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Is the Transplant Quality at the Time of Surgery Adequate for Matrix-guided Autologous Cartilage Transplantation? A Pilot Study

  • Symposium: Tscherne Festschrift
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Matrix-guided autologous chondrocyte transplantation (MACT) has been proposed as an option for treating large full-thickness cartilage defects. However, little is known about the chondrogenic potential of transplants for MACT at the time of implantation, although cell quality and chondrogenic differentiation of the implants are crucial for restoration of function after MACT.

Questions/purposes

We therefore asked: (1) Do MACT implants allow deposition of extracellular cartilage matrix in an in vitro culture model? (2) Are these implants associated with improved knee function 1 year after MACT in large cartilage defects?

Methods

We retrospectively reviewed all 125 patients with large localized cartilage defects (mean defect size 5 cm2) of the knee who were treated with MACT from 2005 to 2010. The mean age was 31 years (range, 16–53 years). Portions of the cell-matrix constructs (n = 50) that were not implanted in the cartilage defects were further cultured and tested for their potential to form articular cartilage. Knee function of all patients was analyzed preoperatively, 3 months, and 1 year postoperatively with the International Knee Documentation Committee (IKDC) score.

Results

In vitro assessment of the cell-matrix implants showed chondrogenic differentiation with positive staining for glycosaminoglycans and collagen II in all cultures. Enzyme-linked immunosorbent assay showed an increase of collagen II production. We observed an improvement in median IKDC score from 41 to 67 points at last followup.

Conclusions

Cartilage extracellular matrix deposition shows adequate implant quality for MACT at the time of implantation and justifies the use for treatment of large cartilage defects.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Daniela Drenkard for her technical assistance with histological and enzyme-linked immunosorbent assay analysis.

Author information

Authors and Affiliations

  1. Department of Trauma Surgery, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Germany

    Johannes Zellner MD, Peter Angele MD, Richard Kujat PhD & Michael Nerlich MD

  2. Sporthopaedicum Regensburg, Regensburg, Germany

    Peter Angele MD

  3. Centre of Clinical Studies, University Hospital of Regensburg, Regensburg, Germany

    Florian Zeman PhD

Authors
  1. Johannes Zellner MD
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  2. Peter Angele MD
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  5. Michael Nerlich MD
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Corresponding author

Correspondence to Michael Nerlich MD.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at the University of Regensburg, Regensburg, Germany, and the Sporthopaedicum Regensburg, Regensburg, Germany.

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Zellner, J., Angele, P., Zeman, F. et al. Is the Transplant Quality at the Time of Surgery Adequate for Matrix-guided Autologous Cartilage Transplantation? A Pilot Study. Clin Orthop Relat Res 471, 2852–2861 (2013). https://doi.org/10.1007/s11999-013-2958-y

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