Single-step scaffold-based cartilage repair in the knee: A systematic review

Fischer, Stefan; Kisser, Agnes

doi:10.1016/j.jor.2016.06.004

Cited by 13 publications

(6 citation statements)

References 13 publications

(58 reference statements)

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“…Nevýhodou použití autologních chondrocytů je nutnost dvou operačních zákroků a relativně vyšší cena (14,16). Nově se používají bezbuněčné nosiče (scaffoldy), které je možné do místa defektu implantovat artroskopicky nebo z miniartrotomie v jedné době (8). Na metodu použití bezbuněčných implantátů pak navazuje technika kombinující mikrofraktury spodiny s použitím bezbuněčného scaffoldu AMIC (Autologous Matrix-Induced Chondrogenesis), kdy po provedení mikrofraktur spodiny je do místa defektu implantován nosič podporující vrůstání mezenchymálních kmenových buněk a jejich diferenciaci v chondrogenní buněčnou řadu.…”

Section: Operační Technikaunclassified

Two-Year Results of Modified AMIC Technique for Treatment of Cartilage Defects of the Knee

Otaševič¹,

Vališ²,

Rouchal³

et al. 2020

Acta Chir. orthop. Traum. Cech.

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PURPOSE OF THE STUDYDamage to hyaline cartilage represents a serious problem due to its limited capacity of regeneration. Currently, there are several treatment options available. The purpose of this study is to evaluate the success rate of treatment of chondral and osteochondral defects of the knee joint using the modified AMIC (Autologous Matrix-Induced Chondrogenesis) technique, combining microfractures of the base and the implantation of the type I collagen-based cell-free implant over a two-year period. MATERIAL AND METHODSThe prospective study of the success rate of treatment by the modified AMIC technique included 15 patients (13 men and 2 women) with a defect confirmed by MRI and appropriate indication criteria. The mean age at the time of implantation was 33.4 years (range 19-47 years). The mean size of a treated defect was 3.66 ± 1.71 cm2 (range 2.00-7.05 cm2). The clinical outcomes were monitored through the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Lysholm score and the Tegner activity scale preoperatively and subsequently at 6, 12 and 24 months postoperatively. Control MRI was conducted at 6, 12 and 18 months postoperatively. The MRI finding was evaluated using the Magnetic Observation of Cartilage Repair Tissue (MOCART) score. RESULTSThe total KOOS score was 44.69 ± 7.71 preoperatively, while postoperatively it gradually increased up to 80.45 ± 8.97 (p < 0.001) at 24 months. The Lysholm score significantly rise from 43.47 ± 11.87 preoperatively to the mean value of 81.60 ± 13.07 (p < 0.001) at 24 months postoperatively. The preoperative Tegner score was 3.53 ± 1.41. At 24 months, there was a statistically significant increase to 5.40 ± 1.70 (p = 0.003). The mean MOCART score at 18 months postoperatively was 74.67 ± 14.08. At the end of the monitored period, a complete filling of the defect site by tissue was achieved in 73.33% patients. A complete integration with adjacent cartilage was seen in 66.67% patients and homogenous structure of newly formed tissue was reported in 80% of patients. DISCUSSIONIn recent years, cell-free implants (the so-called scaffolds or carriers) have been used ever more frequently in treating localised cartilage defects. Their main effect should consist in helping the cells penetrate the defect site and support new cartilage tissue formation. In order to improve the efficacy of cell-free implants, a new therapeutic technique was developed, combining the microfractures of the base with the use of cell-free scaffold AMIC (Autologous Matrix-Induced Chondrogenesis). Our modification of the original AMIC technique consists in the use of a type I collagen-based scaffold instead of the original collagen membrane constituted by collagen type I and III. Based on the statistical processing of results, the modified AMIC technique has shown a statistically significant improvement compared to the preoperative values of the KOOS questionnaire and all its sub-groups, the Lysholm core and the Tegner activity scale. These good clinical outcomes correlate with the results obt...

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Section: Operační Technikaunclassified

Two-Year Results of Modified AMIC Technique for Treatment of Cartilage Defects of the Knee

Otaševič¹,

Vališ²,

Rouchal³

et al. 2020

Acta Chir. orthop. Traum. Cech.

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“…The use of scaffolds to augment knee joint preservation surgery has been more consistently described in the literature compared with the use of PRP or stem cells, mainly because scaffolds are used during advanced ACI (matrix-induced ACI, matrixassisted ACI) for the management of articular cartilage lesions. 54,[78][79][80][81][82] Meniscal repair and replacement with the use of scaffold-based technology has been described in Europe, with encouraging short-term results reported. [83][84][85][86][87][88][89][90][91][92] In general, scaffolds are categorized based on whether they incorporate cells and whether they are synthetic or biologic in origin.…”

Section: Role Of Biologic Therapymentioning

confidence: 99%

The Utility of Biologics, Osteotomy, and Cartilage Restoration in the Knee

Frank

Cotter

Strauss

et al. 2018

J Am Acad Orthop Surg

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The management of complex cartilage and meniscal pathology in young, athletic patients is extremely challenging. Joint preservation surgery is most difficult in patients with concomitant knee pathologies, including cartilage defects, meniscal deficiency, malalignment, and/or ligamentous insufficiency. Clinical decision making for these patients is further complicated by articular cartilage lesions, which often are incidental findings; therefore, treatment decisions must be based on the confirmed contribution of articular cartilage lesions to symptomatology. Surgical management of any of the aforementioned knee pathologies that is performed in isolation typically results in acceptable patient outcomes; however, concomitant procedures for the management of concomitant knee pathologies often are essential to the success of any single procedure. The use of biologic therapy as an alternative to or to augment more conventional surgical management has increased in popularity in the past decade, and indications for biologic therapy continue to evolve. Orthopaedic surgeons should understand knee joint preservation techniques, including biologic and reconstructive approaches in young, high-demand patients.

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“…By means of their mechanical properties, scaffolds can provide benefits for patients in early rehabilitation. Scaffolding is one of the most important components of tissue engineering [ 104 ]. Combined with various cartilage-related cytokines, it can be used to raise autologous stem cells to complete tissue repair status in the damaged region, including stem cells from blood, synovial fluid, synovial tissues, and cartilage.…”

Section: Regenerative Medicine In Cartilage Repairmentioning

confidence: 99%

Advances and Prospects in Stem Cells for Cartilage Regeneration

Wang

Yuan

et al. 2017

Stem Cells International

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The histological features of cartilage call attention to the fact that cartilage has a little capacity to repair itself owing to the lack of a blood supply, nerves, or lymphangion. Stem cells have emerged as a promising option in the field of cartilage tissue engineering and regenerative medicine and could lead to cartilage repair. Much research has examined cartilage regeneration utilizing stem cells. However, both the potential and the limitations of this procedure remain controversial. This review presents a summary of emerging trends with regard to using stem cells in cartilage tissue engineering and regenerative medicine. In particular, it focuses on the characterization of cartilage stem cells, the chondrogenic differentiation of stem cells, and the various strategies and approaches involving stem cells that have been used in cartilage repair and clinical studies. Based on the research into chondrocyte and stem cell technologies, this review discusses the damage and repair of cartilage and the clinical application of stem cells, with a view to increasing our systematic understanding of the application of stem cells in cartilage regeneration; additionally, several advanced strategies for cartilage repair are discussed.

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Single-step scaffold-based cartilage repair in the knee: A systematic review

Cited by 13 publications

References 13 publications

Two-Year Results of Modified AMIC Technique for Treatment of Cartilage Defects of the Knee

Two-Year Results of Modified AMIC Technique for Treatment of Cartilage Defects of the Knee

The Utility of Biologics, Osteotomy, and Cartilage Restoration in the Knee

Advances and Prospects in Stem Cells for Cartilage Regeneration

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