Autologous chondrocyte implantation in a novel alginate-agarose hydrogel: OUTCOME AT TWO YEARS

Centre Livet, Centre Albert, Trillat, 8 rue de Margnolles, 69300 Lyon-Caluire, France.
The Bone & Joint Journal (Impact Factor: 3.31). 06/2008; 90(5):597-604. DOI: 10.1302/0301-620X.90B5.20360
Source: PubMed


Autologous chondrocyte implantation is an established method of treatment for symptomatic articular defects of cartilage. CARTIPATCH is a monolayer-expanded cartilage cell product which is combined with a novel hydrogel to improve cell phenotypic stability and ease of surgical handling. Our aim in this prospective, multicentre study on 17 patients was to investigate the clinical, radiological, arthroscopic and histological outcome at a minimum follow-up of two years after the implantation of autologous chondrocytes embedded in a three-dimensional alginate-agarose hydrogel for the treatment of chondral and osteochondral defects. Clinically, all the patients improved significantly. Patients with lesions larger than 3 cm(2) improved significantly more than those with smaller lesions. There was no correlation between the clinical outcome and the body mass index, age, duration of symptoms and location of the defects. The mean arthroscopic International Cartilage Repair Society score was 10 (5 to 12) of a maximum of 12. Predominantly hyaline cartilage was seen in eight of the 13 patients (62%) who had follow-up biopsies. Our findings suggest that autologous chondrocyte implantation in combination with a novel hydrogel results in a significant clinical improvement at follow-up at two years, more so for larger and deeper lesions. The surgical procedure is uncomplicated, and predominantly hyaline cartilage-like repair tissue was observed in eight patients.

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    • "In three-dimensional regeneration methods, the Cartipatch ® , from the TBF laboratory developed and assessed in France, seems to give results that are comparable with an algarose and alginate matrix (Fig. 12) during a phase II study (subjective IKDC score increasing from 36 to 85 at 18 months of follow-up), which needs to be confirmed in an upcoming prospective, randomized multicenter phase III study [64]. "
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    ABSTRACT: Treatment of knee cartilage defect, a true challenge, should not only reconstruct hyaline cartilage on a long-term basis, but also be able to prevent osteoarthritis. Osteochondral knee lesions occur in either traumatic lesions or in osteochondritis dissecans (OCD). These lesions can involve all the articular surfaces of the knee in its three compartments. In principle, this review article covers symptomatic ICRS grade C or D lesions, depth III and IV, excluding management of superficial lesions, asymptomatic lesions that are often discovered unexpectedly, and kissing lesions, which arise prior to or during osteoarthritis. For clarity sake, the international classifications used are reviewed, for both functional assessment (ICRS and functional IKDC for osteochondral fractures, Hughston for osteochondritis) and morphological lesion evaluations (the ICRS macroscopic evaluation for fractures, the Bedouelle or SOFCOT for osteochondritis, and MOCART for MRI). The therapeutic armamentarium to treat these lesions is vast, but accessibility varies greatly depending on the country and the legislation in effect. Many comparative studies have been conducted, but they are rarely of high scientific quality; the center effect is nearly constant because patients are often referred to certain centers for an expert opinion. The indications defined herein use algorithms that take into account the size of the cartilage defect and the patient's functional needs for cases of fracture and the vitality, stability, and size of the fragment for cases of osteochondritis dissecans. Fractures measuring less than 2 cm(2) are treated with either microfracturing or mosaic osteochondral grafting, between 2 and 4 cm(2) with microfractures covered with a membrane or a culture of second- or third-generation chondrocytes, and beyond this size, giant lesions are subject to an exceptional allografting procedure, harvesting from the posterior condyle, or chondrocyte culture on a 3D matrix to restore volume. Cases of stable osteochondritis dissecans with closed articular cartilage can be simply monitored or treated with perforation in cases of questionable vitality. Cases of open joint cartilage are treated with a PLUS fixation if their vitality is preserved; if not, they are treated comparably to osteochondral fractures, with the type of filling depending on the defect size.
    Orthopaedics & Traumatology Surgery & Research 12/2011; 97(8 Suppl):S140-53. DOI:10.1016/j.otsr.2011.09.007 · 1.26 Impact Factor
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    • "BioSeed-C (Biotissue Technologies, Freiburg, Germany) relies on a fibrin and polymer-based scaffold of polyglycolic/polylactic acid and polydioxanone[50]. Cartipatch (Tissue Bank of France, Lyon, France) utilizes an agarose-alginate hydrogel scaffold[51]. Only the MACI technique is currently available in the United States. "
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    ABSTRACT: Full thickness articular cartilage defects have limited regenerative potential and are a significant source of pain and loss of knee function. Numerous treatment options exist, each with their own advantages and drawbacks. The goal of this review is to provide an overview of the problem of cartilage injury, a brief description of current treatment options and outcomes, and a discussion of the current principles and technique of Matrix-induced Autologous Chondrocyte Implantation (MACI). While early results of MACI have been promising, there is currently insufficient comparative and long-term outcome data to demonstrate superiority of this technique over other methods for cartilage repair.
    Sports Medicine Arthroscopy Rehabilitation Therapy & Technology 05/2011; 3(1):10. DOI:10.1186/1758-2555-3-10
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    • "Chondrocytes cultured in agarose adopt a rounded morphology necessary for the maintenance of chondrocytic phenotype, as shown by the synthesis of cartilage-specific aggrecan proteoglycan and type II collagen [2, 3]. For this reason, agarose has also been proposed as a scaffold for cartilage tissue engineering [28, 40] with encouraging clinical outcomes using chondrocytes embedded in a composite agarose-alginate hydrogel [39]. Hence, this study investigated the effect of PLIUS on isolated chondrocytes seeded in agarose gel cast within a six-well plate mounted above an array of ultrasound transducers. "
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    ABSTRACT: Pulsed low intensity ultrasound (PLIUS) has been used successfully for bone fracture repair and has therefore been suggested for cartilage regeneration. However, previous in vitro studies with chondrocytes show conflicting results as to the effect of PLIUS on the elaboration of extracellular matrix. This study tests the hypothesis that PLIUS, applied for 20 min/day, stimulates the synthesis of sulphated glycosaminoglycan (sGAG) by adult bovine articular chondrocytes cultured in either monolayer or agarose constructs. For both culture models, PLIUS at either 30 or 100 mW/cm(2) intensity had no net effect on the total sGAG content. Although PLIUS at 100 mW/cm(2) did induce a 20% increase in sGAG content at day 2 of culture in agarose, this response was lost by day 5. Intensities of 200 and 300 mW/cm(2) resulted in cell death probably due to heating from the ultrasound transducers. The lack of a sustained up-regulation of sGAG synthesis may reflect the suggestion that PLIUS only induces a stimulatory effect in the presence of a tissue injury response. These results suggest that PLIUS has a limited potential to provide an effective method of stimulating matrix production as part of a tissue engineering strategy for cartilage repair.
    Medical & Biological Engineering 10/2010; 48(12):1215-22. DOI:10.1007/s11517-010-0681-3 · 1.73 Impact Factor
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