scholarly journals Time Matters: Knee Cartilage Defect Expansion and High-Grade Lesion Formation while Awaiting Autologous Chondrocyte Implantation

Cartilage ◽  
2021 ◽  
pp. 194760352110638
Author(s):  
Robert J. Pettit ◽  
Joshua S. Everhart ◽  
Alex C. DiBartola ◽  
Ryan E. Blackwell ◽  
David C. Flanigan
Keyword(s):  
Cartilage Defect ◽  
Autologous Chondrocyte Implantation ◽  
Defect Size ◽  
High Grade ◽  
Knee Cartilage ◽  
Initial Defect ◽  
Chondrocyte Implantation ◽  
Outerbridge Grade ◽  
Grade Defect ◽  
Autologous Chondrocyte

Objective The objective of this study was to assess potential risk factors, including time delay until implantation, for knee cartilage defect expansion or new high-grade defect formation between biopsy and Autologous Chondrocyte Implantation (ACI) or Matrix Autologous Chondrocyte Implantation (MACI). Study design Consecutive knee ACI and MACI cases by a single surgeon ( n = 111) were reviewed. The relationship between time between biopsy and staged implantation and (1) progression in primary cartilage defect size and (2) development of a new high-grade (Outerbridge grade ≥3) cartilage defect were determined with adjustment for demographics, body mass index, smoking status, coronal alignment, initial cartilage status, and prior surgery. Results Average size of the primary defect at time of biopsy was 4.50 cm2. Mean time to chondrocyte implantation was 155 days. Defect expansion increased 0.11 cm2 (standard error = 0.03) per month delay to implantation ( P = 0.001). Independent predictors of defect expansion were male sex, smaller initial defect size, and delay to implantation (adjusted mean = 0.15 cm2 expansion per month). A total of 16.2% of patients ( n = 18/111) developed a new high-grade defect. Independent predictors of a new secondary defect were Outerbridge grade 2 changes (vs. 0-1) on the surface opposing the index defect and delayed implantation (per month increase, adjusted odds ratio = 1.21, 95% confidence interval: 1.01-1.44; P = 0.036). Conclusions Patients undergoing 2-stage cell-based cartilage restoration with either ACI or MACI demonstrated long delays between stages of surgery, placing them at risk for expanding defects and development of new high-grade cartilage defects. Patients who were male, had smaller initial defect size, and longer time between surgeries were at greater risk for defect expansion. Level of Evidence III, retrospective comparative study.

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.

Matrix-assisted autologous chondrocyte implantation into a 14cm2 cartilage defect, caused by steroid-induced osteonecrosis

The Knee ◽  
2010 ◽  
Vol 17 (3) ◽  
pp. 255-257 ◽  
Author(s):  
H. Clar ◽  
A. Pascher ◽  
N. Kastner ◽  
G. Gruber ◽  
T. Robl ◽  
...  
Keyword(s):  
Cartilage Defect ◽  
Autologous Chondrocyte Implantation ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

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.

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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