Feasibility of arthroscopic placement of autologous matrix-induced chondrogenesis grafts in the cadaver hip joint

Abstract

An assortment of clinical trials have been done presenting the effectiveness of autologous matrix-induced chondrogenesis (AMIC) for the regeneration of chondral leasions. The purpose of the study was to underline the accessability of the acetabulum and the femoral head through the known portals and prove i) the feasibility of placing the AMIC in the different zones of the hip joint and ii) check for dislocation after joint movement. Six human cadavers underwent hip arthroscopy on both hips. Two chondral lesions were set on each femoral head and two in the acetabulum to evaluate a total of 48 defects. After microfracturing an autologous matrix-induced chondrogenesis graft was placed on these lesions arthroscopically. After repeated joint movement the dislocation of the graft was checked. It was possible to place the AMIC graft in all 48 chondral lesions. The time needed for placing the graft was 8±2.9 minutes. A trend of time reduction could be detected throughout this study as the surgeon gained more experience. For the femoral head, after twenty cycles of joint movement 18/24 spots showed no displacement, 4/24 showed minor displacement (<3 mm) and 2/24 showed major displacement (>3 mm). None showed total displacement. For the acetabulum 22/24 spots showed no displacement and 2/24 showed minor displacement. A combined microfracturing and placing of an AMIC graft of focal chondral lesions of the hip joint can be done arthroscopically. Prospective randomized in vivo studies should compare the results of arthroscopilally placed AMIC grafts with microfracturing and microfracturing alone.

Injectable autologous chondrocyte implantation (ACI) in acetabular cartilage defects—three-year results

“…The injectable autologous chondrocyte implantation resembles a new treatment option. As there is no need for a scaffold material, it offers a technically less demanding arthroscopic option without the risk of a dislocation of the scaffold material [15, 35]. Early studies could show the feasibility of this procedure in the setting of hip arthroscopy [16, 17] and short-term results have been promising [18, 36].…”

“…With the good long-term results of ACI in knee surgery the technique has been transferred to the hip for the treatment of acetabular cartilage defects. First investigations showed excellent results of the ACI procedure using scaffold material in the hip [13, 14], but the use of a scaffold is technically demanding in the concave acetabulum and has the risk of a scaffold dislocation [15]. Therefore, scaffold free matrix-associated injectable agents have been developed with the potential of an easier and less invasive implantation process.…”

Recent advances and future trends in hip arthroscopy

“…Scaffold implantations are technically demanding to stabilize on the concave acetabulum, and therefore, chondrocytes may displace overtime, leading to poorer outcomes. [31] To overcome this problem, some authors have used chondrocytes attached to adhesive spheres or gels that are injected directly into the cartilage deficient surface. A study of 32 hips treated with chondrocytes embedded in injected gels with a 3-year followup concluded that this method was suitable for large defects in weight-bearing zones.…”

Biologische Rekonstruktion lokalisiert vollschichtiger Knorpelschäden des Hüftgelenks: Empfehlungen der Arbeitsgemeinschaft „Klinische Geweberegeneration“ der DGOU und des Hüftkomitees der AGA

“…Das häufig auch als AMIC ® bezeichnete Verfahren (autologe matrixinduzierte Chondrogenese), erfordert bei Anwendung im Hüftgelenk eine hohe operative Geschicklichkeit, speziell für die korrekte Größenkonfektionierung und arthroskopische Fixierung des Biomaterials. Außerdem besteht am Hüftkopf die relevante Gefahr einer Implantatabscherung [37]. Weitere technische Durchführungsempfehlungen sind im aktuellen Praxisleitfaden der AG Geweberegeneration der DGOU im entsprechenden Kapitel zum Hüftgelenk beschrieben [12].…”