up for the treatment of patellar cartilage defects. Women had lower outcomes, and the need for realignment procedures led to a slower recovery. MRI evaluation showed some abnormal findings with the presence of bone overgrowth, but no correlation has been found with the clinical outcome.

Download Full-text