Skip to main content
SpringerLink
Log in

Correlation between the quality of cartilage repair tissue and patellofemoral osteoarthritis after matrix-induced autologous chondrocyte implantation at three-year follow-up: a cross-sectional study

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

To investigate whether the quality of cartilage repair tissue is associated with patellofemoral osteoarthritis (PFOA) at a three year follow-up after matrix-induced autologous chondrocyte implantation (MACI).

Methods

This retrospective study included 32 patients who underwent MACI between October 2014 and May 2018 at our institute. The Lysholm score and Visual Analog Scale (VAS) score were assessed. The magnetic resonance observation of cartilage repair tissue (MOCART) 2.0 score and T2* relaxation time of repair tissue were used to evaluate cartilage repair tissue quality. A modified MRI Osteoarthritis Knee Score (mMOAKS) was used to evaluate PFOA.

Results

Compared with pre-operative scores, the final Lysholm score (50.71 ± 2.22 vs 89.70 ± 1.18; t = 15.5, P < 0.0001) and VAS score (4.67 ± 0.47 vs 0.92 ± 0.64; t = 22.62, P < 0.0001) were improved at 3 years after MACI. At the three year follow-up, the mean MOCART 2.0 score was 61.56 ± 18.11, and the T2* relaxation time of the repair tissue was significantly lower than that in the healthy control region (24.11 ± 6.38 vs 34.39 ± 1.33, t =  − 8.635, P < 0.0001). The mean mMOAKS score was 9.16 ± 4.51. On univariate analysis, the MOCART 2.0 score and T2* relaxation time were negatively associated with the mMOAKS score.

Conclusion

MACI can lead to significant pain relief and restoration of knee joint function, and good quality cartilage repair tissue was a protective factor against PFOA at the three year follow-up.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Salzmann GM, Erdle B, Porichis S, Uhl M, Ghanem N, Schmal H, Kubosch D, Südkamp NP, Niemeyer P (2014) Long-term T2 and qualitative MRI morphology after first-generation knee autologous chondrocyte implantation: cartilage ultrastructure is not correlated to clinical or qualitative MRI outcome. Am J Sports Med 42:1832–1840. https://doi.org/10.1177/0363546514536682

    Article  PubMed  Google Scholar 

  2. Binder H, Hoffman L, Zak L, Tiefenboeck T, Aldrian S, Albrecht C (2021) Clinical evaluation after matrix-associated autologous chondrocyte transplantation: a comparison of four different graft types. Bone Joint Res 10:370–379. https://doi.org/10.1302/2046-3758.107.BJR-2020-0370.R1

    Article  PubMed  PubMed Central  Google Scholar 

  3. Chahla J, Stone J, Mandelbaum BR (2019) How to manage cartilage injuries? Arthroscopy 35:2771–2773. https://doi.org/10.1016/j.arthro.2019.08.021

    Article  PubMed  Google Scholar 

  4. Jungmann PM, Gersing AS, Baumann F, Holwein C, Braun S, Neumann J, Zarnowski J, Hofmann FC, Imhoff AB, Rummeny EJ, Link TM (2019) Cartilage repair surgery prevents progression of knee degeneration. Knee Surg Sports Traumatol Arthrosc 27:3001–3013. https://doi.org/10.1007/s00167-018-5321-8

    Article  PubMed  Google Scholar 

  5. Hinckel BB, Thomas D, Vellios EE, Hancock KJ, Calcei JG, Sherman SL, Eliasberg CD, Fernandes TL, Farr J, Lattermann C, Gomoll AH Algorithm for treatment of focal cartilage defects of the knee: classic and new procedures. Cartilage. 2021937985533:1947603521993219. https://doi.org/10.1177/1947603521993219

  6. Gou GH, Tseng FJ, Wang SH, Chen PJ, Shyu JF, Weng CF, Pan RY (2020) Autologous chondrocyte implantation versus microfracture in the knee: a meta-analysis and systematic review. Arthroscopy 36:289–303

    Article  PubMed  Google Scholar 

  7. Jones KJ, Kelley BV, Arshi A, McAllister DR, Fabricant PD (2019) Comparative effectiveness of cartilage repair with respect to the minimal clinically important difference. Am J Sports Med 47:3284–3293. https://doi.org/10.1177/0363546518824552

    Article  PubMed  Google Scholar 

  8. Trattnig S, Domayer S, Welsch GW, Mosher T, Eckstein F (2009) MR imaging of cartilage and its repair in the knee—a review. Eur Radiol 19(7):1582–1594. https://doi.org/10.1007/s00330-009-1352-3

    Article  CAS  PubMed  Google Scholar 

  9. Tins BJ, McCall IW, Takahashi T, Cassar-Pullicino V, Roberts S, Ashton B, Richardson J (2005) Autologous chondrocyte implantation in knee joint: MR imaging and histologic features at 1-year follow-up. Radiology 234:501–508. https://doi.org/10.1148/radiol.2342031970

    Article  PubMed  Google Scholar 

  10. Schreiner MM, Raudner M, Röhrich S, Zalaudek M, Weber M, Kaiser G, Aldrian S, Chiari C, Windhager R, Trattnig S (2021) Reliability of the MOCART (magnetic resonance observation of cartilage repair tissue) 2.0 knee score for different cartilage repair techniques-a retrospective observational study. Eur Radiol 31:5734–5745. https://doi.org/10.1007/s00330-021-07688-1

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hunter DJ, Guermazi A, Lo GH, Grainger AJ, Conaghan PG, Boudreau RM, Roemer FW (2011) Evolution of semi-quantitative whole joint assessment of knee OA: MOAKS (MRI Osteoarthritis Knee Score). Osteoarthr Cartilage 19(8):990–1002. https://doi.org/10.1016/j.joca.2011.05.004

    Article  CAS  Google Scholar 

  12. Kobayashi S, Peduto A, Simic M, Fransen M, Refshauge K, Mah J, Pappas E (2018) Can we have an overall osteoarthritis severity score for the patellofemoral joint using magnetic resonance imaging? Reliability and validity Clin Rheumatol 37(4):1091–1098. https://doi.org/10.1007/s10067-017-3888-y

    Article  PubMed  Google Scholar 

  13. Ebert JR, Fallon M, Wood DJ, Janes GC (2017) A prospective clinical and radiological evaluation at 5 years after arthroscopic matrix-induced autologous chondrocyte implantation. Am J Sports Med 45:59–69. https://doi.org/10.1177/0363546516663493

    Article  PubMed  Google Scholar 

  14. Niethammer TR, Safi E, Ficklscherer A, Horng A, Feist M, Feist-Pagenstert I, Jansson V, Pietschmann MF, Müller PE et al (2014) Graft maturation of autologous chondrocyte implantation: magnetic resonance investigation with T2 mapping. Am J Sports Med 42(2199–204):2199–2204. https://doi.org/10.1177/0363546514538756

    Article  PubMed  Google Scholar 

  15. AB, DW, CJ V. J Eng, G J, M S, et al. Morphological assessment of MACI grafts in patients with revision surgery and total joint arthroplasty. CARTILAGE. 2019940087998

  16. Moradi B, Schönit E, Nierhoff C, Hagmann S, Oberle D, Gotterbarm T, Schmitt H, Zeifang F (2012) 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. Arthroscopy 28:1851–1861. https://doi.org/10.1016/j.arthro.2012.05.883

    Article  PubMed  Google Scholar 

  17. Ebert JR, Fallon M, Smith A, Janes GC, Wood DJ (2015) Prospective clinical and radiologic evaluation of patellofemoral matrix-induced autologous chondrocyte implantation. Am J Sports Med 43(6):1362–1372. https://doi.org/10.1177/0363546515574063

    Article  PubMed  Google Scholar 

  18. Surowiec RK, Lucas EP, Ho CP (2014) Quantitative MRI in the evaluation of articular cartilage health: reproducibility and variability with a focus on T2 mapping. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 22(6):1385–1395. https://doi.org/10.1007/s00167-013-2714-6

    Article  PubMed  Google Scholar 

  19. Zamli Z, Sharif M (2011) Chondrocyte apoptosis: a cause or consequence of osteoarthritis? Int J Rheum Dis 14(2):159–166. https://doi.org/10.1111/j.1756-185X.2011.01618.x

    Article  PubMed  Google Scholar 

  20. D M, DM F, FM C, AE W, YR L, S E, JS K, (2019) Bone marrow lesions in knee osteoarthritis: regional differences in tibial subchondral bone microstructure and their association with cartilage degeneration. Osteoarthr Cartilage 27(11):1653–1662. https://doi.org/10.1016/j.joca.2019.07.004

    Article  Google Scholar 

  21. A W, JP R, PT O, NC G, PD G, PA N, AG B, GM G, PM G, DH L, (2001) T2 mapping of rat patellar cartilage. Radiology 219(2):395–402. https://doi.org/10.1148/radiology.219.2.r01ma32395

    Article  Google Scholar 

  22. Dai X, Fang J, Wang S, Luo J, Xiong Y, Zhang M, Zhu S, Yu X (2021) Short- to midterm clinical and radiological outcomes after matrix-associated autologous chondrocyte implantation for chondral defects in knees. Orthop J Sports Med 9:2325967120982139. https://doi.org/10.1177/2325967120982139,33718499

    Article  PubMed  PubMed Central  Google Scholar 

  23. Iordache E, Robertson EL, Hirschmann A, Hirschmann MT (2021) Typical MRI-pattern suggests peak maturation of the ACI graft 2 years after third-generation ACI: a systematic review. Knee Surg Sports Traumatol Arthrosc 29:3664–3677. https://doi.org/10.1007/s00167-020-06339-0

    Article  PubMed  Google Scholar 

  24. Enea D, Cecconi S, Busilacchi A, Manzotti S, Gesuita R (2012) Gigante A Matrix-induced autologous chondrocyte implantation (MACI) in the knee. Knee Surg Sports Traumatol Arthrosc 20:862–869. https://doi.org/10.1007/s00167-011-1639-1

    Article  PubMed  Google Scholar 

  25. Anderson DE, Williams RJ, DeBerardino TM, Taylor DC, Ma CB, Kane MS, Crawford DC (2017) Magnetic resonance imaging characterization and clinical outcomes after NeoCart surgical therapy as a primary reparative treatment for knee cartilage injuries. Am J Sports Med 45:875–883. https://doi.org/10.1177/0363546516677255

    Article  PubMed  Google Scholar 

  26. Blackman AJ, Smith MV, Flanigan DC, Matava MJ, Wright RW, Brophy RH (2013) Correlation between magnetic resonance imaging and clinical outcomes after cartilage repair surgery in the knee: a systematic review and meta-analysis. Am J Sports Med 41:1426–1434. https://doi.org/10.1177/0363546513485931

    Article  PubMed  Google Scholar 

  27. Watrin A, Ruaud JP, Olivier PT, Guingamp NC, Gonord PD, Netter PA, Blum AG, Guillot GM, Gillet PM, Loeuille DH (2001) T2 mapping of rat patellar cartilage. Radiology 219:395–402. https://doi.org/10.1148/radiology.219.2.r01ma32395

    Article  CAS  PubMed  Google Scholar 

  28. Trinh TQ, Harris JD, Siston RA, Flanigan DC (2013) Improved outcomes with combined autologous chondrocyte implantation and patellofemoral osteotomy versus isolated autologous chondrocyte implantation. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 29(3):566–574. https://doi.org/10.1016/j.arthro.2012.10.008

    Article  Google Scholar 

  29. Om A, Cg S, Fg JJ, Pj FJ, VC E, C I, (2019) Arthroscopic treatment of patellar and trochlear cartilage lesions with matrix encapsulated chondrocyte implantation versus microfracture: quantitative assessment with MRI T2-Mapping and MOCART at 4-year follow-up. Cartilage 12(3):940142843. https://doi.org/10.1177/1947603519835909

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Dr. Yuli Wang and Dr. Xixiong Qiu for reviewing the cases, Dr. Haofei Hu for his useful suggestions in data statistics, and Dr. Xi Zhou for figure processing. We also thank Medjaden Inc. for the scientific editing of this manuscript.

Author information

Authors and Affiliations

  1. Department of Radiology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Sungang Road West, Futian District, Shenzhen, Guangdong Province, China

    Jialing Lyu, Dingfu Li & Jun Xia

  2. Department of Rehabilitation Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, China

    Hongli Geng

  3. Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, China

    Weimin Zhu & Kang Chen

  4. Department of PET-CT Centre, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China

    Hui Ye

Authors
  1. Jialing Lyu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hongli Geng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Weimin Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dingfu Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kang Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hui Ye
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jun Xia
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Jialing Lyu, Weimin Zhu, Jun Xia, and Hui Ye conceived and designed the study. Jialing Lyu, Hongli Geng, and Kang Chen contributed to the literature search. Jialing Lyu, Hongli Geng, Hui Ye, and Kang Chan contributed to material preparation and data collection. Jialing Lyu, Dingfu Li, and Weimin Zhu contributed to data analysis. Jialing Lyu, Hongli Geng, and Kang Chen contributed to data interpretation. Jialing Lyu and Hongli Geng contributed to the tables and figures. Jialing Lyu contributed to the writing of the first draft of the manuscript. Jun Xia and Hui Ye contributed to the review and editing of the manuscript. All the authors have read and approved the publication of this work.

Corresponding authors

Correspondence to Hui Ye or Jun Xia.

Ethics declarations

Ethics approval

This study was carried out in accordance with the recommendations of Ethics Committee of the First Affiliated Hospital of Shenzhen University, Health Science Center; Shenzhen Second People’s Hospital. All subjects gave written informed consent in accordance with the Declaration of Helsinki.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lyu, J., Geng, H., Zhu, W. et al. Correlation between the quality of cartilage repair tissue and patellofemoral osteoarthritis after matrix-induced autologous chondrocyte implantation at three-year follow-up: a cross-sectional study. International Orthopaedics (SICOT) 47, 2383–2390 (2023). https://doi.org/10.1007/s00264-022-05581-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-022-05581-0

Keywords

Search

Navigation