Article

A Randomized trial comparing autologous chondrocyte implantation with microfracture

University of Oslo, Kristiania (historical), Oslo, Norway
The Journal of Bone and Joint Surgery (Impact Factor: 5.28). 11/2007; 89(10):2105-12. DOI: 10.2106/JBJS.G.00003
Source: PubMed

ABSTRACT

The optimal treatment for cartilage lesions has not yet been established. The objective of this randomized trial was to compare autologous chondrocyte implantation with microfracture. This paper represents an update, with presentation of the clinical results at five years.
Eighty patients who had a single chronic symptomatic cartilage defect on the femoral condyle in a stable knee without general osteoarthritis were included in the study. Forty patients were treated with autologous chondrocyte implantation, and forty were treated with microfracture. We used the International Cartilage Repair Society, Lysholm, Short Form-36, and Tegner forms to collect clinical data, and radiographs were evaluated with use of the Kellgren and Lawrence grading system.
At two and five years, both groups had significant clinical improvement compared with the preoperative status. At the five-year follow-up interval, there were nine failures (23%) in both groups compared with two failures of the autologous chondrocyte implantation and one failure of the microfracture treatment at two years. Younger patients did better in both groups. We did not find a correlation between histological quality and clinical outcome. However, none of the patients with the best-quality cartilage (predominantly hyaline) at the two-year mark had a later failure. One-third of the patients in both groups had radiographic evidence of early osteoarthritis at five years.
Both methods provided satisfactory results in 77% of the patients at five years. There was no significant difference in the clinical and radiographic results between the two treatment groups and no correlation between the histological findings and the clinical outcome. One-third of the patients had early radiographic signs of osteoarthritis five years after the surgery. Further long-term follow-up is needed to determine if one method is better than the other and to study the progression of osteoarthritis.

Download full-text

Full-text

Available from: Eirik Solheim
  • Source
    • "Kon et al. used MACT in non-OA patients over 40 years old[47], with a significant improvement in all scores at medium-term follow-up, but inferior results and higher failure rates with respect to younger study populations. Knutsen et al. reported better clinical outcomes in active and younger (<30 years) patients[48], who had either undergone MF or ACT. Krishnan et al used collagen-covered ACT for the treatment of 199 patients, with a negative correlation between clinical result and older age[49]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: “Early Osteoarthritis (EOA)” has been defined combining clinical, imaging and surgical parameters, with the aim to identify patients in early degenerative phases, who might benefit from the use of available regenerative procedures. Aim of this first clinical trial is to prospectively evaluate the results obtained in a group of patients meeting the inclusion criteria of “EOA” as proposed by the ESSKA Cartilage Committee, and surgically treated with the implantation of a multi-phasic osteochondral scaffold.
    Preview · Article · Dec 2015 · Injury
  • Source
    • "This stimulation leads to the formation of a proteoglycan-rich fibrocartilaginous extra-cellular matrix that fills the defect site. However, likely due to the weaker mechanical properties than hyaline cartilage which is often observed (Knutsen et al, 2007;Saris et al, 2008), clinical outcomes of microfracture at more than 2 years follow-up can be not satisfactory (Kalson et al, 2010). In an attempt to enhance BM-MSC retention, proliferation and differentiation in the cartilage defect site, and ultimately improve the clinical outcome of microfracture, biodegradable scaffolds have been used to cover the blood clot (Chung et al, 2014). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Macrophages are key players in healing processes. However little is known on their capacity to modulate the differentiation potential of mesenchymal stem/stromal cells (MSC). Here we investigated whether macrophages (Mf) with, respectively, pro-inflammatory and tissue-remodeling traits differentially modulate chondrogenesis of bone marrow derived-MSC (BM-MSC). We demonstrated that coculture in collagen scaffolds of BM-MSC with Mf derived from monocytes polarized with M-CSF (M-Mf), but not with GM-CSF (GM-Mf) resulted in significantly higher glycosaminoglycan (GAG) content than what would be expected from an equal number of BM-MSC alone (defined as chondro-induction). Moreover, type II collagen was expressed at significantly higher levels in BM-MSC/M-Mf as compared to BM-MSC/GM-Mf constructs, while type X collagen expression was unaffected. In order to understand the possible cellular mechanism accounting for chondro-induction, developing monoculture and coculture tissues were digested and the properties of the isolated BM-MSC analysed. We observed that as compared to monocultures, in coculture with M-Mf, BM-MSC decreased less markedly in number and exhibited higher clonogenic and chondrogenic capacity. Despite their chondro-inductive effect in vitro, M-Mf did not modulate the cartilage tissue maturation in subcutaneous pockets of nude mice, as evidenced by similar accumulation of type X collagen and calcified tissue. Our results demonstrate that coculture of BM-MSC with M-Mf results in synergistic cartilage tissue formation in vitro. Such effect seems to result from the survival of BM-MSC with high chondrogenic capacity. Studies in an orthotopic in vivo model are necessary to assess the clinical relevance of our findings in the context of cartilage repair. This article is protected by copyright. All rights reserved. © 2014 Wiley Periodicals, Inc.
    Full-text · Article · Jun 2015 · Journal of Cellular Physiology
  • Source
    • "This stimulation leads to the formation of a proteoglycan-rich fibrocartilaginous extra-cellular matrix that fills the defect site. However, likely due to the weaker mechanical properties than hyaline cartilage which is often observed (Knutsen et al., 2007; Saris et al., 2008), clinical outcomes of microfracture at more than 2 years follow-up can be not satisfactory (Kalson et al., 2010). In an attempt to enhance MSC retention, proliferation and differentiation in the cartilage defect site, and ultimately improve the clinical outcome of microfracture, biodegradable scaffolds have been used to cover the blood clot (Chung et al., 2014). "

    Full-text · Article · Oct 2014
Show more