Cell quality affects clinical outcome after MACI procedure for cartilage injury of the knee

Abstract

The aim of our study was to test the hypothesis that in early follow up after matrix guided autologous chondrocyte implantation (MACI), clinical results do not correlate with radiological and histological results, and that MACI as first line procedure and treatment of traumatic cartilage defects leads to better results compared to second line treatment and treatment of degenerative defects. Six and twelve months after MACI, patients IKDC-score was analysed, as well as the results of MRI-examinations. Specimens of the scaffold were histologically assessed at the time of implantation. The IKDC-score as well as the MRI-score improved significantly during follow up. The number of morphological abnormal cells was correlated with a poor clinical outcome. Defect aetiology proved to be a decisive factor for good clinical outcome. Patients with a short history of trauma (<1 year) and an osteochondritis dissecans were found to have better scores 1 year after MACI than patients with a trauma more than 1 year ago. Defect-size, patients age and -gender did not significantly influence the clinical outcome. No differences were seen when MACI was used as first- or second-line procedure. Defect aetiology and quality of the cells are decisive for the clinical outcome. MACI can produce good and very good clinical results even when used as second-line procedure.

The Incidence and Clinical Relevance of Graft Hypertrophy After Matrix-Based Autologous Chondrocyte Implantation

“…The IKDC and VAS scores used in this study are established and validated scores in the follow-up examination of cartilage regeneration procedures and show a high rate of reliability and reproduction, 11,22 hence the frequent use of these scores in follow-up examinations after p-ACI and mb-ACI. 9,14,17,18,21 Magnetic Resonance Imaging A follow-up magnetic resonance imaging (MRI) examination was performed after 3, 6, 12, and 24 months using a 1.5-T machine (Magnetom Sonata, Fa Siemens AG, Erlangen, Germany) with the use of a commercially available circular polarizing 1-channel knee spool in a predetermined protocol. Fast spin echo (dual T2-FSE) and fat saturation gradient echo (3D-GE-FS) sequences were produced.…”

Autologous chondrocyte implantation for cartilage repair: current perspectives

“…Especially, patients with a long history of pain show a significantly worse outcome after MACT. 32,34,[39][40][41][42][43][44] In a recently published study, Vanlauwe et al 45 compared ACI with microfracture and showed a significant improvement of patients' outcome after MACT when the symptoms of the cartilage lesion did not last more than 3 years. On the other hand, in patients with clinical symptoms more than 3 years, ACI failed to improve the functional outcome significantly compared to microfracture.…”

“…The earlier a biological cartilage repair is performed, the better are the clinical results. 10,39,41,45 Thus, primary cartilage defects should be treated as soon as possible to improve the long-term outcome. 10,45 Another problem for biological cartilage repair besides the delay of treatment is the localization of the defect.…”

“…[54][55][56] On the other hand, there are reports in literature that show good results of MACT even as a second-line therapy procedure. 41,57 Additionally, the age-related effects of a cartilage therapy seem to be less significant with the MACT in comparison to microfracture. 6,13,15,41,[58][59][60] Macroscopic and histological findings play an important role after MACT.…”

“…41,57 Additionally, the age-related effects of a cartilage therapy seem to be less significant with the MACT in comparison to microfracture. 6,13,15,41,[58][59][60] Macroscopic and histological findings play an important role after MACT. For the evaluation of the quality of the regenerated tissue, not only histological findings but also the amount of defect filling, the surface quality, and the integration into the surrounding native cartilage are important.…”