Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-07-2015 | Arthroscopy and Sports Medicine

Repair of retropatellar cartilage defects in the knee with microfracture and a cell-free polymer-based implant

Authors: Christoph Becher, Max Ettinger, Marco Ezechieli, Christian Kaps, Marc Ewig, Tomas Smith

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 7/2015

Abstract

Introduction

To analyze magnetic resonance imaging (MRI) at 3T and the clinical outcome in a short-term pilot study after treatment of retropatellar cartilage defects with microfracturing and subsequent covering with the cell-free chondrotissue^® polyglycolic acid–hyaluronan implant.

Methods

Five consecutive patients after microfracturing and defect coverage with the chondrotissue^® implant immersed with autologous serum were included. After a mean follow-up of 21 months (range 11–31 months), defect fill and repair tissue quality was assessed by 3-T MRI followed by applying established MRI scoring systems. The patients’ situation was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS) and a patients’ satisfaction questionnaire.

Results

Magnetic resonance imaging showed good to excellent defect fill with complete integration. The mean MOCART score was 61 (range 50–75) points. The mean Henderson score was 7 (range 6–9) points. All patients showed subchondral bone alterations. The KOOS showed good values in all sub-categories in 4 out of 5 patients and a mean overall score of 73 (range 40–90) points. Two patients rated the outcome as excellent, two as good and one as fair. All patients would have the procedure again and recommend it.

Conclusions

In this small case series, the coverage of symptomatic retropatellar cartilage defects with the chondrotissue^® implant after microfracturing was safe and feasible with improvement of the patients’ situation at short-term follow-up.

Level of evidence

IV, case series.

Davies-Tuck ML, Wluka AE, Wang Y, Teichtahl AJ, Jones G, Ding C, Cicuttini FM (2008) The natural history of cartilage defects in people with knee osteoarthritis. Osteoarthr Cartil 16(3):337–342PubMedCrossRef

Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG (1997) Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy 13(4):456–460PubMedCrossRef

Hjelle K, Solheim E, Strand T, Muri R, Brittberg M (2002) Articular cartilage defects in 1,000 knee arthroscopies. Arthroscopy 18(7):730–734PubMedCrossRef

Widuchowski W, Lukasik P, Kwiatkowski G, Faltus R, Szyluk K, Widuchowski J, Koczy B (2008) Isolated full thickness chondral injuries. Prevalance and outcome of treatment. A retrospective study of 5233 knee arthroscopies. Acta Chir Orthop Traumatol Cech 75(5):382–386PubMed

Widuchowski W, Widuchowski J, Trzaska T (2007) Articular cartilage defects: study of 25,124 knee arthroscopies. Knee 14(3):177–182PubMedCrossRef

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

Rhee SJ, Pavlou G, Oakley J, Barlow D, Haddad F (2012) Modern management of patellar instability. Int Orthop 36(12):2447–2456PubMedCentralPubMedCrossRef

Astur DC, Arliani GG, Binz M, Astur N, Kaleka CC, Amaro JT, Pochini A, Cohen M (2014) Autologous osteochondral transplantation for treating patellar chondral injuries: evaluation, treatment, and outcomes of a two-year follow-up study. J Bone Joint Surg Am 96(10):816–823PubMedCrossRef

Gobbi A, Kon E, Berruto M, Filardo G, Delcogliano M, Boldrini L, Bathan L, Marcacci M (2009) Patellofemoral full-thickness chondral defects treated with second-generation autologous chondrocyte implantation: results at 5 years’ follow-up. Am J Sports Med 37(6):1083–1092PubMedCrossRef

10.

Kreuz PC, Steinwachs MR, Erggelet C, Krause SJ, Konrad G, Uhl M, Sudkamp N (2006) Results after microfracture of full-thickness chondral defects in different compartments in the knee. Osteoarthr Cartil 14(11):1119–1125PubMedCrossRef

11.

Niemeyer P, Steinwachs M, Erggelet C, Kreuz PC, Kraft N, Kostler W, Mehlhorn A, Sudkamp NP (2008) Autologous chondrocyte implantation for the treatment of retropatellar cartilage defects: clinical results referred to defect localisation. Arch Orthop Trauma Surg 128(11):1223–1231PubMedCrossRef

12.

Gomoll AH (2012) Microfracture and augments. J Knee Surg 25(1):9–15PubMedCrossRef

13.

Steadman JR, Rodkey WG, Rodrigo JJ (2001) Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop Relat Res 391(Suppl):S362–S369PubMedCrossRef

14.

Gobbi A, Karnatzikos G, Kumar A (2014) Long-term results after microfracture treatment for full-thickness knee chondral lesions in athletes. Knee Surg Sports Traumatol Arthrosc 22(9):1986–1996PubMedCrossRef

15.

Mithoefer K, McAdams T, Williams RJ, Kreuz PC, Mandelbaum BR (2009) Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: an evidence-based systematic analysis. Am J Sports Med 37(10):2053–2063PubMedCrossRef

16.

Mithoefer K, Williams RJ 3rd, Warren RF, Potter HG, Spock CR, Jones EC, Wickiewicz TL, Marx RG (2005) The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospective cohort study. J Bone Joint Surg Am 87(9):1911–1920PubMedCrossRef

17.

Freymann U, Petersen W, Kaps C (2013) Cartilage regeneration revisited: entering of new one-step procedures for chondral cartilage repair. OA Orthopaedics 1(1):6CrossRef

18.

Anders S, Volz M, Frick H, Gellissen J (2013) A randomized, controlled trial comparing autologous matrix-induced chondrogenesis (AMIC(R)) to microfracture: analysis of 1- and 2-year follow-up data of 2 centers. Open Orthop J 7:133–143PubMedCentralPubMedCrossRef

19.

Benthien JP, Behrens P (2011) 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 19(8):1316–1319PubMedCrossRef

20.

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(11):1456–1464PubMedCrossRef

21.

Stanish WD, McCormack R, Forriol F, Mohtadi N, Pelet S, Desnoyers J, Restrepo A, Shive MS (2013) Novel scaffold-based BST-CarGel treatment results in superior cartilage repair compared with microfracture in a randomized controlled trial. J Bone Joint Surg Am 95(18):1640–1650PubMedCrossRef

22.

Erggelet C, Endres M, Neumann K, Morawietz L, Ringe J, Haberstroh K, Sittinger M, Kaps C (2009) Formation of cartilage repair tissue in articular cartilage defects pretreated with microfracture and covered with cell-free polymer-based implants. J Orthop Res 27(10):1353–1360PubMedCrossRef

23.

Erggelet C, Neumann K, Endres M, Haberstroh K, Sittinger M, Kaps C (2007) Regeneration of ovine articular cartilage defects by cell-free polymer-based implants. Biomaterials 28(36):5570–5580PubMedCrossRef

24.

Zantop T, Petersen W (2009) Arthroscopic implantation of a matrix to cover large chondral defect during microfracture. Arthroscopy 25(11):1354–1360PubMedCrossRef

25.

Patrascu JM, Freymann U, Kaps C, Poenaru DV (2010) Repair of a post-traumatic cartilage defect with a cell-free polymer-based cartilage implant: a follow-up at two years by MRI and histological review. J Bone Joint Surg Br 92(8):1160–1163PubMedCrossRef

26.

Siclari A, Mascaro G, Gentili C, Kaps C, Cancedda R, Boux E (2014) Cartilage repair in the knee with subchondral drilling augmented with a platelet-rich plasma-immersed polymer-based implant. Knee Surg Sports Traumatol Arthrosc 22(6):1225–1234PubMedCrossRef

27.

Siclari A, Mascaro G, Kaps C, Boux E (2014) A 5-year follow-up after cartilage repair in the knee using a platelet-rich plasma-immersed polymer-based implant. Open Orthop J 8:346–354PubMedCentralPubMedCrossRef

28.

Dhollander AA, Verdonk PC, Lambrecht S, Almqvist KF, Elewaut D, Verbruggen G, Verdonk R (2012) The combination of microfracture and a cell-free polymer-based implant immersed with autologous serum for cartilage defect coverage. Knee Surg Sports Traumatol Arthrosc 20(9):1773–1780PubMedCrossRef

29.

Enea D, Cecconi S, Calcagno S, Busilacchi A, Manzotti S, Kaps C, Gigante A (2013) Single-stage cartilage repair in the knee with microfracture covered with a resorbable polymer-based matrix and autologous bone marrow concentrate. Knee 20(6):562–569PubMedCrossRef

30.

Outerbridge RE (1961) The etiology of chondromalacia patellae. J Bone Joint Surg Br 43-B:752–757PubMed

31.

Marlovits S, Singer P, Zeller P, Mandl I, Haller J, Trattnig 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(1):16–23PubMedCrossRef

32.

Henderson IJ, Tuy B, Connell D, Oakes B, Hettwer WH (2003) Prospective clinical study of autologous chondrocyte implantation and correlation with MRI at three and 12 months. J Bone Joint Surg Br 85(7):1060–1066PubMedCrossRef

33.

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(2):88–96PubMedCrossRef

34.

Saris DB, 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(Suppl 1):10S–19SPubMedCrossRef

35.

Van Assche D, Staes F, Van Caspel D, Vanlauwe J, Bellemans J, Saris DB, Luyten FP (2010) Autologous chondrocyte implantation versus microfracture for knee cartilage injury: a prospective randomized trial, with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc 18(4):486–495PubMedCrossRef

36.

Vasiliadis HS, Wasiak J, Salanti G (2010) Autologous chondrocyte implantation for the treatment of cartilage lesions of the knee: a systematic review of randomized studies. Knee Surg Sports Traumatol Arthrosc 18(12):1645–1655PubMedCrossRef

37.

Dhollander AA, De Neve F, Almqvist KF, Verdonk R, Lambrecht S, Elewaut D, Verbruggen G, Verdonk PC (2011) Autologous matrix-induced chondrogenesis combined with platelet-rich plasma gel: technical description and a five pilot patients report. Knee Surg Sports Traumatol Arthrosc 19(4):536–542PubMedCrossRef

38.

Dhollander A, Moens K, Van der Maas J, Verdonk P, Almqvist KF, Victor J (2014) Treatment of patellofemoral cartilage defects in the knee by autologous matrix-induced chondrogenesis (AMIC). Acta Orthop Belg 80(2):251–259PubMed

39.

Tompkins M, Hamann JC, Diduch DR, Bonner KF, Hart JM, Gwathmey FW, Milewski MD, Gaskin CM (2013) Preliminary results of a novel single-stage cartilage restoration technique: particulated juvenile articular cartilage allograft for chondral defects of the patella. Arthroscopy 29(10):1661–1670PubMedCrossRef

40.

Vanlauwe JJ, Claes T, Van Assche D, Bellemans J, Luyten FP (2012) Characterized chondrocyte implantation in the patellofemoral joint: an up to 4-year follow-up of a prospective cohort of 38 patients. Am J Sports Med 40(8):1799–1807PubMedCrossRef

41.

Cole BJ, Farr J, Winalski CS, Hosea T, Richmond J, Mandelbaum B, De Deyne PG (2011) Outcomes after a single-stage procedure for cell-based cartilage repair: a prospective clinical safety trial with 2-year follow-up. Am J Sports Med 39(6):1170–1179PubMedCrossRef

42.

Proffen B, von Keudell A, Vavken P (2012) Evidence-based therapy for cartilage lesions in the knee—regenerative treatment options. Z Orthop Unfall 150(3):280–289PubMed

43.

Shive MS, Restrepo A, Totterman S, Tamez-Pena J, Schreyer E, Steinwachs M, Stanish WD (2014) Quantitative 3D MRI reveals limited intra-lesional bony overgrowth at 1 year after microfracture-based cartilage repair. Osteoarthr Cartil 22(6):800–804PubMedCrossRef

44.

Mouzopoulos G, Borbon C, Siebold R (2011) Patellar chondral defects: a review of a challenging entity. Knee Surg Sports Traumatol Arthrosc 19(12):1990–2001PubMedCrossRef

Title: Repair of retropatellar cartilage defects in the knee with microfracture and a cell-free polymer-based implant
Authors: Christoph Becher
Max Ettinger
Marco Ezechieli
Christian Kaps
Marc Ewig
Tomas Smith
Publication date: 01-07-2015
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 7/2015
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-015-2235-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Repair of retropatellar cartilage defects in the knee with microfracture and a cell-free polymer-based implant

Abstract

Introduction

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Level of evidence

Please log in to get access to this content

Other articles of this Issue 7/2015

Topical and intravenous tranexamic acid reduce blood loss compared to routine hemostasis in total knee arthroplasty: a multicenter, randomized, controlled trial

The course of the median and radial nerve across the elbow: an anatomic study

A new universal, standardized implant database for product identification: a unique tool for arthroplasty registries

Displaced supracondylar humeral fractures: influence of delay of surgery on the incidence of open reduction, complications and outcome

Does intraoperative application of leukocyte-poor platelet-rich plasma during arthroscopy for knee degeneration affect postoperative pain, function and quality of life? A 12-month randomized controlled double-blind trial

Patient-reported outcome assessment after total joint replacement: comparison of questionnaire completion times on paper and tablet computer