Autologous Chondrocyte Implantation

14,000,000 Leading Edge Experts on the ideXlab platform

Scan Science and Technology

Contact Leading Edge Experts & Companies

Scan Science and Technology

Contact Leading Edge Experts & Companies

The Experts below are selected from a list of 2574 Experts worldwide ranked by ideXlab platform

Tom Minas - One of the best experts on this subject based on the ideXlab platform.

Christoph Erggelet - One of the best experts on this subject based on the ideXlab platform.

G Bentley - One of the best experts on this subject based on the ideXlab platform.

  • Autologous Chondrocyte Implantation in the knee mid term to long term results
    Journal of Bone and Joint Surgery American Volume, 2014
    Co-Authors: Syed Zuhair Nawaz, G Bentley, T Briggs, K. Gallagher, John A. Skinner, Richard Carrington, Baljinder S Dhinsa
    Abstract:

    Background: From 1998 to 2008, 1000 skeletally mature patients underwent Autologous Chondrocyte Implantation for an osteochondral defect of the knee. We evaluated the functional outcomes in 827 of 869 patients who had undergone Autologous Chondrocyte Implantation with Chondron or periosteum (ACI-C/ACI-P) or matrix-assisted Chondrocyte Implantation (MACI) and attempted to identify factors that influenced outcome. Methods: The age of the patient, the size and site of the osteochondral lesion, previous surgery, and the presence of early osteoarthritis were assessed for their influence on outcomes. Each factor was evaluated in a separate Cox proportional hazards model with use of hazard ratios (HRs), with 95% confidence intervals (CIs), describing the likelihood of failure for that particular factor. Outcomes were assessed with use of the modified Cincinnati score, visual analog scale pain score, and Stanmore functional score. Results: The mean duration of follow-up was 6.2 years (range, two to twelve years). The mean age was thirty-four years (range, fourteen to fifty-six years), with 493 males and 334 females. The average size of the defect was 409 mm2 (range, 64 to 2075 mm2). Four hundred and twenty-one procedures (51%) were performed on the medial femoral condyle; 109 (13%), on the lateral femoral condyle; 200 (24%), on the patella; and fifty (6%), on the trochlea. Kaplan-Meier survival analysis revealed that the unadjusted graft survival rate was 78.2% at five years and 50.7% and ten years for the entire cohort. No difference was found between the survival rates of the ACI-C/ACI-P and MACI techniques (HR = 0.948, 95% CI = 0.738 to 1.219, p = 0.678). There was a significant postoperative improvement in the function and pain scores of all three outcome measures (p < 0.002). Survivorship in the group with a previous cartilage regenerative procedure was inferior to that in patients with a previously untreated lesion, with failure five times more likely in the former group (HR = 4.718, standard error [SE] = 0.742, 95% CI = 3.466 to 6.420, p < 0.001). Degenerative change in any compartment had a significant detrimental effect on survivorship, with survivorship worsening as the osteoarthritis grade increased (Grade 1: HR = 2.077, 95% CI = 1.299 to 3.322, p = 0.002; Grade 2: HR = 3.450, 95% CI = 2.646 to 4.498, p < 0.001; and Grade 3: HR = 3.820, 95% CI = 2.185 to 6.677, p < 0.001). Conclusions: Our study demonstrated an overall graft survival of 78% at five years and 51% beyond ten years following both Autologous Chondrocyte Implantation techniques. Despite study limitations, our results demonstrate that Autologous Chondrocyte Implantation for the treatment of osteochondral defects of the knee can achieve good results. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  • Autologous Chondrocyte Implantation in the knee mid term to long term results
    Journal of Bone and Joint Surgery American Volume, 2014
    Co-Authors: Syed Zuhair Nawaz, G Bentley, T Briggs, K. Gallagher, John A. Skinner, Richard Carrington, Baljinder S Dhinsa
    Abstract:

    Background: From 1998 to 2008, 1000 skeletally mature patients underwent Autologous Chondrocyte Implantation for an osteochondral defect of the knee. We evaluated the functional outcomes in 827 of 869 patients who had undergone Autologous Chondrocyte Implantation with Chondron or periosteum (ACI-C/ACI-P) or matrix-assisted Chondrocyte Implantation (MACI) and attempted to identify factors that influenced outcome. Methods: The age of the patient, the size and site of the osteochondral lesion, previous surgery, and the presence of early osteoarthritis were assessed for their influence on outcomes. Each factor was evaluated in a separate Cox proportional hazards model with use of hazard ratios (HRs), with 95% confidence intervals (CIs), describing the likelihood of failure for that particular factor. Outcomes were assessed with use of the modified Cincinnati score, visual analog scale pain score, and Stanmore functional score. Results: The mean duration of follow-up was 6.2 years (range, two to twelve years). The mean age was thirty-four years (range, fourteen to fifty-six years), with 493 males and 334 females. The average size of the defect was 409 mm2 (range, 64 to 2075 mm2). Four hundred and twenty-one procedures (51%) were performed on the medial femoral condyle; 109 (13%), on the lateral femoral condyle; 200 (24%), on the patella; and fifty (6%), on the trochlea. Kaplan-Meier survival analysis revealed that the unadjusted graft survival rate was 78.2% at five years and 50.7% and ten years for the entire cohort. No difference was found between the survival rates of the ACI-C/ACI-P and MACI techniques (HR = 0.948, 95% CI = 0.738 to 1.219, p = 0.678). There was a significant postoperative improvement in the function and pain scores of all three outcome measures (p < 0.002). Survivorship in the group with a previous cartilage regenerative procedure was inferior to that in patients with a previously untreated lesion, with failure five times more likely in the former group (HR = 4.718, standard error [SE] = 0.742, 95% CI = 3.466 to 6.420, p < 0.001). Degenerative change in any compartment had a significant detrimental effect on survivorship, with survivorship worsening as the osteoarthritis grade increased (Grade 1: HR = 2.077, 95% CI = 1.299 to 3.322, p = 0.002; Grade 2: HR = 3.450, 95% CI = 2.646 to 4.498, p < 0.001; and Grade 3: HR = 3.820, 95% CI = 2.185 to 6.677, p < 0.001). Conclusions: Our study demonstrated an overall graft survival of 78% at five years and 51% beyond ten years following both Autologous Chondrocyte Implantation techniques. Despite study limitations, our results demonstrate that Autologous Chondrocyte Implantation for the treatment of osteochondral defects of the knee can achieve good results. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  • the role of Autologous Chondrocyte Implantation in the treatment of symptomatic chondromalacia patellae
    International Orthopaedics, 2012
    Co-Authors: S. Macmull, G Bentley, P.k. Jaiswal, J A Skinner, Richard Carrington, T Briggs
    Abstract:

    Purpose Chondromalacia patella is a distinct clinical entity of abnormal softening of the articular cartilage of the patella, which results in chronic retropatellar pain. Its aetiology is still unclear but the process is thought to be a due to trauma to superficial Chondrocytes resulting in a proteolytic enzymic breakdown of the matrix. Our aim was to assess the effectiveness of Autologous Chondrocyte Implantation on patients with a proven symptomatic retropatellar lesion who had at least one failed conventional marrow-stimulating therapy.

  • does smoking influence outcome after Autologous Chondrocyte Implantation a case controlled study
    Journal of Bone and Joint Surgery-british Volume, 2009
    Co-Authors: P.k. Jaiswal, G Bentley, S. Macmull, John A. Skinner, Richard Carrington, Timothy W. R. Briggs
    Abstract:

    Smoking is known to have an adverse effect on wound healing and musculoskeletal conditions. This case-controlled study looked at whether smoking has a deleterious effect in the outcome of Autologous Chondrocyte Implantation for the treatment of full thickness chondral defects of the knee.The mean Modified Cincinatti Knee score was statistically significantly lower in smokers (n = 48) than in non-smokers (n = 66) both before and after surgery (p < 0.05). Smokers experienced significantly less improvement in the knee score two years after surgery (p < 0.05). Graft failures were only seen in smokers (p = 0.016). There was a strong negative correlation between the number of cigarettes smoked and the outcome following surgery (Pearson’s correlation coefficient −0.65, p = 0.004).These results suggest that patients who smoke have worse pre-operative function and obtain less benefit from this procedure than non-smokers. The counselling of patients undergoing Autologous Chondrocyte Implantation should include smok...

  • an overview of Autologous Chondrocyte Implantation
    Journal of Bone and Joint Surgery-british Volume, 2009
    Co-Authors: Panagoitis D. Gikas, G Bentley, Luke Bayliss, Timothy W. R. Briggs
    Abstract:

    Chondral damage to the knee is common and, if left untreated, can proceed to degenerative osteoarthritis. In symptomatic patients established methods of management rely on the formation of fibrocartilage which has poor resistance to shear forces. The formation of hyaline or hyaline-like cartilage may be induced by implanting Autologous, cultured Chondrocytes into the chondral or osteochondral defect. Autologous Chondrocyte Implantation may be used for full-thickness chondral or osteochondral injuries which are painful and debilitating with the aim of replacing damaged cartilage with hyaline or hyaline-like cartilage, leading to improved function. The intermediate and long-term functional and clinical results are promising. We provide a review of Autologous Chondrocyte Implantation and describe our experience with the technique at our institution with a mean follow-up of 32 months (1 to 9 years). The procedure is shown to offer statistically significant improvement with advantages over other methods of management of chondral defects.

Peter E. Müller - One of the best experts on this subject based on the ideXlab platform.

  • Effect of the defect localization and size on the success of third-generation Autologous Chondrocyte Implantation in the knee joint
    International Orthopaedics, 2020
    Co-Authors: Thomas R Niethammer, Martin Holzgruber, Peter E. Müller, David Gallik, Y. Chevalier, Andrea Baur-melnyk, Matthias F Pietschmann
    Abstract:

    Introduction Femoral and patellar cartilage defects with a defect size > 2.5 cm^2 are a potential indication for an Autologous Chondrocyte Implantation (ACI). However, the influence of the localization and the absolute and relative defect size on the clinical outcome has not yet been determined. The purpose of this study is to analyze the influence of the localization and the absolute and relative defect size on the clinical outcome after third-generation Autologous Chondrocyte Implantation. Methods A total of 50 patients with cartilage defects of the knee were treated with third-generation Autologous Chondrocyte Implantation (Novocart® 3D). A match paired analysis was performed of 25 treated femoral and 25 treated patella defects with a follow-up of three years. MRI data was used to do the manual segmentation of the cartilage layer throughout the knee joint. The defect size was determined by taking the defect size measured in the MRI in relation to the whole cartilage area. The clinical outcome was measured by the IKDC score and VAS pre-operatively and after six, 12, 24, and 36 months post-operatively. Results IKDC and VAS scores showed a significant improvement from the baseline in both groups. Femoral cartilage defects showed significantly superior clinical results in the analyzed scores compared to patellar defects. The femoral group improved IKDC from 33.9 (SD 18.1) pre-operatively to 71.5 (SD 17.4) after three years and the VAS from 6.9 (SD 2.9) pre-operatively to 2.4 (SD 2.5) after three years. In the patellar group, IKDC improved from 36.1 (SD 12.6) pre-operatively to 54.7 (SD 20.3) after three years and the VAS improved from 6.7 (SD 2.8) pre-operatively to 3.4 (SD 2.) after three years. Regarding the defect size, results showed that the same absolute defect size at med FC (4.8, range 2–15) and patella (4.6, range 2–12) has a significantly different share of the total cartilaginous size of the joint compartment (med FC: 6.7, range 1.2–13.9; pat: 18.9, range 4.0–47.0). However, there was no significant influence of the relative defect size on the clinical outcome in either patellar or femoral localization. Conclusion Third-generation Autologous Chondrocyte Implantation in ACI-treated femoral cartilage defects leads to a superior clinical outcome in a follow-up of three years compared with patellar defects. No significant influence of the defect size was found in either femoral or patellar cartilage defects.

  • Third generation Autologous Chondrocyte Implantation is a good treatment option for athletic persons
    Knee Surgery Sports Traumatology Arthroscopy, 2020
    Co-Authors: Thomas Richard Niethammer, Daniel Altmann, Martin Holzgruber, Sophia Goller, Andreas Fischer, Peter E. Müller
    Abstract:

    Purpose Autologous Chondrocyte Implantation is an established method for the treatment of joint cartilage damage. However, to date it has not been established that Autologous Chondrocyte Implantation is an appropriate procedure for cartilage defects therapy in athletic persons. The aim of this study is to analyze if third-generation Autologous Chondrocyte Implantation is an appropriate treatment for athletic persons with full cartilage defect of the knee joints. Methods A total of 84 patients were treated with third-generation Autologous Chondrocyte Implantation (NOVOCART^® 3D). The mean follow-up time was 8 years (5–14). Sports activity was measured via UCLA Activity Score and Tegner Activity Scale before the onset of knee pain and postoperatively in an annual clinical evaluation. 41 athletic persons and 43 non-athletic persons (UCLA-Cut-off: 7; Tegner Activity Scale-Cut-off: 4) were analyzed. Patient reported outcomes were captured using IKDC subjective, KOOS, Lysholm score and VAS score on movement. Results Patient reported outcomes (IKDC, VAS at rest, VAS on movement) showed significant improvement ( p  

  • graft hypertrophy after third generation Autologous Chondrocyte Implantation has no correlation with reduced cartilage quality matched pair analysis using t2 weighted mapping
    American Journal of Sports Medicine, 2018
    Co-Authors: Thomas R Niethammer, Peter E. Müller, A Horng, Mehmet F Gulecyuz, Ansgar Loitzsch, Andrea Baurmelnyk, Martin Bendiks, Matthias F Pietschmann
    Abstract:

    Background:Graft hypertrophy is common after matrix-based Autologous Chondrocyte Implantation (ACI) in the knee joint. However, it is not clear whether graft hypertrophy is a complication or an adj...

  • matrix based Autologous Chondrocyte Implantation in children and adolescents a match paired analysis in a follow up over three years post operation
    International Orthopaedics, 2017
    Co-Authors: Thomas R Niethammer, Martin Holzgruber, Matthias F Pietschmann, Mehmet F Gulecyuz, Patrick Weber, Peter E. Müller
    Abstract:

    Purpose The aim of this study is the investigation of the clinical results after third generation Autologous Chondrocyte Implantation in the knee in a follow-up over three years post-operation. Our primary focus is on the effects of this procedure on children and adolescent patients as there is a lack of knowledge regarding the clinical outcomes in children/adolescents in particular when compared with adults.

  • the incidence and clinical relevance of graft hypertrophy after matrix based Autologous Chondrocyte Implantation
    American Journal of Sports Medicine, 2012
    Co-Authors: Matthias F Pietschmann, Thomas R Niethammer, A Horng, Mehmet F Gulecyuz, Isa Feistpagenstert, Volkmar Jansson, Peter E. Müller
    Abstract:

    Background: Graft hypertrophy is the most common complication of periosteal Autologous Chondrocyte Implantation (p-ACI).Purpose: The aim of this prospective study was to analyze the development, the incidence rate, and the persistence of graft hypertrophy after matrix-based Autologous Chondrocyte Implantation (mb-ACI) in the knee joint within a 2-year postoperative course.Study Design: Case series; Level of evidence, 4.Methods: Between 2004 and 2007, a total of 41 patients with 44 isolated cartilage defects of the knee were treated with the mb-ACI technique. The mean age of the patients was 35.8 years (standard deviation [SD], 11.3 years), and the mean body mass index was 25.9 (SD, 4.2; range, 19-35.3). The cartilage defects were arthroscopically classified as Outerbridge grades III and IV. The mean area of the cartilage defect measured 6.14 cm2 (SD, 2.3 cm2). Postoperative clinical and magnetic resonance imaging (MRI) examinations were conducted at 3, 6, 12, and 24 months to analyze the incidence and cou...

J B Richardson - One of the best experts on this subject based on the ideXlab platform.

  • evaluating joint morbidity after chondral harvest for Autologous Chondrocyte Implantation aci a study of aci treated ankles and hips with a knee chondral harvest
    Cartilage, 2016
    Co-Authors: Helen S Mccarthy, J Parker, J B Richardson, Sally Roberts
    Abstract:

    ObjectiveTo establish if harvesting cartilage to source Chondrocytes for Autologous Chondrocyte Implantation (ACI) results in donor site morbidity.DesignTwenty-three patients underwent ACI for chon...

  • combined Autologous Chondrocyte Implantation and allogenic meniscus transplantation a biological knee replacement
    Knee, 2007
    Co-Authors: A Bhosale, P.e. Harrison, J. Menage, Sally Roberts, B A Ashton, J B Richardson, P Myint, T Smith, I W Mccall
    Abstract:

    Introduction: Before proceeding to long-term studies, we studied early clinical results of combined Autologous Chondrocyte Implantation (ACI) and Allogenic Meniscus Transplantation (AMT). Meniscus deficient knees develop early osteo-arthritis (OA) of the knee joint. Autologous Cartilage Implantation (ACI) is contraindicated in case of meniscus deficient knees. And on contrary the Allogenic Meniscus Transplantation (AMT) is contraindicated in cartilage defects in the knee joint. But a combination of the two procedures for bone on bone OA might be a solution for this problem. This was the main purpose of our study. Methods: We studied a consecutive series of eight patients (7 males and 1 female), with an average age= 43 years (29–58), presenting with painful secondary arthritis, due to premature loss of meniscus and chondral defect/s. Median size of the femoral defects was 8.16 cm2 and of the tibial side 2.69 cm2 All patients were treated with a combination of Autologous Chondrocyte Implantation (ACI) and Allogenic Meniscus Transplantation (AMT). Chondral defects were covered with periosteum/ Chondroguide membrane, secured in place with in-vitro cultured Autologous Chondrocytes injected underneath the path. Meniscus placed as load-bearing washer on the surface of ACI of tibia. ACI rehabilitation protocol followed post-operatively. Assessment at the end of one year was done with self-assessed Lysholm score, histology and the MRI scan. Results: Mean pre-operaive Lysholm score was 49 (17–75). This increased to a mean of 66 (26–87) at 1 year, an average increase of 16.4 points. Average one-year satisfaction score was 3 and they were back to all active life style. Five out of eight patients showed significant functional improvement at last post-operative follow-up (2 to 6 years; mean of 3.2 years). Complications were aseptic synovitis in 3 cases. Three failures were noted showig persistant pain and swelling in one, rupture of meniscus in second and third patient had a knee replacement. Arthroscopy at 1 year showed a stable meniscus with all healed peripheral margins in all except in one case with some thinning with no evidence of rejection. Histology of meniscus showed a fibrocartilage well populated with viable cells and the peripheral zone was well vascularised and integrated with capsule. Biopsy of ACI site was predominantly of fibrocartilage with good basal integration with subchondral bone. On MRI scan, allogenic meniscus was well integrated with capsule along the line of repair, showing foci of variable signal intensities within the meniscus. There was no evidence of meniscal subluxation in all but one case showing mild extrusion. ACI graft site showed a varied appearance, with 3 grafts showing focal grade 3to 4 changes. Conclusion: Seven out of eight patients improved post-operatively at one year, in terms of pain relief and increased activity. It’s possible to combine these two techniques together. Short-term outcomes are satisfactory. We could not find any deleterious effects of combining these two techniques together. So we conclude that, this might act as a one step towards a biological knee replacement.

  • Autologous Chondrocyte Implantation in knee joint mr imaging and histologic features at 1 year follow up
    Radiology, 2005
    Co-Authors: Bernhard J. Tins, Iain W Mccall, Victor N Cassarpullicino, Sally Roberts, B A Ashton, Tomoki Takahashi, J B Richardson
    Abstract:

    PURPOSE: To evaluate magnetic resonance (MR) imaging features of Autologous Chondrocyte Implantation (ACI) grafts and compare these with graft histologic features 1 year after ACI for treatment of femoral condylar defects. MATERIALS AND METHODS: This study was approved by the regional ethics committee, and all patients gave informed consent. Forty-one patients (mean age, 35 years; 30 men, 11 women) underwent ACI for treatment of femoral condylar defects. One year later, knee joint MR imaging and graft biopsy were performed. Graft biopsy results were categorized into those showing hyaline, mixed fibrohyaline cartilage, fibrocartilage, and fibrous tissue. Standard T1-, T2-, T2*-, and intermediate-weighted sequences were performed, as well as three-dimensional (3D) fast low-angle shot (FLASH) and double-echo steady-state sequences for cartilage assessment. ACI grafts were assessed for signal intensity (with FLASH sequence), thickness, overgrowth, surface smoothness, integration to adjacent cartilage and unde...

  • Autologous Chondrocyte Implantation and osteochondral cylinder transplantation in cartilage repair of the knee joint
    Journal of Bone and Joint Surgery American Volume, 2003
    Co-Authors: George Davey Smith, Christoph Erggelet, Gunnar Knutsen, Mats Brittberg, B A Ashton, J B Richardson, R Verdonk, I K Ashton, P Harrison
    Abstract:

    To The Editor: We would like to raise the following points regarding the article entitled “Autologous Chondrocyte Implantation and Osteochondral Cylinder Transplantation in Cartilage Repair of the Knee Joint” (2003;85:185-92), by Horas et al. A German-language paper by the same authors presents what appears to be the same study comparing osteochondral cylinder transplantation (OCT) with Autologous Chondrocyte Implantation (ACI)1 and concludes that the two methods have equally good results. We would like to know why the paper published in The Journal comes to a different conclusion. We commend the authors for publishing their raw data on the Internet. We note that the mean preoperative Lysholm score was lower in the ACI group. If this is accounted for by analyzing the mean change in score, we find no significant difference between the two treatment groups at … Corresponding author: U. Horas, MD, Department of Trauma Surgery, University of Giessen, Rudolf-Buchheim-Strasse 7, D-35385 Giessen, Germany, E-mail address for R. Schnettler:, reinhard.schnettler{at}chiru.med.uni-giessen.de

  • Autologous Chondrocyte Implantation for cartilage repair monitoring its success by magnetic resonance imaging and histology
    Arthritis Research & Therapy, 2002
    Co-Authors: P.e. Harrison, Helena Evans, J. Menage, Alan J. Darby, Iain W Mccall, Sally Roberts, J B Richardson
    Abstract:

    Autologous Chondrocyte Implantation is being used increasingly for the treatment of cartilage defects. In spite of this, there has been a paucity of objective, standardised assessment of the outcome and quality of repair tissue formed. We have investigated patients treated with Autologous Chondrocyte Implantation (ACI), some in conjunction with mosaicplasty, and developed objective, semiquantitative scoring schemes to monitor the repair tissue using MRI and histology. Results indicate repair tissue to be on average 2.5 mm thick. It was of varying morphology ranging from predominantly hyaline in 22% of biopsy specimens, mixed in 48%, through to predominantly fibrocartilage, in 30%, apparently improving with increasing time postgraft. Repair tissue was well integrated with the host tissue in all aspects viewed. MRI scans provide a useful assessment of properties of the whole graft area and adjacent tissue and is a noninvasive technique for long-term follow-up. It correlated with histology (P = 0.02) in patients treated with ACI alone.

Related terms

Autologous Chondrocyte Implantation - 15 days free trial to Access Experts & Abstracts