Advertisement

Repair of Osteochondral Defects in the Knee by Cellular (Chondrocyte and Stem Cell) Transplantation

  • George Bentley
  • Panos D. Gikas
Chapter
Part of the Orthopaedic Study Guide Series book series (ORTHSTUDY)

Abstract

Autologous chondrocyte implantation is now established as a successful treatment for many patients with osteochondral injuries of the knee. Indications, preoperative preparation, operative technique, post-operative management and rehabilitation are detailed. Newer developments such as matrix-assisted chondrocyte implantation (MACI) and “multilayer” repair are possible for filling deep bony defects. Anterior cruciate ligament repair and para-articular osteotomy for realignment of the tibio-femoral joint are also possible. Realignment procedures of the patella-femoral joint are essential where there is mal-tracking. The published results over a 10-year period indicate that 80% of patients have a satisfactory outcome. Autologous stem cells show promise for similar results by a “one-step” procedure and accelerated rehabilitation.

Keywords

Articular cartilage Repair Autologous chondrocyte implantation with collagen membrane (ACIC) Matrix-assisted chondrocyte implantation (MACI) Stem cells Surgical indications Preoperative preparation Imaging Surgical techniques—ACIC, MACI Complications Outcomes 

References

  1. 1.
    Bentley G, et al. A prospective, randomised comparison of autologous chon- drocyte implantation versus mosaicplasty for osteochondral defects in the knee. J Bone Joint Surg Br. 2003;85(2):223–30.CrossRefGoogle Scholar
  2. 2.
    Bentley G, et al. Minimum ten-year results of a prospective randomised study of autologous chondrocyte implantation versus mosaicplasty for symptomatic articular cartilage lesions of the knee. J Bone Joint Surg Br. 2012;94(4):50.Google Scholar
  3. 3.
    Beris AE, et al. Treatment of full-thickness chondral defects of the knee with autologous chondrocyte implantation: a functional evaluation with long-term follow-up. Am J Sports Med. 2012;40(3):562–7.CrossRefGoogle Scholar
  4. 4.
    Filardo G, et al. Arthroscopic second generation autologous chondrocytes implantation associated with bone grafting for the treatment of knee osteo- chondritis dissecans: results at 6 years. Knee. 2012;19(5):658–63.CrossRefGoogle Scholar
  5. 5.
    Curl WW, et al. Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy. 1997;13(4):456–60.CrossRefGoogle Scholar
  6. 6.
    Aroen A, et al. Articular cartilage lesions in 993 consecutive knee arthro- scopies. Am J Sports Med. 2004;32(1):211–5.CrossRefGoogle Scholar
  7. 7.
    Flanigan DC, et al. Prevalence of chondral defects in athletes’ knees: a systematic review. Med Sci Sports Exerc. 2010;42(10):1795–801.CrossRefGoogle Scholar
  8. 8.
    Jaiswal PK, et al. The adverse effect of elevated body mass index on outcome after autologous chondrocyte implantation. J Bone Joint Surg Br. 2012;94(10):1377–81.CrossRefGoogle Scholar
  9. 9.
    Jaiswal PK, et al. Does smoking influence outcome after autologous chondrocyte implantation?: a case-controlled study. J Bone Joint Surg Br. 2009;91(12):1575–8.CrossRefGoogle Scholar
  10. 10.
    Nawaz SZ, Bentley G, Briggs TW, Skinner JA, Carrington RWJ, Gallagher KR, Dhinsa BS. Autologous chondrocyte implantation in the knee: mid- to long-term results. J Bone Joint Surg Am. 2014;96(10):824–30.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • George Bentley
    • 1
    • 2
  • Panos D. Gikas
    • 2
    • 3
  1. 1.Institute of Orthopaedics and Musculo-Skeletal ScienceUniversity College LondonLondonUK
  2. 2.Royal National Orthopaedic Hospital NHS TrustStanmoreUK
  3. 3.Bone Tumour UnitRoyal National Orthopaedic Hospital NHS TrustStanmoreUK

Personalised recommendations