Clinical and Radiological Regeneration of Large and Deep Osteochondral Defects of the Knee by Bone Augmentation Combined With Matrix-Guided Autologous Chondrocyte Transplantation

Zellner, Johannes; Grechenig, Stephan; Pfeifer, Christian; Krutsch, Werner; Koch, Matthias; Welsch, Goetz H.; Scherl, Madeleine; Seitz, Johannes; Zeman, Florian; Nerlich, Michael; Angele, Peter

doi:10.1177/0363546517717679

Cited by 34 publications

(34 citation statements)

References 39 publications

(82 reference statements)

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“…The result of the treatment we proposed in this report is comparable to the good results obtained with other types of treatment 10 , 13 , 14 , 17 , 18) . It also has the advantage of not requiring an intra-articular donor site and allografts in cases with deep and large defects greater than 2 cm 2 .…”

Section: Discussionsupporting

confidence: 86%

“…Hohmann and Tetsworth 13) described in patients with OCD over 2.5 cm 2 , the use of a fresh-frozen irradiated allograft provided good results; nevertheless, this type of graft is expensive and unavailable worldwide. Zellner et al 14) reported good outcomes were achieved with use of bone autograft from either the iliac crest or the distal femur, combined with autologous chondrocyte transplantation in large and deep osteochondral defects; however, this also raises costs and is not widely available.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Treatment of Osteochondritis Dissecans of the Knee with Autologous Iliac Bone Graft and Hyaluronic Acid Scaffold

Hinzpeter

Zamorano

Barahona

et al. 2019

Knee Surg Relat Res

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Treatment of Osteochondritis Dissecans of the Knee with Autologous Iliac Bone Graft and Hyaluronic Acid Scaffold

Hinzpeter

Zamorano

Barahona

et al. 2019

Knee Surg Relat Res

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“…Gobbi et al [ 30 ] reported a long-term and sustained benefit of concentrated bone-marrow aspirate compared to microfracture for the treatment of osteochondral lesions of the knees. Zellner et al [ 31 ] described promising clinical and radiological results, achieving successful bone regeneration of large and deep osteochondral defects of the knee joint after the treatment with concentrated bone-marrow aspirate combined with bone augmentation. In our study, arthroplasty was avoided in all the patients during the follow-up period.…”

Section: Discussionmentioning

confidence: 99%

Use of autologous bone marrow stem cell implantation for osteonecrosis of the knee in sickle cell disease: a preliminary report

Daltro¹,

Franco²,

Faleiro³

et al. 2018

BMC Musculoskelet Disord

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BackgroundThe purpose of our study was to evaluate safety, feasibility and clinical results of bone marrow mononuclear cell (BMC) implantation for early-stage osteonecrosis of the knee (OK) secondary to sickle cell disease.MethodsThirty-three SCD patients (45 knees) with OK treated with BMC implantation in the osteonecrotic lesion were clinically and functionally evaluated through the American Knee Society Clinical Score (KSS), Knee Functional Score (KFS) and Numeric Rating Scale (NRS) pain score. MRI and radiographic examinations of the knee were assessed during a period of five years after intervention.ResultsNo complications or serious adverse event were associated with BMC implantation. From preoperative assessment to the latest follow-up, there was a significant (p < 0.001) improvement of clinical KSS (64.3 ± 9.7, range: 45–80 and 2.2 ± 4.1, range: 84–100, respectively), KFS (44.5 ± 8.0, range: 30–55 and 91.6 ± 5.8, range: 80–100, respectively) and reduction of NRS pain score (6.7 ± 1.2, range: 4–9 and 3.4 ± 1.0, range: 2–5, respectively). In total, 87% of patients (29/33) consistently experienced improvements in joint function and activity level as compared to preoperative score. No patient had additional surgery following BMC implantation. Radiographic assessment showed joint preservation and no progression to subchondral collapse at most recent follow-up.ConclusionsThe technique of BMC implantation is a promising, relatively simple and safe procedure for OK in SCD patients. Larger and long-term controlled trials are needed to support its clinical effectiveness.Trial registrationClinicalTrials.gov NCT02448121. Retrospectively registered 19 May 2015.

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“… 40 The combination of MACT using Novocart 3D and bone augmentation even showed a MOCART score of 82.6 at 1 year after treatment. 41 Furthermore, long-term MACT results are available. Aldrian et al 2 examined patients treated using Hyalocraft C (Anika Therapeutics), a hyaluronic acid-based scaffold, after a minimum period of 10 years.…”

Section: Discussionmentioning

confidence: 99%

“…However, we did not find evidence for a correlation between MRI and clinical outcome scores, which creates doubts about this choice of examination. 2 , 10 , 41 For this purpose, functional (biochemical) MRI, such as delayed gadolinium-enhanced MRI of cartilage, quantitative T1rho, T2-weighted mapping, or chemical exchange saturation transfer on glycosaminoglycans (GagCest), might be more suitable for the evaluation of cartilage repair in concordance with the clinical situation. 39 , 40 However, availability and applicability of these techniques are still limited, and the interpretation is complex and time-consuming.…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional, Scaffold-Free, Autologous Chondrocyte Transplantation: A Systematic Review

Riedl¹,

Vadalà

Papalia

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: A 3-dimensional, scaffold-free, and completely autologous form of chondrocyte transplantation (ACT3D) has been developed and applied in clinical practice in the past decade to overcome disadvantages of previous-generation procedures. Purpose: To document and analyze the available literature on the results of ACT3D in the treatment of articular chondral lesions in the knee and hip joints. Study Design: Systematic review; Level of evidence, 4. Methods: All studies published in English addressing ACT3D were identified and included those that fulfilled the following criteria: (1) level 1 through 4 evidence, (2) measures of radiological or functional/clinical outcome, and (3) outcome related to cartilage lesions of the knee and hip joints. Results: A total of 10 studies were selected: 2 randomized controlled trials, 1 cohort study, and 7 case series. The studies revealed significant increases in patients’ subjective quality of life, satisfaction, pain reduction, and improvement in joint function at short- to medium-term follow-up. Magnetic resonance imaging-assisted examination and second-look arthroscopy showed a hyaline-like repair tissue with a high degree of defect filling and integration. Conclusion: ACT3D shows promising results in the therapy of articular cartilage defects in the knee as well as in the hip, but well-designed, long-term studies are lacking. ACT3D might have relevant advantages over common matrix-associated autologous chondrocyte transplantation products, but systematic evaluation and randomized controlled studies are crucial to verify the potential of this tissue-engineered approach.

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Clinical and Radiological Regeneration of Large and Deep Osteochondral Defects of the Knee by Bone Augmentation Combined With Matrix-Guided Autologous Chondrocyte Transplantation

Abstract: Large and deep osteochondral defects of the knee joint can be treated successfully with bone augmentation and MACT. The treatment of shallow bony defects with cancellous bone grafting and deep bony defects with bone block augmentation shows promising results.

Cited by 34 publications

References 39 publications

Treatment of Osteochondritis Dissecans of the Knee with Autologous Iliac Bone Graft and Hyaluronic Acid Scaffold

Treatment of Osteochondritis Dissecans of the Knee with Autologous Iliac Bone Graft and Hyaluronic Acid Scaffold

Use of autologous bone marrow stem cell implantation for osteonecrosis of the knee in sickle cell disease: a preliminary report

Three-dimensional, Scaffold-Free, Autologous Chondrocyte Transplantation: A Systematic Review

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