scholarly journals Autologous Chondrocyte Implantation “Segmental-Sandwich” Technique for Deep Osteochondral Defects in the Knee: Clinical Outcomes and Correlation With Magnetic Resonance Imaging Findings

2019 ◽  
Vol 7 (5) ◽  
pp. 232596711984717 ◽  
Author(s):  
Takahiro Ogura ◽  
Gergo Merkely ◽  
Tim Bryant ◽  
Carl S. Winalski ◽  
Tom Minas
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Autologous Chondrocyte Implantation ◽  
Osteochondral Defects ◽  
Resonance Imaging ◽  
Sandwich Technique ◽  
Chondrocyte Implantation ◽  
The Mean ◽  
Autologous Chondrocyte

Background: Symptomatic osteochondral defects are difficult to manage, especially in patients with deep (>8-10 mm) empty defects. The restoration of articular congruence is crucial to avoid the progression to osteoarthritis (OA). Purpose: To describe the autologous chondrocyte implantation (ACI) “segmental-sandwich” technique for restoration of the osteochondral unit and to evaluate midterm outcomes in patients treated with this procedure. Correlations between magnetic resonance imaging (MRI) and radiographic findings with outcomes were assessed. Study Design: Case series; Level of evidence, 4. Methods: Outcomes were evaluated for a consecutive cohort of 15 patients with symptomatic deep (>8 mm) osteochondral lesions who underwent autologous bone grafting plus the ACI segmental-sandwich technique performed by a single surgeon between 2003 and 2011. Patients with a minimum 2-year follow-up were included. All patients completed validated clinical outcome scales and a patient satisfaction survey. The Kellgren-Lawrence (K-L) grade was assessed for the progression to OA. The repair site was evaluated with the MOCART (magnetic resonance observation of cartilage repair tissue) score. Filling and tissue characteristics of the bone defect were analyzed with MRI. Results: All patients (mean age at surgery, 31.0 ± 9.1 years) were available for follow-up (mean follow-up, 7.8 ± 3.0 years; range, 2-15 years). The mean chondral lesion size was 6.0 ± 3.5 cm2 (range, 1.5-13.5 cm2), with a mean bone defect area of 1.7 cm2 (27%-40% of overall surface area treated by ACI) and depth of 1.0 cm. All patients had successful clinical outcomes, and all functional scores improved significantly ( P < .05). Patients reported a very high satisfaction rate (93%). The K-L grade demonstrated no significant progression to OA over a mean follow-up of 4.7 years. For 12 patients with MRI results available, the mean MOCART score at a mean of 3.3 years was 64.2 ± 19.9, with complete or near-complete (≥75% of defect volume) chondral defect filling (83%) and complete integration to adjacent cartilage (83%). Bone defects were completely filled in 83% of patients. Conclusion: The ACI segmental-sandwich technique provides significant functional improvements at midterm follow-up and excellent survival rates. This unique treatment allows for the resurfacing of cartilage defects and the repair of underlying segmental bone lesions.

scholarly journals Autologous Chondrocyte Implantation to Isolated Patella Cartilage Defects

Cartilage ◽  
2016 ◽  
Vol 8 (2) ◽  
pp. 146-154 ◽  
Author(s):  
Arvind von Keudell ◽  
Roger Han ◽  
Tim Bryant ◽  
Tom Minas
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Outcome Measures ◽  
Autologous Chondrocyte Implantation ◽  
Tibial Tubercle ◽  
Resonance Imaging ◽  
Patient Reported ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

Background Autologous chondrocyte implantation (ACI) is a durable treatment for patients with chondral defects. This study presents the comprehensive evaluation of patients with patella defects treated with ACI at medium- to long-term follow-up. Methods Thirty consecutive patients with isolated chondral lesions of the patella were enrolled prospectively. Primary outcome measures were validated patient reported outcome measures and objective magnetic resonance imaging. Results Nineteen of 30 patients underwent tibial tubercle osteotomy (TTO) to correct lateral maltracking in combination with soft tissue balancing. The defect sizes were large, averaging 4.7 ± 2.1 cm2 (range 2.2-30.0 cm2). Pidoriano/Fulkerson classification revealed that 3 defects were type II (lateral), 9 were type III (medial), and 18 were type IV (central/panpatella). Age at the time of surgery was 32 ± 10 years. At follow-up of 2 to 14 years, knee function was rated good to excellent in 25 (83%) patients, fair in 4 (13%) patients, and poor in 1 (3%) patient. Three patients failed treatment after a mean of 75 months (6.25 years). All 3 failures were Workers Compensation (WC) cases. They were older than the non-WC patients, 42 ± 6 years compared with the non-WC 28 ± 9 years ( P = 0.0019). Significant increases in all clinical and health utility outcome scores were seen. Magnetic resonance imaging demonstrated that the fill grade, surface and integrity of the repair tissue correlated with clinical scores. Conclusion ACI to isolated patella defects results in significant functional improvement at a minimum of 24 months, with the results remaining durable at latest follow-up of 15 years. Level of evidence Level 4.

scholarly journals AUTOLOGOUS CHONDROCYTE IMPLANTATION IN BRAZIL

2020 ◽  
Vol 28 (3) ◽  
pp. 131-136
Author(s):  
PEDRO NOGUEIRA GIGLIO ◽  
NELSON FORESTO LIZIER ◽  
DÉBORA LEVY ◽  
MARCEL FARACO SOBRADO ◽  
RICCARDO GOMES GOBBI ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cell Viability ◽  
Repeated Measures ◽  
Autologous Chondrocyte Implantation ◽  
Collagen Membrane ◽  
Resonance Imaging ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

ABSTRACT Objective: To describe the first series of cases of autologous chondrocyte implantation (ACI) in collagen membrane performed in Brazil. Methods: ACI was performed in 12 knees of 11 patients, aged 32.1 ± 10.9 years, with 5.3 ± 2.6 cm2 full-thickness knee cartilage lesions, with a six-month minimum follow-up. Two surgical procedures were performed: arthroscopic cartilage biopsy for isolation and expansion of chondrocytes, which were seeded onto collagen membrane and implanted in the lesion site; the characterization of cultured cells and implant was performed using immunofluorescence for type II collagen (COL2) for cell viability and electron microscopy of the implant. Clinical safety, KOOS and IKDC scores and magnetic resonance imaging were evaluated. We used repeated-measures ANOVA and post-hoc comparisons at α = 5%. Results: COL2 was identified in the cellular cytoplasm, cell viability was higher than 95% and adequate distribution and cell adhesion were found in the membrane. The median follow-up was 10.9 months (7 to 19). We had two cases of arthrofibrosis, one of graft hypertrophy and one of superficial infection as complications, but none compromising clinical improvement. KOOS and IKDC ranged from 71.2 ± 11.44 and 50.72 ± 14.10, in preoperative period, to 85.0 ± 4.4 and 70.5 ± 8.0, at 6 months (p = 0.007 and 0.005). MRI showed regenerated tissue compatible with hyaline cartilage. Conclusion: ACI in collagen membrane was feasible and safe in a short-term follow-up, presenting regenerated formation visualized by magnetic resonance imaging and improved clinical function. Level of evidence IV, Case series.

scholarly journals Reconstruction of osteochondral defects by combined bone grafting and a bilayer collagen membrane as a sandwich technique

2013 ◽  
Vol 5 (4) ◽  
pp. 36 ◽  
Author(s):  
Maximilian Petri ◽  
Max Ettinger ◽  
Christian Von Falck ◽  
Nael Hawi ◽  
Michael Jagodzinski ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Bone Grafting ◽  
International Knee Documentation Committee ◽  
Osteochondral Lesions ◽  
Collagen Membrane ◽  
Osteochondral Defects ◽  
Resonance Imaging ◽  
Sandwich Technique ◽  
Chondrocyte Implantation

Treatment of osteochondral lesions of the knee remains a major challenge in orthopedic surgery. Recently established procedures like autologous chondrocyte implantation or matrix-associated chondrocyte implantation yield good results, but include the disadvantage of two-step procedures. The purpose of this study was to evaluate the clinical and magnetic resonance imaging outcome of repairs of osteochondral defects of the knee by a combined procedure of bone grafting and covering with a bilayer collagen membrane in a sandwich technique. Seven male patients with a mean age of 42 (range 30-55) years and symptomatic focal osteochondral lesions of the knee grade IV according to the International Cartilage Repair Society classification were included. The mean diameter of defects was 28.6 (range 15-40) mm. Results were evaluated at a minimum of 24 months after surgery by International Knee Documentation Committee score, Lysholmscore, visual analogue scale, and magnetic resonance imaging with specific cartilage sequences, evaluating the ICRS score and the Magnetic Observation of Cartilage Repair Tissue (MOCART) score. All patients judged the operation as successful. Among the patients available for the long-term follow-up, mean visual analogue scale value was 1.3 (range 0-3) out of 10 points. Mean International Knee Documentation Committee score was 80.8 (range 63.2-88.5) out of 100 points. Mean Lysholm score was 85 (range 55-95) out of 100 points. None of the patients had to be reoperated until today. Evaluation of magnetic resonance imaging using the MOCART score revealed a good correlation to the clinical outcome. This is the first study reporting results after reconstruction of osteochondral defects of the knee joint by bone grafting and a bilayer collagen membrane. This new method offers the advantage of a one-step-procedure and yields both good clinical and magnetic resonance findings. We conclude that this procedure can be a valuable tool to improve joint function after osteochondral defects, trauma, and in joints with local arthritic lesions.

Matrix-Induced Autologous Chondrocyte Implantation (MACI) Grafting for Osteochondral Lesions of the Talus

2020 ◽  
Vol 41 (9) ◽  
pp. 1099-1105 ◽  
Author(s):  
Christopher G. Lenz ◽  
Shu Tan ◽  
Andrew L. Carey ◽  
Kaenson Ang ◽  
Timothy Schneider
Keyword(s):  
Autologous Chondrocyte Implantation ◽  
Treatment Method ◽  
Osteochondral Lesions ◽  
Osteochondral Defects ◽  
Long Term Follow Up ◽  
Chondrocyte Implantation ◽  
The Mean ◽  
Autologous Chondrocyte

Background: Matrix-induced autologous chondrocyte implantation (MACI) is an established treatment method for larger joints and has shown promising results in the ankle as well. We present a series of patients after ankle MACI with long-term follow-up of clinical and radiological outcomes. Methods: We present the follow-up of 15 patients who underwent MACI grafting from August 2003 to February 2006. The mean follow-up was 12.9 years. Clinical evaluations were conducted using the American Orthopaedic Foot & Ankle Society (AOFAS), Foot and Ankle Activity Measurement (FAAM), and visual analog scale (VAS) scoring systems and the magnetic resonance observation of cartilage repair tissue (MOCART) scoring system for radiological evaluation. Results: The mean size of the talar osteochondral defects was 204 mm2. We found a significant improvement in mean AOFAS score from 60 preoperatively to a mean of 84 at 12 years postoperatively. The 12-year FAAM score for Activities of Daily Living was 89% (range, 62%-99%). The mean 12-year MOCART score was 65 points (range, 30-100 points) with significant agreement between assessors ( P < .001). However, the MOCART scores did not correlate with the FAAM scores ( P = .86). Conclusion: Considering our long-term follow-up, we believe MACI is a reliable treatment method for talar osteochondral defects providing lasting pain relief and satisfying clinical results. However, with an equivalent outcome, but at higher costs, and the requirement for 2 operative procedures, the results do not seem to be superior to other established methods. The clinical utility of the MOCART score requires further scrutiny since we were not able to show any correlation between the score and clinical outcome. Level of Evidence: Level IV, case series.

Bilayer Matrix Autologous Chondrocyte Implantation without Bone Graft for Knee Osteochondral Lesion Less than 8 mm Deep

2017 ◽  
Vol 31 (09) ◽  
pp. 851-857
Author(s):  
Cetin Isik ◽  
Safa Gursoy ◽  
Mustafa Akkaya ◽  
Oktay Algin ◽  
Metin Dogan ◽  
...  
Keyword(s):  
Bone Graft ◽  
Autologous Chondrocyte Implantation ◽  
Cartilage Tissue ◽  
Osteochondral Defects ◽  
3T Mri ◽  
Membrane Technique ◽  
Chondrocyte Implantation ◽  
The Mean ◽  
Autologous Chondrocyte

AbstractThis article investigates the clinical and radiological results of bilayer matrix autologous chondrocyte implantation (MACI) membrane technique in the treatment of shallow osteochondral defects. An analysis was made of eight patients who were operated on using the bilayer MACI (Genzyme Biosurgery, Cambridge, MA) technique (mean age: 20.2 years, mean defect size: 3.8 cm2, mean defect depth: 6.2 ± 0.9 mm, and mean follow-up time: 22.1 ± 5.3 [14–26.1] months). According to the defect, the first membrane was secured to the base of the defect with the cells facing up, and the second membrane was implanted on top of the first membrane with the cells facing down using fibrin glue. Clinical assessment was performed with modified Cincinnati and Tegner Lysholm scores. Patients were evaluated using 3-Tesla magnetic resonance imaging (3T MRI) with a 15-channel transmit knee coil in the 6th, 12th, and 24th months postoperatively. Magnetic observation of cartilage repair tissue (MOCART) scoring was used to evaluate the cartilage tissue. The mean modified Cincinnati score was 36.4 (21–48) preoperatively and 84.2 (81–90) at 6 months postoperatively, 87.2 (82–92) at 12 months, and 89.6 (85–94) at 24 months (p < 0.05). The postoperative results were evaluated as excellent. The mean Tegner Lysholm score was 36.4 (21–48) preoperatively and 88.2 (84–92), 90.2 (84–95), and 90.4 (86–95) at 6, 12, and 24 months postoperatively (p < 0.05). According to the 3T MRI findings, the mean modified MOCART scores were 8 in the preimplantation period, 38 in the 6th postoperative month, 70 in the 12th postoperative month, and 79 in the 24th postoperative month (p < 0.05). The 2-year follow-up MRI showed good regeneration, healing, and integration developing in time in cartilage tissue. In the treatment of shallow osteochondral defects, the bilayer MACI technique can be an alternative to filling the defect with bone graft.

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