Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-04-2018 | Knee

Good clinical results but moderate osseointegration and defect filling of a cell-free multi-layered nano-composite scaffold for treatment of osteochondral lesions of the knee

Authors: Dominic T. Mathis, Raphael Kaelin, Helmut Rasch, Markus P. Arnold, Michael T. Hirschmann

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 4/2018

Abstract

Purpose

The aim of this retrospective study was to evaluate the clinical and radiological results of a nano-composite multi-layered three-dimensional biomaterial scaffold for treatment of osteochondral lesions (OCL) of the knee. It was a particular radiological interest to analyse the osseointegration, filling of the defects and the bone tracer uptake (BTU), and it was hypothesised that this scaffold, which was created to mimic the entire osteo-cartilaginous unit, is integrated within the bone 12 months postoperatively and comes along with improved patients symptoms and function.

Methods

Fourteen patients (male:female = 11:3, mean age ± SD 33.1 ± 10.7 years) treated for OCL (size 1.0–3.5 cm²) were clinically and radiologically evaluated at 1 year postoperatively. The data were prospectively collected including SPECT/CT, Tegner and Lysholm scores. BTU was anatomically localised and volumetrically quantified in SPECT/CT. Defect filling was analysed in CT. Spearman’s rho and Wilcoxon test were used for correlation of BTU in SPECT/CT and clinical scores (p < 0.05).

Results

A significant improvement in Lysholm knee score (p < 0.001) and slight deterioration in Tegner score were found (p < 0.01). A complete filling of the defect was shown in 14%, a partial filling in 14% and only minor filling was seen in 72%. A significant correlation (p < 0.001) was found between location of osteochondral lesions and increased BTU. At the lesion sites pre- and postoperative BTU was markedly increased and did not show any decrease at 12-month follow-up. Median Tegner and mean Lysholm scores did not correlate with BTU at any time.

Conclusions

Treatment of OCL in the knee joint with a nano-composite multi-layered three-dimensional biomaterial scaffold resulted in a significant clinical improvement at 1-year follow-up. However, osseointegration was still ongoing at 12-month follow-up.

Level of evidence

Case series, Level IV.

Aglietti P, Buzzi R, Bassi PB, Fioriti M (1994) Arthroscopic drilling in juvenile osteochondritis dissecans of the medial femoral condyle. Arthroscopy 10:286–291CrossRefPubMed

Aichroth P (1971) Osteochondritis dissecans of the knee. A clinical survey. J Bone Joint Surg Br 53:440–447CrossRefPubMed

Al-Nabhani K, Michopoulou S, Allie R, Alkalbani J, Saad Z, Sajjan R, Syed R, Bomanji J (2014) Painful knee prosthesis: can we help with bone SPECT/CT? Nucl Med Commun 35:182–188CrossRefPubMed

Anderson AF, Pagnani MJ (1997) Osteochondritis dissecans of the femoral condyles. Long-term results of excision of the fragment. Am J Sports Med 25:830–834CrossRefPubMed

Bentley G, Bhamra JS, Gikas PD, Skinner JA, Carrington R, Briggs TW (2013) Repair of osteochondral defects in joints—how to achieve success. Injury 44(Suppl 1):S3–S10CrossRefPubMed

Boegard T, Rudling O, Dahlstrom J, Dirksen H, Petersson IF, Jonsson K (1999) Bone scintigraphy in chronic knee pain: comparison with magnetic resonance imaging. Ann Rheum Dis 58(1):20–26CrossRefPubMedPubMedCentral

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. N Engl J Med 331:889–895CrossRefPubMed

Brix M, Kaipel M, Kellner R, Schreiner M, Apprich S, Boszotta H, Windhager R, Domayer S, Trattnig S (2016) Successful osteoconduction but limited cartilage tissue quality following osteochondral repair by a cell-free multilayered nano-composite scaffold at the knee. Int Orthop 40:625–632CrossRefPubMed

Buck FM, Hoffmann A, Hofer B, Pfirrmann CW, Allgayer B (2009) Chronic medial knee pain without history of prior trauma: correlation of pain at rest and during exercise using bone scintigraphy and MR imaging. Skelet Radiol 38:339–347CrossRef

10.

Cahill B (1985) Treatment of juvenile osteochondritis dissecans and osteochondritis dissecans of the knee. Clin Sports Med 4(2):367–384PubMed

11.

Cain EL, Clancy WG (2001) Treatment algorithm for osteochondral injuries of the knee. Clin Sports Med 20:321–342CrossRefPubMed

12.

Chopra A (2007) 99mTc-methyl diphosphonate. In: Molecular imaging and contrast agent database (MICAD). National Center for Biotechnology Information (US) 2004–2013, Bethesda, MD

13.

Christensen BB, Foldager CB, Jensen J, Jensen NC, Lind M (2016) Poor osteochondral repair by a biomimetic collagen scaffold: 1- to 3-year clinical and radiological follow-up. Knee Surg Sports Traumatol Arthrosc 24:2380–2387CrossRefPubMed

14.

Cook GJ, Ryan PJ, Clarke SE, Fogelman I (1996) SPECT bone scintigraphy of anterior cruciate ligament injury. J Nucl Med 37:1353–1356PubMed

15.

de Windt TS, Welsch GH, Brittberg M, Vonk LA, Marlovits S, Trattnig S, Saris DB (2013) Is magnetic resonance imaging reliable in predicting clinical outcome after articular cartilage repair of the knee? A systematic review and meta-analysis. Am J Sports Med 41:1695–1702CrossRefPubMed

16.

Delcogliano M, de Caro F, Scaravella E, Ziveri G, De Biase CF, Marotta D, Marenghi P, Delcogliano A (2014) Use of innovative biomimetic scaffold in the treatment for large osteochondral lesions of the knee. Knee Surg Sports Traumatol Arthrosc 22:1260–1269PubMed

17.

Donaldson LD, Wojtys EM (2008) Extraarticular drilling for stable osteochondritis dissecans in the skeletally immature knee. J Pediatr Orthop 28:831–835CrossRefPubMed

18.

Dordevic M, Hirschmann MT, Rechsteiner J, Falkowski A, Testa E, Hirschmann A (2016) Do chondral lesions of the knee correlate with bone tracer uptake by using SPECT/CT? Radiology 278:223–231CrossRefPubMed

19.

Dye SF, Chew MH (1994) The use of scintigraphy to detect increased osseous metabolic activity about the knee. Instr Course Lect 43:453–469PubMed

20.

Emmerson BC, Gortz S, Jamali AA, Chung C, Amiel D, Bugbee WD (2007) Fresh osteochondral allografting in the treatment of osteochondritis dissecans of the femoral condyle. Am J Sports Med 35:907–914CrossRefPubMed

21.

Filardo G, Kon E, Di Martino A, Busacca M, Altadonna G, Marcacci M (2013) Treatment of knee osteochondritis dissecans with a cell-free biomimetic osteochondral scaffold: clinical and imaging evaluation at 2-year follow-up. Am J Sports Med 41:1786–1793CrossRefPubMed

22.

Gomoll AH, Madry H, Knutsen G, van Dijk N, Seil R, Brittberg M, Kon E (2010) The subchondral bone in articular cartilage repair: current problems in the surgical management. Knee Surg Sports Traumatol Arthrosc 18:434–447CrossRefPubMedPubMedCentral

23.

Henckel JRR, Lozhkin K, Harris S, Baena FM, Barrett AR, Cobb JP (2006) Very low-dose computed tomography for planning and outcome measurement in knee replacement. The imperial knee protocol. J Bone Joint Surg Br 88:1513–1518CrossRefPubMed

24.

Hirschmann A, Hirschmann MT (2016) Chronic knee pain: clinical value of MRI versus SPECT/CT. Semin Musculoskelet Radiol 20:3–11CrossRefPubMed

25.

Hirschmann MT, Adler T, Rasch H, Hugli RW, Friederich NF, Arnold MP (2010) Painful knee joint after ACL reconstruction using biodegradable interference screws—SPECT/CT a valuable diagnostic tool? A case report. Sports Med Arthrosc Rehabil Ther Technol 2:24PubMedPubMedCentral

26.

Hirschmann MT, Davda K, Iranpour F, Rasch H, Friederich NF (2011) Combined single photon emission computerised tomography and conventional computerised tomography (SPECT/CT) in patellofemoral disorders: a clinical review. Int Orthop 35:675–680CrossRefPubMed

27.

Hirschmann MT, Davda K, Rasch H, Arnold MP, Friederich NF (2011) Clinical value of combined single photon emission computerized tomography and conventional computer tomography (SPECT/CT) in sports medicine. Sports Med Arthrosc 19:174–181CrossRefPubMed

28.

Hirschmann MT, Henckel J, Rasch H (2013) SPECT/CT in patients with painful knee arthroplasty—what is the evidence? Skelet Radiol 42:1201–1207CrossRef

29.

Hirschmann MT, Iranpour F, Davda K, Rasch H, Hugli R, Friederich NF (2010) Combined single-photon emission computerized tomography and conventional computerized tomography (SPECT/CT): clinical value for the knee surgeons? Knee Surg Sports Traumatol Arthrosc 18:341–345CrossRefPubMed

30.

Hirschmann MT, Konala P, Iranpour F, Kerner A, Rasch H, Friederich NF (2011) Clinical value of SPECT/CT for evaluation of patients with painful knees after total knee arthroplasty—a new dimension of diagnostics? BMC Musculoskelet Disord 12:36CrossRefPubMedPubMedCentral

31.

Hirschmann MT, Mathis D, Afifi FK, Rasch H, Henckel J, Amsler F, Wagner CR, Friederich NF, Arnold MP (2013) Single photon emission computerized tomography and conventional computerized tomography (SPECT/CT) for evaluation of patients after anterior cruciate ligament reconstruction: a novel standardized algorithm combining mechanical and metabolic information. Knee Surg Sports Traumatol Arthrosc 21:965–974CrossRefPubMed

32.

Hirschmann MT, Mathis D, Rasch H, Amsler F, Friederich NF, Arnold MP (2013) SPECT/CT tracer uptake is influenced by tunnel orientation and position of the femoral and tibial ACL graft insertion site. Int Orthop 37:301–309CrossRefPubMed

33.

Hirschmann MT, Schon S, Afifi FK, Amsler F, Rasch H, Friederich NF, Arnold MP (2013) Assessment of loading history of compartments in the knee using bone SPECT/CT: a study combining alignment and 99mTc-HDP tracer uptake/distribution patterns. J Orthop Res 31:268–274CrossRefPubMed

34.

Hirschmann MT, Wagner CR, Rasch H, Henckel J (2012) Standardized volumetric 3D-analysis of SPECT/CT imaging in orthopaedics: overcoming the limitations of qualitative 2D analysis. BMC Med Imaging 12:5CrossRefPubMedPubMedCentral

35.

Hughston JC, Hergenroeder PT, Courtenay BG (1984) Osteochondritis dissecans of the femoral condyles. J Bone Joint Surg Am 66:1340–1348CrossRefPubMed

36.

Kivisto R, Pasanen L, Leppilahti J, Jalovaara P (2002) Arthroscopic repair of osteochondritis dissecans of the femoral condyles with metal staple fixation: a report of 28 cases. Knee Surg Sports Traumatol Arthrosc 10:305–309CrossRefPubMed

37.

Kon E, Delcogliano M, Filardo G, Altadonna G, Marcacci M (2009) Novel nano-composite multi-layered biomaterial for the treatment of multifocal degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc 17:1312–1315CrossRefPubMedPubMedCentral

38.

Kon E, Delcogliano M, Filardo G, Fini M, Giavaresi G, Francioli S, Martin I, Pressato D, Arcangeli E, Quarto R, Sandri M, Marcacci M (2010) Orderly osteochondral regeneration in a sheep model using a novel nano-composite multilayered biomaterial. J Orthop Res 28:116–124PubMed

39.

Kon E, Delcogliano M, Filardo G, Pressato D, Busacca M, Grigolo B, Desando G, Marcacci M (2010) A novel nano-composite multi-layered biomaterial for treatment of osteochondral lesions: technique note and an early stability pilot clinical trial. Injury 41:693–701CrossRefPubMed

40.

Kon E, Filardo G, Di Martino A, Busacca M, Moio A, Perdisa F, Marcacci M (2014) Clinical results and MRI evolution of a nano-composite multilayered biomaterial for osteochondral regeneration at 5 years. Am J Sports Med 42:158–165CrossRefPubMed

41.

Kon E, Vannini F, Buda R, Filardo G, Cavallo M, Ruffilli A, Nanni M, Di Martino A, Marcacci M, Giannini S (2012) How to treat osteochondritis dissecans of the knee: surgical techniques and new trends: AAOS exhibit selection. J Bone Joint Surg Am 94:e1–e8CrossRefPubMed

42.

Konala P, Iranpour F, Kerner A, Rasch H, Friederich NF, Hirschmann MT (2010) Clinical benefit of SPECT/CT for follow-up of surgical treatment of osteochondritis dissecans. Ann Nucl Med 24:621–624CrossRefPubMed

43.

Maas O, Joseph GB, Sommer G, Wild D, Kretzschmar M (2015) Association between cartilage degeneration and subchondral bone remodeling in patients with knee osteoarthritis comparing MRI and (99 m)Tc-DPD-SPECT/CT. Osteoarthr Cartil 23(10):1713–1720CrossRefPubMed

44.

Magnussen RA, Dunn WR, Carey JL, Spindler KP (2008) Treatment of focal articular cartilage defects in the knee: a systematic review. Clin Orthop Relat Res 466:952–962CrossRefPubMedPubMedCentral

45.

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 52:310–319CrossRefPubMed

46.

Mathis DT, Hirschmann A, Falkowski AL, Kiekara T, Amsler F, Rasch H, Hirschmann MT (2017) Increased bone tracer uptake in symptomatic patients with ACL graft insufficiency: a correlation of MRI and SPECT/CT findings. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-017-4588-5

47.

Mathis DT, Rasch H, Hirschmann MT (2015) In vivo bone tunnel remodeling in symptomatic patients after ACL reconstruction: a retrospective comparison of articular and extra-articular fixation. Muscles Ligaments Tendons J 5:316–324PubMed

48.

McCoy B, Miniaci A (2012) Osteochondral autograft transplantation/mosaicplasty. J Knee Surg 25:99–108CrossRefPubMed

49.

Mucha A, Dordevic M, Hirschmann A, Rasch H, Amsler F, Arnold MP, Hirschmann MT (2015) Effect of high tibial osteotomy on joint loading in symptomatic patients with varus aligned knees: a study using SPECT/CT. Knee Surg Sports Traumatol Arthrosc 23:2315–2323CrossRefPubMed

50.

Mucha A, Dordevic M, Testa EA, Rasch H, Hirschmann MT (2013) Assessment of the loading history of patients after high tibial osteotomy using SPECT/CT—a new diagnostic tool and algorithm. J Orthop Surg Res 8:46CrossRefPubMedPubMedCentral

51.

Pallante AL, Bae WC, Chen AC, Gortz S, Bugbee WD, Sah RL (2009) Chondrocyte viability is higher after prolonged storage at 37 °C than at 4 °C for osteochondral grafts. Am J Sports Med 37(Suppl 1):24S–32SCrossRefPubMedPubMedCentral

52.

Pascual-Garrido C, Friel NA, Kirk SS, McNickle AG, Bach BR Jr, Bush-Joseph CA, Verma NN, Cole BJ (2009) Midterm results of surgical treatment for adult osteochondritis dissecans of the knee. Am J Sports Med 37(Suppl 1):125S–130SCrossRefPubMed

53.

Peterson L, Minas T, Brittberg M, Lindahl A (2003) Treatment of osteochondritis dissecans of the knee with autologous chondrocyte transplantation: results at two to ten years. J Bone Joint Surg Am 85-A(Suppl 2):17–24CrossRef

54.

Ramirez A, Abril JC, Chaparro M (2010) Juvenile osteochondritis dissecans of the knee: perifocal sclerotic rim as a prognostic factor of healing. J Pediatr Orthop 30:180–185CrossRefPubMed

55.

Rasch H, Falkowski AL, Forrer F, Henckel J, Hirschmann MT (2013) 4D-SPECT/CT in orthopaedics: a new method of combined quantitative volumetric 3D analysis of SPECT/CT tracer uptake and component position measurements in patients after total knee arthroplasty. Skelet Radiol 42:1215–1223CrossRef

56.

Schon SN, Afifi FK, Rasch H, Amsler F, Friederich NF, Arnold MP, Hirschmann MT (2014) Assessment of in vivo loading history of the patellofemoral joint: a study combining patellar position, tilt, alignment and bone SPECT/CT. Knee Surg Sports Traumatol Arthrosc 22:3039–3046CrossRefPubMed

57.

Shimomura K, Moriguchi Y, Ando W, Nansai R, Fujie H, Hart DA, Gobbi A, Kita K, Horibe S, Shino K, Yoshikawa H, Nakamura N (2014) Osteochondral repair using a scaffold-free tissue-engineered construct derived from synovial mesenchymal stem cells and a hydroxyapatite-based artificial bone. Tissue Eng Part A 20:2291–2304CrossRefPubMed

58.

Tampieri A, Sandri M, Landi E, Pressato D, Francioli S, Quarto R, Martin I (2008) Design of graded biomimetic osteochondral composite scaffolds. Biomaterials 29:3539–3546CrossRefPubMed

59.

Wasiak J, Clar C, Villanueva E (2006) Autologous cartilage implantation for full thickness articular cartilage defects of the knee. Cochrane Database Syst Rev 3:CD003323

60.

Wright RW, McLean M, Matava MJ, Shively RA (2004) Osteochondritis dissecans of the knee: long-term results of excision of the fragment. Clin Orthop Relat Res 424:239–243CrossRef

Title: Good clinical results but moderate osseointegration and defect filling of a cell-free multi-layered nano-composite scaffold for treatment of osteochondral lesions of the knee
Authors: Dominic T. Mathis
Raphael Kaelin
Helmut Rasch
Markus P. Arnold
Michael T. Hirschmann
Publication date: 01-04-2018
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 4/2018
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-017-4638-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Good clinical results but moderate osseointegration and defect filling of a cell-free multi-layered nano-composite scaffold for treatment of osteochondral lesions of the knee

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 4/2018

Anatomic reconstruction of the medial patellofemoral ligament in children and adolescents using a pedicled quadriceps tendon graft shows favourable results at a minimum of 2-year follow-up

Patient and surgical characteristics that affect revision risk in dynamic intraligamentary stabilization of the anterior cruciate ligament

Hamstring autograft maturation is superior to tibialis allograft following anatomic single-bundle anterior cruciate ligament reconstruction

2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries

Sagittal femoral condyle morphology correlates with femoral tunnel length in anatomical single bundle ACL reconstruction

Stress distribution is deviated around the aperture of the femoral tunnel in the anatomic anterior cruciate ligament reconstruction