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

Cartilage ◽  
2016 ◽  
Vol 8 (2) ◽  
pp. 131-138 ◽  
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.

Third-generation autologous chondrocyte implantation after failed bone marrow stimulation leads to inferior clinical results

2019 ◽  
Vol 28 (2) ◽  
pp. 470-477 ◽  
Author(s):  
Peter Ernst Müller ◽  
David Gallik ◽  
Florian Hammerschmid ◽  
Andrea Baur-Melnyk ◽  
Matthias Frank Pietschmann ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Autologous Chondrocyte Implantation ◽  
Clinical Results ◽  
Third Generation ◽  
Bone Marrow Stimulation ◽  
Marrow Stimulation ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

Autologous Chondrocyte Implantation for Bipolar Chondral Lesions in the Patellofemoral Compartment: Clinical Outcomes at a Mean 9 Years’ Follow-up

2019 ◽  
Vol 47 (4) ◽  
pp. 837-846 ◽  
Author(s):  
Takahiro Ogura ◽  
Tim Bryant ◽  
Gergo Merkely ◽  
Tom Minas
Keyword(s):  
Patient Satisfaction ◽  
Autologous Chondrocyte Implantation ◽  
Survival Rates ◽  
Collagen Membrane ◽  
Chondral Lesions ◽  
Marrow Stimulation ◽  
Satisfaction Rate ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

Background: Treating bipolar chondral lesions in the patellofemoral (PF) compartment is a challenging problem. There are few reports available on the treatment of bipolar chondral lesions in the PF compartment. Purpose: To evaluate the clinical outcomes and graft survivorship after autologous chondrocyte implantation (ACI) for the treatment of bipolar chondral lesions in the PF compartment. Study Design: Case series; Level of evidence, 4. Methods: The authors evaluated 58 patients who had ACI by a single surgeon for the treatment of symptomatic bipolar chondral lesions in the PF compartment between November 1995 and June 2014. All 58 patients (60 knees; mean age, 36.6 years) were included with a minimum 2-year follow-up. The mean ± SD sizes of the patellar and trochlear lesions were 5.6 ± 2.7 cm2 and 4.2 ± 2.8 cm2, respectively. Forty-two patients had osteotomy, as they had PF lateral maltracking, patellar instability, or tibiofemoral malalignment. Patients were evaluated with the modified Cincinnati Knee Rating Scale, Western Ontario and McMaster Universities Osteoarthritis Index, visual analog scale, the 36-Item Short Form Health Survey, and a patient satisfaction survey. Radiographs were evaluated with the Iwano classification. Results: Overall, the survival rates were 83% and 79% at 5 and 10 years, respectively. Of the 49 (82%) knees with retained grafts, all functional scores significantly improved postoperatively with a very high satisfaction rate (88%) at a mean 8.8 ± 4.2 years after ACI (range, 2-16 years). At the most recent follow-up, 28 of 49 successful knees were radiographically assessed (mean, 4.9 years; range, 2-17 years), with no increase of the Iwano classification in 26 knees. Outcomes for 11 patients were considered failures at a mean 2.9 years. Forty-two knees (70%) required a mean 1.0 subsequent surgical procedure. The primary reasons for chondroplasty were hypertrophy of the ACI graft (17; periosteum in 14, collagen membrane in 3), delamination of the ACI graft (5; periosteum in 4, collagen membrane in 1), and new chondral lesions (3). The best survival rates were observed among patients who underwent ACI with concomitant tibial tubercle osteotomy (TTO) as the first procedure without previous failed TTO and/or marrow stimulation technique (91% at 5 and 10 years), while the worst survival rates were observed among patients who had previous marrow stimulation (43% at 5 and 10 years). Conclusion: Results demonstrated that ACI with concomitant osteotomy, when it is necessary for the treatment of bipolar/kissing lesions in the PF compartments, gives significant improvement in pain and function, with good survival rates at 5 and 10 years (83% and 79%, respectively). The high patient satisfaction rate is encouraging, and a high survival rate can be expected when ACI with a concomitant TTO is performed at the initial surgery for this difficult condition.

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.

Severe Bone Marrow Edema Among Patients Who Underwent Prior Marrow Stimulation Technique Is a Significant Predictor of Graft Failure After Autologous Chondrocyte Implantation

2019 ◽  
Vol 47 (8) ◽  
pp. 1874-1884 ◽  
Author(s):  
Gergo Merkely ◽  
Takahiro Ogura ◽  
Tim Bryant ◽  
Tom Minas
Keyword(s):  
Body Mass Index ◽  
Graft Failure ◽  
Autologous Chondrocyte Implantation ◽  
Bone Marrow Edema ◽  
Control Group ◽  
Case Group ◽  
Marrow Stimulation ◽  
Chondrocyte Implantation ◽  
Marrow Edema ◽  
Autologous Chondrocyte

Background: Autologous chondrocyte implantation (ACI) is a well-established cartilage repair procedure; however, numerous studies have shown higher ACI graft failure rates after prior marrow stimulation techniques (MSTs). Purpose: To identify which factors may predict decreased graft survival after ACI among patients who underwent a prior MST. A secondary aim was to investigate the specificity of these predictors. Study Design: Case-control study; Level of evidence, 3. Methods: In this review of prospectively collected data, the authors analyzed 38 patients who had failed prior MST surgery and subsequently underwent collagen-covered ACI (case group). The case group was divided into graft failure ACI (n = 8, 21%) and successful ACI (n = 30, 79%). Fourteen clinical variables were categorized and analyzed to determine predictors for failure of the ACI graft: age, body mass index, sex, defect characteristics (number, size, location, etiology, type), presence of kissing lesion, intraoperative presence of intralesional osteophyte, time between an MST and ACI, previous surgery, duration of the symptoms, and concomitant surgical procedure. Preoperative magnetic resonance imaging (MRI) was used to evaluate the severity of subchondral bone marrow edema (BME), graded I (absent) to IV (severe), and the presence of subchondral cyst, hypertrophic sclerosis, and intralesional osteophyte. The effects of these MRI findings on the graft survivor were also investigated. Concurrently, a control group without a prior MST was matched to investigate the specificity of the previously determined predictors. These patients were matched individually according to age, sex, body mass index, and outcome of the procedure (failure [n = 8] or successful [n = 30] per the case group). Results: In the case group, the presence of preoperative severe BME was significantly higher among patients with failed ACI as compared with patients with successful ACI ( P < .001). In the control group, the presence of severe BME was not significantly different between the failure and successful groups ( P = .747). The ACI graft failure rate among patients with a prior MST and preoperative grade IV BME was 83.7% at 5 years postoperatively, resulting in a significantly lower survival rate as compared with patients with a prior MST and without severe BME (5-year graft failure rate, 6.5%; P < .001). All the other parameters did not differ significantly. Conclusion: After a prior MST, the presence of grade IV BME by MRI was a predictive factor for graft failure among patients who then underwent second-generation ACI.

Autologous chondrocyte implantation at the knee using a bilayer collagen membrane with bone graft

2005 ◽  
Vol 87-B (3) ◽  
pp. 330-332 ◽  
Author(s):  
W. Bartlett ◽  
C. R. Gooding ◽  
R. W. J. Carrington ◽  
J. A. Skinner ◽  
T. W. R. Briggs ◽  
...  
Keyword(s):  
Bone Graft ◽  
Autologous Chondrocyte Implantation ◽  
Collagen Membrane ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

Primary Autologous Chondrocyte Implantation of the Knee Versus Autologous Chondrocyte Implantation After Failed Marrow Stimulation: A Systematic Review

2020 ◽  
pp. 036354652096828
Author(s):  
Hayden B. Schuette ◽  
Matthew J. Kraeutler ◽  
John B. Schrock ◽  
Eric C. McCarty
Keyword(s):  
Systematic Review ◽  
Knee Joint ◽  
Treatment Failure ◽  
Autologous Chondrocyte Implantation ◽  
Marrow Stimulation ◽  
Pain Scores ◽  
Chondrocyte Implantation ◽  
Group A ◽  
Group B ◽  
Autologous Chondrocyte

Background: Marrow stimulation (MST) surgery, which includes microfracture, subchondral drilling, and abrasion arthroplasty, and autologous chondrocyte implantation (ACI) are 2 surgical options to treat articular cartilage lesions in the knee joint. Recent studies have suggested worse outcomes when ACI is used after failed MST. Purpose: To investigate the failure rates and clinical outcomes of primary knee ACI versus ACI after failed MST surgery (secondary ACI). Study Design: Systematic review. Methods: A systematic review was performed by searching the PubMed, Embase, and Cochrane Library databases to identify studies evaluating clinical outcomes of patients undergoing primary versus secondary ACI of the knee joint. The search terms used were as follows: “knee” AND (“autologous chondrocyte implantation” OR “osteochondral allograft”) AND (microfracture OR “marrow stimulation”). Patients undergoing primary ACI (group A) were compared with those undergoing secondary ACI (group B) based on treatment failure rates and patient-reported outcomes (PROs). Results: Seven studies (2 level 2 studies, 5 level 3 studies) were identified and met inclusion criteria, including a total of 1335 patients (group A: n = 838; group B: n = 497). The average patient age in all studies was 34.2 years, and the average lesion size was 5.43 cm2. Treatment failure occurred in 14.0% of patients in group A and 27.6% of patients in group B ( P < .00001). Four studies reported PROs. One study found significantly better Subjective International Knee Documentation Committee scores ( P = .011), visual analog scale (VAS) pain scores ( P = .028), and VAS function scores ( P = .005) in group A. Another study found significantly better Knee injury and Osteoarthritis Outcome Score (KOOS) Pain scores ( P = .034), KOOS Activities of Daily Living scores ( P = .024), VAS pain scores ( P = .014), and VAS function scores ( P = .032) in group A. Two studies found no significant difference in PROs between groups A and B ( P < .05). Conclusion: Patient-reported improvement can be expected in patients undergoing primary or secondary ACI of the knee joint. Patients undergoing secondary ACI have a significantly higher risk of treatment failure and may have worse subjective outcomes compared with patients undergoing primary ACI.

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