One-Step Cartilage Repair with Bone Marrow Aspirate Concentrated Cells and Collagen Matrix in Full-Thickness Knee Cartilage Lesions: Results at 2-Year Follow-up
Alberto Gobbi, Georgios Karnatzikos, Celeste Scotti, Vivek Mahajan, Laura Mazzucco, Brunella Grigolo, Alberto Gobbi, Georgios Karnatzikos, Celeste Scotti, Vivek Mahajan, Laura Mazzucco, Brunella Grigolo
Abstract
Objective: The purpose of our study was to determine the effectiveness of cartilage repair utilizing 1-step surgery with bone marrow aspirate concentrate (BMAC) and a collagen I/III matrix (Chondro-Gide, Geistlich, Wolhusen, Switzerland).
Materials and methods: We prospectively followed up for 2 years 15 patients (mean age, 48 years) who were operated for grade IV cartilage lesions of the knee. Six of the patients had multiple chondral lesions; the average size of the lesions was 9.2 cm(2). All patients underwent a mini-arthrotomy and concomitant transplantation with BMAC covered with the collagen matrix. Coexisting pathologies were treated before or during the same surgery. X-rays and MRI were collected preoperatively and at 1 and 2 years' follow-up. Visual analog scale (VAS), International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm, Marx, SF-36 (physical/mental), and Tegner scores were collected preoperatively and at 6, 12, and 24 months' follow-up. Four patients gave their consent for second-look arthroscopy and 3 of them for a concomitant biopsy.
Results: Patients showed significant improvement in all scores at final follow-up (P < 0.005). Patients presenting single lesions and patients with small lesions showed higher improvement. MRI showed coverage of the lesion with hyaline-like tissue in all patients in accordance with clinical results. Hyaline-like histological findings were also reported for all the specimens analyzed. No adverse reactions or postoperative complications were noted.
Conclusion: This study showed that 1-step surgery with BMAC and collagen I/III matrix could be a viable technique in the treatment of grade IV knee chondral lesions.
Keywords: BMAC; Chondro-Gide; Plateltex Act; cartilage; chondral lesion; knee.
Conflict of interest statement
Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the authorship and/or publication of this article.
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References
- Hunter W. On the structure and diseases of articulating cartilage. Philos Trans Rsoc Lond B Biol Sci. 1743;9:277.
- Mankin HJ. The response of articular cartilage to mechanical injury. J Bone Joint Surg Am. 1982;64(3):460-6.
- Nuki G. Osteoarthritis. In: Luqmani R, Robb J, Porter D, et al., editors. Textbook of orthopaedics, trauma and rheumatology. Chicago: Mosby; 2008. p. 193.
- Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med. 1994;331(14):889-95.
- Behrens P, Bitter T, Kurz B, Russlies M. Matrix-associated autologous chondrocyte transplantation/implantation (MACT/MACI): 5-year follow-up. Knee. 2006;13(3):194-202.
- Peterson L, Brittberg M, Kiviranta I, Akerlund EL, Lindahl A. Autologous chondrocyte transplantation: biomechanics and long-term durability. Am J Sports Med. 2002;30(1):2-12.
- Peterson L, Vasiliadis HS, Brittberg M, Lindahl A. Autologous chondrocyte implantation: a long-term follow-up. Am J Sports Med. 2010;38(6):1117-24.
- Henderson IJ, Tuy B, Connell D, Oakes B, Hettwer WH. Prospective clinical study of autologous chondrocyte implantation and correlation with MRI at three and 12 months. J Bone Joint Surg Br. 2003;85(7):1060-6.
- Henderson I, Francisco R, Oakes B, Cameron J. Autologous chondrocyte implantation for treatment of focal chondral defects of the knee: a clinical, arthroscopic, MRI and histologic evaluation at 2 years. Knee. 2005;12(3):209-16.
- Minas T, Peterson L. Advanced techniques in autologous chondrocyte transplantation. Clin Sports Med. 1999;18(1):13-44.
- Bekkers JE, Inklaar M, Saris DB. Treatment selection in articular cartilage lesions of the knee: a systematic review. Am J Sports Med. 2009;37 Suppl 1:148S-55S.
- Kon E, Gobbi A, Filardo G, Delcogliano M, Zaffagnini S, Marcacci M. Arthroscopic second-generation autologous chondrocyte implantation compared with microfracture for chondral lesions of the knee: prospective nonrandomized study at 5 years. Am J Sports Med. 2009;37(1):33-41.
- Mandelbaum B, Browne JE, Fu F, Micheli LJ, Moseley JB, Jr, Erggelet C, Anderson AF. Treatment outcomes of autologous chondrocyte implantation for full-thickness articular cartilage defects of the trochlea. Am J Sports Med. 2007;35(6):915-21.
- Gobbi A, Bathan L. Minimally invasive second-generation autologous chondrocyte implantation. In: Cole BJ, Gomoll A, editors. Biologic joint reconstruction. Thorofare, NJ: SLACK Incorporated; 2009. p. 155-61.
- Marcacci M, Kon E, Zaffagnini S, Filardo G, Delcogliano M, Neri MP, et al. Arthroscopic second generation autologous chondrocyte implantation. Knee Surg Sports Traumatol Arthrosc. 2007;15(5):610-9.
- Marcacci M, Zaffagnini S, Kon E, Visani A, Iacono F, Loreti I. Arthroscopic autologous chondrocyte transplantation: technical note. Knee Surg Sports Traumatol Arthrosc. 2002;10(3):154-9.
- Nehrer S, Domayer S, Dorotka R, Schatz K, Bindreiter U, Kotz R. Three-year clinical outcome after chondrocyte transplantation using a hyaluronan matrix for cartilage repair. Eur J Radiol. 2006;57(1):3-8.
- Sgaglione NA, Miniaci A, Gillogly SD, Carter TR. Update on advanced surgical techniques in the treatment of traumatic focal articular cartilage lesions in the knee. Arthroscopy. 2002;18(2 Suppl 1):9-32.
- Gobbi A, Kon E, Berruto M, Filardo G, Delcogliano M, Boldrini L, et al. Patellofemoral full-thickness chondral defects treated with second-generation autologous chondrocyte implantation: results at 5 years’ follow-up. Am J Sports Med. 2009;37(6):1083-92.
- Marcacci M, Berruto M, Brocchetta D, Delcogliano A, Ghinelli D, Gobbi A, et al. Articular cartilage engineering with Hyalograft C: 3-year clinical results. Clin Orthop Relat Res. 2005;435:96-105.
- Fortier LA, Balkman CE, Sandell LJ, Ratcliffe A, Nixon AJ. Insulin-like growth factor-I gene expression patterns during spontaneous repair of acute articular cartilage injury. J Orthop Res. 2001;19(4):720-8.
- Fortier LA, Mohammed HO, Lust G, Nixon AJ. Insulin-like growth factor-I enhances cell-based repair of articular cartilage. J Bone Joint Surg Br. 2002;84(2):276-88.
- Fortier LA, Potter H, Rickey E, Schnabel L, Foo L, Chong L, et al. Concentrated bone marrow aspirate improves full-thickness cartilage repair. Proceedings of the 55th ORS Annual Meeting; 2009 Feb 22-25; Las Vegas, NV.
- Gobbi A. L’impiego delle cellule mesenchimali autologhe e del gel piastrinico per il trattamento delle lesioni cartilaginee. Archivio di Ortopedia e Reumatologia. 2009;120(3-4):29-31.
- Johnstone B, Hering TM, Caplan AI, Goldberg VM, Yoo JU. In vitro chondrogenesis of bone marrow-derived mesenchymal progenitor cells. Exp Cell Res. 1998;238(1):265-72.
- Mackay AM, Beck SC, Murphy JM, Barry FP, Chichester CO, Pittenger MF. Chondrogenic differentiation of cultured human mesenchymal stem cells from marrow. Tissue Eng. 1998;4(4):415-28.
- Muraglia A, Cancedda R, Quarto R. Clonal mesenchymal progenitors from human bone marrow differentiate in vitro according to a hierarchical model. J Cell Sci. 2000;113:1161-6.
- Sudo K, Kanno M, Miharada K, Ogawa S, Hiroyama T, Saijo K, Nakamura Y. Mesenchymal progenitors able to differentiate into osteogenic, chondrogenic, and/or adipogenic cells in vitro are present in most primary fibroblast-like cell populations. Stem Cells. 2007;25(7):1610-7.
- Wakitani S, Imoto K, Yamamoto T, Saito M, Murata N, Yoneda M. Human autologous culture expanded bone marrow mesenchymal cell transplantation for repair of cartilage defects in osteoarthritic knees. Osteoarthritis Cartilage. 2002;10(3):199-206.
- Wilke MM, Nydam DV, Nixon AJ. Enhanced early chondrogenesis in articular defects following arthroscopic mesenchymal stem cell implantation in an equine model. J Orthop Res. 2007;25(7):913-25.
- Minas T. Autologous chondrocyte implantation in the osteoarthritic knee. In: Cole BJ, Malek M, editors. Articular cartilage lesions. New York: Springer-Verlag Inc.; 2004. p. 105-18.
- Giannini S, Buda R, Vannini F, Cavallo M, Grigolo B. One-step bone marrow-derived cell transplantation in talar osteochondral lesions. Clin Orthop Relat Res. 2009;467(12):3307-20.
- Salzmann GM, Niemeyer P, Steinwachs M, Kreuz PC, Südkamp NP, Mayr HO. Cartilage repair approach and treatment characteristics across the knee joint: a European survey. Arch Orthop Trauma Surg. Epub 2010. January 16.
- Peterson L, Vasiliadis HS, Brittberg M, Lindahl A. Autologous chondrocyte implantation: a long-term follow-up. Am J Sports Med. 2010;38(6):1117-24.
- Robey PG, Bianco P. The use of adult stem cells in rebuilding the human face. J Am Dent Assoc. 2006;137(7):961-72.
- Caplan AI. Why are MSCs therapeutic? New data: new insight. J Pathol. 2009;217:318-24.
- Caplan AI. Mesenchymal stem cells: cell-based reconstructive therapy in orthopedics. Tissue Eng. 2005;11:1198-211.
- Caplan AI, Dennis JE. Mesenchymal stem cells as trophic mediators. J Cell Biochem. 2006;98:1076-84.
- Jones E, McGonagle D. Human bone marrow mesenchymal stem cells in vivo. Rheumatology (Oxford). 2008;47(2):26-31.
- Wang L, Li Y, Chen X, Chen J, Gautam SC, Xu Y, Chopp M. MCP-1, MIP-1, IL-8 and ischemic cerebral tissue enhance human bone marrow stromal cell migration in interface culture. Hematology. 2002;7(2):113-7.
- Caplan AI. Mesenchymal stem cells: the past, the present, the future. Cartilage. 2010;1(1):6-9.
- Ochi M, Adachi N, Nobuto H, Yanada S, Ito Y, Agung M. Articular cartilage repair using tissue engineering technique: novel approach with minimally invasive procedure. Artif Organs. 2004;28(1):28-32.
- Kobayashi T, Ochi M, Yanada S, Ishikawa M, Adachi N, Deie M, et al. A novel cell delivery system using magnetically labeled mesenchymal stem cells and an external magnetic device for clinical cartilage repair. Arthroscopy. 2008;24(1):69-76.
- Yanada S, Ochi M, Adachi N, Nobuto H, Agung M, Kawamata S. Effects of CD44 antibody—or RGDS peptide—immobilized magnetic beads on cell proliferation and chondrogenesis of mesenchymal stem cells. J Biomed Mater Res A. 2006;77 (4):773-84.
- Grigolo B, Lisignoli G, Desando G, Cavallo C, Marconi E, Tschon M, et al. Osteoarthritis treated with mesenchymal stem cells on hyaluronan-based scaffold in rabbit. Tissue Eng Part C Methods. 2009;15(4):647-58.
- Pelttari K, Steck E, Richter W. The use of mesenchymal stem cells for chondrogenesis. Injury. 2008;39 Suppl 1:S58-65.
- Scotti C, Tonnarelli B, Papadimitropoulos A, Scherberich A, Schaeren S, Schauerte A, et al. Recapitulation of endochondral bone formation using human adult mesenchymal stem cells as a paradigm for developmental engineering. Proc Natl Acad Sci U S A. 2010;107(16):7251-6.
- Scotti C, Wirz D, Wolf F, Schaefer DJ, Bürgin V, Daniels AU, et al. Engineering human cell-based, functionally integrated osteochondral grafts by biological bonding of engineered cartilage tissues to bony scaffolds. Biomaterials. 2010;31(8):2252-9.
- Horas U, Pelinkovic D, Herr G, Aigner T, Schnettler R. Autologous chondrocyte implantation and osteochondral cylinder transplantation in cartilage repair of the knee joint: a prospective, comparative trial. J Bone Joint Surg Am. 2003;85-A(2): 185-92.
- Knutsen G, Engebretsen L, Ludvigsen TC, Drogset JO, Grøntvedt T, Solheim E, et al. Autologous chondrocyte implantation compared with microfracture in the knee: a randomized trial. J Bone Joint Surg Am. 2004;86-A(3):455-64.
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