Third-Generation Autologous Chondrocyte Implantation at the Knee Joint Using the Igor Scaffold: A Case Series With 2-Year Follow-up

Abstract

Background: For large, locally restricted cartilage defects in young patients, third-generation matrix-supported autologous chondrocyte implantation (ACI) with a variety of scaffolds has shown good mid- to long-term results. Purpose/Hypothesis: This study aimed to monitor the clinical and radiological outcomes of patients who received ACI at the knee joint using the Igor scaffold (IGOR–Institute for Tissue and Organ Reconstruction) at 2-year follow-up. Our hypothesis was that there would be improvements in postoperative subjective scores and cartilage repair tissue quality. Study Design: Case series; Level of evidence, 4. Methods: A total of 21 patients (12 male and 9 female) were available for 2-year follow-up after third-generation ACI using the Igor scaffold. All were clinically assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity Scale, Brittberg score, International Knee Documentation Committee (IKDC) Subjective Knee Form, Noyes Sports Activity Rating Scale, and visual analog scale for pain. For morphological evaluation, the magnetic resonance observation of cartilage repair tissue (MOCART) and MOCART 2.0 scores were calculated using 3-T magnetic resonance imaging performed at 3, 6, 12, and 24 months postoperatively. Results were compared between baseline and 24 months postoperatively. Results: After 2 years, the clinical and radiological scores showed good to excellent results in the majority of patients. On the IKDC, 10 patients were graded as excellent, 4 as good, 5 as fair, and 2 as severe; on the KOOS, 7 patients were graded as excellent, 8 as good, 4 as fair, and 2 as severe. From baseline to latest follow-up, visual analog scale pain scores decreased from 5.6 ± 3.2 (mean ± SD) to 1.5 ± 2; KOOS results increased from 51 ± 20.7 to 75.2 ± 15.4; and the Tegner score improved from 2.2 ± 1.8 to 4.3 ± 1.3. The MOCART and MOCART 2.0 scores were comparable at 2-year follow-up, with mean values of 74 ± 10 and 78 ± 13, respectively. Satisfactory filling and integration were found in 90.5%. Overall, 16 of 21 patients (76.1%) were satisfied with the surgery and would undergo the procedure again. Conclusion: Third-generation ACI using the Igor scaffold showed improvements in clinical and radiological results that were comparable with other scaffolds for patients with large traumatic or degenerative cartilage defects. Patients reported a decrease in pain and an increase in activity, with the majority reporting good results.

High-Density Autologous Chondrocyte Implantation (HD-ACI) in patients with bilateral knee chondral defects

“…These results indicate that improvement in pain and knee function is perceived by patients as a real improvement, indicating a satisfactory clinical outcome in these patients. In the case of unilateral lesions, improvement in clinical parameters is accompanied by good integration of the implant in the surrounding cartilage measured by MOCART score, as demonstrated by several authors (19,20). Similar events took place for patients with bilateral lesions studied in the present work: satisfactory clinical outcome was presented together with a high MOCART score, revealing a good integrity of neoformed tissue.…”

Time-Dependent Change in Cartilage Repair Tissue Evaluated by Magnetic Resonance Imaging up to 2 years after Atelocollagen-Assisted Autologous Cartilage Transplantation: Data from the CaTCh Study

“… 17 , 18 Other third-generation ACI studies that included radiological results after 2 years showed the MOCART score was all graded as good. In addition, Zak et al , 19 who used an Igor scaffold, showed that the MOCART 2.0 knee score was 78 at 24 months after implantation. Similar to previous reports, our current study showed that the MOCART 2.0 knee score significantly improved from 57.5 at 6 months after implantation to 71 at 24 months.…”

“…Therefore, MOCART 2.0 decreased from 5 to 10 points between 12 and 24 months. 19 Previous studies showed a 3-fold increase in the failure rate of ACI after previous marrow stimulation such as microfracture. 20,21 In addition, the preoperative subchondral bone injury was significantly associated with post-ACI subchondral bone changes.…”

Four cases report: Treatment of knee joint cartilage defects using autologous chondrocyte patch implantation

“…Pestka et al and Erdle et al showed that returning to low-intensity and moderate-intensity activities was feasible, but returning to high-intensity or identical-intensity activities to that before surgery was infeasible in 1 year ( 39 , 40 ). Ebert et al and Erggelet et al advised their patients to return to contact and competitive activities 12-month postoperatively ( 41 , 42 ). Furthermore, Niethammer et al compared the rehabilitation process postoperatively.…”