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Articular cartilage repair using autologous collagen-induced chondrogenesis (ACIC): a pragmatic and cost-effective enhancement of a traditional technique

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The autologous collagen-induced chondrogenesis technique is described, and the results of a 6-year follow-up clinical study using this technique are presented.

Methods

30 patients with International Cartilage Repair Society (ICRS) Grade III/IVa symptomatic chondral defects of the knee treated with enhanced microdrilling using atelocollagen were prospectively examined in this clinical series. The median age of the patients was 39.0 years (range 19–61 years). Patients were followed up to 72 months. Clinical evaluation was performed using functional knee scores and radiologically. Both quantitative and qualitative assessments were performed.

Results

Statistically significant and clinically relevant improvement was observed in 2 years and was sustained for the 6 years of the study observation. At 6 years, the mean Lysholm score was 79.7 (SD 6.8) compared to 52.6 (SD 10.7) pre-operatively (p < 0.05). The symptomatic Knee Injury and Osteoarthritis Outcome Score (KOOS) improved from 68.3 (SD 11.4) to 90.2 (SD 4.3) (p < 0.05). The subjective International Knee Documentation Committee (IKDC) also showed improvement from 39.1 (SD 4.1) to 81.6 (SD 7.8) (p  < 0.05). The calculated T2* relaxation times were 26.0 (SD 4.2) seconds and 30.3 (SD 6.2) seconds for the repair tissue and native cartilage, respectively. The average magnetic resonance observation of cartilage repair tissue (MOCART) score was 78.5 (SD 9.6) for all lesions.

Conclusion

The enhanced microdrilling using atelocollagen is an enhancement of the traditional microfracture method using an off-the-shelf product. When used to treat moderate to severe chondral lesions, this enhancement produces hyaline-like cartilage with a corresponding improvement in symptoms.

Level of evidence

IV.

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Acknowledgements

SK was involved in reviewing the literature and drafting the manuscript as the main author. NK, NS, DS, and SA were involved in documentation and data preparation. SL, YS, and YC were involved in the interpretation of the results and giving intellectual contributions. AS gave an original concept of this paper and was responsible for the final proofreading of the manuscript. All authors read and approved the final manuscript.

Funding

This study had no funding.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Seok Jung Kim, Yoon Joo Cho & Sang Heon Lee

  2. Institute of Medical Sciences, Faculty of Health and Social Sciences, Canterbury Christ Church University, 30 Pembroke Court, Chatham Maritime, ME4 4UF, Kent, UK

    Asode Ananthram Shetty, Nibu M. Kurian, Saif Ahmed & Neha Shetty

  3. Kent Knee Unit, Spire Alexandra Hospital, Chatham, Kent, UK

    Asode Ananthram Shetty, Nibu M. Kurian, Saif Ahmed & Neha Shetty

  4. Department of Orthopaedics and Trauma Surgery, Hanush Hospital, Vienna, Austria

    David Stelzeneder

  5. Department of Orthopaedic Surgery, College of Medicine, The Inje University of Korea, Seoul, Republic of Korea

    Yong-Woon Shin

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  1. Seok Jung Kim
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  2. Asode Ananthram Shetty
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  4. Saif Ahmed
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  8. Yoon Joo Cho
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  9. Sang Heon Lee
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Correspondence to Asode Ananthram Shetty.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the national research committee (Health Research Authority, NHS) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

All applicable international, national, and/or institutional guidelines for the care and use of animals were followed.

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Kim, S.J., Shetty, A.A., Kurian, N.M. et al. Articular cartilage repair using autologous collagen-induced chondrogenesis (ACIC): a pragmatic and cost-effective enhancement of a traditional technique. Knee Surg Sports Traumatol Arthrosc 28, 2598–2603 (2020). https://doi.org/10.1007/s00167-020-05884-y

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