Autologous chondrocyte implantation

Rationale for the treatment of cartilage damage in younger patients depends on a thorough understanding of the predisposing factors for the chondrosis and the stage of disease. Implantation with autologous cultured chondrocytes allows for resurfacing of larger defect areas with reproducibly good/excellent results in 90% of patients with isolated lesions of the femoral condyle. Patellar lesions also may be successfully treated (approximately 75% improved) but strict attention must be given to correction of malalignment. Results in patients with tibial and salvage lesions are encouraging; however, these results should be viewed with caution due to the small number of patients with 2-year follow-up. Autologous chondrocyte implantation involves an open technique with the inherent disadvantages of adhesions and a more prolonged recovery. However, these disadvantages must be weighed against the procedure's ability to produce a hyaline-type tissue with greater durability than fibrocartilage repairs produced by traditional marrow-stimulation techniques. We recommended matching the treatment procedure to patient expectations and lesion/demographic characteristics. Based on the available literature. algorithms have been published that recommend autologous chondrocyte implantation be reserved as first-line treatment for high-demand patients with large lesions (>2 cm2) and as revision therapy in patients with lesions of all sizes, regardless of patient demand, who have failed alternative marrow stimulation techniques.     

Autologous chondrocyte transplantation of the ankle

Autologous chondrocyte transplantation has been used in the treatment of chondral and osteochondral lesions in a limited number of patients. The results are promising over a medium-length follow-up (2-6 years). Deeper involvement of the subchondral bone may need autologous bone grafting along with ACT. Future long-term, comparative studies are needed to evaluate the efficacy and safety of the treatment.     

Autologous chondrocyte implantation: a systematic review

OBJECTIVE: To critically analyze the existing literature relating to autologous chondrocyte implantation (ACI) and thereby to ascertain whether the technique is clinically effective and safe. METHODS: Using predefined criteria, we searched a number of automated databases, such as MEDLINE, EMBASE, Cochrane, CRD, etc., for relevant articles, which were then analyzed by two independent reviewers. RESULTS: Three clinical trials and nine case series were evaluated. The clinical trials yielded no evidence that ACI was superior to the therapeutic alternatives with which it was compared. In contrast, the case series revealed an improvement in patients. However, as with the clinical trials, the follow-up periods were usually very short. In general, few adverse effects were observed, indicating that ACI is a safe technique. CONCLUSION: Available data afford no evidence that ACI is more effective than other conventional techniques in treating chondral lesions of the knee.     

Autologous chondrocyte implantation: an overview of technique and outcomes

Articular cartilage is susceptible to damage; however, it has limited capacity for repair. Damage can lead to persistent symptoms including pain, swelling, and loss of function and may ultimately progress to symptomatic degeneration of the joint. To restore function and minimize symptoms, many advocate surgical intervention in selected candidates, which can range from arthroscopic debridement to restorative procedures depending on patient and lesion characteristics. Autologous Chondrocyte Implantation (ACI) is a two-stage, typically second-line intervention where cultured autologous chondrocytes are used with the aim of resurfacing symptomatic chondral defects with hyaline or hyaline-like cartilage. Careful patient selection is important. We present an overview of this procedure including indications and contraindications, surgical technique, and post-operative management. A review of published ACI outcomes is then presented.     

Autologous chondrocyte transplantation for osteochondritis dissecans of the talus

Eight patients with osteochondritis dissecans of the talus were reviewed. The average followup was 17.6 months (range, 8-26 months). The mean age of the patients was 31.8 years (range, 22-42 years). All patients had a preoperative examination, magnetic resonance imaging, and radiologic classification of the lesion through regular anteroposterior and lateral radiographs. Diagnostic arthroscopy and biopsies of healthy cartilage were done, which then had chondrocyte extraction and culture. After an average of 2.5 weeks, an arthrotomy, malleolar osteotomy, subchondral bone sclerosis debridement, and autologous chondrocyte transplantation were done. The postoperative treatment included nonweightbearing for 6 to 7 weeks, physiotherapy, and continuous passive motion. According to the postoperative evaluation score, all results were excellent to good with an average score of 0.6. No complications occurred. The arthroscopic reexamination of three patients at the sixth postoperative month and the radiologic evaluation of all patients showed the existence of cartilagelike tissue with complete coverage of the chondral defect. This method enables reconstructive intervention for unicompartmental defects of articular cartilage through implantation of new chondrocytes, establishment of a subchondral blood supply, and reconstruction of the articular surface.     

Autologous versus pooled human serum for articular chondrocyte growth

PURPOSE. To evaluate the effect of autologous human serum (AHS) versus pooled human serum (PHS) versus foetal bovine serum (FBS) for growth of articular chondrocytes and formation of chondrocytefibrin constructs. METHODS. Experiments with monolayer culture expansion of human articular chondrocytes were performed using basic culture media supplemented with 10% AHS, PHS, or FBS. Growth kinetics and specific phenotypic expression of the serially expanded chondrocytes were evaluated. Large-scale culture expansion was used to obtain about 30 million cells to form chondrocyte-fibrin constructs. All constructs were implanted subcutaneously at the dorsum part of athymic nude mice for 8 weeks. The in vivo constructs were evaluated using histological and gene expression studies. RESULTS. The morphology of primary cultured chondrocytes (P0) was polygonal and became more elongated and larger after serial passages (P1, P2, and P3). This was comparable for AHS, PHS, and FBS. Total cell yields accumulated for AHS (28 million) and PHS (41 million) were significantly higher than those for FBS (4 million). After 8 weeks of implantation, in vivo chondrocyte-fibrin constructs demonstrated a glistening white and firm texture, comparable to normal hyaline cartilage. All constructs exhibited histo-architectural characteristics of well-distributed cartilage-isolated cells embedded within basophilic ground substance. Presence of accumulated proteoglycans cartilage-rich matrix was indicated by positive orange-red Safranin O staining. During monolayer culture expansion, collagen type II gene expression was down-regulated, while collagen type I gene expression was up-regulated. Collagen type II--the specific chondrogenesis marker--was re-expressed in the in vivo chondrocyte-fibrin construct. CONCLUSION. AHS and PHS are better than FBS for in vitro cultivation of human articular chondrocytes.     

Autologous chondrocyte implantation and anteromedialization in the treatment of patellofemoral chondrosis

Patellofemoral articular cartilage lesions are challenging to treat. While treatment with tibial tuberosity anteromedialization (AMZ) is effective for isolated distal lateral patellar lesions, other patellar or trochlear lesions have suboptimal outcomes with AMZ. Historically, when autologous cultured chondroctye implantation (ACI) was used at the patellofemoral compartment without optimizing the contact areas, the results were poor. In recent years, the combination of AMZ and ACI has yielded overall outcomes superior to either technique used in isolation for large patellar and trochlear chondral lesions.     

Autologous chondrocyte implantation. A review of techniques and preliminary results

The treatment of deep focal bone and cartilage defects in weight-bearing areas of the knee remains challenging. Autologous chondrocyte implantation is a recently introduced alternative to drilling and mosaicplasty and is gaining ground in France under the impetus of favorable results obtained in other countries in highly selected cases. The technique and preliminary results are discussed herein.     

Autologous chondrocyte transplantation in osteochondral lesions of the ankle joint

The aim of this study was to assess the repair of osteochondral defects of the ankle joint with hyaline cartilage. For this purpose we have been using a technique of autologous chondrocyte transplantation for osteochondral defects of the talus for the last two years. Until the method described in the paper, treatment methods proposed for the repair of cartilaginous defects have not been histologically effective in restoring the hyaline cartilage sheath, and in all cases the neoformation of cartilage was of a fibrocartilaginous nature with varying cellular characteristics. Clinical and histological results obtained using this surgical technique have confirmed its validity. Furthermore, neither subjective nor objective complications have been reported. Less pain and better articular function have also been observed. According to the AOFAS score, an improvement from an average score of 32/100 points pre-op. to 91/100 points at 24 months of follow up was obtained. Laboratory data have confirmed the presence of reconstructed cartilage with chondrocytes and expression of collagen II, characteristic of hyaline cartilage.     

Autologous chondrocyte implantation: where do we stand now?

Chondral damage to the young knee is common. In symptomatic patients current surgical treatment has focused on filling the defect with fibrocartilage; however, this tissue has poor resistance to shear forces, leading to failure and the onset of degenerative osteoarthritis.     

Autologous chondrocyte transplantation for treating cartilage defects of the talus

BACKGROUND: Despite its highly specialized nature, articular cartilage has a poor reparative capability. Treatment of symptomatic osteochondral defects of the talus has been especially difficult until now. METHODS: We performed autologous chondrocyte transplantation in twelve patients with a focal deep cartilage lesion of the talus. There were seven female and five male patients with a mean age of 29.7 years. The mean size of the lesion was 2.3 cm(2). All patients were studied prospectively. Evaluation was performed with use of the Hannover ankle rating score, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, a visual analogue scale for pain, and magnetic resonance imaging. RESULTS: All patients were available for follow-up at a mean of sixty-three months. There was a significant improvement in the Hannover score, from 40.4 points preoperatively to 85.5 points at the follow-up examination, with seven excellent results, four good results, and one satisfactory result. The AOFAS mean score was 88.4 points compared with 43.5 points preoperatively. Magnetic resonance imaging showed a nearly congruent joint surface in seven patients, discrete irregularities in four, and an incongruent surface in one. The patients who had been involved in competitive sports were able to return to their full activity level. CONCLUSIONS: The promising clinical results of this study suggest that autologous chondrocyte transplantation is an effective and safe way to treat symptomatic osteochondral defects of the talus in appropriately selected patients.     

Autologous chondrocyte implantation for osteochondral lesions in the knee using a bilayer collagen membrane and bone graft: a two- to eight-year follow-up study

Matrix-induced autologous chondrocyte implantation (MACI) is an established technique used to treat osteochondral lesions in the knee. For larger osteochondral lesions (> 5 cm(2)) deeper than approximately 8 mm we have combined the use of two MACI membranes with impaction grafting of the subchondral bone. We report our results of 14 patients who underwent the 'bilayer collagen membrane' technique (BCMT) with a mean follow-up of 5.2?years (2 to 8). There were 12 men and two women with a mean age of 23.6 years (16 to 40). The mean size of the defect was 7.2 cm(2) (5.2 to 12?cm(2)) and were located on the medial (ten) or lateral (four) femoral condyles. The mean modified Cincinnati knee score improved from 45.1 (22 to 70) pre-operatively to 82.8 (34 to 98) at the most recent review (p < 0.05). The visual analogue pain score improved from 7.3 (4 to 10) to 1.7 (0 to 6) (p < 0.05). Twelve patients were considered to have a good or excellent clinical outcome. One graft failed at six?years. The BCMT resulted in excellent functional results and durable repair of large and deep osteochondral lesions without a high incidence of graft-related complications.