Abstract
Introduction
Early results using injectable autologous chondrocyte implantation (ACI) for the treatment of full thickness acetabular cartilage defects have been promising. However, so far there is no information on radiological results after injectable ACI using spheroids. The purpose of this sturdy was to (1) investigate the quality of tissue repair on MRI and (2) investigate the correlation between the MRI results and clinical results at a minimum follow-up of 24 months after third generation ACI in full thickness acetabular cartilage defects. It was hypothesized that ACI shows good MRI results in patients with large full thickness acetabular cartilage defects 24 months after surgery. It was also hypothesized that there is a correlation between postoperative clinical and MRI morphological results at a minimum follow-up of 24 months.
Study design
Retrospective case series.
Materials and methods
Patients with ACI for full thickness acetabular cartilage defects > 2 cm2 were evaluated by preoperative and postoperative clinical scoring tools including the modified Harris Hip Score (mHHS), the International Hip Outcome Tool (iHOT-33), and the Subjective Hip Value (SHV) as well as a high resolution indirect arthro-MRI 24 months after surgery utilizing an identical imaging protocol for all patients. The magnetic resonance observation of cartilage repair tissue (MOCART) scoring system was used to classify the repair tissue on MRI. Demographic patient data was evaluated for influencing factors for pre- and postoperative clinical as well as radiological results.
Results
Thirty six consecutive patients (5 women/31 men, average age 32.9 years) had undergone two stage ACI procedure. The average size of the cartilage defect was 5.0 (2–6) cm2. The average follow-up was 29.9 (24–42) months. Four patients were not available for the final follow-up (follow-up rate 89%). The postoperative average MOCART score was 82.2 (± 14.2). MOCART score showed medium correlation of the item defect fill and the postoperative mHHS (r = 0.384, p = 0.043). There was no correlation of the other items or the total score with postoperative results. The patients showed significant improvement in the outcome measurements between preoperative and postoperative in the mHHS, the iHOT-33, and the SHV.
Conclusions
Despite the large acetabular cartilage defects included in this study, ACI showed good MRI results with complete defect fill in 87.5% after a minimum 24-month follow-up. Statistically significant correlation of MRI and clinical results could only be seen with the item defect fill. Further research with longer follow-up is needed to evaluate the long-term results of ACI in acetabular cartilage defects.
Similar content being viewed by others
References
Byrd JW, Jones KS (2009) Arthroscopic femoroplasty in the management of cam-type femoroacetabular impingement. Clin Orthop Relat Res 467(3):739–746
Egerton T, Hinman RS, Takla A, Bennell KL, O’Donnell J (2013) Intraoperative cartilage degeneration predicts outcome 12 months after hip arthroscopy. Clin Orthop Relat Res 471(2):593–599
Haviv B, Singh PJ, Takla A, O’Donnell J (2010) Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damage. J Bone Joint Surg Br 92(5):629–633
Classen T, Korsmeier K, Kamminga M et al (2016) Is early treatment of cam-type femoroacetabular impingement the key to avoiding associated full thickness isolated chondral defects? Knee Surg Sports Traumatol Arthrosc 24(7):2332–2337
Fontana A, Bistolfi A, Crova M, Rosso F, Massazza G (2012) Arthroscopic treatment of hip chondral defects: autologous chondrocyte transplantation versus simple debridement–a pilot study. Arthroscopy 28(3):322–329
Mancini D, Fontana A (2014) Five-year results of arthroscopic techniques for the treatment of acetabular chondral lesions in femoroacetabular impingement. Int Orthop 38(10):2057–2064
Fontana A (2016) Long-term benefit of arthroscopic autologous matrix-induced chondrogenesis compared to microfracture for femoral acetabular impingement-induced chondral lesions. J Hip Preserv Surg 3(suppl_1)
Karthikeyan S, Roberts S, Griffin D (2012) Microfracture for acetabular chondral defects in patients with femoroacetabular impingement: results at second-look arthroscopic surgery. Am J Sports Med 40(12):2725–2730
Leunig M, Beck M, Dora C, Ganz R (2006) Femoroacetabular impingement: trigger for the development of coxarthrosis. Orthopade 35(1):77–84
Crawford K, Philippon MJ, Sekiya JK, Rodkey WG, Steadman JR (2006) Microfracture of the hip in athletes. Clin Sports Med 25(2):327–335
Philippon MJ, Schenker ML, Briggs KK, Maxwell RB (2008) Can microfracture produce repair tissue in acetabular chondral defects? Arthroscopy 24(1):46–50
Wright TM, Maher SA (2009) Current and novel approaches to treating chondral lesions. J Bone Joint Surg Am 91(Suppl 1):120–125
Yen YM, Kocher MS (2010) Chondral lesions of the hip: microfracture and chondroplasty. Sports Med Arthrosc Rev 18(2):83–89
Fu FH, Zurakowski D, Browne JE et al (2005) 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 33(11):1658–1666
Kon E, Filardo G, Berruto M et al (2011) Articular cartilage treatment in high-level male soccer players: a prospective comparative study of arthroscopic second-generation autologous chondrocyte implantation versus microfracture. Am J Sports Med 39(12):2549–2557
Saris DB, Vanlauwe J, Victor J et al (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
Saris DB, Vanlauwe J, Victor J et al (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
Hoburg A, Loer I, Korsmeier K et al (2019) Matrix-associated autologous chondrocyte implantation is an effective treatment at midterm follow-up in adolescents and young adults. Orthop J Sports Med 7(4):2325967119841077
Niemeyer P, Laute V, Zinser W et al (2020) Safety and efficacy of matrix-associated autologous chondrocyte implantation with spheroid technology is independent of spheroid dose after 4 years. Knee Surg Sports Traumatol Arthrosc
Fickert S, Schattenberg T, Niks M, Weiss C, Thier S (2014) Feasibility of arthroscopic 3-dimensional, purely autologous chondrocyte transplantation for chondral defects of the hip: a case series. Arch Orthop Trauma Surg 134(7):971–978
Schroeder JH, Hufeland M, Schutz M, Haas NP, Perka C, Krueger DR (2016) Injectable autologous chondrocyte transplantation for full thickness acetabular cartilage defects: early clinical results. Arch Orthop Trauma Surg 136(10):1445–1451
Thorey F, Budde S, Ezechieli M, Albrecht UV, Ettinger M (2013) Feasibility of arthroscopic placement of autologous matrix-induced chondrogenesis grafts in the cadaver hip joint. Orthop Rev (Pavia) 5(3):26
Krueger DR, Gesslein M, Schuetz M, Perka C, Schroeder JH (2018) Injectable autologous chondrocyte implantation (ACI) in acetabular cartilage defects-three-year results. J Hip Preserv Surg 5(4):386–392
Krueger DR, Karczewski D, Geßlein M, Schuetz M, Perka C, Schroeder JH (2017) Is a minimal invasive autologous chondrocyte implantation (ACI) in the hip possible? A feasibility and safety study of arthroscopic treatment of full thickness acetabular cartilage defects with an injectable ACI. J Orthopedic Surg Tech 1(1):1–6
Thier S, Weiss C, Fickert S (2017) Arthroscopic autologous chondrocyte implantation in the hip for the treatment of full-thickness cartilage defects—a case series of 29 patients and review of the literature. SICOT J 3:72
Liu YW, Tran MD, Skalski MR et al (2019) MR imaging of cartilage repair surgery of the knee. Clin Imaging 58:129–139
Dienst M, Seil R, Kohn DM (2005) Safe arthroscopic access to the central compartment of the hip. Arthroscopy 21(12):1510–1514
Fry R, Domb B (2010) Labral base refixation in the hip: rationale and technique for an anatomic approach to labral repair. Arthroscopy 26(9 Suppl):S81-89
Jackson TJ, Hanypsiak B, Stake CE, Lindner D, El Bitar YF, Domb BG (2014) Arthroscopic labral base repair in the hip: clinical results of a described technique. Arthroscopy 30(2):208–213
Anderer U, Libera J (2002) In vitro engineering of human autogenous cartilage. J Bone Miner Res 17(8):1420–1429
Korsmeier K, Classen T, Kamminga M, Rekowski J, Jager M, Landgraeber S (2016) Arthroscopic three-dimensional autologous chondrocyte transplantation using spheroids for the treatment of full-thickness cartilage defects of the hip joint. Knee Surg Sports Traumatol Arthrosc 24(6):2032–2037
Mohtadi NG, Griffin DR, Pedersen ME et al (2012) The Development and validation of a self-administered quality-of-life outcome measure for young, active patients with symptomatic hip disease: the International Hip Outcome Tool (iHOT-33). Arthroscopy 28(5):595–605
Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 51(4):737–755
Krueger DR, Leopold VJ, Schroeder JH, Perka C, Hardt S (2020) Correlation of the subjective hip value with validated patient-reported outcome measurements for the hip. J Clin Med 9(7)
Gilbart MK, Gerber C (2007) Comparison of the subjective shoulder value and the Constant score. J Shoulder Elbow Surg 16(6):717–721
Kemp JL, Collins NJ, Roos EM, Crossley KM (2013) Psychometric properties of patient-reported outcome measures for hip arthroscopic surgery. Am J Sports Med 41(9):2065–2073
Sampson TG (2001) Complications of hip arthroscopy. Clin Sports Med 20(4):831–836
Minkara AA, Westermann RW, Rosneck J, Lynch TS (2019) Systematic review and meta-analysis of outcomes after hip arthroscopy in femoroacetabular impingement. Am J Sports Med 47(2):488–500
Ayeni OR, Bedi A, Lorich DG, Kelly BT (2011) Femoral neck fracture after arthroscopic management of femoroacetabular impingement: a case report. J Bone Joint Surg Am 93(9):e47
Matsuda DK (2009) Acute iatrogenic dislocation following hip impingement arthroscopic surgery. Arthroscopy 25(4):400–404
Bushnell BD, Dahners LE (2009) Fatal pulmonary embolism in a polytraumatized patient following hip arthroscopy. Orthopedics 32(1):56
Pietschmann MF, Horng A, Glaser C et al (2014) Post-treatment rehabilitation after autologous chondrocyte implantation: state of the art and recommendations of the Clinical Tissue Regeneration Study Group of the German Society for Accident Surgery and the German Society for Orthopedics and Orthopedic Surgery. Unfallchirurg 117(3):235–241
Marlovits S, Striessnig G, Resinger CT et al (2004) Definition of pertinent parameters for the evaluation of articular cartilage repair tissue with high-resolution magnetic resonance imaging. Eur J Radiol 52(3):310–319
Marlovits S, Singer P, Zeller P, Mandl I, Haller J, Trattnig S (2006) 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 57(1):16–23
Bretschneider H, Trattnig S, Landgraeber S et al (2020) Arthroscopic matrix-associated, injectable autologous chondrocyte transplantation of the hip: significant improvement in patient-related outcome and good transplant quality in MRI assessment. Knee Surg Sports Traumatol Arthrosc 28(4):1317–1324
Fickert S, Gerwien P, Helmert B et al (2012) One-year clinical and radiological results of a prospective, investigator-initiated trial examining a novel, purely autologous 3-dimensional autologous chondrocyte transplantation product in the knee. Cartilage 3(1):27–42
Barie A, Kruck P, Sorbi R et al (2020) Prospective long-term follow-up of autologous chondrocyte implantation with periosteum versus matrix-associated autologous chondrocyte implantation: a randomized clinical trial. Am J Sports Med 48(9):2230–2241
McCarthy HS, McCall IW, Williams JM et al (2018) Magnetic resonance imaging parameters at 1 year correlate with clinical outcomes up to 17 years after autologous chondrocyte implantation. Orthop J Sports Med 6(8):2325967118788280
Ochs BG, Muller-Horvat C, Albrecht D et al (2011) Remodeling of articular cartilage and subchondral bone after bone grafting and matrix-associated autologous chondrocyte implantation for osteochondritis dissecans of the knee. Am J Sports Med 39(4):764–773
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(6):1426–1434
Cvetanovich GL, Riboh JC, Tilton AK, Cole BJ (2017) Autologous chondrocyte implantation improves knee-specific functional outcomes and health-related quality of life in adolescent patients. Am J Sports Med 45(1):70–76
Niethammer TR, Holzgruber M, Gulecyuz MF, Weber P, Pietschmann MF, Muller PE (2017) Matrix based autologous chondrocyte implantation in children and adolescents: a match paired analysis in a follow-up over three years post-operation. Int Orthop 41(2):343–350
Ogura T, Bryant T, Minas T (2017) Long-term outcomes of autologous chondrocyte implantation in adolescent patients. Am J Sports Med 45(5):1066–1074
Kreuz PC, Muller S, von Keudell A et al (2013) Influence of sex on the outcome of autologous chondrocyte implantation in chondral defects of the knee. Am J Sports Med 41(7):1541–1548
Niethammer TR, Gallik D, Chevalier Y et al (2021) Effect of the defect localization and size on the success of third-generation autologous chondrocyte implantation in the knee joint. Int Orthop 45(6):1483–1491
Jannelli E, Fontana A (2017) Arthroscopic treatment of chondral defects in the hip: AMIC, MACI, microfragmented adipose tissue transplantation (MATT) and other options. SICOT J 3:43
Krueger DR, Gesslein M, Schuetz M, Perka C, Schroeder J (2018) Injectable autologous chondrocyte implantation (ACI) in acetabular cartilage defects—three-year results. J Hip Preserv Surg
Niemeyer P, Kostler W, Salzmann GM, Lenz P, Kreuz PC, Sudkamp NP (2010) Autologous chondrocyte implantation for treatment of focal cartilage defects in patients age 40 years and older: a matched-pair analysis with 2-year follow-up. Am J Sports Med 38(12):2410–2416
Funding
None.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The author(s) declare that they have no competing interests.
Ethical approval
EA1/108/17.
Informed consent
Not necessary.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Krueger, D.R., Baur, A.D.J., Perka, C. et al. Injectable autologous chondrocyte implantation in acetabular cartilage defects: 2-year minimum clinical and MRI results. Arch Orthop Trauma Surg 143, 739–747 (2023). https://doi.org/10.1007/s00402-021-04141-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-021-04141-2