Skip to main content
SpringerLink
Log in

Satisfactory long-term MRI after autologous chondrocyte implantation at the knee

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

Abstract

Purpose

Autologous chondrocyte implantation (ACI) to address isolated condylar lesions is supposed to limit degenerative deterioration in neutrally aligned knees. Here, we report long-term results of the first-generation ACI technique with periosteal flap.

Methods

Twelve patients, 29 years old on average, were included on the basis of pre-operative MRI selection of lesions >2 cm2. Cartilage carrots were harvested arthroscopically, then cultured and finally re-implanted within a mean time interval of 12 weeks. Ten-year MRI results were analysed according to a semi-quantitative scale, along with functional assessment based on International Knee Documentation Committee score, Lysholm et al. score and the Tegner et al. activity scale.

Results

One patient secondarily required valgus tibial osteotomy with mosaic plasty. Another incurred graft hypertrophy that necessitated arthroscopic peeling. MRI showed that cartilage repair filled more than 50 % of the initial defect in 9 patients. Standard radiographs revealed slight narrowing of the joint line. Overall, functional scores improved durably by 50 %, although activity level decreased substantially.

Conclusion

ACI contained degenerative changes within moderate stages while maintaining durable functional improvement. However, in the absence of controls, it was difficult to differentiate between these findings and the spontaneous evolution of non-treated lesions.

Level of evidence

Case series, Level IV.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Ahlbäck S (1968) Osteoarthrosis of the knee. A radiographic investigation. Acta Radiol Diagn (Stockh) 277(Suppl):7–72

    Google Scholar 

  2. Arøen A, Løken S, Heir S, Alvik E, Ekeland A, Granlund OG, Engebretsen L (2004) Articular cartilage lesions in 993 consecutive knee arthroscopies. Am J Sports Med 32:211–215

    Article  PubMed  Google Scholar 

  3. Barber-Westin SD, Noyes FR (1999) Assessment of sports participation levels following knee injuries. Sports Med 28:1–10

    Article  CAS  PubMed  Google Scholar 

  4. Battaglia M, Vannini F, Buda R, Cavallo M, Ruffilli A, Monti C, Galletti S, Giannini S (2011) Arthroscopic autologous chondrocyte implantation in osteochondral lesions of the talus: mid-term T2-mapping MRI evaluation. Knee Surg Sports Traumatol Arthrosc 19:1376–1384

    Article  PubMed  Google Scholar 

  5. Brittberg M (2008) Autologous chondrocyte implantation–technique and long-term follow-up. Injury 39(Suppl 1):S40–S49

    Article  PubMed  Google Scholar 

  6. 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 

  7. Browne JE, Anderson AF, Arciero R, Mandelbaum B, Moseley JB Jr, Micheli LJ, Fu F, Erggelet C (2005) Clinical outcome of autologous chondrocyte implantation at 5 years in US subjects. Clin Orthop Relat Res 436:237–245

    Article  PubMed  Google Scholar 

  8. Cavalli F, Izadi A, Ferreira APRB, Braga L, Braga-Baiak A, Schueda MA, Gandhi M, Pietrobon R (2011) Interobserver reliability among radiologists and orthopaedists in evaluation of chondral lesions of the knee by MRI. Adv Orthop 2011:743742

    Article  PubMed Central  PubMed  Google Scholar 

  9. Cicuttini FM, Wluka AE, Stuckey SL (2001) Tibial and femoral cartilage changes in knee osteoarthritis. Ann Rheum Dis 60:977–980

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG (1997) Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy 13:456–460

    Article  CAS  PubMed  Google Scholar 

  11. Davies-Tuck ML, Martel-Pelletier J, Wluka AE, Pelletier J-P, Ding C, Jones G, Davis S, Cicuttini FM (2008) Meniscal tear and increased tibial plateau bone area in healthy post-menopausal women. Osteoarthr Cartil 16:268–271

    Article  CAS  PubMed  Google Scholar 

  12. Gille J, Schuseil E, Wimmer J, Gellissen J, Schulz AP, Behrens P (2010) Mid-term results of autologous matrix-induced chondrogenesis for treatment of focal cartilage defects in the knee. Knee Surg Sports Traumatol Arthrosc 18:1456–1464

    Article  CAS  PubMed  Google Scholar 

  13. Gooding CR, Bartlett W, Bentley G, Skinner JA, Carrington R, Flanagan A (2006) A prospective, randomised study comparing two techniques of autologous chondrocyte implantation for osteochondral defects in the knee: periosteum covered versus type I/III collagen covered. Knee 13:203–210

    Article  CAS  PubMed  Google Scholar 

  14. Graichen H, Al-Shamari D, Hinterwimmer S, von Eisenhart-Rothe R, Vogl T, Eckstein F (2005) Accuracy of quantitative magnetic resonance imaging in the detection of ex vivo focal cartilage defects. Ann Rheum Dis 64:1120–1125

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Heir S, Nerhus TK, Røtterud JH, Løken S, Ekeland A, Engebretsen L, Arøen A (2010) Focal cartilage defects in the knee impair quality of life as much as severe osteoarthritis: a comparison of knee injury and osteoarthritis outcome score in 4 patient categories scheduled for knee surgery. Am J Sports Med 38:231–237

    Article  PubMed  Google Scholar 

  16. Jobanputra P, Parry D, Fry-Smith A, Burls A (2001) Effectiveness of autologous chondrocyte transplantation for hyaline cartilage defects in knees: a rapid and systematic review. Health Technol Assess 5:1–57

    CAS  PubMed  Google Scholar 

  17. Jungmann PM, Salzmann GM, Schmal H, Pestka JM, Südkamp NP, Niemeyer P (2012) Autologous chondrocyte implantation for treatment of cartilage defects of the knee: what predicts the need for reintervention? Am J Sports Med 40:58–67

    Article  PubMed  Google Scholar 

  18. Kim MK, Choi SW, Kim SR, Oh IS, Won MH (2010) Autologous chondrocyte implantation in the knee using fibrin. Knee Surg Sports Traumatol Arthrosc 18:528–534

    Article  PubMed  Google Scholar 

  19. Marcacci M, Zaffagnini S, Kon E, Visani A, Iacono F, Loreti I (2002) Arthroscopic autologous chondrocyte transplantation: technical note. Knee Surg Sports Traumatol Arthrosc 10:154–159

    Article  CAS  PubMed  Google Scholar 

  20. 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 57:16–23

    Article  PubMed  Google Scholar 

  21. McDermott AG, Langer F, Pritzker KP, Gross AE (1985) Fresh small-fragment osteochondral allografts. Long-term follow-up study on first 100 cases. Clin Orthop Relat Res 197:96–102

    PubMed  Google Scholar 

  22. Minas T (2001) Autologous chondrocyte implantation for focal chondral defects of the knee. Clin Orthop Relat Res 391(Suppl):S349–S361

    Article  PubMed  Google Scholar 

  23. Moseley JB Jr, Anderson AF, Browne JE, Mandelbaum BR, Micheli LJ, Fu F, Erggelet C (2010) Long-term durability of autologous chondrocyte implantation: a multicenter, observational study in US patients. Am J Sports Med 38:238–246

    Article  PubMed  Google Scholar 

  24. 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 

  25. Peterson L, Vasiliadis HS, Brittberg M, Lindahl A (2010) Autologous chondrocyte implantation: a long-term follow-up. Am J Sports Med 38:1117–1124

    Article  PubMed  Google Scholar 

  26. Pietschmann MF, Niethammer TR, Horng A, Gülecyüz MF, Feist-Pagenstert I, Jansson V, Müller PE (2012) The incidence and clinical relevance of graft hypertrophy after matrix-based autologous chondrocyte implantation. Am J Sports Med 40:68–74

    Article  PubMed  Google Scholar 

  27. Pridie KH (1959) A method of resurfacing osteoarthritic knee joints. J Bone Joint Surg Br 41-B(3):618–619

    Google Scholar 

  28. Shah MR, Kaplan KM, Meislin RJ, Bosco JA 3rd (2007) Articular cartilage restoration of the knee. Bull NYU Hosp Jt Dis 65:51–60

    PubMed  Google Scholar 

  29. Shelbourne KD, Jari S, Gray T (2003) Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J Bone Joint Surg Am 85-A(Suppl 2):8–16

    PubMed  Google Scholar 

  30. Steadman JR, Rodkey WG, Briggs KK (2002) Microfracture to treat full-thickness chondral defects: surgical technique, rehabilitation, and outcomes. J Knee Surg 15:170–176

    PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  32. Vasiliadis HS, Danielson B, Ljungberg M, McKeon B, Lindahl A, Peterson L (2010) Autologous chondrocyte implantation in cartilage lesions of the knee: long-term evaluation with magnetic resonance imaging and delayed gadolinium-enhanced magnetic resonance imaging technique. Am J Sports Med 38:943–949

    Article  PubMed  Google Scholar 

  33. Widuchowski W, Widuchowski J, Koczy B, Szyluk K (2009) Untreated asymptomatic deep cartilage lesions associated with anterior cruciate ligament injury: results at 10- and 15-year follow-up. Am J Sports Med 37:688–692

    Article  PubMed  Google Scholar 

  34. Yates JW Jr (2003) The effectiveness of autologous chondrocyte implantation for treatment of full-thickness articular cartilage lesions in workers’ compensation patients. Orthopedics 26:295–300

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Bichat Claude Bernard Hospital, Paris Diderot University, 46 rue Henri Huchard, 75877, Paris Cedex 18, France

    A. Pelissier, P. Boyer & P. Massin

  2. Department of Orthopaedic and Hand Surgery, Strasbourg University Hospitals, 10, Avenue Achille-Baumann, 67403, Illkirch, France

    Y. Boussetta, W. Van Hille, P. Hamon & J. H. Jaeger

  3. Department of Radiology, Strasbourg University Hospitals, 10, Avenue Molière, 67098, Strasbourg, France

    G. Bierry

Authors
  1. A. Pelissier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Boyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Y. Boussetta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G. Bierry
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. W. Van Hille
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. Hamon
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. H. Jaeger
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. P. Massin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Pelissier.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pelissier, A., Boyer, P., Boussetta, Y. et al. Satisfactory long-term MRI after autologous chondrocyte implantation at the knee. Knee Surg Sports Traumatol Arthrosc 22, 2007–2012 (2014). https://doi.org/10.1007/s00167-013-2428-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-013-2428-9

Keywords

Search

Navigation