Implementing one standardized rehabilitation protocol following autologous chondrocyte implantation or microfracture in the knee results in comparable physical therapy management

Assche, Dieter Van; Caspel, Danny Van; Staes, Filip; Saris, Daniël B.F.; Bellemans, Johan; Vanlauwe, Johan; Luyten, Frank P.

doi:10.3109/09593981003681046

Cited by 17 publications

(11 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…All patients were dismissed 1 day after surgery and followed the same standardized phased rehabilitation protocol supervised by their own physiotherapist and adjusted to individual goals . All patients were non weight bearing for 3 weeks with a gradual increase to full weight bearing at 9 weeks.…”

Section: Methodsmentioning

confidence: 99%

Allogeneic MSCs and Recycled Autologous Chondrons Mixed in a One-Stage Cartilage Cell Transplantion: A First-in-Man Trial in 35 Patients

et al. 2017

View full text Add to dashboard Cite

MSCs are known as multipotent mesenchymal stem cells that have been found capable of differentiating into various lineages including cartilage. However, recent studies suggest MSCs are pericytes that stimulate tissue repair through trophic signaling. Aimed at articular cartilage repair in a one-stage cell transplantation, this study provides first clinical evidence that MSCs stimulate autologous cartilage repair in the knee without engrafting in the host tissue. A phase I (first-in-man) clinical trial studied the one-stage application of allogeneic MSCs mixed with 10% or 20% recycled defect derived autologous chondrons for the treatment of cartilage defects in 35 patients. No treatment-related serious adverse events were found and statistically significant improvement in clinical outcome shown. Magnetic resonance imaging and second-look arthroscopies showed consistent newly formed cartilage tissue. A biopsy taken from the center of the repair tissue was found to have hyaline-like features with a high concentration of proteoglycans and type II collagen. DNA short tandem repeat analysis delivered unique proof that the regenerated tissue contained patient-DNA only. These findings support the hypothesis that allogeneic MSCs stimulate a regenerative host response. This first-in-man trial supports a paradigm shift in which MSCs are applied as augmentations or "signaling cells" rather than differentiating stem cells and opens doors for other applications. Stem Cells 2017;35:1984-1993.

show abstract

Section: Methodsmentioning

confidence: 99%

Allogeneic MSCs and Recycled Autologous Chondrons Mixed in a One-Stage Cartilage Cell Transplantion: A First-in-Man Trial in 35 Patients

et al. 2017

View full text Add to dashboard Cite

show abstract

“…All patients were dismissed one day after surgery and followed the same standardized phased rehabilitation protocol supervised by their own physiotherapist and adjusted to individual goals . To ensure correct use if this protocol, a specialised physiotherapist contacted each patient and their physiotherapist prior to starting the protocol.…”

Section: Methodsmentioning

confidence: 99%

Allogeneic Mesenchymal Stem Cells Stimulate Cartilage Regeneration and Are Safe for Single-Stage Cartilage Repair in Humans upon Mixture with Recycled Autologous Chondrons

et al. 2016

View full text Add to dashboard Cite

Traditionally, mesenchymal stem cells (MSCs) isolated from adult bone marrow were described as being capable of differentiating to various lineages including cartilage. Despite increasing interest in these MSCs, concerns regarding their safety, in vivo behavior and clinical effectiveness have restrained their clinical application. We hypothesized that MSCs have trophic effects that stimulate recycled chondrons (chondrocytes with their native pericellular matrix) to regenerate cartilage. Searching for a proof of principle, this phase I (first-in-man) clinical trial applied allogeneic MSCs mixed with either 10% or 20% recycled autologous cartilage-derived cells (chondrons) for treatment of cartilage defects in the knee in symptomatic cartilage defect patients. This unique first in man series demonstrated no treatment-related adverse events up to one year postoperatively. At 12 months, all patients showed statistically significant improvement in clinical outcome compared to baseline. Magnetic resonance imaging and second-look arthroscopies showed completely filled defects with regenerative cartilage tissue. Histological analysis on biopsies of the grafts indicated hyaline-like regeneration with a high concentration of proteoglycans and type II collagen. Short tandem repeat analysis showed the regenerative tissue only contained patient-own DNA. These findings support the novel insight that the use of allogeneic MSCs is safe and opens opportunities for other applications. Stem cell-induced paracrine mechanisms may play an important role in the chondrogenesis and successful tissue regeneration found. STEM CELLS 2017;35:256-264 SIGNIFICANCE STATEMENTThis is the first study showing allogeneic MSCs are safe and effective in stimulating cartilage regeneration in the knee when combined with autologous chondrons. The fact that one year after surgery, no stem cell DNA could be traced in the regenerative tissue, may confirm the recent view on MSCs as cellular moderators, that stimulate autologous tissue repair through paracrine mechanisms.

show abstract

“…Broad electronic-evidence assimilation could be provided in this manner, embracing a range of peerreviewed journals as opposed to the 2 or 3 that rehabilitators may have access to; compliance management for all parties could also be facilitated by this approach. 54 Adopting a standard protocol and adding the nuances that an evidence-based approach demands may be the future according to Van Assche et al 48 While this will increase the quality of reporting of clinical trials, it may not be productive in the evaluation of optimal rehabilitative practice, as standardizing rehabilitation eliminates variability in study designs. One adaptation based on the characteristics of the patient is timed duration of graded weight bearing, which is regarded as an area where good evidence exists.…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Reporting of Rehabilitation in Articular-Cartilage-Repair Studies of Third-Generation Autologous Chondrocyte Implantation in the Knee

Bright¹,

Hambly²

2014

Journal of Sport Rehabilitation

View full text Add to dashboard Cite

Context: Autologous chondrocyte implantation (ACI) is a tissue-engineered surgical technique initially developed for articular cartilage repair of isolated chondral lesions of the knee. Third-generation techniques (ACI3) are now available that deliver autologous cultured chondrocytes into the defect using cell scaffolds. The successful outcomes of these techniques have some dependency on presurgical and postsurgical patient rehabilitation. Objectives: To determine if the standard of reporting for rehabilitation has improved in ACI3 studies; previous reviews in this field recommended describing the detail of this rehabilitation and patient compliance as integral elements. Evidence Acquisition: A computerized search was performed in March 2013. Criteria for inclusion were any studies that evaluated or described the process of ACI3 in the knee and subsequent rehabilitation. The modified Coleman Methodology Score (CMS) was used to rate the standard of reporting of rehabilitation and surgical procedures; review articles were also evaluated for quality using the Strength of Recommendation Taxonomy (SORT). Mean scores, odds ratios, 95% confidence intervals, and Mann-Whitney U statistics were calculated. Evidence Synthesis: An improvement in mean CMS was seen compared with previous reviews, but rehabilitation reporting scores were lower than their surgical equivalent; significant association was seen between studies with rehabilitator involvement and high scores in the individual CMS rehabilitation element. Predominant SORT scores of 2A indicated medium strength of recommendation. Conclusions:The CMS provides a general overview of methodological quality, but a more specialized tool to report on the quantitative and qualitative aspects of the rehabilitation process would help raise the standards. It is recommended that rehabilitation therapists be included as key members of research teams and be involved in the design, implementation, and reporting of future studies.

show abstract

Implementing one standardized rehabilitation protocol following autologous chondrocyte implantation or microfracture in the knee results in comparable physical therapy management

Abstract: Overall, the compliance post-surgery with the rehabilitation protocol was excellent and the applied rehabilitation was comparable in both treatment groups. A high amount of low-load activities post-surgery appears beneficial for the objective functional outcome.

Cited by 17 publications

References 33 publications

Allogeneic MSCs and Recycled Autologous Chondrons Mixed in a One-Stage Cartilage Cell Transplantion: A First-in-Man Trial in 35 Patients

Allogeneic MSCs and Recycled Autologous Chondrons Mixed in a One-Stage Cartilage Cell Transplantion: A First-in-Man Trial in 35 Patients

Allogeneic Mesenchymal Stem Cells Stimulate Cartilage Regeneration and Are Safe for Single-Stage Cartilage Repair in Humans upon Mixture with Recycled Autologous Chondrons

A Systematic Review of Reporting of Rehabilitation in Articular-Cartilage-Repair Studies of Third-Generation Autologous Chondrocyte Implantation in the Knee

Contact Info

Product

Resources

About