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

2009 ◽  
Vol 30 (9) ◽  
pp. 810-814 ◽  
Author(s):  
Timothy E. Schneider ◽  
Sriram Karaikudi
Keyword(s):  
Articular Cartilage ◽  
Autologous Chondrocyte Implantation ◽  
Case Series ◽  
Treatment Method ◽  
Cartilage Defects ◽  
Osteochondral Lesions ◽  
Osteochondral Defects ◽  
Level Of Evidence ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

Background: Articular cartilage is limited in its ability to repair itself. Matrix-induced Autologous Chondrocyte Implantation (MACI) is an established treatment method for such articular cartilage defects in the knee. Recently the technique has been used in the ankle. We present a series of patients treated with MACI for osteochondral defects of the ankle, and assess the functional and clinical results. Materials and Methods: From August 2003 to February 2006, 20 patients underwent MACI grafting for osteochondral defects in the ankle. Age ranged from 19 to 61 (mean, 36) years. Mean followup was 21.1 months. Clinical and functional evaluations were conducted using the AOFAS scoring system. Results: The mean size was 233 mm2. There was a significant improvement in mean AOFAS score from 60 (range, 25 to 87) to 87 (range, 41 to 100) ( p < 0.0001). Overall improvement in pain scores was also significant ( p < 0.0001). All osteotomies healed. Four patients required hardware removal and two underwent arthroscopic debridement for anterior impingement. There were two failures which are awaiting subsequent procedures. Conclusion: We believe MACI is a reliable treatment method for talar osteochondral defects. The method usually requires an intra-articular osteotomy, although this proved to be a reasonably simple aspect of the procedure for the treatment of cartilage defects of the talus. Level of Evidence: IV, Case Series

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.

Characteristic Complications after Autologous Chondrocyte Implantation for Cartilage Defects of the Knee Joint

2008 ◽  
Vol 36 (11) ◽  
pp. 2091-2099 ◽  
Author(s):  
Philipp Niemeyer ◽  
Jan M. Pestka ◽  
Peter C. Kreuz ◽  
Christoph Erggelet ◽  
Hagen Schmal ◽  
...  
Keyword(s):  
Knee Joint ◽  
Revision Surgery ◽  
Complication Rate ◽  
Autologous Chondrocyte Implantation ◽  
Case Series ◽  
Cartilage Defects ◽  
Level Of Evidence ◽  
Therapeutic Concepts ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

Background Although autologous chondrocyte implantation (ACI) is a well-established therapy for the treatment of isolated cartilage defects of the knee joint, little is known about typical complications and their treatment after ACI. Hypothesis Unsatisfactory outcome after ACI is associated with technique-related typical complications. Study Design Case series; Level of evidence, 4. Methods A total of 309 consecutive patients with 349 ACI procedures of the knee joint were analyzed. Three different ACI techniques were used: periosteum-covered ACI in 52 cases (14.9%), Chondrogide (Geistlich Biomaterials, Wolhusen, Switzerland) membrane-covered ACI in 215 cases (61.6%), and a 3-dimensional matrix-associated ACI (BioSeed-C, Biotissue Technologies, Freiburg, Germany) in 82 cases (23.5%). In 52 patients, revision surgery was performed for persistent clinical problems. These patients were analyzed for defect size and location, technique of ACI, and intraoperative findings during revision surgery. The mean time of follow-up for patients after ACI was 4.5 years (standard deviation, ±1.5). Results Four typical major complications were identified: hypertrophy of the transplant, disturbed fusion of the regenerative cartilage and the healthy surrounding cartilage, insufficient regenerative cartilage, and delamination. These diagnoses covered a total of 88.5% of the patients who underwent revision surgery. The overall complication rate was highest in the group of patients treated with periosteum-covered ACI ( P = .008). The incidence of symptomatic hypertrophy was 5.2% for all techniques and defect locations; the highest incidence was in patients treated with periosteum-covered ACI (15.4%) ( P = .001). The incidence of disturbed fusion was highest in the Chondrogide-covered ACI (3.7%) and the matrix-associated ACI group (4.8%). Concerning the incidence of complications by defect location, there was a tendency for increased complications in patellar defects ( P = .095). Within the patellar defects group, no correlation was found for the occurrence of delamination, insufficient regeneration, and disturbed fusion. As a statistical trend, an increased rate of hypertrophy was found for patellar defects ( P = .091). Conclusion A major proportion of complications after ACI can be summarized by 4 major diagnoses (symptomatic hypertrophy, disturbed fusion, delamination, and graft failure). Among those, the overall complication rate and incidence of hypertrophy of the transplant were higher for periosteum-covered ACI. Furthermore, an increased rate of symptomatic hypertrophy was found for patellar defects. Therapeutic concepts need to be developed to treat these typical complications of ACI.

scholarly journals Short- to Midterm Clinical and Radiological Outcomes After Matrix-Associated Autologous Chondrocyte Implantation for Chondral Defects in Knees

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712098213
Author(s):  
Xuesong Dai ◽  
Jinghua Fang ◽  
Siheng Wang ◽  
Jianyang Luo ◽  
Yan Xiong ◽  
...  
Keyword(s):  
Autologous Chondrocyte Implantation ◽  
T2 Mapping ◽  
Case Series ◽  
International Knee Documentation Committee ◽  
Cartilage Defects ◽  
Level Of Evidence ◽  
Chondral Defects ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

Background: Matrix-associated autologous chondrocyte implantation (MACI) has been proven to provide favorable short-term results for chondral defects in knees. However, it remains unclear whether the clinical benefits of MACI persist in the longer term. Purpose: The purpose of this prospective study was to evaluate the clinical and radiological outcomes, at short- and midterm follow-up, for patients undergoing MACI for focal chondral defects of the knee. Study Design: Case series; Level of evidence, 4. Methods: A total of 30 consecutive patients (31 knees) were treated using MACI between October 2010 and March 2018. There were 24 male patients and 6 female patients with an average age of 26 years (range, 12-48 years). The areas of the cartilage defect were consistently >2 cm2. All patients underwent MACI for a focal chondral defect of the femoral condyles or trochlea in the knee. These patients had been evaluated for up to 5 years, with an average follow-up of 44 months (range, 6-60 months) postoperatively. The International Knee Documentation Committee (IKDC) score, Lysholm score, and magnetic resonance imaging (MRI) with T2 mapping were used to assess the outcomes. Results: No patients were lost to follow-up. Mean IKDC scores improved from 58.6 (range, 40.2-80.5) to 79.1 (range, 39.1-94.3) at 12 months and up to 88.4 (range, 83.9-100) at 5 years; mean Lysholm scores improved from 67.3 (range, 46-95) to 90.6 (range, 71-100) at 12 months and up to 95.9 (range, 85-100) at 5 years. The MRI with T2 mapping value of the transplanted area was evaluated for 21 knees, which revealed no differences compared with the normal area at 12 months postoperatively. Conclusion: From the first year onward, the clinical outcome scores and MRI with T2 mapping values showed continuous and marked improvement, suggesting that MACI is a valid option for localized cartilage defects in the knee.

Autologous Chondrocyte Implantation as Treatment for Unsalvageable Osteochondritis Dissecans: 10- to 25-Year Follow-up

2020 ◽  
Vol 48 (5) ◽  
pp. 1134-1140 ◽  
Author(s):  
James L. Carey ◽  
Kevin G. Shea ◽  
Anders Lindahl ◽  
Haris S. Vasiliadis ◽  
Carl Lindahl ◽  
...  
Keyword(s):  
Osteochondritis Dissecans ◽  
Open Surgery ◽  
Autologous Chondrocyte Implantation ◽  
Case Series ◽  
Activity Level ◽  
Osteochondral Allograft ◽  
Level Of Evidence ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

Background: An unsalvageable osteochondritis dissecans (OCD) fragment has been defined as one that cannot be saved. Unsalvageable OCD lesions have been treated with various techniques, including fragment excision, microfracture, osteochondral autograft transfer, fresh osteochondral allograft transplantation, and autologous chondrocyte implantation (ACI). Hypothesis: Patients who underwent ACI as treatment for unsalvageable OCD more than 10 years ago would maintain satisfactory patient-oriented outcome measures and have a low need for additional open surgery, especially arthroplasty. Study Design: Case series; Level of evidence, 4. Methods: All Swedish and Norwegian patients (59 patients with 67 OCD lesions) who underwent ACI for OCD under the direction of the senior author between 1990 and 2005 were identified through manual chart review. Features of the patient, OCD lesion, and surgery were extracted from the medical record and intraoperative photographs. Patients were sent questionnaires to assess the Knee injury and Osteoarthritis Outcome Score, Tegner-Wallgren activity score, and Lysholm score. In addition, patients were asked whether they had to undergo further surgery, including knee replacement, of the knee that underwent ACI. They were asked whether they would have the surgery again if in the same situation. Results: A total of 55 patients (93%) with 61 OCD lesions (91%) responded. The median follow-up duration was 19 years (range, 10-26 years) and the median age at follow-up was 43 years (range, 28-69 years). Subsequent arthroscopy was performed in the majority of cases, although many of these were scheduled “second looks” as part of a study. With respect to other subsequent surgery, 12 knees (20%) underwent any additional open surgery, but only 2 knees (3%) underwent arthroplasty. Eight knees (13%) underwent revision ACI. Most patients reached their preinjury activity level (62%) and would undergo ACI again if in the same situation (85%). If failure is defined as revision of the graft or conversion to arthroplasty, then survivorship after ACI for OCD in the current study would be 87% at 10 years, 85% at 15 years, and 82% at 20 years. Conclusion: ACI for OCD provides a durable treatment option. At a median follow-up of 19 years, there was a very low (~3%) conversion to total knee arthroplasty.

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.

scholarly journals Joint Preservation Techniques in Orthopaedic Surgery

2017 ◽  
Vol 9 (6) ◽  
pp. 545-554 ◽  
Author(s):  
Philip J. York ◽  
Frank B. Wydra ◽  
Matthew E. Belton ◽  
Armando F. Vidal
Keyword(s):  
Articular Cartilage ◽  
Autologous Chondrocyte Implantation ◽  
Hyaline Cartilage ◽  
Articular Surface ◽  
Joint Surface ◽  
Level Of Evidence ◽  
Joint Preservation ◽  
The Past ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

Context: With increasing life expectancy, there is growing demand for preservation of native articular cartilage to delay joint arthroplasties, especially in younger, active patients. Damage to the hyaline cartilage of a joint has a limited intrinsic capacity to heal. This can lead to accelerated degeneration of the joint and early-onset osteoarthritis. Treatment in the past was limited, however, and surgical treatment options continue to evolve that may allow restoration of the natural biology of the articular cartilage. This article reviews the most current literature with regard to indications, techniques, and outcomes of these restorative procedures. Evidence Acquisition: MEDLINE and PubMed searches relevant to the topic were performed for articles published between 1995 and 2016. Older articles were used for historical reference. This paper places emphasis on evidence published within the past 5 years. Study Design: Clinical review. Level of Evidence: Level 4. Results: Autologous chondrocyte implantation and osteochondral allografts (OCAs) for the treatment of articular cartilage injury allow restoration of hyaline cartilage to the joint surface, which is advantageous over options such as microfracture, which heal with less favorable fibrocartilage. Studies show that these techniques are useful for larger chondral defects where there is no alternative. Additionally, meniscal transplantation can be a valuable isolated or adjunctive procedure to prolong the health of the articular surface. Conclusion: Newer techniques such as autologous chondrocyte implantation and OCAs may safely produce encouraging outcomes in joint preservation.

A 20-Year Follow-up After First-Generation Autologous Chondrocyte Implantation

2017 ◽  
Vol 45 (12) ◽  
pp. 2751-2761 ◽  
Author(s):  
Takahiro Ogura ◽  
Brian A. Mosier ◽  
Tim Bryant ◽  
Tom Minas
Keyword(s):  
Articular Cartilage ◽  
Clinical Outcomes ◽  
Autologous Chondrocyte Implantation ◽  
First Generation ◽  
Short Form ◽  
Cartilage Defects ◽  
Sf 36 ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

Background: Treating articular cartilage defects is a demanding problem. Although several studies have reported durable and improved clinical outcomes after autologous chondrocyte implantation (ACI) over a long-term period, there is no report with over 20 years’ follow-up. Purpose: To evaluate clinical outcomes after first-generation ACI for the treatment of knees with disabling, large single and multiple cartilage defects for which patients wished to avoid prosthetic arthroplasty, with a minimum of 20 years’ follow-up. Study Design: Case series; Level of evidence, 4. Methods: The authors reviewed prospectively collected data from 23 patients (24 knees; mean age, 35.4 years [range, 13-52 years]) undergoing ACI for the treatment of symptomatic, full-thickness articular cartilage lesions. A mean of 2.1 lesions per knee were treated over a mean total surface area of 11.8 cm2 (range, 2.4-30.5 cm2) per knee. Kaplan-Meier survival analysis and functional outcome scores, including the modified Cincinnati Knee Rating System, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Short Form–36 (SF-36), were used. Patients also self-reported an improvement in pain with a visual analog scale and a satisfaction survey. Results: The 20-year survival rate was 63% (95% CI, 40%-78%). The evaluation of the 15 knees with retained grafts demonstrated that all clinical scores except the WOMAC subscore for stiffness and SF-36 mental component summary score improved significantly and were sustained to 20 years postoperatively. Ninety-three percent of these patients rated knee-specific outcomes as good or excellent. The outcomes for 9 of 24 knees were considered failures, including 5 undergoing revision ACI and 4 being converted to arthroplasty at a mean of 1.7 and 5.9 years, respectively. Only 1 of 5 knees that underwent revision ACI was converted to arthroplasty at 1.9 years after the index surgery, and the other 4 patients were able to maintain their biological knee. Overall, 20 years later, 79% of patients maintained their native knee, for which they initially sought treatment, and were satisfied when evaluated. Conclusion: First-generation ACI provided satisfactory survival rates and significant clinical improvements over a 20-year follow-up, which offers an important standard for comparison with newer-generation ACI technologies of the future.

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