Top

Journal of Orthopaedic Surgery and Research

Published in:

Open Access 01-12-2015 | Research article

In vivo animal study and clinical outcomes of autologous atelocollagen-induced chondrogenesis for osteochondral lesion treatment

Authors: Jinsu Kim, Hunki Cho, Kiwon Young, Jaehyun Park, Junkeun Lee, Dongsam Suh

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2015

Abstract

Background

Collagen acts as a scaffold for healing damaged cartilage. This study evaluated the results of an in vivo animal study and provides short-term clinical results on a mixture of atelocollagen and fibrin glue-enhanced microfracture techniques in patients with osteochondral lesions (OCL) of the talus.

Methods

This paper contains animal in vivo data and clinical outcomes on the effectiveness of atelocollagen. An in vivo animal study was conducted with full-thickness cartilage defects created in the femoral condyle of 12 rabbits equally divided into 4 groups evaluated at 2, 4, 8, and 12 weeks. Four chondral lesions were created according to one procedure on each rabbit with each lesion treated as follows: (1) microfracture, (2) microfracture and the lesion covered with atelocollagen, (3) microfracture and the lesion covered with mixture of atelocollagen and fibrin glue, and (4) microfracture and the lesion covered with fibrin glue. In the clinical evaluation, 17 patients were treated with a combination of microfracture and atelocollagen injection for symptomatic full-thickness OCL of the talus. They were evaluated by the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS), Hannover Ankle Score System (HSS), visual analog scale (VAS), and magnetic resonance imaging (MRI) at baseline and at 12-months follow-up. Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score of the post-op status was compared with the MOCART score and a modified Anderson’s score of the pre-op status.

Results

In the animal study, subchondral bone and cartilage were generated completely in groups 2 and 3 microscopically. Hyaline-like cartilage was found in the repair tissue. In the clinical evaluation, mean AOFAS improved from 62 to 88, mean HSS improved from 62 to 87, and mean VAS score improved from 64 to 18, respectively (p <0.001). Fifteen patients (89 %) reported good or excellent satisfaction. We defined the improvement of most of the subchondral bone edema and bone cyst as well as a chondral lesion by radiologic evaluation.

Conclusions

Rapid regeneration of cartilage was demonstrated in the in vivo animal study, and patients showed significant clinical improvement. Atelocollagen-enhanced microfracture enabled a reasonable treatment of cartilage defects.

Buckwalter JA, Lane NE. Athletics and osteoarthritis. Am J Sports Med. 1997;25:873–81.CrossRefPubMed

Dowthwaite GP, Bishop JC, Redman SN, Khan IM, Rooney P, Evans DJ, et al. The surface of articular cartilage contains a progenitor cell population. J Cell Sci. 2004;117:889–97.CrossRefPubMed

Steinwachs MR, Guggi T, Kreuz PC. Marrow stimulation techniques. Injury. 2008;39:26–31.CrossRef

Becher C, Driessen A, Hess T, Longo UG, Maffulli N, Thermann H. Microfracture for chondral defects of the talus: maintenance of early results at midterm follow-up. Knee Surg Sports Traumatol Arthrosc. 2010;18:656–63.CrossRefPubMed

Ferkel RD, Zanotti RM, Komenda GA, Sgaglione NA, Cheng MS, Applegate GR, et al. Arthroscopic treatment of chronic osteochondral lesions of the talus: long-term results. Am J Sports Med. 2008;36:1750–62.CrossRefPubMed

Dorotka R, Windberger U, Macfelda K, Bindreiter U, Toma C, Nehrer S. Repair of articular cartilage defects treated by microfracture and a three-dimensional collagen matrix. Biomaterials. 2005;26:3617–29.CrossRefPubMed

Dhollander AA, De Neve F, Almqvist KF, Verdonk R, Lambrecht S, Elewaut D, et al. Autologous matrix-induced chondrogenesis combined with platelet-rich plasma gel: technical description and a five pilot patients report. Knee Surg Sports Traumatol Arthrosc. 2011;19:536–42.CrossRefPubMed

Gille J, Schuseil E, Wimmer J, Gellissen J, Schulz AP, Behrens P. Mid-term results of Autologous Matrix-Induced Chondrogenesis for treatment of focal cartilage defects in the knee. Knee Surg Sports Traumatol Arthrosc. 2010;18:1456–64.CrossRefPubMed

Chaipinyo K, Oakes BW, Van Damme MP. The use of debrided human articular cartilage for autologous chondrocyte implantation: maintenance of chondrocyte differentiation and proliferation in type I collagen gels. J Orthop Res. 2004;22:446–55.CrossRefPubMed

10.

Mimura T, Imai S, Kubo M, Isoya E, Ando K, Okumura N, et al. A novel exogenous concentration-gradient collagen scaffold augments full-thickness articular cartilage repair. Osteoarthritis Cartilage. 2008;16:1083–91.CrossRefPubMed

11.

Andereya S, Maus U, Gavenis K, Muller-Rath R, Miltner O, Mumme T, et al. First clinical experiences with a novel 3D-collagen gel (CaReS) for the treatment of focal cartilage defects in the knee. Z Orthop Ihre Grenzgeb. 2006;272:144.

12.

Ochi M, Uchio Y, Kawasaki K, Wakitani S, Iwasa J. Transplantation of cartilage-like tissue made by tissue engineering in the treatment of cartilage defects of the knee. J Bone Joint Surg (Br). 2002;84:571–8.CrossRef

13.

International ASTM. Standard guide for in vivo assessment of implantable devices intended to repair or regenerate articular cartilage. West Conshohocken, PA: ASTM International; 2010. [cited 2014 7, October], Available from: http://www.astm.org/Standards/F2451.htm.

14.

Wakitani S, Goto T, Pineda SJ, Young RG, Mansour JM, Caplan AI, et al. Mesenchymal cell-based repair of large, full-thickness defects of articular cartilage. J Bone Joint Surg Am. 1994;76:579–92.PubMed

15.

Pineda S, Pollack A, Stevenson S, Goldberg V, Caplan A. A semiquantitative scale for histologic grading of articular cartilage repair. Acta Anat (Basel). 1992;143:335–40.CrossRef

16.

O’Driscoll SW, Keeley FW, Salter RB. Durability of regenerated articular cartilage produced by free autogenous periosteal grafts in major full-thickness defects in joint surfaces under the influence of continuous passive motion. A follow-up report at one year. J Bone Joint Surg Am. 1988;70:595–606.PubMed

17.

Anderson IF, Crichton KJ, Grattan-Smith T, Cooper RA, Brazier D. Osteochondral fractures of the dome of the talus. J Bone Joint Surg Am. 1989;71:1143–52.PubMed

18.

Marlovits S, Striessnig G, Resinger CT, Aldrian SM, Vecsei V, Imhof H, et al. Definition of pertinent parameters for the evaluation of articular cartilage repair tissue with high-resolution magnetic resonance imaging. Eur J Radiol. 2004;52:310–9.CrossRefPubMed

19.

Fei X, Tan BK, Lee ST, Foo CL, Sun DF, Aw SE. Effect of fibrin glue coating on the formation of new cartilage. Transplant Proc. 2000;32:210–7.CrossRefPubMed

20.

Chuckpaiwong B, Berkson EM, Theodore GH. Microfracture for osteochondral lesions of the ankle: outcome analysis and outcome predictors of 105 cases. Arthroscopy. 2008;24:106–12.CrossRefPubMed

21.

Knutsen G, Drogset JO, Engebretsen L, Grontvedt T, Isaksen V, Ludvigsen TC, et al. A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years. J Bone Joint Surg Am. 2007;89:2105–12.CrossRefPubMed

22.

Shetty AA, Kim SJ, Bilagi P, Stelzeneder D. Autologous collagen-induced chondrogenesis: single-stage arthroscopic cartilage repair technique. Orthopedics. 2013;36:e648–52.CrossRefPubMed

23.

Volpi P, Bait C, Quaglia A, Redaelli A, Prospero E, Cervellin M, et al. Autologous collagen-induced chondrogenesis technique (ACIC) for the treatment of chondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc. 2014;22:1320–6.PubMed

24.

Kusano T, Jakob RP, Gautier E, Magnussen RA, Hoogewoud H, Jacobi M. Treatment of isolated chondral and osteochondral defects in the knee by autologous matrix-induced chondrogenesis (AMIC). Knee Surg Sports Traumatol Arthrosc. 2012;20:2109–15.CrossRefPubMed

25.

Gille J, Behrens P, Volpi P, De Girolamo L, Reiss E, Zoch W, et al. Outcome of Autologous Matrix Induced Chondrogenesis (AMIC) in cartilage knee surgery: data of the AMIC Registry. Arch Orthop Trauma Surg. 2013;133:87–93.CrossRefPubMedCentralPubMed

26.

Dhollander AA, Verdonk PC, Lambrecht S, Almqvist KF, Elewaut D, Verbruggen G, et al. The combination of microfracture and a cell-free polymer-based implant immersed with autologous serum for cartilage defect coverage. Knee Surg Sports Traumatol Arthrosc. 2012;20:1773–80.CrossRefPubMed

27.

Wiewiorski M, Leumann A, Buettner O, Pagenstert G, Horisberger M, Valderrabano V. Autologous matrix-induced chondrogenesis aided reconstruction of a large focal osteochondral lesion of the talus. Arch Orthop Trauma Surg. 2011;131:293–6.CrossRefPubMed

28.

Zantop T, Petersen W. Arthroscopic implantation of a matrix to cover large chondral defect during microfracture. Arthroscopy. 2009;25:1354–60.CrossRefPubMed

29.

Barnes CJ, Ferkel RD. Arthroscopic debridement and drilling of osteochondral lesions of the talus. Foot Ankle Clin. 2003;8:243–57.CrossRefPubMed

30.

Bedi A, Feeley BT, Williams 3rd RJ. Management of articular cartilage defects of the knee. J Bone Joint Surg Am. 2010;92:994–1009.CrossRefPubMed

31.

Whittaker JP, Smith G, Makwana N, Roberts S, Harrison PE, Laing P, et al. Early results of autologous chondrocyte implantation in the talus. J Bone Joint Surg (Br). 2005;87:179–83.CrossRef

32.

Knutsen G, Engebretsen L, Ludvigsen TC, Drogset JO, Grontvedt T, Solheim E, et al. Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial. J Bone Joint Surg Am. 2004;86-A:455–64.PubMed

33.

Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med. 1994;331:889–95.CrossRefPubMed

Title: In vivo animal study and clinical outcomes of autologous atelocollagen-induced chondrogenesis for osteochondral lesion treatment
Authors: Jinsu Kim
Hunki Cho
Kiwon Young
Jaehyun Park
Junkeun Lee
Dongsam Suh
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2015
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-015-0212-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

In vivo animal study and clinical outcomes of autologous atelocollagen-induced chondrogenesis for osteochondral lesion treatment

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2015

Total knee arthroplasty in a patient with a fused ipsilateral hip

A simple method for establishing an ostrich model of femoral head osteonecrosis and collapse

Significant pain reduction and improved functional outcome after surgery for displaced midshaft clavicular fractures

Accuracy of cartilage-specific 3-Tesla 3D-DESS magnetic resonance imaging in the diagnosis of chondral lesions: comparison with knee arthroscopy

The use of morselized allografts without impaction and cemented cage support in acetabular revision surgery: a 4- to 9-year follow-up

Clinical outcomes of allograft with locking compression plates for elderly four-part proximal humerus fractures