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All-Arthroscopic Matrix-Associated Autologous Chondrocyte Implantation for a Trochlear Defect.

ABSTRACT: Matrix-associated autologous chondrocyte implantation (MACI) is a 2-step technique designed to treat symptomatic full-thickness articular cartilage defects of the knee. In this technique article, MACI (autologous cultured chondrocytes on porcine collagen membrane) is used to treat a femoral trochlear defect of the knee. Treating a defect with this technique leads to improved clinical outcomes by restoring the native chondral surface architecture and biomechanics of the knee. In addition, it has the potential to prevent or delay further progressive degeneration of the joint. It is a 2-stage procedure consisting of an initial arthroscopic cartilage biopsy, followed by 4 to 6 weeks of in vitro chondrocyte expansion and, finally, re-implantation. We recommend performing the MACI procedure arthroscopically for the second stage to treat a femoral trochlear defect. During the second surgical procedure, we examine and prepare the recipient site, followed by graft introduction in an all-arthroscopic manner via dry scoping, secured by a thin layer of fibrin glue.

SUBMITTER: Zhang T

PROVIDER: S-EPMC10995805 | biostudies-literature | 2024 Mar

REPOSITORIES: biostudies-literature

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All-Arthroscopic Matrix-Associated Autologous Chondrocyte Implantation for a Trochlear Defect.

Zhang Ting T Akhter Fauzan F Almasri Mahmoud M Chilelli Brian J BJ

Arthroscopy techniques 20240111 3

Matrix-associated autologous chondrocyte implantation (MACI) is a 2-step technique designed to treat symptomatic full-thickness articular cartilage defects of the knee. In this technique article, MACI (autologous cultured chondrocytes on porcine collagen membrane) is used to treat a femoral trochlear defect of the knee. Treating a defect with this technique leads to improved clinical outcomes by restoring the native chondral surface architecture and biomechanics of the knee. In addition, it has ...[more]

PMID: 38584623

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Project description:BackgroundMatrix-induced autologous chondrocyte implantation (MACI) was developed for knee cartilage restoration involving seeding autologous chondrocytes onto a collagen membrane. Maintaining chondrocyte viability and achieving proper membrane size and contour are crucial for successful outcomes. Scissor cutting (Sc) has traditionally been used to shape the membrane, but recently, custom cutting (CC) have gained popularity for their enhanced preparation efficiency.PurposeTo determine the difference in chondrocyte viability using the Sc versus CC methods.Study designControlled laboratory study.MethodsUsing Sc and CC methods, 15 mm-diameter circular specimens were cut from 5 residual membranes. Membranes were stained, and confocal microscopy was used to visualize live/dead cells. Three zones were defined: the impact zone (the outermost zone at the cut edge), the central zone (the least manipulated zone), and the adjacent zone (the intermediate zone between the central and impact zones). For each circular specimen, the following measurements were recorded: the dimension of the impact zone, cell viability (percentage of live cells among total) for each zone, and the total number of cells within each zone (as cell density ×105/cm2).ResultsThe width of the impact zone (mean ± standard error) was 355 ± 31 μm and 342 ± 24 μm for CC and Sc, respectively, and the impact zone occupied approximately 10% of the specimen. With both cutting techniques, cell viability was significantly lower in the impact zone (mean ± standard error: CC, 36.42% ± 3.85%; Sc, 40.94% ± 2.85%) compared with the adjacent zone (CC, 77.69% ± 2.97%; Sc, 74.17% ± 2.8%). The cell density from all zones varied from 5.84 ± 0.26 to 6.49 ± 0.34 × 105/cm2, with no significant difference in cell viability in the impact zones between the cutting methods.ConclusionBoth cutting techniques led to a significant reduction in cell viability in the impact zone compared with other zones of the MACI specimen. There was no significant difference in chondrocyte viability or cell density for membranes cut by Sc or CC.Clinical relevanceThis evaluation of the newly introduced CC method on the chondrocyte viability of the MACI membrane will enable surgeons to make a more informed decision regarding cutting techniques.

Project description:BackgroundAutologous chondrocyte implantation (ACI) is an established method for treating cartilage defects in the knee of adult patients. However, less is known about its effectiveness in adolescents.HypothesisThird-generation matrix-associated ACI (MACI) using spheroids (co.don chondrosphere/Spherox) is an effective and safe treatment for articular cartilage defects in adolescents aged 15 to 17 years, with outcomes comparable with those for young adults aged 18 to 34 years.Study designCohort study; Level of evidence, 3.MethodsA total of 71 patients (29 adolescents, 42 young adults) who had undergone ACI using spheroids were evaluated retrospectively in this multicenter study. For adolescents, the mean defect size was 4.6 ± 2.4 cm2, and the follow-up range was 3.5 to 8.0 years (mean, 63.3 months). For young adults, the mean defect size was 4.7 ± 1.2 cm2, and the follow-up range was 3.8 to 4.3 years (mean, 48.4 months). At the follow-up assessment, outcomes were assessed by using validated questionnaires (Knee injury and Osteoarthritis Outcome Score [KOOS], International Knee Documentation Committee [IKDC] subjective knee evaluation form and current health assessment form, and modified Lysholm score), the magnetic resonance observation of cartilage repair tissue (MOCART) score, and if relevant, time to treatment failure. Safety was assessed by the treatment failure rate.ResultsNo significant difference between the 2 study groups was found for KOOS, IKDC, or MOCART scores, with all patients achieving high functional values. A significant difference was found in the modified Lysholm score, favoring the young adult group over the adolescent group (22.3 ± 1.9 vs 21.0 ± 2.4, respectively; P = .0123). There were no differences between the rates of treatment failure, with 3% in the adolescent group and 5% in the young adult group.ConclusionThird-generation MACI using spheroids is a safe and effective treatment for large cartilage defects of the knee in adolescents at midterm follow-up. Outcomes are comparable with those for young adults after ACI.

Project description:BackgroundFocal cartilage injuries in the knee might have devastating effect due to the predisposition of early onset osteoarthritis. Various surgical treatment options are available, however no statistically significant differences have been found between the different surgical treatments. This supports the suggestion that the improvement might be a result of the post-operative rehabilitation rather than the surgery itself. Autologous chondrocyte implantation (ACI) has become a recognized treatment option for larger cartilage lesions in the knee. Although ACI has been compared to other surgical treatment such as microfracture and mosaicplasty, it has never been directly compared to simple arthroscopic debridement and rehabilitation alone. In this study we want to increase clinical and economic knowledge about autologous chondrocyte implantation compared to arthroscopic debridement and physical rehabilitation in the short and long run.Methods/designWe will conduct a randomized controlled trial to compare ACI with simple arthroscopic debridement (AD) and physiotherapy for the treatment of cartilage lesions in the knee. The study will include a total of 82 patients, both men and non-pregnant women, with a full thickness cartilage defect in the weight bearing area of the femoral condyles or trochlea larger than 2 cm2. The lesion must be symptomatic, with a Lysholm score less than 75. The two treatment groups will receive identical rehabilitation protocol according to a modification of Wondrasch et al., which is an active rehabilitation and education program divided into 3 phases: accommodation, rehabilitation and return to activity. The patients will be followed for 24 months, with additional late follow-ups at 5 and 10 years to monitor the potential onset of osteoarthtitis. The primary outcome measure will be the difference in the KOOS knee-related quality of life (QoL) subscore in the ACI group compared to the AD group at 2 years. A combination of self-explanatory questionnaires, clinical parameters, clinical hop tests and radiographs and Magnetic Resonance Imaging (MRI) will be used as secondary endpoints.DiscussionThis is the first study with a high level of evidence to compare ACI with simple debridement and physiotherapy for the treatment of isolated symptomatic full thickness lesions of the knee.Trial registrationClinicalTrial NCT02636881 (21 December 2015).

Project description:BackgroundMatrix-induced autologous chondrocyte implantation (MACI), the third-generation of the technique, is an established procedure for the treatment of focal cartilage defects in the knee. However, the literature lacks long-term results of MACI with good statistical power.PurposeTo determine long-term survival and patient-reported outcomes (PROs) in a representative cohort and to identify patient- and surgery-related parameters that may influence long-term clinical outcomes.Study designCase series; Level of evidence, 4.MethodsA total of 103 patients were clinically evaluated at the current follow-up of 8.1 years (range, 5-11.9 years). PRO measures (PROMs) included the Knee injury and Osteoarthritis Outcome Score (KOOS), EQ-5D, visual analog scale for pain, and Tegner Activity Scale. Magnetic resonance imaging results were evaluated by using the AMADEUS (area measurement and depth and underlying structures) and MOCART (magnetic resonance observation of cartilage repair tissue) 2.0 knee score classification systems. Potential factors influencing PROs were first identified univariately and investigated in a multivariate regression model.ResultsThe defects had a mean size of 4.8 cm2 (range, 1.2-12 cm2) and were predominantly femorotibial (66%). The mean Kaplan-Meier survival rate of revision for any reason was 97.2% ± 1.6% at 10 years. In comparison to preoperative values, all PROMs were significantly improved at the current follow-up (P < .05). The MOCART 2.0 score peaked at 12 months (mean, 80.2 ± 15.3 months) and showed no significant change at 96 months (mean, 76.1 ± 19.5 months; P = .142). The linear multivariate regression model identified an association of body mass index (BMI), MOCART 2.0 score, and number of previous knee surgeries with KOOS (R2 = 0.41; f2 = 0.69). Further analysis of the individual determinants revealed an optimal BMI range of 20 to 29 for favorable PROs at 96 months. Significant correlations of MOCART subscores with the overall KOOS were found for graft surface and structure, bony reaction, and subchondral detectable changes. Only 30% of patients with 2 previous surgeries and 20% of patients with 3 previous surgeries achieved a Patient Acceptable Symptom State (χ2 = 10.93; P = .012).ConclusionThe present study shows consistently good long-term clinical outcomes after MACI with a low revision rate and high patient satisfaction. BMI and number of previous knee surgeries may influence clinical outcomes and should be considered in patient selection and education. There is a correlation between graft structure, subchondral bone changes on magnetic resonance imaging, and long-term PROMs.

Dataset Information

All-Arthroscopic Matrix-Associated Autologous Chondrocyte Implantation for a Trochlear Defect.

Publications

All-Arthroscopic Matrix-Associated Autologous Chondrocyte Implantation for a Trochlear Defect.

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