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Knee Surg Sports Traumatol Arthrosc. 2019 Jun 25. doi: 10.1007/s00167-019-05572-6. [Epub ahead of print]

Arthroscopic gel-type autologous chondrocyte implantation presents histologic evidence of regenerating hyaline-like cartilage in the knee with articular cartilage defect.

Author information

1
Department of Orthopedic Surgery, Severance Hospital, Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
2
Department of Radiology, Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
3
Department of Orthopedic Surgery, YonseSarang Hospital, Seoul, Republic of Korea.
4
Department of Orthopedic Surgery, Severance Hospital, Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea. orthohwan@gmail.com.
5
Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06237, Republic of Korea. orthohwan@gmail.com.

Abstract

PURPOSE:

To investigate the clinical, radiological, and histological results of arthroscopic gel-type autologous chondrocyte implantation (GACI) in treating chondral defects of the knee.

METHODS:

This study prospectively examined five males and five females with a mean age of 40.3 ± 10.3 years who underwent arthroscopic GACI between March 2012 and February 2013. The gel comprised a mixture of 1 ml of fibrinogen plus 0.1-0.2 ml of thrombin. The mean size of chondral defect was 2.9 ± 1.2 cm2 (range 1.2-5.4 cm2). International knee documentation committee (IKDC) subjective score, knee injury and osteoarthritis outcome score (KOOS), knee society score, and visual analog scale (VAS) for pain were assessed preoperatively and during regular follow-up examinations performed for up to 5 years postoperatively. Serial magnetic resonance imaging was performed for up to 2 years after the surgery to observe healing, using the modified magnetic resonance observation of cartilage repair tissue (MOCART) score. In eight patients, second-look arthroscopy was performed at 1 year after the implantation to assess the status of treated cartilage, and a portion of regenerated cartilage was harvested for histologic evaluation.

RESULTS:

The mean VAS score (p = 0.045), IKDC subjective score (p = 0.041), KOOS pain (p = 0.025), KOOS activities of daily living (p = 0.048), and KOOS quality of life (p = 0.029) showed significant improvement at 5 years after the surgery. The modified MOCART evaluation showed that the scores were 59.5 ± 29.4 and 85.0 ± 8.0 at 12 weeks and 2 years after the operation, respectively. Histologic examination demonstrated a mean regenerated cartilage thickness of 3.5 ± 0.8 mm and a mean Oswestry score of 8.2 ± 1.8. Immunohistochemistry analysis showed that the expression of collagen type II was more evident and more evenly distributed than collagen type I in regenerated cartilage. There was a significant correlation between Oswestry score and change in VAS scale from postoperative 2-5 years.

CONCLUSIONS:

Arthroscopic GACI produces satisfactory clinical and radiologic outcomes, and histologic evaluation confirms sufficient regeneration of hyaline-like cartilage that correlates with improved symptoms. Therefore, it is an acceptable, minimally invasive, and technically simple option for the restoration of cartilage defects of the knee.

LEVEL OF EVIDENCE:

IV.

KEYWORDS:

Autologous chondrocyte implantation; Cartilage; Gel type; Knee; Minimally invasive

PMID:
31240378
DOI:
10.1007/s00167-019-05572-6

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