Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-04-2011 | Knee

Autologous matrix-induced chondrogenesis combined with platelet-rich plasma gel: technical description and a five pilot patients report

Authors: A. A. M. Dhollander, F. De Neve, K. F. Almqvist, R. Verdonk, S. Lambrecht, D. Elewaut, G. Verbruggen, P. C. M. Verdonk

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 4/2011

Abstract

Purpose

This pilot study was designed to describe the technical details and to present the preliminary outcome of autologous matrix-induced chondrogenesis (AMIC) combined with platelet-rich plasma gel, the so called AMIC plus technique, for the treatment of patellar cartilage defects in the knee.

Methods

The AMIC plus technique was used for the treatment of (osteo) chondral patellar lesions in the knee. The surgical technique is extensively described. Five patients were clinically prospectively evaluated during 2 years. MRI data were analysed based on the original MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) and modified MOCART scoring system.

Results

A clinical improvement became apparent after 24 months of follow-up. Both MOCART scoring systems revealed no significant deterioration or improvement of the repair tissue between one and 2 years of follow-up. However, all cases showed subchondral lamina and bone changes. The formation of intralesional osteophytes was observed in 3 of the 5 patients during the 2 years of follow-up.

Conclusions

AMIC plus is feasible for the treatment of symptomatic patellar cartilage defects and resulted in a clinical improvement in all patients. The favourable clinical outcome of the AMIC plus technique was not confirmed by the MRI findings.

Level of evidence

IV.

Behrens P, Bitter T, Kurz B, Russlies M (2006) Matrix-associated autologous chondrocyte transplantation/implantation (MACT/MACI)–5-year follow-up. Knee 13:194–202PubMedCrossRef

Bekkers JE, de Windt TS, Raijmakers NJ, Dhert WJ, Saris DB (2009) Validation of the knee injury and osteoarthritis outcome score (KOOS) for the treatment of focal cartilage lesions. Osteoarthr Cartil 17:1434–1439PubMedCrossRef

Benthien JP, Behrens P (2010) Autologous matrix-induced chondrogenesis (AMIC) combining microfracturing and a collagen I/III matrix for articular cartilage resurfacing. Cartilage 1:65–68CrossRef

Bijur PE, Silver W, Gallagher EJ (2001) Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med 8:1153–1157PubMedCrossRef

Buckwalter JA, Lane NE (1997) Athletics and osteoarthritis. Am J Sports Med 25:873–881PubMedCrossRef

Cerynik DL, Lewullis GE, Joves BC, Palmer MP, Tom JA (2009) Outcomes of microfracture in professional basketball players. Knee Surg Sports Traumatol Arthrosc 17:1135–1139PubMedCrossRef

Dhollander AAM, Huysse WCJ, Almqvist KF, Verdonk PCM, Verstraete KL, Verdonk R, Verbruggen G (2010) MRI evaluation of a new scaffold-based allogenic chondrocyte implantation for cartilage repair. Eur J Radiol 75:72–81PubMedCrossRef

Dorotka R, Windberger U, Macfelda K, Bindreiter U, Toma C, Nehrer S (2005) Repair of articular cartilage defects treated by microfracture and a three-dimensional collagen matrix. Biomaterials 26:3617–3629PubMedCrossRef

Farr J (2007) Autologous chondrocyte implantation improves patellofemoral cartilage treatment outcomes. Clin Orthop Relat Res 463:187–194PubMed

10.

Gallaher EJ, Bijur PE, Laimer C, Silver W (2002) Reliability and validity of a visual analog scale for acute abdominal pain in the ED. Am J Emerg Med 20:287–290CrossRef

11.

Gille J, Meisner U, Ehlers EM, Muller A, Russlies M, Behrens P (2005) Migration pattern, morphology and viability of cells suspended in or sealed with fibrin glue: a histomorphologic study. Tissue Cell 37:339–348PubMedCrossRef

12.

Gille J, Schuseil E, Wimmer J, Gellissen J, Schulz AP, Behrens P (2010) Mid-term results of autologous matrix-induced chondrogenesis for treatment of focal cartilage defects in the knee. Knee Surg Sports Traumatol Arthrosc 18:1456–1464PubMedCrossRef

13.

Gobbi A, Kon E, Berruto M, Francisco R, Filardo G, Marcacci M (2006) Patellofemoral full-thickness chondral defects treated with Hyalograft-C: a clinical, arthroscopic, and histologic review. Am J Sports Med 34:1763–1773PubMedCrossRef

14.

Hjelle K, Soljeim E, Strand T, Muri R, Brittberg M (2002) Articular cartilage defects in 1,000 knee arthroscopies. Arthroscopy 18:730–734PubMedCrossRef

15.

Knutsen G, Drogset JO, Engebretsen L, Grontvedt T, Isaksen V, Ludvigsen TC, Roberts S, Solheim E, Strand T, Johansen O (2007) A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years. J Bone Joint Surg Am 89:2105–2112PubMedCrossRef

16.

Kreuz PC, Steinwachs M, Erggelet C, Krause SJ, Ossendorf C, Maier D, Ghanem N, Uhl M, Haag M (2007) Classification of graft hypertrophy after autologous chondrocyte implantation of full-thickness chondral defects in the knee. Osteoarthritis Cart 15:1339–1347CrossRef

17.

Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O (1993) Scoring of patellofemoral disorders. Arthroscopy 9:159–163PubMedCrossRef

18.

Lopez-Vidriero E, Goulding KA, Simon DA, Sanchez M, Johnson DH (2010) The use of platelet-rich plasma in arthroscopy and sports medicine: optimizing the healing environment. Arthroscopy 26:269–278PubMedCrossRef

19.

Marlovits S, Singer P, Zeller P, Mandl I, Haller J, Trattning S (2006) Magnetic resonance observation of cartilage repair tissue (MOCART) for the evaluation of autologous chondrocyte transplantation: determination of interobserver variability and correlation to clinical outcome after 2 years. Eur J Radiol 57:16–23PubMedCrossRef

20.

Marlovits S, Striessnig G, Resinger CT, Aldrian SM, Vecsei V, Imhof H, Trattnig S (2004) Definition of pertinent parameters for the evaluation of articular cartilage repair tissue with high-resolution magnetic resonance imaging. Eur J Radiol 52:310–319PubMedCrossRef

21.

Milano G, Passino ES, Deriu L, Careddu G, Manunta L, Manunta A, Saccomanno MF, Fabbriciani C (2010) The effect of platelet rich plasma combined with microfractures on the treatment of chondral defects. An experimental study in a sheep model. Osteoarthr Cartil 18:971–980PubMedCrossRef

22.

Minas T, Bryant T (2005) The role of autologous chondrocyte implantation in the patellofemoral joint. Clin Orthop Relat Res 436:30–39PubMedCrossRef

23.

Nehrer S, Breinan HA, Ramappa A, Shortkroff S, Young G, Minas T, Sledge CB, Yannas IV, Spector M (1997) Canine chondrocytes seeded in type I and type II collagen implants investigated in vitro. J Biomed Mater Res 38:95–104PubMedCrossRef

24.

Niemeyer P, Steinwachs M, Erggelet C, Kreuz PC, Kraft N, Köstler W, Mehlhorn A, Südkam NP (2008) Autologous chondrocyte implantation for the treatment of retropatellar cartilage defects: clinical results referred to defect localisation. Arch Orthop Trauma Surg 128:1223–1231PubMedCrossRef

25.

Niemeyer P, Petska JM, Kreuz PC, Erggelet C, Schmal H, Suedkamp NP, Steinwachs M (2008) Characteristic complications after autologous chondrocyte implantation for cartilage defects of the knee joint. Am J Sports Med 36:2091–2099PubMedCrossRef

26.

Pascual-Garrido C, Slabaugh MA, L’Heureux DR, Friel NA, Cole BJ (2009) Recommendations and treatment outcomes for patellofemoral articular cartilage defects with autologous chondrocyte implantation: prospective evaluation at average 4-year follow-up. Am J Sports Med 37:33–41CrossRef

27.

Peterson L, Minas T, Brittberg M, Nilsson A, Sjogren-Jansson E, Lindahl A (2000) Two- to 9-year outcome after autologous chondrocyte transplantation of the knee. Clin Orthop Relat Res 374:212–234PubMedCrossRef

28.

Roos EM, Roos HP, Ekdahl C, Lohmander LS (1998) Knee injury and osteoarthritis outcome score (KOOS): validation of a Swedish version. Scand J Med Sci Sports 8:439–448PubMedCrossRef

29.

Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee injury and osteoarthritis outcome score (KOOS): development of a self-administered outcome measure. J Orthop Sports Phys Ther 28:88–96PubMed

30.

Roos EM, Toksvig-Larsen S (2003) Knee injury and osteoarthritis outcome score (KOOS): validation and comparison to the WOMAC in total knee replacement. Health Qual Life Outcomes 1:17PubMedCrossRef

31.

Russlies M, Behrens P, Ehlers EM, Brohl C, Vindigni C, Spector M, Kurz B (2005) Periosteum stimulates subchondral bone densification in autologous chondrocyte transplantation in a sheep model. Cell Tissue Res 319:133–142PubMedCrossRef

32.

Saris DBF, Vanlauwe J, Victor J, Almqvist KF, Verdonk R, Bellemans J, Luyten FP (2009) Treatment of symptomatic cartilage defects of the knee: characterized chondrocyte implantation results in better clinical outcome at 36 months in a randomized trial compared to microfracture. Am J Sports Med 37:10–19CrossRef

33.

Shapiro F, Koide S, Glimcher MJ (1993) Cell origin and differentiation in the repair of full-thickness defects of articular cartilage. J Bone Joint Surg Am 75:532–553PubMed

34.

Steadman JR, Rodkey WG, Briggs KK (2002) Microfracture to treat full-thickness chondral defects: surgical technique, rehabilitation, and outcomes. J Knee Surg 15:170–176PubMed

35.

Tegner Y (1985) Cruciate ligament injuries in the knee: evaluation and rehabilitation [dissertation]. Linköping University, Linköping

36.

Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop 198:43–49PubMed

Title: Autologous matrix-induced chondrogenesis combined with platelet-rich plasma gel: technical description and a five pilot patients report
Authors: A. A. M. Dhollander
F. De Neve
K. F. Almqvist
R. Verdonk
S. Lambrecht
D. Elewaut
G. Verbruggen
P. C. M. Verdonk
Publication date: 01-04-2011
Publisher: Springer-Verlag
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 4/2011
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-010-1337-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Autologous matrix-induced chondrogenesis combined with platelet-rich plasma gel: technical description and a five pilot patients report

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Please log in to get access to this content

Other articles of this Issue 4/2011

Evaluation of the intercondylar roof impingement after anatomical double-bundle anterior cruciate ligament reconstruction using 3D-CT

Relationship between quadriceps femoris muscle volume and muscle torque after anterior cruciate ligament rupture

Different knee joint loading patterns in ACL deficient copers and non-copers during walking

The influence of posterior-inferior tibial slope in ACL injury

Axial and torsional stability of supracondylar femur osteotomies: biomechanical comparison of the stability of five different plate and osteotomy configurations

We do not have evidence based methods for the treatment of cartilage defects in the knee