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Third-generation autologous chondrocyte implantation after failed bone marrow stimulation leads to inferior clinical results

  • Peter Ernst Müller
  • David Gallik
  • Florian Hammerschmid
  • Andrea Baur-Melnyk
  • Matthias Frank Pietschmann
  • Anja Zhang
  • Thomas Richard NiethammerEmail author
KNEE
  • 95 Downloads

Abstract

Purpose

Third-generation autologous chondrocyte implantation (ACI) is an established and frequently used method and successful method for the treatment of full-thickness cartilage defects in the knee. There are also an increasing number of patients with autologous chondrocyte implantation as a second-line therapy that is used after failed bone marrow stimulation in the patient’s history. The purpose of this study is to investigate the effect of previous bone marrow stimulation on subsequent autologous chondrocyte implantation therapy. In this study, the clinical results after the matrix-based autologous chondrocyte implantation in the knee in a follow-up over 3 years postoperatively were analysed.

Methods

Forty patients were included in this study. A total of 20 patients with cartilage defects of the knee were treated with third-generation autologous chondrocyte implantation (Novocart® 3D) as first-line therapy. The mean defect size was 5.4 cm2 (SD 2.6). IKDC subjective score and VAS were used for clinical evaluation after 6, 12, 24 and 36 months postoperatively. The results of these patients were compared with 20 matched patients with autologous chondrocyte implantation as second-line therapy. Matched pair analysis was performed by numbers of treated defects, defect location, defect size, gender, age and BMI.

Results

Both the first-line (Group I) and second-line group (Group II) showed significantly better clinical results in IKDC score and VAS score in the follow-up over 3 years compared with the preoperative findings. In addition, Group I showed significantly better results in the IKDC and VAS during the whole postoperative follow-up after 6, 12, 24 and 36 months compared to Group II with second-line autologous chondrocyte implantation (IKDC 6 months p = 0.015, 1 year p = 0.001, 2 years p = 0.001, 3 years p = 0.011). Additionally, we found a lower failure rate in Group I. No revision surgery was performed in Group I. The failure rate in the second-line Group II was 30%.

Conclusion

This study showed that third-generation autologous chondrocyte implantation is a suitable method for the treatment of full-thickness cartilage defects. Both, Group I and Group II showed significant improvement in our follow-up. However, in comparing the results of the two groups, autologous chondrocyte implantation after failed bone marrow stimulation leads to worse clinical results.

Level of evidence

III

Keywords

ACI Second-line therapy Cartilage 

Notes

Acknowledgements

The authors declared that they have no conflicts of interest in the authorship and publication of this contribution. Prof. Müller and David Gallik have contributed equally to this article and share the first authorship.

Funding

No external funding was used.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

All procedures were performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1864 Helsinki declaration and its later amendments or comparable ethical standards.

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  • Peter Ernst Müller
    • 1
  • David Gallik
    • 1
  • Florian Hammerschmid
    • 1
  • Andrea Baur-Melnyk
    • 2
  • Matthias Frank Pietschmann
    • 1
  • Anja Zhang
    • 1
  • Thomas Richard Niethammer
    • 1
    Email author
  1. 1.Department of Orthopaedics, Physical Medicine and RehabilitationUniversity Hospital, LMU MunichMunichGermany
  2. 2.Department of RadiologyUniversity Hospital, LMU MunichMunichGermany

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