Histological evaluation of chondral defects after autologous chondrocyte implantation of the knee

Abstract

We have performed a prospective, single-surgeon study analysing the histological results of autologous chondrocyte implantation. Fourteen patients underwent autologous chondrocyte implantation of the knee and were evaluated at one year by clinical assessment and arthroscopy. Standard staining was used to examine the sections. In addition, in situ hybridisation was used to establish type-IIa and type-IIb collagen mRNA expression and immunolocalisation techniques demonstrated the positions of type-II and type-X collagen. Eight patients regenerated hyaline cartilage and also contained type-X collagen in the deepest layers and type-II collagen in the deep layers. Three demonstrated fibrocartilage and had type-I collagen in the deep layers. In situ hybridisation revealed that all 14 samples had the potential to express both type-IIa and type-IIb collagen. We have shown that one year after the initial implantation chondrocytes are capable of producing type-II collagen and that they continue to proliferate and mature.

Clinical and cost-effectiveness of autologous chondrocyte implantation for cartilage defects in knee joints: systematic review and economic evaluation

“…It appears that all interventions are mostly successful in the short-term. Second, results in the trials differ, with Knutsen and colleagues 63 finding fibrocartilage in biopsies after ACI, whereas Briggs and colleagues 66 found hyaline in about half. Third, the distinction between hyaline cartilage and fibrocartilage may be too crude; more sophisticated ways of assessing the quality of regenerating cartilage may provide better predictors of later success.…”

“…Briggs and colleagues 66 carried out biopsies in 14 patients 1 year after ACI. Eight patients had hyaline cartilage (six had hyaline only, two had mixed hyaline and fibrocartilage) and the others had fibrocartilage.…”

“…66 So, even some of the 85% clinical successes at 10 years may develop osteoarthritis later, about 44%. (However, the Briggs results were at 1 year, and there may be more hyaline cartilage at 2 years or later, because the graft takes time to mature.…”

Therapie von Knorpelschäden

“…Nach Anzucht einer ausreichenden Zellzahl werden sie unter einen wasserdicht aufgenähten Periostlappen injiziert [12]. Im weiteren Verlauf entsteht in den meisten Fällen ein Gewebe, das dem hyalinen Gelenkknorpel in seinen Eigenschaften sehr nahe kommt [11,37,41]. Auch nach langen Verlaufszeiten wurden von Peterson et al [38,39] …”

Efficacy and Safety of Autologous Cell Therapies for Knee Cartilage Defects (Autologous Stem Cells, Chondrocytes or the Two): Randomized Controlled Trial Design

“…The cell suspension is retained by either a patch of periosteum or a commercially available collagen membrane, sutured to the edges of the defect and sealed with fibrin. Our center has used ACI in approximately 500 procedures and we and others have shown that it has the potential to improve functional outcome [2][3][4] and generate repair tissue that offers a durable surface and is well integrated with the surrounding cartilage [5][6][7][8]. In our audits of ACI, 80% of patients improve by 15 months, and this improvement is sustained for 9-16 years [3,9].…”