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Autologous chondrocyte implantation for the treatment of chondral and osteochondral defects of the talus: a meta-analysis of available evidence

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

While autologous chondrocyte implantation (ACI) has become an established surgical treatment for cartilage defects of the knee, only little is known about the clinical outcome following ACI for chondral or osteochondral lesion of the ankle. To evaluate efficiency and effectiveness of ACI for talar lesions was aim of the present meta-analysis.

Methods

An OVID-based literature search was performed to identify any published clinical studies on autologous chondrocyte implantation (ACI) for the treatment of pathologies of the ankle including the following databases: MEDLINE, MEDLINE preprints, EMBASE, CINAHL, Life Science Citations, British National Library of Health, and Cochrane Central Register of Controlled Trials (CENTRAL). Literature search period was from the beginning of 1994 to February 2011. Of 54 studies that were identified, a total of 16 studies met the inclusion criteria of the present meta-analysis. Those studies were systematically evaluated.

Results

All studies identified represented case series (EBM Leven IV). 213 cases with various treatment for osteochondral and chondral defects with a mean size of 2.3 cm2 (±0.6) have been reported. A total of 9 different scores have been used as outcome parameters. Mean study size was 13 patients (SD 10; range 2–46) with a mean follow-up of 32 ± 27 months (range 6–120). Mean Coleman Methodology Score was 65 (SD 11) points. Overall clinical success rate was 89.9%.

Conclusions

Evidence concerning the use of ACI for osteochondral and chondral defects of the talus is still elusive. Although clinical outcome as described in the studies available seems promising—with regard to a lack of controlled studies—a superiority or inferiority to other techniques such as osteochondral transplantation or microfracturing cannot be estimated.

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References

  1. Aurich M, Venbrocks RA, Fuhrmann RA (2008) Autologous chondrocyte transplantation in the ankle joint. Rational or irrational? Orthopade 37(3):188 (190–195)

    Google Scholar 

  2. Basad E, Ishaque B, Bachmann G, Sturz H, Steinmeyer J (2010) Matrix-induced autologous chondrocyte implantation versus microfracture in the treatment of cartilage defects of the knee: a 2-year randomised study. Knee Surg Sports Traumatol Arthrosc 18(4):519–527

    Article  PubMed  Google Scholar 

  3. Baums MH, Heidrich G, Schultz W, Steckel H, Kahl E, Klinger HM (2006) Autologous chondrocyte transplantation for treating cartilage defects of the talus. J Bone Joint Surg Am 88(2):303–308

    Article  PubMed  CAS  Google Scholar 

  4. Behrens P, Bosch U, Bruns J, Erggelet C, Esenwein SA, Gaissmaier C, Krackhardt T, Lohnert J, Marlovits S, Meenen NM, Mollenhauer J, Nehrer S, Niethard FU, Noth U, Perka C, Richter W, Schafer D, Schneider U, Steinwachs M, Weise K (2004) Indications and implementation of recommendations of the working group “Tissue Regeneration and Tissue Substitutes” for autologous chondrocyte transplantation (ACT). Z Orthop Ihre Grenzgeb 142(5):529–539

    Article  PubMed  CAS  Google Scholar 

  5. Bekkers JE, Inklaar M, Saris DB (2009) Treatment selection in articular cartilage lesions of the knee: a systematic review. Am J Sports Med 37(Suppl 1):148S–155S

    Article  PubMed  Google Scholar 

  6. Benthien JP, Schwaninger M, Behrens P (2010) We do not have evidence based methods for the treatment of cartilage defects in the knee. Knee Surg Sports Traumatol Arthrosc 19(4):543–552

    Article  PubMed  Google Scholar 

  7. Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L (1994) Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med 331(14):889–895

    Article  PubMed  CAS  Google Scholar 

  8. Brittberg M, Tallheden T, Sjogren-Jansson B, Lindahl A, Peterson L (2001) Autologous chondrocytes used for articular cartilage repair: an update. Clin Orthop Relat Res 391(Suppl):S337–S348

    Article  PubMed  Google Scholar 

  9. Cole BJ, Pascual-Garrido C, Grumet RC (2009) Surgical management of articular cartilage defects in the knee. J Bone Joint Surg Am 91(7):1778–1790

    PubMed  Google Scholar 

  10. Coleman BD, Khan KM, Maffulli N, Cook JL, Wark JD (2000) Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies. Victorian Institute of Sport Tendon Study Group. Scand J Med Sci Sports 10(1):2–11

    Article  PubMed  CAS  Google Scholar 

  11. Dorotka R, Kotz R, Trattnig S, Nehrer S (2004) Mid-term results of autologous chondrocyte transplantation in knee and ankle. A one- to six-year follow-up study. Z Rheumatol 63(5):385–392

    Article  PubMed  CAS  Google Scholar 

  12. Giannini S, Battaglia M, Buda R, Cavallo M, Ruffilli A, Vannini F (2009) Surgical treatment of osteochondral lesions of the talus by open-field autologous chondrocyte implantation: a 10-year follow-up clinical and magnetic resonance imaging T2-mapping evaluation. Am J Sports Med 37(Suppl 1):112S–118S

    Google Scholar 

  13. Giannini S, Buda R, Vannini F, Di Caprio F, Grigolo B (2008) Arthroscopic autologous chondrocyte implantation in osteochondral lesions of the talus: surgical technique and results. Am J Sports Med 36(5):873–880

    Article  PubMed  Google Scholar 

  14. Giannini S, Vannini F (2004) Operative treatment of osteochondral lesions of the talar dome: current concepts review. Foot Ankle Int 25(3):168–175

    PubMed  Google Scholar 

  15. Gikas PD, Bayliss L, Bentley G, Briggs TW (2009) An overview of autologous chondrocyte implantation. J Bone Joint Surg Br 91(8):997–1006

    Article  PubMed  CAS  Google Scholar 

  16. Haddo O, Mahroof S, Higgs D, David L, Pringle J, Bayliss M, Cannon SR, Briggs TW (2004) The use of chondrogide membrane in autologous chondrocyte implantation. Knee 11(1):51–55

    Article  PubMed  Google Scholar 

  17. Hanzlik S, Mahabir RC, Baynosa RC, Khiabani KT (2009) Levels of evidence in research published in The Journal of Bone and Joint Surgery (American Volume) over the last thirty years. J Bone Joint Surg Am 91(2):425–428

    Article  PubMed  Google Scholar 

  18. Hayes DW Jr, Averett RK (2001) Articular cartilage transplantation. Current and future limitations and solutions. Clin Podiatr Med Surg 18(1):161–176

    PubMed  Google Scholar 

  19. Jakobsen RB, Engebretsen L, Slauterbeck JR (2005) An analysis of the quality of cartilage repair studies. J Bone Joint Surg Am 87(10):2232–2239

    Article  PubMed  Google Scholar 

  20. Knutsen G, Drogset JO, Engebretsen L, Grontvedt T, Isaksen V, Ludvigsen TC, Roberts S, Solheim E, Strand T, Johansen O (2007) A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years. J Bone Joint Surg Am 89(10):2105–2112

    Article  PubMed  Google Scholar 

  21. Knutsen G, Engebretsen L, Ludvigsen TC, Drogset JO, Grontvedt T, Solheim E, Strand T, Roberts S, Isaksen V, Johansen O (2004) Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial. J Bone Joint Surg Am 86-A(3):455–464

    Google Scholar 

  22. Kon E, Gobbi A, Filardo G, Delcogliano M, Zaffagnini S, Marcacci M (2009) 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 37(1):33–41

    Article  PubMed  Google Scholar 

  23. Koulalis D, Schultz W, Heyden M (2002) Autologous chondrocyte transplantation for osteochondritis dissecans of the talus. Clin Orthop Relat Res 395:186–192

    Article  PubMed  Google Scholar 

  24. Koulalis D, Schultz W, Psychogios B, Papagelopoulos PJ (2004) Articular reconstruction of osteochondral defects of the talus through autologous chondrocyte transplantation. Orthopedics 27(6):559–561

    PubMed  CAS  Google Scholar 

  25. Kreuz PC, Erggelet C, Steinwachs MR, Krause SJ, Lahm A, Niemeyer P, Ghanem N, Uhl M, Sudkamp N (2006) Is microfracture of chondral defects in the knee associated with different results in patients aged 40 years or younger? Arthroscopy 22(11):1180–1186

    Article  PubMed  Google Scholar 

  26. Kuettner KE, Cole AA (2005) Cartilage degeneration in different human joints. Osteoarthritis Cartil 13(2):93–103

    Article  CAS  Google Scholar 

  27. Lee KT, Choi YS, Lee YK, Kim JS, Young KW, Kim JH (2010) Comparison of MRI and arthroscopy after autologous chondrocyte implantation in patients with osteochondral lesion of the talus. Orthopedics 33(8). doi:10.3928/01477447-20100625-12

  28. Mandelbaum BR, Gerhardt MB, Peterson L (2003) Autologous chondrocyte implantation of the talus. Arthroscopy 19(Suppl 1):129–137

    Google Scholar 

  29. Marlovits S, Zeller P, Singer P, Resinger C, Vecsei V (2006) Cartilage repair: generations of autologous chondrocyte transplantation. Eur J Radiol 57(1):24–31

    Article  PubMed  Google Scholar 

  30. Minas T, Gomoll AH, Rosenberger R, Royce RO, Bryant T (2009) Increased failure rate of autologous chondrocyte implantation after previous treatment with marrow stimulation techniques. Am J Sports Med 37(5):902–908

    Article  PubMed  Google Scholar 

  31. Mitchell ME, Giza E, Sullivan MR (2009) Cartilage transplantation techniques for talar cartilage lesions. J Am Acad Orthop Surg 17(7):407–414

    PubMed  Google Scholar 

  32. Mithoefer K, McAdams T, Williams RJ, Kreuz PC, Mandelbaum BR (2009) Clinical efficacy of the microfracture technique for articular cartilage repair in the knee: an evidence-based systematic analysis. Am J Sports Med 37(10):2053–2063

    Article  PubMed  Google Scholar 

  33. Mithoefer K, Williams RJ III, Warren RF, Potter HG, Spock CR, Jones EC, Wickiewicz TL, Marx RG (2005) The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospective cohort study. J Bone Joint Surg Am 87(9):1911–1920

    Article  PubMed  Google Scholar 

  34. Moseley JB Jr, Anderson AF, Browne JE, Mandelbaum BR, Micheli LJ, Fu F, Erggelet C (2010) Long-term durability of autologous chondrocyte implantation: a multicenter, observational study in US patients. Am J Sports Med 38(2):238–246

    Article  PubMed  Google Scholar 

  35. Nam EK, Ferkel RD, Applegate GR (2009) Autologous chondrocyte implantation of the ankle: a 2- to 5-year follow-up. Am J Sports Med 37(2):274–284

    Article  PubMed  Google Scholar 

  36. Obremskey WT, Pappas N, Attallah-Wasif E, Tornetta P III, Bhandari M (2005) Level of evidence in orthopaedic journals. J Bone Joint Surg Am 87(12):2632–2638

    Article  PubMed  Google Scholar 

  37. Petersen L, Brittberg M, Lindahl A (2003) Autologous chondrocyte transplantation of the ankle. Foot Ankle Clin 8(2):291–303

    Article  PubMed  Google Scholar 

  38. Peterson L, Vasiliadis HS, Brittberg M, Lindahl A (2010) Autologous chondrocyte implantation: a long-term follow-up. Am J Sports Med 38(6):1117–1124

    Article  PubMed  Google Scholar 

  39. Quirbach S, Trattnig S, Marlovits S, Zimmermann V, Domayer S, Dorotka R, Mamisch TC, Bohndorf K, Welsch GH (2009) Initial results of in vivo high-resolution morphological and biochemical cartilage imaging of patients after matrix-associated autologous chondrocyte transplantation (MACT) of the ankle. Skeletal Radiol 38(8):751–760

    Article  PubMed  Google Scholar 

  40. Saris DB, Vanlauwe J, Victor J, Almqvist KF, Verdonk R, Bellemans J, Luyten FP (2009) Treatment of symptomatic cartilage defects of the knee: characterized chondrocyte implantation results in better clinical outcome at 36 months in a randomized trial compared to microfracture. Am J Sports Med 37(Suppl 1):10S–19S

    Google Scholar 

  41. Saris DB, Vanlauwe J, Victor J, Haspl M, Bohnsack M, Fortems Y, Vandekerckhove B, Almqvist KF, Claes T, Handelberg F, Lagae K, van der Bauwhede J, Vandenneucker H, Yang KG, Jelic M, Verdonk R, Veulemans N, Bellemans J, Luyten FP (2008) Characterized chondrocyte implantation results in better structural repair when treating symptomatic cartilage defects of the knee in a randomized controlled trial versus microfracture. Am J Sports Med 36(2):235–246

    Article  PubMed  Google Scholar 

  42. Schneider TE, Karaikudi S (2009) Matrix-induced autologous chondrocyte implantation (MACI) grafting for osteochondral lesions of the talus. Foot Ankle Int 30(9):810–814

    Article  PubMed  Google Scholar 

  43. Steinwachs MR, Kreuz PC (2003) Clinical results of autologous chondrocyte transplantation (ACT) using a collagen membrane cartilage surgery and future perspectives, chap 5. In: Hendrich N, Eulert J (ed) Cartilage surgery and future perspectives, pp 37–47

  44. Thermann H, Driessen A, Becher C (2008) Autologous chondrocyte transplantation in the treatment of articular cartilage lesions of the talus. Orthopade 37(3):232–239

    Article  PubMed  CAS  Google Scholar 

  45. van Dijk CN, Reilingh ML, Zengerink M, van Bergen CJ (2010) The natural history of osteochondral lesions in the ankle. Instr Course Lect 59:375–386

    PubMed  Google Scholar 

  46. van Dijk CN, Reilingh ML, Zengerink M, van Bergen CJ (2010) Osteochondral defects in the ankle: why painful? Knee Surg Sports Traumatol Arthrosc 18(5):570–580

    Article  PubMed  Google Scholar 

  47. Vasiliadis HS, Danielson B, Ljungberg M, McKeon B, Lindahl A, Peterson L (2010) 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 38(5):943–949

    Article  PubMed  Google Scholar 

  48. Vasiliadis HS, Wasiak J (2010) Autologous chondrocyte implantation for full thickness articular cartilage defects of the knee. Cochrane Database Syst Rev (10):CD003323

  49. Vasiliadis HS, Wasiak J, Salanti G (2010) Autologous chondrocyte implantation for the treatment of cartilage lesions of the knee: a systematic review of randomized studies. Knee Surg Sports Traumatol Arthrosc 18(12):1645–1655

    Article  PubMed  Google Scholar 

  50. Vavken P, Samartzis D (2010) Effectiveness of autologous chondrocyte implantation in cartilage repair of the knee: a systematic review of controlled trials. Osteoarthritis Cartil 18(6):857–863

    Article  CAS  Google Scholar 

  51. Wasiak J, Clar C, Villanueva E (2006) Autologous cartilage implantation for full thickness articular cartilage defects of the knee. Cochrane Database Syst Rev 3:CD003323

  52. Wasiak J, Villanueva E (2002) Autologous cartilage implantation for full thickness articular cartilage defects of the knee. Cochrane Database Syst Rev 4:CD003323

    Google Scholar 

  53. Whittaker JP, Smith G, Makwana N, Roberts S, Harrison PE, Laing P, Richardson JB (2005) Early results of autologous chondrocyte implantation in the talus. J Bone Joint Surg Br 87(2):179–183

    Article  PubMed  CAS  Google Scholar 

  54. Zengerink M, Struijs PA, Tol JL, van Dijk CN (2010) Treatment of osteochondral lesions of the talus: a systematic review. Knee Surg Sports Traumatol Arthrosc 18(2):238–246

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department for Orthopedic Surgery and Traumatology, Freiburg University Hospital, Hugstetter Str. 55, 79095, Freiburg, Germany

    Philipp Niemeyer, Gian Salzmann, Hagen Schmal, Hermann Mayr & Norbert P. Südkamp

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  1. Philipp Niemeyer
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Correspondence to Philipp Niemeyer.

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Niemeyer, P., Salzmann, G., Schmal, H. et al. Autologous chondrocyte implantation for the treatment of chondral and osteochondral defects of the talus: a meta-analysis of available evidence. Knee Surg Sports Traumatol Arthrosc 20, 1696–1703 (2012). https://doi.org/10.1007/s00167-011-1729-0

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