Autologous Chondrocyte Implantation Using a Bilayer Collagen Membrane: A Preliminary Report

Abstract

Purpose. To present preliminary clinical experience with Matrix-induced autologous chondrocyte implantation, a new tissue-engineering technique for treatment of deep cartilage defects, in which autologous chondrocytes are seeded on a tridimensional scaffold provided by a bilayer type I–III collagen membrane. Methods. From December 1999 to January 2001, 13 patients underwent implantation procedure for deep cartilage defects. Age of patients ranged from 18 to 49 years (mean age, 35 years). The mean defect size was 3.5 cm2 (range, 2.0–4.5 cm2). Clinical and functional evaluation were performed using various score systems for the ankle and the knee, and magnetic resonance imaging was performed at 6 and 12 months postoperatively. Membrane structure and cellular population were investigated by light microscopy, scanning electron microscopy, and electrophoresis before implantation. Results. The mean follow-up was 6.5 months (range, 2–15 months). No complications were observed in the postoperative period. The 6 patients with a minimum follow-up of 6 months showed an improvement in clinical and functional status after surgery. Magnetic resonance images showed the presence of hyaline-like cartilage at the site of implantation; there was evidence of chondroblasts and type II collagen inside the seeded membrane. Conclusion. Matrix-induced autologous chondrocyte implantation offers several advantages with respect to the traditional cultured cell procedure. These include technical simplicity, short operating time, minimal invasiveness, and easier access to difficult sites. It appears to be a reliable method for the repair of deep cartilage defects.

Treatment of osteochondral defects of the talus

“…Although this is promising in animal and human knees, 35,451 only two short-term ankle cases have been reported. 75 Using Hyalograft C as the scaffold, Giannini et al performed arthroscopic ACI in 30 patients with good shortterm results. 149 Regarding OATS, the postoperative application of pulsed electromagnetic fields has been recently shown to limit graft resorption and cyst formation in sheep.…”

“…148 Furthermore, different scaffolds have been developed that can be implanted with cultured chondrocytes, obviating the need for periosteal grafting for fixation. 75,269,451 Matrix-induced autologous chondrocyte implantation (MACI) makes use of a collagen type I-III membrane, which serves as the scaffold for implanted chondrocytes. Although this is promising in animal and human knees, 35,451 only two short-term ankle cases have been reported.…”

Shaped, Stratified, Scaffold-free Grafts for Articular Cartilage Defects

“…Larger constructs that are needed for repair of large articular cartilage defects may become feasible with expansion and redifferentiation methods for the cells in conjunction with a bioreactor for improved construct growth and maturation. To attach such constructs to the surrounding native tissue, such shaped grafts may either be fixed in the defect area with fibrin glue, as with current tissue-engineered grafts like MACI [11], or be fabricated in vitro atop a boney substance, which can integrate into the surrounding native bone after implantation as with current allo-or autograft techniques. In vivo implantation of these grafts is needed to better assess the functionality and durability of such biomimetic, tissueengineered grafts with appropriate shape and stratification.…”

“…Large defects and widespread joint degeneration, as found in osteoarthritis, impair normal joint function and are associated with pain [13]. Surface restoration is one of the goals of treatment with osteochondral allografts [6] and autografts or mosaicplasty [30], as well as with tissue engineering-based, chondral graft treatments, such as autologous cell implantation (ACI) [3] and matrix-guided autologous cell implantation (MACI) [11]. However, these treatments are limited by availability of donor tissue sources, donor site morbidity, and prolonged rehabilitation times.…”

Cartilage damage: a review of surgical repair options and outcomes

“…First generation of ACI used a porcine periosteal cover (ACI-P) which was replaced by a collagen type I/III cover in the second generation ACI-C both of which were secured with sutures; the collagen cover was proven to have lower instances of post-operative hypertrophy compared to periosteal covers [69,70]. Third generation of cell-based regenerative therapy for treatment of full-thickness cartilage defects is referred to as maxtrix-induced autoloug chondrocyte implantation (MACI) which adapted the second generation collage type I/III membrane into a bilayer membrane "seeded" with autologous chondrocytes and secured with fibrin glue [69][70][71][72][73][74]. MACI is a two-stage procedure including harvesting of chondrocytes for graft preparation then transplant/implantation of chondrocyte matrix graft approximately 4-6 weeks later.…”