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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2021; 56(04): 470-477
DOI: 10.1055/s-0040-1716764
Artigo Original
Joelho

Treatment of Chondral Knee Lesions with Autologous Chondrocytes Embedded in a Fibrin Scaffold. Clinical and Functional Assessment[*]

Article in several languages: português | English
Eduardo Alvarez-Lozano 
1   Departamento de Cirurgia Ortopédica, Hospital Jose E Gonzalez, Universidad Autonóma de Nuevo Leon, Monterrey, México
,
Herminia Martinez-Rodriguez 
2   Departamento de Bioquímica, Universidad Autonóma de Nuevo Leon, Monterrey, México
,
Francisco Forriol 
3   Facultad de Medicina, Universidade San Pablo CEU, IMMA, Boadilla del Monte, Madri, Espanha
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Abstract

Objective The aim of our study is to analyze the clinical and functional results obtained using autologous chondrocytes embedded in a fibrin scaffold in knee joint injuries.

Methods We included 56 patients, 36 men and 20 women, with a mean age 36 years. Six of the patients were professional athletes, with single knee injuries that were either chondral or osteochondral (43 chondral, 9 osteochondral, 2 cases of osteochondritis dissecans and 2 osteochondral fractures), 2 to 10 cm2 in size and ≤ 10 mm deep, with no signs of osteoarthritis. The location of the injury was in the patella (8), the medial femoral condyle (40) and lateral femoral condyle (7) and one in the trochlea. The mean follow-up was 3 (range: 1–6) years. The clinical course was assessed using the Cincinnati and Knee Injury and Osteoarthritis Outcome (KOOS) scores, 6 and 12 months after surgery. The paired Student t-test was used to compare pre-and postoperative results.

Results Six months after the implant, patients resumed their everyday activities. On the assessment scores, their condition was improving in comparison with their presurgical state (p < 0.05). They were also able to carry out their sporting activities more easily than prior to surgery (p < 0.05).

Conclusion The seeding of chondrocytes in fibrin may provide a favorable micro-environment for the synthesis of extracellular matrix and improved the clinical condition and activity of the patients 1 year after surgery.

Keywords

cartilage - knee - scaphoid bone - chondrocytes - fibrin

Financial Support

There was no financial support from public, commercial, or non-profit sources.


* Work developed at the CEU-San Pablo University School of Medicine, IMMA, Boadilla del Monte, Madrid, Spain.




Publication History

Received: 05 January 2020

Accepted: 06 July 2020

Article published online:
29 October 2020

© 2020. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • Referências

  • 1 Wakitani S, Kawaguchi A, Tokuhara Y, Takaoka K. Present status of and future direction for articular cartilage repair. J Bone Miner Metab 2008; 26 (02) 115-122
    CrossrefPubMedGoogle Scholar
  • 2 Forriol F. Growth factors in cartilage and meniscus repair. Injury 2009; 40 (Suppl. 03) S12-S16
    CrossrefPubMedGoogle Scholar
  • 3 Ochi M, Uchio Y, Kawasaki K, Wakitani S, Iwasa J. Transplantation of cartilage-like tissue made by tissue engineering in the treatment of cartilage defects of the knee. J Bone Joint Surg Br 2002; 84 (04) 571-578
    CrossrefPubMedGoogle Scholar
  • 4 Brittberg M, Peterson L, Sjögren-Jansson E, Tallheden T, Lindahl A. Articular cartilage engineering with autologous chondrocyte transplantation. A review of recent developments. J Bone Joint Surg Am 2003; 85 (Suppl. 03) 109-115
    CrossrefPubMedGoogle Scholar
  • 5 Marcacci M, Berruto M, Brocchetta D. et al. Articular cartilage engineering with Hyalograft C: 3-year clinical results. Clin Orthop Relat Res 2005; (435) 96-105
    CrossrefPubMedGoogle Scholar
  • 6 Visna P, Pasa L, Hart R, Kocis J, Cizmár I, Adler J. [Treatment of deep chondral defects of the knee using autologous chondrocytes cultured on a support--results after one year]. Acta Chir Orthop Traumatol Cech 2003; 70 (06) 356-362
    PubMedGoogle Scholar
  • 7 Murphy CL, Polak JM. Control of human articular chondrocyte differentiation by reduced oxygen tension. J Cell Physiol 2004; 199 (03) 451-459
    CrossrefPubMedGoogle Scholar
  • 8 Brodkin KR, García AJ, Levenston ME. Chondrocyte phenotypes on different extracellular matrix monolayers. Biomaterials 2004; 25 (28) 5929-5938
    CrossrefPubMedGoogle Scholar
  • 9 da Cunha Cavalcanti FM, Doca D, Cohen M, Ferretti M. Updating on diagnosis and treatment of chondral lesion of the knee. Rev Bras Ortop 2015; 47 (01) 12-20
    Google Scholar
  • 10 Knutsen G, Drogset JO, Engebretsen L. et al. A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years. J Bone Joint Surg Am 2007; 89 (10) 2105-2112
    CrossrefPubMedGoogle Scholar
  • 11 Bentley G, Bhamra JS, Gikas PD, Skinner JA, Carrington R, Briggs TW. Repair of osteochondral defects in joints--how to achieve success. Injury 2013; 44 (Suppl. 01) S3-S10
    CrossrefPubMedGoogle Scholar
  • 12 Tamez-Peña JG, Farber J, González PC, Schreyer E, Schneider E, Totterman S. Unsupervised segmentation and quantification of anatomical knee features: data from the Osteoarthritis Initiative. IEEE Trans Biomed Eng 2012; 59 (04) 1177-1186
    CrossrefPubMedGoogle Scholar
  • 13 Cole BJ, Pascual-Garrido C, Grumet RC. Surgical management of articular cartilage defects in the knee. J Bone Joint Surg Am 2009; 91 (07) 1778-1790
    PubMedGoogle Scholar
  • 14 Vaquero J, Forriol F. Knee chondral injuries: clinical treatment strategies and experimental models. Injury 2012; 43 (06) 694-705
    CrossrefPubMedGoogle Scholar
  • 15 Gomoll AH, Probst C, Farr J, Cole BJ, Minas T. Use of a type I/III bilayer collagen membrane decreases reoperation rates for symptomatic hypertrophy after autologous chondrocyte implantation. Am J Sports Med 2009; 37 (Suppl. 01) 20S-23S
    CrossrefPubMedGoogle Scholar
  • 16 Bolliger-Stucki B, Baillod P, Mäder W, Furlan M. Biochemical properties of the fibrinogen component of a fibrin glue before and after severe dry heat treatment. J Biomed Mater Res 2000; 53 (05) 577-583
    CrossrefPubMedGoogle Scholar
  • 17 Perka C, Spitzer RS, Lindenhayn K, Sittinger M, Schultz O. Matrix-mixed culture: new methodology for chondrocyte culture and preparation of cartilage transplants. J Biomed Mater Res 2000; 49 (03) 305-311
    CrossrefPubMedGoogle Scholar
  • 18 de Windt TS, Bekkers JE, Creemers LB, Dhert WJ, Saris DB. Patient profiling in cartilage regeneration: prognostic factors determining success of treatment for cartilage defects. Am J Sports Med 2009; 37 (Suppl. 01) 58S-62S
    CrossrefPubMedGoogle Scholar
  • 19 Saris DB, Vanlauwe J, Victor J. et al. Characterized chondrocyte implantation results in better structural repair when treating symptomatic cartilage defects of the knee in a randomized controlled trial versus microfracture. Am J Sports Med 2008; 36 (02) 235-246
    CrossrefPubMedGoogle Scholar
  • 20 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. 01) 148S-155S
    CrossrefPubMedGoogle Scholar
  • 21 Knutsen G, Engebretsen L, Ludvigsen TC. et al. Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial. J Bone Joint Surg Am 2004; 86 (03) 455-464
    CrossrefPubMedGoogle Scholar
  • 22 Micheli LJ, Moseley JB, Anderson AF. et al. Articular cartilage defects of the distal femur in children and adolescents: treatment with autologous chondrocyte implantation. J Pediatr Orthop 2006; 26 (04) 455-460
    CrossrefPubMedGoogle Scholar
  • 23 Moseley Jr JB, Anderson AF, Browne JE. et al. Long-term durability of autologous chondrocyte implantation: a multicenter, observational study in US patients. Am J Sports Med 2010; 38 (02) 238-246
    CrossrefPubMedGoogle Scholar
  • 24 Roberts S, McCall IW, Darby AJ. et al. Autologous chondrocyte implantation for cartilage repair: monitoring its success by magnetic resonance imaging and histology. Arthritis Res Ther 2003; 5 (01) R60-R73
    CrossrefPubMedGoogle Scholar
  • 25 Tins BJ, McCall IW, Takahashi T. et al. Autologous chondrocyte implantation in knee joint: MR imaging and histologic features at 1-year follow-up. Radiology 2005; 234 (02) 501-508
    CrossrefPubMedGoogle Scholar
  • 26 Bartlett W, Skinner JA, Gooding CR. et al. Autologous chondrocyte implantation versus matrix-induced autologous chondrocyte implantation for osteochondral defects of the knee: a prospective, randomised study. J Bone Joint Surg Br 2005; 87 (05) 640-645
    CrossrefPubMedGoogle Scholar
  • 27 Manfredini M, Zerbinati F, Gildone A, Faccini R. Autologous chondrocyte implantation: a comparison between an open periosteal-covered and an arthroscopic matrix-guided technique. Acta Orthop Belg 2007; 73 (02) 207-218
    PubMedGoogle Scholar
  • 28 Saris DB, Vanlauwe J, Victor J. et al. TIG/ACT/01/2000&EXT Study Group. Treatment of symptomatic cartilage defects of the knee: characterized chondrocyte implantation results in better clinical outcome at 36 months in a randomized trial compared to microfracture. Am J Sports Med 2009; 37 (Suppl. 01) 10S-19S
    CrossrefPubMedGoogle Scholar
  • 29 Basad E, Ishaque B, Bachmann G, Stürz H, Steinmeyer J. Matrix-induced autologous chondrocyte implantation versus microfracture in the treatment of cartilage defects of the knee: a 2-year randomised study. Knee Surg Sports Traumatol Arthrosc 2010; 18 (04) 519-527
    CrossrefPubMedGoogle Scholar
  • 30 Vascellari A, Rebuzzi E, Schiavetti S, Coletti N. Implantation of matrix-induced autologous chondrocyte (MACI ®) grafts using carbon dioxide insufflation arthroscopy. Knee Surg Sports Traumatol Arthrosc 2014; 22 (01) 219-225
    CrossrefPubMedGoogle Scholar