Natural progression of osteo-chondral defect in the femoral condyle

Prakash, Divya; Learmonth, D.J.A.

doi:10.1016/s0968-0160(01)00133-8

Cited by 98 publications

(77 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Three case series [36][37][38] reported high levels of return to activities after cartilage injuries after 14, 9 and 9 years, respectively. Messner and Maletius 36 reported a case series of young athletes (mean age 25 years, range 14-38 years) who had no treatment.…”

Section: Conservative Managementmentioning

confidence: 99%

Autologous chondrocyte implantation in the knee: systematic review and economic evaluation

Mistry

Connock

Pink

et al. 2017

Health Technol Assess

201

164

View full text Add to dashboard Cite

BackgroundThe surfaces of the bones in the knee are covered with articular cartilage, a rubber-like substance that is very smooth, allowing frictionless movement in the joint and acting as a shock absorber. The cells that form the cartilage are called chondrocytes. Natural cartilage is called hyaline cartilage. Articular cartilage has very little capacity for self-repair, so damage may be permanent. Various methods have been used to try to repair cartilage. Autologous chondrocyte implantation (ACI) involves laboratory culture of cartilage-producing cells from the knee and then implanting them into the chondral defect.ObjectiveTo assess the clinical effectiveness and cost-effectiveness of ACI in chondral defects in the knee, compared with microfracture (MF).Data sourcesA broad search was done in MEDLINE, EMBASE, The Cochrane Library, NHS Economic Evaluation Database and Web of Science, for studies published since the last Health Technology Assessment review.Review methodsSystematic review of recent reviews, trials, long-term observational studies and economic evaluations of the use of ACI and MF for repairing symptomatic articular cartilage defects of the knee. A new economic model was constructed. Submissions from two manufacturers and the ACTIVE (Autologous Chondrocyte Transplantation/Implantation Versus Existing Treatment) trial group were reviewed. Survival analysis was based on long-term observational studies.ResultsFour randomised controlled trials (RCTs) published since the last appraisal provided evidence on the efficacy of ACI. The SUMMIT (Superiority of Matrix-induced autologous chondrocyte implant versus Microfracture for Treatment of symptomatic articular cartilage defects) trial compared matrix-applied chondrocyte implantation (MACI®) against MF. The TIG/ACT/01/2000 (TIG/ACT) trial compared ACI with characterised chondrocytes against MF. The ACTIVE trial compared several forms of ACI against standard treatments, mainly MF. In the SUMMIT trial, improvements in knee injury and osteoarthritis outcome scores (KOOSs), and the proportion of responders, were greater in the MACI group than in the MF group. In the TIG/ACT trial there was improvement in the KOOS at 60 months, but no difference between ACI and MF overall. Patients with onset of symptoms < 3 years’ duration did better with ACI. Results from ACTIVE have not yet been published. Survival analysis suggests that long-term results are better with ACI than with MF. Economic modelling suggested that ACI was cost-effective compared with MF across a range of scenarios.LimitationsThe main limitation is the lack of RCT data beyond 5 years of follow-up. A second is that the techniques of ACI are evolving, so long-term data come from trials using forms of ACI that are now superseded. In the modelling, we therefore assumed that durability of cartilage repair as seen in studies of older forms of ACI could be applied in modelling of newer forms. A third is that the high list prices of chondrocytes are reduced by confidential discounting. The main research needs are for longer-term follow-up and for trials of the next generation of ACI.ConclusionsThe evidence base for ACI has improved since the last appraisal by the National Institute for Health and Care Excellence. In most analyses, the incremental cost-effectiveness ratios for ACI compared with MF appear to be within a range usually considered acceptable. Research is needed into long-term results of new forms of ACI.Study registrationThis study is registered as PROSPERO CRD42014013083.FundingThe National Institute for Health Research Health Technology Assessment programme.

show abstract

Section: Conservative Managementmentioning

confidence: 99%

Autologous chondrocyte implantation in the knee: systematic review and economic evaluation

Mistry

Connock

Pink

et al. 2017

Health Technol Assess

201

164

View full text Add to dashboard Cite

show abstract

“…In addition, the amount and molecular size of hyaluronic acid in the synovial fluid are also reduced (Belcher et al 1997). Such progressive degeneration is a very invasive process, and early intervention is key for its management: radiological osteoarthritic findings may develop in less than 10 years when the patients are not treated during the early period of injury (Prakash and Learmonth 2002). Even small (~10 mm) defects can result in the reduction of 50% or more of cartilage tissue in the joint, while larger (>10 mm) defects are known to provide an additional burden of 64% to the surrounding cartilage, as observed in a 14-year follow up study (Kock et al 2008).…”

Section: Cartilage Diseasesmentioning

confidence: 99%

Peptide-Based Materials for Cartilage Tissue Regeneration

Haştar

Arslan

Güler

et al. 2017

Peptides and Peptide-Based Biomaterials and Their Biomedical Applications

View full text Add to dashboard Cite

Cartilaginous tissue requires structural and metabolic support after traumatic or chronic injuries because of its limited capacity for regeneration. However, current techniques for cartilage regeneration are either invasive or ineffective for long-term repair. Developing alternative approaches to regenerate cartilage tissue is needed. Therefore, versatile scaffolds formed by biomaterials are promising tools for cartilage regeneration. Bioactive scaffolds further enhance the utility in a broad range of applications including the treatment of major cartilage defects. This chapter provides an overview of cartilage tissue, tissue defects, and the methods used for regeneration, with emphasis on peptide scaffold materials that can be used to supplement or replace current medical treatment options.

show abstract

“…durch Achsfehlstellungen, Meniskusschäden, Übergewicht oder ligamentäre Instabilitäten, können zu lokaler mechanischer Überlastung eines Gelenkbereichs oder -kompartimentes führen und somit den vorzeitigen Knorpelverschleiß bedingen (Dougados et al, 1992;Felson et al, 1997;Nebelung et al, 2005;Goldring et al, 2007). Die avaskuläre Knochennekrose des subchondralen Knochens (Osteochondritis dissecans -OD) prädisponiert ebenfalls zum vorzeitigen Knorpelverschleiß: Im unbehandelten Krankheitsverlauf einer OD des Femurkondylus konnte bei Erwachsenen im mittelfristigen Follow-up die signifikant häu-figere Ausprägung einer Osteoarthrose klinisch und radiologisch detektiert werden (Prakash et al, 2002). Nicht zuletzt sind entzündliche Gelenkveränderungen, z.B.…”

Section: 3) äTiologie Und Epidemiologie Von Knorpeldefektenunclassified