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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 6/2016

01-06-2016 | Knee

Chondral and osteochondral operative treatment in early osteoarthritis

Authors: Peter Angele, Philipp Niemeyer, Matthias Steinwachs, Giuseppe Filardo, Andreas H. Gomoll, Elizaveta Kon, Johannes Zellner, Henning Madry

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 6/2016

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Abstract

In recent years treatment of early osteoarthritis came more and more into focus of orthopaedic research. In particular regenerative therapy options seem to have a high potential to fill the existing treatment gap for patients with early osteoarthritic changes. This article focuses on basic science, recent developments and available clinical data in the important field of operative regeneration procedures for treatment of chondral and osteochondral defects in early degenerative joints. It highlights current knowledge and perspectives of treatment options like microfracture, autologous or allogenous osteochondral transplantations and autologous chondrocyte transplantation. Further the role of biomaterials in a degenerative joint environment is illuminated. First clinical data of regenerative therapy in early osteoarthritis are encouraging to intensify research efforts in this important field. Future treatment perspectives for patients who suffer from early degenerative cartilage changes are discussed.
Level of evidence IV.
Literature
1.
Albrecht C, Tichy B, Zak L, Aldrian S, Nurnberger S, Marlovits S (2014) Influence of cell differentiation and IL-1beta expression on clinical outcomes after matrix-associated chondrocyte transplantation. Am J Sports Med 42(1):59–69CrossRefPubMed
2.
Angele P, Fritz J, Albrecht D, Koh J, Zellner J (2015) Defect type, localization and marker gene expression determines early adverse events of matrix-associated autologous chondrocyte implantation. Injury 46(Suppl 4):S2–S9CrossRefPubMed
3.
Bae DK, Yoon KH, Song SJ (2006) Cartilage healing after microfracture in osteoarthritic knees. Arthroscopy 22(4):367–374CrossRefPubMed
4.
Berruto M, Delcogliano M, de Caro F, Carimati G, Uboldi F, Ferrua P, Ziveri G, De Biase CF (2014) Treatment of large knee osteochondral lesions with a biomimetic scaffold: results of a multicenter study of 49 patients at 2-year follow-up. Am J Sports Med 42(7):1607–1617CrossRefPubMed
5.
Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L (1994) Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. New Engl J Med 331(14):889–895CrossRefPubMed
6.
Brittberg M, Winalski CS (2003) Evaluation of cartilage injuries and repair. J Bone Joint Surg (Am) 85-A(Suppl 2):58–69
7.
Cole BJ, Pascual-Garrido C, Grumet RC (2009) Surgical management of articular cartilage defects in the knee. J Bone Joint Surg (Am) 91(7):1778–1790
8.
Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG (1997) Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy 13(4):456–460CrossRefPubMed
9.
de Windt TS, Vonk LA, Brittberg M, Saris DB (2013) Treatment and prevention of (early) osteoarthritis using articular cartilage repair-fact or fiction? A systematic review. Cartilage 4(3 Suppl):5S–12SCrossRefPubMedPubMedCentral
10.
Dearing J, Nutton RW (2008) Evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 15(3):159–163CrossRefPubMed
11.
Filardo G, Kon E, Di Matteo B, Di Martino A, Marcacci M (2014) Single-plug autologous osteochondral transplantation: results at minimum 16 years’ follow-up. Orthopedics 37(9):e761–e767CrossRefPubMed
12.
Filardo G, Kon E, Perdisa F, Balboni F, Marcacci M (2014) Autologous osteochondral transplantation for the treatment of knee lesions: results and limitations at two years’ follow-up. Int Orthop 38(9):1905–1912CrossRefPubMed
13.
Filardo G, Kon E, Perdisa F, Tetta C, Di Martino A, Marcacci M (2015) Arthroscopic mosaicplasty: long-term outcome and joint degeneration progression. Knee 22(1):36–40CrossRefPubMed
14.
Gomoll AH, Filardo G, de Girolamo L, Espregueira-Mendes J, Marcacci M, Rodkey WG, Steadman JR, Zaffagnini S, Kon E (2012) Surgical treatment for early osteoarthritis. Part I: cartilage repair procedures. Knee Surg Sports Traumatol Arthrosc 20(3):450–466CrossRefPubMed
15.
Hangody L, Dobos J, Balo E, Panics G, Hangody LR, Berkes I (2010) Clinical experiences with autologous osteochondral mosaicplasty in an athletic population: a 17-year prospective multicenter study. Am J Sports Med 38(6):1125–1133CrossRefPubMed
16.
Harris JD, Hussey K, Wilson H, Pilz K, Gupta AK, Gomoll A, Cole BJ (2015) Biological knee reconstruction for combined malalignment, meniscal deficiency, and articular cartilage disease. Arthroscopy 31(2):275–282CrossRefPubMed
17.
Hjelle K, Solheim E, Strand T, Muri R, Brittberg M (2002) Articular cartilage defects in 1,000 knee arthroscopies. Arthroscopy 18(7):730–734CrossRefPubMed
18.
Hollander AP, Dickinson SC, Sims TJ, Brun P, Cortivo R, Kon E, Marcacci M, Zanasi S, Borrione A, De Luca C, Pavesio A, Soranzo C, Abatangelo G (2006) Maturation of tissue engineered cartilage implanted in injured and osteoarthritic human knees. Tissue Eng 12(7):1787–1798CrossRefPubMed
19.
Kaul G, Cucchiarini M, Remberger K, Kohn D, Madry H (2012) Failed cartilage repair for early osteoarthritis defects: a biochemical, histological and immunohistochemical analysis of the repair tissue after treatment with marrow-stimulation techniques. Knee Surg Sports Traumatol Arthrosc 20(11):2315–2324CrossRefPubMed
20.
21.
Kon E, Drobnic M, Davidson PA, Levy A, Zaslav KR, Robinson D (2014) Chronic posttraumatic cartilage lesion of the knee treated with an acellular osteochondral-regenerating implant: case history with rehabilitation guidelines. J Sport Rehabil 23(3):270–275CrossRefPubMed
22.
Kon E, Filardo G, Perdisa F, Di Martino A, Busacca M, Balboni F, Sessa A, Marcacci M (2014) A one-step treatment for chondral and osteochondral knee defects: clinical results of a biomimetic scaffold implantation at 2 years of follow-up. J Mater Sci Mater M 25(10):2437–2444CrossRef
23.
Kon E, Roffi A, Filardo G, Tesei G, Marcacci M (2015) Scaffold-based cartilage treatments: with or without cells? A systematic review of preclinical and clinical evidence. Arthroscopy 4:767–775CrossRef
24.
Kon EFG, Perdisa F, Venieri G, Marcacci M (2014) Clinical results of multilayered biomaterials for osteochondral regeneration. J Exp Orthop 1(10):1–8
25.
Kreuz PC, Erggelet C, Steinwachs MR, Krause SJ, Lahm A, Niemeyer P, Ghanem N, Uhl M, Sudkamp N (2006) Is microfracture of chondral defects in the knee associated with different results in patients aged 40 years or younger? Arthroscopy 22(11):1180–1186CrossRefPubMed
26.
Kreuz PC, Steinwachs MR, Erggelet C, Krause SJ, Konrad G, Uhl M, Sudkamp N (2006) Results after microfracture of full-thickness chondral defects in different compartments in the knee. Osteoarthr Cartil 14(11):1119–1125CrossRefPubMed
27.
28.
Li CS, Karlsson J, Winemaker M, Sancheti P, Bhandari M (2014) Orthopedic surgeons feel that there is a treatment gap in management of early OA: international survey. Knee Surg Sports Traumatol Arthrosc 2:363–378CrossRef
29.
Luyten FP, Denti M, Filardo G, Kon E, Engebretsen L (2012) Definition and classification of early osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 20(3):401–406CrossRefPubMed
30.
Meric G, Gracitelli GC, Gortz S, De Young AJ, Bugbee WD (2015) Fresh osteochondral allograft transplantation for bipolar reciprocal osteochondral lesions of the knee. Am J Sports Med 43(3):709–714CrossRefPubMed
31.
Miller BS, Steadman JR, Briggs KK, Rodrigo JJ, Rodkey WG (2004) Patient satisfaction and outcome after microfracture of the degenerative knee. J Knee Surg 17(1):13–17PubMed
32.
Minas T, Gomoll AH, Solhpour S, Rosenberger R, Probst C, Bryant T (2010) Autologous chondrocyte implantation for joint preservation in patients with early osteoarthritis. Clin Orthop Rel Res 468(1):147–157CrossRef
33.
Mithoefer K, McAdams T, Williams RJ, Kreuz PC, Mandelbaum BR (2009) Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: an evidence-based systematic analysis. Am J Sports Med 37(10):2053–2063CrossRefPubMed
34.
Mithoefer K, Williams RJ III, Warren RF, Potter HG, Spock CR, Jones EC, Wickiewicz TL, Marx RG (2005) The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospective cohort study. J Bone Joint Surg (Am) 87(9):1911–1920CrossRef
35.
Muschler GF, Nitto H, Boehm CA, Easley KA (2001) Age- and gender-related changes in the cellularity of human bone marrow and the prevalence of osteoblastic progenitors. J Orthop Res 19(1):117–125CrossRefPubMed
36.
Niemeyer P, Andereya S, Angele P, Ateschrang A, Aurich M, Baumann M, Behrens P, Bosch U, Erggelet C, Fickert S, Fritz J, Gebhard H, Gelse K, Gunther D, Hoburg A, Kasten P, Kolombe T, Madry H, Marlovits S, Meenen NM, Muller PE, Noth U, Petersen JP, Pietschmann M, Richter W, Rolauffs B, Rhunau K, Schewe B, Steinert A, Steinwachs MR, Welsch GH, Zinser W, Albrecht D (2013) Autologous chondrocyte implantation (ACI) for cartilage defects of the knee: a guideline by the working group “Tissue Regeneration” of the German Society of Orthopaedic Surgery and Traumatology (DGOU). Z Orthop Unfall 151(1):38–47PubMed
37.
Niemeyer P, Schweigler K, Grotejohann B, Maurer J, Angele P, Aurich M, Becher C, Fay J, Feil R, Fickert S, Fritz J, Hoburg A, Kreuz P, Kolombe T, Laskowski J, Lutzner J, Marlovits S, Muller PE, Niethammer T, Pietschmann M, Ruhnau K, Spahn G, Tischer T, Zinser W, Albrecht D (2015) The German Cartilage Registry (KnorpelRegister DGOU) for evaluation of surgical treatment for cartilage defects: experience after six months including first demographic data. Z Orthop Unfall 153(1):67–74CrossRefPubMed
38.
Ochs BG, Muller-Horvat C, Albrecht D, Schewe B, Weise K, Aicher WK, Rolauffs B (2011) Remodeling of articular cartilage and subchondral bone after bone grafting and matrix-associated autologous chondrocyte implantation for osteochondritis dissecans of the knee. Am J Sports Med 39(4):764–773CrossRefPubMed
39.
Panics G, Hangody LR, Balo E, Vasarhelyi G, Gal T, Hangody L (2012) Osteochondral autograft and mosaicplasty in the football (soccer) athlete. Cartilage 3(1 Suppl):25S–30SCrossRefPubMedPubMedCentral
40.
Perdisa F, Filardo G, Di Matteo B, Marcacci M, Kon E (2014) Platelet rich plasma: a valid augmentation for cartilage scaffolds? A systematic review. Histol Histopathol 29(7):805–814PubMed
41.
Peterson L, Brittberg M, Kiviranta I, Akerlund EL, Lindahl A (2002) Autologous chondrocyte transplantation. Biomechanics and long-term durability. Am J Sports Med 30(1):2–12PubMed
42.
Salzmann GM, Sah B, Sudkamp NP, Niemeyer P (2013) Clinical outcome following the first-line, single lesion microfracture at the knee joint. Arch Orthop Trauma Surg 133(3):303–310CrossRefPubMed
43.
Salzmann GM, Sah B, Sudkamp NP, Niemeyer P (2013) Reoperative characteristics after microfracture of knee cartilage lesions in 454 patients. Knee Surg Sports Traumatol Arthrosc 21(2):365–371CrossRefPubMed
44.
Shasha N, Krywulak S, Backstein D, Pressman A, Gross AE (2003) Long-term follow-up of fresh tibial osteochondral allografts for failed tibial plateau fractures. J Bone Joint Surg Am 85-A(Suppl 2):33–39PubMed
45.
Sherman SL, Garrity J, Bauer K, Cook J, Stannard J, Bugbee W (2014) Fresh osteochondral allograft transplantation for the knee: current concepts. J Am Acad Orthop Surg 22(2):121–133PubMed
46.
Shive MS, Restrepo A, Totterman S, Tamez-Pena J, Schreyer E, Steinwachs M, Stanish WD (2014) Quantitative 3D MRI reveals limited intra-lesional bony overgrowth at 1 year after microfracture-based cartilage repair. Osteoarthr Cartil 22(6):800–804CrossRefPubMed
47.
Solheim E, Hegna J, Inderhaug E, Øyen J, Harlem T, Strand T (2014) Results at 10–14 years after microfracture treatment of articular cartilage defects in the knee. Knee Surg Sports Traumatol Arthrosc. doi:10.​1007/​s00167-014-3443-1
48.
Steinwachs MR, Guggi T, Kreuz PC (2008) Marrow stimulation techniques. Injury 39(Suppl 1):S26–S31CrossRefPubMed
49.
Steinwachs MR, Waibl B, Niemeyer P (2011) Use of human progenitor cells in the treatment of cartilage damage. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz 54(7):797–802CrossRefPubMed
50.
Vaquero J, Forriol F (2012) Knee chondral injuries: clinical treatment strategies and experimental models. Injury 43(6):694–705CrossRefPubMed
51.
Vavken P, Samartzis D (2010) Effectiveness of autologous chondrocyte implantation in cartilage repair of the knee: a systematic review of controlled trials. Osteoarthr Cartil 18(6):857–863CrossRefPubMed
52.
Vijayan S, Bartlett W, Bentley G, Carrington RW, Skinner JA, Pollock RC, Alorjani M, Briggs TW (2012) Autologous chondrocyte implantation for osteochondral lesions in the knee using a bilayer collagen membrane and bone graft: a two- to eight-year follow-up study. J Bone Joint Surg (Br) 94(4):488–492CrossRef
53.
Vonk LA, Kragten AH, Dhert WJ, Saris DB, Creemers LB (2014) Overexpression of hsa-miR-148a promotes cartilage production and inhibits cartilage degradation by osteoarthritic chondrocytes. Osteoarthr Cartil 22(1):145–153CrossRefPubMed
54.
Widuchowski W, Widuchowski J, Trzaska T (2007) Articular cartilage defects: study of 25,124 knee arthroscopies. Knee 14(3):177–182CrossRefPubMed
55.
Zellner J, Angele P, Zeman F, Kujat R, Nerlich M (2013) Is the transplant quality at the time of surgery adequate for matrix-guided autologous cartilage transplantation? A pilot study. Clin Orthop Relat Res 471(9):2852–2861CrossRefPubMedPubMedCentral
56.
Zhang Q, Li H, Zhang Z, Yang F, Chen J (2015) Serum metabolites as potential biomarkers for diagnosis of knee osteoarthritis. Dis Markers 2015:684794PubMedPubMedCentral
Metadata
Title
Chondral and osteochondral operative treatment in early osteoarthritis
Authors
Peter Angele
Philipp Niemeyer
Matthias Steinwachs
Giuseppe Filardo
Andreas H. Gomoll
Elizaveta Kon
Johannes Zellner
Henning Madry
Publication date
01-06-2016
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 6/2016
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-016-4047-8

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