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J Knee Surg 2018; 31(09): 851-857
DOI: 10.1055/s-0037-1615811
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Bilayer Matrix Autologous Chondrocyte Implantation without Bone Graft for Knee Osteochondral Lesion Less than 8 mm Deep

Murat Bozkurt
1   Department of Orthopedics and Traumatology, Yildirim Beyazit University, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
,
Cetin Isik
1   Department of Orthopedics and Traumatology, Yildirim Beyazit University, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
,
Safa Gursoy
2   Department of Orthopedics and Traumatology, Yenimahalle Training and Research Hospital, Ankara, Turkey
,
Mustafa Akkaya
2   Department of Orthopedics and Traumatology, Yenimahalle Training and Research Hospital, Ankara, Turkey
,
Oktay Algin
3   Department of Radiology, Yildirim Beyazit University, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
,
Metin Dogan
1   Department of Orthopedics and Traumatology, Yildirim Beyazit University, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
› Author Affiliations
Further Information

Publication History

28 June 2017

22 November 2017

Publication Date:
28 December 2017 (online)

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Abstract

This article investigates the clinical and radiological results of bilayer matrix autologous chondrocyte implantation (MACI) membrane technique in the treatment of shallow osteochondral defects. An analysis was made of eight patients who were operated on using the bilayer MACI (Genzyme Biosurgery, Cambridge, MA) technique (mean age: 20.2 years, mean defect size: 3.8 cm2, mean defect depth: 6.2 ± 0.9 mm, and mean follow-up time: 22.1 ± 5.3 [14–26.1] months). According to the defect, the first membrane was secured to the base of the defect with the cells facing up, and the second membrane was implanted on top of the first membrane with the cells facing down using fibrin glue. Clinical assessment was performed with modified Cincinnati and Tegner Lysholm scores. Patients were evaluated using 3-Tesla magnetic resonance imaging (3T MRI) with a 15-channel transmit knee coil in the 6th, 12th, and 24th months postoperatively. Magnetic observation of cartilage repair tissue (MOCART) scoring was used to evaluate the cartilage tissue. The mean modified Cincinnati score was 36.4 (21–48) preoperatively and 84.2 (81–90) at 6 months postoperatively, 87.2 (82–92) at 12 months, and 89.6 (85–94) at 24 months (p < 0.05). The postoperative results were evaluated as excellent. The mean Tegner Lysholm score was 36.4 (21–48) preoperatively and 88.2 (84–92), 90.2 (84–95), and 90.4 (86–95) at 6, 12, and 24 months postoperatively (p < 0.05). According to the 3T MRI findings, the mean modified MOCART scores were 8 in the preimplantation period, 38 in the 6th postoperative month, 70 in the 12th postoperative month, and 79 in the 24th postoperative month (p < 0.05). The 2-year follow-up MRI showed good regeneration, healing, and integration developing in time in cartilage tissue. In the treatment of shallow osteochondral defects, the bilayer MACI technique can be an alternative to filling the defect with bone graft.

Keywords

articular cartilage - magnetic resonance imaging - knee - autologous chondrocyte

Note

This study was originally presented at the International Cartilage Repair Society (ICRS) World Congress, 2013.


 

  • References

  • 1 Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG. Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy 1997; 13 (04) 456-460
    CrossrefPubMedSearch in Google Scholar
  • 2 Schreiber GB, Busch MP, Kleinman SH, Korelitz JJ. The risk of transfusion-transmitted viral infections. The Retrovirus Epidemiology Donor Study. N Engl J Med 1996; 334 (26) 1685-1690
    CrossrefPubMedSearch in Google Scholar
  • 3 Tomford WW. Transmission of disease through transplantation of musculoskeletal allografts. J Bone Joint Surg Am 1995; 77 (11) 1742-1754
    CrossrefPubMedSearch in Google Scholar
  • 4 Andrade R, Vasta S, Pereira R. , et al. Knee donor-site morbidity after mosaicplasty - a systematic review. J Exp Orthop 2016; 3 (01) 31
    CrossrefPubMedSearch in Google Scholar
  • 5 Bartlett W, Skinner JA, Gooding CR. , et al. Autologous chondrocyte implantation versus matrix-induced autologous chondrocyte implantation for osteochondral defects of the knee: a prospective, randomised study. J Bone Joint Surg Br 2005; 87 (05) 640-645
    CrossrefPubMedSearch in Google Scholar
  • 6 Iwasa J, Engebretsen L, Shima Y, Ochi M. Clinical application of scaffolds for cartilage tissue engineering. Knee Surg Sports Traumatol Arthrosc 2009; 17 (06) 561-577
    CrossrefPubMedSearch in Google Scholar
  • 7 Behrens P, Bitter T, Kurz B, Russlies M. Matrix-associated autologous chondrocyte transplantation/implantation (MACT/MACI)--5-year follow-up. Knee 2006; 13 (03) 194-202
    CrossrefPubMedSearch in Google Scholar
  • 8 Bartlett W, Gooding CR, Carrington RW, Skinner JA, Briggs TW, Bentley G. Autologous chondrocyte implantation at the knee using a bilayer collagen membrane with bone graft. A preliminary report. J Bone Joint Surg Br 2005; 87 (03) 330-332
    PubMedSearch in Google Scholar
  • 9 Brun P, Dickinson SC, Zavan B, Cortivo R, Hollander AP, Abatangelo G. 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 2008; 10 (06) R132
    CrossrefPubMedSearch in Google Scholar
  • 10 Peterson L. Chondrocyte transplantation. In: Jackson DW. , ed. Master Techniques in Orthopaedic Surgery: Reconstructive Knee Surgery. Philadelphia: Lippincott, Williams & Wilkins; 2003: 353-373
    Search in Google Scholar
  • 11 Dimitriou R, Mataliotakis GI, Angoules AG, Kanakaris NK, Giannoudis PV. Complications following autologous bone graft harvesting from the iliac crest and using the RIA: a systematic review. Injury 2011; 42 (Suppl. 02) S3-S15
    PubMedSearch in Google Scholar
  • 12 Peterson L, Minas T, Brittberg M, Lindahl A. Treatment of osteochondritis dissecans of the knee with autologous chondrocyte transplantation: results at two to ten years. J Bone Joint Surg Am 2003; 85-A (Suppl. 02) 17-24
    PubMedSearch in Google Scholar
  • 13 Ebert JR, Robertson WB, Lloyd DG, Zheng MH, Wood DJ, Ackland T. A prospective, randomized comparison of traditional and accelerated approaches to postoperative rehabilitation following autologous chondrocyte implantation: 2-year clinical outcomes. Cartilage 2010; 1 (03) 180-187
    CrossrefPubMedSearch in Google Scholar
  • 14 Peterson L, Minas T, Brittberg M, Nilsson A, Sjögren-Jansson E, Lindahl A. Two- to 9-year outcome after autologous chondrocyte transplantation of the knee. Clin Orthop Relat Res 2000; (374) 212-234
    PubMedSearch in Google Scholar
  • 15 Minas T, Peterson L. Advanced techniques in autologous chondrocyte transplantation. Clin Sports Med 1999; 18 (01) 13-44
    CrossrefPubMedSearch in Google Scholar
  • 16 Levy YD, Görtz S, Pulido PA, McCauley JC, Bugbee WD. Do fresh osteochondral allografts successfully treat femoral condyle lesions?. Clin Orthop Relat Res 2013; 471 (01) 231-237
    CrossrefPubMedSearch in Google Scholar
  • 17 LaPrade RF, Botker J, Herzog M, Agel J. Refrigerated osteoarticular allografts to treat articular cartilage defects of the femoral condyles. A prospective outcomes study. J Bone Joint Surg Am 2009; 91 (04) 805-811
    CrossrefPubMedSearch in Google Scholar
  • 18 Iwasaki N, Kato H, Kamishima T, Suenaga N, Minami A. Donor site evaluation after autologous osteochondral mosaicplasty for cartilaginous lesions of the elbow joint. Am J Sports Med 2007; 35 (12) 2096-2100
    CrossrefPubMedSearch in Google Scholar
  • 19 Petersen EF, Fishbein KW, Laouar L, Spencer RG, Wenz JF. Ex vivo magnetic resonance microscopy of an osteochondral transfer. J Magn Reson Imaging 2003; 17 (05) 603-608
    CrossrefPubMedSearch in Google Scholar
  • 20 Reddy S, Pedowitz DI, Parekh SG, Sennett BJ, Okereke E. The morbidity associated with osteochondral harvest from asymptomatic knees for the treatment of osteochondral lesions of the talus. Am J Sports Med 2007; 35 (01) 80-85
    CrossrefPubMedSearch in Google Scholar
  • 21 Bakay A, Csönge L, Papp G, Fekete L. Osteochondral resurfacing of the knee joint with allograft. Clinical analysis of 33 cases. Int Orthop 1998; 22 (05) 277-281
    CrossrefPubMedSearch in Google Scholar
  • 22 Li X, Ding J, Wang J, Zhuang X, Chen X. Biomimetic biphasic scaffolds for osteochondral defect repair. Regen Biomater 2015; 2 (03) 221-228
    CrossrefPubMedSearch in Google Scholar
  • 23 Christensen BB, Foldager CB, Jensen J, Jensen NC, Lind M. Poor osteochondral repair by a biomimetic collagen scaffold: 1- to 3-year clinical and radiological follow-up. Knee Surg Sports Traumatol Arthrosc 2016; 24 (07) 2380-2387
    CrossrefPubMedSearch in Google Scholar
  • 24 Tallheden T, Dennis JE, Lennon DP, Sjögren-Jansson E, Caplan AI, Lindahl A. Phenotypic plasticity of human articular chondrocytes. J Bone Joint Surg Am 2003; 85-A (Suppl. 02) 93-100
    PubMedSearch in Google Scholar