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Knee Surgery, Sports Traumatology, Arthroscopy

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Open Access 01-04-2021 | KNEE

Third generation autologous chondrocyte implantation is a good treatment option for athletic persons

Authors: Thomas Richard Niethammer, Daniel Altmann, Martin Holzgruber, Sophia Goller, Andreas Fischer, Peter Ernst Müller

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 4/2021

Abstract

Purpose

Autologous chondrocyte implantation is an established method for the treatment of joint cartilage damage. However, to date it has not been established that autologous chondrocyte implantation is an appropriate procedure for cartilage defects therapy in athletic persons. The aim of this study is to analyze if third-generation autologous chondrocyte implantation is an appropriate treatment for athletic persons with full cartilage defect of the knee joints.

Methods

A total of 84 patients were treated with third-generation autologous chondrocyte implantation (NOVOCART^® 3D). The mean follow-up time was 8 years (5–14). Sports activity was measured via UCLA Activity Score and Tegner Activity Scale before the onset of knee pain and postoperatively in an annual clinical evaluation. 41 athletic persons and 43 non-athletic persons (UCLA-Cut-off: 7; Tegner Activity Scale-Cut-off: 4) were analyzed. Patient reported outcomes were captured using IKDC subjective, KOOS, Lysholm score and VAS score on movement.

Results

Patient reported outcomes (IKDC, VAS at rest, VAS on movement) showed significant improvement (p < 0.001) postoperatively. Athletic persons demonstrated significantly better results than non-athletic persons in the analyzed outcome scores (IKDC: p < 0.01, KOOS: p < 0.01, Lysholm score: p < 0.01). 96.4% of the patients were able to return to sport and over 50% returned or surpassed their preinjury sports level. The remaining patients were downgraded by a median of two points on the UCLA- and 2.5 on the Tegner Activity Scale. A shift from high-impact sports to active events and moderate or mild activities was found. Furthermore, it was shown that preoperative UCLA score and Tegner Activity Scale correlated significantly with the patient reported outcome postoperatively.

Conclusion

Autologous chondrocyte implantation is a suitable treatment option for athletic persons with full-thickness cartilage defects in the knee. The return to sports activity is possible, but includes a shift from high-impact sports to less strenuous activities.

Aldrian S, Zak L, Wondrasch B, Albrecht C, Stelzeneder B, Binder H et al (2014) Clinical and radiological long-term outcomes after matrix-induced autologous chondrocyte transplantation: a prospective follow-up at a minimum of 10 years. Am J Sports Med 42:2680–2688CrossRef

Allender S, Hutchinson L, Foster C (2008) Life-change events and participation in physical activity: a systematic review. Health Promot Int 23:160–172CrossRef

Amstutz HC, Thomas BJ, Jinnah R, Kim W, Grogan T, Yale C (1984) Treatment of primary osteoarthritis of the hip. A comparison of total joint and surface replacement arthroplasty. J Bone Jt Surg Am 66:228–241CrossRef

Anders S, Schaumburger J, Schubert T, Grifka J, Behrens P (2008) Matrix-associated autologous chondrocyte transplantation (MACT). Minimally invasive technique in the knee. Oper Orthop Traumatol 20:208–219CrossRef

Briggs KK, Kocher MS, Rodkey WG, Steadman JR (2006) Reliability, validity, and responsiveness of the Lysholm knee score and Tegner activity scale for patients with meniscal injury of the knee. J Bone Jt Surg Am 88:698–705

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 331:889–895CrossRef

Campbell AB, Pineda M, Harris JD, Flanigan DC (2016) Return to sport after articular cartilage repair in athletes’ knees: a systematic review. Arthroscopy 32:651–668.e651CrossRef

Chapman CR (1984) New directions in the understanding and management of pain. Soc Sci Med 19:1261–1277CrossRef

Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM (2011) Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care Res (Hoboken) 63(Suppl 11):S208–228CrossRef

10.

Collins NJ, Roos EM (2012) Patient-reported outcomes for total hip and knee arthroplasty: commonly used instruments and attributes of a “good” measure. Clin Geriatr Med 28:367–394CrossRef

11.

Dahm DL, Barnes SA, Harrington JR, Sayeed SA, Berry DJ (2008) Patient-reported activity level after total knee arthroplasty. J Arthroplasty 23:401–407CrossRef

12.

Della Villa S, Kon E, Filardo G, Ricci M, Vincentelli F, Delcogliano M et al (2010) Does intensive rehabilitation permit early return to sport without compromising the clinical outcome after arthroscopic autologous chondrocyte implantation in highly competitive athletes? Am J Sports Med 38:68–77CrossRef

13.

Engberg E, Alen M, Kukkonen-Harjula K, Peltonen JE, Tikkanen HO, Pekkarinen H (2012) Life events and change in leisure time physical activity: a systematic review. Sports Med 42:433–447CrossRef

14.

Erdle B, Herrmann S, Porichis S, Uhl M, Ghanem N, Schmal H et al (2017) Sporting activity is reduced 11 years after first-generation autologous chondrocyte implantation in the knee joint. Am J Sports Med 45:2762–2773CrossRef

15.

Gille J, Behrens P, Schulz AP, Oheim R, Kienast B (2016) Matrix-associated autologous chondrocyte implantation: a clinical follow-up at 15 years. Cartilage 7:309–315CrossRef

16.

Gobbi A, Francisco R (2006) Factors affecting return to sports after anterior cruciate ligament reconstruction with patellar tendon and hamstring graft: a prospective clinical investigation. Knee Surg Sports Traumatol Arthrosc 14:1021–1028CrossRef

17.

Harris JD, Brophy RH, Siston RA, Flanigan DC (2010) Treatment of chondral defects in the athlete's knee. Arthroscopy 26:841–852CrossRef

18.

Harris JD, Siston RA, Pan X, Flanigan DC (2010) Autologous chondrocyte implantation: a systematic review. J Bone Jt Surg Am 92:2220–2233CrossRef

19.

Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, Neyret P et al (2001) Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 29:600–613CrossRef

20.

Kon E, Filardo G, Berruto M, Benazzo F, Zanon G, Della Villa S et al (2011) Articular cartilage treatment in high-level male soccer players: a prospective comparative study of arthroscopic second-generation autologous chondrocyte implantation versus microfracture. Am J Sports Med 39:2549–2557CrossRef

21.

Kreuz PC, Kalkreuth RH, Niemeyer P, Uhl M, Erggelet C (2019) Long-term clinical and MRI results of matrix-assisted autologous chondrocyte implantation for articular cartilage defects of the knee. Cartilage 10:305–313CrossRef

22.

Kreuz PC, Muller S, Freymann U, Erggelet C, Niemeyer P, Kaps C et al (2011) Repair of focal cartilage defects with scaffold-assisted autologous chondrocyte grafts: clinical and biomechanical results 48 months after transplantation. Am J Sports Med 39:1697–1705CrossRef

23.

Kreuz PC, Steinwachs M, Erggelet C, Lahm A, Krause S, Ossendorf C et al (2007) Importance of sports in cartilage regeneration after autologous chondrocyte implantation: a prospective study with a 3-year follow-up. Am J Sports Med 35:1261–1268CrossRef

24.

Krych AJ, Pareek A, King AH, Johnson NR, Stuart MJ, Williams RJ 3rd (2017) Return to sport after the surgical management of articular cartilage lesions in the knee: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 25:3186–3196CrossRef

25.

Mandelbaum BR, Browne JE, Fu F, Micheli L, Mosely JB Jr, Erggelet C et al (1998) Articular cartilage lesions of the knee. Am J Sports Med 26:853–861CrossRef

26.

Minas T (1998) Chondrocyte implantation in the repair of chondral lesions of the knee: economics and quality of life. Am J Orthop (Belle Mead NJ) 27:739–744

27.

Mithoefer K, Hambly K, Della Villa S, Silvers H, Mandelbaum BR (2009) Return to sports participation after articular cartilage repair in the knee: scientific evidence. Am J Sports Med 37(Suppl 1):167s–176sCrossRef

28.

Mithoefer K, Hambly K, Logerstedt D, Ricci M, Silvers H, Della Villa S (2012) Current concepts for rehabilitation and return to sport after knee articular cartilage repair in the athlete. J Orthop Sports Phys Ther 42:254–273CrossRef

29.

Naal FD, Impellizzeri FM, Leunig M (2009) Which is the best activity rating scale for patients undergoing total joint arthroplasty? Clin Orthop Relat Res 467:958–965CrossRef

30.

Niemeyer P, Albrecht D, Andereya S, Angele P, Ateschrang A, Aurich M et al (2016) Autologous chondrocyte implantation (ACI) for cartilage defects of the knee: A guideline by the working group “Clinical Tissue Regeneration”of the German Society of Orthopaedics and Trauma (DGOU). Knee 23:426–435CrossRef

31.

Niethammer TR, Altmann D, Holzgruber M, Pietschmann MF, Gulecyuz MF, Notohamiprodjo S et al (2020) Patient reported and MRI outcomes of third generation autologous chondrocyte implantation after 10 years. Arthroscopy. https://doi.org/10.1016/j.arthro.2020.03.009CrossRefPubMed

32.

Niethammer TR, Limbrunner K, Betz OB, Gulecyuz MF, Pietschmann MF, Feist M et al (2016) Analysis of the autologous chondrocyte quality of matrix-based autologous chondrocyte implantation in the knee joint. Int Orthop 40:205–212CrossRef

33.

Niethammer TR, Pietschmann MF, Horng A, Rossbach BP, Ficklscherer A, Jansson V et al (2014) Graft hypertrophy of matrix-based autologous chondrocyte implantation: a two-year follow-up study of NOVOCART 3D implantation in the knee. Knee Surg Sports Traumatol Arthrosc 22:1329–1336CrossRef

34.

Panagopoulos A, van Niekerk L, Triantafillopoulos I (2012) Autologous chondrocyte implantation for knee cartilage injuries: moderate functional outcome and performance in patients with high-impact activities. Orthopedics 35:e6–14CrossRef

35.

Pestka JM, Feucht MJ, Porichis S, Bode G, Sudkamp NP, Niemeyer P (2016) Return to sports activity and work after autologous chondrocyte implantation of the knee: which factors influence outcomes? Am J Sports Med 44:370–377CrossRef

36.

Peterson L, Vasiliadis HS, Brittberg M, Lindahl A (2010) Autologous chondrocyte implantation: a long-term follow-up. Am J Sports Med 38:1117–1124CrossRef

37.

Riboh JC, Cvetanovich GL, Cole BJ, Yanke AB (2017) Comparative efficacy of cartilage repair procedures in the knee: a network meta-analysis. Knee Surg Sports Traumatol Arthrosc 25:3786–3799CrossRef

38.

Rodriguez-Merchan EC (2012) Knee instruments and rating scales designed to measure outcomes. J Orthop Traumatol 13:1–6CrossRef

39.

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

40.

Wondrasch B, Zak L, Welsch GH, Marlovits S (2009) Effect of accelerated weightbearing after matrix-associated autologous chondrocyte implantation on the femoral condyle on radiographic and clinical outcome after 2 years: a prospective, randomized controlled pilot study. Am J Sports Med 37(Suppl 1):88S–96SCrossRef

41.

Zak L, Albrecht C, Wondrasch B, Widhalm H, Vekszler G, Trattnig S et al (2014) Results 2 years after matrix-associated autologous chondrocyte transplantation using the novocart 3D scaffold: an analysis of clinical and radiological data. Am J Sports Med 42:1618–1627CrossRef

Title: Third generation autologous chondrocyte implantation is a good treatment option for athletic persons
Authors: Thomas Richard Niethammer
Daniel Altmann
Martin Holzgruber
Sophia Goller
Andreas Fischer
Peter Ernst Müller
Publication date: 01-04-2021
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 4/2021
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-020-06148-5

At a glance: The STEP trials

Springer Medicine

Third generation autologous chondrocyte implantation is a good treatment option for athletic persons

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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