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Published in: Skeletal Radiology 12/2013

01-12-2013 | Scientific Article

Repair tissue quality after arthroscopic autologous collagen-induced chondrogenesis (ACIC) assessed via T2* mapping

Authors: David Stelzeneder, Ananthram A. Shetty, Seok-Jung Kim, Siegfried Trattnig, Stephan E. Domayer, Vishvas Shetty, Praveen Bilagi

Published in: Skeletal Radiology | Issue 12/2013

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Abstract

Objective

A novel single-stage approach using arthroscopic microdrilling and atelocollagen/fibrin-gel application is employed for cartilage repair of the knee. The purpose of our study was to investigate the morphological and biochemical MRI outcome after this technique.

Materials and methods

A retrospective case series of ten patients (mean age 45 years) with symptomatic chondral defects in the knee who were treated arthroscopically with microdrilling and atelocollagen application was analyzed. All defects were ICRS grade III or IV and the sizes were 2–8 cm2 intra-operatively. All patients underwent morphological MRI and T2-star mapping at 1.5 T at 1-year follow-up. The magnetic resonance observation of cartilage repair tissue (MOCART) score was assessed. T2* relaxation time values of repair tissue and a healthy native cartilage area was assessed by means of region of interest analysis on the T2* maps.

Results

The mean MOCART score at 1-year follow-up was 71.7 ± 21.0 ranging from 25 to 95. The mean T2* relaxation times were 30.6 ± 11.3 ms and 28.8 ± 6.8 ms for the repair tissue and surrounding native cartilage, respectively. The T2* ratio between the repair tissue and native cartilage was 105 % ± 30 %, indicating repair tissue properties similar to native cartilage.

Conclusions

An arthroscopic single-stage procedure using microdrilling in combination with atelocollagen gel and fibrin-glue can provide satisfactory MRI results at 1-year follow-up, with good cartilage defect filling. The T2* values in the repair tissue achieved similar values compared to normal hyaline cartilage.
Literature
1.
go back to reference Gomoll AH, Farr J, Gillogly SD, Kercher JS, Minas T. Surgical management of articular cartilage defects of the knee. Instr Course Lect. 2011;60:461–83.PubMed Gomoll AH, Farr J, Gillogly SD, Kercher JS, Minas T. Surgical management of articular cartilage defects of the knee. Instr Course Lect. 2011;60:461–83.PubMed
2.
go back to reference Shapiro F, Koide S, Glimcher MJ. Cell origin and differentiation in the repair of full-thickness defects of articular cartilage. J Bone Joint Surg Am. 1993;75(4):532–53.PubMed Shapiro F, Koide S, Glimcher MJ. Cell origin and differentiation in the repair of full-thickness defects of articular cartilage. J Bone Joint Surg Am. 1993;75(4):532–53.PubMed
3.
go back to reference Benthien JP, Behrens P. The treatment of chondral and osteochondral defects of the knee with autologous matrix-induced chondrogenesis (AMIC): method description and recent developments. Knee Surg Sports Traumatol Arthrosc. 2011;19(8):1316–9.PubMedCrossRef Benthien JP, Behrens P. The treatment of chondral and osteochondral defects of the knee with autologous matrix-induced chondrogenesis (AMIC): method description and recent developments. Knee Surg Sports Traumatol Arthrosc. 2011;19(8):1316–9.PubMedCrossRef
4.
go back to reference Behrens P, Bitter T, Kurz B, Russlies M. Matrix-associated autologous chondrocyte transplantation/implantation (MACT/MACI)–5-year follow-up. Knee. 2006;13(3):194–202.PubMedCrossRef Behrens P, Bitter T, Kurz B, Russlies M. Matrix-associated autologous chondrocyte transplantation/implantation (MACT/MACI)–5-year follow-up. Knee. 2006;13(3):194–202.PubMedCrossRef
5.
go back to reference 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(11):1456–64.PubMedCrossRef 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(11):1456–64.PubMedCrossRef
6.
go back to reference Efe T, Theisen C, Fuchs-Winkelmann S, Stein T, Getgood A, Rominger MB, et al. Cell-free collagen type I matrix for repair of cartilage defects-clinical and magnetic resonance imaging results. Knee Surg Sports Traumatol Arthrosc. 2012;20(10):1915–22. Efe T, Theisen C, Fuchs-Winkelmann S, Stein T, Getgood A, Rominger MB, et al. Cell-free collagen type I matrix for repair of cartilage defects-clinical and magnetic resonance imaging results. Knee Surg Sports Traumatol Arthrosc. 2012;20(10):1915–22.
7.
go back to reference 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(4):536–42.PubMedCrossRef 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(4):536–42.PubMedCrossRef
8.
go back to reference de Girolamo L, Bertolini G, Cervellin M, Sozzi G, Volpi P. Treatment of chondral defects of the knee with one step matrix-assisted technique enhanced by autologous concentrated bone marrow: in vitro characterisation of mesenchymal stem cells from iliac crest and subchondral bone. Injury. 2010;41(11):1172–7.PubMedCrossRef de Girolamo L, Bertolini G, Cervellin M, Sozzi G, Volpi P. Treatment of chondral defects of the knee with one step matrix-assisted technique enhanced by autologous concentrated bone marrow: in vitro characterisation of mesenchymal stem cells from iliac crest and subchondral bone. Injury. 2010;41(11):1172–7.PubMedCrossRef
9.
go back to reference Benthien JP, Behrens P. Autologous matrix-induced chondrogenesis (AMIC). A one-step procedure for retropatellar articular resurfacing. Acta Orthop Belg. 2010;76(2):260–3.PubMed Benthien JP, Behrens P. Autologous matrix-induced chondrogenesis (AMIC). A one-step procedure for retropatellar articular resurfacing. Acta Orthop Belg. 2010;76(2):260–3.PubMed
10.
go back to reference 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(10):2109–15. 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(10):2109–15.
11.
go back to reference Shetty AA, Kim SJ, Bilagi P, Stelzeneder D. Autologous collagen-induced chondrogenesis: single-stage arthroscopic cartilage repair technique. Orthopedics. 2013;36(5):e648–52. Shetty AA, Kim SJ, Bilagi P, Stelzeneder D. Autologous collagen-induced chondrogenesis: single-stage arthroscopic cartilage repair technique. Orthopedics. 2013;36(5):e648–52.
12.
go back to reference Welsch GH, Mamisch TC, Domayer SE, Dorotka R, Kutscha-Lissberg F, Marlovits S, et al. Cartilage T2 assessment at 3-T MR imaging: in vivo differentiation of normal hyaline cartilage from reparative tissue after two cartilage repair procedures–initial experience. Radiology. 2008;247(1):154–61.PubMedCrossRef Welsch GH, Mamisch TC, Domayer SE, Dorotka R, Kutscha-Lissberg F, Marlovits S, et al. Cartilage T2 assessment at 3-T MR imaging: in vivo differentiation of normal hyaline cartilage from reparative tissue after two cartilage repair procedures–initial experience. Radiology. 2008;247(1):154–61.PubMedCrossRef
13.
go back to reference Trattnig S, Mamisch TC, Pinker K, Domayer S, Szomolanyi P, Marlovits S, et al. Differentiating normal hyaline cartilage from post-surgical repair tissue using fast gradient echo imaging in delayed gadolinium-enhanced MRI (dGEMRIC) at 3 Tesla. Eur Radiol. 2008;18(6):1251–9.PubMedCrossRef Trattnig S, Mamisch TC, Pinker K, Domayer S, Szomolanyi P, Marlovits S, et al. Differentiating normal hyaline cartilage from post-surgical repair tissue using fast gradient echo imaging in delayed gadolinium-enhanced MRI (dGEMRIC) at 3 Tesla. Eur Radiol. 2008;18(6):1251–9.PubMedCrossRef
14.
go back to reference Domayer SE, Kutscha-Lissberg F, Welsch G, Dorotka R, Nehrer S, Gabler C, et al. T2 mapping in the knee after microfracture at 3.0 T: correlation of global T2 values and clinical outcome—preliminary results. Osteoarthr Cartil. 2008;16(8):903–8.PubMedCrossRef Domayer SE, Kutscha-Lissberg F, Welsch G, Dorotka R, Nehrer S, Gabler C, et al. T2 mapping in the knee after microfracture at 3.0 T: correlation of global T2 values and clinical outcome—preliminary results. Osteoarthr Cartil. 2008;16(8):903–8.PubMedCrossRef
15.
go back to reference Bittersohl B, Miese FR, Hosalkar HS, Herten M, Antoch G, Krauspe R, et al. T2* mapping of hip joint cartilage in various histological grades of degeneration. Osteoarthr Cartil. 2012;20(7):653–60. Bittersohl B, Miese FR, Hosalkar HS, Herten M, Antoch G, Krauspe R, et al. T2* mapping of hip joint cartilage in various histological grades of degeneration. Osteoarthr Cartil. 2012;20(7):653–60.
16.
go back to reference Apprich S, Mamisch TC, Welsch GH, Bonel H, Siebenrock KA, Kim YJ, et al. Evaluation of articular cartilage in patients with femoroacetabular impingement (FAI) using T2* mapping at different time points at 3.0-Tesla MRI: a feasibility study. Skelet Radiol. 2012;41(8):987–95. Apprich S, Mamisch TC, Welsch GH, Bonel H, Siebenrock KA, Kim YJ, et al. Evaluation of articular cartilage in patients with femoroacetabular impingement (FAI) using T2* mapping at different time points at 3.0-Tesla MRI: a feasibility study. Skelet Radiol. 2012;41(8):987–95.
17.
go back to reference Krause FG, Klammer G, Benneker LM, Werlen S, Mamisch TC, Weber M. Biochemical T2* MR quantification of ankle arthrosis in pes cavovarus. J Orthop Res. 2010;28(12):1562–8.PubMedCrossRef Krause FG, Klammer G, Benneker LM, Werlen S, Mamisch TC, Weber M. Biochemical T2* MR quantification of ankle arthrosis in pes cavovarus. J Orthop Res. 2010;28(12):1562–8.PubMedCrossRef
18.
go back to reference Mamisch TC, Hughes T, Mosher TJ, Mueller C, Trattnig S, Boesch C, et al. T2 star relaxation times for assessment of articular cartilage at 3 T: a feasibility study. Skeletal Radiol. 2012;41(3):287–92.PubMedCrossRef Mamisch TC, Hughes T, Mosher TJ, Mueller C, Trattnig S, Boesch C, et al. T2 star relaxation times for assessment of articular cartilage at 3 T: a feasibility study. Skeletal Radiol. 2012;41(3):287–92.PubMedCrossRef
19.
go back to reference Marik W, Apprich S, Welsch GH, Mamisch TC, Trattnig S. Biochemical evaluation of articular cartilage in patients with osteochondrosis dissecans by means of quantitative T2- and T2*-mapping at 3T MRI: A feasibility study. Eur J Radiol. 2012;81(5):923–7.PubMedCrossRef Marik W, Apprich S, Welsch GH, Mamisch TC, Trattnig S. Biochemical evaluation of articular cartilage in patients with osteochondrosis dissecans by means of quantitative T2- and T2*-mapping at 3T MRI: A feasibility study. Eur J Radiol. 2012;81(5):923–7.PubMedCrossRef
20.
go back to reference Miese FR, Zilkens C, Holstein A, Bittersohl B, Kropil P, Mamisch TC, et al. Assessment of early cartilage degeneration after slipped capital femoral epiphysis using T2 and T2* mapping. Acta Radiol. 2011;52(1):106–10.PubMed Miese FR, Zilkens C, Holstein A, Bittersohl B, Kropil P, Mamisch TC, et al. Assessment of early cartilage degeneration after slipped capital femoral epiphysis using T2 and T2* mapping. Acta Radiol. 2011;52(1):106–10.PubMed
21.
go back to reference Qian Y, Williams AA, Chu CR, Boada FE. Multicomponent T2* mapping of knee cartilage: technical feasibility ex vivo. Magn Reson Med. 2010;64(5):1426–31.PubMedCrossRef Qian Y, Williams AA, Chu CR, Boada FE. Multicomponent T2* mapping of knee cartilage: technical feasibility ex vivo. Magn Reson Med. 2010;64(5):1426–31.PubMedCrossRef
22.
go back to reference Welsch GH, Mamisch TC, Hughes T, Zilkens C, Quirbach S, Scheffler K, et al. In vivo biochemical 7.0 Tesla magnetic resonance: preliminary results of dGEMRIC, zonal T2, and T2* mapping of articular cartilage. Investig Radiol. 2008;43(9):619–26.CrossRef Welsch GH, Mamisch TC, Hughes T, Zilkens C, Quirbach S, Scheffler K, et al. In vivo biochemical 7.0 Tesla magnetic resonance: preliminary results of dGEMRIC, zonal T2, and T2* mapping of articular cartilage. Investig Radiol. 2008;43(9):619–26.CrossRef
23.
go back to reference Mendlik T, Faber SC, Weber J, Hohe J, Rauch E, Reiser M, et al. T2 quantitation of human articular cartilage in a clinical setting at 1.5 T: implementation and testing of four multiecho pulse sequence designs for validity. Investig Radiol. 2004;39(5):288–99.CrossRef Mendlik T, Faber SC, Weber J, Hohe J, Rauch E, Reiser M, et al. T2 quantitation of human articular cartilage in a clinical setting at 1.5 T: implementation and testing of four multiecho pulse sequence designs for validity. Investig Radiol. 2004;39(5):288–99.CrossRef
24.
go back to reference Maier CF, Tan SG, Hariharan H, Potter HG. T2 quantitation of articular cartilage at 1.5 T. J Magn Reson Imaging. 2003;17(3):358–64.PubMedCrossRef Maier CF, Tan SG, Hariharan H, Potter HG. T2 quantitation of articular cartilage at 1.5 T. J Magn Reson Imaging. 2003;17(3):358–64.PubMedCrossRef
25.
go back to reference Dardzinski BJ, Laor T, Schmithorst VJ, Klosterman L, Graham TB. Mapping T2 relaxation time in the pediatric knee: feasibility with a clinical 1.5-T MR imaging system. Radiology. 2002;225(1):233–9.PubMedCrossRef Dardzinski BJ, Laor T, Schmithorst VJ, Klosterman L, Graham TB. Mapping T2 relaxation time in the pediatric knee: feasibility with a clinical 1.5-T MR imaging system. Radiology. 2002;225(1):233–9.PubMedCrossRef
26.
go back to reference 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(3):310–9.PubMedCrossRef 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(3):310–9.PubMedCrossRef
27.
go back to reference 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(9):1773–80. 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(9):1773–80.
28.
go back to reference Krusche-Mandl I, Schmitt B, Zak L, Apprich S, Aldrian S, Juras V, et al. Long-term results 8 years after autologous osteochondral transplantation: 7-T gagCEST and sodium magnetic resonance imaging with morphological and clinical correlation. Osteoarthr Cartil. 2012;20(5):357–63. Krusche-Mandl I, Schmitt B, Zak L, Apprich S, Aldrian S, Juras V, et al. Long-term results 8 years after autologous osteochondral transplantation: 7-T gagCEST and sodium magnetic resonance imaging with morphological and clinical correlation. Osteoarthr Cartil. 2012;20(5):357–63.
29.
go back to reference Schneider U, Rackwitz L, Andereya S, Siebenlist S, Fensky F, Reichert J, et al. A prospective multicenter study on the outcome of type I collagen hydrogel-based autologous chondrocyte implantation (CaReS) for the repair of articular cartilage defects in the knee. Am J Sports Med. 2011;39(12):2558–65.PubMedCrossRef Schneider U, Rackwitz L, Andereya S, Siebenlist S, Fensky F, Reichert J, et al. A prospective multicenter study on the outcome of type I collagen hydrogel-based autologous chondrocyte implantation (CaReS) for the repair of articular cartilage defects in the knee. Am J Sports Med. 2011;39(12):2558–65.PubMedCrossRef
30.
go back to reference Bittersohl B, Hosalkar HS, Hughes T, Kim YJ, Werlen S, Siebenrock KA, et al. Feasibility of T2* mapping for the evaluation of hip joint cartilage at 1.5T using a three-dimensional (3D), gradient-echo (GRE) sequence: a prospective study. Magn Reson Med. 2009;62(4):896–901.PubMedCrossRef Bittersohl B, Hosalkar HS, Hughes T, Kim YJ, Werlen S, Siebenrock KA, et al. Feasibility of T2* mapping for the evaluation of hip joint cartilage at 1.5T using a three-dimensional (3D), gradient-echo (GRE) sequence: a prospective study. Magn Reson Med. 2009;62(4):896–901.PubMedCrossRef
31.
go back to reference Marlovits S, Singer P, Zeller P, Mandl I, Haller J, Trattnig S. 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. 2006;57(1):16–23.PubMedCrossRef Marlovits S, Singer P, Zeller P, Mandl I, Haller J, Trattnig S. 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. 2006;57(1):16–23.PubMedCrossRef
Metadata
Title
Repair tissue quality after arthroscopic autologous collagen-induced chondrogenesis (ACIC) assessed via T2* mapping
Authors
David Stelzeneder
Ananthram A. Shetty
Seok-Jung Kim
Siegfried Trattnig
Stephan E. Domayer
Vishvas Shetty
Praveen Bilagi
Publication date
01-12-2013
Publisher
Springer Berlin Heidelberg
Published in
Skeletal Radiology / Issue 12/2013
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-013-1708-2

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