Autologous chondrocyte implantation for cartilage repair: monitoring its success by magnetic resonance imaging and histology

Abstract

3D = three-dimensional; ACI = autologous chondrocyte implantation; H&E = haematoxylin and eosin; ICC = intraclass correlation; MOD = modified O'Driscoll; MRI = magnetic resonance imaging; TE = echo time; TR = repetition time. (Print ISSN 1478-6354; Online ISSN 1478-6362). This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any non-commercial purpose, provided this notice is preserved along with the article's original URL. Arthritis Research and Therapy AbstractAutologous chondrocyte implantation is being used increasingly for the treatment of cartilage defects. In spite of this, there has been a paucity of objective, standardised assessment of the outcome and quality of repair tissue formed. We have investigated patients treated with autologous chondrocyte implantation (ACI), some in conjunction with mosaicplasty, and developed objective, semiquantitative scoring schemes to monitor the repair tissue using MRI and histology. Results indicate repair tissue to be on average 2.5 mm thick. It was of varying morphology ranging from predominantly hyaline in 22% of biopsy specimens, mixed in 48%, through to predominantly fibrocartilage in 30%, apparently improving with increasing time postgraft. Repair tissue was well integrated with the host tissue in all aspects viewed. MRI scans provide a useful assessment of properties of the whole graft area and adjacent tissue and is a noninvasive technique for long-term follow-up. It correlated with histology (P = 0.02) in patients treated with ACI alone. Keywords: cartilage repair, collagens, glycosaminoglycans histology, MRI Open AccessAvailable online http://arthritis-research.com/content/5/1/R60 R61Cartilage function reflects its biochemical composition [8]. A small biopsy specimen such as is used for histochemical assessment can provide only limited information, as it is from a discrete location. MRI, in contrast, can provide information on the whole area. In addition, it is noninvasive and successive scans can be carried out, so allowing longitudinal monitoring at different time points. MR images have been shown to correlate with biochemical composition in other tissues, in cartilage in vivo, and even in engineered cartilage generated in a bioreactor [9][10][11]. Thus in this study we have used both forms of assessment of articular cartilage and correlated them where they are available at the same time points post-treatment. We have previously reported on the immunohistochemical appearance of such biopsy specimens, but only on two individuals and at 12 months after implantation [12]. Here we report on a much more extensive sample group, obtained up to 3 years after treatment, and compare histological assessments with those obtained by MRI. Materials and methods Tissue biopsiesPatients receiving ACI in our centre undergo arthroscopic assessment and biopsy of the treated region as part of their routine follow-up at approximately 12 months postgraft. The taking of biopsies from grafted regions was given ethical ap...

Adipose, Bone Marrow and Synovial Joint-Derived Mesenchymal Stem Cells for Cartilage Repair

“…The repair tissue produced by ACI has been shown to be varied but in general is more hyaline-like than produced using microfracture. However, there is often an abundance of type I collagen which is also characteristic of fibrocartilage (Roberts et al, 2002). Improvements in the procedure have led to second generation ACI techniques; synthetic collagen membranes have replaced the periosteal flap, and several biomaterial and natural scaffolds have been developed into which the chondrocytes are seeded (Redman et al, 2005).…”

Clinical outcome of autologous chondrocyte implantation is correlated with infrared spectroscopic imaging-derived parameters

“…Evaluation of the success of cartilage repair procedures can include assessment of tissue harvested from the repair site, and several scoring systems are in use for semi-quantitative histological tissue evaluations [18], including the ICRS II score [19], O’Driscoll score [20] and OsScore [21]. In general, these scoring systems consider tissue integrity, proteoglycan staining, chondrocyte clustering, presence of hyaline cartilage, and integration of repair with surrounding tissue.…”

“…To date, there has been limited success in correlating the clinical outcome of patients who have undergone cartilage repair procedures with the quality of the repair tissue formed [21, 23]. The aims of the current study were, therefore threefold, namely (I) to investigate the molecular properties of cartilage repair tissue post-ACI procedure using FT-IRIS, (II) to assess correlations between FT-IRIS-derived properties and the gold-standard techniques of histological grading and type II collagen IHC and (III) to investigate if FT-IRIS is a viable alternative to histological or immunochemical assessment by exploring the relationship between histological, IHC, or FT-IRIS assessment of tissue quality and clinical outcome.…”

Loss of spatial organization and destruction of the pericellular matrix in early osteoarthritis in vivo and in a novel in vitro methodology

“…To delay or avoid the progression of osteoarthritis (OA), a major debilitating disease, current therapies replace the tissue or surgically induce the migration of regeneration-competent cells from the subchondral bone[1]. None of the procedures re-create the original tissue function[2] or architecture[3], highlighting that developing more sufficient treatment strategies is hindered by a limited understanding of basic cartilage biology.…”