Patellofemoral Cartilage Restoration: Indications, Techniques, and Outcomes of Autologous Chondrocytes Implantation, Matrix-Induced Chondrocyte Implantation, and Particulated Juvenile Allograft Cartilage

2017 ◽  
Vol 31 (03) ◽  
pp. 212-226 ◽  
Author(s):  
Betina Hinckel ◽  
Andreas Gomoll
Keyword(s):  
Surgical Treatment ◽  
First Generation ◽  
Collagen Membrane ◽  
Type I ◽  
Generation Technique ◽  
Chondral Defects ◽  
Diagnostic Arthroscopy ◽  
Cartilage Restoration ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocytes Implantation

AbstractFocal chondral defects are common in the patellofemoral (PF) joint and can significantly impair the quality of life. The autologous chondrocytes implantation (ACI) technique has evolved over the past 20 years: the first-generation technique involves the use of a periosteal patch, the second-generation technique (collagen-cover) uses a type I/III collagen membrane, and the newest third-generation technique seeds and cultivates the collagen membrane with chondrocytes prior to implantation and is referred to as matrix-induced autologous chondrocyte implantation. Particulated juvenile allograft cartilage (PJAC) (DeNovo NT) is minced cartilage allograft from juvenile donors. A thorough physical exam is important, especially for issues affecting the PF joint, to isolate the location and source of pain, and to identify associated pathologies. Imaging studies allow further characterization of the lesions and identification of associated pathologies and alignment. Conservative management should be exhausted before proceeding with surgical treatment. Steps of surgical treatment are diagnostic arthroscopy and biopsy, chondrocytes culture and chondrocyte implantation for the three generations of ACI, and diagnostic arthroscopy and implantation for PJAC. The techniques and their outcomes will be discussed in this article.

scholarly journals Arthroplasty Using Autologous Multipotent Mesenchymal Cells and Collagen Membrane Chondro-Gide

2014 ◽  
Vol 21 (1) ◽  
pp. 62-66
Author(s):  
A. I Bryanskiy ◽  
T. A Kulyaba ◽  
N. N Kornilov ◽  
V. P Rumakin ◽  
V. S Gornostaev
Keyword(s):  
Surgical Treatment ◽  
Fat Body ◽  
Articular Surface ◽  
Femoral Condyle ◽  
Cartilage Regeneration ◽  
Multipotent Mesenchymal Stromal Cells ◽  
Collagen Membrane ◽  
Slowing Down ◽  
Body Tissues ◽  
Diagnostic Arthroscopy

Surgical treatment results for 13 patients with local deep defects of the articular surface of femoral condyle are presented. Surgical treatment was performed in two steps. At first step diagnostic arthroscopy with removal of loose intraarticular bodies, resection of injured menisci and harvesting of fat body tissues for multipotent mesenchymal stromal cells (MMSC) isolation were applied. Second step consisted of knee arthroplasty; zone of defect was covered with collagen membrane Chondro-Gide under which MMSC were implanted. Control arthroscopy with biopsy of articular surface fragment in the zone of defect restoration was performed to four patients (30.8%) 2 years after arthroplasty. It is shown that after surgical intervention cartilage regeneration goes on owing to fibrillar cartilage formation. In 2 years follow up good results were achieved in 92.3% of cases that proved the efficacy of the elaborated technique for restoration of knee joint function and slowing down of degenerative-dystrophic changes development

The Importance of Staging Arthroscopy for Chondral Defects of the Knee

2020 ◽  
Author(s):  
Hytham S. Salem ◽  
Zaira S. Chaudhry ◽  
Ludovico Lucenti ◽  
Bradford S. Tucker ◽  
Kevin B. Freedman
Keyword(s):  
Articular Surface ◽  
Treatment Plan ◽  
Meniscal Repair ◽  
Osteochondral Allograft ◽  
Mri Findings ◽  
Allograft Transplantation ◽  
Chondral Defects ◽  
Cartilage Restoration ◽  
Chondrocyte Implantation ◽  
Magnetic Resonance Imaging Mri

AbstractThis study aims to evaluate the role of staging arthroscopy in the diagnosis of knee chondral defects and subsequent surgical planning prior to autologous chondrocyte implantation (ACI), osteochondral allograft transplantation (OCA), and meniscus allograft transplantation (MAT). All patients who underwent staging arthroscopy prior to ACI, OCA, or MAT at our institution from 2005 to 2015 were identified. Medical records were reviewed to document the diagnosis and treatment plan based on symptoms, magnetic resonance imaging (MRI) findings and previous operative records. Operative records of the subsequent staging arthroscopy procedure were reviewed to document the proposed treatment plan after arthroscopy. All changes in treatment plan following staging arthroscopy were recorded. Univariate analyses were performed to identify any significant predictors for likelihood to change. A total of 98 patients were included in our analysis. A change in surgical plan was made following arthroscopy in 36 patients (36.7%). Fourteen patients (14.3%) were found to have additional defects that warranted cartilage restoration surgery. In 15 patients (15.3%), at least one defect that was originally thought to warrant cartilage restoration surgery was found to be amenable to debridement alone. The surgical plan was changed from ACI to OCA in four cases (4.1%) and OCA to ACI in one case (1%). A previously proposed MAT was deemed unwarranted in one case (1%), and a planned meniscal repair was changed to MAT in another (1%). Patient age, sex, and the affected knee compartment were not predictors for a change in surgical plan. Body mass index (BMI) was significantly higher in patients who had a change in surgical plan (29.5 kg/m2) compared with those who did not (26.5 kg/m2). A change in surgical plan was more likely to occur for trochlear lesions (46.4%) compared with other articular surface lesions (p = 0.008). The results of our study indicate that staging arthroscopy is an important step in determining the most appropriate treatment plan for chondral defects and meniscal deficiency, particularly those with trochlear cartilage lesions.

scholarly journals Arthroplasty Using Autologous Multipotent Mesenchymal Cells and Collagen Membrane Chondro-Gide

2014 ◽  
pp. 62-66 ◽  
Author(s):  
A. I. Bryanskiy ◽  
T. A. Kulyaba ◽  
N. N. Kornilov ◽  
V. P. Rumakin ◽  
V. S. Gornostaev
Keyword(s):  
Surgical Treatment ◽  
Fat Body ◽  
Articular Surface ◽  
Femoral Condyle ◽  
Cartilage Regeneration ◽  
Multipotent Mesenchymal Stromal Cells ◽  
Collagen Membrane ◽  
Slowing Down ◽  
Body Tissues ◽  
Diagnostic Arthroscopy

Surgical treatment results for 13 patients with local deep defects of the articular surface of femoral condyle are presented. Surgical treatment was performed in two steps. At first step diagnostic arthroscopy with removal of loose intraarticular bodies, resection of injured menisci and harvesting of fat body tissues for multipotent mesenchymal stromal cells (MMSC) isolation were applied. Second step consisted of knee arthroplasty; zone of defect was covered with collagen membrane Chondro-Gide under which MMSC were implanted. Control arthroscopy with biopsy of articular surface fragment in the zone of defect restoration was performed to four patients (30.8%) 2 years after arthroplasty. It is shown that after surgical intervention cartilage regeneration goes on owing to fibrillar cartilage formation. In 2 years follow up good results were achieved in 92.3% of cases that proved the efficacy of the elaborated technique for restoration of knee joint function and slowing down of degenerative-dystrophic changes development

scholarly journals Autologous Chondrocyte Implantation Using a Bilayer Collagen Membrane: A Preliminary Report

2003 ◽  
Vol 11 (1) ◽  
pp. 10-15 ◽  
Author(s):  
P Cherubino ◽  
FA Grassi ◽  
P Bulgheroni ◽  
M Ronga
Keyword(s):  
Magnetic Resonance ◽  
Autologous Chondrocyte Implantation ◽  
Cartilage Defects ◽  
Collagen Membrane ◽  
Type I ◽  
Functional Evaluation ◽  
Chondrocyte Implantation ◽  
The Mean ◽  
Autologous Chondrocyte

Purpose. To present preliminary clinical experience with Matrix-induced autologous chondrocyte implantation, a new tissue-engineering technique for treatment of deep cartilage defects, in which autologous chondrocytes are seeded on a tridimensional scaffold provided by a bilayer type I–III collagen membrane. Methods. From December 1999 to January 2001, 13 patients underwent implantation procedure for deep cartilage defects. Age of patients ranged from 18 to 49 years (mean age, 35 years). The mean defect size was 3.5 cm2 (range, 2.0–4.5 cm2). Clinical and functional evaluation were performed using various score systems for the ankle and the knee, and magnetic resonance imaging was performed at 6 and 12 months postoperatively. Membrane structure and cellular population were investigated by light microscopy, scanning electron microscopy, and electrophoresis before implantation. Results. The mean follow-up was 6.5 months (range, 2–15 months). No complications were observed in the postoperative period. The 6 patients with a minimum follow-up of 6 months showed an improvement in clinical and functional status after surgery. Magnetic resonance images showed the presence of hyaline-like cartilage at the site of implantation; there was evidence of chondroblasts and type II collagen inside the seeded membrane. Conclusion. Matrix-induced autologous chondrocyte implantation offers several advantages with respect to the traditional cultured cell procedure. These include technical simplicity, short operating time, minimal invasiveness, and easier access to difficult sites. It appears to be a reliable method for the repair of deep cartilage defects.

Health-related quality of life one year after surgical treatment of the type I chronic aortic dissection

2019 ◽  
Vol 38 (1) ◽  
Author(s):  
Oksana Kamenskaya ◽  
Asya Klinkova ◽  
Irina Loginova ◽  
Alexander Chernyavskiy ◽  
Dmitry Sirota ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Aortic Dissection ◽  
Type I ◽  
Health Related Quality ◽  
Chronic Aortic Dissection ◽  
Related Quality ◽  
Health Related ◽  
One Year

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

Concomitant Osteotomy Reduces Risk of Reoperation Following Cartilage Restoration Procedures of the Knee: A Matched Cohort Analysis

Cartilage ◽  
2021 ◽  
pp. 194760352110115
Author(s):  
Jacob G. Calcei ◽  
Kunal Varshneya ◽  
Kyle R. Sochacki ◽  
Marc R. Safran ◽  
Geoffrey D. Abrams ◽  
...  
Keyword(s):  
Cohort Analysis ◽  
Reoperation Rate ◽  
Similar Rate ◽  
Osteochondral Allograft ◽  
Complication Rates ◽  
Cartilage Restoration ◽  
Chondrocyte Implantation ◽  
The Cost ◽  
Reoperation Rates

Objective The objective of this study is to compare the (1) reoperation rates, (2) 30-day complication rates, and (3) cost differences between patients undergoing isolated autologous chondrocyte implantation (ACI) or osteochondral allograft transplantation (OCA) procedures alone versus patients with concomitant osteotomy. Study Design Retrospective cohort study, level III. Design Patients who underwent knee ACI (Current Procedural Terminology [CPT] 27412) or OCA (CPT 27415) with minimum 2-year follow-up were queried from a national insurance database. Resulting cohorts of patients that underwent ACI and OCA were then divided into patients who underwent isolated cartilage restoration procedure and patients who underwent concomitant osteotomy (CPT 27457, 27450, 27418). Reoperation was defined by ipsilateral knee procedure after the index surgery. The 30-day postoperative complication rates were assessed using ICD-9-CM codes. The cost per patient was calculated. Results A total of 1,113 patients (402 ACI, 67 ACI + osteotomy, 552 OCA, 92 OCA + osteotomy) were included (mean follow-up of 39.0 months). Reoperation rate was significantly higher after isolated ACI or OCA compared to ACI or OCA plus concomitant osteotomy (ACI 68.7% vs. ACI + osteotomy 23.9%; OCA 34.8% vs. OCA + osteotomy 16.3%). Overall complication rates were similar between isolated ACI (3.0%) and ACI + osteotomy (4.5%) groups and OCA (2.5%) and OCA + osteotomy (3.3%) groups. Payments were significantly higher in the osteotomy groups at day of surgery and 9 months compared to isolated ACI or OCA, but costs were similar by 2 years postoperatively. Conclusions Concomitant osteotomy at the time of index ACI or OCA procedure significantly reduces the risk of reoperation with a similar rate of complications and similar overall costs compared with isolated ACI or OCA.

Sign in / Sign up

Export Citation Format

Share Document