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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 5/2016

01-05-2016 | Knee

Second-look assessment after all-arthroscopic autologous chondrocyte implantation with spheroides at the knee joint

Authors: Rainer Siebold, Georgios Karidakis, Sven Feil, Francis Fernandez

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 5/2016

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Abstract

Purpose

To report arthroscopic second look as well as clinical results after arthroscopic autologous chondrocyte implantation (ACI) for articular cartilage repair at the knee joint.

Methods

A second-look assessment after arthroscopic ACI using spheroides was performed in 41 patients with 57 full-size articular cartilage defects of the knee. The median time from ACI to second-look arthroscopy was 10 (6–72) months. The ACI was assessed macroscopically and by probing according to the International Cartilage Repair Score (ICRS)–Cartilage Repair Assessment (CRA) to get information on the amount and quality of regeneration. Clinical follow-up with subjective outcome scores was performed an average of 34.5 ± 19.2 months after ACI. Twenty-seven (65.8 %) of ACI’s were combined with additional procedures.

Results

The ICRS-CRA was rated “normal” or “nearly normal” in 52 of 57 (91.3 %) and “abnormal” in 5 (8.8 %) of all cartilage defects. At follow-up, evaluation of KOOS was an average of 81.0 ± 12.9 for pain, 76.8 ± 16.6 for symptoms, 85.1 ± 14.9 for activities of daily living, 55.3 ± 27.7 for sport and recreation and 50.6 ± 23.8 for quality of live. IKDC was 63.0 ± 18.8, Lysholm score was 79.0 ± 18.0, and Tegner score was 4 (1–6). Subjective assessment according to the VAS scale was an average of 7.4 ± 2.1 for overall satisfaction and 6.7 ± 2.5 satisfaction for the operated knee. Seven patients (22.6 %) showed low subjective outcome scores at last follow-up—of these, 2 patients showed a CRA 3 and 5 a CRA 1 or 2.

Conclusion

At second-look arthroscopy, 52 (91.3 %) of all cartilage defects showed a normal or nearly normal macroscopic articular cartilage regeneration after arthroscopic ACI using spheroides. Twenty-four patients (77.4 %) showed good subjective clinical results. The high number of concomitant surgery reflexes the complex aetiology of cartilage lesions and complexity of treatment. Thus, a strict indication and surgical planing is necessary to avoid clinical failures.

Level of evidence

IV.
Literature
1.
Adachi N, Ochi M, Deie M, Nakamae A, Kamei G, Uchio Y, Iwasa J (2014) Implantation of tissue-engineered cartilage-like tissue for the treatment for full-thickness cartilage defects of the knee. Knee Surg Sports Traumatol Arthrosc 22(6):1241–1248CrossRefPubMed
2.
Anderer U, Libera J (2002) In vitro engineering of human autogenous cartilage. J Bone Miner Res 17(8):1420–1429CrossRefPubMed
3.
Bartlett W, Skinner JA, Gooding CR, Carrington RW, Flanagan AM, Briggs TW, Bentley G (2005) Autologous chondrocyte implantation versus matrix-induced autologous chondrocyte implantation for osteochondral defects of the knee: a prospective, randomised study. J Bone Joint Surg Br 87(5):640–645CrossRefPubMed
4.
Bedi A, Feeley BT, Williams RJ 3rd (2010) Management of articular cartilage defects of the knee. J Bone Joint Surg Am 92(4):994–1009CrossRefPubMed
5.
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(14):889–895CrossRefPubMed
6.
Brun P, Dickinson SC, Zavan B, Cortivo R, Hollander AP, Abatangelo G (2008) Characteristics of repair tissue in second-look and third-look biopsies from patients treated with engineered cartilage: relationship to symptomatology and time after implantation. Arthritis Res Ther 10(6):R132CrossRefPubMedPubMedCentral
7.
Cole BJ, Pascual-Garrido C, Grumet RC (2009) Surgical management of articular cartilage defects in the knee. J Bone Joint Surg Am 91(7):1778–1790PubMed
8.
Enea D, Cecconi S, Busilacchi A, Manzotti S, Gesuita R, Gigante A (2012) Matrix-induced autologous chondrocyte implantation (MACI) in the knee. Knee Surg Sports Traumatol Arthrosc 20(5):862–869CrossRefPubMed
9.
Ferruzzi A, Buda R, Faldini C, Vannini F, Di Caprio F, Luciani D, Giannini S (2008) Autologous chondrocyte implantation in the knee joint: open compared with arthroscopic technique. Comparison at a minimum follow-up of five years. J Bone Joint Surg Am 90(Suppl 4):90–101CrossRefPubMed
10.
Fickert S, Gerwien P, Helmert B, Schattenberg T, Weckbach S, Kaszkin-Bettag M, Lehmann L (2012) One-year clinical and radiological results of a prospective, investigator-initiated trial examining a novel, purely autologous 3-dimensional autologous chondrocyte transplantation product in the knee. Cartilage 3(1):27–42CrossRefPubMedPubMedCentral
11.
Fortier LA, Potter HG, Rickey EJ, Schnabel LV, Foo LF, Chong LR, Stokol T, Cheetham J, Nixon AJ (2010) Concentrated bone marrow aspirate improves full-thickness cartilage repair compared with microfracture in the equine model. J Bone Joint Surg Am 92(10):1927–1937CrossRefPubMed
12.
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):1083–1092CrossRefPubMed
13.
Hangody L, Feczko P, Bartha L, Bodo G, Kish G (2001) Mosaicplasty for the treatment of articular defects of the knee and ankle. Clin Orthop Relat Res 391(Suppl):S328–S336CrossRefPubMed
14.
Harris JD, Siston RA, Pan X, Flanigan DC (2010) Autologous chondrocyte implantation: a systematic review. J Bone Joint Surg Am 92(12):2220–2233CrossRefPubMed
15.
Horas U, Pelinkovic D, Herr G, Aigner T, Schnettler R (2003) Autologous chondrocyte implantation and osteochondral cylinder transplantation in cartilage repair of the knee joint. A prospective, comparative trial. J Bone Joint Surg Am 85-A(2):185–192PubMed
16.
Jones DG, Peterson L (2006) Autologous chondrocyte implantation. J Bone Joint Surg Am 88(11):2502–2520PubMed
17.
Knutsen G, Drogset JO, Engebretsen L, Grontvedt T, Isaksen V, Ludvigsen TC, Roberts S, Solheim E, Strand T, Johansen O (2007) A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years. J Bone Joint Surg Am 89(10):2105–2112CrossRefPubMed
18.
Knutsen G, Engebretsen L, Ludvigsen TC, Drogset JO, Grontvedt T, Solheim E, Strand T, Roberts S, Isaksen V, Johansen O (2004) Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial. J Bone Joint Surg Am 86-A(3):455–464PubMed
19.
Kon E, Filardo G, Berruto M, Benazzo F, Zanon G, Della Villa S, Marcacci M (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(12):2549–2557CrossRefPubMed
20.
Kon E, Gobbi A, Filardo G, Delcogliano M, Zaffagnini S, Marcacci M (2009) Arthroscopic second-generation autologous chondrocyte implantation compared with microfracture for chondral lesions of the knee: prospective nonrandomized study at 5 years. Am J Sports Med 37(1):33–41CrossRefPubMed
21.
Kvist J, Ek A, Sporrstedt K, Good L (2005) Fear of re-injury: a hindrance for returning to sports after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 13(5):393–397CrossRefPubMed
22.
Libera J, Ruhnau K, Baum P, Lüthi U, Schreyer T, Meyer U, Wiesmann HP, Herrmann A, Korte T, Pullig O, Siodla V (2009) Cartilage Engineering. In: Meyer U, Handschel J, Wiesmann HP, Meyer T (eds) Fundamentals of tissue engineering and regenerative medicine. Springer, Berlin, pp 233–242CrossRef
23.
Manfredini M, Zerbinati F, Gildone A, Faccini R (2007) Autologous chondrocyte implantation: a comparison between an open periosteal-covered and an arthroscopic matrix-guided technique. Acta Orthop Belg 73(2):207–218PubMed
24.
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):16–23CrossRefPubMed
25.
Meyerkort D, Ebert JR, Ackland TR, Robertson WB, Fallon M, Zheng MH, Wood DJ (2014) Matrix-induced autologous chondrocyte implantation (MACI) for chondral defects in the patellofemoral joint. Knee Surg Sports Traumatol Arthrosc 22(10):2522–2530CrossRefPubMed
26.
Minas T (2001) Autologous chondrocyte implantation for focal chondral defects of the knee. Clin Orthop Relat Res 391(Suppl):S349–S361CrossRefPubMed
27.
Mithofer K, Peterson L, Mandelbaum BR, Minas T (2005) Articular cartilage repair in soccer players with autologous chondrocyte transplantation: functional outcome and return to competition. Am J Sports Med 33(11):1639–1646CrossRefPubMed
28.
Moradi B, Schonit E, Nierhoff C, Hagmann S, Oberle D, Gotterbarm T, Schmitt H, Zeifang F (2012) First-generation autologous chondrocyte implantation in patients with cartilage defects of the knee: 7 to 14 years’ clinical and magnetic resonance imaging follow-up evaluation. Arthroscopy 28(12):1851–1861CrossRefPubMed
29.
Ochi M, Uchio Y, Kawasaki K, Wakitani S, Iwasa J (2002) Transplantation of cartilage-like tissue made by tissue engineering in the treatment of cartilage defects of the knee. J Bone Joint Surg Br 84(4):571–578CrossRefPubMed
30.
Peterson L, Brittberg M, Kiviranta I, Akerlund EL, Lindahl A (2002) Autologous chondrocyte transplantation. Biomechanics and long-term durability. Am J Sports Med 30(1):2–12PubMed
31.
Peterson L, Minas T, Brittberg M, Nilsson A, Sjogren-Jansson E, Lindahl A (2000) Two- to 9-year outcome after autologous chondrocyte transplantation of the knee. Clin Orthop Relat Res 374:212–234CrossRefPubMed
32.
Peterson L, Vasiliadis HS, Brittberg M, Lindahl A (2010) Autologous chondrocyte implantation: a long-term follow-up. Am J Sports Med 38(6):1117–1124CrossRefPubMed
33.
Rosenberger RE, Gomoll AH, Bryant T, Minas T (2008) Repair of large chondral defects of the knee with autologous chondrocyte implantation in patients 45 years or older. Am J Sports Med 36(12):2336–2344CrossRefPubMed
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–19SCrossRefPubMed
35.
Steadman JR, Briggs KK, Rodrigo JJ, Kocher MS, Gill TJ, Rodkey WG (2003) Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy 19(5):477–484CrossRefPubMed
36.
Zaslav K, Cole B, Brewster R, DeBerardino T, Farr J, Fowler P, Nissen C (2009) A prospective study of autologous chondrocyte implantation in patients with failed prior treatment for articular cartilage defect of the knee: results of the Study of the Treatment of Articular Repair (STAR) clinical trial. Am J Sports Med 37(1):42–55CrossRefPubMed
Metadata
Title
Second-look assessment after all-arthroscopic autologous chondrocyte implantation with spheroides at the knee joint
Authors
Rainer Siebold
Georgios Karidakis
Sven Feil
Francis Fernandez
Publication date
01-05-2016
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 5/2016
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-015-3822-2

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