Stefan Marlovits

VITOS Vienna International Trauma Orthopedics Sport · Center for Cartilage Regeneration, Orthobiology and Joint Preservation

Zusammenfassung Die Arbeitsgemeinschaft „Klinische Geweberegeneration“ hat bereits in den Jahren 2004, 2013 und 2016 Empfehlungen in Bezug auf die Indikation für verschiedene knorpelregenerative Verfahren zur Behandlung von Knorpelschäden am Kniegelenk publiziert. Auf Basis neuer wissenschaftlicher Erkenntnisse sollen in der vorliegenden Arbeit die...

Objective Since the first introduction of the MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score, significant progress has been made with regard to surgical treatment options for cartilage defects, as well as magnetic resonance imaging (MRI) of such defects. Thus, the aim of this study was to introduce the MOCART 2.0 knee scor...

475 LONGITUDINAL ASSESSMENT OF CARTILAGE COMPOSITION BY HIGH-FIELD MRI IN PATIENTS WITH LOW-GRADE KNEE CARTILAGE INJURY C. Scotti 1, D. Laurent 1, V. Juras 2, V. Mlynarik 2, M. Schreiner 2, P. Szomolanyi 2, S. Zbyn 2, J. Goldhahn 3, H. Haber 1, E. Kubiak 1, R. Roubenoff 1, S. Marlovits 4, M. Schieker 1, S. Trattnig 2. 1 Novartis Inst. for BioMed. R...

Zusammenfassung Für die operative Sanierung lokalisiert vollschichtiger Knorpelschäden der großen Gelenke stehen mit den Transplantationstechniken (autologe Knorpelzelltransplantation, autologe osteochondrale Transplantation) und knochenmarkstimulierenden Techniken unterschiedliche Therapieoptionen zur Verfügung. Vor allem für das Kniegelenk konnte...

Objectives Matrix associated chondrocyte transplantation (MACT) is routinely used in joints of the extremities, but not in the temporomandibular joint (TMJ). Study design We report the first case series in 7 patients of a tissue engineering approach to regenerate severely degraded articulating surfaces in the TMJ by simultaneously completely resur...

Purpose: The increasing awareness on the role of subchondral bone in the etiopathology of articular surface lesions led to the development of osteochondral scaffolds. While safety and promising results have been suggested, there are no trials proving the real potential of the osteochondral regenerative approach. Aim was to assess the benefit provi...

Melanoma inhibitory activity (MIA) affects the differentiation to hyaline cartilage and can inhibit the osteogenic potential of bone morphogenetic protein (BMP)-2 in mesenchymal stem cells (MSC). The aim of this study was to investigate if MIA also inhibits the osteogenic potential of BMP-2 in human articular chondrocytes during redifferentiation,...

Minimal data set. Minimal data set for each gene and the GAG/DNA. (PDF)

Vote-signed-at-20150303. Statement of the Ethics Board of the University of Vienna. (PDF)

Background: Matrix-associated autologous chondrocyte transplantation (MACT) has been an effective therapy for large, full-thickness cartilage lesions for years. However, little is known about how graft maturation is affected by characteristics of transplanted chondrocytes. Purpose: To investigate the influence of gene expression of chondrocytes...

Articular cartilage is the clinically most relevant hyaline cartilage since frequently damaged by trauma or abuse but without any intrinsic potential to regenerate. It covers the ends of the bones and allows frictionless movement due to its stiff and elastic properties. The biomechanics and consecutive function of articular cartilage are determined...

The present study reports for the first time the presence of giant crystals in mitochondria of equine chondrocytes. These structures show dark contrast in TEM images as well as a granular substructure of regularly aligned 1–2 nm small units. Different zone axes of the crystalline structure were analysed by means of Fourier transformation of lattice...

Background: Autologous chondrocyte implantation (ACI) is an established and well-accepted procedure for the treatment of localised full-thickness cartilage defects of the knee. Methods: The present review of the working group "Clinical Tissue Regeneration" of the German Society of Orthopaedics and Trauma (DGOU) describes the biology and function...

An attempt to define pre-osteoarthritis (OA) versus early OA and definitive osteoarthritis. A group of specialists in the field of cartilage science and treatment was formed to consider the nature of OA onset and its possible diagnosis. Late-stage OA, necessitating total joint replacement, is the end stage of a biological process, with many previou...

The German Cartilage Registry (KnorpelRegister DGOU) has been introduced in October 2013 and aims on the evaluation of patients who underwent cartilage repair for symptomatic cartilage defects. It represents a nation-wide cohort study which has been introduced by the working group "Tissue Regeneration" of the Germany Society of Orthopaedic Surgery...

Background: Long-term effects of different weightbearing (WB) modalities after matrix-associated autologous chondrocyte implantation (MACI) on changes in knee articular cartilage and clinical outcomes are needed to establish more evidence-based recommendations for postoperative rehabilitation. Hypothesis: There will be no differences between acc...

The aim of this study was to determine in vivo high-resolution morphological and biochemical gender related differences in cartilage repair tissue (MACT). Forty patients were examined clinically and by MR scans at 3T-MRI (coronal 3D True-FISP sequence for morphologic assessment and multi-echo spin-echo T2-mapping for biochemical assessment of healt...

Background: It is unclear whether matrix-associated autologous chondrocyte transplantation (MACT) results in objective and subjective clinical improvements at 10 years after surgery. Hypothesis: Matrix-associated autologous chondrocyte transplantation will result in clinical and radiological improvements in patients with symptomatic, traumatic c...

Musculoskeletal surgery is associated with a high risk of venous thrombosis and pulmonary embolism. The introduction of direct oral anticoagulants (DOAK) has broadened the possibilities for prevention of venous thromboembolism in the course of orthopedic and trauma surgery. Addressing this recent development, the Austrian Societies of Orthopedics a...

Background: A range of scaffolds is available from various manufacturers for cartilage repair through matrix-associated autologous chondrocyte transplantation (MACT), with good medium- to long-term results. Purpose: To evaluate clinical and magnetic resonance imaging (MRI) outcomes 2 years after MACT on the knee joint using the Novocart 3D scaff...

To develop an MRI scoring system for follow-up of knee cartilage repair procedures integrating assessment of the repair site and the whole joint called Cartilage Repair OsteoArthritis Knee Score (CROAKS), and to assess its reliability. MRI examinations of 20 patients that had undergone matrix-associated autologous chondrocyte transplantation (MACT)...

Autologous osteochondral transplantation (OCT) is one of the surgical options currently used to treat cartilage defects. It is the only cartilage repair method that leads to a transfer of hyaline cartilage repair tissue. The purpose of this study was to evaluate the magnetic resonance observation of cartilage repair tissue (MOCART) score, the 3D MO...

Die autologe Chondrozytentransplantation (ACT) hat sich seit ihrer Einführung in den klinischen Alltag zu einem Standardverfahren zur Behandlung von großen umschriebenen Knorpeldefekten im Kniegelenk etabliert. Trotz der zunehmenden Ausweitung des Verfahrens bestehen noch viele Fragen hinsichtlich der optimalen postoperativen Therapie. Ziel unserer...

Background: Several patient- and defect-specific factors influencing clinical outcomes after matrix-associated chondrocyte transplantation (MACT) have been identified, including the patient's age, location of the defect, or duration of symptoms before surgery. Little is known, however, about the influence of cell-specific characteristics on clinic...

Our aim was to evaluate the impact of cryopreservation, cultivation time and patient's age on the expression of specific chondrogenic markers in Hyalograft® C transplants. Gene expression of chondrocyte markers [collagen type I (COL1A1), COL2A1, aggrecan, versican, melanoma inhibitory activity (MIA) and interleukin (IL)-1β] was analysed in cartilag...

Purpose: To determine in vivo biomechanical properties of articular cartilage and cartilage repair tissue of the patella, using biochemical MRI by means of quantitative T2 mapping. Methods: Twenty MR scans were achieved at 3T MRI, using a new 8-channel multi-function coil allowing controlled bending of the knee. Multi-echo spin-echo T2 mapping w...

Autologous chondrocyte transplantation/implantation (ACT/ACI) is an established and recognised procedure for the treatment of localised full-thickness cartilage defects of the knee. The present review of the working group "Clinical Tissue Regeneration" of the German Society of Orthopaedics and Traumatology (DGOU) describes the biology and function...

Background While MRI can provide a detailed morphological evaluation after articular cartilage repair, its additional value in determining clinical outcome has yet to be determined. Purpose To evaluate the correlation between MRI and clinical outcome after cartilage repair and to identify parameters that are most important in determining clinical...

Treatment of cartilage defects poses challenging problems in human and veterinary medicine, especially in horses. This study examines the suitability of applying scaffold materials similar to those used for human cartilage regeneration on equine chondrocytes. Chondrocytes gained from biopsies of the talocrural joint of three horses were propagated...

Background: Over the course of the past two decades autologous chondrocyte implantation (ACI) has become an important surgical technique for treating large cartilage defects. The original method using a periostal flap has been improved by using cell-seeded scaffolds for implantation, the matrix-based autologous chondrocyte implantation (mb-ACI) pr...

Background: Cartilage injuries often occur during sports activities, and return to sports after cartilage surgery is an important outcome parameter for different treatment methods in the competitive as well as the recreationally active population. Hypothesis: At the time of midterm follow-up after matrix-associated autologous chondrocyte transpl...

To date, few studies have been published reporting the 5-year follow-up of clinical and radiological outcomes for chondral defects treated with matrix-induced autologous chondrocyte implantation (MACI). A significant improvement in clinical and radiological outcomes after treatment of symptomatic, traumatic chondral defects of the knee with the MAC...

Grundlagen: Für die normale Gelenkfunktion ist der hyaline Knorpel zur Lastverteilung der mechanischen Kräfte und als Gleitfläche für reibungsarme Bewegungen unerläßlich. Das artikuläre Knorpelgewebe besteht aus einer einzigen Zellpopulation, integriert in ein dreidimensionales Netzwerk hochorganisierter Matrixstrukturen. Dieser feingewebliche Aufb...

To correlate long-term clinical outcome and the results of morphological as well as advanced biochemical magnetic resonance imaging (MRI) techniques [T2-mapping, glycosaminoglycan chemical exchange saturation transfer (gagCEST), sodium-23-imaging] in patients after autologous osteochondral transplantation (AOT) in knee joints. Nine AOT patients (tw...

PURPOSE Aim of this study was to exploit dGEMRIC, T2 mapping and diffusion weighted imaging (DWI) in a clinical approach in patients after cartilage repair. METHOD AND MATERIALS Eighteen patients (age:35.3±10years, follow-up:35.7±21months) after matrix-associated autologous condrocyte transplantation (MACT) of the knee were included at 3T MRI. A g...

To use a new approach which provides, based on the widely used three-dimensional double-echo steady-state (DESS) sequence, in addition to the morphological information, the generation of biochemical T2 maps in one hybrid sequence. In 50 consecutive MRIs at 3.0 Tesla (T) after matrix-associated autologous chondrocyte transplantation (MACT) of the kn...

Overweight and obesity are afflictions that lead to an increased risk of health problems including joint problems. The aim of the study was to assess the condition of articular cartilage in obese adolescent patients suffering from knee pain. MRI of 24 knees of 20 morbidly obese patients, mean age 14.2 years, was performed in an open 1.0 Tesla MR sy...

The combination of lateral condyle and medial epicondyle fractures of the humerus and a radial nerve transection is extremely rare. We could not find a similar case in the literature. Hereby we report such a case. An eight-year old female fell down while playing. She had wrist, thumb and fingers drop associated with hypoaesthesia over the first web...

Although scaffold composition and architecture are considered to be important parameters for tissue engineering, their influence on gene expression and cell differentiation is rarely investigated in scaffolds used for matrix-associated autologous chondrocyte transplantation (MACT). In this study we have therefore comparatively analyzed the gene exp...

Articular cartilage lesions are a common pathology of the knee joint, and many patients may benefit from cartilage repair surgeries that offer the chance to avoid the development of osteoarthritis or delay its progression. Cartilage repair surgery, no matter the technique, requires a noninvasive, standardized, and high-quality longitudinal method t...

Objective: This pilot study of cartilage defect treatment was designed to establish the horse as a suitable animal model for MACT (Matrix-Associated Autologous Chrondrocyte Transplantation) transplants and to analyse the morphological aspects of repair tissue development and differentiation. Design: Hyaluronan-based and collagen-based biodegradable...

To evaluate a new isotropic 3D proton-density, turbo-spin-echo sequence with variable flip-angle distribution (PD-SPACE) sequence compared to an isotropic 3D true-fast-imaging with steady-state-precession (True-FISP) sequence and 2D standard MR sequences with regard to the new 3D magnetic resonance observation of cartilage repair tissue (MOCART) sc...

PURPOSE To use the capabilities of new isovoxel sequences and their 3D multiplanar-reconstruction (MPR) in the monitoring after cartilage repair, the 3D magnetic resonance observation of cartilage repair tissue (MOCART) scoring system was recently introduced. The purpose of this study was to evaluate a new isotropic 3D proton-density, turbo-spin-ec...

Scaffold architecture and composition are important parameters in cartilage tissue engineering. In this in vitro study, we compared the morphology of four different cell-graft systems applied in clinical cartilage regeneration and analyzed the cell distribution (DAPI nuclei staining) and cell-scaffold interaction (SEM, TEM). Our investigations reve...

Engineering cartilage tissue is challenging, mainly because chondrocytes lose their differentiated phenotype when cultured in monolayer. The aim of this study was to analyse the influence of 3D-culture conditions on the redifferentiation of chondrocytes, devoting special attention to BMPs. Dedifferentiated chondrocytes were seeded onto two differen...

In this study, we investigated the influence of transforming growth factor beta 3 (TGF-beta3), bone morphogenetic protein 6 (BMP-6) and basic fibroblast growth factor (FGF-2) on chondrogenesis in adipose derived stem cells (ASC). Cells were isolated from liposuction material, expanded and subjected to chondrogenic differentiation. Micromass pellets...

Purpose: To prospectively determine on T2 cartilage maps the effect of unloading during a clinical magnetic resonance (MR) examination in the postoperative follow-up of patients after matrix-associated autologous chondrocyte transplantation (MACT) of the knee joint. Materials and methods: Ethical approval for this study was provided by the local...

In cartilage repair, bioregenerative approaches using tissue engineering techniques have tried to achieve a close resemblance to hyaline cartilage, which might be visualized using advanced magnetic resonance imaging. To compare cartilage repair tissue at the femoral condyle noninvasively after matrix-associated autologous chondrocyte transplantatio...

PURPOSE Unloading during an MR examination might change the biochemical parameters related to tissue anisotropy and hydration, such as quantitative T2. The aim of this study was to use cartilage T2 mapping for the assessment of changes related to unloading during a clinical MR examination in the post-operative follow-up of patients after matrix-ass...

PURPOSE In the post-operative evaluation of cartilage repair procedures, the magnetic resonance observation of cartilage repair tissue (MOCART) score is widely used. Aim of this study was to introduce a new 3D MOCART score using the possibilities of an isotropic 3D sequence in the post-operative evaluation of patients after matrix-associated autolo...

Die autologe Knorpelzelltransplantation (ACT) wird zur Behandlung umschriebener Defekte des artikulären Gelenkknorpels als zellbiologische Methode der Knorpelreparatur empfohlen. Die Modifikation der klassischen ACT mit der Verwendung von Biomaterialien zur matrixassoziierten autologen Knorpelzelltransplantation (MACT) zeigt operationstechnische un...

To use T2 and T2* mapping in patients after matrix-associated autologous chondrocyte transplantation (MACT) of the knee, and to compare and correlate both methodologies. 3.0-Tesla MRI was performed on 30 patients (34.6 +/- 9.9 years) with a follow-up period of 28.1 +/- 18.8 months after MACT. Multi-echo, spin-echo-based T2 mapping using six echoes...

Autologous chondrocyte transplantation (ACT) is a cell-based biological cartilage repair procedure for the regeneration of injured articular cartilage. The further modification of classical ACT to matrix-associated autologous chondrocyte transplantation (MACT) includes the use of biomaterials as cell carriers and has biological and surgical advanta...

There is no consensus about the optimal time for weightbearing activities after matrix-associated autologous chondrocyte implantation (MACI) of the femoral condyle. A comprehensive protocol after MACI on the femoral condyle with accelerated weightbearing leads to a better functional and radiographic outcome compared with the same comprehensive prot...

Human articular chondrocytes are expanded in monolayer culture in order to obtain sufficient cells for matrix-associated cartilage transplantation. During this proliferation process, the cells change their shape as well as their expression profile. These changes resemble those that occur during embryogenesis, when the limb anlagen form the interzon...

Cartilage defects are common pathologies and surgical cartilage repair shows promising results. In its postoperative evaluation, the magnetic resonance observation of cartilage repair tissue (MOCART) score, using different variables to describe the constitution of the cartilage repair tissue and the surrounding structures, is widely used. High-fiel...

Activation of granulocytes causes a considerable rise in the concentration of lactoferrin (Lf) in synovial fluid (SF). We here investigate consequences thereof on signal transduction and the balance between catabolic and anabolic metabolism in chondrocytes. Signal transduction was analysed in cultured chondrocytes by immunodetection of mitogen acti...

The purpose of this article was to evaluate the potential of in vivo zonal T2-mapping as a noninvasive tool in the longitudinal visualization of cartilage repair tissue maturation after matrix-associated autologous chondrocyte transplantation (MACT). Fifteen patients were treated with MACT and evaluated cross-sectionally, with a baseline MRI at a f...

The aim of the present pilot study is to show initial results of a multimodal approach using clinical scoring, morphological magnetic resonance imaging (MRI) and biochemical T2-relaxation and diffusion-weighted imaging (DWI) in their ability to assess differences between cartilage repair tissue after microfracture therapy (MFX) and matrix-associate...

In this study we compared the expression of hormone receptors and markers of differentiation in growth plate chondrocytes (GPC) and articular chondrocytes (AC) under different culture conditions by real-time PCR and immunofluorescence. After one week of monolayer culture, porcine GPC and AC of 6-8-week-old piglets were either seeded in alginate bea...

The purpose of this study was to investigate the expression of different CD44 and hyaluronan synthase isoforms in cartilage, their alterations during the chondrocyte dedifferentiation process in monolayer culture and during the redifferentiation process on 3D scaffolds. Chondrocytes isolated from human articular cartilage were cultured as a monolay...

The aim of this study was to use morphological as well as biochemical (T2 and T2* relaxation times and diffusion-weighted imaging (DWI)) magnetic resonance imaging (MRI) for the evaluation of healthy cartilage and cartilage repair tissue after matrix-associated autologous chondrocyte transplantation (MACT) of the ankle joint. Ten healthy volunteers...

To evaluate the use of diffusion-weighted imaging (DWI) for the assessment of cartilage maturation in patients after matrix-associated autologous chondrocyte transplantation (MACT). Fifteen patients after MACT were examined by 3.0-T magnetic-resonance-tomography; the examination was up to 13 month after surgery in group 1, and later than 13 month a...

Various treatment options for deep cartilage defects are presently available. The efficacy of bone marrow stimulation with microfracture, of mosaicplasty and of various autologous chondrocyte implantation (ACI) techniques has been subject to numerous studies recently. Magnetic resonance imaging (MRI) has gained a major role in the assessment of car...