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Open Access 01-06-2021 | Original Paper

Effect of the defect localization and size on the success of third-generation autologous chondrocyte implantation in the knee joint

Authors: Thomas R. Niethammer, David Gallik, Y. Chevalier, Martin Holzgruber, Andrea Baur-Melnyk, Peter E. Müller, Matthias F. Pietschmann

Published in: International Orthopaedics | Issue 6/2021

Abstract

Introduction

Femoral and patellar cartilage defects with a defect size > 2.5 cm² are a potential indication for an autologous chondrocyte implantation (ACI). However, the influence of the localization and the absolute and relative defect size on the clinical outcome has not yet been determined. The purpose of this study is to analyze the influence of the localization and the absolute and relative defect size on the clinical outcome after third-generation autologous chondrocyte implantation.

Methods

A total of 50 patients with cartilage defects of the knee were treated with third-generation autologous chondrocyte implantation (Novocart® 3D). A match paired analysis was performed of 25 treated femoral and 25 treated patella defects with a follow-up of three years. MRI data was used to do the manual segmentation of the cartilage layer throughout the knee joint. The defect size was determined by taking the defect size measured in the MRI in relation to the whole cartilage area. The clinical outcome was measured by the IKDC score and VAS pre-operatively and after six, 12, 24, and 36 months post-operatively.

Results

IKDC and VAS scores showed a significant improvement from the baseline in both groups. Femoral cartilage defects showed significantly superior clinical results in the analyzed scores compared to patellar defects. The femoral group improved IKDC from 33.9 (SD 18.1) pre-operatively to 71.5 (SD 17.4) after three years and the VAS from 6.9 (SD 2.9) pre-operatively to 2.4 (SD 2.5) after three years. In the patellar group, IKDC improved from 36.1 (SD 12.6) pre-operatively to 54.7 (SD 20.3) after three years and the VAS improved from 6.7 (SD 2.8) pre-operatively to 3.4 (SD 2.) after three years. Regarding the defect size, results showed that the same absolute defect size at med FC (4.8, range 2–15) and patella (4.6, range 2–12) has a significantly different share of the total cartilaginous size of the joint compartment (med FC: 6.7, range 1.2–13.9; pat: 18.9, range 4.0–47.0). However, there was no significant influence of the relative defect size on the clinical outcome in either patellar or femoral localization.

Conclusion

Third-generation autologous chondrocyte implantation in ACI-treated femoral cartilage defects leads to a superior clinical outcome in a follow-up of three years compared with patellar defects. No significant influence of the defect size was found in either femoral or patellar cartilage defects.

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Title: Effect of the defect localization and size on the success of third-generation autologous chondrocyte implantation in the knee joint
Authors: Thomas R. Niethammer
David Gallik
Y. Chevalier
Martin Holzgruber
Andrea Baur-Melnyk
Peter E. Müller
Matthias F. Pietschmann
Publication date: 01-06-2021
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 6/2021
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-020-04884-4

At a glance: The STEP trials

Springer Medicine

Effect of the defect localization and size on the success of third-generation autologous chondrocyte implantation in the knee joint

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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