Skip to main content

Advertisement

Log in

Autologous chondrocyte implantation in the knee using fibrin

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

Abstract

Autologous chondrocyte implantation (ACI) is widely used to treat symptomatic articular cartilage injury of the knee. Fibrin ACI is a new tissue-engineering technique for the treatment of full-thickness articular cartilage defects, in which autologous chondrocytes are inserted into a three-dimensional scaffold provided by fibrin gel. The objective of this study is to document and compare mean changes in overall clinical scores at both baseline and follow-up. Fibrin ACI was used to treat deep cartilage defects of the femoral condyle in 30 patients. There were 24 men and 6 women with a median age of 35 years (range 15–55) and with a mean defect size of 5.8 cm2 (range 2.3–12). Clinical and functional knee evaluations were performed using different scoring systems, MRI was performed 24 months postoperatively, and arthroscopy was performed 12 months postoperatively. All patients achieved clinical and functional status improvements following surgery (P < 0.01). The mean scores of the Henderson classification (MRI evaluation) significantly improved from 14.4 to 7 (P = 0.001), and no graft-associated complications were noted. Arthroscopic assessments performed 12 months postoperatively produced nearly normal (grade II) International Cartilage Repair Society scores in 8 of the 10 study patients. Fibrin ACI offers the advantages of technical simplicity, minimal invasiveness, a short surgery time, and easier access to difficult sites than classical ACI. Based on the findings of this clinical pilot study, we conclude that fibrin ACI offers a reliable means of treating articular cartilage defects of the knee.

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

Access this article

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

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Briggs TW, Mahroof S, David LA, Flannelly J, Pringle J, Bayliss M (2003) Histological evaluation of chondral defects after autologous chondrocyte implantation of the knee. J Bone Joint Surg Br 85:1077–1083

    Article  CAS  PubMed  Google Scholar 

  2. Brittberg M (1999) Autologous chondrocyte transplantation. Clin Orthop Relat Res 367(Suppl):S147–S155

    Article  PubMed  Google Scholar 

  3. 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 331:889–895

    Article  CAS  PubMed  Google Scholar 

  4. Brittberg M, Sjogren-Jansson E, Lindahl A, Peterson L (1997) Influence of fibrin sealant (Tisseel) on osteochondral defect repair in the rabbit knee. Biomaterials 18:235–242

    Article  CAS  PubMed  Google Scholar 

  5. Erggelet C, Sittinger M, Lahm A (2003) The arthroscopic implantation of autologous chondrocytes for the treatment of full-thickness cartilage defects of the knee joint. Arthroscopy 19:108–110

    PubMed  Google Scholar 

  6. Filova E, Rampichova M, Handl M et al (2007) Composite hyaluronate-type I collagen-fibrin scaffold in the therapy of osteochondral defects in miniature pigs. Physiol Res 56(Suppl 1):S5–S16

    PubMed  Google Scholar 

  7. Gilbert JE (1998) Current treatment options for the restoration of articular cartilage. Am J Knee Surg 11:42–46

    CAS  PubMed  Google Scholar 

  8. Haddo O, Mahroof S, Higgs D et al (2004) The use of chondrogide membrane in autologous chondrocyte implantation. Knee 11:51–55

    Article  PubMed  Google Scholar 

  9. Henderson IJ, Tuy B, Connell D, Oakes B, Hettwer WH (2003) Prospective clinical study of autologous chondrocyte implantation and correlation with MRI at three and 12 months. J Bone Joint Surg Br 85:1060–1066

    Article  CAS  PubMed  Google Scholar 

  10. Hendrickson DA, Nixon AJ, Grande DA et al (1994) Chondrocyte-fibrin matrix transplants for resurfacing extensive articular cartilage defects. J Orthop Res 12:485–497

    Article  CAS  PubMed  Google Scholar 

  11. Homminga GN, Buma P, Koot HW, van der Kraan PM, van den Berg WB (1993) Chondrocyte behavior in fibrin glue in vitro. Acta Orthop Scand 64:441–445

    CAS  PubMed  Google Scholar 

  12. Itay S, Abramovici A, Nevo Z (1987) Use of cultured embryonal chick epiphyseal chondrocytes as grafts for defects in chick articular cartilage. Clin Orthop Relat Res 220:284–303

    PubMed  Google Scholar 

  13. Kirilak Y, Pavlos NJ, Willers CR et al (2006) Fibrin sealant promotes migration and proliferation of human articular chondrocytes: possible involvement of thrombin and protease-activated receptors. Int J Mol Med 17:551–558

    CAS  PubMed  Google Scholar 

  14. Marlovits S, Hombauer M, Truppe M, Vecsei V, Schlegel W (2004) Changes in the ratio of type-I and type-II collagen expression during monolayer culture of human chondrocytes. J Bone Joint Surg Br 86:286–295

    Article  CAS  PubMed  Google Scholar 

  15. Messner K, Maletius W (1996) The long-term prognosis for severe damage to weight-bearing cartilage in the knee: a 14-year clinical and radiographic follow-up in 28 young athletes. Acta Orthop Scand 67:165–168

    Article  CAS  PubMed  Google Scholar 

  16. Micheli LJ, Browne JE, Erggelet C et al (2001) Autologous chondrocyte implantation of the knee: multicenter experience and minimum 3-year follow-up. Clin J Sport Med 11:223–228

    Article  CAS  PubMed  Google Scholar 

  17. Minas T, Peterson L (1999) Advanced techniques in autologous chondrocyte transplantation. Clin Sports Med 18:13–44

    Article  CAS  PubMed  Google Scholar 

  18. Minns J (2000) Gothenburg, Sweden: 3rd symposium of the International Cartilage Repair Society. Knee 7:195–196

    Article  PubMed  Google Scholar 

  19. Munirah S, Samsudin OC, Chen HC, Salmah SH, Aminuddin BS, Ruszymah BH (2007) Articular cartilage restoration in load-bearing osteochondral defects by implantation of autologous chondrocyte-fibrin constructs: an experimental study in sheep. J Bone Joint Surg Br 89:1099–1109

    Article  CAS  PubMed  Google Scholar 

  20. Nehrer S, Spector M, Minas T (1999) Histologic analysis of tissue after failed cartilage repair procedures. Clin Orthop Relat Res 365:149–162

    Article  PubMed  Google Scholar 

  21. Noyes FR, Barber SD, Mangine RE (1990) Bone-patellar ligament-bone and fascia lata allografts for reconstruction of the anterior cruciate ligament. J Bone Joint Surg Am 72:1125–1136

    CAS  PubMed  Google Scholar 

  22. Pavesio A, Abatangelo G, Borrione A et al (2003) Hyaluronan-based scaffolds (Hyalograft C) in the treatment of knee cartilage defects: preliminary clinical findings. Novartis Found Symp 249:203–217

    Article  PubMed  Google Scholar 

  23. Peterson L, Brittberg M, Kiviranta I, Akerlund EL, Lindahl A (2002) Autologous chondrocyte transplantation. Biomechanics and long-term durability. Am J Sports Med 30:2–12

    PubMed  Google Scholar 

  24. Peterson L, Minas T, Brittberg M, Nilsson A, Sjogren-Jansson E, Lindahl A (2000) Two- to 9-year outcome after autologous chondrocyte transplantation of the knee. Clin Orthop Relat Res 374:212–234

    Article  PubMed  Google Scholar 

  25. Robinson D, Ash H, Yayon A, Nevo Z, Aviezer D (2001) Characteristics of cartilage biopsies used for autologous chondrocytes transplantation. Cell Transpl 10:203–208

    CAS  Google Scholar 

  26. Silverman RP, Passaretti D, Huang W, Randolph MA, Yaremchuk MJ (1999) Injectable tissue-engineered cartilage using a fibrin glue polymer. Plast Reconstr Surg 103:1809–1818

    Article  CAS  PubMed  Google Scholar 

  27. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49

    PubMed  Google Scholar 

  28. Ueno T, Kagawa T, Mizukawa N, Nakamura H, Sugahara T, Yamamoto T (2001) Cellular origin of endochondral ossification from grafted periosteum. Anat Rec 264:348–357

    Article  CAS  PubMed  Google Scholar 

  29. van Susante JL, Buma P, Schuman L, Homminga GN, van den Berg WB, Veth RP (1999) Resurfacing potential of heterologous chondrocytes suspended in fibrin glue in large full-thickness defects of femoral articular cartilage: an experimental study in the goat. Biomaterials 20:1167–1175

    Article  PubMed  Google Scholar 

  30. Wakitani S, Kimura T, Hirooka A et al (1989) Repair of rabbit articular surfaces with allograft chondrocytes embedded in collagen gel. J Bone Joint Surg Br 71:74–80

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This paper was selected to be supported by a grant from the Jeju National University Hospital Research Fund (2009).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sung Wook Choi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kim, M.K., Choi, S.W., Kim, S.R. et al. Autologous chondrocyte implantation in the knee using fibrin. Knee Surg Sports Traumatol Arthrosc 18, 528–534 (2010). https://doi.org/10.1007/s00167-009-0905-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-009-0905-y

Keywords

Navigation