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Good clinical and MRI outcome after arthroscopic autologous chondrocyte implantation for cartilage repair in the knee

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

Abstract

Purpose

To analyze the clinical outcome and cartilage regeneration after all-arthroscopic Autologous Chondrocyte Implantation (ACI) using chondrospheres® (ACT3D) for the treatment of full-size articular cartilage lesions at the knee.

Methods

Thirty consecutive patients treated by all-arthroscopic ACI for full-size articular cartilage lesions in an otherwise healthy knee were enrolled. The defects were located on the femoral condyles (n = 18), in the trochlea (n = 7) and at the patella (n = 5). Follow-up consisted of a clinical evaluation with assessment of subjective scores. Patient satisfaction was evaluated on a visual analog scale (VAS). 3-Tesla MRI and T2 mapping of the operated and the contralateral healthy knees were included to control the quality of the regenerated cartilage. The MOCART score was assessed by three blinded independent radiologists.

Results

At the mean follow-up of 3 years ± 10.2 months 26 of the 30 patients (86.6%) were subjectively highly satisfied with the surgical result and assured they would undergo the same procedure again. The mean Lysholm score increased to 77.7 ± 14.6, the mean subjective IKDC significantly to 84.2 ± 5.6 (p < 0.05) and all five subgroups of the KOOS improved significantly (p < 0.05). The subjective outcome was not influenced by the duration of symptoms, age, location, size of defects nor dose of spheroids. The modified MOCART score was a mean of 60 ± 21 (0–80) points. Twenty-four patients (82.7%) were rated higher than 60 points. T2 mapping documented similar cartilage quality of the area of the ACI and the same location at the contralateral knee. Three patients had a MOCART score of 0 with few or no cartilage regeneration on MRI and were considered as failure of the ACI.

Conclusion

In this small cohort of 30 patients, minimal invasive all-arthroscopic ACT 3D using spheroids led to convincing clinical short-to-mid-term results with a significant increase in patients quality of life, satisfaction, reduction of pain, and improvement in knee function. The high morphologic integrity and quality of the ACI was reconfirmed by the Mocart Score and T2 mapping.

Level of evidence

IV.

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Author information

Authors and Affiliations

  1. HKF, International Center for Hip-Knee-Foot Surgery, ATOS Hospital Heidelberg, Bismarckstrasse 9-15, 69115, Heidelberg, Germany

    Rainer Siebold & Ferzan Suezer

  2. Institute for Anatomy and Cell Biology, INF, Karl-Ruprecht University Heidelberg, Heidelberg, Germany

    Rainer Siebold

  3. Sporthopaedicum Berlin, Berlin, Germany

    Ferzan Suezer

  4. MRI-Department, German Cancer Research Center (DKFZ), INF, Heidelberg, Germany

    Benjamin Schmitt & Marco Essig

  5. Siemens Healthcare Pty Ltd, Sydney, Australia

    Benjamin Schmitt

  6. Department of Radiology, MR Center-High Field MR, Medical University Vienna, Vienna, Austria

    Siegfried Trattnig

  7. Department of Radiology, University of Manitoba, Winnipeg, Canada

    Marco Essig

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  1. Rainer Siebold
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  2. Ferzan Suezer
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  4. Siegfried Trattnig
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Correspondence to Rainer Siebold.

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The authors have no conflicts of interest.

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No funding has been received for this study.

Ethical approval

The study was approved by the institutional ethical review board of the University of Heidelberg (ID: S-323/2010).

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Patients gave individual written informed consent.

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Siebold, R., Suezer, F., Schmitt, B. et al. Good clinical and MRI outcome after arthroscopic autologous chondrocyte implantation for cartilage repair in the knee. Knee Surg Sports Traumatol Arthrosc 26, 831–839 (2018). https://doi.org/10.1007/s00167-017-4491-0

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  • DOI: https://doi.org/10.1007/s00167-017-4491-0

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