Advertisement

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

Published:October 04, 2012DOI:https://doi.org/10.1016/j.arthro.2012.05.883

      Purpose

      The purpose of this study was to evaluate the overall long-term improvement of autologous chondrocyte implantation (ACI) treatment in terms of patient satisfaction, clinical assessment, and magnetic resonance imaging (MRI) evaluation. Furthermore, we aimed to assess the impact of independent variables on clinical outcomes and patient satisfaction.

      Methods

      We evaluated 23 patients (mean age, 30.5 ± 8.2 years) with full-thickness chondral lesions of the distal femur who underwent first-generation ACI with periosteum between 1997 and 2004. The Lysholm score, Tegner activity score, subjective International Knee Documentation Committee score, numeric rating scale score, and Short Form 36 score were used for clinical assessment preoperatively, at 1 year postoperatively, and at 7 to 14 years (mean, 9.9 years) after surgery. MRI was performed to evaluate the cartilage preoperatively and at final follow-up, by use of the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score.

      Results

      ACI resulted in a substantial improvement in all clinical outcome parameters, even as much as 14 years after implantation, although a small deterioration was noticed between intermediate and final evaluations in some outcome parameters. Of the patients, 73.1% stated that they would undergo the operation again. Younger patients with a shorter duration of preoperative symptoms and smaller defect sizes benefited most. MRI findings confirmed complete defect filling in 52.3% of the patients at final follow-up.

      Conclusions

      Our long-term results confirm that first-generation ACI is an effective treatment for large full-thickness chondral and osteochondral lesions of the knee joint. Younger patients with a shorter duration of preoperative symptoms and smaller defect size benefited most in our study.

      Level of Evidence

      Level IV, therapeutic case series.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Mandelbaum B.R.
        • Browne J.E.
        • Fu F.
        • et al.
        Articular cartilage lesions of the knee.
        Am J Sports Med. 1998; 26: 853-861
        • Brittberg M.
        • Lindahl A.
        • Nilsson A.
        • Ohlsson C.
        • Isaksson O.
        • Peterson L.
        Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation.
        N Engl J Med. 1994; 331: 889-895
        • Jones D.G.
        • Peterson L.
        Autologous chondrocyte implantation.
        J Bone Joint Surg Am. 2006; 88: 2502-2520
        • Kreuz P.C.
        • Müller S.
        • Ossendorf C.
        • Kaps C.
        • Erggelet C.
        Treatment of focal degenerative cartilage defects with polymer-based autologous chondrocyte grafts: Four-year clinical results.
        Arthritis Res Ther. 2009; 11: R33
        • Peterson L.
        • Brittberg M.
        • Kiviranta I.
        • Akerlund E.L.
        • Lindahl A.
        Autologous chondrocyte transplantation.
        Am J Sports Med. 2002; 30: 2-12
        • 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: 17-24
        • Horas U.
        • Pelinkovic D.
        • Herr G.
        • Aigner T.
        • Schnettler R.
        Autologous chondrocyte implantation and osteochondral cylinder transplantation in cartilage repair of the knee joint.
        J Bone Joint Surg Am. 2003; 85: 185-192
        • Knutsen G.
        • Drogset J.O.
        • Engebretsen L.
        • et al.
        A randomized trial comparing autologous chondrocyte implantation with microfracture.
        J Bone Joint Surg Am. 2007; 89: 2105-2112
        • Browne J.E.
        • Anderson A.F.
        • Arciero R.
        • et al.
        Clinical outcome of autologous chondrocyte implantation at 5 years in US subjects.
        Clin Orthop Relat Res. 2005; : 237-245
        • Fu F.H.
        • Zurakowski D.
        • Browne J.E.
        • et al.
        Autologous chondrocyte implantation versus debridement for treatment of full-thickness chondral defects of the knee: An observational cohort study with 3-year follow-up.
        Am J Sports Med. 2005; 33: 1658-1666
        • McNickle A.G.
        • L'Heureux D.R.
        • Yanke A.B.
        • Cole B.J.
        Outcomes of autologous chondrocyte implantation in a diverse patient population.
        Am J Sports Med. 2009; 37: 1344-1350
        • Peterson L.
        • Vasiliadis H.S.
        • Brittberg M.
        • Lindahl A.
        Autologous chondrocyte implantation: A long-term follow-up.
        Am J Sports Med. 2010; 38: 1117-1124
        • Moseley J.B.
        • Anderson A.F.
        • Browne J.E.
        • et al.
        Long-term durability of autologous chondrocyte implantation: A multicenter, observational study in US patients.
        Am J Sports Med. 2010; 38: 238-246
        • Outerbridge R.E.
        The etiology of chondromalacia patellae.
        J Bone Joint Surg Br. 1961; 43: 752-757
        • Tegner Y.
        • Lysholm J.
        Rating systems in the evaluation of knee ligament injuries.
        Clin Orthop Relat Res. 1985; : 43-49
        • Irrgang J.J.
        • Anderson A.F.
        Development and validation of health-related quality of life measures for the knee.
        Clin Orthop Relat Res. 2002; : 95-109
        • Hefti F.
        • Müller W.
        • Jakob R.P.
        • Stäubli H.U.
        Evaluation of knee ligament injuries with the IKDC form.
        Knee Surg Sports Traumatol Arthrosc. 1993; 1: 226-234
        • Bellach B.-M.
        Der SF-36 im Bundesgesundheitssurvey—Erste Ergebnisse und neue Fragen.
        Bundesgesundheitsblatt. 2000; 43 (in German): 210-216
        • Zeifang F.
        • Oberle D.
        • Nierhoff C.
        • Richter W.
        • Moradi B.
        • Schmitt H.
        Autologous chondrocyte implantation using the original periosteum-cover technique versus matrix-associated autologous chondrocyte implantation: A randomized clinical trial.
        Am J Sports Med. 2010; 38: 924-933
        • Marlovits S.
        • Striessnig G.
        • Resinger C.T.
        • et al.
        Definition of pertinent parameters for the evaluation of articular cartilage repair tissue with high-resolution magnetic resonance imaging.
        Eur J Radiol. 2004; 52: 310-319
        • Lysholm J.
        • Gillquist J.
        Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale.
        Am J Sports Med. 1982; 10: 150-154
        • Irrgang J.J.
        • Anderson A.F.
        • Boland A.L.
        • et al.
        Development and validation of the international knee documentation committee subjective knee form.
        Am J Sports Med. 2001; 29: 600-613
        • Marlovits S.
        • Singer P.
        • Zeller P.
        • Mandl I.
        • Haller J.
        • Trattnig S.
        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. 2006; 57: 16-23
        • Bartlett W.
        • Skinner J.A.
        • Gooding C.R.
        • 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: 640-645
        • Briggs K.K.
        • Steadman J.R.
        • Hay C.J.
        • Hines S.L.
        Lysholm score and Tegner activity level in individuals with normal knees.
        Am J Sports Med. 2009; 37: 898-901
        • Shelbourne K.D.
        • Jari S.
        • Gray T.
        Outcome of untreated traumatic articular cartilage defects of the knee: A natural history study.
        J Bone Joint Surg Am. 2003; 85: 8-16
        • Vasiliadis H.S.
        • Danielson B.
        • Ljungberg M.
        • McKeon B.
        • Lindahl A.
        • Peterson L.
        Autologous chondrocyte implantation in cartilage lesions of the knee: Long-term evaluation with magnetic resonance imaging and delayed gadolinium-enhanced magnetic resonance imaging technique.
        Am J Sports Med. 2010; 38: 943-949
        • Harris J.D.
        • Siston R.A.
        • Pan X.
        • Flanigan D.C.
        Autologous chondrocyte implantation: A systematic review.
        J Bone Joint Surg Am. 2010; 92: 2220-2233
        • Vanlauwe J.
        • Saris D.B.F.
        • Victor J.
        • et al.
        Five-year outcome of characterized chondrocyte implantation versus microfracture for symptomatic cartilage defects of the knee: Early treatment matters.
        Am J Sports Med. 2011; 39: 2566-2574
        • Kon E.
        • Gobbi A.
        • Filardo G.
        • Delcogliano M.
        • Zaffagnini S.
        • Marcacci M.
        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. 2009; 37: 33-41
        • Mithoefer K.
        • McAdams T.
        • Williams R.J.
        • Kreuz P.C.
        • Mandelbaum B.R.
        Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: An evidence-based systematic analysis.
        Am J Sports Med. 2009; 37: 2053-2063
        • Steadman J.R.
        • Briggs K.K.
        • Rodrigo J.J.
        • Kocher M.S.
        • Gill T.J.
        • Rodkey W.G.
        Outcomes of microfracture for traumatic chondral defects of the knee: Average 11-year follow-up.
        Arthroscopy. 2003; 19: 477-484